Handout for the Neuroscience Education Institute (NEI) online activity: Juvenile Bipolar Disorder: Further Complicated by Comorbidity
|
|
- Prudence Madison Atkinson
- 6 years ago
- Views:
Transcription
1 Handout for the Neuroscience Education Institute (NEI) online activity: Juvenile Bipolar Disorder: Further Complicated by Comorbidity
2 Learning Objectives Utilize evidence-based strategies to accurately diagnose pediatric patients with bipolar disorder and mania Identify current best practices for the treatment of pediatric bipolar disorder and mania
3 Pretest Question Tony is an 11-year-old patient with bipolar disorder I. In discussion with the patient and his parents, it is determined that an atypical antipsychotic may be the best choice of treatment. Which of the following atypical antipsychotics is currently FDA-approved for the treatment of bipolar disorder in children 10 years and older? 1. Asenapine 2. Olanzapine 3. Paliperidone 4. All of the above 5. None of the above
4 Case of Joey Joey is a 14-year-old male with a history of trauma referred because of "fights" with his mother Mother complains of quick temper, "rapid mood swings," agitation, inappropriate "jokes" and "touching," and times of poor sleep (and not tired) Marginally passing school (on educational plan) Previous trials of stimulants for ADHD were "ineffective and made him angry;" previous SSRI for early mood "set him in a rage" No medical history; no hospitalizations MSE: Joey reports sad/mad, angry with mother; reactive; laughs inappropriately; appears disinhibited; no psychosis; no suicidality/homicidality Diagnosis(es)?
5 Juvenile Bipolar Disorder (BPD) Prevalence: 2.9% of children and adolescents (Merikangas 2010) Estimated 10-15% of cases in child psychiatric practices (Carlson et al. 1999, Wozniak et al. 1995) Chronic course: under study (Geller et al. 2006, 2009; Birmaher et al. 2009, 2014; Wozniak et al. 2010; Wilens et al. 2016)
6 Mean Age of Onset for Bipolar Disorder; Many Adult Cases Onset in Childhood Kennedy et al. CNS Spectrums 2011;16.
7 Pediatric-Onset Bipolar Disorder: Mood History MANIA Irritable, angry, grouchy, cranky, snappy, swearing, disrespectful, threatening, rage attacks Explosions: how often, how long, how destructive, how aggressive Giddy, goofy, silly, high, "on drugs," laughing fits, class clown DEPRESSION Depressed, sad, no pleasure, down on self, suicidal, self-destructive, whiney, complaining, lower-level irritability
8 Distribution of Irritable Mood in Children With ADHD Mick. Biol Psychiatry 2005;58:576.
9 Essential Features of Pediatric BPD Mania is cardinal symptom: Without mania = depressive disorder Several types of BPD based on duration, patterns Manic episodes (>1 week); Hypomania (4-6 days) Persistently elevated/irritable mood May alternate between irritable/expanded mood If only irritable, then need grandiosity/inflated self esteem, reduced sleep(not tired), pressured speech, flight of ideas, severe distractibility, increased goal directed and high risk behaviors DSM IV vs V: Change in mixed episodes- now mixed features ([hypo]mania+depressive symptoms) \.
10 Disruptive Mood Dysregulation Disorder (DMDD) The symptoms of DMDD include: Severe temper outbursts at least 3 times a week Sad, irritable, or angry mood almost every day Reaction is bigger than expected Child must be at least 6 years old Symptoms begin before age 10 Symptoms are present for at least a year Child has trouble functioning in more than one place (eg, home, school, and/or with friends) DDX: bipolar disorder, oppositional + mood disorder, ADHD Axelson et al. J Clin Psychiatry 201;73(10): ; Guide/Disruptive-Mood-Dysregulation-Disorder-%28DMDD% aspxl.
11 Predictors of Manic Switches Family history of mood (major depressive and bipolar) disorders (5/7 studies) FHx of MDD, FHx of BPD Multigenerational FHx Family loading (>3 affected relatives per family) Aggression, conduct, and behavioral difficulties (2/7 studies) Comorbid conduct disorder Comorbid oppositional defiant disorder Aggressive and bullying behaviors Emotional dysregulation (2/7 studies) Medication-induced hypomania (3/3 studies)
12 Factors That Differentiate Bipolar Depression From Unipolar Depression Family history of psychiatric illness (3/4 studies) Comorbid conduct or oppositional defiant disorders/aggressive behaviors (4/4 studies) High severity of depression (2/4 studies) High level of impairment (2/4 studies) Wozniak 2004, Luby 2008, Merikengas 2012, Shon 2013.
13 COBY BP Spectrum Conversion to BP-I/II * Axelson et al. J Am Acad Child Adolesc Psychiatry 2011;50:
14 Psychiatric Comorbidity Is Common in Adolescent BPD Psychiatric Comorbidity % p<.0001 p<.0001 p<.0001 p<.0001 Conduct Disorder Oppositional Defiant Disorder ADHD Multiple Anxiety Disorder BPD non-bpd Wilens et al. Drug Alcohol Dependence 2008.
15 Psychiatric Comorbidity in Youth With BPD Stratified by Presence of Psychosis Avoidant Disorder OCD Agoraphobia Simple Phobia Social Phobia ** BPD+Psychosis BPD-Psychosis ** ** ψ Panic PTSD GAD * * OCD: obsessive compulsive disorder PTSD: posttraumatic stress disorder GAD: generalized anxiety disorder BPD: bipolar disorder Percent Comorbid *p<0.05 **p 0.01 ψ trend, p=0.05 Hua et al. J Clin Psychiatry 2011;72(3):
16 Global Assessment of Functioning (GAF) Associated With Psychosis in Pediatric BPD 50 t = 5.93, p < 0.01 Lowest Past GAF Score ± ± BPD-Psychosis BPD+Psychosis Hua et al. J Clin Psychiatry 2011;72(3):
17 High Rates of Neuropsychologically Defined Executive Function Deficits in Bipolar Disorder Percent Controls 45 BP-I Doyle et al. Biol Psychiatry 2013.
