Lecture 23: Child & Adolescent Psychopharmacology Flashcards
1
Q
how many women have a psychiatric illness that predates or emerges during pregnancy?
A
500,000
2
Q
3 potential risks of psychoactive medication to fetus
A
- teratogenic damage (physical abnormalities)
- behavioral abnormalities
- neonatal toxicity through breastfeeding
3
Q
untreated maternal illness can result in (6)
A
- poor compliance with prenatal care
- poor nutrition
- drug exposure
- increased self medication
- deficits in mother infant bonding
- disruptions in family environment
4
Q
impact of anxiety disorders on fetus (obstetric, 4)
A
- long labor
- fetal distress
- preterm labor
- spontaneous abortion
5
Q
what % of pregnancies are unplanned?
A
50%
6
Q
depression during pregnancy leads to increased risk of ___
A
postpartum depression
7
Q
what can increase the risk of teratogenicity in pregnancy?
A
more than one antidepressant
8
Q
SSRI discontinuation symptoms in baby (5)
A
- irritability
- constant crying
- sleep disturbances
- hyperactive reflexes
- breathing and feeding difficulties
9
Q
4 anxiety disorders in preschoolers
A
- situational anxiety
- generalized anxiety
- selective mutism
- specific phobias
10
Q
first pharmacological choice for child anxiety disorders
A
prozac
11
Q
__% of medical practitioners prescribe medications for preschooler PTSD
A
89%
12
Q
autism must present before ___
A
age 3
13
Q
non-autism pervasive developmental disorders are usually recognized by ___
A
age 3
14
Q
what two drugs are used to treat irritability and autism-associated behaviors?
A
risperidone
aripiprazole
15
Q
autism affects __% of all children
A
1%
16
Q
impact of anxiety disorders on fetus (neonatal, 2)
A
- reduced developmental scores
2. slowed mental development
17
Q
the risk of a bipolar episode during pregnancy is ___ for a female diagnosed with bipolar disorder
A
71%
18
Q
bipolar: time to first recurrence is _x shorter once medication is stopped
A
4x
19
Q
the risk of a bipolar episode is ___ if a woman discontinues medication
A
doubled
20
Q
bipolar after stopping meds: proportion of weeks spent in episodes is _x greater
A
5x
21
Q
pregnancy risk of lithium
A
cardiac malformations
22
Q
3 risks of valproic acid in pregnancy
A
- highest risk of congenital malformations
- can impair cog functioning and lower IQ
- can increase risk for autism spectrum disorder
23
Q
danger of topiramate
A
high risk of congenital malformations such as oral clefts and penile malformations
24
Q
3 high risk mood stabilizers for pregnancy
A
- lithium
- valproic acid
- topiramate
25
3 low risk mood stabilizers for pregnancy
1. carbamazepine
2. lamotrigine
3. gabapentin
26
pregnancy risk for carbamazepine
slightly teratogenic
27
pregnancy risk for lamotrigine
slight risk for cleft palate
28
3 risks for atypical antipsychotics during pregnancy
1. large for gestational age/heavy at birth
2. increase risk for diabetes later in life
3. risperidone in 3rd trimester problems
29
problems with taking risperidone in 3rd trimester (4)
1. jitteriness
2. irritability
3. feeding problems
4. somnolence
30
__% of preschoolers with moderate-severe ADHD have comorbid disorders. which 3?
70%
1. oppositional defiant disorder
2. communication disorders
3. anxiety disorders
31
2 challenges for diagnosing/treating ADHD in preschoolers
1. symptoms vary across lifespan, so may need different diagnostic criteria
2. comorbidity varies by age
32
ritalin is __ effective in preschoolers than school age children
less
33
if ritalin is ineffective, it can be substituted by __-
adderall
34
pharmacological treatments are usually discontinued in __ months for preschoolers
6 months
35
behavioral disinhibition in preschool years may be an antecedent of __
disruptive behavioral disorders and mood disorders
36
is there evidence for efficacy of medication in preschoolers with disruptive behavioral disorders without comorbidities for mental retardation or autism?
no
37
___ can be considered for treating disruptive disorders
antipsychotics
38
depression is common in children who have __ (3)
1. other mood disorder
2. past trauma
3. mother with depression
39
5 signs of depression in young children
1. appear sad even when playing games
2. games have themes of death or somber topics
3. appetite loss
4. sleep problems
5. maladaptive guilt and shame
40
autism affects _% of all children
1%
41
are SSRIs efficacious for autism?
no
42
what type of drugs are most effective for autism?
atypical antipsychotics
43
3 serious side effects of atypical antipsychotics in autism
1. weight gain
2. glucose intolerance
3. high cholesterol
44
omega 3 fatty acids are used in __% of children with autism
28%
45
_% of children with rages were initially diagnosed with bipolar. what % actually had bipolar?
