Ott Pharmacotherapy of Ped Psych Flashcards
Why must medications be used with caution in pediatric patients?
Kids have a higher risk for significant adverse effects compared to adults
Definition of Tourette’s disorder
-Tics may wax and wane in frequency, but have been present for over a year
-Onset before age 18
Common comorbidities associated with tic disorders
-~75% have ADHD
-~50% have OCD
Tic disorder rule of thirds
-1/3 resolve
-1/3 improve
-1/3 stay the same
-~10% have persistent symptoms as adults
First-line treatment for tics
Alpha 2 agonists:
-Tics of mild to moderate severity
-~30% reduction
Second-line treatment for tics
Atypical antipsychotics (30-60% reduction_
Third-line treatment for tics
Typical antipsychotics (~80% reduction)
What are the alpha 2 agonists used to treat tics?
-Clonidine
-Guanfacine
-Guanfacine ER
What are the atypical antipsychotics used to treat tics?
-Aripiprazole
-Risperidone
What are the typical antipsychotics used to treat tics?
-Haloperidol
-Pimozide
What is the age range that aripiprazole is approved for treating?
6-17 years old
How do you treat ADHD and Tourette’s at the same time?
-Can discontinue amphetamine-based stimulant and give a trial of atomoxetine or a tricyclic antidepressant
-If ADHD symptoms are not well-controlled, can resume amphetamine-based stimulant and adjust dose of antipsychotic to better control Tourette’s symptoms
What must be specified when diagnosing conduct disorder?
-Childhood-onset type: less than 10 years old
-Adolescent-onset type: older than 10 years old (no symptoms under 10)
-Unspecified onset: unclear information to determine age at onset
When should pharmacotherapy be considered in patient with ODD or CD?
Pharmacotherapy is considered adjunctive, palliative, non-curative and should only be used after baseline symptoms/behaviors have been determined, other interventions have failed and/or aggression has escalated to dangerous levels
How do you treat ODD and CD?
Treat underlying conditions (ADHD, depression/anxiety, mania) - ADHD common
Which drugs are considered first choice to treat ODD and CD?
Stimulants and clonidine/guanfacine before atypical antipsychotics
When are atypical antipsychotics used for ODD and CD?
May be used to treat severe aggression, serious oppositional behaviors, defiance
What medications are often given to ODD and CD patients?
Combination stimulant/alpha agonist treatment of ADHD with impulsivity or need for sedation for sleep
What is first-line treatment for separation anxiety disorder?
First-line treatment for mild anxiety is psychotherapy with combination therapy for moderate to severe anxiety
What is the first-line drug choice for separation anxiety disorder?
SSRIs are the first-line drug therapy choice
What are common co-morbidities associated with separation anxiety disorder
-Depression
-ADHD
-Bipolar disorder
Co-morbidities must be treated
What is autism spectrum disorder?
-Persistent deficits in social communication and social interaction across multiple contexts
-Restricted, repetitive patterns of behavior, interests, activities
Behavioral symptoms associated with autism spectrum disorder
-Aggression
-Hyperactivity
-Inattention
-Irritability
-Mood instability
-Poor frustration tolerance
-Self-harm
-Severe temper tantrum
-Sleep disturbances
-OCD symptoms
-Hypersensitivity of senses
Medical problems associated with autism spectrum disorder
-Seizure disorder
-GI disorders
