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Psychopharmacology > Lecture 23: Child & Adolescent Psychopharmacology > Flashcards

Lecture 23: Child & Adolescent Psychopharmacology Flashcards

1
Q

how many women have a psychiatric illness that predates or emerges during pregnancy?

A

500,000

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2
Q

3 potential risks of psychoactive medication to fetus

A
  1. teratogenic damage (physical abnormalities)
  2. behavioral abnormalities
  3. neonatal toxicity through breastfeeding
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3
Q

untreated maternal illness can result in (6)

A
  1. poor compliance with prenatal care
  2. poor nutrition
  3. drug exposure
  4. increased self medication
  5. deficits in mother infant bonding
  6. disruptions in family environment
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4
Q

impact of anxiety disorders on fetus (obstetric, 4)

A
  1. long labor
  2. fetal distress
  3. preterm labor
  4. spontaneous abortion
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5
Q

what % of pregnancies are unplanned?

A

50%

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6
Q

depression during pregnancy leads to increased risk of ___

A

postpartum depression

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7
Q

what can increase the risk of teratogenicity in pregnancy?

A

more than one antidepressant

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8
Q

SSRI discontinuation symptoms in baby (5)

A
  1. irritability
  2. constant crying
  3. sleep disturbances
  4. hyperactive reflexes
  5. breathing and feeding difficulties
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9
Q

4 anxiety disorders in preschoolers

A
  1. situational anxiety
  2. generalized anxiety
  3. selective mutism
  4. specific phobias
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10
Q

first pharmacological choice for child anxiety disorders

A

prozac

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11
Q

__% of medical practitioners prescribe medications for preschooler PTSD

A

89%

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12
Q

autism must present before ___

A

age 3

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13
Q

non-autism pervasive developmental disorders are usually recognized by ___

A

age 3

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14
Q

what two drugs are used to treat irritability and autism-associated behaviors?

A

risperidone

aripiprazole

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15
Q

autism affects __% of all children

A

1%

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16
Q

impact of anxiety disorders on fetus (neonatal, 2)

A
  1. reduced developmental scores

2. slowed mental development

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17
Q

the risk of a bipolar episode during pregnancy is ___ for a female diagnosed with bipolar disorder

A

71%

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18
Q

bipolar: time to first recurrence is _x shorter once medication is stopped

A

4x

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19
Q

the risk of a bipolar episode is ___ if a woman discontinues medication

A

doubled

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20
Q

bipolar after stopping meds: proportion of weeks spent in episodes is _x greater

A

5x

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21
Q

pregnancy risk of lithium

A

cardiac malformations

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22
Q

3 risks of valproic acid in pregnancy

A
  1. highest risk of congenital malformations
  2. can impair cog functioning and lower IQ
  3. can increase risk for autism spectrum disorder
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23
Q

danger of topiramate

A

high risk of congenital malformations such as oral clefts and penile malformations

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24
Q

3 high risk mood stabilizers for pregnancy

A
  1. lithium
  2. valproic acid
  3. topiramate
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25
Q

3 low risk mood stabilizers for pregnancy

A
  1. carbamazepine
  2. lamotrigine
  3. gabapentin
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26
Q

pregnancy risk for carbamazepine

A

slightly teratogenic

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27
Q

pregnancy risk for lamotrigine

A

slight risk for cleft palate

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28
Q

3 risks for atypical antipsychotics during pregnancy

A
  1. large for gestational age/heavy at birth
  2. increase risk for diabetes later in life
  3. risperidone in 3rd trimester problems
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29
Q

problems with taking risperidone in 3rd trimester (4)

A
  1. jitteriness
  2. irritability
  3. feeding problems
  4. somnolence
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30
Q

__% of preschoolers with moderate-severe ADHD have comorbid disorders. which 3?

A

70%

  1. oppositional defiant disorder
  2. communication disorders
  3. anxiety disorders
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31
Q

