Exam 4 Pediatric Psychiatry Flashcards
(32 cards)
Why is medication use limited in children?
Kids have a higher risk of significant adverse effects from medications than adults
What are the two psychiatric medications approved for kids and at what ages can they be used?
Risperidone: Age 5
Aripiprazole: Age 6-17
What criteria need to be met to be diagnosed with Tourette’s Disorder?
Tics can wax and wane in frequency but must be present for > 1 year
Onset before age 18
What comorbidities are common with Tic Disorders?
ADHD -75%
OCD -50%
What is the Rule of Thirds for tic disorders?
1/3 resolve
1/3 improve
1/3 stay the same
(about 10% have persistent symptoms as adults)
True or False: Stimulants can cause tics
TRUE
-we still treat ADHD though
-even if they exacerbate the tics, if benefit is greater then keep them on the stimulant
What is the first-line treatment for tic disorders?
Alpha-2 Agonists
-Clonidine
-Guanfacine
*ER Guanfacine
(30% reduction)
What is the second-line treatment for tic disorders?
Atypical antipsychotics
***Aripiprazole
Risperidone
(30-60% reduction)
What is the third-line treatment for tic disorders?
Typical antipsychotics
Haloperidol
Pimozide
(80% reduction)
Which medication has weight-based dosing?
Aripiprazole
Which medication has the highest D2 block of all atypical antipsychotics?
Risperidone/Paliperidone
What are the age cut-offs for the two types of Conduct Disorder?
Childhood-Onset: <10 years old
Adolescent-Onset: >10 years old
Unspecified Onset: unclear information to determine age of onset
What is the most common comorbid condition with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
ADHD
**must treat underlying conditions
What are the fist-choice drugs for treating Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
Stimulants
Clonidine/Guanfacine
*atypical antipsychotics are second-choice
*often see combination
When would we treat Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) with atypical antipsychotics?
-Severe persistent aggression
-Serious oppositional behaviors
-Defiance
When would we use a combination stimulant/alpha antagonist for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?
If comorbid ADHD with impulsivity or need for sedation for sleep
What is the first-line drug therapy for Separation Anxiety Disorder?
SSRIs (fluoxetine down to 8 years old)
*note that first-line treatment is therapy
What are the associated medical disorders with Autism Spectrum Disorder?
-Seizure disorder (up to 30%)
-GI disorders
What medications are used for Autism Spectrum Disorder?
No medications have currently shown efficacy in treating the core symptoms
For irritability/aggression or :stereotypy and hyperactivity:
-Aripiprazole (6-17yo)
-Risperidone (5-16yo)
*NOTE: lamotrigine/levetiracetam have no effect on irritability
What are the drugs used for repetitive behaviors?
Antipsychotics: Haloperidol, Risperidone, Aripiorazole
What medication can be used to help with sleep?
Melatonin 1-6mg nightly
What is Disruptive Mood Dysregulation Disorder (DMDD)?
-Severe recurrent temper outbursts manifesting verbally that are out of proportion with the intensity/duration of the situation
*present in at least 2 out of 3 settings and severe in at least 1
*diagnosis not made before age 6 or after age 18
What is the treatment used for Disruptive Mood Dysregulation Disorder (DMDD)?
SSRIs and Stimulants
*similar to depression, ADHD, or anxiety
*differentiate from bipolar disorder to decipher whether to use antidepressants and need for mood stabilizers
What is the only anti-depressant FDA approved to treat kids down to 8 years old?
Fluoxetine
