Pediatric Psychiatry Flashcards
Med use in peds risk
-kids have higher risk of significant side effects
DSM-5 Tic Disorders
-Tourette’s
-Persistent Motor OR! Vocal Tic Disorder
-Provisional Tic disorder (sx less than year)
Tourette’s Disorder
-tics may wax and wane in freq but present >1 year
-onset before 18
-motor and vocal tics both present
Overview of Tic disorders
-75% also have ADHD
-50% also have OCD
-rule of thirds: 1/3 resolve, improve, stay same
-10% have sx as adults
Tx of Tics
- a2 gaonists (clonidine, guanfacine)
- aripiprazole or risperidone
- haloperidol
aripiprazole in kids
-FDA approved 6-17 years old
-weight based dosing
Stimulant use in Tourette’s
-must tx BOTH ADHD and Tourette’s
-can dc if amphetamine-based stimulant and try atomoxetine or TCA
-if ADHD not controlled, resume amphetamine-based stimulant and adj dose of antipsychotic to better control Tourette’s
Conduct disorder
-specify whether:
-childhood onset <10
-adolescent onset >10
-unspecified onset
-basic rights or societal norms violated in past year (bully/theft)
Oppositional Defiant disorder
-angry, defiant behavior >6 months
Tx of ODD and CD when
-pharma only after baseline sx determined, other interventions have failed, and/or aggression has escalated to dangerous levels
-treat underlying conditions (ADHD, anxiey, depression, mania)
ODD and CD tx
- stimulants + guanfacine/clonidine
- Atypical antipsychotics for severe/persistent aggresion/defiance
-often see combo stimulant/a2 if ADHD w impulsivity or need for sedation for sleep
Separation Anxiety Tx
-psychotherapy + adj for mod to severe
-SSRI first line
-treat underlying depression, ADHD, screen for bipolar
DSM-5 Autism Spectrum Disorder (ASD)
-persistent deficits in social communications and social interaction across multiple context
-restricted, repetitive patterns of behavior, interests, activities
hallmark signs and sx of ASD
-associated behavioral sx: aggression, hyperactivity, inattention, irritability, moood instability, poor frustration tolerance, self-harm, severe temper tantrum, sleep disturbances, OCD sx, hypersensitivity of senses
-associated w seizure (up to 30%) and GI disorders
-no meds have shown overall efficacy
Treatment of Disruptive behaviors in ASD
-behavioral interventions are first-line treatment (applied behavioral analysis)
-atypical antipsychotics approved for irritability/aggression are considered first-line agents, may have efficacy for stereotypy and hyperactivity
-aripiprazole (6-17 years old)
-risperidone (5-16 years old)
Tx of repetitive behaviors in kids
-antipsychotics:
-haloperidol
-risperidone
-aripiprazole
ADHD tx in kids
-stimulants (methylphenidate preferred)
-clonidine/guanfacine: modest effect on irritability and explosive behavior
Sleep tx in kids
-melatonin reduced sleep latency and inc time asleep
-1-6mg nightly
DSM-5 disruptive mood dysregulation disorder (DMDD)
-severe recurrent temper outbursts manifested verbally that are out of proportion with the intensity/duration of the situation
-present in at least two of three settings (home, school, w peers) and are severe in at least one of these
-dx should NOT be made before age 6 or after 18
DMDD treatment
-more similarity to depression/ADHD/anxiety than bipolar
-need to differentiate from bipolar (antidepressant use and eval need for mood stabilizer)
-SSRIs and stimulants are considered first-line
Pediatric Depression
-kids: physical complaints, irritability, conduct, suicidal ideation
-adolescents: express feelings of depression/suicide more often than kids
-more chronic
-instability in mood common
-may be marker for bipolar
Depression tx in kids
-nonpharma first-line, need motivation of familty/caregivers for success
-CBT 70% success
-antidepressant suicide risk
-fluoxetine age 8+
-escitalopram 12+
-AvOID paroxetine in kids (suicide warning)
Antidepressant suicide risk
-highest risk in first 1-3 months
-med guide w each Rx
-antidepressants may lower completed suicide rate
Bipolar I w/o psychosis tx in kids
-lithium
-valproate
-carbamazepine
-olanzapine
-risperidone
-quetiapine
-may augment w 2nd agent if needed after 4 weeks
Bipolar I w psychosis tx in kids
-lithium
-valproate
-carbamazepine
-WITH any atypical antipsychotic
-consider sc atypical antipsychotic if remission 12-24 months
Bipolar depressed tx in kids
- lithium
-SRRI/bupropion for depression in adj to lithium
PTSD in kids
-trauma-focused therapy
-SSRIs
Childhood onset schizophrenia
-use adult dx criteria
-not explained by substance use or PDD/autism
-more hallucinations than in adults
-onset of sx before age 13
-rare in kids, adolescent prevalence reaches adult prevalence of 0.5-1%
Atypical antipsychotics for kids
-Aripiprazole
-Asenapine
-Brexpiprazole
-Lurasidone
-Olanzapine
-Olanzapine/Fluoxetine
-Paliperidone
-Quetiapine
-Risperidone
SSRIs for kids
Aripiprazole
-bipolar 10-17
-autism irritability 6-17
-schizophrenia 13-17
-Tourette’s 6-17
Asenapine
-10-17
Brexpiprazole
-schizophrenia 13-17
Lurasidone
-schizophrenia 13-17
-bipolar 10-17
Olanzapine
-bipolar disorder 13-17
-schizophrenia 13-17
Olanzapine/Fluoxetine
-bipolar I 10-17
Paliperidone
-schizophrenia 12-17
Quetiapine
-bipolar 10-17
-schizophrenia 13-17
Risperidone
-bipolar 10-17
-irritability 5-17
-schizophrenia 13-17
