Child and Adolescent Psychopharmacology
Summary
TLDRThis lecture delves into child and adolescent psychopharmacology, highlighting the unique challenges of prescribing medication for young patients whose metabolic and hormonal systems differ from adults. It covers various psychiatric illnesses, the impact of untreated mental health during pregnancy, and the cautious use of drugs like SSRIs and antipsychotics. The importance of combining medication with therapy and the potential of omega-3 fatty acids in treatment are underscored, concluding with a look at pharmacological approaches to psychotic disorders in youth.
Takeaways
- 🔍 Psychopharmacology for children and adolescents is distinct from that for adults due to differences in metabolism, growth, and hormonal systems.
- 💊 Many drugs prescribed to adolescents are off-label, indicating a need for caution and deeper investigation into their effects.
- 🤰 The use of psychotropic drugs during pregnancy is a complex issue with no FDA-approved options, highlighting the importance of careful decision-making between women and their healthcare providers.
- 🚫 Untreated mental illness during pregnancy can lead to poor prenatal care, inadequate nutrition, and increased substance use, all of which can negatively affect the fetus.
- 🚫 Certain SSRIs carry risks during pregnancy, such as Paxil potentially increasing the risk of congenital malformations, while fluoxetine may be a safer choice.
- 👶 Preschool psychopharmacology is limited by scant research and should be a last resort, with a focus on severe cases and non-pharmacological interventions first.
- 💪 Atypical antipsychotic drugs can reduce irritability in children with autism, but they come with significant side effects requiring careful monitoring.
- 🎯 Stimulant medications for ADHD work by increasing dopamine levels in the prefrontal cortex, which is crucial for behavior regulation, and are most effective when combined with educational and mental health services.
- 🌟 Only two SSRIs are approved for treating depressive disorders in children and adolescents: fluoxetine and escitalopram, with the recommendation to include cognitive behavioral therapy.
- 🧠 Omega-3 fatty acids, particularly EPA and DHA, show potential in treating ADHD, bipolar disorder, and other behavioral problems without known side effects and are worth exploring.
- 🧪 Psychotic disorders in children are rare but significant, requiring careful consideration and exploration of treatment options due to limited data in this area.
Q & A
What is the main focus of the lecture on psychopharmacology across the lifespan?
-The lecture primarily focuses on child and adolescent psychopharmacology, discussing the unique considerations in prescribing medications for these age groups compared to adults.
Why is prescribing medication for children and adolescents different from adults?
-Children and adolescents have different metabolic systems, are still growing, and have different hormonal situations compared to adults, which makes the prescribing process distinct and requires special consideration.
What is the term used to describe the practice of prescribing drugs off-label for adolescents?
-The term used is 'Wild West,' indicating the lack of strict regulations and the need for caution in this area of medicine.
What percentage of children between the ages of 3 and 17 experience some mental disorder in any given year?
-About thirteen to twenty percent of children between the ages of 3 and 17 experience some mental disorder in any given year.
Which psychiatric illnesses are mentioned as having their greatest toll during childhood and adolescence?
-Anxiety disorders, depression, and ADHD are mentioned as having their greatest toll during childhood and adolescence.
Why is the use of psychotropic drugs during pregnancy a complex issue?
-The use of psychotropic drugs during pregnancy is complex because untreated mental illness can have negative effects on both the mother and the fetus, but the drugs themselves may also pose risks to the fetus.
What are some of the potential risks of using psychoactive medication during pregnancy?
-Potential risks include the possibility of teratogenic damage to the fetus, postnatal behavioral abnormalities, and neonatal toxicity from breastfeeding.
What is the general recommendation regarding the use of SSRIs during pregnancy?
-The recommendation is to avoid certain SSRIs like Paxil during the first trimester due to increased risks of congenital malformations, and Fluoxetine might be considered the best choice among them.
What are some of the challenges in treating preschool children with psychopharmacology?
