New research from King’s College London has highlighted the important role that emotions play in the onset and persistence of psychosis.
The research, published inEarly Intervention in Psychiatry, advocates for the development of emotion-focused interventions that seek to prevent a person’s relapse in their health as well as maintain their recovery.
Psychosis is a symptom of mental illness typified by hallucinations, delusional thoughts and disorganised thinking. While previous research has implicated emotion in the onset and continuation of psychosis, there has not yet been a universally acknowledged theory to account for the influence that emotions can have on it.
Researchers in this study conducted a systematic review of 78 studies comparing the experiences of healthy controls with individuals at Clinical High Risk (CHR), a diagnosis of schizophrenia (SZ), and those experiencing their First Episode of Psychosis (FEP). Researchers wanted to better understand both the role of emotions, as well as emotional coping strategies, in their experiences.
This systematic review found that SZ and CHR individuals demonstrated significant impairments in their emotional awareness, their understanding of self and others, and their ability to regulate their emotions when compared to healthy controls. They also demonstrated a heightened emotional reactivity.
The researchers, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s, found that individuals with schizophrenia reported high levels of “Negative Affect” – a reduction or absence of normal emotional expression – which was a strong predictor of paranoia.
“Experiencing emotions is a natural part of everyday life. However, our study highlights that people with psychosis experience emotions with more intensity, which can significantly contribute to the emergence and maintenance of their psychosis symptoms. Therefore, psychological interventions that explicitly target emotions and emotional coping in psychosis could help prevent relapse and maintain recovery.”
Dr Anna Georgiades, a Lecturer in Early Intervention in Psychosis at King’s IoPPN and the study’s senior author
The researchers also wanted to explore how individuals at CHR and those with schizophrenia employed coping mechanisms to manage emotional situations. They found that, while the healthy controls were more likely to adopt “Adaptive Coping Strategies”, in which individuals seek to manage stress and difficult situations in healthy and constructive ways, people with psychosis were more likely to employ maladaptive techniques that were associated with an increase in their symptoms and increased depression.
Dr Anna Georgiades, a Lecturer in Early Intervention in Psychosis at King’s IoPPN and the study’s senior author said, “There are two ways in which a person might manage an emotionally stressful situation; either by removing the stressor, or by seeking to manage the stress that is being caused.
“From the studies we reviewed, we consistently found that people with psychosis used more unhelpful emotional coping such as avoidance and suppression rather than helpful emotional coping such as problem solving or changing the way they think about the situation.
“By reducing unhelpful emotional coping and by increasing more helpful emotional coping (ie, by increasing active problem solving and the skill in changing one’s view of a situation), we could prevent relapse and maintain recovery. This therefore has important implications for the psychological treatment of psychosis.”
Despite concerns about increased stimulant prescribing, nonmedical use of ADHD drugs among adolescents has declined in the last 20 years, a University of Michigan study shows.While medical use of prescription stimulants for ADHD among adolescents increased slightly between 2005 and 2023, nonmedical use declined more.
“Lifetime medical use was 2% lower in 2005 when compared to nonmedical use, and is now 2% higher,” said study co-author Philip Veliz, U-M research associate professor at the U-M School of Nursing and Center for the Study of Drugs, Alcohol, Smoking, and Health.
This reversal is important and “is what all parents want to see,” he said.
Recently, prescription stimulant dispensing has increased in the United States, especially among adults. While nonmedical prescription stimulant use has decreased among teens, no national studies have examined medical and nonmedical use patterns among US adolescents. One concern is that nonmedical use could have increased along with medical use.
To answer that question, Veliz and colleagues analysed data from 2005 to 2023 from 19 cohorts of 8th, 10th and 12th grade students in the Monitoring the Future Study, an annual survey at U-M that tracks student substance use and other related trends.
The current study, supported by the National Institute on Drug Abuse and the US Food and Drug Administration and published in JAMA, found that lifetime use of nonmedical stimulants in 2005 was at 10% and dropped to 6% in 2023. Lifetime medical use was roughly 8% in both 2005 and 2023.
