Current Issues in Child and Adolescent Psychiatry - Dr. Neil S. Kaye



a fresh look at today's Health voice America health and wellness welcome to psychiatry ask the expert posted by dr. Neil k all comments views and opinions expressed are solely those of the host guests and colors dr. K will not diagnose or treat callers the information provided is informational in nature in the next hour dr. K explores the inner workings of the brain and mind grab a pen and paper and sit back here is your host dr. Neil k good evening and welcome to psychiatry ask the expert i'm dr. neal k and my co-host j birch and i want to welcome you all to our show tonight hi everybody I know how are you this evening very good nice to see you again J now each week on psychiatry ask the expert we focus on a specific topic in psychiatry we talk about the disease or illness itself the common symptoms and presentation of the alist and of course treatment options with a focus on psychopharmacology meaning medication treatment we talk about potential risks and benefits side effects dosing women how to use the best medication and how to get the best information tonight Jay and I are really honored to have dr. Thomas wind with us dr. wind is a friend and a colleague for many years he's a board-certified child and adolescent psychiatrist and also a board-certified adult psychiatrist dr. windows a very busy outpatient practice he does both psychotherapy talking therapy as well as medication management with children and adolescents tonight we're going to be discussing children and adolescents and the evidence base behind the treatment and the controversies involving treatment of minors with medication for things like depression anxiety attention deficit disorder hyperactivity and bipolar disorder palm dr we'd welcome nice to have you with us tonight hi Neil hi Jay hello everybody it's a pleasure to be here today I'm looking forward to our conversation well great we are you're here we are great day out of here listeners you can call in with questions L throughout the show tonight our column number tonight 866 for 725 79 to drop psychiatry ask the expert you know how about we go right to our on our radar segment what's on your radar this week my radar screen this week really comes down to two main issues looking at treatments both natural treatments as well as medication treatments and the need to look at whether or not a treatment works is it efficacious and also is it safe and balancing safety and efficacy is the theme we're going to carry through the show tonight we're going to talk with dr. wind about this but there's been a lot under the gun this week in this area including things like well calcium might not really be beneficial for women and too much of vitamin E might be harmful we've seen the controversy about fat and diet and does that really make any difference so have a lot looking at both a natural alternative as well as traditional pharmaceuticals in the area of safety and efficacy and we want to see some of both what about you what you seen this week actually no I'm going to turn my radar screen on retro and revisit an article that you talked a little bit about last week and I want to get dr. wins opinion I'm referring to the recent controversies stirred up at the FDA regarding the medications for the treatment of attention deficit disorder and attention deficit hyperactivity disorder specifically an FDA advisory committee recommended a new black box warning of about certain cardiovascular risk that they theorize are associated with these drugs now this is just the Advisory Committee recommending the warning the full FDA has to vote on this and this hasn't happened yet but already the controversy I'm sure has come home to roost in in in child psychiatry offices so Tom what's your opinion about the cardiovascular risk associated with these drugs and has this already caused controversy in your office well the controversy began actually last January with the issues around adderall XR and it's being banned by Health Canada that band has since been rescinded but the issues were first brought to light there to say the the public at large where there is a connection between taking the stimulant and the possibility of generating a heart attack the problem is when you look at the wide picture in the population of large for every million children 10 of them are going to have a heart attack because of cardiac anomalies structural anomalies conduction anomalies that are present in their heart and this is going to happen for no reason at all this is this is what we responsible for sports depth the basketball player who has the fantastic game and drops dead on the floor the football player who who's dead on the field after making a touchdown these the silent killers that are present in our heart the FDA is looking at the data that's available about heart attacks with people on stimulants so far there is evidence that there might be a very slight increase in risk when you take a stimulant to your heart if you already have one of these anomalies but finding these anomalies is extremely difficult even when you know the tests to do and perform the tests you're looking for literally one in a million and the tests don't always show that one even if its present so you got big Tom Biggs in racine there's a base rate issue what's the natural occurrence of the problem in the population you have to factor that in and then whether or not there's an increase I think you're also talking about it specifically shoe here with that when something is very rare in order to actually find it it's truly that needle in the haystack you may need huge numbers of people before you can conclusively scientifically say the evidence shows that this really is a problem on the other hand I think a lot of times partly because it will be litigation issues in our country every one of those can end up having a lawyer attached to them and being a major problem for physicians frankly for physicians and for all of the people who need this medication