-Challenges include the scarcity of research and practice guidelines, the need to prioritize non-medication interventions, and the focus on severe cases where children are significantly impaired.
What are the two FDA-approved SSRIs for treating depression in adolescents?
-The two FDA-approved SSRIs for treating depression in adolescents are fluoxetine (Prozac) and escitalopram (Lexapro).
What is the role of cognitive behavioral therapy in treating childhood and adolescent depression?
-Cognitive behavioral therapy is recommended to be combined with medication for treating depression in children and adolescents, as it enhances the safety and effectiveness of the treatment.
What is the potential benefit of omega-3 fatty acids in treating certain mental health conditions?
-Omega-3 fatty acids, particularly EPA and DHA, show potential in treating ADHD, bipolar disorder, and other behavioral problems, with the advantage of having no known side effects.
How do atypical antipsychotic drugs help in treating autism spectrum disorders?
-Atypical antipsychotic drugs, such as risperidone and aripiprazole, have been shown to reduce irritability and aggression associated with autism spectrum disorders, although they require careful monitoring due to potential side effects.
What are some of the side effects associated with stimulant medications used to treat ADHD?
-Side effects of stimulant medications for ADHD can include insomnia, elevated blood pressure and heart rate, reduced appetite, possible growth suppression, and potential for exacerbating psychiatric symptoms.
What is the significance of the prefrontal cortex in ADHD?
-The prefrontal cortex plays a critical role in regulating behavior, attention, and cognition. Disruptions in its functioning, possibly due to alterations in dopaminergic activity, are believed to be linked to ADHD symptoms.
Outlines
💊 Introduction to Child and Adolescent Psychopharmacology
The lecture introduces the complexities of psychopharmacology in children and adolescents, emphasizing the differences in metabolic and hormonal systems compared to adults. It highlights the importance of cautious medication prescribing due to the off-label use common in this demographic. The lecture will cover various psychiatric illnesses in young populations, the impact of psychotropic drugs during pregnancy, and touch upon the use of omega-3 fatty acids and medications for psychotic disorders. The statistics provided underscore the prevalence of mental disorders in children and the necessity of careful treatment considerations.
🤰 Psychopharmacology and Pregnancy: Challenges and Considerations
This section delves into the intricate issue of using psychotropic drugs during pregnancy, discussing the lack of FDA approval for such use and the potential risks to the fetus, including structural damage and postnatal behavioral abnormalities. It outlines the dilemma of untreated mental illness during pregnancy, which can lead to poor prenatal care and increased substance abuse, and the importance of making informed decisions with healthcare providers. The summary also reviews the potential impact of untreated mental health on pregnancy outcomes and the options available for treating various conditions like depression, bipolar disorder, and schizophrenia during pregnancy.
🧒 Preschool Psychopharmacology: Cautions and Guidelines
The third paragraph addresses the limited research and guidelines for psychopharmacology in preschool children, stating that medication should be a last resort due to the potential for severe side effects. It discusses the importance of focusing on children with severe symptoms or impairments and the necessity of a comprehensive psychiatric evaluation before initiating treatment. The summary also covers the importance of developing a treatment plan that includes psychosocial support and monitoring outcomes, as well as the need for caution and education regarding medication use in this age group.
🧬 Long-Term Treatment of Autism and ADHD in Children and Adolescents
This section discusses the long-term treatment of children and adolescents with autism and ADHD, noting the increase in autism diagnoses and the use of psychotropic drugs to reduce aggression and self-injurious behaviors. It details the efficacy of atypical antipsychotic drugs and the importance of monitoring for serious side effects. The paragraph also covers the biological basis for ADHD, the role of stimulants in treating the disorder, and the significance of combining medication with educational and mental health services for optimal outcomes.
