H-IPPE: Pediatric Behavioral Health

1 in 13 kids take psych meds

My first clinical specialist day paired me with the pediatric resident during his behavioral health month.  When our preceptors asked us if their was any particular area we wanted to see as a specialty, I asked for anything dealing with the brain.  I enjoy neuroscience and found it to be my favorite section in my Anatomy class to teacher.  So I figured that it would be interesting - mental illnesses, Alzheimer's,
Parkinson's, etc.  I was not disappointed with my day in pediatric behavioral health.

We started the morning by talking about a few basic things like introductions, the layout of the ward, how the rounds would work and then went up to the pediatric psychiatric unit.  The doctors, residents, nurses, and their teachers piled into a very small room to discuss the 10 children on the ward for the day.  These were some serious 9-13 year olds who had been through more than most people in their 30s.  These kids were diagnosed with MDD, ADHD, ODD, Mood D/O with symptoms of SIB, SI, HI taking various amounts of Prozac, Lexapro, Concerta.  Some stay in the unit for a few days, but others had been there for a month.  The Hospital School addresses their education needs while they are in the hospital and the teachers work closely with the doctors.  The Hospital teachers would contact the home school for information and IEPs - pretty much every kid had one.  Parents would come during visiting hours with a pass, but generally the kids cannot leave the floor.  

We talked about their medication treatments, but mostly these kids required intense therapy and behavioral plans.  To treat the younger kids the doctors prefer hugs to drugs.  As a pharmacist, we sometimes forget that and go straight to medications.  But let's not forget that these kids are on some serious prescriptions.  Fluoxetine and escitalopram (SSRIs) were the favorites for depression.  Agitated patients would also recieve ropinarole, a 2nd gen antipsychotic).  But then the agitation could be due to the ADHD requiring a stimulant.  Even if the patient was on only 2-3 drugs, there was a lot to consider in matching the medication to indication and achieving therapeutic doses.  For another point, you don't want to open the door to greater abuse in young children by prescribing long-term benzodiazapem.  Pediatric dosing for neuro-drugs was different as well.  Usually, the doctor titrated up from the lowest dose available until reaching an effective point.  Not only are these kids growing, their brains continue to develop as well.

Unfortunately, I had to leave for a meeting before actually meeting with the kids and families.  They had left for the Hospital School when we came out of our meeting.  The resident showed me the other areas on the floor for adolescents and eating disorders.  I learned a lot during this day and was actually able to talk about this more due to my education background.  As a subspecialty, Pediatric Behavioral Health would be incredibly interesting, but potentially devastating.  I was glad to experience it.  At any rate, almost every pharmacist will dispense psychiatric drugs to pediatric patients.  One in 13 children take some kind of psych med in the US.  It is important to see the most extreme cases to understand the others.

Alphabet Soup Notes:
MDD - Major Depressive Disorder
ADHD - Attention-Deficit with Hyperactivity Disorder
ODD - Oppositional Defiant Disorder
Mood D/O - Mood Disorder
SIB - Self-Injurous Behavior
SI - Suicidal Ideation
HI - Homicidal Ideation
IEP - Individualized Education Plan