“In other words, while the lifetime prevalence of medical use was relatively stable, with a modest increase in current use, we still saw a decrease in both lifetime and current nonmedical use,” Veliz said. “Accordingly, these fears of an uptick in misusing these prescriptions may be slightly overstated given the current trends shown in this study.”
The decline in nonmedical use of prescription stimulants among adolescents follows similar declines in other types of nonmedical prescription drugs use, such as opioids and benzodiazepines.
“This more than likely is linked to public health messaging, prescribing practices and stimulant shortages as it relates to these types of drugs,” Veliz said.
He said the findings were not surprising given how substance use has been declining among more recent cohorts of adolescents, and that they will help clinicians and policymakers to consider population-level trends in medical and nonmedical use patterns when weighing the risks and benefits of prescription stimulants.
For over two decades, finasteride – a prescription drug taken by millions of men to treat hair loss – has carried troubling signals of deeper harm: depression, anxiety, and in some cases, suicide.
A new review by Prof Mayer Brezis of the Hebrew University of Jerusalem argues that the medical and regulatory community failed the public by repeatedly overlooking evidence of finasteride’s potentially psychiatric effects.
The review, published in The Journal of Clinical Psychiatry, compiles data from eight major studies conducted between 2017 and 2023, showing a consistent pattern: users of finasteride were significantly more likely to experience mood disorders and suicidal thoughts than those not taking the drug. Findings come from multiple countries and data systems, including the US FDA, as well as national health records in Sweden, Canada, and Israel.
“The evidence is no longer anecdotal,” said Prof. Brezis, professor emeritus of medicine and public health. “We now see consistent patterns across diverse populations. And the consequences may have been tragic.”
According to the paper, hundreds of thousands of people may have suffered from depression related to finasteride, and hundreds – possibly more – may have died by suicide.
A Delayed Response, With a High Cost
While the FDA acknowledged depression as a potential side effect in 2011 and added suicidality in 2022, concerns had already been raised as early as 2002. Internal FDA documents from 2010, cited in Prof Brezis’ paper, reveal large portions blacked out as “confidential” – including estimates of how many users could have been affected.
By 2011, the FDA had recorded just 18 suicides linked to finasteride. Based on global usage, he argues, the number should have been ranged in the thousands. “It wasn’t just underreporting,” he wrote. “It was a systemic failure of pharmacovigilance.”
Unlike weight-loss or psychiatric medications, which receive intense post-marketing scrutiny, finasteride’s “cosmetic” status may have shielded it from investigation. Notably, none of the studies cited in Brezis’ review were initiated by Merck, the original manufacturer, or requested by regulators.
A Cosmetic Drug With Life-Altering Risks
Finasteride works by blocking the conversion of testosterone into dihydrotestosterone (DHT). In the process, it may also disrupt neurosteroids like allopregnanolone, which are linked to mood regulation in the brain. Animal studies show long-term effects on neuroinflammation and even structural changes in the hippocampus.
For some patients, the harm does not end when the drug is stopped. Reports of “post-finasteride syndrome” describe lingering symptoms – insomnia, panic attacks, cognitive dysfunction, and suicidal thoughts – that persist months or years after discontinuation.
Regulatory Gaps and Corporate Silence
The report is particularly critical of the FDA and Merck. Despite having access to millions of patient records, neither acted in time. Brezis suggests that industry silence was strategic, motivated by market pressures and legal liability -echoing past controversies like Merck’s handling of Vioxx.
“Nothing is more important to Organon than the safety of our medicines,” the company recently stated. Yet none of the safety studies cited were initiated by the manufacturer.
The FDA, meanwhile, took five years to respond to a citizen petition calling for a black-box warning. Its final decision was to add suicidal ideation to the label – but not as a formal warning.
What Now?
Brezis is calling for immediate changes in how drugs like finasteride are approved, monitored, and prescribed. His recommendations include:
Suspending marketing of the drug for cosmetic purposes until safety is re-established.
Rquiring mandatory post-approval studies with strict enforcement.