who then are afraid to take it and that's a big problem in Don so we're to come back to that in Monaco the third segment tonight one of corrion our listeners just a little bit where to start off with referral questions in the first segment don't want to talk about some of the therapeutic process treatment issues then we're going to get directly into pharmacotherapy but let's start with a big broad question for you before the break here how does it child end up in your office anyway I mean how is it that a child could need to see a psychiatrist well the genetics of mental illness begin at birth not at age 18 and many children as much as twenty five percent may experience an issue in their childhood that needs some assistance now how they end up in my office basically the pattern of child development has been disturbed in some way and it's been observed either by a teacher by parents by relatives or brought to everyone else's attention by the taboo sell something has disturbed the pattern of development and that disturbance in the pattern of development is what brings the child eventually to my office either through their family or through their pediatrician or some other source source okay so basically you're saying you call a pattern of development it's okay if i call of behavior you can call it behavior okay so a child has a behavior or change in behavior and somebody notices it but they end up in a specialist to begin with or should they see their family doctor pediatrician school counselor what's a normal process if there is such a thing there is really no one way that people end up in my office some of them are literally self-referred teenage child who then says to their parents i need to see somebody i'm feeling depressed suicidal can end up in my office somebody who's been seeing a pediatrician and the pediatrician says this is outside of my field you need to see a psychiatrist they're referred people who have been evaluated by psychologists or therapists get referred to me it's a wide net this presentation we got multiple ways to get in now you know I'm an adult psychiatrist really but I hear that the presentation of mental illness this is different in children than in adults can you comment on that there are some differences that are clearly observable for example with depression we're much more likely to see agitation acting out anger issues in a child than we are depressed moods they still meet the full criterion for the adult DSM depression when they have a major depressive episode but the original presentation doesn't look like it doesn't an adult see the sad mood and the loss of interest is not as evident to the children there's bipolar disorder when it occurs in children is often mistaken for either an anxiety disorder or ADHD because the full effect of that disease really doesn't become present until a person is in their 20s it was possible that kids again you present behaviorally only because they don't have enough language development to express their emotions the way that adults do well it's not just language development though that is a part of it but it's also the way they formulate concept of the child is really very concrete and and unable to formulate a abstract ideas and they just know that something's wrong they don't know what it is khammam I'm always surprised when I visit a chiclet a child psychiatrist about the age range especially the lower end of the age range talk to the audience a little bit about the scope of that age range of children and adolescent that you'll treat the truth is that I have treated from conception forward my youngest current patient is two and a half years old I treat from whenever they're brought in for a demonstrating lack of appropriate behavior on up through adolescence and young adulthood I'm always amazed that child psychiatrist can can diagnose something at two and a half or three how do you do that I mean what what was there to answer your basement what sorts of things are you seeing that for you kid in generally some very vast difference in behavior from their peers the younger they come in the wider that difference has to be because parents are much more likely to overlook difficulties in young infants and children the difficulties really actually have to be quite glaring the things that you look at of course are patterns of behavior and you get as many sources to report on those patterns of behavior as possible it's not just me looking at a child or interviewing a child but it's me interviewing all the people who work with that child so that i can get multiple perspectives on that child's patterns of behavior and how they differ from the norm I think that's great and that's important distinction I think between adult and child psychology where an adult psychiatry we don't usually have access to other family and all their observations and child psychiatry I think it's really important you see parents stepparents get other information from school we're going to be going to the break now and we're going to continue with dr. Thomas wind on psychiatry ask the expert I'm dr. K call in number eight six six four seven two five seven nine to see after the break real life solutions voice America health and wellness to perform at your maximum potential you need to have all aspects of your life working properly online brain and body dr. michael john kell will bring you honest open discussions concerning their physical mental and financial health if you're ready to find purpose and meaning in your life tune into mine brain and body every friday at eight a.m. pacific line brain and body on voice america health and wellness radio dedicated to your health wealth wisdom and purpose videos de aprendizaje dnase maxima caridad blancas cucharas alguien vendiendo do Cascione natalia pero con programas familiarise carrot Altos SI puedes obtener riyadh occasion que necesitas ya know alguno hoc hacat tres de seis Cinco cuatro hecho una para información sobre programme's carrot we chose deltasone familia para hang on a key of