Kaplan + Sadock's Synopsis of Psychiatry, 11e

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31.18d Pharmacotherapy

Table 31.18d-2 Pharmacologic Agents for Psychiatric Disorders in Children Adolescents Drug Indications Dosage

Adverse Reactions

Antipsychotics Risperidone (Risperdal), Olanzapine (Zyprexa),

Psychosis; agitation self- injurious behaviors aggression Tics Clozapine-refractory schizophrenia in adolescents

Risperidone 1–4 mg per day Olanzapine 2.5–10 mg per day Quetiapine 25–500 mg per day Aripiprazole 2–20 mg per day Ziprasidone up to 160 mg per day Clozapine < 600 mg per day Haloperidol up to 10 mg per day

Sedation, weight gain, hypotension, lowered seizure threshold, constipation, extrapyramidal symptoms, jaundice, agranulocytosis, dystonic reaction, tardive dyskinesia Hyperprolactinemia Monitor blood pressure, CBC LFTs, prolactin Clozapine: weekly WBC

Quetiapine (Seroquel)

Aripiprazole (Abilify)

Ziprasidone (Geodon)

Clozapine (Clozaril)

Haloperidol (Haldol) Stimulants Dextroamphetamine and Amphetamine Mixed Amphetamine Salts (Adderall) FDA approved for 3 years and older Adderall XR Lisdexamfetamine (Vyvanse) Methylphenidate Ritalin (Dexedrine spansule)

ADHD hyperactivity, impulsivity, and inattentiveness Narcolepsy

Dextroamphetamine 5–40 mg per d 0.25 mg/kg/dose FDA max 40 mg per day 5–40 mg per d

Insomnia, anorexia, weight loss (possibly growth delay), rebound hyperactivity, headache, tachycardia, precipitation or exacerbation of tic disorders

Or 0.25 mg/kg/dose FDA approved max 40 mg per day 5–30 mg per day FDA approved max 30 mg per day

20–70 mg per day FDA approved max 70 mg per day Methylphenidate—10–60 mg per day or up to 0.5 mg/kg per dose FDA approved max 60 mg per day FDA approved max 54 mg per day for children; 72 mg per day for adolescents FDA approved max 30 mg per day Patch worn 9 hours per day FDA approved max 20 mg per day Begin with 0.5 mg/kg Up to 1.4 mg/kg Or 100 mg, whichever is less 600–2,100 mg in two or three divided doses; keep blood levels to 0.4–1.2 mEq/L

Ritalin SR Concerta

Daytrana patch Focalin XR

Skin irritation

Non-stimulants Atomoxetine (Straterra)

ADHD

Abdominal pain Loss of appetite

Mood stabilizers Lithium—antiaggression properties

Studies support use in MR and CD for aggressive and self- injurious behaviors; can be used for same in PDD; also indicated for early-onset bipolar disorder

Nausea, vomiting, polyuria, headache, tremor, weight gain, hypothyroidism Experience with adults suggests renal function monitoring Monitor CBC count and LFTs for possible blood dyscrasias and hepatotoxicity Nausea, vomiting, sedation, hair loss, weight gain, possibly polycystic ovaries ( continued )

Divalproex (Depakote)

Bipolar disorder, aggression Up to about 20 mg/kg per day; therapeutic blood level range appears to be 50–100 m g/mL