💔 Depression and Anxiety in Children and Adolescents: Treatment Approaches
The fifth paragraph focuses on the treatment of depression and anxiety in children and adolescents, highlighting the high prevalence of suicidal ideation and the importance of exploring childhood adversity. It discusses the FDA approval of specific SSRIs for use in adolescents and the need for caution due to the potential for exacerbating suicide risk. The summary also emphasizes the benefits of combining medication with cognitive behavioral therapy for treating anxiety disorders and the potential of omega-3 fatty acids as a supplement for various mental health conditions.
💫 Psychotic Disorders in Children: A Rare but Significant Challenge
The final paragraph addresses the rare occurrence of psychotic disorders in children and the significant challenges they present. It notes the lack of sufficient data for treatment and the importance of exploring the best treatments available for those exhibiting psychotic symptoms. The summary acknowledges the rarity of psychotic disorders in children and the need for further information and research in this area, setting the stage for the next topic in the series, geriatric psychopharmacology.
Mindmap
Keywords
💡Psychopharmacology
💡Off-label
💡Mental Disorders
💡Pregnancy and Psychotropic Drugs
💡Anxiety Disorders
💡ADHD (Attention Deficit Hyperactivity Disorder)
💡SSRIs (Selective Serotonin Reuptake Inhibitors)
💡Autism Spectrum Disorder
💡Atypical Antipsychotic Drugs
💡Omega-3 Fatty Acids
💡Psychotic Disorders
Highlights
Psychopharmacology for children and adolescents differs significantly from adults due to different metabolic systems and developmental stages.
Many medications for adolescents are often prescribed off-label, making cautious and informed decisions crucial.
Thirteen to twenty percent of children aged 3 to 17 experience some mental disorder annually, with half of all lifetime psychiatric illnesses starting before age 14.
Anxiety, depression, and ADHD are the most common psychiatric illnesses in children and adolescents.
No psychotropic drug is FDA approved for use during pregnancy, necessitating careful risk-benefit analysis.
Untreated mental illness during pregnancy can lead to poor prenatal care, inadequate nutrition, and increased substance use.
Potential impacts of untreated mental illness during pregnancy include long labor, fetal distress, preterm labor, spontaneous abortion, and reduced developmental scores.
For severe mental health problems in preschool children, psychopharmacology responses are considered a last resort.
Only severe cases of ADHD in preschoolers might justify short-term medication use, reassessed every six months.
Antipsychotic drugs for severe disruptive behaviors should not be used as chemical restraints for caregiver convenience.
Fluoxetine (Prozac) is the most recommended SSRI for pregnant women due to its lower risk profile compared to other SSRIs.
Lithium and lamotrigine are considered safer mood stabilizers during pregnancy compared to valproic acid and carbamazepine.
Risperidone and aripiprazole are FDA-approved for treating irritability associated with autism in children aged 5 to 17.
Combining psychopharmacology with education and mental health services is crucial for treating ADHD in children and adolescents.
Omega-3 fatty acid supplements show potential benefits for children with ADHD, bipolar disorder, and other behavioral problems with no known side effects.
