|
|
Post by Admin on Dec 14, 2015 12:07:11 GMT -4
|
|
Navleen Gill MS3 AUA
Guest
|
Post by Navleen Gill MS3 AUA on Dec 15, 2015 0:01:31 GMT -4
This article was a very interesting read and brings light to a very alarming and sad topic. Its unbelievable to see that medications like Seroquel and Risperdal, which have severe side effects in adults are administered to a young population. In the article, it mentioned how a child with seizures who exhibited violent symptoms was prescribed Risperdal even though one of the serious side effects of that medication is seizures. Reading this article makes me question so many things. Upon questioning of expert child psychiatrists and neurologists, they stated that they had never heard of children under the age of 3 being prescribed afore mentioned antipsychotics and struggled to explain it. If that is the case, who are the practitioners prescribing these medications and why are they doing so without having the expertise to do so? Why are pediatricians allowed to prescribe these medications and play the role of a child psychiatrist if they are not adequately trained to do so? Another point that comes to mind is that since the nervous system is not fully developed in children how does augmenting neurotransmitters affect the future development of these young minds. Without adequate research regarding the side effects in this specific population the potential harm for these strong medications is completely unknown and therefore outweighs the potential benefit. In this article, practitioners diagnosed ADHD in children as young as 2, which begs the question, are these children just being "kids" and learning in a way that is different than what society deems as normal or are they clinically functionally impaired that they meet the criteria for a diagnosis? Only thorough research and time will tell. In conclusion, this article in my opinion reiterates how much more has to be researched specifically when it comes to the use of antipsychotics in a young population.
|
|
|
|
Post by Amy Jones on Dec 15, 2015 12:39:53 GMT -4
I believe in the science of medicine. I began my career as a physician first as a scientist. I was trained to look at data and make inferences and conclusions based on evidence and statistics. I know how to read articles and dissect them and try to tease out the language that could be biased and could ultimately change my perceived results from a study. I found that in medical school, many of my peers were not in agreement. Many of my peers were not as enthusiastic about research and its implications as I was. When I was racing to hear a speaker share about their research, they were wishing they could avoid the speech and study books or sleep a few more hours.
I also believe in the art of medicine. Research can bring information to the table and then how we use that information becomes the art of medicine. Understanding the patient and their ability to understand their illness or to read a patient and their intention becomes less scientific and more about interpersonal skills and relationships. There is a grey area for some medications. There is some practice involved.
Where these two areas blend well and create harmony and heal people is the max optimum point. Some physicians may overshoot the scientific and others may overshoot the art. In this case I see the physician is trying to help the parents and the child. Unfortunately, where children are concerned I believe that we are best served to have a very reserved medical management strategy, in that the drugs that could have serious neurological and permanent side effects should be saved for those children that have no other alternatives at a normal successful life. Once therapy for the parents and children have failed, and other more benign medications have failed, then perhaps a trial on a more potent medication could be tried. |
|
|
|
Post by Juan Camilo Pineda on Dec 15, 2015 14:01:30 GMT -4
This article presents two dilemmas. One being how far we as physicians go in order to treat patients and what the optimal methods are; the latter being at what point do we accept the fact that we have no proven/beneficial options for our patients. It is an alarming and potential dangerous situation to provide our youth with such potent medication with proven significant side effects. I believe that on one side one cannot fully understand the depths one is willing to go in order to help treat a family member or friend when they are in a similar situation. Much of the population would be completely opposed to treating a person with a medication with such dire side effects and such potency, but when there are no options left and you deeply care for the person most would change their mind and say to go forward with the treatment. At this junction it is our job as physicians to best advise our patients and their families to what the optimal path would be to follow based on our knowledge, experience, and current new developments in medicine. To add medicine is still young in its abilities and there is still much we do not know, as a scientific field there is something to be said about experimenting and trying new methods of treatment, with appropriate caution, to help patients who have run out of options. In the end our job is to help the patient and do no harm in whatever method that may be.
