Child Psychiatry Research: Equipping our Colleagues in the Trenches

Stephen Grcevich, MD

President and Founder, Family Center by the Falls Chagrin Falls, OH

Assistant Professor of Psychiatry Northeastern Ohio Universities College of Medicine

Division of Child and Adolescent Psychiatry Case Western Reserve University School of Medicine

AACAP Research Forum, October 26, 2010

E-mail: drgrcevich@fcbtf.com Phone: (440) 543-3400 Twitter: @drgrcevich

Educational objective:

Provide an office-based clinician’s perspective to the discussion of research priorities in child and adolescent mental health

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/MedscapeLeerink-Swann

Major Shareholder None

Stephen Grcevich, MD: disclosures:

What research would be most helpful to clinicians “in the

trenches?” “Real world” data-from more representative patient

populations

Predicting adverse responses to medication

Research that helps answer common questions from parents

Research that would help improve accuracy of diagnosis

“Personalized medicine”…offering the most effective or acceptable treatment first, knowing when to depart from algorithms…drug, dose, alternative treatments

The conundrum : What’s desirable may not be possible

The best possible treatments:

More “real-world” clinical trials…atypicals in treatment-naïve bipolar patients, intermediate to long-term acceptability of medications (ADHD treatments)

How effective is community-based psychotherapy performed by clinicians on managed care panels? Working for public agencies?

Kids with severe irritability, aggression, self-injurious behavior in chaotic living situations (SMD, TDD)

Validation of existing algorithms, practice parameters (TMAP-ADHD)

Pliszka, SR et al. J. Am. Acad. Child Adolesc. Psychiatry, 45:6, JUNE 2006

With the fewest adverse effects:

Studies to help predict in advance which patients will experience serious adverse effects…

Who’ll develop metabolic syndrome, tardive dyskinesia on a SGA?

What are the intermediate to long term effects of SGAs?

Suicidal behavior, behavioral activation on a SSRI?

Precipitation or exacerbation of mania on stimulants, atomoxetine, SSRIs

Answering questions from parents:

Long term effects on medications on neurodevelopment…unintended consequences of treatment?

For how long will their child need medication?

How does therapy, psychosocial treatment attenuate the need for medical intervention?

Safety, effectiveness of homeopathic treatments

Improving accuracy of diagnosis:

Biological markers (DNA analysis, neuroimaging) to help confirm accuracy of diagnosis

Essential questions to include in electronic medical record templates-evaluation, follow-up

Personalized medicine:

Identification of genetic factors contributing to response (or lack of response) to standard treatments

Rapid vs. slow metabolizers

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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Questions?