- Email: [email protected]
Hyperactivity Disorder
INSTITUTES 8.0 — 8.3
accused meets the diagnostic criteria for ID may make a difference between life and death since execution of persons with ID is unconstitutional. A separate category comprises cases concerning constitutional rights of persons in state-run institutions to adequate care, including mental health care. People with ID/DD have the right to the same protection as everyone else if they are subjects in medical research, as well as a right to be such subjects if ethical and legal principles of informed consent are followed. The techniques of psychiatric assessment pertaining to various competencies will be reviewed and illustrated with case examples. Conclusions: Psychiatric assessment of various forms of legal competence of persons who have ID/DD is most important. Yet, there exists a professional practice gap in this area, as few training programs include teaching the necessary skills. The techniques of psychiatric assessment have to be adapted to a person’s cognitive and communication skills
Results: The literature, combined with practice parameters and the clinical experience, indicate that both stimulants and nonstimulants remain among first-line pharmacotherapy for ADHD in preschoolers, latency/school-aged youth, and adolescents. Alterations in the use of traditional stimulants, the use of nonstimulants, and combinations of medications can enhance a patient’s response to ADHD. Data on the FDA-approved combination of a agonists and stimulants will be reviewed. A discussion of predictable (e.g., weight loss) and idiosyncratic adverse effects will be undertaken. Conclusions: In this session, recent pharmacological strategies for treating children and adolescents with ADHD will be presented, incorporating new research findings and FDA approvals with systematic clinical observation.
ETH, FCP, ID
8.2 MAJOR DEPRESSIVE DISORDER IN CHILDREN AND ADOLESCENTS
http://dx.doi.org/10.1016/j.jaac.2017.07.565
INSTITUTE 8 PRACTICAL PEDIATRIC PSYCHOPHARMACOLOGY FOR PEDIATRICIANS AND NON-CHILD PSYCHIATRISTS Adelaide S. Robb, MD, Children’s National Medical Center, [email protected] Objectives: The primary objective of this Institute is to provide practical information to early career psychiatrists and pediatricians on the use of psychotropic medications in their practices Methods: The presentations will include discussions of clinically relevant aspects of pediatric psychopharmacology for the treatment of ADHD, depression, and anxiety disorders. Additionally, management of medications for bipolar disorder, pervasive developmental disorders, and aggression will be addressed. Recent literature will be reviewed, and discussions will focus on medication selection, initiation, titration, and management. After the more formal didactics, brief vignettes will allow for the application of information from earlier presentations and audience involvement in practical clinical discussions. Results: Recent clinical trials provide a growing evidence base for the use of psychotropic medications in the treatment of children and adolescents with mental illness. In all categories of psychotropic medications, we have large clinical trials funded by both industry and federally that demonstrate safety and/or efficacy in pediatric mental illness, including ADHD, anxiety, depression, bipolar, and aggression in autism spectrum disorder. Conclusions: Awareness of recent research and the application of practical clinical information pertaining to pediatric psychopharmacology can inform and positively impact patient care.
ADP, APS, STIM Sponsored by AACAP's Psychopharmacology Committee http://dx.doi.org/10.1016/j.jaac.2017.07.567
8.1 TREATMENT OF ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Timothy E. Wilens, MD, Massachusetts General Hospital and Harvard University, [email protected] Objectives: With the increasing presentation of children and adults with ADHD, practitioners are requiring strategies for those individuals with the disorder and those who do not respond to or cannot tolerate traditional treatment. Methods: A systematic review of the literature was undertaken to elucidate data on stimulant and nonstimulant pharmacological treatments for ADHD simplex and for treatment refractory or comorbid ADHD. Studies using controlled, open, retrospective, and case series will be highlighted and “weighted” according to the study design. Longer-term outcomes of existing agents and recently published data are favored.
