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Drug-Induced Psychiatric Problems in Children and Adolescence

Drug-Induced Psychiatric Problems in Children and Adolescence. Padideh Ghaeli , Pharm.D Professor of Clinical Pharmacy April 2014. Drug-Induced Psychiatric Problems. Drug-induced psychiatric diseases can occur at therapeutic doses

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Drug-Induced Psychiatric Problems in Children and Adolescence

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  1. Drug-Induced Psychiatric Problemsin Children and Adolescence PadidehGhaeli, 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 Ranitidine Bismuth Subsalicylate Anticholinergic Withdrawal ACTH (adrencorticotropic Hormone) Prednisone • Reserpine • Methyldopa • Nifedipine • Propranolol • Interferon

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

  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

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