Papers by Paramala Santosh
Suicidality in childhood and adolescence is of increasing concern. The aim of this paper was to r... more Suicidality in childhood and adolescence is of increasing concern. The aim of this paper was to review the published literature identifying key psychosocial risk factors for suicidality in the paediatric population. A systematic two-step search was carried out following the PRISMA statement guidelines, using the terms ‘suicidality, suicide, and self-harm’ combined with terms ‘infant, child, adolescent’ according to the US National Library of Medicine and the National Institutes of Health classification of ages. Forty-four studies were included in the qualitative synthesis. The review identified three main factors that appear to increase the risk of suicidality: psychological factors (depression, anxiety, previous suicide attempt, drug and alcohol use, and other comorbid psychiatric disorders); stressful life events (family problems and peer conflicts); and personality traits (such as neuroticism and impulsivity). The evidence highlights the complexity of suicidality and points towar...
Systematic Review and Meta-analysis: Efficacy of Pharmacological Interventions for Irritability and Emotional Dysregulation in Autism Spectrum Disorder and Predictors of Response
Journal of the American Academy of Child and Adolescent Psychiatry, Feb 1, 2023
Emotional dysregulation and irritability are common in individuals with autism spectrum disorder ... more Emotional dysregulation and irritability are common in individuals with autism spectrum disorder (ASD). We conducted the first meta-analysis assessing the efficacy of a broad range of pharmacological interventions for emotional dysregulation and irritability in ASD and predictors of response.Following a preregistered protocol (PROSPERO: CRD42021235779), we systematically searched multiple databases until January 1, 2021. We included placebo-controlled randomized controlled trials (RCTs) and evaluated the efficacy of pharmacological interventions and predictors of response for emotional dysregulation and irritability. We assessed heterogeneity using Q statistics and publication bias. We conducted subanalyses and meta-regressions to identify predictors of response. The primary effect size was the standardized mean difference. Quality of studies was assessed using the Cochrane Risk of Bias Tool (RoB2).A total of 2,856 individuals with ASD in 45 studies were included, among which 26.7% ...
Sibling's Views Questionnaire
The SVQ enables support group facilitators (including healthcare professionals, school counsellor... more The SVQ enables support group facilitators (including healthcare professionals, school counsellors, researchers, and young carers' group leaders) to ascertain the most significant aspects of siblings' experiences of living with a brother or sister with complex care needs, from siblings' perspectives. <br> Facilitators complete the 'SVQ – pre-intervention' through individual 'interview' with the sibling before the support group begins. The pre-intervention SVQ allows facilitators to establish what most concerns siblings and to establish what siblings need from their support group. There is therefore the potential to tailor the support group/intervention more carefully to help ensure it is beneficial for the siblings taking part. <br> Through completing the 'SVQ - post-intervention' after the support group, the information siblings shared at the start of the support group is re-visited. This enables siblings to reflect on anything that has changed (or stayed the same) and the reasons for this being the case. It also forms an evaluation of the support group thus providing facilitators with a focused means of measuring the effectiveness of the intervention. <br> The full original research article detailing the use of the SVQ is available online (see References).
Zurich Open Repository and Archive (University of Zurich), 2008
A panel of experts from several European countries has accomplished a systematic review of publis... more A panel of experts from several European countries has accomplished a systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorders, on the basis of which practical recommendations for the application of these medications have been developed. The current article outlines results of this analysis, comparing the effect sizes and numbers-needed to-treat for extended-release stimulant preparations and atomoxetine (ATX). It is concluded (1) that long-acting preparations should be licensed and used. (2) However, they should not completely replace short-acting medications, in view of costs as well as the greater flexibility of dosing. Individual choices of therapy are necessary. (3) Both ATX and retarded-release stimulants should be available.
BMJ Open, Dec 1, 2019
To investigate the feasibility of delivering structured psychotropic medication review in communi... more To investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).Single-arm feasibility study conducted over a 6-month period.Specialist community ID teams in England.Psychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.A structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making.Feasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and sug...
A panel of experts from several European countries has accomplished a systematic review of publis... more A panel of experts from several European countries has accomplished a systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorders, on the basis of which practical recommendations for the application of these medications have been developed. The current article outlines results of this analysis, comparing the effect sizes and numbers-needed to-treat for extended-release stimulant preparations and atomoxetine (ATX). It is concluded (1) that long-acting preparations should be licensed and used. (2) However, they should not completely replace short-acting medications, in view of costs as well as the greater flexibility of dosing. Individual choices of therapy are necessary. (3) Both ATX and retarded-release stimulants should be available.
