The prevalence of mental disorders among children was higher in those with families that had lower annual incomes and high BMI. Risk for any child mental disorder was elevated among boys and children from homes with lower annual incomes and high BMI, according to results of a study published in the Journal of the American Academy of Child & Adolescent Psychiatry. There have been few robust and recent studies about trends in mental disorders among children in the United States. As such, this study was designed to be a current snapshot of the prevalence of and trends in mental disorders among children aged 9 to 10 years in the US. Investigators at Columbia University, New York, New York, sourced data from the Adolescent Brain Cognitive Development (ABCD) study which recruited 11,874 children from 21 sites in the US between 2016 and 2018. The overall prevalence of mental disorders and associations with sociodemographic and physical characteristics were evaluated. The children comprised 52.15% boys, 55.79% were White, 24.18% were Hispanic, 13.78% were Black, 62.51% had a healthy weight, 73.60% were born to a mother that was aged 20 to 34 years, 67.18% of parents were married or living with a partner, and 43.43% lived in a home with an annual income of $75,000 or higher. "[T]he findings highlight the threat posed by poverty to the mental health of children, especially to their liability to develop disruptive behavior disorders." Any mental disorder was observed among 10.11% of children. The most prevalent conditions were mood disorders (3.11%), anxiety disorders (2.90%), attention-deficit/hyperactivity disorder (ADHD; 2.73%), and disruptive behavior disorders (2.52%). The average number of disorders per child was 0.15%

Long-term methylphenidate treatment is not likely to be associated with growth impairments. Two years of treatment with methylphenidate for attention-deficit/hyperactivity disorder (ADHD) did not affect growth outcomes among children. These results from a study were published in The Lancet Psychiatry. The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study was a prospective, pharmacovigilance, multicenter study conducted between 2012 and 2016 at 27 mental health centers in the United Kingdom and in other countries in Europe. Children and adolescents with ADHD who were treatment-naïve and about to start methylphenidate (n=756) or had no intention to start methylphenidate (n=391) and a group of healthy controls (n=263) were followed for 2 years. The outcomes of interest in this study were height, weight, cardiovascular health, and psychiatric outcomes. The methylphenidate, no treatment, and control groups comprised children with mean ages 9.22, 8.74, and 10.25 years (P <.0001); 82.2%, 84.1%, and 45.2% were boys (P <.0001); 92.1%, 95.4%, and 92.4% were White; and they had BMIs of 18.4, 17.9, and 18.4 kg/m2, respectively. Methylphenidate appeared to slow weight velocity at 6 months compared with ADHD nonusers (P <.0001), however, no differences in weight were observed thereafter, nor were there any significant group differences in height or BMI throughout the study. "[T]he results of this study suggest that the safety profile of long-term treatment with methylphenidate for 2 years is acceptable." At 12 months, methylphenidate use associated with significantly elevated pulse rate, systolic blood pressure, and diastolic blood pressure (all P <.0001) compared with nonusers with ADHD. Between baseline at 24 months systolic blood pressure increased from 108 to 113 mmHg (P <.0001) among methylphenidate users and from 104 to 108 mmHg (P <.0001) among nonusers with ADHD while remaining unchanged among controls (mean, 109 vs 111 mmHg; P =.08), respectively. In addition, significant increases in diastolic blood pressure (mean, 65 vs 67 mmHg; P =.02) and pulse (mean, 80 vs 83 bpm) were observed among methylphenidate users between baseline and 24 months, respectively.

