pediatric psych

Question 1

Tic disorders

Answer 1

Tourette’s: both multiple motor and one or more vocal tics present at some time, not necessarily concurrently; onset before age 18
Persistent Motor or Vocal Tic Disorder: single or multiple motor or vocal tics present, but not both; onset before age 18
Provisional tic disorder: symptoms as above, present under 1 year

Question 2

antipsychotics

Answer 2

used in tic disorders
Haloperidol: very effective at low doses, More cognitive/EPS side effects, Fewer EKG changes, Titrate dose slowly
aripirazole approved in ages 6-17
Risperidone/Paliperidone
Other atypical not considered effective
Orap (primozide): Less cognitive/EPS side effects than haloperidol, QTc prolongation = monitor EKG (falled out of use), Avoid 3A4 inhibitors

Question 3

stimulants in tourettes

Answer 3

ADHD is common comorbidity of Tourette’s
Use of amphetamine based stimulants can exacerbate both motor and vocal tics
Must treat BOTH ADHD and Tourette’s - Can discontinue amphetamine-based stimulant and trial atomoxetine, clonidine, guanfacine, or TCA, Can resume amphetamine based stimulant and adjust dose of anti-psychotic to better control Tourette’s
Just because amphetamines can worsen Tourette’s, it is not an absolute contraindication

Question 4

oppositional defiant disorder

Answer 4

pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months

Question 5

conduct disorder

Answer 5

repetitive and persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated with at least 3 of the following criteria present in the last year: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules

Question 6

treatment of oppositional defiant disorder and conduct disorder

Answer 6

Multimodal treatment including individual and family psychotherapy, pharmacotherapy, and social interventions
Psychosocial interventions are first line options
Pharmacotherapy is considered adjunctive, non-curative, palliative, and should only be used after other interventions have failed
treat underlying conditions (ADHD)
drugs of choice: stimulants, clonidine/guanfacine
Atypical antipsychotics may be used (avoid valproate in young females) - then consider typical antipsychotic or mood stabilizer
Monotherapy is preferred

Question 7

separation anxiety

Answer 7

Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whole the individual is attached
Treatment: Multimodal including psychotherapy and medications, Combination treatment is better than medication monotherapy which is better than CBT monotherapy, First line drug therapy are SSRIs then Venlafaxine, TCAs, buspirone, benzodiazepines can be considered as alternatives

Question 8

intellectual disaility

Answer 8

Onset during developmental period that includes intellectual and adaptive functioning deficits

Question 9

autism spectrum disorder

Answer 9

Includes persistent deficits in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behavior, interests, activities
Treatment
-Disruptive Behavior: behavioral interventions -> typical antipsychotics (haloperidol) -> Atypicals : aripiprazole (6-17 years old) and risperidone (5-16 years old) for *irritability/aggression
-Repetitive Behaviors: SSRIs -> antipsychotics (haloperidol, risperidone, aripiprazole), Divalproex
-ADHD: Stimulants -> atomoxetine -> clonidine/guanfacine -> Naltrexone
-Sleep: sleep hygiene and medication (melatonin)

Question 10

disruptive mood dysregulation disorder

Answer 10

Severe recurrent temper outbursts manifested verbally that are out of proportion with the intensity/duration of the situation - Present at least 2 of 3 settings, Diagnosis made between ages 6-18

Question 11

pediatric depression

Answer 11

More chronic that episodic, instability in mood common, may be marker for bipolar disorder
Higher placebo response rate to medications
Treatment:
-Non-pharmacological treatment is first-line, need motivation of family/ caregivers for success
-CBT: 70% remission rates
-Antidepressants: black box warning for suicidality
-Fluoxetine approved for kids at *8 years old
-Escitalopram approved for *12-17 years old
-Avoid Paroxetine in kids (suicidal ideation)

Question 12

pediatric bipolar disorder**

Answer 12

bipolar 1 without psychosis: lithium, valproate, carbamazepine, olanzapine, risperidone, quetiapine; may augment second agent if needed after 4 weeks
bipolar 1 with psychosis: lithium, valproate, carbamazepine WITH any atypical antipsychotic (approved at younger ages), consider d/c of atypical if in remission for 12-24 months
bipolar depression: lithium (first line), SSRI/bupropion for depression that continues (adjunct)

Question 13

childhood-onset schizophrenia

Answer 13

Adult diagnostic criteria
Treatment:
-Atypical antipsychotics are considered treatment of choice
-Abilify (first line): approved 13-17 years old
-Risperdal, Seroquel, Zyprexa: all approved 13-17 years old
-If onset is before 13, *medications will generally be used anyway

Question 14

aripiprazole use in peds

Answer 14

bipolar: 10-17 years old
irritability with autism: 6-17
schizophrenia: 13-17
tourette’s: 6-17

Question 15

asenapine use in peds

Answer 15

bipolar: 10-17 years old

Question 16

olanzapine use in peds

Answer 16

bipolar: 13-17 years old
schizophrenia: 13-17

Question 17

paliperidone use in peds

Answer 17

schizophrenia: 12-17 years old

Question 18

quetiapine use in peds

Answer 18

bipolar: 10-17
schizophrenia: 13-17

Question 19

risperidone use in peds

Answer 19

bipolar: 10-17
irritabiliy with autism: 5-17
schizophrenia: 13-17