2 challenges for diagnosing/treating ADHD in preschoolers

A
  1. symptoms vary across lifespan, so may need different diagnostic criteria
  2. comorbidity varies by age
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32
Q

ritalin is __ effective in preschoolers than school age children

A

less

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33
Q

if ritalin is ineffective, it can be substituted by __-

A

adderall

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34
Q

pharmacological treatments are usually discontinued in __ months for preschoolers

A

6 months

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35
Q

behavioral disinhibition in preschool years may be an antecedent of __

A

disruptive behavioral disorders and mood disorders

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36
Q

is there evidence for efficacy of medication in preschoolers with disruptive behavioral disorders without comorbidities for mental retardation or autism?

A

no

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37
Q

___ can be considered for treating disruptive disorders

A

antipsychotics

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38
Q

depression is common in children who have __ (3)

A
  1. other mood disorder
  2. past trauma
  3. mother with depression
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39
Q

5 signs of depression in young children

A
  1. appear sad even when playing games
  2. games have themes of death or somber topics
  3. appetite loss
  4. sleep problems
  5. maladaptive guilt and shame
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40
Q

autism affects _% of all children

A

1%

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41
Q

are SSRIs efficacious for autism?

A

no

42
Q

what type of drugs are most effective for autism?

A

atypical antipsychotics

43
Q

3 serious side effects of atypical antipsychotics in autism

A
  1. weight gain
  2. glucose intolerance
  3. high cholesterol
44
Q

omega 3 fatty acids are used in __% of children with autism

A

28%

45
Q

_% of children with rages were initially diagnosed with bipolar. what % actually had bipolar?

A

33%; 9%

46
Q

__% of youth with behavioral disruptive disorders progressed to ___

A

50%, antisocial personality disorder

47
Q

behavioral aggression is likely to be comorbid with (4)

A
  1. ADHD
  2. pervasive developmental disorders
  3. depression
  4. substance abuse
48
Q

plan for treating behavioral/aggressive disorders

A

mood stabilizers and atypical antipsychotics plus psychological therapy

49
Q

___ is recommended for management of severe aggression in children

A

lithium

50
Q

3 side effects of lithium in children

A
  1. weight gain
  2. cognitive impairment
  3. fatal elevations of blood ammonia
51
Q

what % of children w behavioral or aggressive disorders responded positively to valproic acid?

A

75%

52
Q

3 meds used for treating behavioral or aggressive disorders

A
  1. psychostimulants
  2. SSRIs
  3. benzos
53
Q

problem with using benzos in aggressive children

A

can cause behavioral disinhibition

54
Q

1 in every __ children has ADHD

A

10-15

55
Q

what % of children with ADHD are on stimulant medications?

A

50%

56
Q

what might underlie ADHD?

A

alterations in dopaminergic activity in the PFC

57
Q

the PFC is critical in regulating (3)

A
  1. behavior
  2. attention
  3. cognition
58
Q

5 effects of PFC lesions

A
  1. distractibility
  2. forgetfulness
  3. impulsivity
  4. poor planning
  5. locomotor hyperactivity
59
Q

optimal levels of (2) are essential for PFC control of behavior and attention

A

NE and DA

60
Q

stimulant medications augment (2)

A

deficient dopaminergic or NE systems

61
Q

psychostimulants improve behavior and learning in __% of children with ADHD

A

60-80%

62
Q

stimulants improve ADHD symptoms but do not affect

A

functional impairments

63
Q

functional impairments

A

impairments like reading, writing, math, relationships, following directions, disrupting class, etc

64
Q

2 conclusions from MTA study

A
  1. medical management better than behavioral treatment and community care
  2. medication and behavioral treatment was not better than medication alone, but is beneficial for nonADHD symptoms and positive function
65
Q

8 years after MTA, how many were still receiving medication? did they still meet ADHD criteria?