Paediatric Bipolar Disorder With Comorbid Autism Spectrum Disorder: An Update
61st Annual Meeting, Oct 25, 2014
Prescribing psychotropic medications for children and adolescents by young psychiatrists attending the ECNP School of Neuropsychopharmacology
Use of Selective Serotonin Reuptake Inhibitors in Children and Adolescents
Drug Safety, 2004
ABSTRACT Depression is a serious condition, associated with considerable morbidity and mortality;... more ABSTRACT Depression is a serious condition, associated with considerable morbidity and mortality; selective serotonin reuptake inhibitors (SSRIs) were commonly used in its treatment in child and adolescent psychiatry until recently. In the wake of the recent UK Committee on Safety of Medicines (CSM) advice, we conducted a rapid review of current available information on SSRIs and suicidality (suicidal ideation, self-harm and suicide attempt) in children and adolescents from clinical trials and epidemiological studies. There is insufficient safety information from the randomised controlled trials to confirm a definite association between SSRIs and suicidality. Furthermore, analysis of suicide and antidepressant prescribing trends in three countries and a large case-control study do not support the hypothesis that there is a link between use of SSRIs and death caused by suicide. Regulatory agencies and the media should have strict guidelines for the management of information relating to the treatment of this condition so that clinicians can make properly informed decisions. We suggest clinical guidelines for managing depression in children and adolescents. SSRIs should not be considered for use as first-line treatment in mild or moderate depression of childhood, where psychological interventions such as cognitive behaviour therapy or interpersonal therapy are the mainstay. SSRIs should be considered when there is severe depression that does not respond to psychological interventions; when the child is suicidal and is admitted as an inpatient, is severely depressed or has bipolar depression despite adequate doses of mood-stabilisation agents; or when the child or family prefers pharmacotherapy to psychological interventions and gives informed consent. Local bodies of clinicians or peer groups should agree protocols and acceptable guidelines, taking into consideration the type of patients being assessed, the availability of nonpharmacological intervention, and the benefit-risk ratio of the pharmacological intervention. It is important that parents (and patients when possible) be given accurate information regarding the current controversy over SSRI prescribing. More research into the use of SSRIs in childhood depression is urgently required.
Paediatric Psychopharmacology - Special Considerations
ABSTRACT Psychotropic prescriptions in children and adolescents are on the increase, including in... more ABSTRACT Psychotropic prescriptions in children and adolescents are on the increase, including in pre-school age. This article focuses on aspects of psychopharmacology that have a special relevance in children and adolescents. The minimum effective dose (MED) strategy is a useful one to follow in children and adolescents, especially in those with developmental disability. A holistic biopsychosocial formulation and management is essential and the use of psychotropics alone is best avoided in most situations. Despite paediatric pharmacovigilance and long-term studies on efficacy and side-effects being sparse, it is safe to assume that paediatric populations are at least as, or more, vulnerable to adverse effects as adults.
Suizide bei Kindern und Jugendlichen gelten seit langem als Besorgnis erregendes Thema in der mod... more Suizide bei Kindern und Jugendlichen gelten seit langem als Besorgnis erregendes Thema in der modernen Gesellschaft, insbesondere für Ärzte, die mit psychischen Problemen von Kindern und Jugendlichen konfrontiert sind. So hat etwa die Wiener Psychoanalytische Gesellschaft mit Sigmund Freud im Jahr 1910 eine entsprechende Konferenz einberufen, da angenommen wurde, dass Suizide bei Jugendlichen ein epidemisches Ausmaß angenommen haben (Greydanus & Calles, 2007). Zu Beginn des 21. Jahrhunderts stellen Suizide und Suizidversuche bei Kindern und Jugendlichen nach wie vor ein ernsthaftes Problem für die öffentliche Gesundheit dar, und aktuelle Studien bestätigen, dass Suizid eine der häufigsten Todesursachen junger Menschen ist.
Medical Care, Dec 5, 2019
Background: Recent reports of increased national estimates of pediatric psychiatric emergency dep... more Background: Recent reports of increased national estimates of pediatric psychiatric emergency department (ED) visits and psychiatric hospitalizations emphasize the need to research these utilization patterns. Objectives: To assess the patient-provider continuity of care (CoC) and compare the risk of psychiatric ED visits or hospitalization according to the CoC level. Research Design: A cohort design was applied to Medicaid administrative claims data (2007-2014) for 3-16-year olds with a first psychiatric diagnosis between 2009 and 2013 (n = 38,825). Subjects: Continuously enrolled youths with (1) ≥ 1 outpatient psychiatric visits and (2) ≥ 4 pediatric outpatient visits in the prior 24 months. Measures: The authors assessed CoC in the 24 months before the first psychiatric outpatient visit and quantified CoC using the Alpha Index. The authors assessed patient-provider CoC before first psychiatric diagnosis and the odds of psychiatric ED visits or psychiatric hospitalizations in the year after diagnosis. Results: Of the 38,825 youths, 88.9% received a first psychiatric diagnosis by age 14. The odds of ED visits were significantly higher among youths with low CoC [6.63%, adjusted odds ratio (AOR), 1.27; 95% confidence interval (CI), 1.13-1.41] or moderate CoC (5.76%; AOR, 1.14; 95% CI, 1.02-1.27) compared with those with high CoC (4.96%). Greater odds of psychiatric hospitalization related to low (7.53%; AOR, 1.17; 95% CI, 1.06-1.29) or moderate CoC (7.01%; AOR, 1.15; 95% CI, 1.03-1.27) compared with high CoC (6.06%). Conclusions: The odds of potentially disruptive clinical management and costly psychiatric ED visits or hospitalizations were lower for youths with high CoC. The findings support the need to research the impact of CoC on long-term pediatric mental health service use.
HAL (Le Centre pour la Communication Scientifique Directe), Oct 16, 2017
Franic, Tomislav et al.. (2017) Protocol for a cohort study of adolescent mental health service u... more Franic, Tomislav et al.. (2017) Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and costeffectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study). BMJ Open, 7 (10). e016055.
Beyond “Psychotropic”
The Journal of Clinical Psychiatry, Mar 20, 2023
Sibling's Views Questionnaire
PsycTESTS Dataset, 2015
The Maudsley Centre for Interventional Paediatric Psychopharmacology Model of Care in Complex Neurodisability and Neurodegeneration
61st Annual Meeting, Oct 22, 2014
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Papers by Paramala Santosh