tango mejor vocabulary owning a g'nite asado internet Faso una vida mejor phone inside the National Center for Family Literacy bill atkinson achieve exceptional levels of health and fitness through integrating the very best in fitness nutrition and healing tune in to Total Fitness with fitness nutrition and healing coaches Catherine carrion and James Williams each week get inspired to exercise eat and rest in harmony with your body's needs and take advantage of effective natural healing methods with in-depth cutting-edge information get fit get healthy get motivated and get real with total fitness broadcasting every friday at seven a.m. on voice america health and wellness are you tired of being tired are you sick of sitting around while life passes you by you can get back on track by tuning into voice america health and wellness every monday at 12pm pacific time for attracting abundance the energy of success with carol look attracting abundance is the program that empowers you to finally break through your limiting beliefs and blocks and shows you how to succeed in all areas of your life from improved financial abundance health and weight problem as well as your relationships don't wait another week to be joyful listen to attracting abundance the energy of success with Carol look this Monday at 12 p.m. pacific time right here on voice america health and wellness a fresh look at today's Health voice America health and wellness welcome back to psychiatry ask the expert if you have a question or comment dial toll-free at one eight six six three six nine 3742 now back to the show here's dr. K bye you're listening to psychiatry ask the expert Jay burch i'm here with dr. Neil k and dr. Thomas wind our topic tonight is about child psychiatry and before we left for our break we were discussing with dr. Wyn exactly how it is the child ends up in a psychiatrist office Tom we talked right before the break about the the age range of children speak to the audience about the types and the numbers of different kinds of mental illnesses that you see from from children adolescents in your practice well today there are there's actually a very large variety of mental illnesses that I see but there's a three main predominant groups that have this pleasure of sharing my office with me the first largest group actually is kids with ADHD but I don't get garden-variety ADHD I get the kids who are really having difficulty and who seemed to have failed at least one trial of a medication i do see patients who are new to the diagnosis and new to medication but i also see the ones that the pediatricians or the neurologists of the behavioral specialists have looked at worked with begun a trial of medications and not have the greatest say let me stop you right there because what you're saying then is the the primary care physicians for these children which would be the pediatricians yes they are perfectly comfortable and perfectly at ease with going ahead and initiate incrementally that they're diagnosing to themselves that in my career about fifty percent of them are feel comfortable with that diagnosis okay and treatment neurology pediatric neurologists are 100-percent comfortable developmental pediatricians also tend to be one hundred percent so not fairly comparable to what we see in the adult community where primary care physicians may feel some may feel comfortable treating depression bipolar disorder in their adult practice others may not may refer to a psychiatrist sooner rather than than later right okay the second group our largest groups that I see is very smooth disorders anxiety and depression panic are the three major ones in that group that I see and this group is more often coming to me directly rather than coming from a pediatricians office or the pediatrician started a medication and said see a psychiatrist okay and then the third group is the autistic spectrum disorders and I'm seeing a lot more of that now than I did initially and again it's the situation of a child needs very close monitoring as they go through working with medications to address mood attention etc and the developmental pediatricians who are the ones or new neurologist who are the ones who are working with them don't actually have the time to spend with them to fine tune all of the medications that might be helpful in these situations now we're hearing a lot more today about autism at least a lot more than I ever heard about it before and you mentioned autistic spectrum disorders so why don't you take take some time and explain to myself into the audience exactly what is or are autistic spectrum disorders the autistic spectrum disorders are a number of disorders that all have in common and inability to relate appropriately to the outside world in severe autism the child literally is living in a world of their own everything in the world outside of themselves seems to have the same weight so that a person is given the same weight as a chair is given the same way as little pieces of cotton and this is of course extremely disturbing for parents when they experience it may have very odd behaviors they flaps a twist they spin they don't they avoid direct eye contact they often walk on their toes instead of on their feet there's lots of things that they do this that shows that they're wiring is different there often extremely sensitive to touch to fabric they don't like any changes they're very limited in what they eat often and they are just unac room will not accept changes it's very difficult to work with that's at one end of the spectrum at the other end of something like Asperger's disorder where the problem is relating to people where they tend to not be as spontaneous and how they show their emotions they tend not to make good eye contact they don't regulate their communication with facial expressions the way normal kids do and they may be involved in some of the what they call stereotypic behaviors the hand flapping or spinning or touching or things that look like OCD but are actually not totally ask you a