Profiles of sleep problems were related with behavioral and emotional during the transition from childhood to adolescence. During the transition from childhood to adolescence, a study published in JAMA Psychiatry identified profiles of sleep problems which were related with behavioral and emotional problems. Investigators from the University of Melbourne in Australia sourced data for this study from the Adolescent Brain Cognitive Development (ABCD) study which was an observational cohort study conducted in a community setting in the United States. Caregivers of children (N=10,313) completed the Sleep Disturbance Scale for Children (SDSC) and the 113-item Child Behavior Checklist (CBCL) instruments at baseline and at a 2-year follow-up between 2016 and 2020. The change in sleep problems and their relationship with psychopathology symptoms during the transition from childhood and adolescence were evaluated. Sleep pathology was defined as a SDSC t score of 70 or greater and internalizing, externalizing, and total problems were defined as SDSC t scores of 65 or greater. At baseline, the children were mean age 119 (SD, 7.51) months, 52.4% were boys, 54.0% were White, they had a BMI of 18.7 (SD, 3.72) kg/m2, and 42.7% had a parent with psychopathology. "The identification of discrete sleep profiles suggests that interventions should target specific patterns of sleep problems as an alternative to nonspecific targeting of sleep difficulties." At baseline, 7.9% met the criteria for sleep problems, 8.9% for internalizing problems, and 8.8% for externalizing problems. At follow-up, the proportion who met the criteria for sleep (7.8%) and internalizing (8.8%) problems were similar but the proportion who met the criteria for externalizing symptoms had decreased from baseline (7.3%).

The likelihood of developing cognitive impairment or Parkinson disease in adulthood may be tied to experiencing frequent nightmares in childhood. Experiencing distressing dreams in childhood may be associated with an increased risk for cognitive impairment and Parkinson disease (PD) during adulthood, according to study findings published in the journal eClinicalMedicine. Several recent studies have shown that the occurrence of frequent bad dreams and nightmares among adults may be an early sign or a potentially modifiable risk factor for the development of both PD and dementia — with the latter known as a type of cognitive impairment. Evidence also suggests that experiencing regular distressing dreams in the middle adult years may be linked to an elevated risk for PD or cognitive impairment a few decades later. In the current analysis, researchers sought to explore whether having distressing dreams during childhood can be linked to the risk for PD or cognitive impairment by age 50. For the longitudinal analysis, researchers utilized 50 years of prospectively obtained data from the 1958 British Birth Cohort Study to investigate the possible link. The British Birth Cohort Study is a prospective birth cohort that comprised all individuals who had been born in Great Britain during a single week in 1958. The base study population comprised 11,721 individuals who were enrolled at birth in 1958, and had information available on distressing dreams in 1965 (at age 7) and in 1969 (at age 11). Following numerous study exclusions, the final analytical sample included a total of 6991 children with follow-up available at age 50. "[I]t is possible that early treatment of distressing dreams could become a primary prevention strategy for dementia and PD." All of the data gathered on the children’s distressing dreams were collected prospectively from their mothers in 1965, then again in 1969. The mothers were requested to report whether their child had experienced “bad dreams or night terrors” in the prior 3 months by providing a “yes” or a “no” response. The participants were divided into 3 groups, according to the presence or lack thereof of distressing dreams at ages 7 and 11:

The new generation of safe and effective weight loss drugs seems to have helped boost the US profile of such medications and has fueled interest in nearly half the US adult population. A recent survey of more than 1000 US adults showed that 18% were "somewhat interested" in taking a "safe, effective" weight loss drug, 27% were "very interested," and 4% said they were already using such an agent, together constituting 49% of the surveyed adults. The newer, more potent and generally safe agents that work by stimulating receptors to nutrient-stimulated hormones, such as incretins like glucagon-like peptide-1 (GLP-1), seem to drive this interest. When asked, "How much have you heard, if anything, about a new class of drugs being used for weight loss, such as Ozempic, [semaglutide formulated and approved for people with type 2 diabetes], Wegovy, [semaglutide for weight loss], and Mounjaro, [tirzepatide, currently only approved for treating people with type 2 diabetes]?" 43% said they had heard some, or a lot, about these agents. This was particularly true among people at least 65 years old, who had a 55% prevalence of knowing some, or a lot, about these new weight-loss agents, while an additional 26% had heard at least "a little" about them, reported staff members of KFF (formerly the Kaiser Family Foundation) in a report posted online in early August. Weight-Loss Drugs Garner 'Increasing' Attention "A new class of prescription drugs, initially developed to treat type 2 diabetes, have been garnering an increasing amount of attention due to their ability to act as highly effective weight-loss drugs for overweight or obese adults," write the report’s authors. However, surveyed interest fell markedly when respondents answered further questions that hinged on certain limitations of the newer weight-loss formulations.