18 Treatment of Bipolar Disorder Thorough diagnostics (use of DSM-5) Education assessment (remember neuropsychological issues, comorbidity) Family evaluation Level of care if acute crisis Pharmacotherapy Psychotherapy
19 Psychotherapy for Juvenile BPD Psychoeducation family groups Family-focused therapy Cognitive behavioral therapy Group therapy Pavuluri et al. J Am Acad Child Adolesc Psychiatry 2004;43:528-37; Fristad et al. Arch Gen Psychiatry 2009;66: ; West et al. Minerva Psichiatrica 2011;52(1):21-35.
20 Effect Size for Change in Manic Youth With Mood Stabilizers Medication Effect Size 95% CI Divalproex-IR/ER Lithium Oxcarbazepine Topiramate Weighted YMRS = Young Mania Rating Scale Courtesy M. Delbello Correll et al. Bipolar Disord 2010.
21 Effect Size for Bipolar Change in Manic Youth With Second-Generation Antipsychotics (SGAs) Medication Effect Size 95% CI Aripiprazole Olanzapine Quetiapine Risperidone Ziprasidone Weighted SGAs YMRS = Young Mania Rating Scale Courtesy M. Delbello Correll et al. Bipolar Disord 2010.
22 FDA-Approved Uses of Mood Stabilizers and SGAs in Children With Bipolar Disorder Lithium 12+ years* Aripiprazole (Abilify) 10+ years Asenapine (Saphris) 10+ years Olanzapine (Zyprexa) 13+ years Quetiapine (Seroquel) 10+ years Risperidone (Risperdal) 10+ years Ziprasidone (Geodon) 10+ years *Under consideration for label change
23 Adverse Effects of Medications for Juvenile BPD SGAs - Weight gain, sedation, metabolic abnormalities, dyskinesias, prolactin elevation, EPS/TD - Risk depends on agent Mood stabilizers - Weight gain, sedation (general), thyroid abnormalities/renal/dermatological (Li), polycystic ovary syndrome (valproic acid), blood dyscrasia, rash (carbamazepine) Monitoring required - Height, weight, BMI, glucose/lipid panel, levels, other depending on agent De Hert et al. Eur Psychiatry 2011;26:144-58: Martin et al, eds. Pediatric Psychopharmacology. Oxford University Press, 2010.
24 TREATING COMORBIDITY WITH BPD
25 Diagnostic Overlap Between Conduct Disorder and BPD BPD N=110 N=76 N=116 Conduct Disorder Biederman et al. J Am Acad Child Adolesc Psychiatry 1999;38:468-76; Biol Psychiatry 2003;53:952-60; Joshi G, Wilens TE. In: Strakowski S et al, eds. Bipolar Disorder in Youth: Presentation, Treatment and Neurobiology. Oxford University Press: 2015:56-93.
26 ADHD in BPD Youth Mania N=43 N=42 ADHD N=206 Geller et al. J Child Adolesc Psychopharmacol 10(3):56-93.
27 Juvenile BPD MGH Sample 17% of outpatient psychopharmacology referrals under age 12 met criteria for BPD 91% comorbid with ADHD Wozniak, Biederman. J Am Acad Child Adolesc Psychiatry 1995;34:
28 Prepubertal and Early Adolescent ADHD and Bipolar Disorder Comorbidity with ADHD 87% (81/93) of BPD sample with ADHD Subjects with comorbid ADHD were significantly younger (10 years vs. 14 years, p<0.001) Comorbidity with ADHD occurred more often in males than females (98% vs. 69%, p<0.001) Geller et al. J Child Adolesc Psychopharmacol 2000;10(3):
29 ADHD Rates in Children, Adolescents, and Adults With BPD 100 N=63 Rates of ADHD N=22 % p<0.05 vs. controls & manic adols (adol onset) p<0.05 vs. manic adols (adol onset) N=108 p<0.05 vs. non-mood adol N=500 0 N=68 N=25 Manic Children Manic Adolescents (Childhood Onset) Manic Adolescents (Adolescent Onset) N=500 Manic Adults Wozniak et al. J Am Acad Child Adolesc Psychiatry 2005; Faraone et al. 1997; Wiens et al. Drug Alcohol Dependence 2008; Nierenberg et al. Biol Psychiatry 2005.
30 Volumetric Differences Between ADHD Patients and Controls Blue: volumetric decrease Red: volumetric increase Light blue: trend towards volumetric decreases CGa: anterior cingulate gyrus F1: superior frontal gyrus F3o: inferior frontal gyrus, pars opercularis F3t: inferior frontal gyrus, pars triangularis Biederman et al
31 Volumetric Differences Between BPD Patients and Controls Blue: volumetric decreases in the BPD group Red: volumetric increases in the BPD group FOC: frontal orbital cortex Biederman et al
32 Emotional Impulsivity in Adults With ADHD vs. Community Controls ADHD Community Impatient Quick to Anger, Get Upset Easily Frustrated Overreact Emotionally Easily Excited Barkley RA et al. ADHD in Adults: What the Science Says. New York, NY: Guilford Press; 2008:176-9.
