Mental Health and Developmental Disabilities Committee

Question 1

Among young children with congenital heart disease, sudden death is associated with which 2 specific conditions?

Answer 1

1. Tetralogy of Fallot
2. D-transposition of the great arteries
   (after Mustard or Senning procedure)

Question 2

Based on studies, what do we conclude is the risk of sudden death in children on ADHD medication compared to the general population?

Answer 2

The risk is the same

Question 3

What are four useful questions on history that might help identify a patient at risk of sudden death?

Answer 3

1. Decreased exercise intolerance
2. Fainting/syncopal episodes
3. Palpitations with exercise/startle/fright
4. Detailed family history of sudden death, particularly less than 35 years old (including MVCs, drownings, SIDS)

Question 4

Does the CPS recommend routine ECG monitoring prior to putting an ADHD patient on stimulants?

Answer 4

No provided that history, family history, and physical exam are normal

Question 5

For ADHD patients with known heart disease, should the cardiologist or ADHD specialist make recommendations on treatment?

Answer 5

the physician with expertise in ADHD likely remains the appropriate individual to evaluate benefit and risk, and make a recommendation for medication therapy, because there is little evidence that taking medication further increases the risk of sudden death.
Discussion may be appropriate with the cardiologist

Question 6

What is the routine blood work that is required before initiating or maintaining SSRI medication use in children and teenagers?

Answer 6

No bloodwork is necessary

Question 7

Children with prolonged QT syndrome should not be treated with which SSRI for depression?

Answer 7

Citalopram

Question 8

As per the FDA, how frequently should a patient be monitored once they are started on an SSRI?

Answer 8

Weekly for the first 4 weeks, Every 2 weeks for the next 4 weeks, At 12 weeks, and then as clinically indicated

Question 9

Of the SSRIs, which medication has the most data supporting its use for treating depression in children and adolescents?

Answer 9

Fluoxetine

Question 10

Before starting a patient with anxiety on a SSRI, what should be carefully documented prior to treatment initiation?

Answer 10

Documenting the physical symptoms of anxiety so that it is not mistaken as SSRI side effects