High frequency of discrimination and microaggressions in health care settings were reported by Black patients with serious illness. HealthDay News — Epistemic injustice is the most common manifestation of racism experienced by Black patients with serious illness and is associated with worsened mistrust and negative patient-clinician communication outcomes, according to a study published online July 5 in JAMA Network Open. Crystal E. Brown, M.D., from the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, and colleagues examined whether experiences with racism are associated with patient-clinician communication and decision-making among Black patients with serious illness. The analysis included data from semistructured interviews conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center between January 2021 and February 2023. Researchers found that the participants had substantial socioeconomic disadvantage and reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. The most common manifestation of racism participants reported was epistemic injustice, including silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. These experiences made participants feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences exacerbated existing medical mistrust and poor patient-clinician communication. “These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life,” the authors write. Full Article

Children exposed to physical assault were twice as likely to be diagnosed with mental illness in the years following the assault than those who weren't exposed, a new population-based study shows. The greatest risk was found in the first year following the assault, increasing to three times the risk of being diagnosed with mental illness compared with children not assaulted. Mood and anxiety disorders were the most common diagnoses. "From a clinical and policy perspective, our study highlights that there is a critical opportunity for healthcare clinicians to support children in the first year following physical assault," report Natasha Saunders, MD, MSc, of the Hospital for Sick Children in Toronto, Canada, and colleagues. "There is a need to develop and implement targeted mental illness prevention, screening, and treatment programs for assaulted children." The findings were published online August 16 in JAMA Network Open. While it has been well-established that children exposed to assault have an increased risk for subsequent mental illness, Saunders and her co-investigators noted that using an age-matched, population-based cohort study would enable them to obtain detailed information on the patterns and timing of subsequent psychiatric diagnoses. To that end, the researchers used several medical databases in Ontario to find 5487 children (infants to age 13 years) who required an emergency room visit or hospitalization for a physical assault in Ontario between 2006 and 2014. These children were matched on a 1:4 basis with 21,948 children not exposed to physical assault. The children were followed until their 18th birthday or until the study ended in March 2019. The researchers found that more than a third of the children (39%) who were exposed to assault received a mental health diagnosis, according to health records, compared with 23% of unexposed children. Mood and anxiety disorders were the most common diagnoses among children exposed to assault (16.2% vs 10.6%, respectively); followed by select childhood behavior disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder (9.9% vs 5.2%); and substance use disorders (2.4% vs 0.4%). Triple Risk of Mental Illness in First Year The researchers found that the children exposed to assault were nearly twice as likely to be diagnosed with a mental illness over a median follow-up of 7 years compared with those not exposed to assault (adjusted hazard ratio [aHR], 1.96; 95% CI, 1.85 - 2.08). In the year following the assault, children exposed to assault bore three times the risk of being diagnosed with a mental illness compared with unexposed children (aHR, 3.08; 95% CI, 2.68 - 3.54). In addition, the children who had been assaulted were more likely to be diagnosed in an acute care setting than those who were not assaulted (14% vs 2.8%). The children who had been assaulted were an average age of 7 years and were more often boys (55% vs 45%). Children who were assaulted were also more likely to have mothers with mental illness (35% vs 19%). The investigators noted that the study likely underestimated the number of children exposed to assault, as many do not end up in the ER. In addition to highlighting the need for medical personnel to support children in the first year following assault, the investigators noted that "our results also advocate for accessible mental health care outside of the acute setting and for care that addresses the social and health needs of mothers, who themselves have high social and health risks." This study received funding from the National Foundation to End Child Abuse and Neglect and the Ontario Ministry of Health and the Ministry of Long-Term Care. Saunders reported receiving personal fees from The BMJ Group, Archives of Diseases in Childhood outside the submitted work. Full Article