33 Adults With ADHD and BPD DSM-IV ADHD: Inattention Symptoms Difficulty Sustaining Attention Easily Distracted Doesn't Listen Forgetful Difficulty Following Instructions Careless/Sloppy Difficulty Organizing Tasks/Activities ADHD+BPD ADHD-BPD Difficulty Concentrating Loses Things Percent with Symptom Wilens et al. Biol Psychiatry 2003.
34 Adults With ADHD and BPD Mean Bipolar Symptoms 8 6 ADHD-BPD ** 5.7 ADHD+BPD p< Bipolar Symptoms Wilens et al. Biol Psychiatry 2003.
35 The picture can't be displayed. ADHD vs Bipolar Disorder Distinguishing Factors Characteristic Course ADHD Constant Bipolar Chronic (cycling) Impairment Effect of structure Environmental role Moderate ++ + Severe +/ ++ Wilens et al. In: Hendren, ed. Disruptive Behavioral Disorders in Youth. 1998; Gagan, Wilens. Comorbidity in Bipolar Disorder
36 MGH Open Study: Bupropion for ADHD in Adults With Bipolar Disorder Mean Change to Endpoint DSM-IV ADHD Checklist Baseline: p < YMRS 9.4 p = Wilens et al. Biol Psychiatry 2003.
37 Treating Juvenile BPD+ADHD Study of BPD spectrum youth Ages 6-17 (9 ± 2.4 years) Design 8-week open (N=40) with DPK 4-week double-blind -5 Placebo (N=30) DPK + Adderall (5 mg BID) or PBO YMRS scores (endpoint) PBO 5.9 Amph 7.1 (pns) ADHD CGI-Improvement Scheffer et al. Am J Psychiatry;162: p< Amph Salts
38 Effect of Methylphenidate on ADHD in Stabilized Youth With BPD 40 ADHD RS p<0.05 vs. PBO ES = N=16; ages 4-17 (mean 11 years) Euthymic-stable on thymoleptic 1 week Tx No effect on mania 10 Baseline Placebo 5 mg 10 mg 15 mg Dose condition (BID) Best Dose Week *ARS-IV: parent-completed ADHD Rating Scale-IV Findling R et al. J Am Acad Child Adolesc Psychiatry 2007;46:11:
39 Association Between Adolescent BPD and Smoking and Substance Use Disorders (SUD) Emerging data suggests a bidirectional overrepresentation of BPD and SUD across the life cycle About half of referred and community samples of adults with BPD have a lifetime history of SUD Himmelhoch, 1979; Reich, 1974; Strakowski, 1998; Winokur, 1995.
40 Impact of SUD in Juvenile BD MSIT: Multisource Interference Task HC: healthy controls Gruber et al. J Am Acad Child Adolesc Psychiatry 2015.
41 Development of Nicotine Dependence in BPD Youth Lifetime Prevalence p=0.001 Bipolar Control Wilens et al. J Clin Psychiatry 2016;77(10):
42 Development of Substance Use Disorders (SUD) in BD Youth Lifetime Prevalence p=0.004 Bipolar Control Wilens et al. J Clin Psychiatry 2016;77(10):
43 Persistence of Adolescent BPD: BPD Status From Ages 14 to 19 (N=68) % No BPD Subthreshold BPD Full BPD DX based on KSAD/SCID 66% have BPD Wilens et al. J Clin Psychiatry 2016;77(10):
44 Development of SUD in BPD Youth Lifetime Prevalence Persistent BPD vs. Control: p=0.001 Persistent BPD vs. Non-Persistent BPD: p=0.2 Non-Persistent BPD vs. Controls: p=0.2 Persistent BPD Nonpersistent BPD Control Wilens et al. J Clin Psychiatry 2016;77(10):
45 BPD Adolescent Substance Use and Self-Medication Start to Change Mood, p=0.02 Cont to Change Mood, p=0.1 BPD Control Start to Get High, p=0.7 Start to Aid Sleep, p= Motivation from 1= very true to 4= not true at all Lorberg et al. Am J Addict 2010;19:
46 Deficits in Emotional Regulation Are Related to SUD in Bipolar Youth Kaplan-Meier Curve of Any SUD (moderate/severe; N=308) Hazard ratio: 4.55; 95% confidence interval: 1.84, 11.27; p=0.001; while controlling for BD Failure Estimate Dysregulated Not dysregulated Association remained significant when controlling for both BP and ADHD (HR: 5.16; 95% CI: 2.06, 12.90; p<0.001). Association lost significance when controlling for ADHD, CD, and BP (p=0.06; trend). CBCL =Child Behavior Checklist. Wilens et al. Drug Alcohol Dependence; epub:
47 Deficits in Emotional Regulation Are Associated With Polysubstance Abuse 40 *p<0.05 vs. CBCL<180 Percent with Alcohol+Drug Disorders More dysregulation p=0.02 p< CBCL <180 CBCL 180 <210 CBCL 210 Wilens et al. Drug Alcohol Dependence; epub:
48 Temporal Association of BPD and SUD % BPD prior to SUD BPD within 1 year of SUD BPD after SUD Wilens et al. Drug Alcohol Dependence 2008.
49 BPD and SUD: Clinical Implications Assess youth with severe or binge substance use disorders for BPD Assess all adolescents with BPD for cigarette smoking and substance use disorders
50 Controlled Study of Lithium for Bipolar Adolescents With SUD Percent Positive Urines Substance Use Functioning 60 Placebo (N=12) p< Lithium (N=13) Mean CGAS Scores Lithium (N=13) BSL p<0.05 Placebo (N=12) Weeks Mean age = 16 years Alcohol and/or drugs (marijuana) Dose: [lithium] = meq/l Weeks Geller et al. J Am Acad Child Adolesc Psychiatry 1998.
