Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review.

ADHD Children acceptability adolescents autism brain stimulation dis­ruptive behavior disorders efficacy pharmacotherapy psychosocial interventions psychotherapies

Journal

World psychiatry : official journal of the World Psychiatric Association (WPA)
ISSN: 1723-8617
Titre abrégé: World Psychiatry
Pays: Italy
ID NLM: 101189643

Informations de publication

Date de publication:
Jun 2021
Historique:
entrez: 18 5 2021
pubmed: 19 5 2021
medline: 19 5 2021
Statut: ppublish

Résumé

Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta-analyses (NMAs) and meta-analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability outcomes. Co-primary outcomes were disease-specific symptom reduction and all-cause discontinuation ("acceptability"). We included 14 NMAs and 90 MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co-primary outcomes, and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta-analytic evidence, the most convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention-deficit/hyperactivity disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy (CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive-compulsive disorder; CBT in post-traumatic stress disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results from this umbrella review of interventions for mental disorders in children/adolescents provide evidence-based information for clinical decision making.

Identifiants

DOI: 10.1002/wps.20881 PMID: 34002501 PMC: PMC8129843
pubmed: 34002501
doi: 10.1002/wps.20881
pmc: PMC8129843
doi:

Types de publication

Journal Article

Langues

eng

Pagination

244-275

Informations de copyright

© 2021 World Psychiatric Association.

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Auteurs

Christoph U Correll (CU)

Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, NY, USA.
Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.

Samuele Cortese (S)

Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
Solent NHS Trust, Southampton, UK.
Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.

Giovanni Croatto (G)

Neurosciences Department, University of Padua, Padua, Italy.

Francesco Monaco (F)

Department of Mental Health, ASL Salerno, Salerno, Italy.

Damir Krinitski (D)

Integrated Psychiatry Winterthur, Winterthur, Switzerland.

Gonzalo Arrondo (G)

Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain.

Edoardo G Ostinelli (EG)

Psychiatry Department, Oxford University, Oxford, UK.

Caroline Zangani (C)

Department of Health Sciences, University of Milan, Milan, Italy.

Michele Fornaro (M)

Department of Psychiatry, Federico II University, Naples, Italy.

Andrés Estradé (A)

Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Department of Clinical and Health Psychology, Catholic University, Montevideo, Uruguay.

Paolo Fusar-Poli (P)

Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Andre F Carvalho (AF)

Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.

Marco Solmi (M)

Neurosciences Department, University of Padua, Padua, Italy.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Classifications MeSH