couple questions Connie ladies to this like Jay we're hearing more about these disorders are these illnesses whether it's a DD child depression or even some of the autism spectrum disorders that you've talked about are these actually increasing in frequency are they becoming more common or is it just that or now identifying them talking about in making diagnoses but the actual incident isn't really changing with ADHD and depression anywhere you go in the world whether it's a developed country or an undeveloped country when they measure the rate of children who express those symptom patterns they're basically the same this is not something new and this hasn't gotten worse our responses may have gotten worse but this is a condition that has existed it's reported in the literature from the 1800s so for those illnesses maybe we're talking about it more because we now contrarian sense though attends to bring it out people show off for even know that we've got medications or other interventions but not really increasing in frequency not increasing in frequency now that doesn't hold true for everything there is a suggestion that the autistic spectrum is increasing in frequency there are some articles about that might be due to scientists marrying each other and having children what you think about that I think that's a wonderful suggestion but no this is that the the theories are multi and I just I have no basis to say this is better than that other than one of the patterns that we are seeing in our society that makes this slightly more prevalent is the women having children much later in life okay now you also said earlier that pretty much its behavior that gets kicked into your office the Deborah Kendra doesn't sit still in class have a DD and does all behavior need medication I mean the first thing I hear out in the world is we're over medicating kids or give an animal these kids to all these meds and we're all we're doing what do you think what's what's behind this and how do we go about knowing or how do you go about knowing who really needs medicine is it does right good question again we start with observation and we have instruments they're called that I give to both teachers and parents and children and let them answer you know how do they feel what are they observing what's going on and these instruments give you a there's a numerical value that you can give to them for problems with attention for problems with hyperactivity for problems with impulsivity or mood and then you compare them to norms and there is there's a distribution of normal behavior that occurs in every child there are children who are quiet their children who are active their children who are somewhat impulsive there are children who are very contained that this is the normal variation of behavior and we literally can classify that big big that normal they have normal variation of behavior and we look at basically two standard deviations on either side we say this is normal but if you're outside of those two standard deviations then the likelihood that something abnormal is going on becomes higher and the farther out you go the higher the likelihood so I have scales that show me this behavior pattern in this child is possibly abnormal or this false completely within the normal range or there's no way it can be normal as far outside the normal range and I use those scales to determine in part what's going on with the child and whether or not it's normal behavior or abnormal behavior come before we leave what what brings a child into your office how often you come across a situation where the child is really responding to dysfunctional parents and you know how do you go about addressing that parent education is at least half of what I do at least have in some situations it can be 99 percent of what I do the two and a half year old i'm referring to right now parent education is what's happening with that child to improve that child's behavior and it's working okay so that does work the the parents become more functional or better parents than the child responds to that and shows more normal responses right and so what you're really saying that the child is almost a bill for what's going on in the family and their behavior while you might be identified as the problem it's really not the problem it's kind of a signal that there's problems going on in the family and not that the kid is sick is that the kid is responding to 86 at least twenty percent of the patients that I see that is the case that the child is responding to some major stress evolved within the home either as a direct result of the behavior of a parent or someone else close to them there really is mental illness and children really do become victim to mental illness and the issue is what stressors produce that in what stress what relief of stress can mitigate that I think in all the earlier sessions Jane I talked about it's never nature or nurture their the combination of our mental stressors you mention they take place on a genetic backbone of illness or risk or propensity for illness and that's a lot of what you see and it all comes together we're going to go to break now we're going to come back with dr. wind after the break continue talking about a child and adolescent psychiatry a couple more questions were beginning to the therapeutic process and hopefully we'll get some callers eight six six or seven two five seven nine to psychiatry has the expert so you have to break opinions options answers voice America health and wellness stay mentally physically and emotionally fit with younger every day hosted by dr. 