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Medicating Children with Psychiatric Drugs

Published Online Tue, 18 Jan 2011 20:00:00, To the Best of My Knowledge at WPSU Public Broadcasting, Penn State University Penn State President Graham Spanier’s monthly call-in program featured this program on medication involving children.  “Both the number of children diagnosed with psychiatric disorders and the number receiving medications have risen dramatically, raising concerns for many parents and patients. On this edition of “To the Best of My Knowledge,” we’ll talk about the benefits and risks of medicating children. Guests: Christopher Petersen, M.D., Child Psychiatrist at Penn State Hershey Medical Center, and Craig Feaster, M.D. Board Certified Child and Adolescent Psychiatrist at SunPointe Health in State College, PA“ Click on this button to see the...

Childhood Schizophrenia Brain Findings

Childhood-Onset Schizophrenia: Structural Brain Abnormalities  Courtney Dawson  Penn State College of Medicine 2003   Basic information regarding childhood-onset schizophrenia (COS): Onset of psychosis by age 12 (2) Rare à 1/50 the prevalence of later-onset disease (1) Insidious rather than episodic onset (7) Continuing severe illness in about ½ of the cases (7) Psychotic symptomatology prior to the completion of normal brain maturation (9)   A retrospective study (17 subjects) conducted at the University of Colorado looked at premorbid and prodromal diagnostic features of COS (8): 65% reported problems is school as the initial symptom 59% reported 1st sign of psychotic symptoms between 5-10 years of age Average age of 1st clinical diagnosis of COS or schizoaffective disorder reported as 10.5 years of age Significant lag time between initial symptoms and a concrete clinical diagnosis   Neurodevelopmental Hypothesis of Schizophrenia: Brain “lesion” is present early in life but does not manifest itself until late in adolescence or early adulthood (6)   Underlying brain pathology presents differently at different ages: 1) Global delays in motor and possibly language development 2) Nonspecific attentional and behavioral dysfunction 3) Clinically identifiable thought disorder 4) Development of the full clinical syndrome as the brain matures   COS subjects had an increased incidence of speech and motor abnormalities prior to the onset of psychosis à possible indication of earlier brain developmental abnormalities   Current research focused on structural changes in COS: (9) Most of the research has been conducted by Rapoport and colleagues at the National Institute of Mental Health, most are prospective studies involving 15-75 COS subjects with initial MRI scans and follow-up scans at...

Childhood Schizophrenia Summary

 Childhood Schizophrenia Contributed by Melissa Yates Penn State College of Medicine   Definition:            –                Same diagnostic criteria apply to children, adolescents, and adults –                Based on characteristic symptoms, deficits in adaptive functioning, and duration of six months General Characteristics:    Incidence of childhood schizophrenia is less than 1/10,000 births Slight male predominance Less educated and professionally successful families Patients have low-average to average range of intelligence Patterns of behavior before a formal diagnosis: attention/conduct problems, earlier patterns of inhibition, withdrawal and sensitivity Disease is rarely observed before age 5 80% of children have auditory hallucinations; 50% have delusional beliefs Can be observed with additional conditions such as: conduct disorder, learning disabilities, mental retardation, and autism Poor prognosis if onset before age 10 with above personality difficulties   Since 1990 there has been an ongoing study of childhood onset schizophrenia (COS) of 49 patients at the National Institute of Mental Health (NIMH) which most of the following findings are based on.   Findings before a Formal Diagnosis is made6:    based on 49 treatment refractory patients at NIMH (patients that did not respond to conventional therapy currently available for schizophrenia) – 55% had language abnormalities – 57% had motor abnormalities – 55% had social abnormalities – 3% either failed a grade or required placement in special education – overall poor neuropsychological functioning in attention, working memory and executive function (i.e. making and carrying out appropriate decisions on a day to day basis) – findings were more striking than those in adult patients which indicates a more severe early disruption of brain development in COS – also indicates greater familial vulnerability (possibly a...

Child Sexual Abuse: Evaluation and Outcomes

Evaluation, Diagnosis, and Outcomes of Child Sexual Abuse Jessica Smith  Penn State College of Medicine March 2002   Definition: “Sexual abuse of children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or uses coercion. The perpetrator and the victim may be of the same sex of the opposite sex.     The sexual behaviors include touching breasts, buttocks, and genitals whether the victim is dressed or undressed; exhibitionism; fellatio; cunnilingus; and penetration of the vagina or anus with sexual organs or with objects. Pornographic photography is usually included in the definition of sexual abuse. It is important to consider developmental factors in assessing whether sexual behaviors between two children is abusive or normative.”5 Epidemiology1: Women: 16.8% , Men: 7.9% Number of substantiated or indicated cases has decreased by 41% in the time period of 1992 to 2000. Risk Factors4: Age: incidence of child sexual abuse increases with age 0-3 y/o: 10% of victims 4-7 y/o: 28.4% of victims 8-11 y/o: 25% of victims 12 and older: 35.9% of victims Gender: 2.5-3:1 female predominance 25% of victims are male Disabilities: Risk increased for those with physical disabilities, especially those that impair the child’s perceived credibility: blindness, deafness, and mental retardation Gender effect: boys are over represented among sexually abused children when compared to sexually abused children without disabilities Family Constellation: Absence of one or both parents is a risk factor Presence of stepfather in home doubles the risk for girls Parental impairments are also associated with increased risk Socioeconomic status: More important for physical abuse and neglect...

