This document discusses pediatric psychopharmacology and provides an overview of various psychiatric disorders that affect children and the medications used to treat them. It covers the history and regulations of pediatric psychopharmacology, pharmacokinetics in children, classification of drugs, common disorders like ADHD, bipolar disorder, depression, OCD, schizophrenia, and anxiety, and summarizes evidence from studies on the effectiveness of stimulants, antidepressants, mood stabilizers, and antipsychotics in treating pediatric conditions.
This slide contains information regarding Lithium Toxicity. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
This slide contains information regarding Lithium Toxicity. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
obsessive compulsive and related disorders (OCD)mamtabisht10
Obsessive-Compulsive and related disorders include obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
The following slides talks about the half way home which is meant for psycho- social rehabilitation of the mentally ill patients. the concept of half way home is contemporary in India and confined to metropolitan areas, mass need awareness of such model and the rights of the mentally ill, the topic itself covers many aspects and it is hard to assemble under one title.
ADHD also known as hyperkinetic disorder is a common childhood disorder among school aged children that is characterised by persistent patterns of inattention, hyperactivity and impulsivity resulting in an underachievement in the school or work performance.
RxP International presents Gender and Psychiatric DrugsRXP International
This powerpoint presentation is presented by RxP International to provide information for mental health and medical professionals pertaining to gender differences in pharmacokinetics, pharmacodynamics, disease prevalence, adverse drug reactions and theories about why women are more likely to present with disease. Differences in drug metabolism, distribution and elimination are included. Impact of oral contraceptives are reviewed.
obsessive compulsive and related disorders (OCD)mamtabisht10
Obsessive-Compulsive and related disorders include obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
The following slides talks about the half way home which is meant for psycho- social rehabilitation of the mentally ill patients. the concept of half way home is contemporary in India and confined to metropolitan areas, mass need awareness of such model and the rights of the mentally ill, the topic itself covers many aspects and it is hard to assemble under one title.
ADHD also known as hyperkinetic disorder is a common childhood disorder among school aged children that is characterised by persistent patterns of inattention, hyperactivity and impulsivity resulting in an underachievement in the school or work performance.
RxP International presents Gender and Psychiatric DrugsRXP International
This powerpoint presentation is presented by RxP International to provide information for mental health and medical professionals pertaining to gender differences in pharmacokinetics, pharmacodynamics, disease prevalence, adverse drug reactions and theories about why women are more likely to present with disease. Differences in drug metabolism, distribution and elimination are included. Impact of oral contraceptives are reviewed.
The Mental Status Examination in Primary Care by the Natural Medicine Physician (DC/ND). Alan B. Korbett, DC, DO, DABCO, DACAN. Adult, Child & Adolescent Psychiatrist. lecturer@aol.com
This is an introduction to pediatric psychopharmacology. Presentation done on July 25th as a part of the nuts and bolts lecture series. Thanks to all the chief fellows over the last 6 years who have contributed to the development of these slides. Please refer to scientific literature for accuracy. This can serve as a rough guide to pediatric psychopharm for child and adol psychiatry fellows as well as residents, and medical students. If you have any questions please feel free to send them my way at pallavpareek@gmail.com
Pharmacokinetics - drug absorption, drug distribution, drug metabolism, drug ...http://neigrihms.gov.in/
A power point presentation on general aspects of Pharmacokinetics suitable for undergraduate medical students beginning to study Pharmacology. Also suitable for Post Graduate students of Pharmacology and Pharmaceutical Sciences.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
