- Email: [email protected]
6.6 Medications for Insomnia
INSTITUTES 6.6 — 7.1
contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills.
Results: Complex bidirectional relationships exist between psychiatric disorders and sleep problems that present common challenges to clinicians. The speaker will provide case presentations discussing common challenges in the treatment of sleep disorders comorbid with psychiatric conditions such as ADHD, autism spectrum disorder, and mood and anxiety disorders among children and adolescents. Conclusions: A large number of children and adolescents with sleep problems remain unidentified and untreated. Differential diagnosis and effective management of insomnia will be discussed as an essential part of comprehensive psychiatric evaluation and treatment.
CBT, SLP, TREAT
INTELLECTUAL DISABILITY AND CO-OCCURRING PSYCHIATRIC DISORDERS: DIAGNOSIS, TREATMENT, AND FORENSIC ISSUES
http://dx.doi.org/10.1016/j.jaac.2017.07.554
6.6 MEDICATIONS FOR INSOMNIA Judith Owens, MD, MPH, Boston Children’s Hospital, judith. [email protected] Objectives: The goals of this session are as follows: 1) to provide an update on current pharmacologic prescription options available for the treatment of pediatric insomnia; 2) to review the data supporting safety and efficacy of over-the-counter (OTC) medications, including melatonin; and 3) to present an outline to assist the child mental health professional in developing a practical and rational approach to using sedative hypnotic drugs in clinical practice, including patient and medication selection and potential pitfalls in management. Methods: This session will include comprehensive literature review, lecture and discussion, and case presentations. Results: Although there is widespread use of a large variety of prescription and OTC drugs for insomnia in child mental health settings, little data exist from randomized controlled trials regarding their safety and efficacy for the treatment of insomnia in children and adolescents, and no hypnotic drugs have yet been approved by the US Food and Drug Administration for use in children. Despite this, there are several new developments in the pharmacologic treatment of insomnia of which the child psychiatrist should be aware, including several new insomnia drugs that have recently been approved in adults. Given the relative lack of empirical data, mental health providers are faced with considerable challenges in the use of pharmacotherapy in treating insomnia in the pediatric population; thus, development of a systematic and rational approach is imperative. In addition, case presentations of common scenarios in child psychiatry clinical practice may help inform appropriate decision making in the face of limited evidence. Conclusions: The current status of knowledge regarding sedative/hypnotic drugs and pharmacological treatment of pediatric insomnia will be discussed in detail during the presentation.
PPC, SLP, TREAT http://dx.doi.org/10.1016/j.jaac.2017.07.555
6.7 TREATING SLEEP DISORDERS IN CHILDREN WITH PSYCHIATRIC DIAGNOSES: A CASE-BASED APPROACH Anna Ivanenko, MD, PhD, Northwestern Feinberg School of Medicine, [email protected] Objectives: Sleep problems often occur in the context of mental illness. Symptoms of insomnia identified early in childhood have been later correlated with anxiety, depression, attentional difficulties, family or parental distress, chronic persistent sleep problems, aggression, and social problems. This presentation will review the clinical approaches to children presenting with comorbid sleep disorders to psychiatric practice. Methods: Case-based examples and literature review will be presented.
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
ADOL, SLP, TREAT http://dx.doi.org/10.1016/j.jaac.2017.07.556
INSTITUTE 7
James C. Harris, MD, Johns Hopkins University School of Medicine, [email protected] Objectives: The goals of this study are to understand the assessment, diagnosis, and treatment of children and adolescents with a diagnosis of intellectual disability/intellectual developmental disorder (ID/IDD) and a cooccurring psychiatric disorder who are often underserved and historically stigmatized and to discuss the gaps in psychiatric interventions and how they may be met Methods: This session will provide a review of the DSM-5 process and the evidence base that led to the new DSM-5 definition of ID (IDD); a review of pertinent issues in the diagnosis of co-occurring psychiatric disorders in ID (IDD); and a review of neurobiological, clinical, and epidemiological literature pertinent to targeted treatment for behavioral phenotypes in neurodevelopmental syndromes. Additionally, the session will evaluate the evidence base of published pharmacotherapy trials for co-occurring conditions in ID (IDD), such as autism spectrum disorder (ASD); review the empirical basis for behavioral interventions for challenging behaviors (aggression, self-injury, and disruptive behavior); review research on family care for persons with ID (IDD) and the literature on effective family interventions; and review the literature on legal and ethical issues pertaining to ID (IDD) and co-occurring psychiatric disorder. Results: These reviews will provide a new understanding of the following gaps in knowledge: 1) DSM-5 diagnostic criteria for ID (IDD) and the new DSM emphasis on adaptive behavior in three domains (conceptual, social, and practical adaptation); 2) assessment and treatment of co-occurring psychiatric disorders in people with ID (IDD); 3) targeted neurobiological treatment of neurogenetic syndromes; 4) rational and evidence-based psychopharmacology for co-occurring psychiatric disorders; 5) behavioral interventions and combined drug and medication interventions; 6) family interventions, including mindfulness-based strategies; and 7) legal and ethical issues necessary for effective care of affected children and their families. Conclusions: This Institute will provide new knowledge for participants that will allow them to provide better care for people with ID (IDD) and their families based on in-depth presentations and panel discussions that will focus on case examples to illustrate effective treatment.
PPC, ID, CM Sponsored by AACAP's Autism and Intellectual Disability Committee http://dx.doi.org/10.1016/j.jaac.2017.07.558
7.1 UNDERSTANDING THE INTELLECTUAL DEVELOPMENTAL DISORDER ADAPTIVE REASONING PARADIGM SHIFT IN DSM-5 James C. Harris, MD, Johns Hopkins University School of Medicine, [email protected]
www.jaacap.org
S147
contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills.
