Term
| most common mental disorders in children 9-17 years |
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Definition
estimated ~20% of children ages 9-17 years have mental disorders with at least mild functional impairment
MOST COMMON = ANXIETY DISORDER 13%
disruptive disorder = 10.3%
mood disorder = 6.2%
child mental disorders persist into adulthood |
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Term
| disorders usually first diagnosed in infancy, childhood, and adolescence |
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Definition
anxiety disorders:
OCD
attention deficit and disruptive behavior disorders
eating disorders:
anorexia nervosa
bulimia nervosa
elimination disorders:
enuresis
mood disorders:
depression
bipolar disorder
pervasive developmental disorders:
autism
schizophrenia
tic disorders:
Tourette's disorder
not uncommon to have more than one disorder (Autism and ADHD, depression and anxiety) |
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Term
| risk factors for mental disorders in children |
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Definition
biological influences:
injury
infection
poor nutrition during pregnancy
exposure to toxins (i.e. lead)
prenatal tobacco/alcohol use
perinatal trauma
traumatic brain injury
chromosomal syndromes
psychosocial factors:
severe parental discord
parents psychopathology/criminality
large family size/overcrowding
economic hardship
exposure to violence
poor care giving practices
security of parental attachment
exposure to inconsistent discipline
genetics:
children of depressed parents are > 3 x more likely to have a depressive episode
other genetic d/o - bipolar, ADHD, autism, SCZ
parental depression
stressful life events
childhood maltreatment:
physical abuse
psychological maltreatment
peer/sibling influences:
sibling rivalry |
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Term
| treatment of mental disorders in children |
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Definition
MULTIMODAL THERAPY
psychotherapy:
supportive
psychodynamic
cognitive-behavioral
interpersonal
family systems
psychopharmacology:
many medications used "off label"
monotherapy versus combined treatment |
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Term
| frequently used psychotropic medications in children for ADHD, conduct disorders, bipolar disorder, and OCD |
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Definition
ADHD: stimulants
conduct disorders: mood stabilizers (valproate and carbamazepine)
bipolar disorder: mood stabilizers (valproate and carbamazepine)
OCD: SSRIs |
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Term
| anxiety disorders in children and treatment |
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Definition
generalized anxiety disorder
OCD
separation anxiety
social phobia
post-traumatic stress disorder
treatment:
benzodiazepines for acute symptoms
SSRIs are considered 1st line
TCAs are effective but are not first line b/c of ADRs |
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Term
| elimination disorders in children and treatment |
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Definition
enuresis - repeated voiding of urine into inappropriate places
age > 5 years
treatment:
1st line
nondrug therapy preferred due to intolerability of drug treatment
scheduled bathroom time; limit liquid at night
2nd line
DDVAP (desmopressin) HS - increases water reabsorption in the kidney and decreases urine volume entering bladder
not intranasal - associated with seizures and coma due to Na imbalances
3rd line
TCAs (imipramine)
relapse is common after stopping DDVAP
encopresis - repeated voiding of feces into inappropriate places |
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Term
| depression in children and treatment |
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Definition
depression - depressed mood, loss of interest or pleasure in nearly all activities, irritability
the most common symptom is headache and stomach ache (somatic complaint), suicide (3rd cause of death in adolescents)
reactive depression is most common (i.e. rejection or loss)
treatment:
SSRIs are considered 1st and 2nd line
TCAs not effective
other antidepressants considered 3rd line |
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Term
| treatment of adolescents with depression study (TADS) |
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Definition
NIMH sponsored, multicenter
12-17 years old with MDD
compare efficacy of fluoxetine, CBT, combination, and placebo in 36 weeks with 1 year follow up
response rate: combination 71%, fluoxetine 61%, CBT 43%, placebo 35%
fluoxetine and escitalopram are the 2 SSRIs that have data to support use in teenagers
2-3 out of 100 are at risk of suicide with SSRI use in teenagers |
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Term
| bipolar disorder in children and treatment |
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Definition
manic or mixed episodes usually accompanied by major depressive episode
treatment:
mood stabilizers (valproate/carbamazepine) considered 1st line
antipsychotics may be useful if psychotic features are present (aripiprazole, quetiapine, risperidone) |
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Term
| pervasive developmental disorders in children |
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Definition
severe and pervasive impairment in several areas of development including reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities
autism:
markedly abnormal or impaired development in social interaction and communication and markedly restricted repertoire of activity and interests |
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Term
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Definition
antipsychotics may be effective for aggression/perseveration
antidepressants (citalopram) controversial for anxiety/obsessive-compulsive symptoms |
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Term
| tic disorders in children and treatment |
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Definition
sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations
occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year. there is never a tic-free period of more than 3 consecutive months.