Attention Deficit disorder with its etiology, types and pathophysiology clinical features, Diagnosis, Assessment, differential Diagnosis and treatment , Medical Treatment and prognosis
Presentation by Dr. Jacob Kagan on addiction psychiatry, covers the neurobiology of addiction, diagnosis and management od dually-diagnosed patients, relapse prevention, psycopharmacology interventions and more. http://www.jacobkaganmd.com
Attention deficit hyperactivity disorderajith joseph
Attention deficit hyperactivity disorder (ADHD) is a mental disorder of the neurodevelopmental type.[9][10] It is characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age.[1][2] The symptoms appear before a person is twelve years old, are present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities). children, problems paying attention may result in poor school performance
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. INTRODUCTION
Pediatric Psychopharmacology refers to the study of
interaction of drugs with the body and its behavioral effects
in children [1]
First reports of psychotropic drug use in adolescents in the
1930’s by Charles Bradley [2]
4. HISTORY OF PEDIATRIC PSYCHOPHARMACOLOGY
1997- FDA Moderation Act gave incentives for pediatric
research on already adult-approved medications [3]
2002- Best Pharmaceuticals for Children Act- an extensive
process for studying medications in pediatric populations [3]
2003- Pediatric Research Equity Act authorized FDA to require
drug manufacturers to conduct pediatric studies [3]
With these regulations consumers and medical providers
have a fairly large database for using these psychotropic
medications in children
5. PHARMACOKINETICS:
Pharmacokinetics: constitutes absorption,
distribution, metabolism, and excretion
Gastric absorption
Stomach contents are less acidic, so weakly acidic drugs may be absorbed less
efficiently
Distribution
Most neuroleptics and antidepressants are lipophilic (less body fat)
Antipsychotics, TCA’s and Lithum eliminated more
rapidly
Metabolism
Increased hepatic metabolic capacity and more efficient renal clearance
6. BEFORE STARTING MEDICATIONS
Physical exam: height, weight, vitals and abbreviated neurological
exam
Labs may be required:
CBC, CMP, UA/UDS, TSH
Urine HCG in females of reproductive age
Fasting lipids and glucose
May consider lead level, karyotype and/or specific chromosomal analysis
if MR is suspected
7. CLASSIFICATION OF DRUGS
Each class of drugs has a different way of functioning in the
body [4]:
• Stimulants
• Anti-depressants
• Anti-psychotics
• Mood Stabilizers/Anti-Convulsants
• Anxiolytics and Sedatives
8. STIMULANTS
Centrally and peripherally enhance both dopaminergic and
noradrenergic transmission to improve cognitive and behavioral
functioning [2]
Methylphenidate (Ritalin), Dextroamphetamine (Focalin),
Pemoline (Cylert), Amphetamine-dextroamphetamine
(Adderall)
Are the most prescribed psychotropic agents
Most commonly used with ADHD [5]
Over 200 controlled studies have shown that stimulant
medications are safe and effective [2]
9. ANTI-DEPRESSANTS
Act on central pre- and post-synaptic receptors affect
neurotransmitter release and uptake (i.e. serotonin,
norepinephrine, dopamine) [2]
4 main sub-classes: monoamine oxidase inhibitors (MAOIs),
tricyclic (TCAs), selective serotonin uptake inhibitors (SSRIs),
atypical anti-depressants
Of these, SSRIs are the most frequently prescribed (i.e. Prozac,
Zoloft, Paxil)
Mostly used for major depressive disorder, but also for: OCD,
insomnia, ADHD, anxiety disorders [4]
10. ANTI-PSYCHOTICS
Effectively treat psychosis, including hallucinations, delusions,
bizarre behavior, severe agitation [4]
Thought to be related to dopamine antagonist properties
2 main classes: traditional and atypical
Common anti-psychotics: Olanzapine (Zyprexa), Clozapine
(Clorzaril), Chlorpromazine (Thorazine)
Mostly used for schizophrenia, but also for psychotic
depression, mania, autism spectrum disorders, severe
aggressive behaviors [15]
11. MOOD STABILIZERS/ANTI-CONVULSANTS
Act through a variety of mechanisms affecting intracellular
processes- still being researched
3 most commonly used: lithium, valproate, and
carbamazepine [2]
Lithium is only FDA approved drug for pediatric bipolar
disorder [4]
Also used to improve aggressive behavior and conduct disorder
Valproate effectively treats mania in adults and possibly
children
12. Anxiolytics and Sedatives
Relatively less evidence compared to the other categories
of medication, but still used with pediatric medications [2]
Benzodiazepines have been used for anxiety (GAD) and
panic disorders [15]
