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

Authors
Correll, C. U. Cortese, S. Croatto, G. Monaco, F. Krinitski, D. Arrondo, G. Ostinelli, E. G. Zangani, C. Fornaro, M. Estrade, A. Fusar-Poli, P. Carvalho, A. F. Solmi, M.
Year
2021
Journal
World Psychiatry
Volume
20
Pages
244-275
Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions 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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Type of intervention

Treatment and Child Welfare Interventions

Topic

Mental Health Problems and Disorders

Behavior Problems

Externalizing Behaviors / Challenging Behaviors

Antisocial Behaviors

Behavioral Disorders

Emotional Problems

Depression and Depressed Mood

Bipolar Disorders

Selective Mutism

Anxiety Problems

Anxiety and Anxiousness

Phobias

Stress

Obsessive Compulsive Disorder

Trauma/ Post-traumatic Stress Disorder (PTSD)

ADHD

Autism Spectrum Disorder

Eating Disorders

Other Problems

Encopresis/Enuresis

Tics and Tourettes

Sexual Risk Behaviors

Intervention

Psychological Treatments

Family Therapy

Cognitive Behavioral Therapy, Behavioral Therapy and Cognitive Therapy

Mindfulness

Psychodynamic/Interpersonal Therapy

Pharmacological Treatment

Antidepressants

Sedatives

Stimulants

Antipsychotics

Antiepileptics

The organization of interventions

E-health interventions

Alternative Treatment

Music/Art and Expression Therapy

Age group

Age not specified

Characteristics

Overviews of Reviews

More information
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