Systematically recording drug histories in suicide investigations.
For many patients, those reforms will come too late.
The paper, “Failing Public Health Again? Analytical Review of Depression and Suicidality from Finasteride” was published in The Journal of Clinical Psychiatry and is available here.
Pretoria, 28 September 2025 – The South African Health Products Regulatory Authority (SAHPRA) wishes to reassure the public that paracetamol remains a safe and recommended option for the relief of pain and fever during pregnancy, when used short-term at recommended doses.
Paracetamol is one of the most widely used medicines globally and has been extensively studied for decades. There is currently no scientific evidence that using paracetamol in pregnancy causes attention-deficit hyperactivity disorder (ADHD) and autism.
SAHPRA will continue to monitor emerging evidence on the safety of paracetamol.
Advice for healthcare professionals
Paracetamol remains a recommended safe treatment for pain or fever in pregnant women. Pregnant women should be reassured that there is no evidence that taking paracetamol during pregnancy causes autism or ADHD in children. Healthcare professionals are encouraged to provide counselling to patients about the side effects of paracetamol, as detailed in the product’s professional information and patient information leaflet (https://pi-pil-repository.sahpra.org.za/).
Advice for healthcare professionals to provide to patients
Pregnant women and those planning a pregnancy should be advised to use paracetamol only when needed and at the lowest effective dose for the shortest possible time. Untreated fever and pain may pose risks to the unborn baby, and it is therefore important to seek treatment if recommended by a healthcare professional. Pregnant women should consult a healthcare professional if pain or fever persists or if they have any concerns about medicine use during pregnancy. Pregnant women should also be advised to avoid combining paracetamol with other medicines without first seeking medical advice.
Report any suspected adverse drug reactions
Healthcare professionals and members of the public are urged to report any suspected adverse drug reactions (ADRs) related to the use of paracetamol and other health products to SAHPRA via the eReporting link available on the SAHPRA website (www.sahpra.org.za) or complete an ADR reporting form accessible via the SAHPRA website and email it to adr@sahpa.org.za. Alternatively, reporting can be done via the Med Safety App, downloadable through Google Play or the Apple App Store.
SAHPRA remains committed to ensuring the safety of medicines available in South Africa and will update the public if new scientific evidence changes current recommendations.
Chest pain ranks as the second most common reason for emergency department (ED) visits, making it a key concern for patients and doctors. However, 80% of these cases are considered low-risk and not related to heart disease, and for these patients, anxiety and panic disorders are frequent diagnoses.
A new study led by the Indiana University School of Medicine and Regenstrief Institute shows that many patients who visit the emergency department (ED) with low-risk chest pain might benefit more from treatment for underlying psychological conditions than from extensive cardiac testing. The study appears in Academic Emergency Medicine.
Anxiety is not only common among low-risk chest pain patients, but is often accompanied by other treatable comorbidities, including depression, somatisation – the experience of psychological distress through physical symptoms – and post-traumatic stress disorder. By identifying and addressing these conditions, more targeted follow-up strategies can be developed to reduce repeat ED visits and unnecessary evaluations, improving patient outcomes and allowing health systems to focus resources where they matter most.
“Anxiety is a common fellow traveller with low-risk chest pain,” said corresponding author, IU School of Medicine and Regenstrief Research Scientist Kurt Kroenke, MD. “It is a frequent issue in the emergency department. While many patients worry about their heart, in many cases the chest pain is not cardiac, which raises the important question of whether there is something else that can be treated.”
The research, part of the Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) trial, showed that more than 42% of patients had severe anxiety, defined by a score of 15 or higher on the Generalized Anxiety Disorder (GAD-7) scale, a standardised tool developed by Dr Kroenke to assess the severity of anxiety symptoms. In addition, three-quarters of ED patients screened positive for panic disorder.
Evidence-based treatments for anxiety and comorbidities
Researchers identified two effective approaches to reduce anxiety in patients with low-risk chest pain: Cognitive Behavioural Therapy (CBT) and prescription medications. These treatments can be used on their own or combined to create a more comprehensive care plan, helping to better manage symptoms and prevent unnecessary return visits to the ED.
