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

Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review
Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review
Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour­nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter­ventions 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.
ADHD, Children, acceptability, adolescents, autism, brain stimulation, dis­ruptive behavior disorders, efficacy, pharmacotherapy, psychosocial interventions, psychotherapies
2051-5545
244-275
Correll, Christoph
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Cortese, Samuele
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Croatto, Giovanni
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Monaco, Francesco
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Krinitski, Damir
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Arrondo, Gonzalo
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G. Ostinelli, Edoardo
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Zangani, Caroline
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Fornaro, Michele
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Estradé, Andrés
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Fusar-Poli, Paolo
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Carvalho, Andre F.
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Solmi, Marco
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Correll, Christoph
b41a207d-2126-41b8-8856-a86214ed97b4
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Croatto, Giovanni
2b0f321a-25df-457a-9f6b-776e4ae9e319
Monaco, Francesco
24953337-14f3-4a52-bd5f-779907109607
Krinitski, Damir
0a90fdfb-f76c-4c5a-a798-1cdc91fdcb32
Arrondo, Gonzalo
5b9c1446-74f9-4dc7-aa73-6c67f3eaddbc
G. Ostinelli, Edoardo
b9ac1314-edb7-490b-87b1-8cfc40272572
Zangani, Caroline
8f262e4e-1078-4e73-b318-04c4634a0c55
Fornaro, Michele
b817f7f5-0787-4906-91ab-a71c87053e34
Estradé, Andrés
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Fusar-Poli, Paolo
15bcf652-42ac-4c62-a0a9-25961c90df01
Carvalho, Andre F.
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Solmi, Marco
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Correll, Christoph, Cortese, Samuele, Croatto, Giovanni, Monaco, Francesco, Krinitski, Damir, Arrondo, Gonzalo, G. Ostinelli, Edoardo, Zangani, Caroline, Fornaro, Michele, Estradé, Andrés, Fusar-Poli, Paolo, Carvalho, Andre F. and Solmi, Marco (2021) Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry, 20 (2), 244-275. (doi:10.1002/wps.20881).

Record type: Article

Abstract

Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour­nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter­ventions 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.

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Correll_Umbrella_ca_efficacy_Mar1_2021_ms - Accepted Manuscript
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Accepted/In Press date: 2 March 2021
e-pub ahead of print date: 18 May 2021
Additional Information: Funding Information: E.G. Ostinelli is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility and the NIHR Oxford Health Biomedical Research Centre (grant BRC‐1215‐20005). Supplementary information on this study is available at https://osf.io/2awu4/ . Publisher Copyright: © 2021 World Psychiatric Association Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: ADHD, Children, acceptability, adolescents, autism, brain stimulation, dis­ruptive behavior disorders, efficacy, pharmacotherapy, psychosocial interventions, psychotherapies

Identifiers

Local EPrints ID: 449373
URI: http://eprints.soton.ac.uk/id/eprint/449373
ISSN: 2051-5545
PURE UUID: fb091e09-4d84-4be8-a638-dc3b3e147581
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 26 May 2021 16:31
Last modified: 17 Mar 2024 06:35

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Contributors

Author: Christoph Correll
Author: Samuele Cortese ORCID iD
Author: Giovanni Croatto
Author: Francesco Monaco
Author: Damir Krinitski
Author: Gonzalo Arrondo
Author: Edoardo G. Ostinelli
Author: Caroline Zangani
Author: Michele Fornaro
Author: Andrés Estradé
Author: Paolo Fusar-Poli
Author: Andre F. Carvalho
Author: Marco Solmi

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