Child and Adolescent

Psychopharmacology
Elizabeth Turner
PSYC3506 Neuropharmacology
Date: March 27th 2013

Common Disorders

Anxiety
Attention Deficit Hyperactivity Disorder
Autistic Spectrum Disorders
Bipolar
Depression
Disruptive or Explosive Behavioural Disorder
Eating disorders
Schizophrenia

disorders. Dont you just hate that

word? I am actually very ordered!
- Luke Jackson Freaks, Geeks and Asperger Syndrome

Pregnancy and
Psychotropic Drugs

Definitions
Teratogens

A drug or other substance capable of interfering

with the normal development of a fetus.

SSRIdiscontinuation
Syndrome

Withdrawal observed in infants whose mother used

SSRIs during pregnancy. Common symptoms are;
irritability, sleep disturbances, hyperactive reflexes,
breathing and feeding difficulties, etc

Adverse Fetal
Outcome

Stillborn

Thalidomide

Drug used as a cure for morning sickness that

caused severe abnormal limb development

Diethylstilboestrol

DES: drug used to prevent abortions causing

increase risk of rare genital cancer and difficulties
conceiving

 500000+ pregnancies occur each year in

women who have psychiatric illness
1/3 of all pregnant women are exposed to a
psychotropic drug during pregnancy
The placental barrier is the easiest barrier to
cross
o Therefore the fetus and the mother will have about the same blood
level of the drug

Teratogens
Impact depends on genotype of organism
Impact changes over course of prenatal
development
Each teratogen affects a specific aspect of
development
Impact depends on dosage
Damage may not be evident at birth

Fig. 2.9 Human Development: A Life-Span View

Teratogens
Impact depends on genotype of organism
Impact changes over course of prenatal
development
Each teratogen affects a specific aspect of
development
Impact depends on dosage
Damage may not be evident at birth

Risk of Medication
Potential teratogenic
damage
Postnatal
behavioural
abnormalities
Perinatal syndromes
or neonatal toxicity
from breast-feeding

Untreated Mothers
Risks
Poor compliance with
prenatal care
Inadequate nutrition
Exposure to undesirable
drugs, medications and
herbals
Increased alcohol, caffeine
and tobacco use
Deficits in mother-infant
bonding
Disruptions in family
environment

Antidepressants and
Neonatal Outcomes
Usually treated with SSRIs
~50% pregnancies are unplanned
Severe, recurrent depression who stop
treatment, are at higher risk of relapse and
postpartum depression
SSRI-discontinuation syndrome common in
infants whose mothers used SSRI during last
trimester
Avoided by taking Prozac and alternative nonpharmacological intervention

Mood Stabilizers and

Neonatal Outcome
Untreated bipolar can lead to substance abuse,
manic episodes, etc
Risk of bipolar episode during pregnancy~70%
o Doubled if untreated

Lithium

Modest teratogen

Cardiac malformations

Depakote

Very teratogenic

Impaired cognitive function,

increases risk of ASD

Tegretol, Equitro

Slightly
teratogenic

Increase in adverse fetal outcomes

Lamictal

Non-teratogenic

Slight increase in cleft lip, cleft

palate

Topiramate

Oral cleft, penile malformations

Atypical Antipsychotic and

Neonatal Outcomes
Treats schizophrenia, bipolar disorder, PTSD,
borderline personality disorder
Little evidence that use during pregnancy
causes teratogenic effects to the fetus
Long term neurobehavioural studies of
exposed children have yet to be done.
Risperidone has been associated with
spontaneous abortions

Child
Psychopharmacology

Definitions

Attention
Characterized by persistent pattern of impulsiveness,
Deficit Disorder short attention , and other symptoms that interfere
with everyday life
Attention
Deficit
Hyperactivity
Disorder

Characterized by persistent patterns of

impulsiveness, short attention span, restlessness and
other symptoms that interfere with everyday life

Generalized
Anxiety
Disorder

Excessive fear and worry that is unable to be

controlled and causes distress and impairment

Social Phobia

Fear and avoidance of situations in which a person is

judged by their peers

Panic Disorder

Repeated attacks of intense paralyzing fear.