Psychotropic medications such as antidepressants and anti-anxiety medicines remain important tools for managing anxiety disorders. When used appropriately, these medications can lessen both the intensity and frequency of symptoms and are often most effective when paired with psychological therapy.
“There are classes of medicines that are effective for anxiety, particularly when it’s chronic,” said Dr Kroenke. “It’s no different than taking a medicine for high blood pressure – if someone has high blood pressure, we have medicines that lower it. Similarly, if someone has high anxiety, we have medicines that can effectively reduce it.”
The other effective approach is CBT, which helps individuals recognize and reframe thought patterns, manage panic symptoms and reduce fear associated with chest discomfort. Research shows that even brief courses of this behavioral therapy can significantly improve anxiety and quality of life. The PACER trial is comparing standard therapist-administered CBT to peer-supported internet-based CBT in patients with LRCP and anxiety.
“Emergency physicians often reassure patients that their chest pain isn’t caused by the heart, but reassurance alone is not enough. Connecting patients with proven therapies like cognitive-behavioural therapy and medications can change the trajectory of their care and improve long-term outcomes,” said IU School of Medicine and Regenstrief Researcher Paul Musey, MD, MS.
Depression and psychosis are more common in women after childbirth than before, but the risk of suicide attempts decreases. This is shown by two new studies from Karolinska Institutet. The results suggest that national guidelines for screening can help women get help earlier.
Mental ill health in connection with pregnancy and childbirth can have long-term consequences for women’s health. During this period, major biological and psychosocial changes occur that can increase vulnerability to depression, anxiety, and other psychiatric conditions. Despite previous research, knowledge has been limited, especially regarding how different psychiatric diagnoses develop before, during, and after pregnancy.
In a new study, researchers have used data from Swedish registers covering all women who gave birth in Sweden between 2003 and 2019 – a total of nearly 1.8 million pregnancies.
The study, published in the journal Molecular Psychiatry, shows that mental ill health has increased over time during this period, especially before pregnancy. During pregnancy itself, the number of new diagnoses decreases, but after childbirth, the risk increases again, especially for depression and psychosis.
“We can see that the risk of depression is about 20 percent higher during weeks 5 to 15 after childbirth, compared to the year before pregnancy. For psychosis, the risk is up to seven times higher during the first 20 weeks after childbirth,” says the study’s first author Emma Bränn, researcher, Institute of Environmental Medicine, Karolinska Institutet.
When Swedish national guidelines for screening pregnant women for depression were introduced in 2010, it opened up the possibility of detecting mental illness earlier. By comparing women who gave birth before and after 2010, the researchers saw that the peak of depression diagnoses occurred earlier after childbirth in women who gave birth after the guidelines were introduced.
“We don’t see that more people are being diagnosed, but screening could mean that women are identified earlier and don’t have to suffer as long before they can get the support and help they need,” says Emma Bränn.
Lower risk for other psychiatric diagnoses
The study also shows that the risk of other psychiatric diagnoses, such as anxiety, stress-related conditions, and substance abuse, is lower during pregnancy and after childbirth compared to before. The researchers believe that this may be due to biological changes, lifestyle changes, and increased contact with healthcare during pregnancy.
Another study from the same research group has investigated the risk of suicide in connection with pregnancy and childbirth. In the study, published in Nature Human Behaviour, researchers found that mothers were less likely to attempt suicide during and after pregnancy compared to fathers. This is the opposite of what researchers usually observe in the general population, where women tend to have higher rates of suicide attempts than men. For fathers, the risk decreased in the first ten weeks after childbirth, only to increase again.
“Our results suggest that both mothers and fathers are less likely to attempt suicide immediately after having a child, especially mothers,” says first author Yihui Yang, PhD student at the same department. She continues:
“Although suicide attempts during and after pregnancy are rare, they can have devastating consequences and are often preventable. It is therefore important that healthcare providers conduct regular check-ups during and after pregnancy to identify parents who are struggling and offer support to prevent suicide.”
