1. Psychiatric Illness
In the medical arena psychiatry is a fairly recent field
A challenging field –
Numerous diagnosis
12,000,000 children – infants through 18 y/o nation wide
5,000,000 suffer severely
Serious depression affects 1 in 50 children
Suicide 3rd leading cause of death years old

2. Children and Medications
Drugs are tested on Adults –
(not children when FDA approves a drug)
When FDA approves drug, physician may apply its use
for other than intended use
Growing bodies present unique challenges.
More than three medications – red flag
Children easily overmedicated.

3. Children and adolescents
physiologic differences (vital organ maturing, body composition) influence drug effectiveness;
have increased hepatic metabolism;
Gastric emptying time and travel time through the small intestine takes longer,etc.

4. Drug Names/Classifications
Drugs have 2 names
Brand Name/Trade Name - Manufacturers
Generic Name - (usually okay)
Example: Tylenol – brand or trade name
Acetaminophen– generic name

5. Psychotropics ALL DRUGS CAN PRODUCE SIDE EFFECTS
Old class drugs and some atypicals are more prone to produce:
Extrapyramidal Symptoms
TardiveDyskinesia
Neuroleptic Malignant Syndrome
EPS: side effects w/use of antipsychotics characterized by restlessness and involuntary rolling of the tongue or twitching of the face, trunk, or limbs.
Tardive Dyskinesia: usually occurring (above) as a complication of long-term therapy with antipsychotic drugs; more likely to be permanent
Neurleptic Malignant Syndrome: a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction. What are the symptoms of neuroleptic malignant syndrome?
Symptoms of neuroleptic malignant syndrome usually include very high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood. ... Atypical antipsychotic drugs that may cause NMS include the following: Olanzapine. Risperidone

6. Mental Health Diagnosis
Common child mental health diagnosis:
Anxiety
Psychotic Disorders
Mood Disorders
Depression
Reactive Attachment Disorder (RAD)
Post Traumatic Stress Disorder (PTSD)
Attention Deficit Hyperactivty Disorder (ADHD)

7. Mental Health Diagnosis – Anxiety
Anxiety Disorders - the most common class of mental disorders present in the general population.
Includes:
generalized anxiety disorder (GAD),
post-traumatic stress disorder (PTSD)
phobias
separation anxiety disorder

8. Psychotropics: Anxiety Medications
Some medications prescribed for anxiety:
Generic Brand Name
Alprazolam Xanax
Chlordiazepoxide Librium
Clonazepam klonopin
Diazepam Valium
Lorazepam Ativan
Buspirone BuSpar
hydroxyzine Vistaril

9. Mental Health Diagnosis Mood Disorders
Four basic forms:
major depression
cyclothymia (a mild form of bipolar disorder)
SAD (seasonal affective disorder)
mania (euphoric, hyperactive, over inflated
ego,unrealistic optimism.)
Bipolar Disorders

10. Psychotropics: Depression
persistent feeling of sadness and loss of interest
can cause physical symptoms, too.
a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure
Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem. But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for many days to weeks and keep you from functioning normally
Antidepressants: Although they do not cure depression, they are usually effective at improving mood and relieving symptoms such as restlessness, anxiety, sleep problems, and suicidal thoughts.
There are at least six main types (classes) of antidepressants and each type has a slightly different action on specific neurotransmitters, such as serotonin, dopamine, or norepinephrine. following are a few of the more common ones

11. Psychotropics: Depression Medications
Names of some SSRI’s:
Generic Brand Name
Citalopram Celexa
Sertaline Zoloft
Fluoxetine Prozac
Paroxetine Paxil
Escitalopram Lexapro
Newer SSRI’s (Selective Serotonin Reuptake Inhibitors)
Affects Serotonin in the brain
Drugs used in the treatment of depression, anxiety, as well as certain personality disorders
Produce fewer side effects
Common Side effects: dry mouth, somnolence, weight gain, appetite
increase/decrease

12. Psychotropics: Depression Medications
Generic Brand name Duloxetine Cymbalta Desyrel Trazodone Venlafaxine Effexor Mirtazapine Remeron
Different classes of drugs – treats depression and anxiety, some for sleep

13. Psychotropics: Depression Medications
Tricyclic Antidepressants (TCAs)
Generic Brand Name
Clomiprimine Anafranil
Amitriptyline Elavil
affects serotonin and norepinephrine in the brain
among the earliest antidepressants developed. They're effective, but they've generally been replaced by antidepressants that cause fewer side effects

14. Mental Health Diagnosis - Bipolar
Bipolar disorder (sometimes called manic-depressive disorder )
associated w/mood swings:
lows of depression
highs of mania.
Treatment w/medications known as "mood
stabilizers“
Used to be called Manic Depression

15. Psychotropics: Bipolar Medications
Generic Brand name
Olanzapine Zyprexa
Quetiapine Seroquel
Risperidone Risperdal
Ariprazole Abilify
Ziprasidone Geodon
Clozapine Clozaril
Divalproex sodium Depakote
Lithium
Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found. (May 2016)
This is important because people with bipolar disorder are 15 times more likely to die by suicide and six times more likely to die by accidental injury than the general population," Hayes explained.