51 Quetiapine Plus Topiramate Reduces Cannabis Use in Adolescents With BPD # Days using substances in past month p<0.05 Quetiapine+placebo Quetiapine+Topiramate Baseline End of Study BPD YMRS scores improved with both treatments -14 quetiapine + topiramate -16 quetiapine + placebo Delbello et al. AACAP presentation, 2011.
52 Juvenile BPD and Comorbidity BPD often onsets in childhood BPD may manifest differently than adult BPD BPD assessment requires consideration of the mood, educational, environmental, and family needs Multimodal treatment is necessary Pharmacologically, second-generation antipsychotics are often first-line agents (and FDA-approved)
53 Juvenile BPD and Comorbidity Juvenile BPD is commonly comorbid with other major psychiatric disorders Evidence suggests that these disorders are not just a manifestation of BPD ADHD, conduct disorder, and substance use disorders are among the most common and disconcerting disorders Treatment of both the underlying BPD and comorbidity is often necessary
Pediatric Bipolar Disorder: Advances in Diagnosis and Research
Pediatric Bipolar Disorder: Advances in Diagnosis and Research Janet Wozniak, M.D. Associate Professor of Psychiatry Director, Pediatric Bipolar Disorder Research Program Harvard Medical School Massachusetts
More informationSevere Mood Dysregulation in Children and Adolescents Research Findings Support Diagnostic Validity of Pediatric Bipolar Disorder
Severe Mood Dysregulation in Children and Adolescents Research Findings Support Diagnostic Validity of Pediatric Bipolar Disorder Janet Wozniak, M.D. Associate Professor of Psychiatry Director, Pediatric
More informationTreatment of Bipolar Disorder in Youth
Treatment of Bipolar Disorder in Youth Janet Wozniak, M.D. Associate Professor of Psychiatry Director, Pediatric Bipolar Disorder Research Program Harvard Medical School Massachusetts General Hospital
More informationPediatric Bipolar Disorder and ADHD
Pediatric Bipolar Disorder and ADHD Janet Wozniak, M.D. Director, Pediatric Bipolar Disorder Research Program Associate Professor Psychiatry Massachusetts General Hospital Harvard Medical School Disclosures
More informationBipolar Disorder in Youth
Bipolar Disorder in Youth Janet Wozniak, M.D. Associate Professor of Psychiatry Director, Pediatric Bipolar Disorder Research Program Harvard Medical School Massachusetts General Hospital Pediatric-Onset
More informationDifferentiating MDD vs. Bipolar Depression In Youth
Differentiating MDD vs. Bipolar Depression In Youth Mai Uchida, M.D. Staff Physician Clinical and Research Programs in Pediatric Psychopharmacology Massachusetts General Hospital Disclosures Neither I
More informationDifferentiating Unipolar vs Bipolar Depression in Children
Differentiating Unipolar vs Bipolar Depression in Children Mai Uchida, M.D. Director, Center for Early Identification and Prevention of Pediatric Depression Massachusetts General Hospital Assistant Professor
More informationPediatric Bipolar Disorder and ASD
Pediatric Bipolar Disorder and ASD Janet Wozniak, MD Associate Professor of Psychiatry Massachusetts General Hospital Disclosures My spouse/partner and I have the following relevant financial relationship
More information#CHAIR2016. September 15 17, 2016 The Biltmore Hotel Miami, FL. Sponsored by
#CHAIR2016 September 15 17, 2016 The Biltmore Hotel Miami, FL Sponsored by Pediatric Bipolar Disorder: Diagnosis and Management Karen Dineen Wagner, MD, PhD University of Texas Medical Branch Galveston,
More informationPost Traumatic Stress Disorder (PTSD) versus Bipolar Disorder: Confusion in the face of chaos.
Post Traumatic Stress Disorder (PTSD) versus Bipolar Disorder: Confusion in the face of chaos. Randall Ricardi D.O. Child and Adolescent Psychiatry Phoenix Children s Hospital 6-24-17 10:50am Disclosures
More informationPractice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder,
Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder, Journal of the Academy of Child and Adolescent Psychiatry, 1997 Primary Authors: Jon McClellan MD
More informationDeficits in Emotional Regulation in ADHD
Deficits in Emotional Regulation in ADHD Joseph Biederman, MD Professor of Psychiatry Harvard Medical School Chief, Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts
More informationComprehensive Quick Reference Handout on Pediatric Bipolar Disorder By Jessica Tomasula
Comprehensive Quick Reference Handout on Pediatric Bipolar Disorder By Jessica Tomasula Official Name Bipolar Disorder; also referred to as Manic Depression Definitions (DSM-IV-TR, 2000) Bipolar I Disorder
More informationRANZCP 2010 AUCKLAND, NEW ZEALAND
RANZCP 2010 AUCKLAND, NEW ZEALAND Dr Veronica Stanganelli et al. RANZCP 2010 1 INTRODUCTION Bipolar disorder within young people has been debated for years. It is still controversial in DSM V (1), whether
More informationPediatric Psychopharmacology
Pediatric Psychopharmacology General issues to consider. Pharmacokinetic differences Availability of Clinical Data Psychiatric Disorders can be common in childhood. Early intervention may prevent disorders
More informationBipolar Disorder in Child Psychiatric Practice: A Case Report
CASE REPORT Bipolar Disorder in Child Psychiatric Practice: A Case Report 1. 2, 2, * A. Tsarkov *, P. Petlovanyi 1 Chainama Hills College Hospital, Lusaka, Zambia 2 Department of Psychiatry, School of
More informationBipolar disorder and severe irritability in youth: Diagnosis and treatment. Ellen Leibenluft, M.D.