Beyond the sneezing and itchy eyes, high pollen seasons are now linked to a significant increase in suicide risk. A new University of Michigan study found a 7.4% jump in deaths, suggesting the physical discomfort of allergies may trigger a deeper, more dangerous despair, an overlooked factor in suicide prevention.
The study indicates that allergies’ physiological effects, such as poor sleep and mental distress, may contribute to this increased risk.
“A small shock could have a big effect if you’re already in a vulnerable state,” said Joelle Abramowitz, associate research scientist at U-M’s Institute for Social Research. “We looked specifically at pollen from all different kinds of plants, including trees, weeds and grasses.”
The effect is incremental. Researchers divided pollen levels into four tiers and found the suicide risk rose with each group: it increased by 4.5% in the second level, 5.5% in the third and peaked at 7.4% in the fourth and highest category.
The study, funded by the American Foundation for Suicide Prevention and U-M ISR, combines daily pollen data from 186 counties of 34 metropolitan areas across the United States, with suicide data from the National Violent Death Reporting System between 2006 and 2018.
Abramowitz and co-authors Shooshan Danagoulian and Owen Fleming of Wayne State University said that while structural factors for suicide are well-researched, short-term triggers are less understood. Pollen allergies are an ideal subject for this research, considering they are an exogenous shock – meaning they are external and not caused by an individual’s mental health status.
“During our study period, there were nearly 500 000 suicides in the US,” Abramowitz said. “Based on our incremental data, we estimate that pollen may have been a contributing factor in up to 12 000 of those deaths over the period, or roughly 900 to 1200 deaths per year.”
Vulnerable populations
Published in the Journal of Health Economics, the study also found that individuals with a known mental health condition or who had received prior mental health treatment had an 8.6% higher incidence of suicide on days with the highest pollen levels. White men strongly drive the effect, but the study also found an unexpectedly high vulnerability among Black individuals.
“While our study’s data comes from the U.S., our findings likely apply globally,” Abramowitz said. “This is supported by earlier research that found similar relationships in locations like Tokyo and Denmark. Our results, therefore, provide crucial new evidence that this phenomenon is a consistent, worldwide trend.”
Public health and awareness
The focus should be on public health and education, as reducing the number of pollen-producing plants isn’t a viable option, the researchers suggest. This includes more accurate pollen forecasting and better public communication. Providing people with clear, timely information about high-pollen days allows them to take proactive steps. Additional recommendations are limiting outdoor activities, wearing a mask or having antihistamines on hand.
There is also a need for a broader approach to mental health awareness, the authors said. Health care providers, particularly those in primary care, can benefit from understanding the connection between environmental factors, such as pollen, and patient well-being. This knowledge could help them tailor care more effectively, especially for vulnerable patients, and serve as a prompt to discuss mental health and stress management during high-pollen seasons or other periods of environmental stress.
“We should be more conscious of our responsiveness to small environmental changes, such as pollen, and our mental health in general,” Abramowitz said. “Given our findings, I believe medical providers should be aware of a patient’s allergy history, as other research has also established a connection between allergies and a higher risk for suicide. I hope this research can lead to more tailored care and, ultimately, save lives.”
The authors predict that as climate change extends and intensifies the pollen season, the impact of allergies on suicide rates could more than double by the end of the century.
On Monday 22 September, US President Donald Trump made a widely-publicised announcement that paracetamol (acetaminophen/Tylenol) during pregnancy was confirmed as causing autism spectrum disorder (ASD). The claim – backed by a single, rather dodgy study – brings to a head long-standing concerns about the apparent, well-documented increase in ASD rates. QuickNews dives into the controversy to find out if there is any validity to the claims.
President Trump said, “With Tylenol, don’t take it. Don’t take it. And if you can’t live, if your fever is so bad, you have to take one because there’s no alternative to that, sadly,” adding that other medicines such as aspirin were also “proven bad”.