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wellness welcome back to psychiatry ask the expert if you have a question or comment dial toll-free at 1 866 369 3742 now back to the show here's dr. k welcome back to psychiatry at the expert rush into it with dr. wins Tom adolescent cutting seems to be the rage I run into parents dinner parties whatever the first and ask me is what about my kids cutting themselves harming themselves injuring them filled boys girls especially in the 13 to 17 year old range tell our audience something about that why do they do it what should the parents do any recommendations you have well the reasons why they do it or multiple there are certain personality disorders that tend to do that as an expression to relieve an inner tension but most of the teenagers who are doing it don't actually fall into that category there is a group of depressed teenagers that cut to relieve emotional tension and either the pain or the sight of blood does give them something physical to focus on that relieves for time their emotional distress a lot of what they're seeing however is more copycat kind of phenomenon where we know that this person does it and we're going to try it and our friends try it not as a group thing but as a as an expression of wanting to be different and yet part of your own cohort of kids it's a milder form of the kind of copycat situation that ends up in multiple suicides at a high school or in a church group or even some other group or one child commits the suicide and then other children move towards that in an effort to make some sort of copycat situation and often make the mistake of actually succeeding but done it is very frightening to apparent as your child cut themselves and extremely how does a parent know is this serious as vicious attention-seeking is acting out what should parents do it there you see a scar on their child's restore blood or they learn about it from a friend's mother or whatever it's something that has to be discussed it has to be brought up it has to be discussed the parent has to face their fear and ask the child what's going on and if the answers aren't satisfactory they need to seek professional help starting either with a psychologist or a psychiatrist they need to have the child evaluated if the answers don't make sense there's a lot of people who think this is something to do with suicide and in fact our friends at the FDA when they were listing the suit increased suicidality of antidepressants used cutting as one of their criteria but cutting isn't is rarely a suicidal gesture and and you notice it because it's superficial the they take objects and they scratch themselves or they make very superficial cuts or they literally just make red lines and no cuts sometimes they do things like rub up with salt with an ice cube which creates an artificial burn usually that's something they'll only do once because it hurts them enough that they will not do it again but there's this another group that uses this to manipulate their parents you did this I'm going to do that you don't let me do this I'm going to cut myself you don't let me go out Friday night I'm going to cut yourself and to them I say never negotiate with a terrorist okay so the kids can be cured they can use it to try to control their parents their environment they can also use it to relieve some stress you're saying it's usually not truly suicidal that is the not streamline there's a strudel and rail extremely rare what else you're saying that parents should not ignore it completely on the other hand they shouldn't overreact that to take on a a middle ground position but also get experts involved that the answer is from the kids don't make sense to them absolutely okay that helps a lot again I think that's an important topic do you about anything you can recommend the parents as a reference in this area because again this is a big one one of the books that I like to give to parents who are having trouble dealing with teenagers in general and with their behavior when it's within the realm of what's normal versus what's pathological is the book called stop negotiating with your teen by Janet Sassoon edge it it's really good it's very easy to read it's a quick read and it goes through situation after situation and says this is what the kids doing this is what you can do to stop the negotiating process and get back on track as being the parent with your teenager that's how they've a great reference stop negotiating with your team I like the title only get a copy myself let's shift gears if we can talk a little bit about the therapeutic process how effective is there are be in children do the parents have to be present do they sit in they stay in the waiting room what's it all about therapy has about a sixty percent success rate with children that about the same as adults in an initial pass it's actually a little better than adult book adults generally on a first pass of standard therapy of about a fifty percent success rate kids have about a sixty percent success rate it depends you know how it's done depends on the age of the child because again you have to do something that's developmentally appropriate to the child I hear parents complain all the time all that psychologist ever did was play with my kid well yes that's what you see on the surface but the psychologist is using play to access the child's emotions to access the child's feelings to access the child's views and experiences and to help mirror appropriate behaviors and to bring about change slowly positively so there's play therapy which is the first level of therapy with kids and yet it's absolutely how you work with the youngest kids and then you move on into the various forms of behavioral therapies behavioral modification and cognitive behavioral therapies and as your child gets older you work with more interpersonal types of therapies to bring about positive change what about diet change caffeine sugar these get talked about any child arena an awful lot right are they toxic are they overwhelm what's the deal sugar is the easiest one to answer because the answer is if you give a classroom fifty percent choc tablets and fifty percent sugar tablets the teachers can't tell the difference between the kids ok so he's done that experiment in fin de and sugars really not evil the other thing do they say sure is not evil for most kids so there's probably some kid we just server sensitive right but in the you