Presidential Institute: Practical Pediatric Psychopharmacology

Sunday, May 4, 2008
10:00 a.m. - 5:00 p.m.
Washington, D.C. Convention Center

6 hours of CME

This special day-long program is targeted to general internists, pediatricians and family physicians as well as adult psychiatrists. It is open to individuals registered for the full APA Annual Meeting as well as those with a daily registration for Sunday. Primary Care Physicians can register for this program onsite for a daily rate of $175. Please show your medical license for proof of physician status. (There will be an on-your-own lunch break.)

Chair:  Christopher J. Kratochvil, M.D.
             University of Nebraska Medical Center

PROGRAM OVERVIEW:
Educational Objective: The primary objective of this Institute is to provide practical information to clinicians on the use of psychotropic medications in the treatment of children and adolescents in their practices.
Methods: The presentations will include discussions of clinically relevant aspects of pediatric psychopharmacology for the treatment of ADHD, depression, and anxiety disorders. Additionally, management of medications for bipolar disorder, schizophrenia, pervasive developmental disorders, and aggression will be addressed. Recent literature will be reviewed, and discussions will focus on medication selection, initiation, titration, and management. Following the more formal didactics, brief vignettes will allow for the application of information from earlier presentations, and audience involvement in practical clinical discussions.
Conclusion: Awareness of recent research and the application of practical clinical information pertaining to pediatric psychopharmacology can inform and positively impact patient care.

A. EVIDENCE-BASED PHARMACOTHERAPY FOR ADHD
     Laurence L. Greenhill, M.D.
     Columbia University
ABSTRACT
Objective: This presentation will provide attendees the opportunity to expand their knowledge base regarding ADHD pharmacotherapies, with a focus on positively impacting management of medications for the treatment of children and adolescents with ADHD. Methods: An overview of current research will provide an update on evidence-based pharmacotherapies for ADHD. Currently available medications will be discussed, followed by recent developments and clinical studies that may impact ADHD treatment in the near future. This information will be presented in the context of what would be useful for the clinician in practice to know, and how it might relate to the treatment of pediatric ADHD in their own patients. Recent regulatory activities will also be reviewed, as will potential implications for clinical practice.
Conclusion: ADHD is a common neuropsychiatric disorder, and one primary care clinicians are often called upon to manage pharmacologically. Recent and ongoing research can help to inform practice, but must be done so in the context of the current regulatory environment.

B. MANAGEMENT OF PEDIATRIC DEPRESSION
     Jefferson B. Prince, M.D.
     Massachusetts General Hospital
ABSTRACT
Objective: This session will provide attendees the opportunity to become more familiar with the identification and management of pediatric depression.
Methods: Data on the epidemiology and impact of depression on children and adolescents will be reviewed, stressing the importance of early identification and intervention. An overview of assessment, evaluation, and diagnosis of pediatric depression, including comorbid disorders, will provide clinical tips and guidance useful for everyday practice in the primary care setting. After discussing assessments, a variety of interventions will be addressed. The potential role of pharmacological as well as non-pharmacological treatments will be presented, with a special emphasis on the risks and benefits of antidepressant medications. This will include important information to be shared with patients and their families on the efficacy and safety of antidepressants.
Conclusion: The ability to identify and manage treatment for pediatric depression is important for clinicians who treat children. It is a common disorder, with significant morbidity and mortality, but also one that responds to available interventions.

C. THINGS A CLINICIAN NEEDS TO KNOW ABOUT BIPOLAR, SCHIZOPHRENIA,
     AUTISM AND AGGRESSION IN CHILDREN & ADOLESCENTS
     Adelaide Sherwood Robb, M.D.
     Children's National Medical Center
ABSTRACT
Objective: The objective of this institute presentation is to teach primary care clinicians the key elements about the diagnosis, treatment and short and long term clinical management of children with bipolar disorder (BD), schizophrenia (SZ), autism (AUT) and aggressive behavior (AGG). As more children with these disorders are being treated in the community, it is important for clinicians to recognize these disorders and be able to manage them with psychotropic medications.
Methods: For each disorder, we describe the DSM-IV-TR diagnostic criteria, common presenting symptoms, pharmacologic treatments including mood stabilizers and second generation antipsychotics, strategies for initiating treatment, monitoring regimens, and recommendations for length of treatment, and discontinuation strategies. The talk covers important side effects, studies in children supporting the use of these medications for BD, SZ, AUT and AGG, and FDA concerns.
Conclusion: This talk teaches clinicians the basics about diagnosis, treatment and management of BD, SZ, AUT, and AGG in their pediatric outpatients.

D. PEDIATRIC ANXIETY DISORDERS
     John T. Walkup, M.D.
     Johns Hopkins University
ABSTRACT
Objective: To provide attendees with the skill set necessary to complete a basic assessment of childhood anxiety, and an understanding of available treatment options.
Methods: The session will begin with an overview of the basic elements of an assessment for an anxiety disorder in a pediatric patient. Treatment options will then be reviewed, providing a discussion of pharmacological treatments as well as cognitive behavioral therapy. Relevant recent studies and literature will be presented, providing a rationale for use of these treatments, as well as a foundation for treatment selection. The strengths and weaknesses of the treatment interventions will be discussed, along with suggestions for how to decide upon the most appropriate treatment modality for an individual patient. Conclusion: Anxiety disorders are common in children and adolescents, but are also commonly overlooked. Data clearly demonstrates that treatment can significantly lower distress and improve functioning.

E. PEDIATRIC PSYCHOPHARMACOLOGY CASE PRESENTATIONS: PRACTICAL
     APPLICATIONS
     Christopher J. Kratochvil, M.D.
     University of Nebraska Medical Center
ABSTRACT
Objective: This session will allow the attendee to apply information from the didactic presentations as well as clinical experience to a series of patient vignettes, providing an opportunity for a practical application of the data presented earlier in the institute.
Method: Vignettes will be presented by the faculty, followed by an interactive format with discussion of patient management by faculty and attendees. Cases will focus on typical patient presentations, simple as well as complex. The use of concomitant medications, comorbidities, side effect management, and issues pertaining to the extended use of psychotropic medications will be addressed. Time will also be allotted for attendees to discuss challenges to using pediatric psychopharmacology in their own practices. Conclusion: The practical application of the data will demonstrate how the information presented on pediatric psychopharmacology can impact the attendee’s clinical practice.