Pervasive
Developmental
Disorder

Any disorder that are characterized by distortions in

the development of basic psychological functions:
language, social skills, attention, perception

Definitions
Childhood
Disintegrative
Disorder

Loss of acquired developmental skills usually starting

around the age of 3

Rett Syndrome Neurodevelopmental disorder affecting mostly girls.

The child develops normally until preschool age then
development starts to slow and deteriorate.
Autistic
Spectrum
Disorders

ASD: various disorders commonly manifesting in

early childhood. Characterized by impaired social or
communication skills, repetitive behaviours, or
restricted range of interests

Autism

Characterized by impaired communication, excessive

rigidity, and emotional detachment

Asperger
Syndrome

Characterized by severely impaired social kills,

repetitive behaviours, and often a narrow set of
interests

Treating ADD/ADHD

Most studied of all childhood disorders

Often children are misdiagnosed
Crosses over with other diagnoses
Common signs of AD(H)D
o
o
o
o
o
o
o
o

Disorganized
Inattentiveness
Hyperfocus
Limited spatial awareness
Limited abstract thinking
Forgetfulness
Emotional over-arousal
Impulsiveness
Hyperactivity

Medications for Treating

ADD/ADHD
Many different
options for treating
ADHD
o Table 18.2 in textbook

 There is one kid at school who pushes and

shoves me all the time but he has ADHD I think
it is wrong that his problem gives him a licence to
beat people up and people just accept it.
- Luke Jackson Freaks, Geeks and Asperger Syndrome

Treating Behavioural or Aggressive

Disorders
Angry, agitated outbursts that pose danger
to the child and others
Have increase association with mania, mood
dysregulation, and impulsive aggression
Commonly misdiagnosed as bipolar
~50% progress to anti-social personality
disorder
Lithium originally recommended
o Severe side effects

Valproate used as alternative

Combination therapy recommended

Treating Depression
Occurs often when mothers have depression,
mood disorders, traumatic experiences
Psychotherapy first choice with preschool
Child/adolescent controversial topic
Adolescent highest risk of onset
Fluoxetine was the only approved treatment
o Recently FDA approved Lexapro

A Note on Suicide

 I tell the students that if they complete that final

act, it is over for them no more pain,
disappointment, feeling alone; no more beauty,
happiness, or opportunity for something better
but for every person who loves them, the hell is
just beginningWe are in our eighth year without
Jeff, and the pain is still so raw it brings tears to
my eyesSome well-meaning friends seem to
think that by now things should be back to
normal. They dont realize there is no more
normal for us. They are involved in their
childrens lives, and as their grandchildren are
arriving, they seem to forget that grandchildren
from Jeff are not in my future. Even more
agonizing Jeff is not in my future.
-Susan ter Borg Why I need to talk about my sons suicide

Treating Bipolar Disorder

Occurrence in preschool aged children
unclear
Older children/adolescents often
accompanied w/ other disorders
Valproic acid and quetiapine
Lamictal

Treating Psychotic Disorders

Schizophrenia rare in young children
Common in adolescents
o Grey matter deficiencies

1 in 3 patients developed symptoms between

10 and 20
Omega-3 polyunsaturated fatty acids
Clozaril, Risperdal, Zyprexa and Seroguel

Treating Anxiety Disorders

Preschool aged hard to treat
Common practice is psychotherapy
Medications avoided because of side effects

Generalized Anxiety, Separation

Anxiety and Social Phobia
Generalized Anxiety characterized by
excessive worry
Separation Anxiety common in young
children
o Increase in developing other forms of anxiety

Social Phobia fear and avoidance of

situations where the child is judged by peers
o Increased use of alcohol and drugs

Difficult to differentiate
Combination therapies

Obsessive-Compulsive
Disorder
Characterized by recurrent compulsions
Failure to complete certain rituals results in
anxiety
2-3% all adolescents have a form of OCD
Compulsive behaviour observed in many
different childhood disorders
Treatment: medication and psychotherapy

http://www.youtube.com/watch?v=3lvbcShuz14

Post-Traumatic Stress
Disorder
Hard to treat in children
Each child needs own specific treatment