motor - eye blinking, lip licking, facial twitching, shoulder shrugging, squatting, twirling
vocal - clicks, grunts, barking, yelping, throat clearing, echolalia
Tourette's Disorder: multiple motor tics and one or more vocal tics
treatment:
1st line = alpha-adrenergic antagonists - clonidine, guanfacine
antipsychotics - halodol most effective for controlling tics (but ADRs are bad) |
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Term
use of SSRIs for:
MDD
anxiety disorders
OCD
autism
tourette's |
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Definition
major depressive disorder: FLUOXETINE, ESCITALOPRAM
anxiety disorders: fluoxetine, sertraline, citalopram, fluvoxamine, escitalopram
OCD: good amount of research for SSRIs in OCD
autism and Tourette's - more efficacious agents |
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Term
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Definition
pharmacokinetics:
fluoxetine, norfluoxetine, sertraline AUC higher in 6-12 years of age
fluoxetine t1/2 8 days, norfluoxetine t1/2 7-19 days: better for non-adherent patients
ADRs:
?suicide
mania/restlessness/agitation (in patients with bipolar)
insomnia
nausea/vomiting/weight loss or gain
avoid abrupt DC |
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Term
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Definition
many trials demonstrate LACK OF EFFICACY FOR CHILDREN with MDD, plus more toxicity versus SSRIs
anxiety disorders - 3rd line = imipramine, clomipramine
NOCTURNAL ENURESIS - IMIPRAMINE, NOTRIPTYLINE (3RD LINE) |
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Term
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Definition
pharmacokinetics:
imipramine t1/2 11 hours in children - avoid desipramine (and imipramine) EKG monitoring
ADRs:
sedation
anticholinergic
arrhythmias
unexplained death - sudden cardiac death |
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Term
| use of bupropion in children |
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Definition
use: ADHD
pharmacokinetics:
biotransformation to 3 active metabolites
adult t1/2 10-21 hours, shorter in children
contraindication: eating disorder
ADRs: seizure, insomnia, weight loss |
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Term
| use of lithium in children |
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Definition
use: bipolar disorder, conduct disorder
pharmacokinetics:
shorter t1/2, higher clearance
ADRs:
tremor/fatigue/atasia/malaise
leukocytosis
hypothyroidism
diabetes
hairloss
nausea/diarrhea
enuresis
requires serum concentration monitoring, not recommended for non-adherent families |
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Term
| use of mood stabilizers in children |
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Definition
CARBAMAZEPINE
pharmacokinetics:
boys may have faster clearance
t1/2 8-14 hours
ADRs:
drowsiness/dizziness/vertigo
aplastic anemia
nausea
VALPROATE
pharmacokinetics:
slower response, lower serum levels in adolescents
ADRs:
sedation/tremor
hyperglycemia
hepatic insufficiency
nausea/vomiting
increased appetite/weight gain
VALPROATE HAS THE BEST RESPONSE RATE VERSUS OTHER MOOD STABILIZERS |
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Term
| use of haloperidol in children |
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Definition
use:
autism
schizophrenia
Tourette's Disorder
conduct disorder
ADHD
ADRs:
usually intolerable
sedation
extrapyramidal effects
tardive dyskinesia
haloperidol is cheap and most effective for Tourette's
atypicals may be more effective for schizophrenia with less ADRs |
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Term
| use of clozapine in children |
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Definition
use:
schizophrenia
ADRs
sedation
seizure
neutropenia: WBC q week x 6 months |
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Term
| use of atypical antipsychotics in children (olanzapine, aripiprazole, quetiazpine, ziprasidone) |
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Definition
uses:
bipolar disorder
schizophrenia
autism
Tourette's Disorder
aripiprazole and risperidone are the leading antipsychotics in children |
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Term
| comparison of increased weight ADR of atypicals |
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Definition
| olanzapine > quetiapine > risperidone > aripiprazole |
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Term
| approved SSRIs for children and age of approval |
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Definition
fluoxetine: 8 yo
sertraline: 6 yo (OCD)
escitalopram: 12 yo
fluvoxamine: 8 yo (OCD) |
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Term
| TCA approved for use in children and age of approval |
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Definition
| imipramine: 6 yo (enuresis) |
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Term
| mood stabilizers approved for children and age of approval |
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Definition
lithium: 12 yo
carbamazepine: any age
valproate: 2 yo |
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Term
| antipsychotics approved for use in children and age of approval |
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Definition
haloperidol: 3 yo
risperidone: 5 yo
paliperidone: 12 yo
olanzapine: 13 yo
aripiprazole: 6 yo
quetiapine: 10 yo |
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