Superagers Even at an advanced age, superagers have the memory of someone 20 or 30 years their junior. But why is that? A new study shows that in superagers, age-related atrophy of the gray matter, especially in the areas responsible for memory, develops much more slowly than in normal older adults. However, the study also emphasizes the importance of physical and mental fitness for a healthy aging process. "One of the most important unanswered questions with regard to superagers is, 'Are they resistant to age-related memory loss, or do they have coping mechanisms that allow them to better offset this memory loss?' " wrote Marta Garo-Pascual, a PhD candidate at the Autonomous University of Madrid, Spain, and colleagues in the Lancet Healthy Longevity. "Our results indicate that superagers are resistant to these processes." Six Years' Monitoring From a cohort of older adults who had participated in a study aiming to identify early indicators of Alzheimer’s disease, the research group chose 64 superagers and 55 normal senior citizens. The latter served as the control group. While the superagers performed just as well in a memory test as people 30 years their junior, the control group’s performance was in line with their age and level of education. All the study participants were over age 79 years. Both the group of superagers and the control group included more females than males. On average, they were monitored for 6 years. During this period, a checkup was scheduled annually with an MRI examination, clinical tests, blood tests, and documentation of lifestyle factors. For Alessandro Cellerino, PhD, of the Leibniz Institute on Aging–Fritz Lipmann Institute in Jena, Germany, this is the most crucial aspect of the study. "Even before this study, we knew that superagers demonstrated less atrophy in certain areas of the brain, but this was always only ever based on a single measurement." Memory Centers Protected The MRI examinations confirmed that in superagers, gray matter atrophy in the regions responsible for memory (such as the medial temporal lobe and cholinergic forebrain), as well in regions important for movement (such as the motor thalamus), was less pronounced. In addition, the volume of gray matter in these regions, especially in the medial temporal lobe, decreased much more slowly in the superagers than in the control subjects over the study period. Garo-Pascual and her team used a machine-learning algorithm to differentiate between superagers and normal older adults. From the 89 demographic, lifestyle, and clinical factors entered into the algorithm, two were the most important for the classification: the ability to move and mental health. Mobility and Mental Health Clinical tests such as the Timed Up-and-Go Test and the Finger Tapping Test revealed that superagers can be distinguished from the normally aging control subjects with regard to their mobility and fine motor skills. Their physical condition was better, although they, by their own admission, did not move any more than the control subjects in day-to-day life. According to Cellerino, this finding confirms that physical activity is paramount for cognitive function. "These people were over 80 years old — the fact that there was not much difference between their levels of activity is not surprising. Much more relevant is the question of how you get there — i.e., how active you are at the ages of 40, 50 or even 60 years old," he stressed. Remaining Active Is Important As a matter of fact, the superagers indicated that generally they had been more active than the control subjects during their middle years. "Attempting to stay physically fit is essential; even if it just means going for a walk or taking the stairs," said Cellerino. On average, the superagers also fared much better in tests on physical health than the control subjects. They suffered significantly less from depression or anxiety disorders. "Earlier studies suggest that depression and anxiety disorders may influence performance in memory tests across all ages and that they are risk factors for developing dementia," said Cellerino. To avoid mental health issues in later life, gerontologist Cellerino recommended remaining socially engaged and involved. "Depression and anxiety are commonly also a consequence of social isolation," he underlined. Potential Genetic Differences Blood sample analyses demonstrated that the superagers exhibited lower concentrations of biomarkers for neurodegenerative diseases than the control group did. In contrast, there was no difference between the two groups in the prevalence of the APOE e4 allele, one of the most important genetic risk factors for Alzheimer’s disease. Nevertheless, Garo-Pascual and her team of researchers assume that genetics also play a role. They found that, despite 89 variables employed, the algorithm used could only distinguish superagers from normal older adults 66% of the time. This suggests that additional factors must be in play, such as genetic differences. Body and Mind Since this is an observational study, whether the determined factors have a direct effect on super-aging cannot be ascertained, the authors wrote. However, the results are consistent with earlier findings. "Regarding the management of old age, we actually haven’t learned anything more than what we already knew. But it does confirm that physical and mental function are closely entwined and that we must maintain both to age healthily," Cellerino concluded.