Buspirone, TCA’s, SSRIs, Beta Blockers, and α-2a agonists
[4]
Need for more research with children, so not as frequently
used
13. Miscellaneous
Atomoxetine (Strattera)- nonstimulant drug that was
approved for ADHD treatment [9]
Thought to inhibit norepinephrine receptors
Clonidine- α-adrenergic agonist used especially for tics and
sometimes ADHD and anxiety disorders [13]
Reduces sympathetic outflow directly at the brain stem
therapeutic
effects
15. ADHD
ADHD is the most commonly diagnosed psychiatric disorder
of childhood [2]
4.5 million children between 5-17 years of age have been
diagnosed with ADHD as of the end of 2006. [6]
• Children with ADHD can experience peer rejection,
impulsivity, disruptive behaviors, low self-esteem
which can affect their daily life [7]
• If not treated, symptoms can persist into adulthood [2]
Medication has proven to be extremely
effective for treating ADHD
16. Over 200 controlled studies have shown that
stimulant medication is safe and effective [2]
Methylphenidate and atomoxetine have repeatedly
been found to decrease inattention and hyperactivity
[9]
Stimulants for ADHD do not result in substance
abuse disorders and may actually have a protective
effect against development of substance abuse in
adolescence [8]
Also protective factor for legal difficulties and poor
impulse control
Concerns that stimulant medication may be
responsible for smaller brain structures not well
supported [5]
ADHD
17. Semrud-Clikeman et al. 2008 [7]
Compared ADHD kids that have at least some
history of medication (current or past) to ADHD
kids that were never exposed to treatment
ADHD children with some history of medication
performed significantly better in writing,
attention, executive functioning, verbal working
memory, and academics. They also had less
mood problems and aggressive behaviors.
ADHD children that have been
medicated show better functioning
even when medicine has been
discontinued.
ADHD
18. Pappadopulos et al. 2004 [11]
When reviewing a decade of studies-
stimulant medication has been tested on over
6000 ADHD children substantial evidence
showing stimulants are effective at treating
ADHD symptoms
ADHD
• Pelham et al. 2002 [12]
– Methylphenidate shown to reduce ADHD
treatments in children with normal and low IQ
19. ADHD Attitudes [5]
Parent
Over 90% of parents challenged and were
skeptical of the doctor’s recommendation
of starting medication
After 2 years- about 80% of parents
considered methylphenidate a safe and
effective drug
ADHD
• A few parents stopped the medication in between- but all of
them restarted treatment because of belief that child
performed better on medication
– Child:
• After 2 years on stimulant drugs- 86% of kids considered
methylphenidate safe and effective
20. In the school settings- teachers and school
psychologists are working with medical doctors to
provide a multinodal treatment for ADHD children
[10]
Medication combined with psychosocial interventions
show greatest decrease in symptoms
75% of parents believe that the best treatment for
ADHD = methylphenidate + psychological support
Behavioral interventions alone did not exert
improvement in academic performance, emotional
status, and overall functioning [13]
American Academy of Pediatrics announced that
stimulant medication should be recommended to
improve outcomes in ADHD children [5]
ADHD
22. PBD children experience moods that alternate
between depression and mania episodes
Early onset PBD often starts with depression episode
that switches to BD [2]
Therefore hard to estimate PBD prevalence
Children with PBD can be extremely harmful to
themselves, family, and society
Medication is critical with
almost all PBD cases
PEDIATRIC BIPOLAR DISORDER
23. PEDIATRIC BIPOLAR DISORDER
Lithium- only FDA approved drug for treatment of PBD [15]
Clinical Global Assessment Scale score of more than 65 was
achieved by 47% of kids receiving lithium versus 8% of kids on
the placebo [11]
Findling et al. 2003 [17]
Lithium + divalproex sodium (mood-stabilizer) treatment produced
significant improvements in various areas 47% subjects met
criteria for full remission after medication for 20 weeks
24. PEDIATRIC BIPOLAR DISORDER
Kafantaris et al. 2001 [18]
Lithium + Anti-psychotic treatment (Haloperidol)
showed improvement of symptoms for adolescents
with PBD
Majority of patients showed reoccurrence of symptoms
once medication was discontinued
• Biederman et al. 2005 [21]
– When given Risperidone (anti-psychotic)- PBD patients
showed 70% response for manic symptoms and 35% for
ADHD symptoms.
