Daytrana patch in children

Do you have a patient whose parents say that he is all over the place as soon as he gets up? In the rare instance of severe adhd where a child needs medications as soon as they get up in the morning you can ask the parent to apply the patch about 1 hour before the child usually gets up. Remember that the blood levels of methylphenidate is much higher when given by the patch. The effects last for 2 to 3 hours after the patch is removed. Do not use for more than 9 hours.

Lithium and lamictal in children: An effective combination

Lithium and lamictal can be used effectively in combination in children who have irritability and mood dysregulation that does not respond to a single mood stabilizer. Also for those rapid cyclers who don't respond to other medications. Response can be seen with lower doses of each. One can give all the Lithium at night to prevent headaches. If needed they can both be titrated to a fully therapeutic blood using blood levels as a guide.

Depakote and Lamictal in children

Using depakote and lamictal together raises the question of the drug interaction between the two. Can it be used safely? Yes it can. I prefer to start the depakote first and titrate it to a therapeutic dose. Then start lamictal at 5mg per day and gradually titrate up by 5mg per week. It is important to know that you will have much higher levels of lamictal at smaller doses. The advantage is that you can reach therapeutic levels sooner. The combination can be effective in treating mood disorders that don't respond to a single mood stabilizer. Be careful and watch for rashes, especially Stevenson Johnson syndrome.

Self abuse in children: Use of Naltrexone

It is not uncommon to find a child who relentlessly self abuses oneself e.g. Scratching, cutter, head banging and hitting self in the face. In such circumstances when mood stabilizers have failed then Naltrexone can be used in doses ranging from 50mg to 200mg per day in decreasing such behaviors.

Depakote in children: Low WBC's

Depakote can suppress the bone marrow and the production of WBC's and thereby lowering the total WBC count. Worry only if the ANC is less than 500.

Clozapine in children: Low levels

It is not uncommon to find a real fast metabolizer and hence not be able to reach therapeutic blood levels of Clozapine. In such cases, adding Cimetidine one time a day will boost Clozapine blood levels without the need to increase the dose. Make sure you closely monitor the blood levels and adjust the dose of Clozapine accordingly.

Lamictal in young children: The dose

I do find that Lamictal is very useful in treating affective dysregulation in young children. I begin at 10mg per day and increase it by 10mg every week to a maximum daily dose of 400mg per day using blood levels and clinical response as a guide.

Zyprexa in children: Is the weight gain avoidable.

Most children do get increased appetites when put on Olanzapine. In all the years in practice I have seen only one child not do so. Try using Zydis, it may not cause as much weight gain. Maybe the route of absorption will do the trick. But in the end a very strict diet and exercise program is needed to prevent excessive weight gain. But how does one cut the "hunger reigns" is still a mystery.

Diagnostic simplicity: All treatments fall into these categories.

In children, most psychiatric issues fall into one of the categories listed below. In a way it is an over simplification but a useful one. There can be one or more of these symptom clusters present.

1. Impulse control issues either due to ADHD or affective impulsivity.
2. Emotional dyscontrol or affective dysregulation. This includes depression, mania and other non specified mood dysregulation.
3. Thinking problems that include thought disorders and other psychotic symptoms.
4. Anxiety related symptoms and disorders.

Now all psychotropic medications used in children address any or all of the catogories above irrespective of the diagnosis. The diagnosis is very important when clear and can be used to guide prescribing of medications safely. Many times in younger children the ability to make a clear diagnosis is very difficult. It is during such times or until more better better diagnostic methods are available that one can go back to a simpler way of thinking while prescribing for symptoms that don't meet a particular category, but only after all non pharmacologic methods have failed.

Lamictal in children: Do blood levels to guide your dosing.

At present there are no guidelines for the use of Lamictal in children. But you can get blood levels of the drug to make sure you have not crossed the higher threshold. Blood ranges can be between 2 to 20, however I do find that a blood range of 8 to 12 is very effective.

Clozapine in children: Pump up the ANC

Is the ANC always low in your Clozapine patient. Then have them do exercise or jumping jacks for 10 minutes prior to their CBC blood draw and boost the ANC above 2.

Are you confident in prescribing psychiatric medications to young children.

Many primary care physicians are more likely to find themselves with a young child on psychiatric medications. Many times they can manage simple drug regimens like those for straight forward ADHD. What happens if the child has multiple psychiatric conditions. Then an expert in children's psychopharmacology is needed. This is a new blog dedicated to prescribing psychiatric medications to children. It is best if one can avoid medications and use other modes of treatment, but sometimes medications become necessary.