BackgroundVarious clinical trials suggested that risperidone was beneficial in the treatment of autism spectrum disorder (ASD) in children and adolescents.ObjectiveThe aim of this systematic review was to determine the efficacy, acceptability and tolerability of risperidone in the treatment of children and adolescents with ASD.Data sourcesThe databases of Scopus, PubMed, CINAHL and Cochrane Controlled Trials Register were searched in February 2017.Study eligibility criteria, participants and interventionsEligible RCTs of risperidone in the treatment of child and adolescent patients with ASD. Languages were not restricted.Study appraisal and synthesis methodsThe full-text versions of relevant studies were thoroughly assessed and extracted. The primary efficacy of outcome was the pooled response rate and the pooled mean changed scores of the standardized rating scales for ASD.ResultsA total of 372 randomized subjects from seven RCTs were included in this review. In acute treatment, the pooled mean change score of the Aberrant Behavior Checklist for irritability subscale (ABC-I) and response rate for the risperidone-treated group had a greater significance than that of the placebo-treated group. In the long-term treatment, the pooled mean change score of the CARS in the risperidone-treated group was significantly greater than that in the placebo-treated group. According to the discontinuation phase, the overall pooled relapse rate of the risperidone-treated group was significantly less than that of the placebo-treated group. The rates of pooled overall discontinuation and discontinuation due to adverse events rates were not different between the two groups in acute and long-term treatments.LimitationsA small study was included in the current review.ConclusionIn relation to the current systematic review, risperidone is efficacious in the treatment of symptoms in children and adolescents with ASD. Although its acceptability is comparable to placebo, treatment with risperidone is well tolerated in children and adolescents with ASD.

BackgroundSeveral studies have shown that lisdexamfetamine (LDX) is efficacious in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).ObjectivesAims of this study were to systematically review the efficacy, acceptability, and tolerability of LDX in child and adolescent ADHD. Any randomized controlled trials (RCTs) of LDX versus placebo carried out in children and adolescents with ADHD were included.Data sourcesThe searches of the SCOPUS, MEDLINE, CINAHL and Cochrane Controlled Trials Register were performed in September 2014. Additional searches in the ClinicalTrials. gov and EU Clinical Trials Register database were conducted.Study eligibility criteria, participants, and interventionsThis review included all RCTs of LDX versus placebo which were carried out in children and adolescents up to 18 years old. Additionally, the included studies must have reported the final outcomes of: i) severity of ADHD symptoms with standardized scales, ii) rates of improvement, iii) rates of discontinuation. To be more thorough, the languages of such RCTs were not limited.Study appraisal and synthesis methodsThe abstracts from databases were inspected and the full text versions of relevant trials were examined and extracted for important outcomes. The efficacious measurements included either the pooled mean end-point or changed scores of ADHD rating scales, and the rate of improvement. Acceptability and tolerability were measured by the pooled overall discontinuation rate and the pooled discontinuation rate due to adverse events, respectively. A random effect model technique was utilized to synthesize the mean differences (either standardized mean differences or weighted mean differences) and relative risks (RRs) with 95% confidence intervals (CIs).ResultsA total of 1,016 children and adolescents with ADHD were included. The dosage of LDX was 30 to 70 mg/day. The pooled mean change scores of LDX-treated group was significantly greater than that of the placebo (weighted mean difference [95% CI] of −15.20 [−19.95, −10.46], I2=94%). The pooled improvement rate of the LDX-treated group was also significantly higher than that of the placebo (RR [95% CI] of 0.34 [0.24, 0.47], I2=80%). The pooled overall discontinuation rate between the two groups was not significantly different (RR [95% CI] of 0.78 [0.46, 1.31], I2=63%). Similarly, the pooled discontinuation rate due to adverse events between the two groups showed no significant difference (RR [95% CI] of 1.99 [0.70, 5.64], I2=0%).LimitationsThe number of included studies was limited (five RCTs).ConclusionAccording to the present review, LDX was effective and well-tolerated in the treatment of child and adolescent ADHD. Unfortunately, the acceptability of LDX was not better than the placebo. Since the number of included studies was limited, the outcome from this review should be carefully interpreted and considered as preliminary. Further studies, therefore, should be conducted to confirm these findings.Implication of key findingsLisdexamfetamine is an efficac...

Introduction To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV). Methods A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age‐ and sex‐matched HIV‐uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9‐item (PHQ‐9) and Generalized Anxiety Disorder 7‐item scales (GAD‐7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ‐9 ≥9), significant anxiety symptoms (GAD‐7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow‐up assessment with PHQ‐9 and GAD‐7 was performed one year after psychiatric referral. Results From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm 3 . At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co‐existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores ( p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist‐confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post‐traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score. Conclusions With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.

No abstract

Purpose Adolescents being in a stage of growth need good sleep, but, today, they suffer from sleep deprivation due to such extrinsic factor as a smartphone which they enjoy spending time using the device. However, the effects of smartphone output power (SOP) on the duration of good sleep remains unclear. The purpose of this paper is to investigate the correlation of the SOP and sleep loss in high school students. Design/methodology/approach The time-series study was conducted among 145 high school students in Chiang Mai Province who completed a sleep diary which applied by the Pittsburg Sleep Quality Index. The SOP was corrected by a smartphone application and transmitted by e-mail to a researcher every day. The completed data set contains 12,969 entries. Headache, anxiety and depression were also assessed. Data were analyzed using the generalized estimating equation adjusted for demographic data, smartphone use and other factors. Findings Most of the study subjects are female, 17.4 years old on average. The prevalence of sleep loss (<8 h) was 52.9 percent with averagely 7.4 ±1.7 h of sleep duration and poor sleep at 32.1 percent. Anxiety, depression, headache had relationships with sleep loss. The daily dose, evening and nocturnal SOP in the range of ≥ 2.00 × 10‒5 mW had stronger relationships with sleep loss than their effects in the range of ≤ 1.79 × 10‒5 mW (ORadj1.32; 95% CI: 1.26–1.76, ORadj1.34; 95% CI: 1.07–1.17 and ORadj1.41; 95% CI: 1.07–1.17, respectively). Meanwhile, morning Lag_2 and daytime Lag_1 in the range of ≥ 2.00 × 10‒5 mW appeared to have a strong relationship with sleep loss (ORadj1.60; 95% CI: 1.26–1.76, ORadj1.36; 95% CI: 1.07–1.17). The relationship between Lag_4 daily dose and sleep loss took the form of a reverse dose-response. Originality/value Sleep loss in adolescents has an increasing trend of prevalence and has been found to be correlated with the highest SOP group (≥ 2.00 × 10‒5 mW range). These results confirmed that increased and longer smartphone use result in reduced sleep time. This causes them to be exposed to smartphone electromagnetic radiation and smartphone screen lighting. This disturbs brain waves and nervous system controlling sleep balance mechanisms. The findings recommended parents setting time and boundaries around technology use at home to reduce contact with electromagnetic radiation and smartphone screen lighting, thereby increasing sleeping time in order to create good sleep quality.