132 Psychopharmacology: Considerations Before Prescribing

https://302.buzz/PM-WhatAreYourThoughtsDr. Brooks Keeshin, a triple-board trained child psychiatrist with a focus on trauma, shares his journey into child psychiatry, and discusses the idea of it being a subspecialty of pediatrics. The conversation leads to a discussion on the role of pediatricians in prescribing psychotropic medication and the importance of identifying and recognizing mental health concerns in children. Dr. Keeshin highlights the pitfalls of thinking about mental health as a catch-all, and reminds pediatricians to consider individual diagnoses to guide treatment options. He also points out that psychotherapeutic interventions are usually at the top of the list, and that medication is only one consideration. Get your pencils out…. You’ll want to take notes… [00:33 -13:56] The Importance of Identifying Mental Health ConcernsIdentifying mental health concerns should begin with listening to the family's concerns and the child's or adolescent's voice.Using measurements such as universal screening or targeted screeners can help inform the differential diagnosis.It is important to move away from the thinking that mental health is a catch-all, and instead focus on individual diagnoses that will guide treatment recommendations.Early identification and treatment of mental health concerns can improve outcomes and prevent future problems.Having a process to rule out other contributing factors to distress, such as adjustment disorders, can lead to more accurate diagnoses and effective treatment.[13:57 - 26:01]  Choosing Treatment Options for Pediatric Anxiety  The importance of getting a full picture of the child's symptoms, including using screeners such as SCAREDConsidering evidence-based interventions for pediatric anxiety, such as anxiety-focused CBT or SSRIsCombination therapy with psychotherapeutic intervention and SSRIs may offer the best chance of complete remissionSSRIs such as Fluoxetine, Sertraline, and Citalopram have the greatest evidence base and experience in youthAssessing the level of impairment and degree of symptoms in making a decision about medication vs. psychotherapeutic intervention[26:02 -38:10]  Addressing Anxiety Symptoms in Traumatized KidsStepped approach involves addressing other contributing factors before using SSRIsEnsure physical safety of environment before trauma-focused therapyAddress sleep first as chronic insomnia can drive anxiety symptomsMaximize other interventions like social determinants of health and trauma therapy before giving SSRIsAggressively titrate SSRIs to effective doses for robust response[28:11 - 51:33]  Improving Access to Expert Child Psychiatric CareImproving access to comprehensive psychiatric evaluations by child psychiatrists is essential for identifying children with severe psychiatric needs.The limited number of child psychiatrists means better triage is needed to ensure the most severely impacted children receive the necessary care.Educating child psychiatrists about the comfort levels and limitations of ongoing psychiatric treatment in primary care can be helpful in improving collaboration.Consider outpatient programs or day treatment programs for kids after inpatient treatment to help them prepare for a return to their normal life.Consider partnering with primary care if it would be more appropriate for the child in the long term.[51:34 - 59:59]  Closing segment TakeawayLinks to resources mentioned on the...

Fecha de Publicación: 8 de marzo de 2023

Duración: 1 hr 1 min