Results: Complex bidirectional relationships exist between psychiatric disorders and sleep problems that present common challenges to clinicians. The speaker will provide case presentations discussing common challenges in the treatment of sleep disorders comorbid with psychiatric conditions such as ADHD, autism spectrum disorder, and mood and anxiety disorders among children and adolescents. Conclusions: A large number of children and adolescents with sleep problems remain unidentified and untreated. Differential diagnosis and effective management of insomnia will be discussed as an essential part of comprehensive psychiatric evaluation and treatment.
CBT, SLP, TREAT
INTELLECTUAL DISABILITY AND CO-OCCURRING PSYCHIATRIC DISORDERS: DIAGNOSIS, TREATMENT, AND FORENSIC ISSUES
http://dx.doi.org/10.1016/j.jaac.2017.07.554
6.6 MEDICATIONS FOR INSOMNIA Judith Owens, MD, MPH, Boston Children’s Hospital, judith. [email protected] Objectives: The goals of this session are as follows: 1) to provide an update on current pharmacologic prescription options available for the treatment of pediatric insomnia; 2) to review the data supporting safety and efficacy of over-the-counter (OTC) medications, including melatonin; and 3) to present an outline to assist the child mental health professional in developing a practical and rational approach to using sedative hypnotic drugs in clinical practice, including patient and medication selection and potential pitfalls in management. Methods: This session will include comprehensive literature review, lecture and discussion, and case presentations. Results: Although there is widespread use of a large variety of prescription and OTC drugs for insomnia in child mental health settings, little data exist from randomized controlled trials regarding their safety and efficacy for the treatment of insomnia in children and adolescents, and no hypnotic drugs have yet been approved by the US Food and Drug Administration for use in children. Despite this, there are several new developments in the pharmacologic treatment of insomnia of which the child psychiatrist should be aware, including several new insomnia drugs that have recently been approved in adults. Given the relative lack of empirical data, mental health providers are faced with considerable challenges in the use of pharmacotherapy in treating insomnia in the pediatric population; thus, development of a systematic and rational approach is imperative. In addition, case presentations of common scenarios in child psychiatry clinical practice may help inform appropriate decision making in the face of limited evidence. Conclusions: The current status of knowledge regarding sedative/hypnotic drugs and pharmacological treatment of pediatric insomnia will be discussed in detail during the presentation.
PPC, SLP, TREAT http://dx.doi.org/10.1016/j.jaac.2017.07.555
6.7 TREATING SLEEP DISORDERS IN CHILDREN WITH PSYCHIATRIC DIAGNOSES: A CASE-BASED APPROACH Anna Ivanenko, MD, PhD, Northwestern Feinberg School of Medicine, [email protected] Objectives: Sleep problems often occur in the context of mental illness. Symptoms of insomnia identified early in childhood have been later correlated with anxiety, depression, attentional difficulties, family or parental distress, chronic persistent sleep problems, aggression, and social problems. This presentation will review the clinical approaches to children presenting with comorbid sleep disorders to psychiatric practice. Methods: Case-based examples and literature review will be presented.
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
ADOL, SLP, TREAT http://dx.doi.org/10.1016/j.jaac.2017.07.556
INSTITUTE 7
James C. Harris, MD, Johns Hopkins University School of Medicine, [email protected] Objectives: The goals of this study are to understand the assessment, diagnosis, and treatment of children and adolescents with a diagnosis of intellectual disability/intellectual developmental disorder (ID/IDD) and a cooccurring psychiatric disorder who are often underserved and historically stigmatized and to discuss the gaps in psychiatric interventions and how they may be met Methods: This session will provide a review of the DSM-5 process and the evidence base that led to the new DSM-5 definition of ID (IDD); a review of pertinent issues in the diagnosis of co-occurring psychiatric disorders in ID (IDD); and a review of neurobiological, clinical, and epidemiological literature pertinent to targeted treatment for behavioral phenotypes in neurodevelopmental syndromes. Additionally, the session will evaluate the evidence base of published pharmacotherapy trials for co-occurring conditions in ID (IDD), such as autism spectrum disorder (ASD); review the empirical basis for behavioral interventions for challenging behaviors (aggression, self-injury, and disruptive behavior); review research on family care for persons with ID (IDD) and the literature on effective family interventions; and review the literature on legal and ethical issues pertaining to ID (IDD) and co-occurring psychiatric disorder. Results: These reviews will provide a new understanding of the following gaps in knowledge: 1) DSM-5 diagnostic criteria for ID (IDD) and the new DSM emphasis on adaptive behavior in three domains (conceptual, social, and practical adaptation); 2) assessment and treatment of co-occurring psychiatric disorders in people with ID (IDD); 3) targeted neurobiological treatment of neurogenetic syndromes; 4) rational and evidence-based psychopharmacology for co-occurring psychiatric disorders; 5) behavioral interventions and combined drug and medication interventions; 6) family interventions, including mindfulness-based strategies; and 7) legal and ethical issues necessary for effective care of affected children and their families. Conclusions: This Institute will provide new knowledge for participants that will allow them to provide better care for people with ID (IDD) and their families based on in-depth presentations and panel discussions that will focus on case examples to illustrate effective treatment.
PPC, ID, CM Sponsored by AACAP's Autism and Intellectual Disability Committee http://dx.doi.org/10.1016/j.jaac.2017.07.558
7.1 UNDERSTANDING THE INTELLECTUAL DEVELOPMENTAL DISORDER ADAPTIVE REASONING PARADIGM SHIFT IN DSM-5 James C. Harris, MD, Johns Hopkins University School of Medicine, [email protected]
www.jaacap.org
S147