The announcement had been expected for some time and doctors, scientists and medical organisations were quick to respond. The president of the American College of Obstetricians and Gynecologists stated that the paracetamol–ASD claim “is not backed by the full body of scientific evidence and dangerously simplifies the many and complex causes of neurologic challenges in children”.
At the very least, such an announcement will causing pregnant women to second-guess their taking one of the few over-the-counter pain medications widely regarded as safe during pregnancy. In 2017, the X account for Tylenol stated “We actually don’t recommend using any of our products while pregnant.” But a major pharmaceutical manufacturer would want to protect itself from liability as broadly as possible. The politically-charged nature of the announcement has also seen pregnant women making TikTok videos of themselves apparently taking paracetamol (often with no reason to).
It is generally accepted that ASD is caused by a combination of genetics and environmental factors. About 1000 genes are believed to be related to ASD. And there is a very long list of possible risk factors, with an uncertain risk contribution: “Non-genetic factors mediating ASD risk could include parental age, maternal nutritional and metabolic status, infection during pregnancy, prenatal stress, and exposure to certain toxins, heavy metals, or drugs.”
Study validity questioned
To date, paracetamol during pregnancy had generally been linked by a number of poorly powered studies to a wide variety of outcomes: in addition to ASD, asthma, lower performance intelligence quotient (IQ), shorter male infant anogenital distance (predicting poor male reproductive potential), neurodevelopmental problems (gross motor development, communication), attention-deficit/hyperactivity disorder, poorer attention and executive function, and behavioural problems in childhood. A study of nearly 2.5 million children, the largest and most comprehensive do date, found a slight link for paracetamol exposure and autism – which vanished when controlled for sibling exposure (representing shared environment).
Before President Trump’s announcement, news releases on a review making the link were published some weeks before – QuickNews even covered it. The review, published in Environmental Health, selected certain related studies using the ‘Navigation Guide’ methodology – a non-quantitative methodology for the narrow use of inferring health impacts from environmental toxins, but was nevertheless used for pharmaco-epidemiology and teratology. According to Nathan A. Schacthman, legal counsel for scientific matters, the study has serious conflicts of interest: for example, last author Andrea A. Baccarelli is an environmental epidemiologist who has been involved with a lawsuit against manufacturers and sellers of paracetamol. In that lawsuit, his claims were thrown out on the basis of not having sufficient validity, including cherry-picked data and over-generalisation to distinct disorders (such as grouping attention-deficit hyperactivity disorder [ADHD] and other neurodevelopmental disorders). In addition, the study also made misleading claimed about being funded by the National Institutes for Health (NIH). Finally, although this is not mentioned by Schacthman, Robert F. Kennedy Jr. is also an environmental lawyer.
What’s this about a ‘cure’ for autism?
The bombshell announcement by President Trump came with an another bombshell announcement that there was ‘cure’ for autism. The cure is allegedly leucovorin – which sounds very impressive to the non-medical public. But leucovorin is merely folinic acid, which is a vitamer of plain old folic acid – aka vitamin B9. Folinic acid is on the World Health Organization’s essential medicines list. On the same Monday, the US Food and Drug Administration approved it for the treatment of ASD in children – bypassing the normal review process.
Can a simple medication – or rather, supplement – really ‘cure’ ASD, an extremely complex neurological disorder? The NIH funds about $300 million in ASD research annually, nearly double the amount in 2011. If anything, this has echoes of President Trump’s touting of hydroxychloroquine as a now-discredited cure for COVID in the height of the pandemic. It might indeed be beneficial if a patient had a bout of malaria and COVID at the same time, but was rapidly discredited.
The largest controlled study for the use of folinic acid supplementation plus usual care found only a modest ~1 point increase in the Childhood Autism Rating Scale (CARS) compared to usual care plus placebo.
There are also concerns about potential conflicts of interest. One of the manufacturers of folinic acid, iHerb, had the celebrity heart doctor Mehmet Oz as an investor, and is now the administrator for the Centers for Medicare & Medicaid Services (CMS), served until recently. CMS has however denied that Dr Oz will receive any financial reward from this.