Transcripts
hello and welcome to lecture number 15
in the series on drugs and human
behavior today we're going to be talking
about psychopharmacology across the
lifespan specifically in this lecture
we're going to talk about child and
adolescent psychopharmacology the
following lecture in this series will be
on geriatric psychopharmacology today
we're going to talk about child and
adolescent psychopharmacology I think
it's really important to understand
before we get into this topic very
deeply that prescribing medications for
children and adolescents is a completely
different thing from prescribing drugs
for adults oftentimes physicians and
other practitioners have taken the
approach that children are just smaller
adults and that's not the case they have
very different metabolic systems be
obviously growing a completely different
hormonal situation so it's really
important to keep that in mind and many
of the drugs that we'll talk about or
oftentimes written off-label for
adolescents and so it's kind of a Wild
West out there so you have to be very
cautious and really try to dig into this
a little bit deeper we're in it present
some of the issues talk a little bit
about some of the research but it's
never an easy question about providing a
psychotropic medication for children
unless it's absolutely necessary so
we'll talk about today our first child
adolescent psychiatric illnesses talked
about pregnancy and psychotropic drugs
and issues they're talked about
preschool psycho preschool
psychopharmacology and then get into
really the sort of typical things that
come up in children and adolescents
autism attention deficit hyperactivity
disorder depression anxiety disorders
talk a little bit about omega-3 fatty
acids and then finally finish up with
medications for treating psychotic
disorders so about thirteen to twenty
percent of children between the ages of
3 and 17 years experience some mental
disorder in any given
year half of all lifetime adult
psychiatric illnesses start prior to the
age of 14
these include anxiety disorders
depression attention deficit
hyperactivity disorder and schizophrenia
bipolar disorder eating disorders autism
spectrum spectrum disorders etc so this
is a pretty significant problem with a
mental illness in children and
adolescents in particular anxiety
depression and ADHD seem to have their
greatest toll in childhood and
adolescence schizophrenia often times
age of onset is late teens early 20s we
talked already about bipolar disorder
and often times the first symptoms are
at around age 15 eating disorders are
certainly oftentimes arise around 13 or
14 and then autism spectrum disorders of
course start during or early childhood I
want to talk a little bit about
pregnancy and psychotropic drugs this is
a tough issue to struggle with because
we don't want to leave women untreated
but we also want to limit the right
agenda s'ti of these drugs want to make
it very clear no psychotropic drug is
FDA approved for use during pregnancy so
any use of these drugs is probably
something to be taken very seriously a
no-decision regarding psychiatric
treatment is risk free and no decision
is perfect again I think it's entirely
up to women and their doctors to make
this decision together more than 1/2
million women each year have a
psychiatric illness that either predates
or emerges during pregnancy pregnancy
the pretty difficult thing often times
the hormonal changes oftentimes can
really be problematic for some women and
certainly depression can emerge during
that time and anxiety about being a
mother
certainly perfectly understandable so we
want to make sure that we are responsive
to these needs and make sure that
treatment is available
we know that psychoactive medications
cross the blood-brain barrier so as a
rule the fetus will have the same blood
level of drug as does the mother because
the placental barrier is far less
effective than the blood-brain barrier
risks of using psychoactive medication
include potential to write a genic
damage so some sort of structural damage
to the fetus if mothers continue their
medications during pregnancy there is
problems with postnatal behavioral
abnormalities from medication
administered during pregnancy will talk
about antipsychotics being administered
in the third trimester oftentimes result
in behavioural abnormalities in infants
some perinatal syndromes or neonatal
toxicity from breastfeeding for medkit
medications continued after pregnancy
many of these drugs will express
themselves in breast milk but there are
also risks from untreated mental illness
during pregnancy poor compliance with
prenatal care and adequate nutrition we
know depression certainly oftentimes
people don't eat or don't eat well or
don't eat right possible exposure to
undesired drugs medication or herbs that
may be worse than the sector with
medication well sometimes we'll
self-medicate with alcohol or other
drugs again increased caffeine alcohol
and tobacco use all of which are
problematic during pregnancy
we have deficits in infant mother
bonding and disruptions to the family