Bipolar disorder and severe irritability in youth: Diagnosis and treatment Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental
More informationBIPOLAR DISORDER AND ADHD IN CHILDREN
BIPOLAR DISORDER AND ADHD IN CHILDREN BIPOLAR I DISORDER IS BEING DIAGNOSED WITH INCREASING FREQUENCY (INTENSITY) IN PRE-PUBERTAL CHIDREN WITH THE CAVEAT (WARNING / STIPULATION) THAT CLASSIC MANIC EPISODES
More informationPEDIATRIC BIPOLAR DISORDER
PEDIATRIC BIPOLAR DISORDER Swapna Deshpande, MD Clinical Assistant Professor Associate Training Director, Child/Adolescent Fellowship Program Department of Psychiatry & Behavioral Sciences University of
More informationD I A G N O S I S ADD/ADHD. Conduct Disorder. Oppositional. Oppositional Defiant Disorder. Defiant. Anxiety Disorder. Adjustment.
Dr. Crismon has no potential conflicts of interest to disclose with regard to this presentation. M. Lynn Crismon, Pharm.D., FCCP, BCPP Dean James T. Doluisio Regents Chair & Behrens Centennial Professor
More informationThe shift in nosology from the Diagnostic PROCEEDINGS FROM CHILDHOOD TO ADOLESCENCE: DIAGNOSIS AND COMORBIDITY ISSUES * Thomas J. Spencer, MD ABSTRACT
FROM CHILDHOOD TO ADOLESCENCE: DIAGNOSIS AND COMORBIDITY ISSUES * Thomas J. Spencer, MD ABSTRACT Attention-deficit/hyperactivity disorder (ADHD) tends to manifest differently in adolescents than in children,
More informationBIPOLAR DISORDERS DIAGNOSTIC AND TREATMENT ISSUES RICHARD RIES MD
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences BIPOLAR DISORDERS DIAGNOSTIC AND TREATMENT ISSUES RICHARD RIES MD PROFESSOR DEPARTMENT OF PSYCHIATRY UNIVERSITY
More informationCHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XV, 2013 INDEX
A acceptance and commitment therapy Posttraumatic Stress, 69 ADHD Adjunctive Fatty Acids, 5 Adjunctive Guanfacine Pharmacokinetics, 27 Amantadine, 21 Atomoxetine, 23 Cancer Risk, 31 CBT for Comorbid Anxiety,
More informationPreferred Practice Guidelines Bipolar Disorder in Children and Adolescents
BadgerCare Plus Preferred 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
More informationCHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX
A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release
More informationIndex. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers
Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic
More informationBipolar Disorder. Other Organic Diagnoses. Assessment/Diagnosis of Bipolar Disorder 2/6/2018 1
Bipolar Disorder 2/6/2018 1 Assessment/Diagnosis of Bipolar Disorder Complicated; mimicking other disorders and has comorbidity (presents with other disorders) Half of bipolar children have relatives with
More informationMood Disorders and Addictions: A shared biology?
Mood Disorders and Addictions: A shared biology? Dr. Paul Stokes Clinical Senior Lecturer, Centre for Affective Disorders, Department of Psychological Medicine Disclosures No relevant disclosures: No paid
More informationPediatrics Grand Rounds 5 March University of Texas Health Science Center at San Antonio I-1
Diagnosis and Treatment of Depression in Children and Adolescents Steven R. Pliszka, M.D. Professor and Vice Chair Chief, Division of Child and Adolescent Psychiatry Department of Psychiatry The Disclosures
More informationTreatment of Anxiety and Mood Disorders. John T. Walkup, MD Division of Child and Adolescent Psychiatry Weill Cornell Medical College New York, NY
Treatment of Anxiety and Mood Disorders John T. Walkup, MD Division of Child and Adolescent Psychiatry Weill Cornell Medical College New York, NY Disclosure: John T. Walkup, MD Consultant Advisory Board
More information5 COMMON QUESTIONS WHEN TREATING DEPRESSION
5 COMMON QUESTIONS WHEN TREATING DEPRESSION Do Antidepressants Increase the Possibility of Suicide? Will I Accidentally Induce Mania if I Prescribe an SSRI? Are Depression Medications Safe and Effective
More information5/2/2017. By Pamela Pepper PMH, CNS, BC. DSM-5 Growth and Development
By Pamela Pepper PMH, CNS, BC DSM-5 Growth and Development The idea that diagnosis is based on subjective criteria and that those criteria should fall neatly into a set of categories is not sustainable,
More informationChildhood Rage: Diagnosis and Treatment Strategies for Severe Mood Dysregulation - Part 2: Diagnosis and Treatment
Liberty University DigitalCommons@Liberty University Faculty Publications and Presentations Department for Counselor Education and Family Studies 2013 Childhood Rage: Diagnosis and Treatment Strategies
More informationChronic irritability in youth that may be misdiagnosed as bipolar disorder. Ellen Leibenluft, M.D.
