Objectives. The use of Psychotropics in Children
|
|
- Beatrix Craig
- 7 years ago
- Views:
Transcription
1 Objectives The use of Psychotropics in Children Ashley E. Little, Pharm.D. Psychopharmacology Resident Nova Southeastern University College of Pharmacy Dade County Pharmacy Association To understand current practice and evidence based use of psychotropics in children Usual recommended doses of common psychotropic medications Distinguish between levels of warnings associated with medication adverse effects 2% of children & 10% of teenagers 35% unipolar depression 48% bipolar disorder Luby et al., 2002 DSM-IV failed to accurately diagnose 76% of young children judged to be suffering with major depression Recommend modified diagnostic criteria Luby JL, Heffelfinger AK, Mrakosky C, Hessler MJ, Brown KM, Hildebrand T. Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41(8): Geller B, Craney JL, Bolhofner K, Nickelsburg MJ, Williams M, Zimerman B. Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder pheype. American Journal of Psychiatry. 2002;159: Geller B, DelBello MP. Bipolar disorder in childhood and early adolescence. New York: Guilford Press Symptoms of Major Depression Depressed or irritable mood for more days than Plus 4 of the following (as opposed to the 5 required for adults) Anhedonia Significant weight loss or gain Insomnia or hypersomnia more days than Psychomotor agitation or retardation Fatigue more days than Feelings of worthlessness or excessive guilt Impaired concentration Recurrent thoughts of death or suicide Luby JL, Heffelfinger AK, Mrakosky C, Hessler MJ, Brown KM, Hildebrand T. Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41(8): Diagnostic and Statistical Manual of Mental Disorders, 4 th ed., Text Revision. Washington, DC; American Psychiatric Press, 2000: Prepubertal children ~1/2 with episodes of major depression first manifestation of bipolar disease 70% initially present with depression 2 to 4 depressive episodes prior to their first manic episode Geller B, DelBello MP. Bipolar disorder in childhood and early adolescence. New York: Guilford Press Tricyclic antidepressants (TCAs) Response in severely depressed, hospitalized children Significant side effects Toxic in overdoses Associated with 6 cases of sudden death in children Found to be no more effective than placebos in the treatment of mild to moderate major depression Walkup J. Child and adolescent psychopharmacology: What s new? Paper presented at the U.S. Psychiatric and Mental Health Congress. 18 Nov San Diego, CA. 1
2 Selective serotonin reuptake inhibitors (SSRIs) Placebo responses in these child studies are higher than those seen in adult studies Tolerated better than TCAs & are significantly more effective than either placebos or TCAs Fluoxetine (Prozac, Sarafem) The only antidepressant approved by the FDA for the treatment of major depression in children (ages 8 and older) Many antidepressants are used off-label Treatment 1 st wk: start with low doses Gradually increase while carefully watching for signs of clinical response or side effects Treat for a month to 6 wks and then increase the dose Continue treatment at same dose for a minimum of 6 months after symptomatic improvement Follow by gradual discontinuation Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. JAACAP. 2007;46(11) Problem Activation Occurs within a few hrs after taking first dose or when dosages are increased Present with anxiety, initial insomnia, agitation Switching Occurs when medication is taken for 2 wks Provokes the emergence of mania or hypomania in bipolar disorder Age (yrs) Starting Dose SSRI 8+ Fluoxetine Prozac, Sarafem C: Sertraline Zoloft C: 25 A: Paroxetine Paxil C: Citalopram Celexa C: Escitalopram Lexapro C: 5 A: Fluvoxamine Luvox C: 25 A: NRI --- Atomoxetine Strattera C: 10 A: Adjusted Daily Dose (mg/kg) Starting Dose SNRI Venlafaxine XR Effexor XR C: 12.5 A: Desvenlafaxine Pristiq C: A: 50 Duloxetine Cymbalta C: NDRI Bupropion SR Wellbutrin SR C: Atypical Mirtazapine Remeron C: 7.5 A: 15 Trazodone Desyrel C: 25 A: Adjusted (mg/kg) Antidepressants & Suicidality Initial concern came from a study in England Statistical significance of increased suicidality in young pts taking Paxil compared to placebo (3.4% & 1.2%, respectively) No actual suicides Suicidal event occurred when the children stopped taking Paxil Significant impact on prescribing and parental fears FDA Black Box warning Increased risk of suicidal ideation in children or adolescence 2
