Embracing Conflict in the Consent Process

Topics: Child Psychiatry | Practice Tools and Tips

What do you do when your teen patient declines an offer of medication yet the parents insist on it? How about if the teen is coming to you for medication and the parents are opposed to the idea? Does the teen have the right to request and receive medication? And what if the teen is using substances? CBD? Do you still treat, or do you refer elsewhere?

Considerations When Prescribing Psychotropic Medications

Topics: Child Psychiatry | Pharmacology Tips

CCPR: Thank you for joining us. To start things off, how do you approach using psychotropic medications for children and adolescents? Dr. Chenven: Most parents do not want to start medications. I empathize with them, which then makes it possible to move together toward medications when indicated. I quote Dr. Oliver Wendell Holmes, Sr., who said, “If

Metformin to Control Antipsychotic-Induced Weight Gain in Children

Topics: Antipsychotics | Child Psychiatry | Pharmacology Tips

Metformin has been used off-label for weight loss in psychiatry for many years, much of it for help with adult weight gain as a side effect of atypical antipsychotics. However, most trials of metformin for weight loss were actually conducted on the child and adolescent population. This article will look at the quality of the data in our pediatric pop

Tips for Good Medication Practice

Topics: Child Psychiatry | Pharmacology Tips

Good practice using psychotropic medications with children and adolescents requires a psychiatrist to pay attention to a number of elements. The following are some recommendations from child psychiatrist Mark Chenven, MD, of the things you should observe and the rules you might want to follow while prescribing medications: Start low, go slow: Most

Youth, Antidepressant Medications, and Type 2 Diabetes

Topics: Antidepressants | Child Psychiatry | Psychopharmacology Tips

Review of: Burco M et al, JAMA Pediatrics 2017;171(12):1200–1207 Over the last decade, several published studies have reported an increased risk of type 2 diabetes associated with antidepressant use in adults. But does the same hold true for children and adolescents? This paper is the first population-based study to examine the risk of onset of

Evidence Behind Aripiprazole for the Treatment of Tourette’s Disorder

Topics: Child Psychiatry | Psychopharmacology Tips | Research Update

Review of: Sallee F et al,   J Child Adolesc Psychopharmacol 2017;27(9):771–781 Tourette’s disorder (TD) is a movement disorder emerging during childhood that causes persistent motor and vocal tics. TD is treated with a variety of medications, but often with an off-label designation. There are only three medications that are FDA approved for

Efficacy and Safety of SSRIs and SNRIs for Child and Adolescent Psychiatric Disorders

Topics: Child Psychiatry | Depressive Disorder | Research Update

Review of: Locher C et al,  JAMA Psychiatry 2017;74(10):1011–1020 Since the 2004 FDA black-box warning on all antidepressants for pediatric use, controversy continues over the use of SSRIs and SNRIs in children and adolescents. Both classes of medication are still commonly used for pediatric depressive disorders, anxiety disorders, and obsessive-

Tips on Managing Medications With Adolescents

Topics: Child Psychiatry | Practice Tools and Tips

Discussing medications with adolescents can be challenging. In general, my approach during the initial evaluation is to have a first evaluation appointment with the parents alone to gather relevant history, and then bring the teen back for a separate and individual appointment. Oftentimes, however, and particularly with older teens, I will see the famil

Understanding Risk-Taking in Adolescents

Topics: Child Psychiatry | Practice Tools and Tips | Psychotherapy

CCPR: Hello, Dr. Shatkin. Your latest book, Born to Be Wild, is about understanding why adolescents are impulsive and take so many risks. Why did you decide to write about this topic? Dr. Shatkin: I’ve long been interested in the public health perspective of psychiatry and the importance of prevention, and I began further exploring the reasons for

Does Methylphenidate Use in Children and Young Adults Increase Risk of Suicide?

