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Foster children, often being removed from neglectful or abusive homes, are one of the country's most vulnerable populations. With the often traumatic circumstances that define their early lives, it is no wonder studies show their tendency for more mental health conditions than other children. Facing these and other significant challenges surrounding foster care programs, state authorities, caseworkers, and parents, are given few options on appropriate treatments. These options often include prescribing heavy-duty psychotropic drugs such as antidepressants and, in some cases, even antipsychotics - drugs which have little research available supporting their use in children. This book examines the practice of medicating America's foster children with a focus on the financial and societal costs.

This book fulfils an urgent need for an updated text on pediatric psychopharmacology. It takes a unique approach in discussing recent findings within the context of current issues, including economic and political ones. The book covers the emerging question of treating children who do not yet meet diagnostic criteria for psychosis, e.g, schizophrenia or bipolar disorder, but who are deemed to be at high risk. This is an active area of debate: such children are being treated in certain centers, while others reject this completely. The book addresses the antidepressant controversy, the placebo response and unique strategies for delineating this, and ways to optimize the differential between active medication and placebo. It reviews the impact of recent American Heart Association guidelines for monitoring children on stimulants and other psychotropics. It adheres closely to DSM-IV diagnostic criteria throughout. The book describes the use of newly approved drugs such as Lexapro for treating adolescent depression and the novel compound Intuniv. It covers the TADS and CAMS studies, which evaluated the use of SSRIs alone and in combination with cognitive behavioral therapy for adolescent depression. Other topics include treatment of bipolar disorders, the increasing popularity of generic equivalents, combination pharmacotherapy and the potential dangers of psychotropic medications. * Third edition of the first ever book published on pediatric psychopharmacology from renowned editors. * Incorporates current developments with regard to SSRIs, their indications and their safety issues, including possible associated suicidal behavior. * Addresses concerns about cardiovascular side effects of the new stimulant medications available, and compares to other FDA-approved medications for ADHD. * Features many tables, figures and pictorials, making it highly accessible and reader friendly.

The human gut contains trillions of symbiotic bacteria that play a key role in programming different aspects of host physiology in health and disease. Psychotropic medications act on the central nervous system (CNS) and are used in the treatment of various psychiatric disorders. There is increasing emphasis on the bidirectional interaction between drugs and the gut microbiome. An expanding body of evidence supports the notion that microbes can metabolise drugs and vice versa drugs can modify the gut microbiota composition. In this review, we will first give a comprehensive introduction about this bidirectional interaction, then we will take into consideration different classes of psychotropics including antipsychotics, antidepressants, antianxiety drugs, anticonvulsants/mood stabilisers, opioid analgesics, drugs of abuse, alcohol, nicotine and xanthines. The varying effects of these widely used medications on microorganisms are becoming apparent from in vivo and in vitro studies. This has important implications for the future of psychopharmacology pipelines that will routinely need to consider the host microbiome during drug discovery and development.

RationaleGrowing evidence supports a role for the microbiota in regulating gut-brain interactions and, thus, psychiatric disorders. Despite substantial scientific efforts to delineate the mechanism of action of psychotropic medications at a central nervous system (CNS) level, there remains a critical lack of understanding on how these drugs might affect the microbiota and gut physiology.ObjectivesWe investigated the antimicrobial activity of psychotropics against two bacterial strain residents in the human gut, Lactobacillus rhamnosus and Escherichia coli. In addition, we examined the impact of chronic treatment with these drugs on microbiota and intestinal parameters in the rat.ResultsIn vitro fluoxetine and escitalopram showed differential antimicrobial effects. Lithium, valproate and aripiprazole administration significantly increased microbial species richness and diversity, while the other treatments were not significantly different from controls. At the genus level, several species belonging to Clostridium, Peptoclostridium, Intestinibacter and Christenellaceae were increased following treatment with lithium, valproate and aripiprazole when compared to the control group. Animals treated with escitalopram, venlafaxine, fluoxetine and aripiprazole exhibited an increased permeability in the ileum.ConclusionsThese data show that psychotropic medications differentially influence the composition of gut microbiota in vivo and that fluoxetine and escitalopram have specific antimicrobial activity in vitro. Interestingly, drugs that significantly altered gut microbial composition did not increase intestinal permeability, suggesting that the two factors are not causally linked. Overall, unravelling the impact of psychotropics on gastrointestinal and microbiota measures offers the potential to provide critical insight into the mechanism of action and side effects of these medications.

Key Points Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting up to half of the patients Psychiatric and neurological comorbidities have a complex relationship with epilepsy: comorbidities can exacerbate epilepsy or each other, and vice versa Treatment of psychiatric and neurological comorbidities needs to be incorporated into the overall management of patients with epilepsy Both pharmacological and surgical management of the seizure disorder can have either a negative or a positive impact on psychiatric and neurological comorbidities Neurologists should be able to treat some of the more common psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients This Review provides practical principles and considerations for the management of the most common psychiatric and neurological comorbidities in patients with epilepsy Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting 30–50% of patients. Neurologists should be able to treat psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients. In this Review, Andres Kanner discusses the complex relationship between epilepsy and psychiatric and neurological comorbidities, and provides considerations for selection of antiepileptic and psychotropic drugs in patients with epilepsy. The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa.

