Nouvelles normalités Nouvelles pathologies Nouvelles ... - Psynem

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6° 6éme Congresso Congrès Européen Europeo de di Psicopatologia Psychopathologie dell’Infanzia de l’Enfance e et dell’Adolescenza de l’Adolescence Nuove Nouvelles normalità normalités Nuove Nouvelles patologie pathologies Nuove pratiche Nouvelles pratiques SATURDAY, May 7 PLENARY SESSIONS Plenary Session 6 Psychopharmacological, treatment in childhood and adolescence: when, what, why & where THE RATIONAL USE OF PSYCO-MEDICINE IN THE DEVELOPMENTAL AGE Maurizio Bonati Laboratory for Mother and Child Health. Public Health Department - IRFMN, Milan (Milan - IT) http://www.WHO.int/childmedicines/en/ ANTIDEPRESSANTS N06A Amitriptiline Citalopram Clomipramine Escitalopram Fluoxetine Fluvoxamine Hypericum Imipramine Mianserin Nortriptiline Oxitriptane Paroxetine Reboxetine Sertraline Venlafaxine Drugs with at least one RCT in children or adolescents (No. 38) ANTIPSYCHOTICS N05A Amisulpride Aripiprazole Chlorpromazine Clozapine Haloperidol Lithium Olanzapine Pimozide Quetiapine Risperidone Sulpiride Tiapride Ziprasidone ANTIEPILEPTICS N03 Carbamazepine Lamotrigine Topiramate Valproic acid http://www.ema.europa.eu ANXIOLYTICS and HYPNOTICS N05B Alprazolam Valeriana Zolpidem PSYCHOSTIMULANT S N06B Atomoxetine Methylphenidate Modafinil Random effects meta-analysis of primary outcome between SSRI treatment and placebo groups in children and adolescents Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Venlafaxime Total 0,1 0,2 0,5 1 2 5 10 Favours Control Favours Treatments Usala T, et al. Eur Neuropsychopharm 2008;18:62-73 394 A general (national) overview ANXIOLYTICS and HYPNOTICS N05B ANTIPSYCHOTICS N05A ANTIEPILEPTICS N03 At least 1 RCT No. RCTs TOTAL 3 (9%) 29 32 13 (52%) 12 25 4 (18%) 18 22 ANTIDEPRESSANTS N06A 15 (71%) 6 21 PSYCHOSTIMULANTS N06B 3 (100%) 0 3 Total 38 (37%) 65 103 Prevalence (%) of the 10 most prescribed psychotropic drugs (0-17 yr) Sertraline 0.52 Paroxetine 0.49 Citalopram 0.38 Risperidone 0.25 Fluoxetine 0.23 Amitriptyline 0.18 Trazodone 0.17 Escitalopram 0.16 Venlafaxine 0.14 Fluvoxamine 0.12 The most frequently prescribed drugs common to all age groups Clavenna et.al. Eur J Paediatr 2007;166:339-47
6° 6éme Congresso Congrès Européen Europeo de di Psicopatologia Psychopathologie dell’Infanzia de l’Enfance e et dell’Adolescenza de l’Adolescence Nuove Nouvelles normalità normalités Nuove Nouvelles patologie pathologies Nuove pratiche Nouvelles pratiques SATURDAY, May 7 PLENARY SESSIONS Plenary Session 6 Psychopharmacological, treatment in childhood and adolescence: when, what, why & where THE RATIONAL USE OF PSYCO-MEDICINE IN THE DEVELOPMENTAL AGE Maurizio Bonati Laboratory for Mother and Child Health. Public Health Department - IRFMN, Milan (Milan - IT) Top 10 most commonly prescribed drug combinations for patients receiving concomitant pharmacotherapy Concomitant pharmacotherapy 52% of children and adolescents receiving drugs Duffy FF, et al. J Child Adolesc Psychopharmcol 2005;15:12–25 Treatment-emergent adverse events by drug treatment in children and adolescents with ADHD Adverse event Methylphenidate Atomoxetine Total (No. 9; 26.5% ) (No. 42; 43.8%) (No. 51; 39.2%) Decreased appetite 5 15 20 Thinning 1 13 14 Irritability - 9 9 Drowsiness 1 8 9 Epigastralgia - 8 8 Tachycardia - 8 8 Unstable mood - 7 7 Insomnia 1 3 4 Psychotic symptoms - 4 4 Dispepsia - 3 3 Abdominal pain - 3 3 Tic 1 2 3 Others 1 5 6 ____ ____ ____ Total 10 80 90 Didoni A, et.al. EJCP in press 395 What is the evidence of toxicity? Side-effects SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants. Side effects of the SSRIs include gastro-intestinal effects (doserelated and fairly common-include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuationmay be sing of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-affects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizzines, asthenia, allucinations, drowsiness, conclusions, galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania, movement disorders and dyskinesias, visual disturbances, hyponatraemia (may be due to inappropriate antidiuretic hormone secretion), and cutaneous bleeding disorders including ecchymoses and purpurea. Suicidal Ideation, self harm, and hostility has been linked with SSRIs. Follow up of MTA study about ADHD sintoms Years Jensen et al. JAACAP 2007 Pharmacological intervention in children and adolescents with autism McPheeters ML, et al. Pediatrics 2011;e1312-21
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Nouvelles normalités Nouvelles pathologies Nouvelles ... - Psynem

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