25. PEDIATRIC BIPOLAR DISORDER
Pavuluri et al. 2009 [16]
Lamotrigine is an anti-convulsant commonly used for adult BD
Controls glutamate release activates serotonin levels
This study showed that kids on lamotrigine medication showed
significantly reduced depressive symptoms and controlled
aggression and irritability compared to the placebo group
Previous adverse effect of benign rash only seen in 6% of
patients and was quickly treated with no long-term effects
26. PEDIATRIC BIPOLAR DISORDER
PBD can be extremely severe if left untreated
Certain researchers today consider it unethical to have a
placebo group for children with PBD because
withholding treatment can have drastic long term effects
Without medication- high risk for substance abuse, conduct
disorder, suicide, and other co-morbidities [21]
Show symptoms of hallucinations, verbal and physical intrusion,
lack of self-control, delusional thinking, possibly assaultive, and
more [2]
27. DEPRESSION
Increased rates of depression among kids: especially in
families dealing with divorce, abuse, neglect, bereavement
[3]
Harvard Medical School study in 2006 found that childhood
depression is increasing by 23% a year
Depression rates and suicide are strongly
correlated suicide is the 6th leading cause of death
among children ages 5-14 [22]
28. DEPRESSION
Fluoxetine (SSRI) has been shown to be superior to placebo
in many controlled studies. Emslie et al. 2002 [24] Tao et al.
2009 [26]
Fluoxetine medication showed significantly improved results
compared to cognitive behavioral therapy alone [25]
Only FDA approved drug for pediatric depression
Tricyclic antidepressant (Anafranil) and paroxetine (Paxil)
have shown some promising results in the treatment of
pediatric depression
More controlled studies is needed before these drugs can be
frequently distributed for treatment
29. OBSESSIVE COMPULSIVE DISORDER
OCD in children obsessions, compulsions, persistent
thoughts, impulses, or images that are intrusive/inappropriate
[14]
Causes anxiety & stress
Repetitive behaviors are in response to obsession
• 1/3-1/4 of OCD patients had symptoms before the age of
15 [27]
• Symptoms can manifest similar to adult OCD but often
differently (i.e. temper tantrums, food restrictions,
decreased academic performance) [2]
30. OBSESSIVE COMPULSIVE DISORDER
Of all childhood disorders- OCD has most evidence supporting
pharmacologic treatment & largest number of FDA approved
drugs [2]
SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), sertraline
(Zoloft) and clomipramine (Anafranil) are FDA approved for
treating childhood OCD (age 6 and up) [2]
Geller et al. 2003 [28]
Meta analysis of children with OCD showed significant difference
between children on medication and placebo
Clomipramine was shown to be the most superior of the SSRIs [2]
31. OBSESSIVE COMPULSIVE DISORDER
Wagner et al. 2003 [29]
Sertaraline has been shown effective in long term trials
because of significant remission rates and improved functional
status in majority of patients
Gellar et al. 2003 [28]
Continued paroxetine treatment significantly reduces pediatric
OCD relapse rates compared to the placebo
Is often comorbid with other disorders such as ADHD,
tics, anxiety disorders, and PBD [14]
32. SCHIZOPHRENIA
Pediatric schizophrenia is serious disorder that affects cognition
and ability to relate socially with others gross impairment of
reality [2]
Symptoms include delusions, hallucinations, distortion,
disordered speech and communication, catatonic behavior,
intensity of emotions and exaggeration of behavioral control
[14]
These children are significantly delayed in their school
functioning, relationships, and self care. Again, without
medication- can be extremely dangerous to themselves and
society.