Rationale Ayahuasca is a psychotropic plant tea from South America used for religious purposes by indigenous people of the Amazon . Increasing evidence indicates that ayahuasca may have therapeutic potential in the treatment of mental health disorders and can enhance mindfulness-related capacities. Most research so far has focused on acute and sub-acute effects of ayahuasca on mental health-related parameters and less on long-term effects. Objectives The present study aimed to assess sub-acute and long-term effects of ayahuasca on well-being and cognitive thinking style. The second objective was to assess whether sub-acute and long-term effects of ayahuasca depend on the degree of ego dissolution that was experienced after consumption of ayahuasca. Results Ayahuasca ceremony attendants ( N  = 57) in the Netherlands and Colombia were assessed before, the day after, and 4 weeks following the ritual. Relative to baseline, ratings of depression and stress significantly decreased after the ayahuasca ceremony and these changes persisted for 4 weeks. Likewise, convergent thinking improved post-ayahuasca ceremony up until the 4 weeks follow-up. Satisfaction with life and several aspects of mindfulness increased the day after the ceremony, but these changes failed to reach significance 4 weeks after. Changes in affect, satisfaction with life, and mindfulness were significantly correlated to the level of ego dissolution experienced during the ayahuasca ceremony and were unrelated to previous experience with ayahuasca. Conclusion It is concluded that ayahuasca produces sub-acute and long-term improvements in affect and cognitive thinking style in non-pathological users. These data highlight the therapeutic potential of ayahuasca in the treatment of mental health disorders, such as depression.

Exposure to stress is an undeniable, but in most cases surmountable, part of life. However, in certain individuals, exposure to severe or cumulative stressors can lead to an array of pathological conditions including posttraumatic stress disorder (PTSD), characterized by debilitating trauma-related intrusive thoughts, avoidance behaviors, hyperarousal, as well as depressed mood and anxiety. In the context of the rapidly changing political and legal landscape surrounding use of cannabis products in the USA, there has been a surge of public and research interest in the role of cannabinoids in the regulation of stress-related biological processes and in their potential therapeutic application for stress-related psychopathology. Here we review the current state of knowledge regarding the effects of cannabis and cannabinoids in PTSD and the preclinical and clinical literature on the effects of cannabinoids and endogenous cannabinoid signaling systems in the regulation of biological processes related to the pathogenesis of PTSD. Potential therapeutic implications of the reviewed literature are also discussed. Finally, we propose that a state of endocannabinoid deficiency could represent a stress susceptibility endophenotype predisposing to the development of trauma-related psychopathology and provide biologically plausible support for the self-medication hypotheses used to explain high rates of cannabis use in patients with trauma-related disorders.

The Cannabis sativa plant contains more than 120 cannabinoids. With the exceptions of ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) and cannabidiol (CBD), comparatively little is known about the pharmacology of the less-abundant plant-derived (phyto) cannabinoids. The best-studied transducers of cannabinoid-dependent effects are type 1 and type 2 cannabinoid receptors (CB1R, CB2R). Partial agonism of CB1R by ∆ 9 -THC is known to bring about the ‘high’ associated with Cannabis use, as well as the pain-, appetite-, and anxiety-modulating effects that are potentially therapeutic . CB2R activation by certain cannabinoids has been associated with anti-inflammatory activities. We assessed the activity of 8 phytocannabinoids at human CB1R, and CB2R in Chinese hamster ovary (CHO) cells stably expressing these receptors and in C57BL/6 mice in an attempt to better understand their pharmacodynamics. Specifically, ∆ 9 -THC, ∆ 9 -tetrahydrocannabinolic acid (∆ 9 -THCa), ∆ 9 -tetrahydrocannabivarin (THCV), CBD, cannabidiolic acid (CBDa), cannabidivarin (CBDV), cannabigerol (CBG), and cannabichromene (CBC) were evaluated. Compounds were assessed for their affinity to receptors, ability to inhibit cAMP accumulation, βarrestin2 recruitment, receptor selectivity, and ligand bias in cell culture; and cataleptic, hypothermic, anti-nociceptive, hypolocomotive, and anxiolytic effects in mice. Our data reveal partial agonist activity for many phytocannabinoids tested at CB1R and/or CB2R, as well as in vivo responses often associated with activation of CB1R. These data build on the growing body of literature showing cannabinoid receptor-dependent pharmacology for these less-abundant phytocannabinoids and are critical in understanding the complex and interactive pharmacology of Cannabis -derived molecules.