The Department of Child and Adolescent Psychiatry has continued expansion of psychiatric services into the community. We have expanded the continuum of care to include school-based clinical services, and currently operate in nine community elementary schools. We have partnered with the Junior League of Cincinnati to organize an advocacy group for mental health issues called MindPeace, and through this collaboration have developed a model for school-based mental health services that is being adopted by regional schools. Our school-based mental health teams, working in conjunction with school personnel, identify children who have developed or are at risk for mental health difficulties. The community-based team approach is used to address the mental health and academic needs of the child and family.
Recent expansion of community services has included improving psychiatric support for youth in the Juvenile Justice System. Drew Barzman, MD. and Chris Hacker, RN, CNS, are working with the Hamilton County Juvenile Court and Youth Center. In Fiscal Year 2005, they have provided over 1200 hours of clinical services. Admissions to the Youth Center indicate that greater than 50% of admissions have co-morbid psychiatric disorders with high rates of mood, attention, and trauma-related problems. Formerly, their care was unable to be followed in the Youth Center, psychiatric assessments and ongoing care, are now provided. Clinical initiatives have included a structured identification of the predictors of aggression in psychiatric settings. This program involving both physicians and nursing staff has been undertaken to better identify predictors of aggressive tendencies on inpatient units and develop a systematic way of evaluating aggressive episodes and their management. Through this structured approach, we have improved clinical care with decreasing the number of episodes that put staff and patients at risk.
The Division of Psychiatry has been involved in clinical research in pediatric mood disorders. Under Dr. Sanjeev Pathak's leadership at Cincinnati Children's, the division participated in the first comparative trial of an antidepressant (fluoxetine), cognitive behavior therapy and their combination in pediatric major depressive disorder (MDD). This landmark study entitled "Treatment for Adolescents with Depression Study (TADS)" (TADS team, 2004, JAMA 292: 807-820. 2004) convincingly demonstrated that combination treatment with Cognitive Behavioral Psychotherapy (CBT) and Fluoxetine has the best benefit and risk ratio, for adolescents with MDD. TADS provides a very important therapeutic advance in the field by providing answers that will guide clinicians in treating this serious disorder.
Additional research in the Division focuses on impulsive aggression. The Aggression Assessment Project aims to improve safety on inpatient psychiatric units by being able to identify children and adolescents at high risk for impulsive aggression while in mental health care. This will provide early identification for appropriate disorder-specific intervention.
There is continued work in the Division in the area of Tourette’s Syndrome and Obsessive Compulsive Disorder. Current work includes exploration of the association between the premonitory urge and tic type and the neurophysiologic correlates of the premonitory urge associated with motor and vocal tics.
There is ongoing work with the University of Cincinnati College of Medicine. Work at Children’s includes the study of Mood Disorder in children and adolescents including neuroimaging, pharmacologic investigations, treatment outcomes, and identification of neurobiologic predictors of mood disorder onset in adolescents at risk for developing bipolar disorder.
The division is also involved in a muti-site study entitled "Substance Abuse Outcome Following Treatment for Adolescent Depression (SOFTAD)" (Cincinnati Principal Investigator- Sanjeev Pathak, MD.). The major goal of this project is to evaluate the effectiveness of treatments for MDD in preventing subsequent disorders, including substance use disorders, recurrent MDD, anxiety and behavior disorders
Another study is looking at genetic markers of response to fluoxetine in pediatric depression (Pharmacogenetics of fluoxetine in depression study; funding- Translational Research Initiative, Principal Investigator- Sanjeev Pathak, MD.). Clinical research in pediatric depression suggests that no clinical or demographic variable strongly predicts fluoxetine response. Pharmacogenetics (using a candidate gene strategy) holds the promise of providing genetic markers to predict response and develop individualized treatment paradigms.
