drug-induced psychiatric problems in children and adolescence padideh ghaeli, pharm.d professor of...
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Drug-Induced Psychiatric Problemsin 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
• The psychiatric disturbances may interfere with the treatment of the primary illness
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
Drug Induced Behaviour Change
• Affecting Neurotransmission
• Affecting Endocrine System– Testosterone- Insulin- Corticosteroids
• Exogenous Drugs– Anticholinergics, Stimulants, Montelukast
Drug-Induced Psychiatric Problems
Problems include
•Hallucination, Anxiety, Depression, Mania, Aggression, Disinhibition, Amnesia, Confession, Incompetence
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)
Drug-Induced Depression
• Reserpine
• Methyldopa
• Nifedipine
• Propranolol
• Interferon
• Ranitidine
• Bismuth Subsalicylate
• Anticholinergic Withdrawal
• ACTH (adrencorticotropic Hormone)
• Prednisone
Drug-Induced Anxiety
• Stimulants– Cocaine– Amphetamine– Methylphenidate
• Theophylline• Caffeine• Decongentant– Pseudoephedrine– Ephedrine
• Antidepressants– TCAs
– SSRIs
– MAOIs
• Thyroid Products
• Beta-agonists– Albuterol
Drug-Induced Mania
• Corticosteroids• Levodopa• Zidovudine• Oral Contraceptives• Isoniazid• Buspirone• Lamotrigine • Risperidone• Antidepressants
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
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
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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