Improvement was seen in measures of sleepiness and cataplexy over 8 weeks vs placebo, but the drug was associated with hepatotoxic effects. HealthDay News — For patients with narcolepsy type 1, an orexin receptor 2 agonist, TAK-994, improves measures of sleepiness and cataplexy over 8 weeks compared with placebo but is associated with hepatotoxic adverse events, according to a study published in the July 27 issue of the New England Journal of Medicine. Yves Dauvilliers, M.D., from Gui de Chauliac Hospital and the University of Montpellier in France, and colleagues conducted a phase 2 randomized, placebo-controlled trial of TAK-994 in patients with narcolepsy type 1. Seventy-three patients were randomly assigned to receive twice-daily oral TAK-994 (30 mg [17 patients], 90 mg [20 patients], and 180 mg [19 patients]) or placebo (17 patients). Owing to hepatotoxic adverse events, the phase 2 trial and extension trial were terminated early. Primary end point data were available for 41 patients. Researchers found that the least-squares mean changes to week 8 in average sleep latency on the Maintenance of Wakefulness Test were 23.9, 27.4, 32.6, and −2.5 minutes in the 30-, 90-, and 180-mg groups and placebo group, respectively. The corresponding least-squares mean changes to week 8 in the Epworth Sleepiness Scale were −12.2, −13.5, −15.1, and −2.1, respectively. The corresponding weekly incidences of cataplexy at week 8 were 0.27, 1.14, 0.88, and 5.83 (rate ratios vs placebo, 0.05, 0.20, and 0.015, respectively). “The outcomes described in the current report may be seen as a backward step because of the decision to terminate the trial,” write the authors of an accompanying editorial. “However, the impressive efficacy is a major step forward in helping patients with narcolepsy type 1.” The study was funded by Takeda Development Center Americas

Psychedelics PARIS — "We need to develop new therapies to treat addiction because of the related cost to society, which is extremely high," said Bruno Roméo, MD, psychiatrist and addiction specialist at the Paul Brousse Hospital in Villejuif, France, at the Paris-based Neuroscience, Psychiatry and Neurology Conference. Roméo spoke about the current place of psychedelics in the treatment of addiction. "Smoking and alcohol consumption are the two main preventable causes of death in France," he said. "Current management strategies for these addictions rarely involve pharmacological therapies, which are not very effective, in any case. We have massive relapse rates, signaling the need to develop other treatments, like psychedelic drugs." But what data are available on the efficacy of psychedelics in treating addiction? Alcohol Use Disorder There are few data concerning the role of psychedelics in the treatment of alcohol use disorder, but one controlled, randomized trial evaluated the efficacy of psilocybin. That trial was published in JAMA Psychiatry in 2022. That study included 95 patients with alcohol use disorder; 49 were treated with psilocybin, and 46 were treated with diphenhydramine. An initial medication session of psilocybin was given in week 4, then another in week 8 at a higher dose. The number of drinking days, the number of heavy drinking days, and the number of drinks consumed between weeks 32 and 36 were assessed. The investigators showed that after two sessions with psilocybin, there was a significant reduction in the number of heavy drinking days. In the control group, between weeks 5 and 36, 20% of days involved heavy drinking, whereas in the psilocybin group, 10% of days involved heavy drinking. There was also a significant and rapid reduction in the number of drinking days, and this was maintained over time. Between weeks 5 and 36, just over 40% of days were reported as drinking days in the control group, vs slightly more than 30% in the psilocybin group. Similarly, the number of glasses per day was drastically reduced after taking psilocybin, and the effect occurred extremely quickly. Consumption went from six drinks to less than one drink between weeks 5 and 8. Overall, between weeks 5 and 36, the number of drinks consumed per day was more than two in the placebo group and more than one in the psilocybin group. "Psilocybin was seen as having potential efficacy in treating alcohol use disorder. But we must tread carefully with these results; the profile of the patients enrolled in this study is different to that of the patients we regularly see in our addiction clinics. The patients enrolled in the study reported less than 60% of days as heavy drinking days," said Romeo. Candidates for Psilocybin According to a retrospective survey of 160 respondents that was conducted online at the Paul Brousse Hospital, patients with the most severe cases of alcohol use disorder who have the most mystical psychedelic experiences seem to respond best to psilocybin and to reduce their alcohol use. It also appears that patients whose alcohol use decreased the most had lower psychological flexibility on