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1.2 The Pharmacotherapy of Conduct Disorder and Related Conditions
INSTITUTES 1. Psychopharmacology Update: Focus on Refractory Cases and Longer Term Outcomes 2. Research Institute: Epigenetics in Child and Adolescent Psychiatry 3. Eating Disorders in Children, Adolescents, and Young Adults 4. Lifelong Learning Institute: Module 13: Relevant Clinical Updates for Child and Adolescent Psychiatrists 5. Managing Suicide and Violence Risk While Building Resilience: Practical Applications in Clinical, School, and Community Settings 6. Evidence-Based Assessment for Child and Adolescent Psychiatry: Better Tools for Better Decisions and Outcomes 7. Autism Spectrum Disorder Update: Screening, Assessment, Genetics, and Multidisciplinary Treatment 8. Practical Pediatric Psychopharmacology for the Primary Care Practitioner and Early Career Psychiatrist
INSTITUTE 1 PSYCHOPHARMACOLOGY UPDATE: FOCUS ON REFRACTORY CASES AND LONGER-TERM OUTCOMES Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 02114-2696 Objectives: At an increasing rate, children and adolescents are presenting for psychopharmacological treatment. Among these youth, a number are either comorbid or refractory to traditional treatments. Furthermore, longerterm outcomes of pharmacological treatments on the course and adverse effects in children remain of concern. Methods: This advanced institute will focus on the short- and longer-term psychopharmacology of difficult cases, such as refractory ADHD, CD, MDD, BD, anxiety/PTSD, SUD, and ASD. Results: A comprehensive evaluation of recent positive and negative pharmacological studies, adjunct therapies, predictors of response, and current controversies surrounding these treatments in pediatric groups will be reviewed. An emphasis will be placed on describing longer-term data available and the treatment of complicated cases. Conclusions: Empirical data and systematically derived clinical experience on the use of medication treatment in children and adolescents will be discussed.
MAE MSS PPC Sponsored by AACAP’s Pediatric Psychopharmacology Committee http://dx.doi.org/10.1016/j.jaac.2016.07.004
1.1 COMPLEX ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER: FOCUS ON PHARMACOTHERAPY Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 02114-2696 Objectives: Increasingly complex cases of children with ADHD are presented to child psychiatrists requiring practitioners to learn new strategies for the advanced treatment of the condition and understand the longer-term outcomes of children who are treated for ADHD. Methods: A systematic review of the literature from recently completed and ongoing trials was reviewed to elucidate short- and longer-term data on stimulant, nonstimulant, and nutraceutical treatments for ADHD. Results: The literature, combined with clinical experience, indicates that alterations in the use of traditional stimulants in existing and novel release forms, such as atomoxetine, a-agonists, antidepressants, the use of alternative agents, and combinations of medications, can enhance a patient’s ADHD response. Comorbidity with ADHD may be treated with mono- or combined medication strategies. Longer-term data with the medications generally do not reveal deleterious adverse effects and are beginning to show improved outcomes.
S84
www.jaacap.org
1.0 – 1.3 Conclusions: Pharmacological strategies will be reported for those who 1) have not responded to traditional agents at traditional dosing, and 2) present with comorbid conditions. Longer-term data, when available, will be provided.
OTH PPC STIM http://dx.doi.org/10.1016/j.jaac.2016.07.005
1.2 THE PHARMACOTHERAPY OF CONDUCT DISORDER AND RELATED CONDITIONS Robert L. Findling, MD, MBA, Johns Hopkins University, and the Kennedy Krieger Institute, 1800 North Broadway, Suite-12-344, Baltimore, MD 21287-0010 Objectives: The goal of this talk is to provide a summary on what is known about the pharmacological management of youths with CD and other disruptive behavior disorders. A key focus of this presentation will be to characterize those youths with disruptive behavior disorders who may be suitable candidates for pharmacotherapy. Methods: A literature search was conducted. Furthermore, data from books, book chapters, and scientific presentations were also considered for inclusion. Results: There are patients with CD for whom pharmacotherapy may not be appropriate. In contrast, there are also youths with CD who may benefit from medication treatment. Medications that may be considered in this patient population include psychostimulants, lithium, antipsychotic drugs (typical and atypical), divalproex sodium, and a2-adrenergic agonists. Conclusions: There is a body of scientific evidence that can inform clinicians when to consider medication treatment for patients with CD. In youths for which pharmacotherapy might be appropriate, several medication options have data to support their use in this patient population.