S150
www.jaacap.org
ATA, ADHD, STIM http://dx.doi.org/10.1016/j.jaac.2017.07.568
Boris Birmaher, MD, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, birmaherb@ upmc.edu Objectives: This session focuses on the diagnosis and management of depression in children and adolescents. Methods: Data on the prevalence of depression, comorbid disorders, and clinical course of depression in children and adolescents will be reviewed. Factors that affect the course of depression will be discussed. The evidence base for antidepressant treatment in children and adolescents will be reviewed. The role of psychotherapy alone and in conjunction with medication will be discussed. Results: Response rates to initial antidepressants are approximately 50–60 percent, and approximately 50 percent of youths who fail to respond to the initial antidepressant will respond to an alternative antidepressant. Cognitive behavioral therapy in combination with medication treatment increases response rates and decreases relapse rates. Comorbid disorders, parental depression, and psychosocial factors affect treatment response. Conclusions: It is important to select evidence-based treatments in the management of depression in children and adolescents.
ADP, DDD, S http://dx.doi.org/10.1016/j.jaac.2017.07.569
8.3 ASSESSMENT AND TREATMENT OF ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS John T. Walkup, MD, Ann and Robert H. Lurie Children’s Hospital of Chicago, [email protected] Objectives: The goal of this session is to provide attendees with the skill set necessary to complete a basic assessment of childhood anxiety in a primary care setting, to implement initial pharmacological treatment, and to provide guidance consistent with principles of cognitive behavioral therapy. Methods: A review of the treatment literature for child and adolescent anxiety disorders was conducted. Results: The session will begin with an overview of the basic elements of an assessment for childhood anxiety disorders that can be carried out by a primary care clinician. Treatment options will then be reviewed. Relevant recent studies and literature will be presented, providing a rationale for the use of these treatments, as well as a foundation for treatment selection. The strengths and weaknesses of the treatment interventions will be discussed, along with suggestions for how to decide on the most appropriate treatment modality for an individual patient. In addition, the key principle of cognitive behavioral therapy that can be used to guide families and children with anxiety disorders will be discussed. Conclusions: Anxiety disorders are common in children and adolescents but are also commonly overlooked. Data clearly demonstrate that treatment can significantly lower distress and improve functioning.
ADP, AD, AXX http://dx.doi.org/10.1016/j.jaac.2017.07.570
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
accused meets the diagnostic criteria for ID may make a difference between life and death since execution of persons with ID is unconstitutional. A separate category comprises cases concerning constitutional rights of persons in state-run institutions to adequate care, including mental health care. People with ID/DD have the right to the same protection as everyone else if they are subjects in medical research, as well as a right to be such subjects if ethical and legal principles of informed consent are followed. The techniques of psychiatric assessment pertaining to various competencies will be reviewed and illustrated with case examples. Conclusions: Psychiatric assessment of various forms of legal competence of persons who have ID/DD is most important. Yet, there exists a professional practice gap in this area, as few training programs include teaching the necessary skills. The techniques of psychiatric assessment have to be adapted to a person’s cognitive and communication skills
Results: The literature, combined with practice parameters and the clinical experience, indicate that both stimulants and nonstimulants remain among first-line pharmacotherapy for ADHD in preschoolers, latency/school-aged youth, and adolescents. Alterations in the use of traditional stimulants, the use of nonstimulants, and combinations of medications can enhance a patient’s response to ADHD. Data on the FDA-approved combination of a agonists and stimulants will be reviewed. A discussion of predictable (e.g., weight loss) and idiosyncratic adverse effects will be undertaken. Conclusions: In this session, recent pharmacological strategies for treating children and adolescents with ADHD will be presented, incorporating new research findings and FDA approvals with systematic clinical observation.