3 Adolescents: 1% Subsyndromal symptoms: 5-6% Onset: Prepubertal: 27% Teens to 18 yo: 38% Adults: 35% Most manic symptoms begin during mid-adolescence Lewinsohn PM, Klein DM, Seeley JR. Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. JAACAP. 1995;34(4): Lewinsohn PM, Klein DM, Seeley JR. Bipolar disorder during adolescence and young adulthood in a community sample ;2: Costello EJ, Pine DS, Hammen C, March JS, Plotsky PM, Weissman MM, et al. Development and natural history of mood disorders. Biological Psychiatry. 2002;52: STEP-BD Program (Systematic Treatment Enhancement Program for : National Institute of Mental Health) Diagnosis of early-onset bipolar disorder is difficult to establish DSM-IV-TR criteria are the same for children, adolescents, & adults Symptom presentation in young pts may be clearly recognizable or may overlap with other disorders P Treatment Aimed at the stabilization of initial presenting target symptoms, full syndrome resolution, & relapse prevention Mania 1 st line: lithium, divalproex, and atypical antipsychotics Majority of children require 2 mood stabilizers Kowatch RA, Suppes T, Carmody TJ, Bucci JP, Hume JH, Kromelis M, et al. Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. JAACAP. 2000;39: Emslie GJ, Mayes TC. Mood disorders in children and adolescents: psychopharmacological treatment. Biological Psychiatry. 2001;49: Geller B, DelBello MP. Bipolar disorder in childhood and early adolescence. New York: Guilford Press Findling RL, McNamara NK, Gracious BL, Youngstrom EA, Stansbrey RJ, Reed MD, et al. Combination lithium and divalproex sodium in Treatment Depression 1) Quetiapine (Seroquel) 2) Lamotrigine (Lamictal) Treat adolescents and caution in children 3) Lithium Doses large enough to achieve a blood level of at least 0.8 meq/l 4) Olanzapine-fluoxetine (Symbyax) 5) Electro-convulsive therapy (ECT) For very severe, psychotic, &/or treatment-resistant pts Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. JAACAP. 2007;46(1): Treatment Severe agitation & sleep disturbance Short-term benzodiazepines Atypical antipsychotics Psychosis Atypical antipsychotics Comorbid ADHD & bipolar disorder Initiate treatment with mood stabilizer(s) Once stability has been achieved, add stimulants gradually Comorbid anxiety disorders and bipolar disorder SSRI : FDA-Approved Drugs Age (yrs) Indication Lithium 12+ manic episode or maintenance therapy Olanzapine Zyprexa acute mixed or manic episodes, maintenance therapy, or agitation Risperidone Risperdal 10+ bipolar 1 disorder Quetiapine Seroquel manic episode, depressed phase, or maintenance therapy Aripiprazole Abilify 10+ moherapy for manic or mixed episodes, adjunctive therapy with lithium or valproate, or psychomotor agitation Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. JAACAP. 2007;46(1):
4 Drug Monitoring Parameters Lithium Divalproex (Depakote) Carbamazepin e (Tegretol) Monitoring Parameters C: mg/kg/day in 3 or 4 divided doses (DD) A: mg/day in 3 or 4 DD (or 2 DD for SR) C & A: mg/kg/day in 2 or 3 DD C: mg/kg/day in 3 or 4 DD A: mg/day in 2 or 3 DD Serum levels: Acute mania: meq/l Maintenance: meq/l EKG, CBC, electrolytes, renal function tests, thyroid function, weight Serum levels: mcg/ml CBC, platelets, liver function, weight Serum levels: 8 12 mcg/ml CBC, EKG, liver function, weight P FDA Black Box Warnings Lithium Toxicity is related to serum lithium levels & can occur at doses close to therapeutic levels Divalproex Hepatotoxicity (some cases fatal) usually occurring during the first 6 months of treatment Teratogenic effects Life-threatening pancreatitis in children & adults Carbamazepine Fatal dermatologic reactions Aplastic anemia & agranulocytosis Anxiety Disorders 5-18% of children Most common psychiatric conditions in children Obsessive-compulsive disorder (OCD) Pharmacotherapy is the standard of treatment Lifetime prevalence 1% for adults 2% for children & adolescents 6-15 yrs old for males yrs old for females Childhood onset: more common in boys (3:2) Adults: 1:1 Practice parameter for the assessment and treatment of children and adolescents with anxiety disorder. JAACAP. 2007;46(2): P Anxiety Disorders: OCD Criteria A: Obsessions & compulsions must be so time consuming (>1hr/day) or intrusive that normal routines, occupational functioning, or relationships are impaired Criteria B: At some point during the disorder, adults recognize the obsessions and compulsions to be excessive and unreasonable Not required for children Compulsions without obsessions may occur in children ( adolescents) Diagnostic and Statistical Manual of Mental Disorders, 4 th ed., Text Revision. Washington, DC; American Psychiatric Press, 2000: P Anxiety Disorders: OCD Begin with CBT alone or CBT combined with an SSRI Most children placed on SSRI moherapy No adequate symptom response Augment with clomipramine or atypical antipsychotic Initial Dose Citalopram Celexa C/ mg C/-60 mg --- Clomipramin e Anxiety Disorders: OCD Anafranil C/A: 25 mg C/A: 200 mg/day or 3 mg/kg/day, whichever is lower Fluvoxamine Luvox C/A: 25 mg at bedtime Fluoxetine Prozac C/ mg daily Sertraline Zoloft C: 25 mg daily A: 50 mg daily C/A: mg/day (higher dosages divided) C: 10 mg/day A: 20 mg/day (also higher weight children) C: mg/day A: mg/day Age (yrs) 10+ yrs 8-17 yrs 7-17 yrs yrs Pedicatric OCD treatment study (POTS) Team. Cognitive-behavior therapy, sertraline and their combination for children and adolescents with obsessive-compulsive disorder. JAMA. 2004;292(16); P
