Child and Adolescent Psychopharmacology

Summary

This 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

00:00

💊 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.

05:03

🤰 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.

10:04

🧒 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.

15:05

🧬 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.

20:07

💔 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.

25:08

💫 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.

Keywords

💡Psychopharmacology

Psychopharmacology is the study of the effects of drugs on mental processes and behavior. It is central to the video's theme, which discusses the prescription and impact of drugs on children and adolescents' mental health. The script mentions 'child and adolescent psychopharmacology' as a specialized area, highlighting the unique considerations required for prescribing medication to younger populations.

💡Off-label

Off-label use refers to the practice of prescribing medications for conditions or in patient groups for which they were not originally approved. The script notes that many drugs discussed for adolescents are 'off-label,' indicating the lack of specific approval for their use in this age group and the need for caution due to the potential uncertainty of their effects.

💡Mental Disorders

Mental disorders are conditions that affect a person's thinking, mood, and behavior. The script emphasizes the prevalence of mental disorders among children and adolescents, such as ADHD, depression, and anxiety, and the challenges in treating these conditions with psychotropic medications due to their developmental stages.

💡Pregnancy and Psychotropic Drugs

This concept addresses the complex issue of administering psychotropic medications during pregnancy due to the potential risks to the fetus. The video script discusses the lack of FDA approval for these drugs during pregnancy and the importance of making informed decisions about treatment, considering both the risks of the medication and untreated mental illness.

💡Anxiety Disorders

Anxiety disorders are characterized by excessive fear, worry, or nervousness that can interfere with daily life. The script identifies anxiety disorders as one of the most common mental health issues affecting children and adolescents, and it discusses the potential impact of untreated anxiety on pregnancy outcomes and the importance of considering both medication and non-medication interventions.

💡ADHD (Attention Deficit Hyperactivity Disorder)

ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. The script frequently mentions ADHD, discussing its biological basis related to dopaminergic activity and the use of stimulant medications to improve behavior and learning abilities in affected children.

💡SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs are a class of antidepressant medications that increase the levels of serotonin in the brain, which can help alleviate symptoms of depression and anxiety. The video script discusses the cautious use of SSRIs in children and adolescents, particularly noting the FDA's black box warning regarding the potential for increased suicidal thoughts and behaviors.

💡Autism Spectrum Disorder

Autism Spectrum Disorder is a developmental disorder affecting communication, social interaction, and behavior. The script discusses the use of certain medications, such as risperidone, to treat behaviors associated with autism, emphasizing the need for careful consideration due to the unique challenges and symptoms of the disorder.

💡Atypical Antipsychotic Drugs

Atypical antipsychotic drugs are a class of medication used to treat various mental health conditions, including schizophrenia and bipolar disorder. The script mentions these drugs as being effective in reducing irritability in autism and as part of the treatment for ADHD, while also highlighting potential serious side effects that require monitoring.

💡Omega-3 Fatty Acids

Omega-3 fatty acids are essential nutrients that have potential health benefits, including for brain health. The video script suggests the exploration of omega-3 supplements as a potential treatment for conditions like ADHD and bipolar disorder, noting their potential benefits and lack of known side effects.

💡Psychotic Disorders

Psychotic disorders are mental health conditions characterized by a loss of contact with reality, which can include hallucinations and delusions. The script briefly touches on the treatment of psychotic disorders in children and adolescents, noting the rarity of these conditions in younger populations and the significant challenges they present.

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