Exam 4 lecture 7 Flashcards
Why is medication use in pediatric psychiatry different
Kids have risk of significant adverse effects from medications than adults.
ADHD med recommendation for preschool age, elementary/middle school/adolescents
1st line- methylphenidate
elementary middle
Elementary/middle school/adolescents- 1st line- stimulants
2nd line- atomoxetine, guanfacine, clonidine
adjunctive treatment for ADHD oediatric
Only guanfacine ER and clonidine ER have evidence as adjuncts to stimulants
ADHD guidelines for adults
Methylphenidate (short or long acting) or lisdexamfetamine ( if no response to one switch to another)
Dextroamphetamine- if unable to tolrate lisdexemphetaine
atomoxetine- if no response to abpve agents)
DSM-5 tic disorders define
Tourettes disorder- tics may wax and wane in frequency but resent for >1 yr
onset before 18 years old
Pharmacologic treatment of tics
1st line- alpha 2 agonists (clonidine, guanfacine)
2nd line- Atypical antipsychotics (aripiprazole, risperidone)
3rd line- Typical antipsychotics
Overview of tic disorders
7s% also have ADHD, 5-% have OCD
rule of thirds, 1/3 resolve, 1/3 improve, 1/3 stay the same. 10% have persistent symptoms as adults
What antipsychotic is approved for 6-17 year olds
Aripiprazole- weight based dosing
Stimulant use in tourettes
Use of amphetamine based stimulants can exacerbate motor and vocal tic symtoms.
What is oppositional defiant disorder
Pattern of angry/irritable mood, argumentative/defiant behavior or indictments lasting atleast 6 months
OPP turns into conduct disorder, turning into antisocial personality disorder
2 different onsets of conduct disorder
Childhood-onset type<10 years old
adolescent onset type- >10 years
Treatment of ODD and CD
pharmacotherapy is considered adjunctive, palliative, non curative, and should only be used after basline symptkms/behaviors have been determined t fail and has escalated to dangerous levels
treat underlying condition (ADHD, depression/anxiety) ADHD is common
atypical antipsychotixcs may be used to treat severe persistent aggression, serious oppositional behaviors, defiance
often see combination stimulant/alpha agonist treatment if ADHD with impulsivity or need for sedation for sleep.
How to treat separation anxiety
first line treatment for mild anxiety is psychotherapy with combination therapy for moderate to severe anxiety
SSRIs are first line
treat co-morbidities (depression, ADHD, screen for bipolar disorder)
autism spectrum disorder DSM 5
persistent deficits in social communication and social interaction across multiple contexts
restricted, repetitive patterns of behavior, interests, activities
Hallmark signs and symptoms of ASD
associated behavioral symptoms, aggression, hyperactivity, inattention, irritability, mood instability, poor frustration, tolerance, self harm, severe temper tantrum, sleep disturbances, OCD symptoms, hypersensitivity of senses.
associated medical problems include seizure disorder (upto 30% have at least one seizure by age 20 and GI disorder
no medications have shown efficacy in treating ASD symptoms.
treatment of disruptive behaviors in ASD
Behavioral interventions are 1st line treatment
Atypical antipsychotics- aripiprazole (6-17 years old) and risperidone (5-16 years old) are FDA approved for management of irritability/aggression and are considered 1st line agents
lamotrigine/levetiracetam have nosignificant effect on irritability
How to treat repetitive behaviors, ADHD and sleep in pediatric pts
Repetitive behaviors- antipsychotics- haloperidol, risperidone and aripiprazole
ADHD- stimulants- methylphenidate preferred. Clonidine/guanfacine-modest effect on irritability and explosive behavior
sleep- melatonin reduced sleeo katency and increased time asleeo. give 1-6 mg nightly
what is disruptive mood dysregulation disorder (DMDD)
severe recurrent temper outbursts manifested verbally that are out of prportion with the intensity/duration of the situation.
present in atleast 2 or 3 settings (home, school with peers)and severe in 1 of these 3
diagnosis should not be made before age 6 or after age 18
DMDD treatment
more similarity to depression, ADHD, or ancxiety that bipolar disorder
SSRIs and stimulants are considered to be 1st line
need to differentiate from bipolar disorder- both for using antidepressants as well as evaluating need for mood stabilizers
describe pediatric depression
Children- physical complaints, irritability, conduct problems, can have suicidal ideation
Adolescents- express feelings of depression and suicidal behaviors than more than young children
more chronic than episodic, instability in mood can be marker for bipolar disorder
pediatric depression treatment
Nonpcol tx is 1st line, need motivation of family/carefgivers for success
CBT- remission rate of 70%
Fluoxetine is the only antidepressant FDA approved to treat kids down to 8 years olf
escitalopram- 12-17 years old
what SSRI to avoid in kids? why? Black box warning of antidepressants
Paroxetine- shows suicidal thinking. avoid in kids
black box warning of antidepressants- suicidality.
How to treat PTSD in children
SSRIs are 1st line tx
childhood onset schizophrenia
Not explained by substance use or PDD/autism
visual hallucinations more common than in adults
onset of symptoms before age 13
Rare in children
Atypical antipsychotics FDA approved in pediatrics
aripiprazole
asenapine
brexipiprazole
lurasidone
olanzapine
olanzapine/fluoxetne
paliperidone
quetiapine
risperidone
brand name of the atypical antipsychotics
Aripiprazole-abilify
asenapine-saphris
brexipiprazole- rexulti
lurasidone- latuda
olanzapine- zyprexa
olanzapine/fluoxetine- symbyaz
paliperidone- invega
quetiapine- seroquel
risperidone- risperdal
What do the different atypical antipsychotics treat
Aripiprazole- bipolar disorder, irritability with autism, schizophrenia, tourettes disorder
asenapine- bipolar disorder
brexipiprazole- schizophrenia
lurasidone- schizophrenia, biolar disorder
olanzapine- bipolar disorder, schiophrenia
olanzapine/fluoxetine- bipolar depression (I)
paliperidone- schizophrenia
quetiapine- bipolar disordr, schizophrenia
risperidone- bipolar disorder, instabiliy with autism, schizophrenia
atypical antipsychotics pediatric treatment ages
aripiprazole- bipolar (10-17)
irritability in autism (6-17)
schizophrenia- 13-17
tourettes- (6-17(
asenapine- bipolar (10-17)
brexipiprazole- schizophrenia (13-17
lurasidone- schizophrenia (13-17)
bipolar depression (10-17)
olanzapine- bipolar (13-17)
schizophrenia (13-17)
olanzapine/fluoxetine- bipolar I depression (10-17)
paliperidone- schizophrenia (12-17)
quetiapine- bipolar disorder (10-17)
schizophrenia (13-17)
risperidone- bipolar disorder (10-17)
irritability with autism (5-17)
schizophrenia- (13-17)
Drug treatment for pediatric pts with bipolar disorder
lithium