5 Psychotic Disorders Schizophrenia & bipolar disorder 1-2% in adolescents Childhood psychotic disorders Schizophrenia and related disorders Phases: prodromal, active, and residual Types: catatonic, disorganized, paranoid, or undifferentiated Psychosis related to a mood disorder Depression &/or mania can present with psychotic symptoms Psychosis related to a medical disorder or substance P Psychotic Disorders Consider antipsychotic medication at the first sign of psychotic symptoms Early intervention is important Start with a low dose, usually given at bedtime Gradually increase until a good response is achieved or side effects become intolerable Continue for at least 1 yr after a psychotic episode (schizophrenia always continue) Loebel AD, Lieberman JA, Alvir JMJ, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first episode schizophrenia. American Journal of Psychiatry. 1992;149: FDA-Approved Typical Antipsychotics Age Indication FDA-approved Atypical Antipsychotics Low Potency First Generation Chlorpromazine Thorazine 6 mo 12 Behavioral syndrome yrs Thioridazine Mellaril 2+ yrs Refractory schizophrenia High Potency First Generation Fluphenazine Prolixin establishe d Schizophrenia Haloperidol Haldol 3+ yrs Hyperactive behavior (shortterm) or problematic behavior (severe) with failure to respond to non-psychiatric medication or psychotherapy, or schizophrenia Perphenazine Trilafon 12+ yrs Schizophrenia Age (yrs) Indication Second Generation Aripiprazole Abilify Schizophrenia Olanzapine Zyprexa Schizophrenia Quetiapine Seroquel Schizophrenia Risperidone Risperdal Schizophrenia Thiothixene Navane 12+ yrs Schizophrenia Trifluoperazine Stelazine 6 12 yrs Schizophrenia Antipsychotic Doses Initial dose Low Potency First Generation Chlorpromazine Thorazine Mesoridazine Serentil Thioridazine Mellaril High Potency First Generation Fluphenazine Prolixin Haloperidol Haldol Loxapine Loxitane Perphenazine Trilafon Pimozide Orap Thiothixene Navane Trifluoperazine Stelazine Equivalence P Antipsychotic Doses Initial Dose Equivalen ce Second Generation Aripiprazole Abilify Clozapine Clozaril Iloperidone Fanapt Olanzapine Zyprexa Paliperidone Invega Quetiapine Seroquel Risperidone Risperdal Ziprasidone Geodon Asenapine Saphris 1 2 Lurasidone Latuda 10 P
6 Typical Antipsychotic Side Effects Sedation Extrapyramidal Anticholinergic Low Potency First Generation Chlorpromazine Thorazine Mesoridazine Serentil Thioridazine Mellaril High Potency First Generation Fluphenazine Prolixin Haloperidol Haldol Loxapine Loxitane Perphenazine Trilafon Pimozide Orap Thiothixene Navane Trifluoperazine Stelazine Key: +++: substantial side effects; ++: moderate side effects; +: mild side effects; +/0: possible side effects; 0: none Atypical Antipsychotic Side Effects Sedation Extrapyramidal Anticholinergic Second Generation Aripiprazole Abilify + +/0 0 Clozapine Clozaril Iloperidone Fanapt + + +/0 Olanzapine Zyprexa ++ +/0 + Paliperidone Invega + + +/0 Quetiapine Seroquel ++ +/0 ++ Risperidone Risperdal + + +/0 Ziprasidone Geodon Asenapine Saphris Lurasidone Latuda Key: +++: substantial side effects; ++: moderate side effects; +: mild side effects; +/0: possible side effects; 0: none FDA Black Box Warnings Atypical Antipsychotics (2 nd Generation) Elderly pts with dementia-related psychosis treated with atypical antipsychotic drugs are at increased risk of death Mesoridazine & Thioridazine Prolongs the QTc interval in a dose related manner & may cause torsade de pointes - type arrhythmias & sudden death Clozapine Agranulocytosis, seizures, myocarditis, orthostatic hypotension, & respiratory &/or cardiac arrest Attention-Deficit/Hyperactivity Disorder (ADHD) ~5% of children 13.6% have received treatment 40% outgrow the disorder by early adulthood 60% ongoing symptoms throughout life Untreated results in: Accumulated disability Co-occurring substance abuse, anxiety, & depression Treatment: Contributes to more-normal brain development Neuroprotective Pliszka S, Greenhill LL, Crimson ML, Sedillo A, Carlson C, Conners CK, et al. The texas children s medication algorithm project: report of the texas consensus conference panel on medication treatment of childhood attention deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2000;39(7): Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, et al. Developmental trajectories of brain volume abnormalities in children and adolscents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association. 2002;288(14): IMMEDIATE RELEASE STIMULANTS (DURATION OF EFFECT IS 3-6 HOURS) Age Methylphenidate Ritalin Metadate Methylin Concerta Dexmethylphenidate Focalin (2.5) 5 20 Dextroamphetamine 3+ Dexedrin 5 40 Lisdexamphetamine Vyvanse Amphetamines 3+ Amphetamine mixed salts (Adderall) Methamphetamine (Desoxyn) (2.5) SUSTAINED RELEASE STIMULANTS (DURATION OF EFFECT IS 6-12 HOURS) Methylphenidate Ritalin SR Ritalin LA Metadate ER Metadate CD Methylin ER Concerta Daytrana (patch) Dextroamphetamine Dexedrine spansules 5 40 Amphetamine Adderall XR 5 40 ALPHA-2 ADRENERGIC AGONISTS Typical Dose Clonidine Catapres mg (3-4x/day) Guanfacine Tenex mg (2-3x/day) ANTIDEPRESSANTS Typical Dose Bupropion Wellbutrin SR/LA C: A: Atomoxetine Strattera C&A: mg/kg Preston JD, O Neal JH, Talaga MC. Child and adolescent clinical psychopharmacology made simple. 2 nd ed. New York: New Harbinger; P
