ABSTRACTS - World Psychiatric Association

sis would not just be OCD with poor insight (the only subtype of
OCD currently recognized in the DSM-IV), but would also include
OCD with high motor symptoms (for OCD patients with tics) or
OCD with a high impulsive component (which might include compulsive
shopping, compulsive gambling or trichotillomania). Utilizing
the dimensional approach will help to ensure that, from the onset, an
OCD with high unstable mood (i.e., OCD with comorbid bipolar disorder)
would be diagnosed and treated appropriately (with antiobsessive
and mood stabilizers). Combining the threshold system
with dimensional components would extend the diagnostic procedure
from a one-step categorical approach (either having OCD or
not) to a two-step procedure, the second step being the “profile” of
the particular patient, based on the dimensions. The idea is to look
for alternative tools to use dimensions as a potential scheme for
improving diagnosis and treatment in OCD.
US3.
TREATMENT ADVANCES IN CHILD PSYCHIATRY
US3.1.
TREATMENTS IN CHILD AND ADOLESCENT
PSYCHIATRY: UPDATE 2009
J.L. Rapoport
Child Psychiatry Branch, National Institute of Mental Health,
Bethesda, MD, USA
Landmark studies over the past few decades have established the
importance of an evidence based approach in child and adolescent
psychiatry. For example, the Isle of Wight epidemiological studies, utilizing
standardized ratings, randomized assignment, and contrast
groups, placebo controlled trials and long-term prospective follow-up
studies advanced the field remarkably. In this highly selective review,
three examples of important treatment findings are highlighted
because of both their practical implications and heuristic importance.
First, placebo controlled trials of mood stabilizers in “bipolar spectrum”
are reviewed. These studies support great caution in the use of
mood stabilizers in bipolar “spectrum” children. Secondly, a successful
school based training trial of executive function in preschool children
is discussed as an inexpensive and possibly preventive approach.
Finally, important advances in a treatment trial leading to substantial
prevention of cerebral palsy are covered. Since half of cerebral palsy
children have psychiatric disorders, this study has major implications
for preventive pharmacological intervention in child psychiatry.
US3.2.
TREATMENTS OF AUTISM SPECTRUM DISORDERS:
AN UPDATE
B.L. Leventhal
Institute for Juvenile Research, University of Illinois, Chicago,
IL, USA
Extensive studies in recent years have dramatically changed the outlook
and perspectives on autistic disorder. First of all, international
collaborative studies have developed standard diagnostic tools and
the only agreement between DSM and ICD for the diagnostic criteria
for a disorder. The agreement on phenotype has lead to an understanding
that autistic disorder is one of a group of conditions now
considered under the rubric of autism spectrum disorders (ASD) and
to extensive epidemiologic studies that now allow for the appreciation
of ASD as relatively common conditions, affecting some 0.6-0.7% of
the population. This perspective has added new gravity to the importance
of understanding the etiology and development of evidencebased
treatments for ASD. While the etiology of autism still remains
unclear (and there are many competing, often non-evidence based
theories), it is becoming increasingly clear that ASD have a strong biological
substrate, with genetics playing a key role in the pathophysiologic
processes that lead to very early (possibly prenatal) disruptions
in brain development. As the genetics and pathophysiology are being
sorted out, studies now suggest that there are safe and effective, evidence-based
treatments that can meaningfully alter the course of the
disorder. While most of these interventions are environmental (language
therapy, education, behavior therapy, social skills training, etc.),
there is also growing evidence of the utility of psychopharmacology as
at least an adjunctive treatment for the symptoms of ASD. The development
of animal models and a developing understanding of the
pathophysiology of ASD is leading to new treatments, some now in
clinical trials, and others that will be available in the very near future.
US3.3.
RECENT ADVANCES IN TREATMENT
OF UNIPOLAR DEPRESSION AND BIPOLAR
DISORDER IN CHILDREN AND ADOLESCENTS
N.D. Ryan
Department of Psychiatry, University of Pittsburgh School
of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh,
PA, USA
The research and clinical experience from past five years has provided
many new insights to the pharmacological and psychological treatment
of child psychiatric disorders. Recent clinical studies and important
clinical data have further clarified and changed our approaches to
both unipolar disorder and bipolar disorder in children and adolescents.
In the treatment of unipolar depression, large scale studies,
including the Treatment for Adolescents with Depression Study
(TADS) and the Treatment of Resistant Depression in Adolescents
(TORDIA), have taught us more about how to use both medications
and psychotherapy in the initial treatment of these disorders and in the
treatment of refractory depression. Over the same time, multiple studies
have shed at least partial light on the vexing question of whether or
not antidepressants overall increase or decrease the ultimate risk for
suicide. In the treatment of bipolar disorder, much more data is now
available on the safe and efficacious use of atypical antipsychotics as
well as other mood stabilizers and we are starting to see studies of psychotherapeutic
approaches useful in combination with medications
for bipolar disorder. At the same time, some studies have suggested a
place for first-generation antipsychotics in the treatment of children.
US4.
OUTCOME IN BIPOLAR DISORDERS: NEW
FINDINGS AND METHODOLOGICAL CHALLENGES
US4.1.
AN ARRAY OF OUTCOMES: RECENT FINDINGS
ON PREDICTION
W. Coryell
University of Iowa Carver College of Medicine, Iowa City, IA, USA
Recent years have seen a rapid increase in new knowledge of the
short- and long-term course of bipolar affective disorders. Outcome
measures have moved beyond simple times to recovery and relapse
and the quantification of excess mortality to include such outcomes as
switching, chronic psychosis and diagnostic revisions, the examina-
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