enrollment in the study. (Psychological flexibility is the ability to adapt to change and to cope with positive and negative experiences in real time without being fazed or trying to flee from the situation.) "It's as if they had a broader capacity for change, and psychedelics helped them more," said Roméo. Smoking Cessation "There are even fewer studies for smoking," said Roméo. In a pilot study with 15 patients, the researchers gave two or three doses of psilocybin at 20 mg to 30 mg in combination with cognitive-behavioral therapy one session per week for 10 weeks. Thereafter, patients were assessed three times: after 6 months, 12 months, and 30 months. The results showed a significant reduction in smoking. Patients went from smoking more than 15 cigarettes per day to smoking one to two cigarettes per day before going back up to six cigarettes daily. Regarding abstinence rates, 12 of 15 patients had stopped smoking after 6 months, eight of 15 after 1 year, and seven of 15 after 30 months. "This study produced some interesting results, although caution must obviously be taken due to the very low number of patients enrolled," said Roméo. As is the case for alcohol, a retrospective survey conducted via questionnaire at the Paul Brousse Hospital showed that the patients who smoked the most and who had the most mystical psychedelic experiences seemed to respond best to psilocybin and therefore to reduce their tobacco use. It also seemed to be the case that patients who reduced tobacco use the most had lower psychological flexibility on enrollment in the study. Constraints on Psychedelics "Psychedelics are somewhat effective in treating addiction, but there are various limitations to their use," said Roméo. One of those limitations is societal. Laurence Bézo, MD, of the addiction services clinic at Paul Brousse Hospital, asked doctors to respond to a questionnaire to determine what they thought about psychedelics. To date, 407 have responded, including 280 general practitioners, 50 addiction specialists, and 50 specialist physicians. Overall, 50% think that psychedelics have no therapeutic potential. Three of five doctors also said that psychedelics are dangerous. Just over half thought that their use is associated with a severe risk of aggression aimed at oneself and toward others. Likewise, half think that the risk of dependency is very high and that there is a risk of co-occurring psychiatric disorders. "From the pool of physicians queried, the consensus is that psychedelics are pretty dangerous. People also seem to frown upon prescribing psychedelics in France," said Roméo. Participants went as far as to classify psychedelics as some of the most dangerous drugs out there. Using a 7-point scale, they classified psychedelics below heroin and cocaine in terms of dangerousness. They are deemed much more harmful than alcohol, tobacco, and cannabis. "A survey of the public carried out several years ago by leading French market research group IFOP had the exact same findings. Nevertheless, a number of studies have set out to determine how dangerous psychedelics are, and their findings point to this class of drugs as being among the least harmful for the individual patient and those around them. On the contrary, alcohol, heroin, crack cocaine (or even cocaine),methamphetamine, and tobacco were shown to be the most harmful. Additionally, psychedelics have a very low risk of dependency and the lowest risk of lethality. There is complete dissonance between what recent studies show us and what society, and some doctors, think," said Roméo. Besides these assumptions, another constraint to the use of psychedelics relates to methods adopted in related clinical studies. "Due to the effect psychedelics have, in the trials conducted, nine participants and nine doctors out of 10 are aware of what they have taken or given, respectively. This is a very important limitation. Nowadays, researchers don't know how to conduct accurate double-blind studies," said Roméo. In sum, for psychiatrists, psychedelics are promising in addiction therapy, but healthcare professionals, public authorities, and society as a whole must be better informed about their use, and received ideas must be dispelled. "The findings need to be replicated, but overall, psychedelics are really quite promising in treating both alcohol and tobacco use disorder. They are generally well-tolerated with few serious side effects. There is no deterioration in patients with psychiatric conditions while they are taking psychedelics. And if persistent symptoms of psychosis do occur, which is extremely rare, it's probably because there are preexisting underlying issues at play. We also don't see increased blood pressure or any other serious physical anomalies. In a supervised setting, as is the case with studies involving psychotherapeutic support, we can no longer say, in this day and age, that psychedelics are harmful," said Roméo. Roméo reported no conflicts of interest regarding the content of this article.