environment all because of inadequate
treatment for mental illness
here are a summary of the potential
impact of untreated mental health
illness on pregnancy outcomes so for
anxiety disorders untreated can end up
with long labor fetal distress preterm
labor or spontaneous abortion even in
terms of the neonatal complications
reduced developmental scores slowed
mental development
one option is fluoxetine as a drug but
probably some psychological therapy is I
would say a better choice for depression
in dis Tommy ow result in low birth
weight reduced fetal growth and
postnatal complications reduced
hippocampal volume in mother and
possibly infant those increased stress
hormone levels can result in reduced
bonding small size and low weight SSRIs
there are a few options certainly
psychotherapy maybe omega-3 fatty acids
and electroconvulsive therapy has been
increasingly used to treat pregnant
women bipolar disorder similar risks all
around there are some options available
we'll talk about then with schizophrenia
untreated increased rate of postnatal
death preterm low weight which can
potentially be treated with
antipsychotics
one of the important things to
understand about treating depression of
women is some sort of adequate treatment
is important so if you look at the
people who relapse or don't relapse
they're less likely to relapse if they
continue their medication during
pregnancy so finding the right
medication is probably important so
women with severe depressing risk are at
high risk for relapse depression during
pregnancy results in increased risks of
postpartum depression a women who
discontinued medication do relapse more
frequently so it's an important
consideration so let's jump right into
what are the problems of SSRI top
antidepressant since this is the most
common the FDA has warned that paxil
used during the first trimester can
result in increased risks of congenital
malformations mostly cardiac defects the
American Council of Gynaecologists or
obstetrics and gynecology sorry advises
against the use of paroxetine sertraline
and citalopram during pregnancy because
an increased risks of the incidence of
congenital malformations although it's
very small but blocks a teen or prozac
had the lowest risk so that's probably
the best choice a follow-up paper did
not support the association between SSRI
use and major congenital malformations
but I think safe safer than sorry
I would certainly avoid a paxil during
the first trimester so probably
fluoxetine is the best choice or perhaps
trying omega-3 fatty acids or if it's
severe enough depression some ECT so the
use of mood stabilizers during pregnancy
untreated maternal mood disorders are
serious risk factors including
impulsivity and impaired judgments of
the pregnant mother
for self-care drug and alcohol abuse
manic episodes in their personal life
disruptions all of these have potential
harmful effects on the fetus as well as
the mother there is some triage Anisa t
of mood stabilizing medications lithium
seems to be a modest teratogen there's
some risk of cardiac malformations
valproic acid is the worst
so let's avoid that car baza
carbamazepine is slightly teratogenic
risk of adverse fetal outcomes is
increased by about 3%
lamotrigine is not considered a major
major trata Jen slight risk for a cleft
palate lip or palate which is treated
with surgery topamax associated with
increase in major congenital
malformations including oral clubs and
penile malformation so that's probably
another one to be avoided so limit
Regina is probably the go-to drug also
potentially lithium if it's severe
enough typical antipsychotics have long
been used in early pregnancy to treat
nausea and vomiting so they're not
associated with any major - right Oh
Jeanette consequences these drugs should
not be could disconnect because risks of
treatment discontinuation outweigh any
risks of medical continuation clozapine
and Alonza pean are associated with high
birth weight so there is a possible risk
of diabetes so these probably aren't the
best choice for pregnant women
risperidone or risperdal is using trutta
the third trimester can be associated
with some infant jitteriness
irritability feeding problems in somnus
somnolence should be used during
pregnancy only if the benefits outweigh
the potential risks so probably best to
avoid that certainly in the third
trimester
so while the risks associated with use
of some of these drugs during pregnancy
may be high the risks from not treating
are also high so it's a tough decision
to try to make the best thing to do is
to be as informed as possible try to
make an informed decision with your
doctor and do the best that you can but
again there are certainly some drugs to
be avoided and some drugs that certainly
are just fine so this moves us into
talking about preschool
psychopharmacology there is scant
research or practice guidelines prior to
2007 in fact there's still not a great
deal of research it's very hard to do
research in this age range preschool
children with severe mental health