Panic Disorder

Repeated attacks of intense paralyzing fear

G.A.D. can evolve into panic disorder
Triggers vary
Usually have warning signs of an oncoming attack
Not much research available for treatment
Symptoms:
o
o
o
o
o
o
o
o
o
o

Chest pain
Dizziness/faintness
Fear of losing control or impeding doom
Feeling of choking
Nausea
Numbness
Palpitations
Shortness of breath
Sweating, chills
Trembling or shaking

Psychotherapy

Treating Pervasive Developmental

Disorders
Usually recognized around age 3
Characterized by delays in development
Types:
o ASD
o Childhood Disintegrative Disorder
o Rett Syndrome

Treatment is similar to ASD

Treating A.S.D.
Autistic Spectrum Disorder, neurobiological
condition
o Severe impairment in several areas of development

Severity of ASD varies

Characteristics of ASD
negatives
Appear unresponsive to
sounds
Difficult to console
Difficulty sleeping
Failure to bond
Limited imagination
Weak immune system
Impaired social relationships
OCD like tendencies
Relying on schedules
Doesnt adapt to new
situations well

positives

Reading abilities
Art
Computer skills
Music
Excellent factual
memory
Perceptual motor skills
Visual spatial abilities

She knew what a German Shepherd looked like

and what a Pekingese. She knew Great Danes
and miniature Poodles. In her minds eye, she
had a picture for each breed. What she couldnt
form was a generic image of dog. What was it,
she said, that made a dog a dog?
-Temple Grandin, Ph.D. from Asperger Syndrome and
Adolescence

Difference Between Autism

and Asperger Syndrome
ASD is a spectrum disorder
Asperger and high functioning Autism have
well developed verbal and communication
skills
Difficulty understanding social norms
for all AS kids, [the] difficulty with language,
body language and facial expressions is a big
one deciphering other kids meanings is harder
than deciphering ancient hieroglyphics
-Luke Jackson Freaks, Geeks and Asperger
Syndrome

Children and adolescents with Asperger Syndrome

may have an unusual conversation styleTheir ideas
flow as long as they have topic control. They are
able to regale others with their knowledge of their
current passion. They often present information that
others havent even thought about. Yet, the same
person can be tongue-tied when asked simple
questions such as What did you do in school today?
Teresa Bolick Asperger Syndrome and Adolescence

When I look at someone straight in the eye,

particularly someone I am not familiar with, the
feeling is so uncomfortable that I cannot really
describe it. First of all I feel as if their eyes are
burning me and I really feel as if I am looking into
the face of an alien.
Luke Jackson Freaks, Geeks and Asperger Syndrome

movies.yahoo.com/movie/adam-2009/trailer

Treatment
Medications used to treat ADHD, OCD and
other common disorders accompany ASD
Rigid schedule.
CF/GF diet
o Caseomorphin and gluteomorphin from casein and gluten
containing food

To Diagnose or To Not?

Weblink
http://www.theglobeandmail.com/life/facts-and-ar
guments/why-i-need-to-talk-about-my-sons-suicide
/article9725378/

References
Alaimo, J. Caseomorphins and Gluteomorphins- The Food Opiods.
[Web Blog]. Retrieved from
http://drjosephalaimo.wordpress.com/2011/06/23/caseomorphinsand-gluteomorphins-%E2%80%93-the-food-opiods/
Ateah, C.A, Kail, R.V., & Cavanaugh, J.C.(2009) Human
Development: A Life-Span View. (2nd ed.) United States: Nelson
Education Ltd. pp68-70
Bolick, T. (2001) Asperger Syndrome and Adolescence.
Massachusetts: Fair Winds Press.
Jackson, L. (2002) Freaks, Geeks and Asperger Syndrome: A User
Guide to Adolescence. Great Britain: Jessica Kingsley Publishers
Julien, R.M., Advokat, C.D., & Comaty, J.E. (2011) A Primer of Drug
Action. (12th ed.) New York: Worth Publishers
ter Borg, S. (2013, March 13). Why I Need to Talk About My Sons
Suicide. The Globe and Mail, Facts & Arguments