Anxiety in Youth

Anxiety in Youth

This section of Focus on Childhood and Adolescent Mental Health includes 3 articles on anxiety disorders in youth and 1 article that examines weight in adolescents with severe mental illness.

The use of technology has become a commonplace occurrence for children and adolescents, and incorporation of technology into treatment may have appeal for youth. St-Jacques and colleagues conducted a study to determine whether virtual reality would be effective in motivating children with a spider phobia toward psychotherapy treatment. The virtual reality environment used an adaption of a 3-D game that consisted of 2 apartment living areas in which spiders were inserted. Thirty-one arachnophobic youths were randomly assigned to either this virtual reality treatment plus an in vivo exposure (which started with pictures of spiders and gradually increased up to a live tarantula) or in vivo exposure alone. Surprisingly, the use of virtual reality did not increase motivation toward psychotherapy. Both groups of youths were similar in their ability to face a live tarantula at the end of treatment.

Strawn and colleagues conducted a review of the literature on the psychopharmacologic treatment of posttraumatic stress disorder (PTSD). This search revealed a small number of double-blind placebo-controlled trials for children and adolescents with PTSD or acute stress disorder; there were 3 trials of selective serotonin reuptake inhibitors (SSRIs) and 1 trial of imipramine. Other medications have not been studied in a controlled fashion. The authors conclude that controlled trials have not demonstrated the efficacy of SSRIs as first-line treatment of youths with PTSD. Although there may be other efficacious agents, these remain to be examined in a randomized controlled trial in children and adolescents with PTSD.

With the upcoming revision of the DSM-IV, Hale and colleagues provide a timely examination of the symptom of worry as it relates to generalized anxiety disorder (GAD) and the personality trait of neuroticism in adolescents. The investigators administered self-rated measures of GAD and neurotic symptoms to 1,313 Dutch secondary school students over a 5-year period. GAD symptoms of worry and neuroticism were found to be 2 separate constructs. The authors conclude that the GAD symptom of worry is more analogous to a personality trait than an anxiety state in adolescents.

Gracious and colleagues examine the important health concern of the prevalence and risk of overweight and obesity in adolescents with serious mental disorders. Using a cross-sectional chart review, they examined data from 114 adolescents in a partial hospitalization program. The prevalence for obesity in these adolescents was 30%, defined as a body mass index (BMI) ≥ 95th percentile for age and sex. The prevalence for overweight was 25%, defined as a BMI between the 85th to < 95th percentile for sex and age. The prevalence of overweight and obese youths with severe mental illness was significantly higher than the rate for national peer groups. Risk factors for overweight and obesity were smoking, antidepressant and antipsychotic treatment, and lack of private insurance. The authors recommend that interventions to prevent weight gain begin at the onset of mental health treatment.

Karen Dineen Wagner, MD, PhD

kwagner@psychiatrist.com

doi:10.4088/JCP.10f06238pin

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