problems present a dilemma when they
don't respond to non-medication
interventions in this population
Sacre pharmaco pharmacology responses
are probably the last choice so drugs
are probably going to be our last resort
in this area so trying other forms of
behavioral intervention is certainly the
first thing to try to do so the focus on
young children with moderate severe
symptoms or impairments some psycho
pharmacological interventions are not
indicated for preschoolers with mild or
single content symptoms or impairments
so these are only for severe cases in
preschool children so those with severe
symptoms or impairments they're not able
to function they're not able to go
school this has to be a severe case
again these are drugs of life these are
the sort of treatment of last resort so
for some cases there are appropriate
uses of these drugs so for attention
deficit hyperactivity disorder
an average of about 14 milligrams a day
and immediate release products reproduce
significant reductions in ADHD symptoms
though that's not not as efficacious as
for school-aged children the protocols
are if it's effective no more than six
months and then reassessed and see if
that hasn't spurred some sort of
development that can be continued
without further use of these medications
for severe disruptive behaviors these of
atypical antipsychotic drugs without any
accompanying psychotherapy are this is
often done as what we call sort of a
chemical restraint are just simply given
to get children these kind of children
to just behave or not be a problem and
this is certainly not something that
would not be endorsed and I would never
just endorse this kind of use of these
kinds of drugs these drugs are for
severely impaired children only not for
caretaker convenience for depression
psychotherapy not medication no
antidepressants in this age group for
bipolar disorder there's no clear
consensus that bipolar disorder occurs
in pre schoolers so I would be against
any treatment there and then for autism
spectrum disorders there are two drugs
that show some use for treating this
disorder so risperidone showed 63%
positive response rate for behaviors
associated with autism and it's been
approved by the fda for ages five and
over for behaviors associated with
autism irreparable aera pippers ol is
FDA approved for irritability associated
with autism for ages 6 to 17
and so that's a possible way to treat
the kind of irritability and difficulty
with autistic kids in terms of the
clinical guidelines for secretary with
medications and children and adolescents
so before initiating psychotherapy there
should be a complete psychiatric
evaluation including physical evaluation
all of that when appropriate should
include a history and medication
evaluate minute evaluation and treatment
should communicate with other
professionals to obtain history and set
the stage for monitoring of any use of
these medications before prescribing
develop psychosocial and medication
plans this isn't a case where kids at
this age should just be the parents
handed a prescription and some other way
there needs to be a plan needs to
include therapy needs to include some
psychosocial help there's also we need
to develop short and long term plans for
outcome monitoring how are we going to
know if this is working how are we going
to know if it's going to continue we
need to know that before we we dive into
these things if there's no monitoring
involved proceed with caution I would
actually argue perceived not at all if
there's going to be no monitoring
everyone needs to be educated about the
treatment plan need to document the
assent of the child and consent to
parents focus on risks and benefits of
medications and alternatives so a
thorough evaluation trying to decide
what's the best course by looking at
risks and benefits best thing to do is
implement a medication trial 30 days
come back in 30 days and we'll see where
we are I'm back 30 days after that
reassess treatment plan if there's no
response to the initial medication
develop a specific plan if there is
medication for discontinuation trial
so figuring out how we're going to get
how we're going to go forward not just
throwing a prescription out and hoping
for the best it's certainly not an
appropriate way to go about that so
we'll move now into talking about sort
of longer term treatment of children
adolescents beyond preschool we know
that the there is an increase in the
diagnosis of autism primarily due to
alterations in how we diagnose autism
and education about diagnosing autism
psychotropic drugs have been shown to
reduce aggression and self-injurious
behaviors anxiety those repetitive
stereotyped behaviors and other
maladaptive behaviors in autism spectrum
disorder children medication may be
particularly useful to reduce physical
aggression and self-injurious behaviors
and adolescents as they get bigger and
they get stronger this can become more
dangerous for caregivers and for the
child themselves so this is really only
in cases where this kind of aggression
is problematic
certainly not all autism spectrum