7 SIDE EFFECT Initial insomnia Reduced appetite Stomachache Mild dysphoria Lethargy, sedation, or impair concentration Headache Stimulant Side Effects SOLUTIONS Give dose earlier, or co-administer clonidine, or trazodone given at bedtime Switch to Focalin (may result in less of this effect) Give with food Switch classes of stimulants, or add an antidepressant Reduce dose Reduce dose, or change stimulants Preston JD, O Neal JH, Talaga MC. Child and adolescent clinical psychopharmacology made simple. 2 nd ed. New York: New Harbinger; P ADHD Treatment Begin medication on the weekend Start with low doses of stimulants Titrate dose up to adequate levels Initially dose 3x per day, determine optimal dose, then move to 1-2x per day dosing Monitor for side effects Provide close follow-up Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/ hyperactivity disorder. JAACAP. 2007;46(7): P FDA Black Box Warnings Methylphenidate & Dexmethylphenidate Give cautiously to pts with a history of drug dependence or alcoholism Amphetamines, Dexamphetamine, & Lisdexamphetamine Have a high potential for abuse & misuse may cause sudden death & serious cardiovascular adverse events Bupropion & Atomoxetine Increased risk of suicidal ideation in children or adolescence Case Study JB is an 8yo boy brought in for evaluation to determine if he has ADHD. He has difficulty sustaining attention in activities at school and at home. He fails to pay close attention to teachers and often makes careless mistakes in schoolwork. He gets out of his seat at inappropriate times and is constantly fidgeting in his seat. He often interrupts the teacher and classmates. His parents are very concerned that he may have to take medication at school. NKDA Past Med Hx: seizures Case Study What do you recommend and why? What should be monitored in this patient? How should the patient be counseled? What if the medication has been causing side effects and the parents want a change in therapy? What would you recommend? Test Questions 1. Risperidone or aripirazole are appropriate choices for a 15-year-old schizophrenic patient. 2. It is appropriate to prescribe Adderall XR 30mg PO once daily for a child 5 years of age. 3. The FDA issued a black box warning describing an increased risk of suicidality (suicidal behavior and ideation) for all antidepressants used in individuals under the age of 18. 7
PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health
PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS Juanaelena Garcia, MD Psychiatry Director Institute for Family Health Learning Objectives Learn basics about the various types of medications that
More informationMedications Used in the Management of Disruptive Behavior Disorders
The following medication chart is provided as a brief guide to some of the medications used in the management of various behavior disorders, along with their potential benefits and possible side effects.
More informationPsychiatric Medications: Pearls and Pitfalls. The majority of medications used in patients with psychiatric diagnoses have more than one use.
Psychiatric Medications: Pearls and Pitfalls Rule #1 The majority of medications used in patients with psychiatric diagnoses have more than one use. Without access to the patient s medical record, to review
More informationPSYCHOSOMATIC INSTITUTE OF SAN ANTONIO New Patient Information
PSYCHOSOMATIC INSTITUTE OF SAN ANTONIO New Patient Information Name: Last: First: MI: Birth Date: Sex: M F Marital Status: Single Married Divorced Separated Widowed Partnered Other Preferred name: Emergency
More informationState of Louisiana. Department of Health and Hospitals Bureau of Health Services Financing
Bobby Jindal GOVERNOR State of Louisiana Department of Health and Hospitals Bureau of Health Services Financing Kathy H. Kliebert SECRETARY The purpose of this memo is to advise you that effective September
More informationMEDICATIONS AND TOURETTE S DISORDER: COMBINED PHARMACOTHERAPY AND DRUG INTERACTIONS. Barbara Coffey, M.D., Cheston Berlin, M.D., Alan Naarden, M.D.
MEDICATIONS AND TOURETTE S DISORDER: COMBINED PHARMACOTHERAPY AND DRUG INTERACTIONS Barbara Coffey, M.D., Cheston Berlin, M.D., Alan Naarden, M.D. Introduction Tourette Syndrome (TS) or Tourette s Disorder
More informationATYPICALS ANTIPSYCHOTIC MEDICATIONS
The atypical antipsychotics are a class of drugs that are used to treat a number of behavioral health disorders, including schizophrenia, other psychotic disorders, mood disorders, and behavioral agitation
More informationBipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic
More informationOverview of Mental Health Medication Trends
America s State of Mind Report is a Medco Health Solutions, Inc. analysis examining trends in the utilization of mental health related medications among the insured population. The research reviewed prescription
More informationPsychopharmacotherapy for Children and Adolescents
TREATMENT GUIDELINES Psychopharmacotherapy for Children and Adolescents Guideline 7 Psychopharmacotherapy for Children and Adolescents Description There are few controlled trials to guide practitioners
More informationPsychotropic Medication Reference Chart
Psychotropic Medication Reference Chart Appendix 4.14 This chart is not an all-inclusive list of medications. If you have a question regarding the classification of a medication you may consult websites
More informationA BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES
INTRODUCTION A BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES Individuals with intellectual disabilities are not uncommonly prescribed psychotropic medications.