take 100 kids you randomize them in well even if you take another kids with ADHD and you split them up into two groups and give one group to chalk in the other group the sugar you're not going to be able to tell the difference it's not sugar isn't bad sugar is sugar there are people who are more sensitive to anything caffeine sensitivities tend to be a little more extreme especially as the child's having any difficulties with sleep get rid of the caffeine makes sense what about exercising hit our society is going ever more towards a sedentary society and that is just not healthy exercise is probably the healthiest thing you can do for yourself no matter whether you're two years old or you're a hundred years old exercise is what keeps us alive and keeps us going there's a wonderful study being published about Alzheimer's disease where they had a group of men going towards Alzheimer's disease they had one group do nothing one group walked two miles a day one group walk four miles a day nothing group went into Alzheimer's at the expected rate the next group went in at thirty percent the expected rate and thirty percent less and the group that walked four miles a day sixty percent less Alzheimer's development you know you talk about exercise and it reminds me a little bit about the importance of play and I thought with a lot of parents that kids they don't play the way you and I used to when we were kids and play was you went outdoors you created your own games and you did whatever and that was truly play total today often are over schedule by notice the parents think they're playing but the kids are really going from this group activities a soccer to dance lessons to violin lessons to whatever an xbox Xbox but they're just never is any unstructured play it seems like we're adding structure into play time now and that seems unhealthy to me it seems like the kids never get to slow down and we're kind of making their miniature adults right and that's insane children are not miniature adults and every time in every situation where children are treated as miniature adults the city the system will go awry the children need time to develop on their own they need time to interact with their peers to develop their own personality to develop their communication styles to develop their ability to relate to the rose peers they need free time to interact with each other so you don't have to always stimulate them or push them they're probably going to grow up okay anyway not only are they going to grow up okay anyway they're going to be less anxious if they're not being pushed Tom when I think about attention deficit disorder especially in a kid I kind of stereotypically think of a boy being treated for attention deficit disorder now among the illnesses and the patients that you have the illnesses at your tree is there a kind of a difference between what you might see in a girl versus a boy or it's pretty much the same across both sexes with the anxiety disorders I can to see an equal number of girls and boys but with depression especially in young teens are much more likely to see a girl depressed and I am a boy for multiple reasons in ADHD we have three classifications we have the hyperactive which is in the earlier ages predominantly boys we have the combined type which actually plays out about 121 boys and girls and then we have the inattentive type which actually tends to be predominantly girls because the inattentive type doesn't stand out there much less likely to be diagnosed as soon as the boys are diagnosed when we get into adulthood there it's basically 5050 boys and girls who have men and women who have ADHD appeared to pick right back in with overstating original that really behavior that gets kids brought into your office if the goal is an attentive know behavior problems altering our screen with behavior problems on the radar screen we're going to go to break or to talk about treatment and medications in kids after the break on psychiatry ask the expert helping you make informed decisions for your life this is voice America health and wellness there are you doing educational videos top-quality right here you'll never hear anyone selling education on the street but with three family learning programs you can get the education you need call 1 877 family one for information on free learning programs 1 877 fa m li t 1 check it out check it out fep right here hiroshima come on check it out free family learning programs from the National Center 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Harvey s varna every wednesday at 1pm pacific and 4 p.m. eastern right here on voice america health and wellness opinions options answers voice America health and wellness welcome back to psychiatry ask the expert if you have a question or comment down toll free at one eight six six three six nine 3742 now back to the show here's dr. K hi dr. K welcome back in psychiatry ask the expert actually the correct phone number tonight eight six six four seven two five seven nine to dr. Wingard child psychiatry expert here there's been a great controversy about antidepressants safety and the suicide risk can you tell the audience a little bit about if they're really a risk with these medications is the risk the same for all of them and what would cause you to use an antidepressant in a child anyway first I need to tell you you're asking the wrong question the right question is what is the risk of suicide in the untreated child because it's far higher than the risk of suicide in the treated child the controversy that's being presented has to do with the studies done to register medications with the FDA for approval with children and those studies in general showed that when you give a depressed child placebo he or she is going to have suicidal thoughts or gestures that look like they might be suicidal on the average is somewhere close to two percent of the time that isn't to say two percent of your time you're having suicidal thoughts that's two out of 100 kids will have some sort of suicidal