disorder kids are going to need this
kind of medication but those that might
the atypical antipsychotic drugs seem to
be the most clinically effective so
that's what we're going to turn next
talk about a typical antipsychotic drugs
they can reduce the irritability
associated with autism they do have
serious side effects much like we talked
about already weight gain glucose
intolerance hyperlipidemia so monitoring
is going to be very necessary for these
patients
some changes are resistant to treatment
even with stimulants era pip Rizal
appears to have fewer metabolic and
sedating side-effects that are unknown
and if improves the core symptoms of
autism
risperidone has been firmly approved for
the F by the FDA for treating your
availability and autistic children
adolescents also improve mood disorders
and reduce disruptive behaviors let's
take a look at that
so here are the same earring
irritability score you can see pretty
significant reductions in that score
compared to placebo so the only
medication treatments for autism
spectrum disorders are really those to
treat those irritability and aggression
the core symptoms of autism certainly
have no pharmacological treatments so
let's move on to talk about attention
deficit hyperactivity disorder this is
certainly an area where probably most
this is an area where most of the
psychotropic drugs given to add less
children or adolescents is in this area
biologically attention deficit
hyperactivity disorder appears to follow
from alterations in the dopaminergic
activity in the prefrontal cortex the
prefrontal cortex is critical and
regulating behavior attention and
cognition lesions to the prefrontal
cortex can produce distractibility
forgetfulness impulsivity poor planning
and low comodo
locomotor hyperactivity all are
prominent in ADHD this is why we think
ADHD seems to be some disruption in
prefrontal cortex functioning the
prefrontal cortex requires optimal
levels of norepinephrine and dopamine
essentially those neurotransmitter
levels are required for the prefrontal
cortex to be able to take control that
is to limit impulsiveness one of the
most important functions of the
prefrontal cortex is to inhibit things
that we don't need to pay attention to
right now
and so that active inhibition process is
important and that's conduct that occurs
through norepinephrine and dopamine and
so this is why stimulants actually have
this paradoxical effect of calming down
ADHD children because it allows that
prefrontal cortex to take control again
so the stimulus tend to augment
deficient dopaminergic and
norepinephrine subsystem systems
these are one of the most broadly
effective drug therapies about sixty to
eighty percent of children with ADHD
show improved behavior and learning
abilities when combined with education
and mental health services I think by
now you've probably learned that I'm not
a fan of just handing people pills and
sending them on their way including
education and mental health services is
an important component of all of this
and particularly in this case what's
important from this data though is that
the long-term learning outcomes are
better for children who are
appropriately treated and I think that's
something that's really important for us
to consider so the first of these drugs
that is the most common is
methylphenidate which is Ritalin and has
a fairly rapid onset but short duration
of action a short half-life is a problem
in some children who served experienced
it's end of does rebound and
dysfunctional behavior so their
medication whereas often they get this
massive rebound so that results in
schools having to have medication
available for the students to take there
are multiple dosage and delivery forms
so there are longer acting forms that
will talk about the efficacy of this
drug is due to increases in dopamine in
the synaptic cleft by blocking
presynaptic dopamine transporters PET
scans studies show peak levels in the
brain about 60 minutes after oral
administration that's pretty clear
concerta is a new formulation of this
drug the tablet that contains an osmotic
pump that gradually releases
methylphenidate over a 10 hour period
and then the shell just gets excreted
there are transdermal versions of ADHD
and caregivers report high satisfaction
satisfaction with the patch improved
behavior and then less need to worry
about miss doses adderall is another
drug available for treatment it is
amphetamine and dextroamphetamine has
longer half-life that's certainly much
greater abuse potential strattera is a
norepinephrine reuptake inhibitor that's
approved for treating ADHD in children
and adults it's more effective in
treatment now you patients than in
patients previously treated with
stimulants so it suggests a trial of
animosity which is strattera
prior to the use of stimulants so this
might be the first thing to try rather
than starting with stimulants so there
are of course side effects of stimulant
medications including insomnia elevated
blood pressure and heart rate reduced
appetite possible growth suppression