Chronic irritability in youth that may be misdiagnosed as bipolar disorder Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental
More informationATTENTION DEFICIT HYPERACTIVITY DISORDER COMORBIDITIES 23/02/2011. Oppositional Defiant Disorder
ATTENTION DEFICIT HYPERACTIVITY DISORDER COMORBIDITIES The comorbidity of ADHD with other disorders is between 60% and 80% The most commonly comorbid disorder that occur alongside ADHD are: Oppositional
More informationForty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science Center San Antonio School of Medicine June 10-12, 2011
Adelaide Robb, MD Associate Professor Psychiatry and Pediatrics Source Advisory Board Disclosure Speaker s Bureau Bristol Myers Squibb Yes Yes Yes Epocrates Research Contract Royalties Yes Stock Janssen
More informationJ. Indian Assoc. Child Adolesc. Ment. Health 2012; 8(1):1-5. Editorial
1 J. Indian Assoc. Child Adolesc. Ment. Health 2012; 8(1):1-5 Editorial Controversies in Paediatric Bipolar Disorder Vivek Agarwal 1, Sivakumar T 2 1.Editor JIACAM & Associate Professor, Department of
More informationPharmacotherapy of ADHD with Non- Stimulants
Pharmacotherapy of ADHD with Non- Stimulants Timothy E. Wilens, M.D. Chief, Division of Child and Adolescent Psychiatry, (Co)Director of Center for Addiction Medicine, Massachusetts General Hospital Massachusetts
More informationTHE HOSPITAL FOR SICK CHILDREN DEPARTMENT OF PSYCHIATRY PARENT INTERVIEW FOR CHILD SYMPTOMS (PICS-7) SCORING GUIDELINES
THE HOSPITAL FOR SICK CHILDREN DEPARTMENT OF PSYCHIATRY PARENT INTERVIEW FOR CHILD SYMPTOMS (PICS-7) SCORING GUIDELINES Copyright, The Hospital for Sick Children, Toronto, Canada 2016. For licensing inquiries,
More informationMood swings in young people
Mood swings in young people Bipolar I & II Disorders are uncommon before puberty; Mood Dysregulation (MD) is very common before puberty Are they the same problem? What are the beginnings of bipolar? What
More informationDisclosure Statement. A Rational Approach to Psychopharmacology. Goals 10/28/2013
A Rational Approach to Psychopharmacology Disclosure Statement Full time employed physician with MaineGeneral Medical Center in Waterville and Augusta No conflicts of interest to disclose Goals Promote
More information2013 Virtual AD/HD Conference 1
Medication for & Coexisting Conditions Part 2 Dr. Kenny Handelman Child, Adolescent & Adult Psychiatrist Halton Healthcare Adjunct Professor of Psychiatry, University of Western Ontario www.drkenny.com
More informationDisruptive Mood Dysregulation Disorder
Walden University ScholarWorks School of Counseling Publications College of Social and Behavioral Sciences 2015 Disruptive Mood Dysregulation Disorder Brandy L. Gilea Walden University Rachel M. O Neill
More informationDisruptive mood dysregulation disorder (DMDD) a
Disruptive mood dysregulation disorder: A better understanding Recognizing key differences in DMDD can help distinguish it from similar pediatric disorders Disruptive mood dysregulation disorder (DMDD)
More informationBipolar Disorder Demystified. Cerrone Cohen, MD FABPN, FABFM Duke Departments of Family Medicine and Psychiatry
Bipolar Disorder Demystified Cerrone Cohen, MD FABPN, FABFM Duke Departments of Family Medicine and Psychiatry Underdiagnoses of Depression In Primary Care 2005 Study of 650 primary care patients on antidepressants
More informationAggression (Severe) in Children under Age 6
Aggression (Severe) in Children under Age 6 Level 0 Comprehensive diagnostic assessments. Refer to Principles of Practice on page 6. Evaluate and treat comorbid conditions (i.e. medical, other psychiatric
More informationThings You Might Not Know About Psychotropic Medications But Wish You Did
Things You Might Not Know About Psychotropic Medications But Wish You Did John E. Dunne, MD December 3, 2016 PAL Conference Conflicts of Interest None to report I am employed by Seattle Children s and
More informationPharmacotherapy of ADHD with Non-Stimulants
Pharmacotherapy of ADHD with Non-Stimulants Timothy E. Wilens, M.D. Chief, Division of Child and Adolescent Psychiatry, (Co)Director of Center for Addiction Medicine, Massachusetts General Hospital Massachusetts
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 informationKelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009
Kelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009 List the antipsychotics most often prescribed Compare and contrast the use and adverse effects experienced in the pediatric
More informationTreatment of Bipolar disorder
8/6/215 Treatment of Bipolar disorder Pichai Ittasakul, M.D. Department of Psychiatry, Ramathibodi Hospital, Mahidol University Bipolar disorder Manic-depressive Illness. is characterized by the occurrence
More informationPsychiatric Medications. Positive and negative effects in the classroom
Psychiatric Medications Positive and negative effects in the classroom Teaching the Medicated Child Beverly Bryant, M.D. Hattiesburg Clinic 9/17/14 Introduction According to the National Survey of Children
More informationOhio Psychotropic Medication Quality Improvement Collaborative. Minds Matter. Toolkit. for You and Your Family. This is the property of
Minds Matter Ohio Psychotropic Medication Quality Improvement Collaborative Minds Matter Toolkit for You and Your Family This is the property of About Minds Matter Minds Matter is a project to help teens,
More informationPediatric Bipolar Disorder
Pediatric Bipolar Disorder Jason J. Washburn, Ph.D., ABPP 1 Overview of Talk Bipolar Disorder Understanding Differences between Adults & Children Diagnosis of Pediatric Bipolar Disorder Treatment of Pediatric
More informationCurrent. A bad boy s behavior problems CASES THAT TEST YOUR SKILLS
Two weeks after changing medications, a hyperactive 11-year-old becomes manic and attempts suicide. Is the new regimen or an undiagnosed mental disorder to blame? A. Kenneth Fuller, MD Chief of psychiatry
More informationPaediatric Psychopharmacology. Dr Jalpa Bhuta. MD, DNB, MRCPsych (UK).