CD PPC TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.006
1.3 AUTISM SPECTRUM DISORDER Gagan Joshi, MD, Bressler Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street Warren 635, Boston, MA 02493-1326 Objectives: This presentation will offer an up-to-date review of the emerging evidence of the psychopharmacological treatments for the management of ASD and associated psychopathology in children and adolescents referred for ambulatory psychiatric services. Methods: The literature on ASD was queried to identify published studies on the following: 1) the prevalence and the clinical presentation of frequently cooccurring psychiatric conditions in youth with ASD, and 2) the psychopharmacological interventions for the treatment of psychopathology in youth with ASD. Results: The presentation will initiate with the information on the prevalence of ASD in nonreferred and psychiatrically referred populations. The initial portion of the talk will underscore the burden of psychopathology associated with ASD, followed by a description of the clinical presentation and recognition of frequently co-occurring psychiatric disorders. The midportion of the talk will cover special considerations in the psychopharmacological management of youth with ASD and will provide a comprehensive overview of the evidence available for pharmacotherapy in ASD. The presentation will emphasize best evidence practice pathways for practical, multimodal treatment of psychiatric disorders and behavioral symptoms in the outpatient setting. The talk will emphasize practical management of common cooccurring psychiatric disorders and behavioral symptoms in ASD, including ADHD, anxiety, and mood dysregulation. The last portion of the talk will discuss the emerging pharmacotherapy for the core features of autism, i.e., social deficits and repetitive behaviors. Finally, the presentation will highlight the promising role of glutamate-modulating agents for the treatment of social deficits and psychopathology in ASD. Conclusions: Emerging literature highlights high levels of psychopathology and dysfunction in youth with ASD. Proper recognition of psychopathology in ASD offers opportunity for appropriate medication intervention. An up-todate knowledge of evidence-based pharmacotherapy in ASD helps optimize therapeutic interventions.
ASD PPC P Supported by NIMH Grant 1K23MH100450 http://dx.doi.org/10.1016/j.jaac.2016.07.007
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
INSTITUTE 1 PSYCHOPHARMACOLOGY UPDATE: FOCUS ON REFRACTORY CASES AND LONGER-TERM OUTCOMES Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 02114-2696 Objectives: At an increasing rate, children and adolescents are presenting for psychopharmacological treatment. Among these youth, a number are either comorbid or refractory to traditional treatments. Furthermore, longerterm outcomes of pharmacological treatments on the course and adverse effects in children remain of concern. Methods: This advanced institute will focus on the short- and longer-term psychopharmacology of difficult cases, such as refractory ADHD, CD, MDD, BD, anxiety/PTSD, SUD, and ASD. Results: A comprehensive evaluation of recent positive and negative pharmacological studies, adjunct therapies, predictors of response, and current controversies surrounding these treatments in pediatric groups will be reviewed. An emphasis will be placed on describing longer-term data available and the treatment of complicated cases. Conclusions: Empirical data and systematically derived clinical experience on the use of medication treatment in children and adolescents will be discussed.
MAE MSS PPC Sponsored by AACAP’s Pediatric Psychopharmacology Committee http://dx.doi.org/10.1016/j.jaac.2016.07.004
1.1 COMPLEX ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER: FOCUS ON PHARMACOTHERAPY Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 02114-2696 Objectives: Increasingly complex cases of children with ADHD are presented to child psychiatrists requiring practitioners to learn new strategies for the advanced treatment of the condition and understand the longer-term outcomes of children who are treated for ADHD. Methods: A systematic review of the literature from recently completed and ongoing trials was reviewed to elucidate short- and longer-term data on stimulant, nonstimulant, and nutraceutical treatments for ADHD. Results: The literature, combined with clinical experience, indicates that alterations in the use of traditional stimulants in existing and novel release forms, such as atomoxetine, a-agonists, antidepressants, the use of alternative agents, and combinations of medications, can enhance a patient’s ADHD response. Comorbidity with ADHD may be treated with mono- or combined medication strategies. Longer-term data with the medications generally do not reveal deleterious adverse effects and are beginning to show improved outcomes.