ETH, FCP, ID
8.2 MAJOR DEPRESSIVE DISORDER IN CHILDREN AND ADOLESCENTS
http://dx.doi.org/10.1016/j.jaac.2017.07.565
INSTITUTE 8 PRACTICAL PEDIATRIC PSYCHOPHARMACOLOGY FOR PEDIATRICIANS AND NON-CHILD PSYCHIATRISTS Adelaide S. Robb, MD, Children’s National Medical Center, [email protected] Objectives: The primary objective of this Institute is to provide practical information to early career psychiatrists and pediatricians on the use of psychotropic medications in their practices Methods: The presentations will include discussions of clinically relevant aspects of pediatric psychopharmacology for the treatment of ADHD, depression, and anxiety disorders. Additionally, management of medications for bipolar disorder, pervasive developmental disorders, and aggression will be addressed. Recent literature will be reviewed, and discussions will focus on medication selection, initiation, titration, and management. After the more formal didactics, brief vignettes will allow for the application of information from earlier presentations and audience involvement in practical clinical discussions. Results: Recent clinical trials provide a growing evidence base for the use of psychotropic medications in the treatment of children and adolescents with mental illness. In all categories of psychotropic medications, we have large clinical trials funded by both industry and federally that demonstrate safety and/or efficacy in pediatric mental illness, including ADHD, anxiety, depression, bipolar, and aggression in autism spectrum disorder. Conclusions: Awareness of recent research and the application of practical clinical information pertaining to pediatric psychopharmacology can inform and positively impact patient care.
ADP, APS, STIM Sponsored by AACAP's Psychopharmacology Committee http://dx.doi.org/10.1016/j.jaac.2017.07.567
8.1 TREATMENT OF ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Timothy E. Wilens, MD, Massachusetts General Hospital and Harvard University, [email protected] Objectives: With the increasing presentation of children and adults with ADHD, practitioners are requiring strategies for those individuals with the disorder and those who do not respond to or cannot tolerate traditional treatment. Methods: A systematic review of the literature was undertaken to elucidate data on stimulant and nonstimulant pharmacological treatments for ADHD simplex and for treatment refractory or comorbid ADHD. Studies using controlled, open, retrospective, and case series will be highlighted and “weighted” according to the study design. Longer-term outcomes of existing agents and recently published data are favored.
S150
www.jaacap.org
ATA, ADHD, STIM http://dx.doi.org/10.1016/j.jaac.2017.07.568
Boris Birmaher, MD, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, birmaherb@ upmc.edu Objectives: This session focuses on the diagnosis and management of depression in children and adolescents. Methods: Data on the prevalence of depression, comorbid disorders, and clinical course of depression in children and adolescents will be reviewed. Factors that affect the course of depression will be discussed. The evidence base for antidepressant treatment in children and adolescents will be reviewed. The role of psychotherapy alone and in conjunction with medication will be discussed. Results: Response rates to initial antidepressants are approximately 50–60 percent, and approximately 50 percent of youths who fail to respond to the initial antidepressant will respond to an alternative antidepressant. Cognitive behavioral therapy in combination with medication treatment increases response rates and decreases relapse rates. Comorbid disorders, parental depression, and psychosocial factors affect treatment response. Conclusions: It is important to select evidence-based treatments in the management of depression in children and adolescents.
ADP, DDD, S http://dx.doi.org/10.1016/j.jaac.2017.07.569
8.3 ASSESSMENT AND TREATMENT OF ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS John T. Walkup, MD, Ann and Robert H. Lurie Children’s Hospital of Chicago, [email protected] Objectives: The goal of this session is to provide attendees with the skill set necessary to complete a basic assessment of childhood anxiety in a primary care setting, to implement initial pharmacological treatment, and to provide guidance consistent with principles of cognitive behavioral therapy. Methods: A review of the treatment literature for child and adolescent anxiety disorders was conducted. Results: The session will begin with an overview of the basic elements of an assessment for childhood anxiety disorders that can be carried out by a primary care clinician. Treatment options will then be reviewed. Relevant recent studies and literature will be presented, providing a rationale for the use of these treatments, as well as a foundation for treatment selection. The strengths and weaknesses of the treatment interventions will be discussed, along with suggestions for how to decide on the most appropriate treatment modality for an individual patient. In addition, the key principle of cognitive behavioral therapy that can be used to guide families and children with anxiety disorders will be discussed. Conclusions: Anxiety disorders are common in children and adolescents but are also commonly overlooked. Data clearly demonstrate that treatment can significantly lower distress and improve functioning.
ADP, AD, AXX http://dx.doi.org/10.1016/j.jaac.2017.07.570
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017