Paediatric Psychopharmacology. Dr Jalpa Bhuta. MD, DNB, MRCPsych (UK). Childhood pharmacokinetics Children have greater hepatic capacity More glomerular filtration Less fatty tissue Less ability to store
More informationCASE 5 - Toy & Klamen CASE FILES: Psychiatry
CASE 5 - Toy & Klamen CASE FILES: Psychiatry A 14-year-old boy is brought to the emergency department after being found in the basement of his home by his parents during the middle of a school day. The
More informationClass Update: Oral Antipsychotics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationBipolar Disorder 4/6/2014. Bipolar Disorder. Symptoms of Depression. Mania. Depression
Bipolar Disorder J. H. Atkinson, M.D. Professor of Psychiatry HIV Neurobehavioral Research Programs University of California, San Diego KETHEA, Athens Slides courtesy of John Kelsoe, M.D. Bipolar Disorder
More informationWhat s New in Psychotropic Prescribing for Children: Trends, Guidelines & Practice
3 rd Annual Challenges & Innovations in Rural Psychiatry Conference What s New in Psychotropic Prescribing for Children: Trends, Guidelines & Practice June 22, 2016 What s New in Psychotropic Prescribing
More informationMood Disorders.
Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationADHD Part II: Managing Comorbities
ADHD Part II: Managing Comorbities Brett Johnson, MD Staff Psychiatrist Rady Children s Behavioral Crisis Center Assistant Clinical Professor (Voluntary), UCSD January 26, 2011 Financial Disclosure I have
More information7/9/2013. Psychiatric medication treatment in children and adolescents: The good, the bad and the ugly. What ADHD is
Psychiatric medication treatment in children and adolescents: The good, the bad and the ugly Gabrielle A. Carlson, MD Professor of Psychiatry and Pediatrics Director, Child and Adolescent Psychiatry Stony
More informationCHAIR SUMMIT 7TH ANNUAL #CHAIR2014. Master Class for Neuroscience Professional Development. September 11 13, Westin Tampa Harbour Island
#CHAIR2014 7TH ANNUAL CHAIR SUMMIT Master Class for Neuroscience Professional Development September 11 13, 2014 Westin Tampa Harbour Island Sponsored by #CHAIR2014 Bipolar Depression: Putting the End Goal
More informationIntroduction. PMDC Team
Best Practices for Outpatient Program in Bipolar Disorder: Pediatric Mood Disorders Program at the University of Illinois at Chicago Julie A. Carbray PhD, PMHN-CNS Introduction five fold increase in diagnosis
More informationTreat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
More information25 Things To Know. mood. disorders
25 Things To Know mood disorders Mood Disorders Depression Bipolar Anxiety Depression Major Depressive Disorder Lasts for weeks at a time Depression Symptoms Lack energy & pleasure Helpless Sad Depression
More informationJonathan Haverkampf BIPOLAR DISORDR BIPOLAR DISORDER. Dr. Jonathan Haverkampf, M.D.
BIPOLAR DISORDER Dr., M.D. Abstract - Bipolar disorder is a condition affecting an individual s affective states (mood). The different flavors of bipolar disorder have in common that there are alterations
More informationCriteria for Child Psychiatrist on the Use of Selected Psychotropic Medications in Children & Adolescents
Criteria for Child Psychiatrist on the Use of Selected Psychotropic Medications in Children & Adolescents DRUG NAME INDICATIONS / ACCEPTABLE USES PRIOR STIMULANT/ADHD DRUGS Daytrana (methylphenidate) ADHD
More information3/9/2017. A module within the 8 hour Responding to Crisis Course. Our purpose
A module within the 8 hour Responding to Crisis Course Our purpose 1 What is mental Illness Definition of Mental Illness A syndrome characterized by clinically significant disturbance in an individual
More informationUpdate on Pediatric Bipolar Disorder
Update on Pediatric Bipolar Disorder Benjamin I. Goldstein, MD,, FRCPC Associate Professor Departments of Psychiatry & Pharmacology Sunnybrook Health Sciences Centre University of Toronto Faculty of Medicine
More informationPresented by Bevan Gibson Southern IL Professional Development Center -Part of the Illinois Community College Board Service Center Network
Bipolar Disorder: What It Means to You and Your Classroom Presented by Bevan Gibson Southern IL Professional Development Center -Part of the Illinois Community College Board Service Center Network Introduction
More informationPSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
More informationTreating Disruptive Behavior Disorders in Children and Teens. A Review of the Research for Parents and Caregivers
Treating Disruptive Behavior Disorders in Children and Teens A Review of the Research for Parents and Caregivers e Is This Information Right for Me? This information is for you if: A health care professional*
More informationChallenges in identifying and treating bipolar depression: a guide
Challenges in identifying and treating bipolar depression: a guide Dr. Paul Stokes Clinical Senior Lecturer, Centre for Affective Disorders, Department of Psychological Medicine Overview Challenges in
More informationMedications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation
Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral
More informationADHD and Substance Use Disorders: An Intoxicating Combination
ADHD and Substance Use Disorders: An Intoxicating Combination Timothy E. Wilens, MD Chief, Division of Child & Adolescent Psychiatry Director, Center for Addiction Medicine Massachusetts General Hospital
More informationADHD and. Shaw Wendi Fortuchang, M.D. Board certified in Child & Adolescent, Adult, and Forensic Psychiatry
ADHD and Beyond Shaw Wendi Fortuchang, M.D. Board certified in Child & Adolescent, Adult, and Forensic Psychiatry Overview Use of medications in children How do medications work in the brain? Risperdal?