More informationMental Health Medications
Mental Health Medications National Institute of Mental Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Contents Mental Health Medications..............................................................1
More informationMedications A detailed booklet that describes mental disorders and the medications for treating them includes a comprehensive list of medications.
A detailed booklet that describes mental disorders and the medications for treating them includes a comprehensive list of medications. 2014 Contents Introduction: Mental Health Medications...1 What are
More informationThe following is a sample of psychotropic drug warnings that drug regulatory agencies
Chronology of International Drug Regulatory Agency Warnings about Psychotropic Drugs The following is a sample of psychotropic drug warnings that drug regulatory agencies around the world have issued.
More informationEarly Morning Waking Excessively Orderly or Perfectionistic
COLLEGE OF MEDICINE Jacksonville 580 W 8 th St T-2 6 th Fl Ste 6005 6266 Dupont Station Ct Department of Psychiatry Jacksonville, FL 32209 Jacksonville, Fl 32217 Division of Adult Psychiatry Phone 904-383-1038
More informationAlgorithm for Initiating Antidepressant Therapy in Depression
Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression
More informationMedication Side Effects:
Medication Side Effects: Staying Healthy While on Psychotropic Medications Megan Maroney PharmD, BCPP Clinical Assistant Professor Ernest Mario School of Pharmacy Rutgers the State University of New Jersey
More informationAntipsychotics and the Nursing Home
Antipsychotics and the Nursing Home Lisa M. O Hara, PharmD, CGP Corporate Director of Clinical Services The State Operations Manual Part 1: F329 Unnecessary Drugs Medication Management Defined Helps promote
More informationNew Treatments. For Bipolar Disorder. Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine
New Treatments For Bipolar Disorder Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine Abbott Laboratories AstraZeneca Bristol-Myers Squibb Corcept
More informationI. The Positive Symptoms...Page 2. The Negative Symptoms...Page 2. Primary Psychiatric Conditions...Page 2
SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Assessment & Treatment of Psychosis Developed March 1, 2003 Revised September 21,
More informationHandout 2 List of medications used to treat mental illness
Navigating Boundaries: Setting Sail With A Mentally Ill Client Handout 2 List of medications used to treat mental illness Information synthesized from www.drugs.com. Additional Information: CR following
More informationMedicines for Treating Depression. A Review of the Research for Adults
Medicines for Treating Depression A Review of the Research for Adults Is This Information Right for Me? Yes, if: A doctor or other health care professional has told you that you have depression. Your doctor
More informationRecognizing and Treating Depression in Children and Adolescents.
Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital
More informationWhat are the best treatments?
What are the best treatments? Description of Condition Depression is a common medical condition with a lifetime prevalence in the United States of 15% among adults. Symptoms include feelings of sadness,
More informationDepression Flow Chart
Depression Flow Chart SCREEN FOR DEPRESSION ANNUALLY Assess for depression annually with the PHQ-9. Maintain a high index of suspicion in high risk older adults. Consider suicide risk and contributing
More informationUpdate on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice
Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological
More informationRecognition and Treatment of Depression in Parkinson s Disease
Recognition and Treatment of Depression in Parkinson s Disease Web Ross VA Pacific Islands Health Care System What is depression? Depression is a serious medical condition that affects a person s feelings,
More informationMOOD DISORDERS PART II BIPOLAR AFFECTIVE DISORDER (BAD) Todd Stull, M.D. James Sorrell, M.D.
MOOD DISORDERS PART II BIPOLAR AFFECTIVE DISORDER (BAD) Todd Stull, M.D. James Sorrell, M.D. BIPOLAR AFFECTIVE DISORDER (BAD) General Assessment is challenging Input important Change in level of functioning
More informationComorbid Conditions in Autism Spectrum Illness. David Ermer MD June 13, 2014
Comorbid Conditions in Autism Spectrum Illness David Ermer MD June 13, 2014 Overview Diagnosing comorbidities in autism spectrum illnesses Treatment issues specific to autism spectrum illnesses Treatment
More informationLamictal, lamotrigine Lithium, lithobid, eskalith Depakote, valproate Trileptal, oxcarbazepine Tegretol, equetro, carbamazepine Atypicals (aripiprazole, abilify, olanzapine, zyprexa, invega, risperdal,
More informationPsychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
More informationPsychotropic Medication
Page 1 T I P S F O R P R A C T I C E Psychotropic Medication Psychotropic medications are symptomatic medications that affect attention, emotions, or behaviors. Communication between the physician, NDHHS
More informationTreatment Options for ADHD in Children and Teens. A Review of Research for Parents and Caregivers
Treatment Options for ADHD in Children and Teens A Review of Research for Parents and Caregivers Is This Summary Right for Me? Yes, if: A doctor said that your child or teen has attention deficit hyperactivity
More informationPreferred Practice Guidelines Bipolar Disorder in Children and Adolescents
These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,
More informationTREATING MAJOR DEPRESSIVE DISORDER
TREATING MAJOR DEPRESSIVE DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, originally published in April 2000.
