School phobia

Berney, T, Kolvin, L, Bhate, S.R., Garside R.F., Jeans, J., Kay, B., and Scarth, L. (1981) School phobia a therapeutic trial with clomipramine and short-term outcome. Br J Psychiatry 138 110-118. 

Gittleman-Klein, R. and Klein, D.F. (1973) School phobia diagnostic considerations in the light of imipramine effects./ Nerv Merit Dis 156 199-215. 

The most often cited publication of psychopharmacol-ogical treatment for pediatric anxiety is a study of IMI for 35 subjects (ages 6-14 years) with school phobia who received concomitant behavior treatment (Gittle-... 

Berney, T, Kolvin, I., Bhate, R.F., Carsioe, R.F, Jeans, J. Kay, B. and Scarth, L. (1981) School phobia a therapeutic trial with clomipramine and short—term outcome. Br J Psychiatry 138 110—118. Bernstein, C.A., Borchardt, C.M., Perwein, A.R., et al. (2000) Imip-ramine plus cognitive-behavioral therapy in in the treatment of school refusal./ Am Acad Child Adolesc Psychiatry 39 276—283. Bernstein, C.A., Crosby, R.D. Perwein, A.R., and Borchardt, C.M. 

Last, C.G., Hansen, C., and Franco, N. (1998). Cognitive-Behavioral Treatment of School Phobia / Am Acad Child Adolesc Psychiatry 37 404 11. 

Tricyclic antidepressants have been used for decades to treat depression and anxiety in the general population, and clomipramine has been used to treat OCD. Clomipramine has been studied with respect to treating school phobia or school refusal (Berney et ah, 1981). Gittleman-Klein and Klein (1971) found imipramine to be superior to placebo in treating school refusal. As the TCAs may improve other disorders such as nocturnal enuresis, ADHD, and sleep disorders, they may be attractive for children with any of these comorbid conditions and anxiety disorder. 

Gittelman-Klein, R. and Klein, D. (1971) Controlled imipra-mine treatment of school phobia. Arch Gen Psychiatry 25 205-207. 

Gitteknan-Klein R, Klein DF Controlled imipramine treatment in school phobia. Arch Gen Psychiatry 25 204-207, 1971... 

In this context, Gittleman-Klein and Klein (104) conducted a double-blind, placebo-controlled study of 35 nonpsychotic, school-phobic children. They found a good response in all children given imipramine but in only 21 % of those on placebo. Because PD patients often experienced separation anxiety as children, this suggests that some cases of school phobia may be the childhood equivalent of PD, for which imipramine is effective. 

Perhaps because of these changes, few treatment studies have been conducted in this area (142, 143,144 and 145). Of the studies reported, most have been open label and involved only a small number of patients. Of the various conditions subsumed under anxiety disorders, OCD is the best studied in children and adolescents, with five double-blind trials leading to formal FDA labeling of several medications for use in such patients. Four double-blind studies for school phobia or refusal and five for GAD or mixed diagnostic groups have also been conducted. None of these studies, however, has been sufficient to lead to formal labeling by the FDA as indicated for the treatment of these conditions in children or adolescents. 

These medications are used by clinicians to treat a wide range of anxiety-related conditions, including separation anxiety, school phobia, and panic disorder. None of these agents, however, has been the subject of systematic, double-blind, placebo-controlled studies in children or adolescents, and opinions about their effectiveness depend primarily on anecdotal experience and reports. 

The efficacy of TCAs, principally impramine, has also been tested as treatment of separation anxiety and school phobia. Four placebo-controlled studies involving 140 children have been conducted (153, 158, 159 and 160). Whereas early studies were positive, subsequent reports were not. Gittelman-Klein and Klein ( 161) demonstrated a significant benefit over placebo from 6 weeks of treatment with imipramine (mean dose = 159 mg per day) in 45 children with school phobia. A subsequent study using lower amounts of clomipramine (40 to 75 mg per day) was negative but the doses used make interpretation difficult. Also, because of its tolerability and safety profile, clomipramine is generally not used as an anxiolytic agent in children or adolescents. 

Berney T, Kolvin I, Bhate SR. School phobia a therapeutic trial with clomipramine and short-term outcome. Br J Psychiatry 1981 138 110-118. 

The DSM-IV classifies anxiety disorders in children into four categories, namely social anxiety, over-anxious disorder, phobias and separation anxiety. Only separation anxiety, a fear of losing a loved one or a close attachment, has been reasonably well studied from the point of view of drug treatment. School phobia is perhaps the most severe form of separation anxiety and there are several trials to show that imipramine, in daily doses of up to 5mg/kg, is effective. Many patients require drug treatment for at least 6 to 8 weeks before an optimal response is achieved. Frequently, children remain symptom free after a 3M month course of treatment. In addition to the usual anticholinergic effects of imipramine, it should be noted that children are often susceptible to withdrawal symptoms such as nausea and gastrointestinal spasm. This may be reduced if the drug is slowly withdrawn over a 2-week period. 

Anxiety (refusal to go to school, phobias, separation or social fears, generalized anxiety, or post-traumatic stress disorders)—if it keeps the youngster from normal daily activities. 

Teaching, serving, and accommodating disorders/disabilities (e.g., learning disabilities attention deficit hyperactivity disorder school phobia conduct disorder depression suicidal or homicidal ideation and behavior posttraumatic stress disorder anorexia and bulimia special education designated disorders such as emotional disturbance and developmental disabilities)... 

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