Researchers found that a 1200-IU dose of vitamin D3 supplementation is tied to a decreased risk for psychiatric symptoms at ages 6 to 8 years vs 400-IU dosing. HealthDay News — Higher doses of vitamin D3 supplementation up to age 2 years are associated with a decreased risk for internalizing problems in later childhood, according to a study published online May 19 in JAMA Network Open. Samuel Sandboge, M.D., Ph.D., from the University of Tampere in Finland, and colleagues conducted a secondary analysis of a randomized clinical trial of 346 children to assess the impact of high-dose (1,200 IU) versus standard-dose (400 IU) vitamin D3 supplementation during the first two years of life on psychiatric symptoms at ages 6 to 8 years. The researchers found that clinically significant internalizing problems occurred in 5.6 percent of participants in the 1,200-IU group versus 11.8 percent in the 400-IU group (odds ratio, 0.40), when adjusting for sex, birth season, maternal depressive symptoms at birth, and parental single status at follow-up. Among 48 children in the 400-IU group with maternal 25(OH)D concentrations <30 ng/mL, higher internalizing problems scores were seen compared with children in the 1,200-IU group, including 44 children with maternal 25(OH)D concentrations <30 ng/mL (adjusted mean difference, 0.49) and 91 children with maternal concentrations >30 ng/mL (adjusted mean difference, 0.37). No differences were seen between the groups for externalizing or total problems. “This should be interpreted cautiously, however, and be considered only as hypothesis generating given the absence of interactions between maternal 25(OH)D level and supplementation status,” the authors write. One author reported receiving grants from the Novo Nordisk Foundation.

Nearly 42.6% of children were prenatally exposed to antiseizure medication. HealthDay News — Prenatal exposure to the antiepileptic medication valproate is associated with an increased risk for later psychiatric disorders among children of mothers with epilepsy, according to a study published online April 17 in JAMA Neurology. Julie Werenberg Dreier, Ph.D., from Aarhus University in Denmark, and colleagues examined the association between prenatal exposure to antiseizure medication (ASM) with a spectrum of psychiatric disorders in childhood and adolescence among children of mothers with epilepsy. The analysis included 38,661 children of mothers with epilepsy born in Denmark, Finland, Iceland, Norway, and Sweden between 1996 and 2017. The researchers found that 42.6 percent of children were prenatally exposed to ASM. Prenatal valproate exposure was associated with an increased risk for the combined psychiatric end point (adjusted hazard ratio [aHR], 1.80; cumulative risk at 18 years in ASM-exposed children, 42.1 versus 31.3 percent in unexposed children), which was driven mainly by disorders within the neurodevelopmental spectrum. There was no increased risk for psychiatric disorders seen with prenatal exposure to lamotrigine, carbamazepine, or oxcarbazepine, while there were associations for prenatal exposure to topiramate with attention-deficit/hyperactivity disorder (aHR, 2.38) and exposure to levetiracetam with anxiety (aHR, 2.17) and attention-deficit/hyperactivity disorder (aHR, 1.78). “This study provides reassuring evidence that lamotrigine, carbamazepine, and oxcarbazepine are not associated with long-term behavioral or developmental disorders but cannot rule out risks with higher doses,” the authors write. Several authors disclosed ties to the pharmaceutical industry.