33. SCHIZOPHRENIA
Sikich et al. 2004 [30]
Schizophrenic children and adolescents between 8-19 years of age
show significant improvement when taking either risperidone,
olazapine, and haloperiodol medication
Sikich et al. 2008 [20]
First and second generation atypical antipsychotics (molindone,
olanzapine and risperidone) have been shown to significantly decrease
pediatric schizophrenia symptoms
Kranzler et al. 2005 [31]
Schizophrenic children can often be extremely aggressive
Clozapine treatment showed significant clinical improvement for
severely aggressive children
34. SCHIZOPHRENIA
Psychotherapy alone has not been proven to be
effective for treating pediatric schizophrenia
Adjunctive psychosocial treatments (psychoeducation,
behaviorally based therapy, cognitive-behavioral
therapy) improves symptoms and reduces relapse
rates [32]
• If the disorder is at an advanced stage- constant
hallucinations and bizarre ideation can take over the child’s
life without medication
35. ANXIETY DISORDERS
One of the most commonly diagnosed psychiatric disorders
affecting populations in U.S. and Europe [14]
Includes separation anxiety, panic disorder, social phobia, specific
phobias, and generalized anxiety
Not only distress to thought of threat, but also cognitive feelings
of losing control, unwelcome or intrusive thoughts, inattention,
insomnia, and perceptual disturbances.
Affects youth more than adults
because anxiety affects normal
physical and mental development
36. ANXIETY DISORDERS
Due to a lack of current research, there are no FDA
approved drugs for the treatment of pediatric
anxiety disorders [2]
But numerous medications have shown promising
results:
SSRIs: such as Fluoxentine have shown notable
symptom reduction with minimal side effects [10]
Benzodiazepines: such as Clonazepam is useful in
short-term treatment (i.e. used to ensure child attends
school) [2]
α-2a Agonists: help with symptoms
of hyperautonomic arousal (i.e. palpitations)
Tricyclic antidepressants [14]
37. OTHER DISORDERS
There are several studies show evidence of psychotropic
medication decreasing symptoms in other disorders:
Autism [2]
SSRIs, anti-psychotic (haloperidol, thioridazine), α-2a agonists,
anticonvulsants, stimulants
Anorexia nervosa [33]
Atypical antipsychotics (olanzapine), appetite enhancers, mood stabilizers
Bulimia nervosa [33]
Anti-depressants, Tri-cyclic anti-depressants, SSRIs (fluoxentine)
Obesity [33]
Anti-depressants, appetite suppressants
54. Category A - Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in
the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Category B - Animal reproduction studies have failed to demonstrate a risk to the fetus and there
are no adequate and well-controlled studies in pregnant women.
Category C - Animal reproduction studies have shown an adverse effect on the fetus and there
are no adequate and well-controlled studies in humans, but potential benefits may warrant use of
the drug in pregnant women despite potential risks.
Category D - There is positive evidence of human fetal risk based on adverse reaction data from
investigational or marketing experience or studies in humans, but potential benefits may warrant
use of the drug in pregnant women despite potential risks.
Category X - Studies in animals or humans have demonstrated fetal abnormalities and/or there is
positive evidence of human fetal risk based on adverse reaction data from investigational or
marketing experience, and the risks involved in use of the drug in pregnant women clearly
outweigh potential benefits.
60. REFERENCES
1) Orkin, B. G. (2002). The use of atypical antipsychotic agents for nonpsychotic disorders in children and adolescents. Doctoral dissertation, ProQuest Information and Learning
Company, Ann Arbor, MI.
2) Cheng, K., & Myers, K. M. (2005). Child and adolescent psychiatry: The essentials. Baltimore: Lippincott Williams & Wilkens.
3) Emslie, G. J. (2009). Understanding Placebo Response in Pediatric Depression Trials. American Journal of Psychiatry, 166(1), 1-3.
4) Brown, R. T., & Sammons, M. T. (2002). Pediatric psychopharmacology: A review of new developments and recent research. Professional psychology, research and practice,
33(2), 135-147.
5) Berger, I., Dor, T., Nevo, Y., & Goldzweig, G. (2008). Attitudes Toward Attention-Deficit Hyperactivity Disorder (ADHD) Treatment: Parents' and Children's Perspectives.
Journal of Child Neurology, 23(9), 1036-1042.
6) (2009). Retrieved April 14, 2009, http://www.cdc.gov/
7) Semrud-Clikeman, M., Pliszka, S., & Liotti, M. (2008). Executive Functioning in Children With Attention-Deficit/Hyperactivity Disorder: Combined Type With and Without a
Stimulant Medication History. Neuropsychology, 22(3), 329-340.
