Exam 4 lecture 7

Question 1

Why is medication use in pediatric psychiatry different

Answer 1

Kids have risk of significant adverse effects from medications than adults.

Question 2

ADHD med recommendation for preschool age, elementary/middle school/adolescents

Answer 2

1st line- methylphenidate
elementary middle

Elementary/middle school/adolescents- 1st line- stimulants
2nd line- atomoxetine, guanfacine, clonidine

Question 3

adjunctive treatment for ADHD oediatric

Answer 3

Only guanfacine ER and clonidine ER have evidence as adjuncts to stimulants

Question 4

ADHD guidelines for adults

Answer 4

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)

Question 5

DSM-5 tic disorders define

Answer 5

Tourettes disorder- tics may wax and wane in frequency but resent for >1 yr

onset before 18 years old

Question 6

Pharmacologic treatment of tics

Answer 6

1st line- alpha 2 agonists (clonidine, guanfacine)

2nd line- Atypical antipsychotics (aripiprazole, risperidone)

3rd line- Typical antipsychotics

Question 6

Overview of tic disorders

Answer 6

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

Question 7

What antipsychotic is approved for 6-17 year olds

Answer 7

Aripiprazole- weight based dosing

Question 8

Stimulant use in tourettes

Answer 8

Use of amphetamine based stimulants can exacerbate motor and vocal tic symtoms.

Question 9

What is oppositional defiant disorder

Answer 9

Pattern of angry/irritable mood, argumentative/defiant behavior or indictments lasting atleast 6 months

OPP turns into conduct disorder, turning into antisocial personality disorder

Question 10

2 different onsets of conduct disorder

Answer 10

Childhood-onset type<10 years old

adolescent onset type- >10 years

Question 11

Treatment of ODD and CD

Answer 11

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.

Question 12

How to treat separation anxiety

Answer 12

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)

Question 13

autism spectrum disorder DSM 5

Answer 13

persistent deficits in social communication and social interaction across multiple contexts

restricted, repetitive patterns of behavior, interests, activities

Question 14

Hallmark signs and symptoms of ASD

Answer 14

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.

Question 15

treatment of disruptive behaviors in ASD

Answer 15

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

Question 16

How to treat repetitive behaviors, ADHD and sleep in pediatric pts

Answer 16

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

Question 17

what is disruptive mood dysregulation disorder (DMDD)

Answer 17

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

Question 18

DMDD treatment

Answer 18

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

Question 19

describe pediatric depression

Answer 19

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

Question 20

pediatric depression treatment

Answer 20

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

Question 21

what SSRI to avoid in kids? why? Black box warning of antidepressants

Answer 21

Paroxetine- shows suicidal thinking. avoid in kids

black box warning of antidepressants- suicidality.

Question 22

How to treat PTSD in children

Answer 22

SSRIs are 1st line tx

Question 23

childhood onset schizophrenia

Answer 23

Not explained by substance use or PDD/autism

visual hallucinations more common than in adults

onset of symptoms before age 13

Rare in children

Question 24

Atypical antipsychotics FDA approved in pediatrics

Answer 24

aripiprazole
asenapine
brexipiprazole
lurasidone
olanzapine
olanzapine/fluoxetne
paliperidone
quetiapine
risperidone

Question 25

brand name of the atypical antipsychotics

Answer 25

Aripiprazole-abilify
asenapine-saphris
brexipiprazole- rexulti
lurasidone- latuda
olanzapine- zyprexa
olanzapine/fluoxetine- symbyaz
paliperidone- invega
quetiapine- seroquel
risperidone- risperdal

Question 26

What do the different atypical antipsychotics treat

Answer 26

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

Question 27

atypical antipsychotics pediatric treatment ages

Answer 27

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)

Question 28

Drug treatment for pediatric pts with bipolar disorder

Answer 28

lithium