More informationDepre r s e sio i n o i n i a dults Yousuf Al Farsi
Depression in adults Yousuf Al Farsi Objectives 1. Aetiology 2. Classification 3. Major depression 4. Screening 5. Differential diagnosis 6. Treatment approach 7. When to refer 8. Complication 9. Prognosis
More informationMedications for bipolar disorder
Medications for bipolar disorder Findings from Australian National Survey of Mental Health and Wellbeing (Mitchell et al, 2004) In 12 months, only one-third saw a mental health professional 40% received
More informationClinical Recommendations for Treatment of Bipolar Disorder for Hong Kong 2013
Clinical Recommendations for Treatment of Bipolar Disorder for Hong Kong 2013 Version: March 2013 Objectives of Treatment Rapid control of symptoms especially agitation, impulsivity, aggression, suicidality
More information1/23/2014 TOPICS PHARMACOLOGY: UPDATES AND REVIEW. Elizabeth Reeve MD HealthPartners Medical Group Gillette Children s Specialty Heath Care
PHARMACOLOGY: UPDATES AND REVIEW Elizabeth Reeve MD HealthPartners Medical Group Gillette Children s Specialty Heath Care TOPICS General pharmacology concepts when prescribing for children and adults When
More informationBasic Principles in the Pharmacologic Management of ADHD
Child & Adolescent Psychiatry and Behavioral Medicine Center Basic Principles in the Pharmacologic Management of ADHD Overview Therapy may be indicated in ADHD to address organizational skills deficits
More informationMedication Management of Depressive Disorders in Children and Adolescents. Satya Tata, M.D. Kansas University Medical Center
Medication Management of Depressive Disorders in Children and Adolescents Satya Tata, M.D. Kansas University Medical Center First Line Medications SSRIs Prozac (Fluoxetine): 5-605 mg Zoloft (Sertraline):
More informationINNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions
INNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions Mary Lynn Stewart, RN, BSN, MSN Amedisys Home Health Care Learning Objectives: Identify key components
More informationMajor Depression. What is major depression?
Major Depression What is major depression? Major depression is a serious medical illness affecting 9.9 million American adults, or approximately 5 percent of the adult population in a given year. Unlike
More informationConjoint Professor Brian Draper
Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course
More informationStimulants and Nonstimulants for ADHD
Stimulants and Nonstimulants for ADHD Stimulants Adderall and Adderall XR (amphetamine mixtures) Concerta (methylphenidate, extended release) Daytrana (methylphenidate topical patch) Dexedrine and Dexedrine
More informationBehavioral Health Diagnoses, Symptoms, and Interventions for Children Ages 4 and older
Diagnosis Typical symptoms Behavioral interventions known to work (Evidence-informed; Manualized) *Descriptions provided below Trauma-related disorders Post-traumatic stress disorder --------------------------
More informationAttention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder Spring 2015 Continuing Education John Erramouspe, PharmD, MS Idaho State University College of Pharmacy 208-282-3019 johnerra@pharmacy.isu.edu I have no relevant
More informationDepression Treatment Guide
Depression Treatment Guide DSM V Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous
More informationA few general principles regarding medications are important to consider before initiating therapy in individuals diagnosed with a dementia
MEDICATIONS USED FOR THE MANAGEMENT OF DEMENTIA AND RELATED BEHAVIORIAL COMPLICATIONS* R.Ron Finley, B.S Pharm, R.Ph,CGP, Aimee Loucks, Pharm. D., Gil D. Rabinovici, M.D The following is intended to be
More informationA Guide to Tourette Syndrome Medications by John T. Walkup M.D.
llllllllllllllll A TSA MEDICAL PUBLICATION A Guide to Tourette Syndrome Medications by John T. Walkup M.D. This publication is intended to provide information about Tourette Syndrome, its management and
More informationTreatment of Behavioral Health Disorders in Adolescents: Depression, Bipolar Disorder, Schizophrenia
Treatment of Behavioral Health Disorders in Adolescents: Depression, Bipolar Disorder, Schizophrenia ELINORE F. MCCANCE-KATZ, MD, PHD CHIEF MEDICAL OFFICER SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
More informationMOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION
MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic
More informationBipolar Disorder Practice Guidelines for Adults
Bipolar Disorder Practice Guidelines for Adults Introduction PerformCare s condensed guidelines for the treatment of Bipolar Disorder are derived from the American Psychiatric Association (APA) Guidelines
More informationAutism Spectrum Disorders and Comorbid Behavioral Health Symptoms
Autism Spectrum Disorders and Comorbid Behavioral Health Symptoms Cynthia King, MD Child and Adolescent Psychiatrist Associate Professor of Psychiatry UNMSOM Psychopharmacologic and Alternative Medicine
More informationFeeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999
Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder
More informationADHD PRACTISE PARAMETER. IRSHAAD SHAFFEEULLAH, M.D. A diplomate American Board of CHILD AND ADOLESCENT PSYCHIATRY
ADHD PRACTISE PARAMETER IRSHAAD SHAFFEEULLAH, M.D. A diplomate American Board of CHILD AND ADOLESCENT PSYCHIATRY Similar type of idea Similar document Similar document AACAP document Neurobiological condition
More informationMedications for Huntington s Disease Vicki Wheelock, M.D.