A

33%; yes

66
Q

__% of MTA participants 8 years later had clinically significant antisocial behavior, opposition defiant disorder, were arrested at least once, or displayed delinquent behavior

A

25-30%

67
Q

__% of MTA participants still had ADHD

A

78%

68
Q

ritalin comprises __% of prescribed ADHD meds

A

90%

69
Q

ritalin must be administered how many times per day?

A

2-3x

70
Q

what is concerta?

A

extended release preparation of ritalin

71
Q

concerta duration of action

A

12 hours; 22% is immediate release, 78% over 10 hour period

72
Q

half life of dexedrine/adderall

A

5-6h

73
Q

4 side effects of stimulants in young people

A
  1. insomnia
  2. elevated bp & hr
  3. reduced appetite
  4. growth suppression
74
Q

5 adverse psychiatric problems with stimulants

A
  1. bipolar illness
  2. suspiciousness
  3. hearing voices
  4. aggression
  5. manic symptoms
75
Q

__% of ADHD patients do not respond well to stimulants

A

10-30%

76
Q

2 other med options for ADHD

A
  1. SNRIs (strattera)

2. BP-lowering dopaminergic agonists

77
Q

MoA of BP lowering dopaminergic agonists

A

increase alpha-2-receptor stimulation in PFC

78
Q

2 BP lowering dopaminergic agonists

A

clonidine, guanfacine

79
Q

__ + a stimulant can improve ADHD symptoms better than either drug alone

A

guanfacine

80
Q

__ is the period of highest risk for depression

A

adolescence

81
Q

does adolescent depression usually persist into adult life?

A

yes

82
Q

prevalence of depression among children? adolescents?

A

3%

6-20%

83
Q

in 1990s, __ was shown to treat childhood depression

A

prozac

84
Q

in 2002, __ youths committed suicide in the USA. suicide is the __ leading cause of death in this age group

A

264; 5th

85
Q

adding __ to prozac enhances safety of medication therapy for depression

A

CBT

86
Q

4 complementary treatments for depression

A
  1. st john’s wort
  2. omega-3 fatty acids
  3. light therapy
  4. exercise
87
Q

prevalence of childhood anxiety disorders

A

6-18%

88
Q

__% of parents of children with childhood anxiety disorders had the disorder themselves

A

40%

89
Q

OCD is the __ most common disorder in children and adolescents

A

4th

90
Q

__ of youth do not improve with combination therapy for anxiety

A

25-30%

91
Q

over __ of children with bipolar experience a prodromal period for __

A

50%; over a year

92
Q

prodrome

A

early symptoms that might indicate start of a disease before specific symptoms occur

93
Q

children with bipolar show ___, often with comorbid (2)

A

rapid fluctuations in mood and behavior

ADHD and disruptive behavioral disorders

94
Q

4 treatments for childhood mania

A
  1. lithium
  2. anticonvulsants
  3. atypical antipsychotics
  4. behavioral and psychosocial therapies
95
Q

lamictal reduces manic symptoms by __ and depressive symptoms by ___

A

72%; 82%

96
Q

___ acid is effective for treating children with ADHD, bipolar, and other problems

A

eicosapentaenoic acid (EPA)

97
Q

__ of participants taking omegabrite D supplement with BP improved

A

half

98
Q

___ schizophrenia patients develop psychotic symptoms between ages 10-20

A

1 in 3

99
Q

prior to symptom onset, schizophrenia adolescents exhibit ___ in ___

A

lower gray matter in frontal and parietal lobes

100
Q

results of omega 3 study on psychotic disorders

A

5% of omega 3 group vs. 28% of placebo group transitioned to psychotic disorder in 12 weeks. omega 3 may offer a safe and efficacious strategy for prevention in young people with sub-threshold psychotic states

101
Q

__ are the best treatment of childhood and adolescent onset schizophrenia

A

atypical antipsychotics

Psychopharmacology (22 decks)

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