16. Mental Health Diagnosis – Psychotic Disorders
Are characterized by dysregulation of thought processes
A group of serious illnesses that affect the mind – they can alter a person's ability to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.
When symptoms are severe, people with psychotic disorders have difficulty staying in touch with reality and often are unable to meet the ordinary demands of daily life.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior; it’s a chronic condition, requiring lifelong treatment.
Severe symptoms: psychotic d/o’s : Schizophreniform, Dementia, Delusional Disorder, Schizoaffective Disorder, and Schizophrenia.

17. Typical Antipsychotics
Older line drugs: can be very effective but are more likely -- in some cases highly likely -- than the atypical (second generation) antipsychotics to cause EPS extrapyramidal side effects.
include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.

18. Typical Antipsychotics
Generic Brand Name
haloperidol Haldol
fluphenazine Prolixin
chlorpromazine Thorazine
trifluoperazine Stelazine
thioridazine Mellaril
Old line – more EPS. Usually second choice

19. Atypical Antipsychotics
…are the “newer” or second generation of antipsychotics
… are the first line treatment for Schizophrenia and other psychotic disorders.
Psychotherapy
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
Behavioral therapy

20. Atypical Antipsychotics
Generic Brand Names
Aripiprazole Abilify
Ziprasidone Geodon
Risperidone Risperdal
Quetiepine Seroquel
Olanzapine Zyprexa
The most common side effects include dry mouth, blurred vision and constipation, dizziness or lightheadedness, and weight gain.

21. Attention Deficit Hyperactivty Disorder (ADHD)
Characterized by and usually in combination
Inattention
Hyperactivity
Impulsivity
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD

22. ADHD Medications Stimulants Non-stimulants Psychotherapy
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
Behavioral therapy

23. ADHD Medications Stimulants
Generic Brand Names
Methylphenidate Concerta, Daytrana,
Ritalin, Methylin
Dextroamphetamine Dexedrine, Dextrostat
ProCentra

24. ADHD Medications Non-Stimulants
Generic Brand Names
Atomoxetine Strattera
Guanfacine Intuniv, Tenex

25. Reactive Attachment D/O (RAD)
Reactive attachment disorder: is common in children who have been abused, bounced around in foster care, lived in orphanages, or taken away from their primary caregiver after establishing a bond.

26. RAD Medications There are no medications for RAD.
The best treatment for a child with reactive detachment disorder is a positive, loving, stable, caring environment and caregiver.

27. Post-Traumatic Stress Disorder (PTSD)
PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

28. PTSD Medications Sertraline Zoloft Fluoxetine Prozac, Sarafem
Generic Brand Names
Sertraline Zoloft
Fluoxetine Prozac, Sarafem
Paroxetine Paxil, Pexeva, Brisdelle
Treatment includes different types of psychotherapy as well as medications to manage symptoms.

29. Role of your Regional OCS Psych Nurse
Obtain and monitor:
Medications the child is currently prescribed and the specifics of that medication
Justification from the provider for the medication
Proof of Informed Consents
Mental Health Services currently provided to the child and are services appropriate to support the child’s needs
Pertinent lab results
General medical information

30. Role of the Case Worker:
Ensure prescribing provider is aware of who gives consent for medications and their contact information
Will provide the new caregiver with “guidelines for Psychotropic Medications for Children in State Custody” and will ask the caregiver to provide a copy to the child’s medical/MH provider
Ensure informed consent regarding recommended medications is obtained
Notification to the regional psych nurse when child is on psychotropic medications
Consult the psych nurse prior to giving approval for any new psychotropic medications
Show informed consent form

31. Role of the Foster Parent
Responsible for providing the “Guidelines for Psychotropic Medications for Children in State Custody” to the child’s medical provider.
Provide the name and contact information of the primary caseworker to Medical/MH provider if they do not already have it.
If a psychotropic medication is recommended for your foster child, please provide the prescribing provider with the “Informed Consent Form” to complete and fax to the OCS worker.
If a psychotropic medication is recommended, please also contact the case worker so that they can obtain or give consent.