8) Wilens, T. E., Faraone, S. V., Biederman, J., & Gunawardene, S. (2003). Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse.
Pediatrics, 111(1), 179-185.
9) Spencer, T., Heilgenstein, J. H., Biederman, J., Faries, D. E., Kratochvil, C. J., Conners, K., et al. (2002). Results from 2 proof-of-concept, placebo-controlled studies of
Atomoxetine in children with attention-deficit/hyperactivity disorder. The Journal of Clinical Psychiatry, 63(12), 1140-1147.
10) Abrams, L., Flood, J., & Phelps, L. (2006). Psychopharmacology in the schools. Psychopharmacology in the schools, 43(4), 493-501.
11) Pappadopulos, E. A., Guelzow, T. B., Wong, C., Ortega, M., & Jensen, P. S. (2004). A review of the growing evidence base for pediatric psychopharmacology . Child and
Adolescent Psychiatric Clinics of North America, 13(4), 817-855.
12) Pelham, W. E., Hoza, B., Pillow, D. R., Gnagy, E. M., Kipp, H. L., Greiner, A. R., et al. (2002). Effects of methylphenidate and expectancy on children with ADHD: behavior,
academic performance, and attributions in a summer treatment program and regular classroom settings. Journal of Consulting and Clinical Psychology, 70(2), 320-325.
13) Abikoff, H., Hechtman, L., Klein, R., Gallagher, R., Fleiss, K., Ectovitch, J., et al. (2004). Social Functioning in Children With ADHD Treated With Long-Term Methylphenidate
and Multimodal Psychosocial Treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 43(7), 820-829.
14) Vitiello, B., Masi, G., & Marazziti, D. (2006). Handbook of child and adolescent psychopharmacology (). New York: Informa HealthCare.
15) Ryan, N. D. (2003). Medication treatment for depression in children and adolescents. CNS Spectrums, 8(4), 283-287.
16) Pavuluri, M. N., Henry, D. B., Moss, M., Mohammed, T., Carbay, J. A., & Sweeney, J. (2009). Effectiveness of Lamotrigine in Maintaining Symptom Control in Pediatric
Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology, 19(1), 75-82.
61. 17) Findling, R. L., McNamara, N. K., Stansbrey, R., Gracious, B. L., Whipkey, R. E., Demeter, C., et al. (2006). Combination lithium and divalproex sodium in
pediatric bipolarity. Journal of the American Academy of Child and Adolescent Psychiatry, 45(2), 142-146.
18) Kafantaris, V., Dicker, R., Coletti, D. J., & Kane, J. M. (2001). Adjunctive Antipsychotic Treatment Is Necessary for Adolescents with Psychotic Mania. Journal of
Child and Adolescent Psychopharmacology, 11(4), 409-413.
19) Biederman, J. (2005). Attention-deficit/hyperactivity disorder: a selective overview. Biological Psychiatry, 57(11), 1215-1220.
20) Sikich, L., Frazier, J., McClellan, J., Findling, R., Vitiello, B., Ritz, L., et al. (2008). Double-Blind Comparison of First- and Second-Generation Antipsychotics in
Early-Onset Schizophrenia and Schizo-affective Disorder: Findings From the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study.
American Journal of Psychiatry, 165, 1369-1372.
21) Wilens, T., Biederman, J., Kwon, A., Ditterline, J., Forkner, P., Moore, H., et al. (2004). Risk of Substance Use Disorders in Adolescents With Bipolar Disorder.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(11), 1380-1386.
22) (2009). Retrieved 14 Apr. 2009, http://www.about-teen-depression.com/depression-statistics.html
23) (2008). Retrieved 14 Apr. 2009, http://www.raisinganoptimisticchild.com/statistics.html
24) Emslie, G. J., Heiligenstein, J., Wagner, K. D., Hoog, S., & Ernest, S. E. (2002). Fluoxetine for Acute Treatment of Depression in Children and Adolescents: A
Placebo-Controlled, Randomized Clinical Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 41(10), 1205-1215.