More informationPsychiatric medication treatment in children and adolescents:
Psychiatric medication treatment in children and adolescents: The good, the bad and the ugly Gabrielle A. Carlson, MD Professor of Psychiatry and Pediatrics Director, Child and Adolescent Psychiatry Stony
More informationPsychotropic Medication Management in Children and Adolescents
Drug Use Research & Management Program DHS Division of Medical Assistance Programs, 500 Summer Street NE, E35; Salem, OR 97301-1079 Phone 503-947-5220 Fax 503-947-1119 Psychotropic Medication Management
More informationExplosive Youth: Common Brain Disorders. Juvenile Law Conference 2005 Larry Fisher, Ph.D. UHS Neurobehavioral Systems
Explosive Youth: Common Brain Disorders Juvenile Law Conference 2005 Larry Fisher, Ph.D. UHS Neurobehavioral Systems For More Information Larry Fisher, Ph.D. Director of Neuropsychological Services UHS
More informationThe Pharmacological Management of Bipolar Disorder: An Update
Psychobiology Research Group The Pharmacological Management of Bipolar Disorder: An Update R. Hamish McAllister-Williams, MD, PhD, FRCPsych Reader in Clinical Psychopharmacology Newcastle University Hon.
More informationWI Alliance of Child Psychiatry and Pediatrics CASE STUDY. Mood Disorders. James A. Meyer MD Adolescent Medicine Marshfield Clinic
WI Alliance of Child Psychiatry and Pediatrics CASE STUDY Mood Disorders 12-09-2014 James A. Meyer MD Adolescent Medicine Marshfield Clinic Disclosure Statement I, James Meyer, M.D., do not have any relevant
More informationMajor Depressive Disorder (MDD) in Children under Age 6
in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 6. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian
More informationBipolar Disorders. Disclosure Statement. I have no financial disclosures or conflicts of interest
Bipolar Disorders Ahsan Naseem, MD Diplomate American Board of Psychiatry and Neurology Adult and Geriatric Psychiatry Medical Director Bryan Heartland Psychiatry Bryan Physician Network Partner Cheney
More informationTreatment Options for Bipolar Disorder Contents
Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8
More informationAntipsychotics in Bipolar
Use of Second-Generation Antipsychotics in Bipolar Disorder: A Practical Guide Flavio Guzman, MD Editor Psychopharmacology Institute This practical guide is an update on the use of second-generation antipsychotics
More informationPiecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder
Piecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder Hannah Sauer, PharmD PGY1 Pediatric Pharmacy Resident Mayo Clinic 2015 MFMER slide-1 Objectives
More informationMajor Depressive Disorder (MDD) in Children under Age 6
in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 5. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian
More informationPediatric Mood Dysregulation: Irritability, Disruptive Mood Dysregulation Disorder, and Bipolar Disorder
Pediatric Mood Dysregulation: Irritability, Disruptive Mood Dysregulation Disorder, and Bipolar Disorder William P. French, MD PAL Conference Everett, WA February 10, 2018 Disclosure of Potential Conflicts
More informationDefining Mental Disorders. Judy Bass, MPH, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More information6/22/2012. Co-morbidity - when two or more conditions occur together. The two conditions may or may not be causally related.
Autism Spectrum Disorders and Co-existing Mental Health Issues By Dr. Karen Berkman Objective To present an overview of common psychiatric conditions that occur in persons with autism spectrum disorders
More informationAnnouncements. The final Aplia gauntlet: Final Exam is May 14, 3:30 pm Still more experiments going up daily! Enhanced Grade-query Tool+
The final Aplia gauntlet: Announcements Chapter 12 Aplia due tonight Chapter 13 Aplia due Wednesday Final Exam is May 14, 3:30 pm Still more experiments going up daily! Enhanced Grade-query Tool+ Now includes
More informationEmpirical Evidence for the Use of Lithium and Anticonvulsants in Children with Psychiatric Disorders
REVIEW Empirical Evidence for the Use of Lithium and Anticonvulsants in Children with Psychiatric Disorders Melissa Lopez-Larson, MD, and Jean A. Frazier, MD Background: The use of psychotropic medications
More information11/12/2017. How effective are treatments of psychiatric disorders in children and adolescents?
How effective are treatments of psychiatric disorders in children and adolescents? Benedetto Vitiello, M.D. Pavia, November 22, 2017 1 Disclosure Benedetto Vitiello, M.D. Professor of Child and Adolescent
More informationIII. Anxiety Disorders Supplement
K-SADS-PL A. Screen Interview B. Supplements I. Disorders Supplement II. Psychotic Disorders Supplement III. Anxiety Disorders Supplement IV. Disorders Supplement V. Substance Disorders Supplement Advanced
More informationWhite Paper: The Treatment of Schizophrenia and Bipolar Disorder
White Paper: The Treatment of Schizophrenia and Bipolar Disorder in Children: What is Medically Necessary? For Health Plans, Medical Management Organizations and TPAs Trends in the Diagnosis and Treatment
More informationVery much. N/A No A little Pretty much. Making careless mistakes
Weiss Symptom Record The following is a list of different kind of problems. Everyone has some of these difficulties at some time. We want to know if any of these things are causing more difficulty than
More informationBipolar Network News Free
Bipolar Network News Free Published since 1995 The latest news on bipolar disorder research from around the world bipolarnews.org Updates from the 2012 Meeting of the American Academy of Child and Adolescent
More informationApril 2016 Prepared By: Kimberly D. Griego, PharmD, CGP
April 2016 Prepared By: Kimberly D. Griego, PharmD, CGP Bipolar disorder (BD), also referred to as manic-depression, presents with dramatic swings in a person s mood and energy level, which affects their
More information