Brain Injury and Misdiagnosis

Misdiagnosis of Psychiatric Disorders Secondary to Brain Injury: ODD, OCD, ADHD Robyn Smith Penn State College of Medicine 2002    I. Traumatic Brain Injury: General information  Prevalence: Traumatic Brain injury in children and adolescents is a major public health problem in the US. Each year, an estimated 2 million people sustain a head injury. About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization, involving the annual hospitalization for about 100,000 children under the age of 15. Preschool- age children are the second highest risk group for brain injury. And 2/3 of children under 3 who are physically abused suffer traumatic brain injuries. (Savage, NHIF pediatric task force) Head injury is most common among males between the ages of 15-24, but can strike, unexpectedly, at any age. Many head injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability. Sometimes the deficits are mild and go unnoticed and others may not exhibit their effects until years after the injury. Causes of TBI: Motor vehicle accidents account for an estimated 28% of traumatic brain injuries; sports/physical activity account for 20%; assaults are responsible for 9%; 43% are due to “other” reasons. However, when considering those brain injuries severe enough to require hospitalization, virtually half (49%) are caused by motor vehicle accidents.2 Consequences of Brain Injury: Cognitive Deficits-Shortened attention span, short-term memory problems, problem solving or judgment deficits, inability to understand abstract concepts. Loss of sense of time and space, identity of self and others. There may also be an inability to accept more than...

Teens Contemplate Suicide

3 million U.S. Teens Contemplate Suicide WASHINGTON (Reuters) –Three million American teens have thought seriously about or even attempted suicide, a government survey released Sunday showed. More than 13 percent of young Americans between 14 and 17 years of age considered suicide in 2000, the report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found. Only 36 percent of them had received mental health treatment or counseling, SAMHSA said. Depression is the main cause of suicide, SAMHSA administrator Charles Curie said in a statement. “We need to help teens make the link between untreated depression and the risk for suicide, and help them identify serious depression or suicide risk in a friend,” Curie said. “We must encourage teens to tell a responsible adult when a friend is at risk for suicide.” More than a third of the three million teens aged 12 to 17 who said they thought about suicide in the past 12 months actually tried it, the survey, the first of its kind ever done by SAMHSA, found. Girls were twice as likely as boys to say they thought about suicide, but race did not seem to make a difference, the report found. Nor did whether the teens lived in the city, suburbs or country. The highest rate was in the western part of the country, where 13.5 percent of children aged 12 to 17 reported having had thoughts of suicide. Copyright 2002 Reuters. All rights reserved. More information: Depression in Children and Adolescents or National Suicide Prevention...

Mania or ADHD: Assessment with CBCL

Differentiating Mania from ADHD in Prepubertal Children Using the Child Behavior Checklist Augusta Czysz   Penn State College of Medicine 2002   Background: Child Behavior Checklists (CBCL) were first published in 1978 and 1979 by Achenbach and Edelbrock. They consist of lists of 118 problem behaviors that are organized into the Internalizing scale, including anxious obsessive behaviors, somatic complaints, schizoid behaviors and depressed withdrawal behaviors; the Mixed scale, comprised of immature-hyperactive behaviors; and the Externalizing scale, which includes delinquent, aggressive and cruel behaviors. A normalized T score was assigned to each behavior using a representative sample of age-appropriate children. These scores are tallied to give a child’s behavioral profile. These profiles were found to aid in differentiation of certain problem behaviors and syndromes. The original CBCL can be found as follows. Achenbach, TM. Edelbrock, CS. The Child Behavior Profile. J Consult Clin Psychol. 46, 478-488. 1978. 47, 223-233. 1979.   Identifying Bipolar Disorder for Early Intervention: Spencer, TJ. Biederman, J. Wozniak, J. Faraone, SV. Wilens, TE. Mick, E. Parsing pediatric bipolar disorder from its associated comorbidity with the disruptive behavior disorders. Biol Psych. 49(12): 1062-1070. 2001. According to a review article by Spencer et al, children with ADHD are 10x as likely to develop bipolar disorder (BD) than age-matched and gender-matched controls so it is important to be able to identify and begin treating BD early to help prevent unnecessary social and functional impairment for the child.   Diagnosing prepubertal Bipolar Disorder vs ADHD: Geller, B. Williams, M. Zimerman, B. Frazier, J. Beringer, L. Warner, KL. Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions,...
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