lecture 67/68 Flashcards
ott - pediatric psychiatry
how does medication affect kids more than adults?
kids have higher risk of significant adverse effects
what disorders are classified as Tic Disorders?
tourette’s disorder
persistent motor or vocal tic disorder
provisional tic disorder
what are the defining characteristics of tourette’s disorder?
tics may wax and wane in frequency, but have been present for over 1 year
onset before age 18
what are co-morbidities associated with Tic disorders?
around 75% have ADHD
around 50% have OCD
what is the rule of thirds in tic disorders?
1/3 resolve
1/3 improve
1/3 stay the same with 10% have persistent symptoms as adults
what are the pharmacologic treatments of tics?
first line – alpha-2 agonists
second line – aripiprazole, risperidone
third line – haloperidol
what is special to note about aripiprazole when used for Tic disorders?
approved for 6-17 years old
when can stimulants be used for tourette’s?
when pt has both ADHD and tourette’s
what stimulants should be utilized for ADHD and tourette’s?
can d/c ampethamine-based (bc can exacerbate symptoms) stimulant and give a trial of atomoxetine or TCAs
when can amphetamine-based stimulants be added back on in tourette’s?
if symptoms of ADHD are not well controlled with atomoxetine or TCA, amphetamine-based stimulant can be resumed and adjust dose of antipsych to better control tourette’s
what are the specific types of conduct disorder?
childhood-onset type (symp under 10 years)
adolescent-onsest type (symp over 10 years)
unspecified onset (unclear info to determine age of onset)
when should pharmacotherapy because considered in ODD/CD in pediatrics?
considered adj, palliative, non-curative
should only be used after baseline symptoms/behaviors have been determined, other interventions have failed, and/or aggression has escalated to dangerous levels
what is the goal of ODD/CD treatment in pediatrics?
treat underlying conditions like ADHD, depression/anxiety, or mania
what is the first line choice for treatment of ODD and CD in pediatrics?
stimulants and clonidine/guanfacine before atypical antipsychs
when should atypical antipsych be used in the treatment of ODD/CD in pediatrics?
used to treat severe persistent aggression, serious oppositional behaviors, and defiance
when would the combination of stimulants and alpha agonists be used for treatment of ODD/CD in pediatrics?
if pt also has ADHD with impulsivity or need for sedation to sleep
what is the treatment of separation anxiety disorders?
first line for mild is psychotherapy within combination therapy (SSRIs) for moderate to severe anxiety
what are common co-morbidities associated with separation anxiety disorders?
depression
ADHD
screen for bipolar disorder
how is autism spectrum disorder defined in the DSM-5?
persistent deficits in social communication and social interaction across multiple contexts
restricted, repetitive patterns of behavior, interests, and activities
what are associated behavioral symptoms of ASD?
aggression
hyperactivity
inattention
irritability
mood instability
poor frustration tolerance
self-harm
severe temper tantrum
sleep disturbances
OCD symptoms
hypersensitivity of senses
what medical problems are associated with ASD?
seizure (up to 30% have at least on seizures by age 20)
GI disorders
can medicines be used to treat autism?
no there are no medications that have shown efficacy in treating the core ASD symptoms
how are disruptive behaviors treated in ASD?
first line – behavioral interventions (applied behavioral analysis)
what is the treatment for irritability in ASD?
first line – abilify 6-17y and risperidone 5-16y (also for aggression, may have efficiacy for stereotypy and hyperactivity)
No effect – lamotrigine and levetiracetam