potential for new worsening behavior and
thoughts new worsening bipolar illness
near worsening aggression and hostility
problems and in children and teenagers
the potential for new psychiatric since
symptoms so want to watch out for that
because potentially can cause some level
of psychosis so it's certainly something
to monitor
depression in children adolescence is
certainly can be a problem there's a
high prevalence of suicidal ideation and
completed suicides among children and
adolescents with depressive disorders we
certainly want to make sure that we are
treating this disorder in these children
to avoid this unfortunate occurrence 62
percent of children with depression had
experienced some sort of childhood
adversity so it's certainly something to
explore adolescence is the period of
highest risk for the onset of depression
untreated childhood and adolescent
depression is associated with later
development of serious personality
disorders and early adulthood so
treating depression in children and
adolescence is an important thing to do
there are only two approved SSRIs for
usin adolescents fluoxetine and SD
hologram so we'll talk about these
individually actually just going to talk
about essa telegram until recently
prozac was young we drive approved in
the US for childhood depression 2009 the
fda approved a cell jammer or lexapro
for the treatment of adolescent stage 12
to 17 significant reductions in
moderate reductions in child depression
ratings compared to placebo there are no
head-to-head comparisons far between
lexapro and Prozac one of the problems
with treating and to prevent treating
children xander depressants that they
all have a block block box warning on
the potential for exacerbating suicide
in 2002 264 children adolescents died by
suicide in the US fda report leaked many
of these deaths to SSRI treatment and
recommended black box warnings to be
required in 2005 unfortunately there's
no clear evidence as to what was going
on here we also know we do know that you
get a reduction in SSRI use also
increases the rates of suicide
so SSRI use in this population went down
rates of suicide went up most suicides
occurred in the context of persistent
depression and insufficient improvement
so it's not necessarily so that the
drugs actually induce the suicidal
behavior one of the things to do is to
add cognitive behavioral therapy again
not just prescribing that adding
cognitive Havel behavioral therapy makes
this a much safer proposition so here's
a summary and recommend the
recommendation from the US Preventive
Services Task Force for broad screening
of children and adolescents for
depressive disorders assess for risk
provide some screening tests including
the patient Health Questionnaire for
adolescents and the Beck Depression
Inventory they don't do as well younger
children but it certainly adolescents
they can
in terms of treatment fluoxetine has
been found to be effective but we need
to include that with psychopharmacology
in terms of treating anxiety disorders
the best outcome with anxiety disorders
is combining zoloft with cognitive
behavioral therapy on their own non
either cognitive behavioral therapy or
Zoloft or circling or any different in
terms of their outcome so only the
combination of those two seems to work
so the best thing for anxiety disorder
is again cognitive behavioral therapy
possibly combined with zola one things
we've talked about a number of these
talks is omega-3 fatty acids and this is
one of those things that there's such
potential benefits for and no known side
effects that I think it's worth
exploring so omega 3 fatty acid
supplements that are high in eco step
atomic acid let's say you say that EPA
was abducted for children with ADHD
bipolar disorder and other educational
behavioral problems Omega bright D
supplement was evaluated in 20 children
with bipolar disorder half experienced a
rapid 30% reduction in symptoms with no
side effects so there I think there is
some potential to explore the use of
these kinds of supplements like omega-3
fatty acids and DHA
that maybe can help treat certainly in
young younger kids or prevent even these
kinds of problems so the final thing to
talk about are medications for treating
psychotic disorders because it's so rare
and children prevent significant
challenges when it appears it occurs
more often in adolescents with gray
matter deficiencies in frontal parietal
lobes before the onset of first episode
symptoms and 1 in 3 schizophrenia
patients develop psychotic symptoms
between ages 10 and 20 so the problem is
there is not enough data in this area if
someone is showing psychotic symptoms
that has to be treated the best
treatments for those are going to have
to be explored so I can't make any
recommendations for you but it's
certainly something that we need to
consider and possibly certainly get some
more information about well thank you
that's our discussion of child
adolescent psychopharmacology the next
thing we'll have coming is geriatric
psychopharmacology
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