Exam 4 Pediatric Psychiatry Flashcards
Why is medication use limited in children?
Kids have a higher risk of significant adverse effects from medications than adults
What are the two psychiatric medications approved for kids and at what ages can they be used?
Risperidone: Age 5
Aripiprazole: Age 6-17
What criteria need to be met to be diagnosed with Tourette’s Disorder?
Tics can wax and wane in frequency but must be present for > 1 year
Onset before age 18
What comorbidities are common with Tic Disorders?
ADHD -75%
OCD -50%
What is the Rule of Thirds for tic disorders?
1/3 resolve
1/3 improve
1/3 stay the same
(about 10% have persistent symptoms as adults)
True or False: Stimulants can cause tics
TRUE
-we still treat ADHD though
-even if they exacerbate the tics, if benefit is greater then keep them on the stimulant
What is the first-line treatment for tic disorders?
Alpha-2 Agonists
-Clonidine
-Guanfacine
*ER Guanfacine
(30% reduction)
What is the second-line treatment for tic disorders?
Atypical antipsychotics
***Aripiprazole
Risperidone
(30-60% reduction)
What is the third-line treatment for tic disorders?
Typical antipsychotics
Haloperidol
Pimozide
(80% reduction)
Which medication has weight-based dosing?
Aripiprazole
Which medication has the highest D2 block of all atypical antipsychotics?
Risperidone/Paliperidone
What are the age cut-offs for the two types of Conduct Disorder?
Childhood-Onset: <10 years old
Adolescent-Onset: >10 years old
Unspecified Onset: unclear information to determine age of onset
What is the most common comorbid condition with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
ADHD
**must treat underlying conditions
What are the fist-choice drugs for treating Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
Stimulants
Clonidine/Guanfacine
*atypical antipsychotics are second-choice
*often see combination
When would we treat Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) with atypical antipsychotics?
-Severe persistent aggression
-Serious oppositional behaviors
-Defiance
When would we use a combination stimulant/alpha antagonist for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
If comorbid ADHD with impulsivity or need for sedation for sleep
What is the first-line drug therapy for Separation Anxiety Disorder?
SSRIs (fluoxetine down to 8 years old)
*note that first-line treatment is therapy
What are the associated medical disorders with Autism Spectrum Disorder?
-Seizure disorder (up to 30%)
-GI disorders
What medications are used for Autism Spectrum Disorder?
No medications have currently shown efficacy in treating the core symptoms
For irritability/aggression or :stereotypy and hyperactivity:
-Aripiprazole (6-17yo)
-Risperidone (5-16yo)
*NOTE: lamotrigine/levetiracetam have no effect on irritability
What are the drugs used for repetitive behaviors?
Antipsychotics: Haloperidol, Risperidone, Aripiorazole
What medication can be used to help with sleep?
Melatonin 1-6mg nightly
What is Disruptive Mood Dysregulation Disorder (DMDD)?
-Severe recurrent temper outbursts manifesting verbally that are out of proportion with the intensity/duration of the situation
*present in at least 2 out of 3 settings and severe in at least 1
*diagnosis not made before age 6 or after age 18
What is the treatment used for Disruptive Mood Dysregulation Disorder (DMDD)?
SSRIs and Stimulants
*similar to depression, ADHD, or anxiety
*differentiate from bipolar disorder to decipher whether to use antidepressants and need for mood stabilizers
What is the only anti-depressant FDA approved to treat kids down to 8 years old?
Fluoxetine
What antidepressant is used to treat kids 12-17 yo?
Escitalopram
Which antidepressant should be avoided in kids because of its suicidal thinking warning?
Paroxetine
What is the overall preferred drug for bipolar treatment in kids?
Lithium
(all stages of bipolar disorder)
What is the first-line treatment pediatric PTSD?
Trauma-focused psychotherapy
What is the first-line drug therapy for pediatric PTSD?
SSRIs
To be considered childhood-onset schizophrenia, by wat age must the disease onset occur?
Before age 13
Adolescent prevalence of schizophrenia reaches what % adult prevalence?
0.5-1%
Which antipsychotics are not used in pediatric patients?
-Iloperidone
-Cariprazine
-Lumateperone
