Psychiatric treatments of child and adolescent mental disorders.

1. Psychiatric treatments of child and adolescent mental disorders. Dr. Oğuzhan Zahmacıoğlu

2. AIMS • a)Learning about the importance of psychotherapy in child and adolescent pscyhiatry. • b)Learning about family therapy, behavioral approaches to child mental disorders, cognitive therapy, play therapy and family guidance. • c)Understanding the basic principles of drug treatments in child and adolescent pscyhiatry. • d)Learning about the pharmacologic agents that are used for child mental health disorders.

3. Classification of Treatments I.PSYCHOTHERAPIES: • Individual therapies (play therapy, cognitive therapiy, behavioral therapies) • Family therapy • Group therapies • Psychoeducational approaches II. Drug treatmens

4. General Principles • 1. Combined treatment approach • 2. Close monitorization of the process • 3. Good cooperation with family needed • 4. Cooperation with school

5. General Principles of Pharmacological Treatments • 1. Plan focusing on the target symptom. • 2. As an adjunct to psychosocial treatments. • 3. Close monitorization of target symptom. • 4. Side effects should be kept in mind. • 5. Consider the risk on the developmental process. • 6. Different responses compared to adults may arise.

6. Pharmacokinetic and pharmacodynamic differences between adults and children • 1. In children absorbtion may be faster. • 2. Body composition, fat ratio differences. • 3. Liver metabolism rate is faster • 4. Glomerular filtration of lithium is faster. • 5. Higher concentration of Dı-D2 receptors. • 6. NA system underdeveloped

7. Main pharmacologic agents • Psychostimulants • Antidepressants • Antipsychotics • Anxiolitic drugs • Antihistaminics • Anticonvulsants

8. Psychostimulants • Indications: ADHD • Metilphenidate (RİTALİN, CONCERTA) • Amphematime group, • Dosage: 5-60 mg/g , • Side effects: insomnia, loss of appetite, feelings of unesiness, tremor, hypertention, tachicardia, crying spells • Contrindications: tics, dyskinezia, psychotic reactions, epilepsy

9. Antidepressants I. Tricyclics: İmipramine, clomipramine II. Selektive serotonine reuptake inhibitors: Fluvoxamine, fluoxetine, sertralin

10. Antipsychotics • 1. Agitations, aggressive behaviors associated with PDD;MR, • 2. Tics, Tourette’s Disorder. • 3. Conduct disorder • 4. Schizophrenic disorder, bipolar disorders

11. Tipik Antipsikotikler

12. Atipik Antipsikotikler

13. Trisiklik antidepresanlar

14. SSRI

15. Antihistaminics • Difenhidramin : 25 mg/g (max: 5mg/kg/g) • Hydroxizin: Max 50 mg/g before 6y • max 100 mg/g after 6. • Indications: insomnia, irritability, anxiety

16. Anticonvulsants • Carbamazepine: impuls control disorders Anger spells, aggressive behavior: 200-600 mg/g Side effects: dizziness, incoordination, aplastic anemia, agranulositosis. • Valproik ascid: angry spells, behavioral disorders, disruptive behavior, manic attack: 10-15 mg/kg/g Side effects: Sedation, nausea, vomiting, tremor, increased appetite, hepatotoxicity, obesity.

17. Psychotherapies • Play therapy • Behavioral therapies • Family therapy • Group therapies • Cognitive therapy

18. Play therapy • Can be used between 2,5-14 yrs.of age • Hypothesis:”What the child plays reflects what is in his/her mind”!

19. Behavior Therapy • 1. Simple conditioning (Conduct problems, eating disorders, hyperactivity, enuresis, encopresis) 2. Systematic Desensitization (Anxiety disorders and phobias) 3. Exposure (OCD) 4. Social skills training

20. Family Therapy • Takes the family system as a whole. • In child psychiatry family assessment is a must. • Most of the time child and family therapy is done together.

21. Cognitive therapies • Most helpful in adolescent period: Depression, Identity disorders Conduct disorders Impulse control disorders