But why are autism rates on the rise?
There are a few good explanations about why the rate of autism diagnoses is increasing, which do not depend on the addition of some new environmental variable. The first and most obvious is that there is increased awareness of this, and more referrals for assessment. A second reason is that the guidelines for diagnosis have become a lot less stringent. The definition of autism diagnoses, unlike schizophrenia, has drifted over time, with more “normal” people being likely to be diagnosed. The DSM-III of 1980 had more stringent criteria, for example, an individual needed to exhibit “a pervasive lack of responsiveness to other people” [emphasis added].
Introduced from 1994, the DSM-IV had broader criteria, and folded Asperger disorder into ASD. With the introduction of the DSM-V, new diagnoses were curbed – for a time. This is because about 20% of the children diagnosed with ASD under DSM-IV-TR would not have received one under the DSM-V. The DSM-V relaxed the criteria for language delay, co-occurrence, and IQ, making it easier for borderline cases to qualify for a diagnosis.
Another underappreciated element is that of social contagion. If parents know a family with a child with ASD, they may be more likely to seek a diagnosis. One study from California showed that ASD diagnoses were more likely the more other ASD diagnoses under one kilometre away.
Back to square one
Considering the weakness of the cited studies, the difficulty of explaining ASD, the underlying social phenomenon of shifting diagnostic thresholds and increased awareness, it seems as though these announcements are mostly without substance. In amidst the headline-grabbing news, the NIH quietly announced the launch of a $50 million initiative into the causes of ASD.
According to the news release, the NIH will fund 13 projects “that draw on genomic, epigenomic, metabolomic, proteomic, clinical, behavioral and autism services data. These projects will integrate, aggregate and analyze existing data resources, generate targeted new data and validate findings through independent replication hubs.”
With this in mind, it really doesn’t look like paracetamol is the singular, mysterious controllable risk factor for ASD rates that President Trump and Robert F. Kennedy Jr have made it out to be. Maybe paracetamol use simply reflects infection, or some other related factor.
A Stanford University-led study has found that young children with attention deficit/hyperactivity disorder (ADHD) often receive medication just after being diagnosed, which contravenes treatment guidelines endorsed by the American Academy of Pediatrics.
The findings, from published JAMA Network Open, highlight a gap in medical care for 4- and 5-year-olds with ADHD. Treatment guidelines recommend that these young children and their families try six months of behaviour therapy before starting ADHD medication.
But paediatricians often prescribe medication immediately upon diagnosis, according to an analysis of medical records from nearly 10 000 young children with ADHD who received care in eight paediatric health networks in the United States.
“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” said the study’s lead author, Yair Bannett, MD, assistant professor of paediatrics. “That’s concerning, because we know starting ADHD treatment with a behavioural approach is beneficial; it has a big positive effect on the child as well as on the family.”
Medications not appropriate to under-6s
In addition, stimulant medications prescribed for the condition cause more side effects in young patients than they do in older children, Bannett said. Before age 6, children’s bodies don’t fully metabolise the drugs.
“We don’t have concerns about the toxicity of the medications for 4- and 5-year-olds, but we do know that there is a high likelihood of treatment failure, because many families decide the side effects outweigh the benefits,” he said. Stimulant medication can make young children more irritable, emotional, and aggressive.
ADHD is a developmental disorder characterised by hyperactivity, difficulty paying attention, and impulsive behaviour.
“It’s important to catch it early because we know these kids are at higher risk for having academic problems and not completing school,” Bannett said. Early identification and effective treatment for ADHD improve children’s academic performance. Research has shown that good treatment also helps prepare individuals with ADHD for many aspects of adulthood, such as maintaining employment, having successful relationships, and avoiding trouble with the law.
Complementary treatments
Behavioral therapy and medication, the two mainstays of ADHD treatment, have different purposes.
“Behavioral treatment works on the child’s surroundings: the parents’ actions and the routine the child has,” Bannett said. The therapy helps parents and kids build skills and establish habits compatible with how the child’s brain works.
