Mental Health Clinician Volume 2: Issue 11

Second generation antipsychotics (SGAs) can be effective in treating mood disorders in pediatric patients; however, these medications also present with a risk of serious adverse effects. A recent review by the Agency for Healthcare Research and Quality (AHRQ) evaluated the use of SGAs in pediatric patients. This article summarizes the findings of the review, with a focus on bipolar disorder and schizophrenia.

Nearly 20% of children and adolescents in the US have at least one mental health condition yet less than half of these youth are engaged in treatment. Violent acts such as school shootings, suicide and even bullying have been attributed in part to inadequate mental health awareness, screening and follow-up care in youth. Children and adolescents with persistent behavioral problems, low academic functioning and high rates of psychosocial adversity are ideal candidates for mental health screening in schools and the community. School-based screening offers easier access and less stigma while community care offers the opportunity for more specialized psychiatric evaluation and treatment. There are simple validated screening tools for the most common mental health problems in youth such as anxiety, depression, substance abuse, autistic spectrum disorder, attention-deficit hyperactivity disorder and suicidality. This paper provides an overview of the prevalence of psychiatric disorders in children and adolescents and recommends screening tools to facilitate recognition and referral for additional evaluation and therapeutic intervention.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a chronic health condition presenting with symptoms of hyperactivity, impulsivity, and/or inattention in early childhood, adolescence and adulthood. Many patients will persist with associated symptoms throughout their life and may require long term treatment to maintain adequate control.

Objective: The purpose of this article is to review the current literature in regards to diagnosis, treatment, and management of ADHD in the pediatric and adolescent population.

Methods: A search was conducted using PubMed, Medline, Ovid, and CINHAL with a focus on studies and reviews in the English language from 2008 – 2013, featuring pediatric/adolescent patients across the ages of 4–17 years using the terms: “management”, “attention-deficit”, “hyperactivity”, and “treatment.” Literature referenced prior to the five-year time frame outlined herein provided foundational information on diagnostics and medications.

Discussion: Stimulants, in conjunction with behavioral therapy, are standard first line treatments used in ADHD. While stimulant medications have been shown to be effective in treating symptoms associated with ADHD, there are a variety of concerns that may prevent their use. These concerns are related to adverse consequences, many of which are not supported by concrete evidence. Other pharmacotherapy options such as norepinephrine reuptake inhibitors and selective alpha-2 adrenergic agonists are typically reserved as second line options. The use of novel and emerging complementary therapies will also be explored.

Conclusion: Patients diagnosed with ADHD must be thoroughly evaluated when making decisions regarding treatment. Many studies and reviews support the efficacy of pharmacotherapy in treatment of ADHD; however, there is insufficient evidence regarding long-term safety of the medications. Further research is warranted to evaluate current treatment options and associated risks and benefits to guide the clinician in optimal management of these patients.

CPNP UNIVERSITY PRODUCT ADDRESSING NEGATIVE SYMPTOMS IN SCHIZOPHRENIA AVAILABLE

Schizophrenia is a chronic, debilitating disorder in which successful long-term management represents a considerable clinical challenge. However, recent advances in the field are beginning to show promise toward enabling clinicians to render effective, personalized care. This activity will examine diagnostic tools for effective symptom assessment in schizophrenia and evolving theories on the pathogenesis of schizophrenia. The limitations of current antipsychotics will also be discussed, as well as the emergence of novel therapeutics with unique receptor binding profiles with the potential to improve patient outcomes.

This complimentary, knowledge-based course consists of four

Managing ciprofloxacin-clozapine interaction with immunoassay-based monitoring: A case report

Kristin WatersPharmD, BCPS, BCPP,

Victoria PopielarzBS, PharmD Candidate,

Joseph LumasagBS, PharmD Candidate,

Sara WiesenfeldBS, PharmD Candidate, and

Ashley TewksburyPharmD, BCPP

Children and adolescent psychopharmacology

Toolbox: Psychotropic medications approved in children and adolescents

ATTENTION-DEFICIT HYPERACTIVITY DISORDER MEDICATIONS

ANTIPSYCHOTIC MEDICATIONS & MOOD STABILIZER WITH PSYCHIATRIC INDICATIONS IN CHILDREN/ADOLESCENTS

ANTIDEPRESSANT MEDICATIONS

Psychotropic medication use in foster children: An opportunity for psychiatric pharmacists

The use of second generation antipsychotics in children and adolescents with bipolar disorder and schizophrenia: A summary of the AHRQ comparative effectiveness review

Recognizing and referring at-risk youth

Clinical considerations for the management of pediatric patients with attention-deficit/hyperactivity disorder

Second generation antipsychotics & nocturnal enuresis in children

Summary of 2012 Cochrane collaboration meta-analysis covering newer generation antidepressants for depressive disorders in children and adolescents

Treatment options for Tourette syndrome

Book Review: Get the residency: ASHP's guide to residency interviews and preparation

From the publisher

Movie Review: My left foot

STUDENT PERSPECTIVE

The annual state of CPNP report

CPNP Announcements

CPNP UNIVERSITY PRODUCT ADDRESSING NEGATIVE SYMPTOMS IN SCHIZOPHRENIA AVAILABLE

Managing ciprofloxacin-clozapine interaction with immunoassay-based monitoring: A case report

Clozapine plasma level toxicity induced by a pharmacokinetic interaction with bupropion: A case report

Management of antidepressant-induced bruxism

Evaluation of workload among Board-Certified Psychiatric Pharmacists in the United States

Impact of psychiatric pharmacist-led ambulatory alcohol withdrawal management