Topics: ADHD | Child Psychiatry | Research Updates

Review Of: Man KKC et al, JAMA Psychiatry 2017;74(10):1048–1055 Some studies have indicated that patients with ADHD may be at an increased risk of suicide. While these studies have shown associations between methylphenidate use and suicide, it is not clear whether the stimulant actually causes suicidality or whether patients taking stimulants are s

An Integrative Approach to Attention Deficit Hyperactivity Disorder

Topics: ADHD | Child Psychiatry | Psychotherapy

Integrative approaches to treating ADHD have become increasingly sought after by parents, especially those who are concerned about the side effects and potential overuse of psychostimulant medication. Surveys report that over 60% of child psychiatry patients are employing integrative tools on their own such as vitamins, specific diets, and herbal remedi

Official 2017 Carlat ADHD Pediatric Stimulant Comparison Table

Topics: ADHD | Child Psychiatry

Our official 2017 Carlat ADHD Stimulant Comparison table, an easy-to- use reference that you’ll find handy. Table: Official 2017 Carlat ADHD Pediatric Stimulant Comparison Table (Click here to view as full-sized PDF.)

Choosing Medications for ADHD

Topics: ADHD | Child Psychiatry

CCPR: Can you tell us about your current practice? Dr. Buchanan: I am responsible for pediatric ER and floor consults, I supervise the school crisis walk-in clinic, and I am responsible for high-risk intakes in the clinic.   CCPR: We hear a lot about overdiagnosis of ADHD. What are your thoughts? Dr. Buchanan: We all hear that the prob

Is Modafinil an Effective Alternative for the Treatment of ADHD?

Topics: ADHD | Child Psychiatry | Research Update

Review of: Wang SM et al, J Psychiatr Res 2017;84:292–300. Modafinil (Provigil) is FDA-approved for narcolepsy, obstructive sleep apnea, and shift work sleep disorder, but not for ADHD. Given that it has some of the same stimulating properties of psychostimulants, it should theoretically be effective. Wang and colleagues identified five randomized

Can Strattera Improve Reading Skills in Children With Dyslexia?

Topics: Child Psychiatry | Research Update

Review of: Shaywitz S et al, J Child Adolesc Psychopharmacol 2016;27(1):19–28. Dyslexia, a learning disability characterized by difficulty in reading skills, is highly prevalent, with rates between 5% and 17%. Treatments include non-medical interventions, which have limited success. Research suggests a critical role for attentional mechanisms in th

Understanding Tantrums in Autism Spectrum Disorder

Topics: Autism Spectrum Disorder | Child Psychiatry | Research Update

Review of: Mayes S et al, J Dev Phys Disabil 2017;29(4):587–596 Why do children with autism spectrum disorder (ASD) have tantrums? One theory is that these tantrums are due in part to children’s frustration with not being able to express themselves. This theory has led to a treatment approach called “mand training.” A mand is a verbal request

Take The CME Post-Test for ADHD in Children and Adolescents, CCPR, September/October 2017

Topics: ADHD | Autism Spectrum Disorder | Child Psychiatry | Research Update

The post-test for this issue is available for one year after the publication date to subscribers only (October 31, 2018). By successfully completing the test you will be awarded a certificate for 2 CME credits. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logge

Treatment of First Episode Psychosis in College Students: It Takes a Team

Topics: Antipsychotics | Child Psychiatry | Depressive Disorder

You are a psychiatrist working in a college student healthcare center when Anna, a junior, comes to your office escorted by her resident advisor. Anna describes feeling severely depressed. Sleeping excessively, she has missed most of her classes over the last two weeks. For the past week, she has heard voices telling her she is worthless and will never

Evaluating Psychosis in Children

Topics: Antipsychotics | Child Psychiatry | Depressive Disorder

CCPR: First of all, how common is psychosis in children? Dr. Cepeda: It depends on what population you are talking about. It is quite uncommon among all kids who show up at a primary care provider’s office. But in a child psychiatric practice, about 3%–5% of children have psychosis, and among children needing hospitalization, the rates are much

Defining a Role for Nutrition in Managing Children With ADHD

Topics: ADHD | Child Psychiatry | Research Update

Review of: Lange KW et al, Curr Psychiatry Rep 2017;19(2):8. Parents of kids with ADHD often ask about the role of diet and nutrition in their child’s symptoms, and research has uncovered some interesting possibilities. For example, there is some evidence that concentrations of long-chain polyunsaturated fatty acids (LC-PUFAs, which includes omega-