S84
www.jaacap.org
1.0 – 1.3 Conclusions: Pharmacological strategies will be reported for those who 1) have not responded to traditional agents at traditional dosing, and 2) present with comorbid conditions. Longer-term data, when available, will be provided.
OTH PPC STIM http://dx.doi.org/10.1016/j.jaac.2016.07.005
1.2 THE PHARMACOTHERAPY OF CONDUCT DISORDER AND RELATED CONDITIONS Robert L. Findling, MD, MBA, Johns Hopkins University, and the Kennedy Krieger Institute, 1800 North Broadway, Suite-12-344, Baltimore, MD 21287-0010 Objectives: The goal of this talk is to provide a summary on what is known about the pharmacological management of youths with CD and other disruptive behavior disorders. A key focus of this presentation will be to characterize those youths with disruptive behavior disorders who may be suitable candidates for pharmacotherapy. Methods: A literature search was conducted. Furthermore, data from books, book chapters, and scientific presentations were also considered for inclusion. Results: There are patients with CD for whom pharmacotherapy may not be appropriate. In contrast, there are also youths with CD who may benefit from medication treatment. Medications that may be considered in this patient population include psychostimulants, lithium, antipsychotic drugs (typical and atypical), divalproex sodium, and a2-adrenergic agonists. Conclusions: There is a body of scientific evidence that can inform clinicians when to consider medication treatment for patients with CD. In youths for which pharmacotherapy might be appropriate, several medication options have data to support their use in this patient population.
CD PPC TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.006
1.3 AUTISM SPECTRUM DISORDER Gagan Joshi, MD, Bressler Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street Warren 635, Boston, MA 02493-1326 Objectives: This presentation will offer an up-to-date review of the emerging evidence of the psychopharmacological treatments for the management of ASD and associated psychopathology in children and adolescents referred for ambulatory psychiatric services. Methods: The literature on ASD was queried to identify published studies on the following: 1) the prevalence and the clinical presentation of frequently cooccurring psychiatric conditions in youth with ASD, and 2) the psychopharmacological interventions for the treatment of psychopathology in youth with ASD. Results: The presentation will initiate with the information on the prevalence of ASD in nonreferred and psychiatrically referred populations. The initial portion of the talk will underscore the burden of psychopathology associated with ASD, followed by a description of the clinical presentation and recognition of frequently co-occurring psychiatric disorders. The midportion of the talk will cover special considerations in the psychopharmacological management of youth with ASD and will provide a comprehensive overview of the evidence available for pharmacotherapy in ASD. The presentation will emphasize best evidence practice pathways for practical, multimodal treatment of psychiatric disorders and behavioral symptoms in the outpatient setting. The talk will emphasize practical management of common cooccurring psychiatric disorders and behavioral symptoms in ASD, including ADHD, anxiety, and mood dysregulation. The last portion of the talk will discuss the emerging pharmacotherapy for the core features of autism, i.e., social deficits and repetitive behaviors. Finally, the presentation will highlight the promising role of glutamate-modulating agents for the treatment of social deficits and psychopathology in ASD. Conclusions: Emerging literature highlights high levels of psychopathology and dysfunction in youth with ASD. Proper recognition of psychopathology in ASD offers opportunity for appropriate medication intervention. An up-todate knowledge of evidence-based pharmacotherapy in ASD helps optimize therapeutic interventions.
ASD PPC P Supported by NIMH Grant 1K23MH100450 http://dx.doi.org/10.1016/j.jaac.2016.07.007
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016