Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

Walter, Heather J.; Bukstein, Oscar G.; Abright, A. Reese; Keable, Hélène; Ramtekkar, Ujjwal; Ripperger-Suhler, Jane; Rockhill, Carol

doi:10.1016/j.jaac.2020.05.005

Cited by 178 publications

(135 citation statements)

References 68 publications

(71 reference statements)

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“…The relationship between NSSI and mood disorders is much weaker than the association between NSSI and suicidal behaviour. Anxiety disorders are one of the most common mental disorders in children and adolescents [105] and are highly comorbid with other psychiatric symptoms like ADHD, ODD, dysthymic disorders, and major depressive disorders [106]. Our results supported that there is a relationship between anxiety disorders and suicide risk [107].…”

Section: Discussionsupporting

confidence: 74%

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

Győri

Farkas

Horváth

et al. 2021

IJERPH

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Although earlier research has highlighted that psychiatric disorders significantly impair patients’ quality of life (QoL), few studies have examined the relationship between nonsuicidal self-injury (NSSI) and QoL. Our aim was to investigate whether QoL mediates the mental disorder–NSSI relationship, and to study the QoL ratings agreement of self and parents in a clinical population of adolescents. We involved 202 adolescents from Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, aged 13–18 years. All participants completed the Deliberate Self-Harm Inventory, Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, and the Mini International Neuropsychiatric Interview Kid. To map the interrelationship between the NSSI, mental disorders, and QoL dimensions, Mixed Graphical Models were estimated. Adolescents with a history of NSSI rated their QoL to be significantly lower than adolescents without NSSI. Self and parents’ QoL ratings are closer in the NSSI sample than in the no-NSSI sample. Among all QoL dimensions, only family problems had a direct significant association with NSSI engagement. Our results highlight that, contrary to our hypothesis, the presence of mental disorders mediates the relationship between most QoL dimensions and the occurrence of NSSI. Our results draw attention to the potential causal effect of environmental factors (e.g., peer problems) on mental disorders that, in turn, result in NSSI. The present paper highlights the importance of network modelling in clinical research.

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Section: Discussionsupporting

confidence: 74%

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

Győri

Farkas

Horváth

et al. 2021

IJERPH

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“…It can be implied that the main mental health problems of patients with COVID-19 were depression, anxiety, and PTSD. Selective serotonin reuptake inhibitor antidepressants are the first-line drug treatment for depression, anxiety, and PTSD [ 44 , 45 ]. Nevertheless, in the conditions of the pandemic, medication for COVID-19–prompted trauma responses is not the best option because it takes effect slowly.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial

Liu¹,

Qiao²,

Xu³

et al. 2021

J Med Internet Res

103

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Background The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ≥7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients’ symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952

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“…1 Fortunately, well-controlled studies have established cognitive-behavior therapy (CBT) as an efficacious and recommended first-line psychosocial treatment for child anxiety disorders, including specific phobias, largely due to CBT's superiority over waitlist control conditions. 4 CBT for child anxiety disorders has not consistently outperformed active control conditions, and an emerging line of research suggests that this may be due to the underuse-particularly with children-of the most active component of anxiety treatment protocols, namely, exposure. 5 Exposure is the process by which individuals directly challenge catastrophic, anxiety-driven beliefs via safe behavioral experiments.…”

Section: What Is the Evidence-based Psychotherapy For Pediatric Anxiementioning

confidence: 99%

“…3 Children with food allergy who have a personal or family history of another anxiety disorder, are female, have experienced previous traumatic events (including anaphylaxis), or have parents with high anxiety and an overprotective style may be particularly at risk. 4 As in the case example above, when children with allergy or their anxious parents avoid situations in which the risk of accidental ingestion is very low, all family members can feel a temporary relief that inadvertently drives increased anxiety via a spiral of negative reinforcement (see Fig 1). Even when the avoidance becomes excessive and compromises daily functioning, it may appear to be ''working,'' if the child does not experience an anaphylactic reaction.…”

mentioning

confidence: 98%

New issue of food allergy: Phobia of anaphylaxis in pediatric patients

Dahlsgaard

Lewis

Spergel

2020

Journal of Allergy and Clinical Immunology

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Your 10-year-old patient with peanut allergy has come for her annual appointment. Her allergy was identified after an anaphylactic event as a toddler that she does not remember. The main concern described by parents is not the food allergy, but anxiety. Over the last year-after experiencing minor allergic symptoms that did not require epinephrine-the child has become increasingly fearful of accidental crosscontamination, even under the most remote of circumstances. She no longer sits near someone eating peanut butter and runs from a room if she smells it. She has stopped eating with friends at school or going on playdates without her mother. There is overwashing of hands and ''constant'' seeking of reassurance that minor stomach aches or ''feeling hot'' aren't signs of an impending allergic reaction. The patient's mother has grown preoccupied with news reports of anaphylactic deaths that are shared on social media. She complains that her husband is ''too cavalier'' about food safety while he snaps back that his wife has become ''too coddling.'' He then begrudgingly admits that he recently removed all peanut products from the family home, such that their daughter can have ''one safe place'' where she ''doesn't have to feel anxious about her allergy.'' This has led to conflicts with her siblings, who want to eat peanut butter sandwiches and enjoy their Halloween candy in relative peace. You wonder if this level of anxiety warrants referral to a mental health provider, and which type? So many of your patients present with comorbid anxiety these days, and you want to make sure they receive evidence-based, effective care.

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Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders

Cited by 178 publications

References 68 publications

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

The Association of Nonsuicidal Self-Injury with Quality of Life and Mental Disorders in Clinical Adolescents—A Network Approach

The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial

New issue of food allergy: Phobia of anaphylaxis in pediatric patients

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