Medications for Huntington s Disease Vicki Wheelock, M.D. Director, HDSA Center of Excellence at UC Davis June 4, 2013 Outline Introduction and disclaimers Medications for cognitive symptoms Medications
More informationTREATMENT-RESISTANT DEPRESSION AND ANXIETY
University of Washington 2012 TREATMENT-RESISTANT DEPRESSION AND ANXIETY Catherine Howe, MD, PhD University of Washington School of Medicine Definition of treatment resistance Failure to remit after 2
More informationClinical Practice Guideline: Depression in Primary Care, Adult 4 Taft Court Rockville, MD 20850 www.mamsi.com
Clinical Practice Guideline: Depression in 4 Taft Court Rockville, MD 20850 www.mamsi.com 40 05 17 035 3/03 Once a primary care patient presents with depressive symptoms, the primary care physician makes
More informationImproving the Recognition and Treatment of Bipolar Depression
Handout for the Neuroscience Education Institute (NEI) online activity: Improving the Recognition and Treatment of Bipolar Depression Learning Objectives Apply evidence-based tools that aid in differentiating
More informationEvaluating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder (ADHD) Comparing Effectiveness, Safety, and Price
Evaluating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder (ADHD) Comparing Effectiveness, Safety, and Price Contents Our Recommendations...........................................
More informationMEDICATIONS USED FOR BEHAVIORAL & EMOTIONAL DISORDERS
MEDICATIONS USED FOR BEHAVIORAL & EMOTIONAL DISORDERS A GUIDE FOR PARENTS, FOSTER PARENTS, FAMILIES, YOUTH, CAREGIVERS, GUARDIANS, AND SOCIAL WORKERS Final May 10, 2010 Overview This booklet is a guide
More informationDepression in Long-Term Care
Depression in Long-Term Care Annette Carron, DO, CMD, FACOI, FAAHPM Director Geriatrics and Palliative Care Botsford Hospital Slide 1 OBJECTIVES Know and understand: Incidence and morbidity of depressive
More informationNICE Clinical guideline 23
NICE Clinical guideline 23 Depression Management of depression in primary and secondary care Consultation on amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised
More informationADHD. Dr. Ellen Hennessy-Harstad DNP, RN, FNP-BC, CPN Indiana University Northwest
ADHD Dr. Ellen Hennessy-Harstad DNP, RN, FNP-BC, CPN Indiana University Northwest Conflict of Interest The presenter indicates that there is no conflict of interest in this presentation, Objectives 1.
More informationTREATING BIPOLAR DISORDER
TREATING BIPOLAR DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition, originally published in April 2002. 1 For Continuing Medical
More informationBIPOLAR DISORDER A GUIDE FOR INDIVIDUALS AND FAMILIES FOR THE TREATMENT OF BIPOLAR DISORDER IN ADULTS
BIPOLAR DISORDER A GUIDE FOR INDIVIDUALS AND FAMILIES FOR THE TREATMENT OF BIPOLAR DISORDER IN ADULTS A publication of the Massachusetts Department of Mental Health and the Massachusetts Division of Medical
More informationPsychiatric Evaluation Intake Form
Psychiatric Evaluation Intake Form 1. Patient Contact Information Patient Name Preferred Name Last First MI Address_ Best contact phone number: Email address: Primary Care Physician Tel Fax Pharmacy Phone
More informationClinical Guideline / Formulary Document Pharmacy Department Medicines Management Services
Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services DEPRESSION Pharmacological Treatment of Depression NICE guidelines suggest the following stepped care model also
More informationBRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS
BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems
More informationMood Disorders. What Are Mood Disorders? Unipolar vs. Bipolar
Mood Disorders What Are Mood Disorders? In mood disorders, disturbances of mood are intense and persistent enough to be clearly maladaptive Key moods involved are mania and depression Encompasses both
More informationNICE clinical guideline 90
Depression in adults The treatment and management of depression in adults Issued: October 2009 NICE clinical guideline 90 guidance.nice.org.uk/cg90 NHS Evidence has accredited the process used by the Centre
More informationUsing Antipsychotics to Treat: Depression. Comparing Effectiveness, Safety, and Price
Using Antipsychotics to Treat: Depression Comparing Effectiveness, Safety, and Price Our Recommendations Although antipsychotics were developed to treat schizophrenia, newer ones are sometimes used to
More informationArizona Department of Health Services/ Division of Behavioral Health Services Behavioral Health Drug List Effective 1/1/2014
Arizona Department of Health Services/ Division of Behavioral Health Services Behavioral Health Drug List Effective 1/1/2014 The Arizona Department of Health Services, Division of Behavioral Health Services,
More informationTreatment of Bipolar Disorder: A Guide for Patients and Families
TREATMENT OF BIPOLAR DISORDER 2004 Treatment of Bipolar Disorder: A Guide for Patients and Families David A. Kahn, M.D., Paul E. Keck, Jr., M.D., Roy H. Perlis, M.D., Michael W. Otto, Ph.D., Ruth Ross,
More informationDepression in Older Adults A Guide for Patients and Families
The Expert Consensus Guideline Series Depression in Older Adults A Guide for Patients and Families Reprinted from: Alexopoulos GS, Katz IR, Reynolds CF III, Carpenter D, and Docherty JP. The Expert Consensus
More informationAntidepressant treatment in adults
Antidepressant treatment in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and
More informationChronic mental illness in LTCF. Chronic mental illness. Other psychiatric disorders.
