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Child Psychiatry Research: Equipping our Colleagues in the Trenches ,[object Object],[object Object],[object Object],[object Object],[object Object],E-mail: drgrcevich@fcbtf.com  Phone:  (440) 543-3400  Twitter: @drgrcevich
Educational objective: ,[object Object]
Stephen Grcevich, MD: disclosures: Pharmaceutical Industry Consulting: Shire US (100% of compensation donated to charity since 1/1/08) Grant/Research Support Child and Adolescent Psychiatry Trials (CAPTN) Network-ASK, PARCA, NOTA studies funded through NIMH Speakers’ Bureaus None since 2006 Other Financial/Material Support Web MD/Medscape Leerink-Swann Major Shareholder None
What research would be most helpful to clinicians  “in the trenches?” ,[object Object],[object Object],[object Object],[object Object],[object Object]
The conundrum : What’s desirable may not be possible
The best possible treatments: ,[object Object],[object Object],[object Object],[object Object],Pliszka, SR et al. J. Am. Acad. Child Adolesc. Psychiatry, 45:6, JUNE 2006
With the fewest adverse effects: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Answering questions from parents: ,[object Object],[object Object],[object Object],[object Object]
Improving accuracy of diagnosis: ,[object Object],[object Object]
Personalized medicine: ,[object Object],[object Object],Rockhill, C, Althof R. J Am Acad Child Adolesc Psychiatry - December 2009 (Vol. 48, Issue 12, Pages 1135-1136) McGough JJ, McCracken JC, Loo SK. J Am Acad Child  Adolesc Psychiatry - December 2009 (Vol. 48, Issue 12, Pages 1155-1164), ,
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A A C A P Research Forum 2010 Grcevich

  • 1.
  • 2.
  • 3. Stephen Grcevich, MD: disclosures: Pharmaceutical Industry Consulting: Shire US (100% of compensation donated to charity since 1/1/08) Grant/Research Support Child and Adolescent Psychiatry Trials (CAPTN) Network-ASK, PARCA, NOTA studies funded through NIMH Speakers’ Bureaus None since 2006 Other Financial/Material Support Web MD/Medscape Leerink-Swann Major Shareholder None
  • 4.
  • 5. The conundrum : What’s desirable may not be possible
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.

Editor's Notes

  1. Clinicians “in the trenches” are getting squeezed We’re asked to do “evidence-based treatment” using evidence that has little to do with patients we see in the real world Example…Mixed Amphetamine Salts in adolescents Example: aripiprazole in newly diagnosed patients with bipolar disorder More pressure to see more kids in less time…how can we be more sure that we have it right? When to depart from practice guidelines?
  2. I’m realistic Cleveland will be challenged to win the NBA championship because free agents don’t want to come We won’t get what we want
  3. Why do so many kids stop taking medication that’s reportedly very helpful? Tolerability very different in patients with comorbid conditions Docs rely on medication because the results are more consistent…PATS/TADS study…how will anxious kids do with the therapists I have available to me in my community or my agency? TDD…discussion of need for diagnosis…how to treat them? Not much data to validate TMAP…ADHD with comorbidities is what we treat most often
  4. Conundrum…You’re in a mental health center…your patient is 8-in his parents’ bedroom with a knife…command hallucinations to stab and kill his parents African American-125# Father has HTN, 300+# both of his grandfathers spent 15+ years in state psychiatric hospitals You’d like to know risks of TD Acute-term studies with atypicals…what will he weigh in 12 months? 24 months? Two small, short-term studies evaluating stimulants in bipolar disorder, but most kids with bipolar disorder have ADHD
  5. Does long-term medication treatment impact the course of the illness? How does behavioral, psychosocial treatment effect the long-term course?
  6. When do we depart from the algorithms?