The evidence-based behavioral treatment recommended by the American Academy of Pediatrics is called parent training in behavior management. The training helps parents build strong, positive relationships with their children; offers guidance in rewarding a child’s good behaviors and ignoring negative behaviors; and recommends tools that help kids with ADHD, such as making visual schedules to help them stay organized.
In contrast, medication relieves ADHD symptoms such as hyperactivity and inattentiveness, with effects that wear off as the body breaks down each dose of the drug.
Both approaches are needed for most kids with ADHD to do well. But previous studies of preschoolers diagnosed at age 4 or 5 show that it’s best to start with six months of behavioural treatment before prescribing any medication.
Rapid prescriptions
The researchers analysed data from electronic health records for children seen at primary care practices affiliated with eight US academic medical centres. They began with 712 478 records from children aged 3, 4, or 5 years old and were seen by their primary care physician at least twice, over a period of at least six months, between 2016 and 2023.
From these records, the scientists identified 9708 children who received an ADHD diagnosis, representing 1.4% of the children in the initial sample. They found that 42.2% were prescribed medication within a month of their ADHD diagnosis. Only 14.1% of children with ADHD first received medication more than six months after diagnosis. The researchers did not have access to data on referrals to behavioural therapy, but since young children are supposed to try the therapy alone for six months before receiving medication, any who were prescribed medication sooner were likely not being treated according to academy guidelines. A smaller study of recommendations for behaviour therapy, published in 2021, found only 11% of families got the therapy in line with guidelines.
Children who were initially given a formal diagnosis of ADHD were more likely to get medication within the first 30 days than those whose medical charts initially noted some ADHD symptoms, with a diagnosis at a later time. But even among preschoolers who did not initially meet full criteria for the condition, 22.9% received medication within 30 days.
Barriers to behavioural treatment?
Because the study was based on an analysis of electronic medical records, the researchers could not ask why physicians made the treatment decisions they did. But in informal conversations with physicians, outside the scope of the study, the researchers asked why they prescribed medication.
“One important point that always comes up is access to behavioural treatment,” Bannett said. Some locales have few or no therapists who offer the treatment, or patients’ insurance may not cover it. “Doctors tell us, ‘We don’t have anywhere to send these families for behavioural management training, so, weighing the benefits and risks, we think it’s better to give medication than not to offer any treatment at all.’”
Bannett said he hopes to educate primary care paediatricians on how to bridge this gap. For example, free or low-cost online resources are available for parents who want to learn principles of the behavioural approach.
And while the study focused on the youngest ADHD patients, behavioural management therapy also helps older children with the diagnosis.
“For kids six and above, the recommendation is both treatments, because behavioural therapy teaches the child and family long-term skills that will help them in life,” Bannett said. “Medication will not do that, so we never think of medication as the only solution for ADHD.”
Schizophrenia and bipolar disorder are serious mental illnesses that affect both males and females, but research in Acta Psychiatrica Scandinavica indicates that sex may influence the characteristics and course of these conditions.
The research included 1516 individuals from the multicentre PsyCourse Study: 543 with bipolar disorder, 517 with schizophrenia, and 456 healthy controls.
Several differences between groups and sexes were identified in age at diagnosis, age at treatment, illness duration, illicit drug use, and smoking. For example, females in the schizophrenia group were older than males at first outpatient treatment compared with females in the bipolar disorder group. Moreover, those who were older at first outpatient treatment presented a longer duration of illness. Regarding substance use, the highest rates were observed in males with schizophrenia. People with bipolar disorder showed better functioning and neurocognitive performance than those with schizophrenia. Among individuals with bipolar disorder, females reported better performance in verbal memory and psychomotor speed than males. Both females and males with serious mental illnesses showed higher rates of thyroid alterations than healthy controls.
“Our findings reveal a clear message: sex-sensitive treatment is essential for improving clinical outcomes, promoting healthy habits, and managing comorbidities,” said corresponding author Anabel Martinez-Arán, PhD, of the Hospital Clinic of Barcelona.