Chronic mental illness in LTCF Abhilash K. Desai MD Medical Director Alzheimer s Center of Excellence Chronic mental illness 1. Schizophrenia and Schizoaffective disorder. 2. Bipolar disorder (Type 1 and
More informationDepression Assessment & Treatment
Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting
More informationCHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc.
CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014 2014 MVP Health Care, Inc. CHAPTER 5 CHAPTER SPECIFIC CATEGORY CODE BLOCKS F01-F09 Mental disorders due to known physiological
More informationObjectives. Depression and Anxiety: Latest in treatment recommendations. At the conclusion of this presentation the attendee will be able to:
Depression and Anxiety: Latest in treatment recommendations Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC President, Fitzgerald Health Education Associates, Inc., North Andover, MA Family
More informationDepression is a common biological brain disorder and occurs in 7-12% of all individuals over
Depression is a common biological brain disorder and occurs in 7-12% of all individuals over the age of 65. Specific groups have a much higher rate of depression including the seriously medically ill (20-40%),
More informationTREATMENT OF BIPOLAR DISORDERS: A Guide for Patients and Families
TREATMENT OF BIPOLAR DISORDERS: A Guide for Patients and Families Sources: David A. Kahn, M.D., Ruth Ross, M.A., David J. Printz, M.D., and Gary S. Sachs, M.D., DSMIV, DBSA Bipolar disorder (also known
More informationA Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood.
Bipolar disorder Bipolar (manic-depressive illness) is a recurrent mode disorder. The patient may feel stable at baseline level but experience recurrent shifts to an emotional high (mania or hypomania)
More informationPSYCHIATRY. Patient Name: Date: / / Date of Birth: / / Age: Pharmacy Name: Pharmacy Phone #:
Patient Name: Date: / / Date of Birth: / / Age: Pharmacy Name: Pharmacy Phone #: Primary Care Physician: Current Therapist/Counselor: How did you hear about us? Internet Insurance Other Providers (specialty):
More informationJane Marie Sulzle, DNP, CNS, MS PrairieCare Medical Group, Edina
Children, Mental Health, and Psychiatric Medication: Empowering parents with information on how to talk to their children about medication and how the medication may impact school performance. Jane Marie
More informationMoody Kids, Bipolar Disorder, and Medication Treatment Strategies. Learning Objectives. Mood Episodes. Irritability and Anger are Nonspecific Symptoms
Moody Kids, Bipolar Disorder, and Medication Treatment Strategies May 6, 2016 Dara Sakolsky, MD, PhD Associate Medical Director, STAR Clinic Assistant Professor of Psychiatry University of Pittsburgh Medical
More informationThe Antidepressants: Treating Depression. Comparing Effectiveness, Safety, and Price
The Antidepressants: Treating Depression Comparing Effectiveness, Safety, and Price Our Recommendations Antidepressants can improve the symptoms of depression, but they can also have serious side effects.
More informationPsychotic Disorder. Psychosis. Psychoses may be caused by: Examples of Hallucinations and Delusions 12/12/2012
Psychosis Psychotic Disorder Dr Lim Boon Leng Psychiatrist and Medical Director Dr BL Lim Centre For Psychological Wellness Tel: 64796456 Email: info@psywellness.com.sg Web: www.psywellness.com.sg A condition
More informationDEPRESSION IN PRIMARY CARE: An Overview. Jorge R. Petit, MD Quality Health Solutions
DEPRESSION IN PRIMARY CARE: An Overview Jorge R. Petit, MD Quality Health Solutions Topics In this Session Overview Clinical Importance of Depression Types of Depression Phases of Depression Care Collaborative
More informationPsychotropic Medications
Psychotropic Medications Medicating children and adolescents for psychiatric problems or learning disabilities continues to be an area of controversy. There are currently two opposing poles in this discussion.
More informationBipolar Disorder: What s the Difference & What s New?
Bipolar Disorder: What s the Difference & What s New? Rex S. Lott, Pharm.D., BCPP Professor, Idaho State University College of Pharmacy Mental Health Clinical Pharmacist, Boise VA Medical Center Clinical
More informationChapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of
Chapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of antipsychotic agents Identify common adverse effects
More informationComorbid Problems in Children and Adults with ADHD: Current Medication Interventions
Comorbid Problems in Children and Adults with ADHD: Current Medication Interventions CANP State Conference March 22, 2013 Monterey, CA Susan R. Opas, PhD, CPNP, CPMHS Workshop Objectives Review defining
More informationHandy charts to help people compare the medications for mental health conditions
Handy charts Handy charts to help people compare the medications for mental health conditions Contents: 1. Acute Psychiatric Emergency 2. ADHD (Attention Deficit Hyperactivity Disorder) 3. Alcohol Dependence
More informationDepression. Medicines To Help You
Medicines To Help You Depression Use this guide to help you talk to your doctor, pharmacist, or nurse about your medicines for depression. The guide lists all of the FDA-approved products now available
More informationUnderstanding Antipsychotic Medications
Understanding Antipsychotic Medications NARSAD RESEARCH National Alliance for Research on Schizophrenia and Depression 60 Cutter Mill Road, Suite 404 Great Neck, NY 11021 516-829-0091 1-800-829-8289 516-487-6930
More information