1. Drug-Induced Psychiatric Problems in Children and Adolescence Padideh Ghaeli, Pharm.D Professor of Clinical Pharmacy April 2014

2. Drug-Induced Psychiatric Problems Drug-induced psychiatric diseases can occur at therapeutic doses The psychiatric disturbances may interfere with the treatment of the primary illness

3. Drug-Induced Psychiatric Problems Many prescription drugs have not been tested in children. However, are prescribed for them Children bodies constantly change and grow Children need different doses compared with adults

4. Drug Induced Behaviour Change Affecting Neurotransmission Affecting Endocrine System – Testosterone- Insulin- Corticosteroids Exogenous Drugs – Anticholinergics, Stimulants, Montelukast

5. Drug-Induced Psychiatric Problems Problems include Hallucination, Anxiety, Depression, Mania, Aggression, Disinhibition, Amnesia, Confession, Incompetence

6. Drug-Induced Depression Antivirals (Efavirenz) CV agents (Clonidine, Methyldopa, Reserpine, Guanethidine) Retinoic Acid Derivatives (Isotretinoin) Antidepressants (SSRIs, TCAs, MAOIs) Anticonvulsants (Primidone, Phenobarbital, Vigabatrin, Topiramate, Levetiracetam, Tiagabine, Phenytoin) Antimigraine Drugs (Triptans) Hormones (Corticosteroids, Tamoxifen, GnRH agonists, OCs) Immunologic Agents (Interferon) Smoking Cessation Agents (Varenicline)

7. Drug-Induced Depression Reserpine Methyldopa Nifedipine Propranolol Interferon Ranitidine Bismuth Subsalicylate Anticholinergic Withdrawal ACTH (adrencorticotropic Hormone) Prednisone

8. Drug-Induced Anxiety Stimulants – Cocaine – Amphetamine – Methylphenidate Theophylline Caffeine Decongentant – Pseudoephedrine – Ephedrine Antidepressants – TCAs – SSRIs – MAOIs Thyroid Products Beta-agonists – Albuterol

9. Drug-Induced Mania Corticosteroids Levodopa Zidovudine Oral Contraceptives Isoniazid Buspirone Lamotrigine Risperidone Antidepressants

10. Drug-Induced Personality Change B12 Deficiency Hg Intoxication

11. Drug-Induced Catatonia Antipsychotics BZD Withdrawal

12. Drug-Induced Suicidality Suicidal Ideation and Behavior Drug Related Suicidality Mostly Happens with Mood Changes and Significantly Increases the Risk to the Patients Antipsychotics BZD Withdrawal

13. Drug-Induced Psychiatric Problems Montelukast (Singular): Behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide Oseltamivir (Tamiflu): Hallucinations, delirium and abnormal behavior Antidepressant: Increased risk of suicidal thoughts and behavior in children and adolescents Accutane (isotretinoin): Increased risk of suicide ideation and suicide

14. Drug-Induced Psychiatric Problems Amoxicillin: Behavioral changes (hyperactivity, agitation) Prednisone: Mood changes, nervousness and insomnia. Diphenhydramine: Drowsiness, sedation and some times agitation Stimulants like methylphenidate: Insomnia, nervousness, headache and dizziness Metoclopramide: Insomnia, restlessness and decreased energy. Acute dystonic reactions and tardive dyskinesia have also been reported Lindane: Stimulation, dizziness, Seizure, headache, death