25) TADS Team (2004) The Treatment for Adolescents with Depression Study (TADS): short-term effectiveness and safety outcomes. JAMA 292:807–820
26) Tao, R., Emslie, G., Mayes, T., Nakonezny, P., Kennard, B., & Hughes, C. (2009). Early prediction of acute antidepressant treatment response and remission in
pediatric major depressive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 48(1), 71-78.
27) Oner, O., & Oner, P. (2008). Psychopharmacology of pediatric obsessive compulsive disorder: three case reports. Journal of Psychopharmacology, 22(7), 809-
811.
28) Geller, D. A., Biederman, J., Stewart, E., Mullin, B., Martin, B., & Spencer, T. (2003). Which SSRI? A Meta-Analysis of Pharmacotherapy Trials in Pediatric
Obsessive-Compulsive Disorder . American Journal of Psychiatry, 160, 1919-1928.
29) Wagner, K., Ambrosini, P., Rynn, M., Wohlberg, C., Yang, R., Greenbaum, M., et al. (2003). Efficacy of Sertraline in the Treatment of Children and Adolescents
With Major Depressive Disorder . The Journal of the American Medical Association, 290(8), 1033-1041.
30) Sikich, L., Hamer, R. M., Bashford, R. A., Sheitman, B. B., & Lieberman, J. A. (2004). A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth:
A double-blind, randomized, 8-week trial. Neuropsychopharmacology, 29(1), 133-145
31) Kranzler, H., Roofeh, D., Gerbino-Rosen, G., Dombrowski, C., McMeniman, C., Dethomas, C., et al. (2005). Clozapine: Its impact on aggressive behavior
among children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 44(1), 55-63.
32) Rector, N. A., & Beck, A. T. (2001). Cognitive Behavioral Therapy for Schizophrenia: An Empirical Review. The Journal of Nervous and Mental Disease, 189(5),
278-287.
33) Powers, P. S., & Bruty, H. (2009). Pharmacotherapy for Eating Disorders and Obesity. Clinics , 18(1), 175-187.
REFERENCES
A year later 1998- FDA passed regulations to require drug manufacturers to evaluate safety and effectiveness of new drugs and biological products in pediatric patients
Stimulants
Anti-depressants
Anti-psychotics
Mood Stabilizers/Anti-Convulsants
Anxiolytics and Sedatives
Severe aggressive behaviors- from fetal alcohol syndrome
Lithium- is oldest and best studied mood stabilizer- treats both manic and depressive episodes in bipolar patients
-acts by decreasing cellular response to NT
Valproate and carbamazepine = anticonvulsants
Vaproate- enhances release of GABA- inhibitory NT
Benzodiazepines- potentiate inhibitory effects of GABA and therefore have direct anxiolytic effect on limbic system
Medication has proven to be extremely effective for treating ADHD.
These kids between 9-15- and the kids on medication did as well as the control group kids- this is showing something!
Adhd kids never on meds- also more depressed and higher withdrawal level
Improved performance on measure that require attention to detail as well as ability to plan and organize sustain neurological gains when on or previously on meds
These kids between 9-15- and the kids on medication did as well as the control group kids- this is showing something!
Adhd kids never on meds- also more depressed and higher withdrawal level
Improved performance on measure that require attention to detail as well as ability to plan and organize sustain neurological gains when on or previously on meds
-there was a study of a group of adolscents with BD and substance abuse dependancy- then put on either lithum or placebo
after just 2 weeks- significant difference seen
-there was a study of a group of adolscents with BD and substance abuse dependancy- then put on either lithum or placebo
after just 2 weeks- significant difference seen
-there was a study of a group of adolscents with BD and substance abuse dependancy- then put on either lithum or placebo
after just 2 weeks- significant difference seen
-there was a study of a group of adolscents with BD and substance abuse dependancy- then put on either lithum or placebo
after just 2 weeks- significant difference seen
If the disorder is at an advanced stage- constant hallucinations and bizarre ideation can take over the child’s life without medication
Talk about stress, cortisol, immune system
Talk about stress, cortisol, immune system
Autism-– profound kids need meds to control their behavior or they become aggressive..you can talk about danger to self/society/family