33%; 9%
46
__% of youth with behavioral disruptive disorders progressed to ___
50%, antisocial personality disorder
47
behavioral aggression is likely to be comorbid with (4)
1. ADHD
2. pervasive developmental disorders
3. depression
4. substance abuse
48
plan for treating behavioral/aggressive disorders
mood stabilizers and atypical antipsychotics plus psychological therapy
49
___ is recommended for management of severe aggression in children
lithium
50
3 side effects of lithium in children
1. weight gain
2. cognitive impairment
3. fatal elevations of blood ammonia
51
what % of children w behavioral or aggressive disorders responded positively to valproic acid?
75%
52
3 meds used for treating behavioral or aggressive disorders
1. psychostimulants
2. SSRIs
3. benzos
53
problem with using benzos in aggressive children
can cause behavioral disinhibition
54
1 in every __ children has ADHD
10-15
55
what % of children with ADHD are on stimulant medications?
50%
56
what might underlie ADHD?
alterations in dopaminergic activity in the PFC
57
the PFC is critical in regulating (3)
1. behavior
2. attention
3. cognition
58
5 effects of PFC lesions
1. distractibility
2. forgetfulness
3. impulsivity
4. poor planning
5. locomotor hyperactivity
59
optimal levels of (2) are essential for PFC control of behavior and attention
NE and DA
60
stimulant medications augment (2)
deficient dopaminergic or NE systems
61
psychostimulants improve behavior and learning in __% of children with ADHD
60-80%
62
stimulants improve ADHD symptoms but do not affect
functional impairments
63
functional impairments
impairments like reading, writing, math, relationships, following directions, disrupting class, etc
64
2 conclusions from MTA study
1. medical management better than behavioral treatment and community care
2. medication and behavioral treatment was not better than medication alone, but is beneficial for nonADHD symptoms and positive function
65
8 years after MTA, how many were still receiving medication? did they still meet ADHD criteria?
33%; yes
66
__% of MTA participants 8 years later had clinically significant antisocial behavior, opposition defiant disorder, were arrested at least once, or displayed delinquent behavior
25-30%
67
__% of MTA participants still had ADHD
78%
68
ritalin comprises __% of prescribed ADHD meds
90%
69
ritalin must be administered how many times per day?
2-3x
70
what is concerta?
extended release preparation of ritalin
71
concerta duration of action
12 hours; 22% is immediate release, 78% over 10 hour period
72
half life of dexedrine/adderall
5-6h
73
4 side effects of stimulants in young people
1. insomnia
2. elevated bp & hr
3. reduced appetite
4. growth suppression
74
5 adverse psychiatric problems with stimulants
1. bipolar illness
2. suspiciousness
3. hearing voices
4. aggression
5. manic symptoms
75
__% of ADHD patients do not respond well to stimulants
10-30%
76
2 other med options for ADHD
1. SNRIs (strattera)
| 2. BP-lowering dopaminergic agonists
77
MoA of BP lowering dopaminergic agonists
increase alpha-2-receptor stimulation in PFC
78
2 BP lowering dopaminergic agonists
clonidine, guanfacine
79
__ + a stimulant can improve ADHD symptoms better than either drug alone
guanfacine
80
__ is the period of highest risk for depression
adolescence
81
does adolescent depression usually persist into adult life?
yes
82
prevalence of depression among children? adolescents?
3%
| 6-20%
83
in 1990s, __ was shown to treat childhood depression
prozac
84
in 2002, __ youths committed suicide in the USA. suicide is the __ leading cause of death in this age group
264; 5th
85
adding __ to prozac enhances safety of medication therapy for depression
CBT
86
4 complementary treatments for depression
1. st john's wort
2. omega-3 fatty acids
3. light therapy
4. exercise
87
prevalence of childhood anxiety disorders
6-18%
88
__% of parents of children with childhood anxiety disorders had the disorder themselves
40%
89
OCD is the __ most common disorder in children and adolescents
4th
90
__ of youth do not improve with combination therapy for anxiety
25-30%
91
over __ of children with bipolar experience a prodromal period for __
50%; over a year
92
prodrome
early symptoms that might indicate start of a disease before specific symptoms occur
93
children with bipolar show ___, often with comorbid (2)
rapid fluctuations in mood and behavior
| ADHD and disruptive behavioral disorders
94
4 treatments for childhood mania
1. lithium
2. anticonvulsants
3. atypical antipsychotics
4. behavioral and psychosocial therapies
95
lamictal reduces manic symptoms by __ and depressive symptoms by ___
72%; 82%
96
___ acid is effective for treating children with ADHD, bipolar, and other problems
eicosapentaenoic acid (EPA)
97
__ of participants taking omegabrite D supplement with BP improved
half
98
___ schizophrenia patients develop psychotic symptoms between ages 10-20
1 in 3
99
prior to symptom onset, schizophrenia adolescents exhibit ___ in ___
lower gray matter in frontal and parietal lobes
100
results of omega 3 study on psychotic disorders
5% of omega 3 group vs. 28% of placebo group transitioned to psychotic disorder in 12 weeks. omega 3 may offer a safe and efficacious strategy for prevention in young people with sub-threshold psychotic states
101
__ are the best treatment of childhood and adolescent onset schizophrenia
atypical antipsychotics
