Pediatric Psychiatry Flashcards
Medication use in pediatric psychiatry
Kids have higher risk of significant adverse effects from medication than adults
DSM-5 tic disorders
Tourettes disorders: tics may wax and wane in frequency, but have been present for more than a year, onset before age 18
persistent motor or vocal tics : onset before age 18, patient present with one or the other symptom not both (must be present for more than a year)
Provisional tic disorder: must be present for more than a year and onset before age 18
Overview of tic disorders
75% also have ADHD, 50% also have OCD
rule of thirds: 1/3 resolve, 1/3 improve, 1/3 stay the same - around 10% have persistent symptoms as adults
First line treatment of tics
Clonidine, guanfacine, ER guanfacine
Second line treatment of tics
Aripiprazole: approved for 6-17 years old, weight based dosing greater than 50kg 2mg daily x 2 days, 5mg daily x 5 days, target 10mg once daily, max 20mg
risperidone
Third line treatment of tics
Haloperidol
pimozide
DSM-5 oppositional defiant disorder
pattern of angry/irritable mood, argumentative behavior, or vindictiveness lasting at least 6 months
if older than 5 behavior should occur on most days for at least 6 months
DSM-5 Conduct disorder
Repetitive 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 criterai present
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
Specify whether:
childhood onset type: <10 years old
Adolescent onset type: > 10 years
Unspecified onset: unclear information to determine age at onset
Treatment of ODD and CD
First choice : clonidine/ guanfacine
Second line: atypical antipsychotics to treat severe persistent aggression
EXAM Q treat underlying conditions (ADHD, depression/anxiety, mania) - ADHD common
Pharmacotherapy should only be considered adjunctive and only used after baseline symptoms have been determined or other interventions have failed
Often see combination stimulants/ alpha agonist treatment if ADHD with impulsivity or need for sedation for sleep
Treatment of separation anxiety disorder
SSRIs are the first line drug therapy - EXAM Q
Fluoxetine - 8 years and older
Escitalopram - 12 years and older
first line treatment for mild anxiety is psychotherapy and combination for moderate to severe anxiety
Always treat co-morbidities
DSM-5 autism spectrum disorder and symptoms
Persistant deficits in social communication and social interaction
restricted, repetitive patterns or behavior, interests, activities
symptoms include: aggression, hyperactivity, inattention, irritability, mood instability, self harm, sleep disturbance
no medications have shown efficacy in treating the core ASD symptoms
Treatment of disruptive behaviors in ASD
First line is always applied behavioral analysis
Aripiprazole (6-17 years old) and risperidone (5-16 years old)
Treatment of repetitive behaviors
haloperidol, risperidone, aripiprazole
Treatment of ADHD
methylphenidate preferred
Clonidine/ guanfacine - modest effect
Treatment of sleep problems
Melatonin 1-6mg nightly
DSM-5 Disruptive modd dysregulation disorder (DMDD)
Severe recurrent temper outburts manifested verbally that are out of proportion with the intensity of the situation
Present in at least two of three settings (home, school, with peers)
diagnosis should not be made before age 6 or after age 18
Treatment of DMDD
SSRIs and stimulants are considered to be first line treatment
need to differentiate from bipolar disorder
More similarity to depression, ADHD, or anxiety than bipolar disorder
Pediatric depression
Children - physical complaints, irritability
Adolescents - express feelings of depression and suicidal behaviors more than younger ages
More chronic than episodic, instability in mood common
Depression treatment
Nonpharm is first line: cognitive behavioral therapy
fluoxetine is the only antidepressant FDA approved to treat kids 8 years and older - EXAM Q
escitalopram 12 - 17 years old - EXAM Q
Black box warning for increased suicidal thought
Pediatric bipolar disorder treatment
For all types of bipolar ( BP I with or without psychosis, and Bipolar, depressed)
Lithium is first line treatment - EXAM Q
Other treatment options for bipolar disorder
Aripiprazole - 10-17 yo
Asenapine 10-17 yo
Lurasidone 10-17 yo
olanzapine 13-17 yo
Olanzapine/fluoxetine (for bipolar I depression) 10-17 yo
Quetiapine 10-17yo
Risperidone 10-17 yo
Pediatric post traumatic stress disorder
First line treatment is trauma focused therapy
First line treatment for pharmacotherapy is SSRIs
fluoxetine - 8 and older
escitalopram - 12 -17
Childhood- onset schizophrenia
use adult diagnostic criteria
not explained by substance use or PDD/autism
visual hallucinations more common than in adults
onset of symptoms before age 13
rare in children, adolescent prevalence reaches adult prevalence
Treatment options
Aripirpazole 13-17 yo
Brexpiprazole 13-17 yo
Lurasidone 13-17 yo
Olanzapine 13-17 yo
Paliperidone 12-17 yo
Quetiapine 13-17 yo
Risperidone 13- 17 yo
