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FASD: Co morbid psychiatric conditions and psychopharmacology

FASD: Co morbid psychiatric conditions and psychopharmacology. Dr. Terri Erwin Assistant Professor of Psychiatry Division of Child and Adolescent Psychiatry Associate’s in Pediatrics Weisskopf Child Evaluation Center University of Louisville Louisville , KY.

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FASD: Co morbid psychiatric conditions and psychopharmacology

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  1. FASD: Co morbid psychiatric conditions and psychopharmacology Dr. Terri Erwin Assistant Professor of Psychiatry Division of Child and Adolescent Psychiatry Associate’s in Pediatrics Weisskopf Child Evaluation Center University of Louisville Louisville , KY

  2. Central Nervous System Abnormalities • 1. Structural • Cerebral cortex: microcephaly, hypo plastic gyri and sulci • Cerebellum, cerebellar cortex, and hippocampus: malformations • Corpus Callosum: alterations in structure 2. Neurotrophic effects, Effects on Neurotransmitter receptors, and Effect on Signal Transduction

  3. Central Nervous System Abnormalities/Functional • Global Cognitive or intellectual deficits representing multiple domains,(2 SD from mean), Or • Functional deficits: (1 SD from mean in 3 areas) • Cognitive or developmental deficits • Executive Function deficits • Motor functioning delays • Problems with attention or hyperactivity • Poor Social Skills • Sensory or Pragmatic language problems, memory deficits

  4. Fetal Alcohol Exposure Effects on Neurobehavior • Cognitive: FAS IQ’s often borderline range • Psychiatric/Behavioral • Memory and learning impairments are common features in FAS and FASD • Verbal Learning: variety of problems with language and memory • Visual-Spatial Learning: perform poorly on tasks involving learning spatial relationships among objects

  5. Psychiatric/Behavioral • Attention: (hallmark of prenatal alcohol exposure), Able to focus and maintain attention, but difficulty shifting attention from one task to another • Reaction time: slower less efficient information processing • Executive Function: easily distracted and impulsive; difficulty abandoning ineffective strategies when approaching problem solving tasks; respond poorly when asked to switch back and forth from identifying objects

  6. Secondary Disabilities • These behaviors may be expressed through secondary disabilities, 6 have been recognized and assessed: • mental health issues- more than 90% • disrupted school experiences - > 60% • trouble with the law, (juvenile justice)-60% • confinement or incarceration-40% • inappropriate sexual behavior • Streissguth,A. (1997), Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Brookes Publishing. ISBN 1-55766-283-5

  7. Psychopharmacological Considerations • 1. Stimulants • 2. Alpha-2 adrenergic agonists • 3. Antidepressants • 4. Neuroleptics • 5. Anti-anxiety drugs

  8. Psychopharm - reviews • “Research based interventions for children and youth with FASD.” Child: Care, health, and development. July 2007 • Literature review with 2 reviewers assessing eligibility and quality of studies, resulting in 10 studies and unable to obtain 3 studies. • Unable to use meta-analysis since studies examined different interventions and outcomes. • Studies included stimulants (Methylphenidate, Dextroamphetamine, and Pemoline) and Cognitive Control Therapy. • Studies had small samples and/or weak design and no conclusive findings.

  9. Psychopharm • “Survey med responses in children and adolescents with FAS.” Mental Health Aspects Developmental Disability. October – December 2001. • FAS, PFAS, ARND ages 3.5 to 17 years with confirmed in utero exposure. • Chart review in child development unit over prior 7 years. 22 patients with 66 med trials • Groups of meds: • 1. Stimulants 63% responded well • 2. Mood stabilizers 88% • 3. SSRI’s 82% • 4. Antipsychotics 83%

  10. Psychopharm: ADHD and FASD • Psychopharm in Neuropsychiatric Diagnosis and Treatment. 2010. • ADHD dx 94% individuals with heavy prenatal alcohol exposure. • Some evidence ADHD in FASD is clinical subtype • Weak evidence Dextroamphetamine may be more effective than Methylphenidate. • Limited scientific evidence on effective interventions for children with FASD and ADHD.

  11. Psychopharm: ADHD and FASD • Canadian Journal of Psychiatry. May 2002 • Animal and human research • FASD + ADHD: Earlier onset of ADHD • Inattentive sub-type • Co morbid psychiatric, medical, and developmental • May be differential response to stimulants.

  12. Psychopharm: FAS and ADHD • Streissguth 1997 Univ. of Washington • 6 – 16 yr old with FAS + ADHD • Predicted Stimulants would improve ADHD symtoms • Mixed results

  13. Psychopharm: Executive Function • Journal of Canadian Academy of Child and Adolescent psychiatry. Review of EF deficits and pharmacological management in Children and adolesents. • Executive System uses Dopamine as main neurotransmitter • Dopamine agonists (stimulants) and antagonists (neuroleptics) commonly used to tx EF • SSRI’s not very helpful

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