thought or they've cut themselves in the way that we talked earlier in the depressant antidepressant treated children basically this was closer to four percent so it doubled but in none of these studies that were presented for approval was there one completed suicide not in the antidepressant group not in the placebo group okay till there weren't any actual leading suicide and I remember that data right is about 24 to 26 studies 4,400 plus patients in that group so what you're saying is probably pretty safe to use drugs is there any data suggests you want to safer or more dangerous than the other the study that showed a pro's x efficacy and children demonstrated that it was safer to be used for depression there are also studies that show safety and efficacy in various anxiety disorders for zoloft and flu box oh okay so we've got some difference between the medications are there how do you store a child on an antidepressant medication what are the things that you and the parents need to do to monitor and look for once treatment has begun with the current FDA guidelines I am required to warn the parents about the risk of increased suicidal thought and action and I'm required to set up a program of seeing the child once a week for the first four weeks twice a week for the next four weeks fuel eat every two weeks for the next four weeks and then three weeks after that at 12 the 12th week interval and then every four to eight weeks depending on what's happening with the child Leslie that's the required frequency of visit with children I generally start at lower doses than adults but oftentimes because of the child higher rates of metabolism the actual end dose ends up being very close to the adult dose in the antidepressants I think that's a really important point on the board exams that we all take the answer is well children start logo slow but anybody's will their small body size so they will need as much but as you just pointed out their metabolisms are often much higher than ours and they in fact go through drove burn off drug digester of metabolize drugs very rapidly and often end up meeting pretty good doses very frequently adult sized doses I have to believe that's especially true in a lot of the icing nine year olds and 10 year olds for bigger than I am these days and although their children by age at least by body size there are certainly growing some pretty big kids around here these days Tom what are your thoughts on the the brain development of the child do these antidepressants and I'm going to assume we're talking about serotonin reuptake inhibitors here do they work the same in the child's brain as they do in the adult brain for the most part or differently in any way well the differences are in the pattern of development of how the brain uses various transmitters there is in the children's brain a larger percentage of serotonin receptors than there is in the adult brain and that's in the process of development see the norepinephrine excuse me okay take a sip of water yeah take your time no bum well you catch your breath there for a minute we're talking about differences between kids and that's the neurotransmitters that are not fully developed in the receptors aren't quite the same in the child brain as in the adult brain takes a while for that to develop in fact it was just a study that came out that showed that children's brains actually don't finish developing so probably at least age 21 so I looked at maturity in 19 to 21 year olds and show that their brains are responding much more like kids brains than adult brains even though we let them vote and drive and go to war but they're not really able to process the same correct and in the physiological development of the actual adult the process is complete at about age 25 well so get kids so happy it a lot older in order to be a truly adult even though again they don't look it I like this idea controlman are not miniature adults that's actually I think it'll bring us towards the end of the show Jeff you got anything short and quick at the end before you some wrap up here short quick I like Thomas he's able to comment I mean oftentimes you oftentimes sometimes I'm guessing you have to use medications in children where there aren't official FDA approvals what would you usually do in terms of advising the parent in that regard half of the medications that I use are not approved and so I will I'll tell that to the para mrs. this is not approved for use in children like so many things that we use it's not approved here's why I'm using it and I'll give them the data that supports the efficacy of the drug with the children ok thanks Tom we wrap things up tonight take-home points for today's show children adolescents are not simply miniature adults parenting and unconditional love really important for kids to know and feel you have to set boundaries you have to keep them doctor we recommended stop negotiating with your teen as one of the books to read I'm going to get that one for myself use experts sometimes medications can make the difference between life and death and we don't want to avoid a treatment simply because its controversial or has a risk sometimes we actually have to take some risk in order to get people better if you or someone you know might be experiencing any mental illness or emotional problem please help them to find professional help contact your doctors local professional organizations and we always recommend any mi org ni-mh org healthy minds org thank you for listening and participating next week we'll have dr. Robert gran occur renowned expert on traumatic brain injury with us for psychiatry ask the expert dr. K and J burst spanking dr. win for his egg some great to be here but I will see you all next week thank you for listening to psychiatry ask the experts to learn more about dr. k visit court psychiatrist calm tune in next Tuesday for another hour of psychiatry ask the experts the doctor me okay Oh you

Author Since: Mar 11, 2019

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