|
|
|
|
Post by Robyn-Ann Lee Hing on Dec 16, 2015 1:03:57 GMT -4
More and more children age 2 or younger are being prescribed psychiatric medications to control behavior rather than to treat a mental illness, which rarely develop before adolescence. This issue of prescribing medications raises a myriad ethical, social, legal and developmental concerns. Doctors are pressured from parents, teachers, and other caretakers to medicate children. For example, some parents cannot afford and/or do not have the resources to take care of their children outside of a daycare facility. If the child has a behavioral issue, some daycares will dismiss the child from their care. The doctor now is left “do something” about the child’s behavior without accounting for social and/or environmental factors that affect the child. I feel that the doctors should explain to the parents that giving these medications may alter the child's developmental process and, as the article states, that there is no published research into the effectiveness and potential health risks for children that young. They should also tell the parents that they can also end the prescription at any time after it has been initiated and to seek other routes of behavioral therapy. At the end of the day, the focus should be what is best for the patient. If the child is under the age of three, we should really question the real need for psychiatric medication.
|
|
|
|
Post by James Butz on Dec 16, 2015 10:50:10 GMT -4
The article describes that the patient was suffering from juvenile epilepsy and was prescribed felbamate, but eventually experienced side effects like becoming “erratic and aggressive.” Due to these side effects the article describes that the patient was given a prescription for Risperdal. The article states that the Risperdal, according to the patient’s mother caused “behavior he had never shown before” including “scream[ing] in his sleep and seemed to interact with people and objects that were not there.” Two questions I have about this article include: 1) was anything else tried before adding Risperdal on to the medication regimen (i.e. ethosuximide, valproate, carbamazepine, barbiturates, etc…)? And 2) are the side effects of noticing the patient act weird and talk to people and objects that aren’t there better than the side effects of neutropenia, elevated LFTs, hyperammonemia, agranulocytosis, etc… Concerning the first question, I’d think that the prescribing physician would have tried another anti-epileptic medication approved for a child before simply adding another drug with an abnormal side effect profile, and perhaps the article left a few of those details out. In relation to the second question, while the abnormal side effects of nightmares and hallucinations are alarming, especially to a parent, I personally would have elected for a smaller dose of a medication causing those side effects than the effects of damaging a toddlers bone marrow, liver, and brain with other epileptic medications.
|
|
|
|
Post by msingson on Dec 16, 2015 12:46:15 GMT -4
It is shocking to read about the Rios case and that the practice of prescribing antipsychotics to patients at such a young age is occurring more often across the country. I thought we as a culture/nation was hasty in the practice of the impulse affixing of the ADD/ADHD label to young children that show the slightest bit of “hyperactivity.” When did we stop realizing that these kids, are just being kids? and that the medications being prescribed come with a long list of adverse reactions. But this, prescribing children of such a young age such as the Rios kid, is incromprehensible and irresponsible in part of the physician. That said, I couldn’t agree more with Dr. Tronick’s statement as I’m all for opting for the most conservative mode/ treatment for myself but moreso when considering treatment for pediatric patients, and patients in general regardless of age. I just hope that the physicians that prescribed these antipsychotics considered/suggested other modes of treatments such as behavior modification programs such as Tronick’s UMass program. Then again, we do live in a culture where we seek the easy way out, opting for that "one pill" that will resolve whatever problem at that moment rather than investing on a more conservative treatment that would take [some] time.
|
|
|
|
Post by Edak Ekere on Dec 16, 2015 15:49:26 GMT -4
This is a sad, but enlightening article. It is hard to believe that these health care practitioners are so quick to prescribe antipsychotics to treat these young children before exploring other behavioral interventions that could be beneficial. I have to agree with Dr. Tronick, making diagnosis of these types of disorders in children younger than 3, is ludicrous. Instead of resorting to administering these medications with harmful side effects, health care practitioners should focus on finding out what is causing these "troubled" behavior in these children, and why the parents are stressed. As stated in the article, this issue is escalating, due to desperation by the families of children who are "suffering", or uninsured ill parents using their insured children as a means of getting these medications. Whatever the reason is, this has to stop. Another contributing factor, would be the cost and scarcity of well trained child psychiatrists, as mentioned in the article. Steps towards resolving this issue would have to include the construction of guidelines regarding the use of antidepressants and antipsychotics in children younger than 3, and an increase in the availability of well trained child psychiatrists. Hopefully, if these issues are resolved, cases like that of Andrew Rios would gradually decrease.
|
|
|
|
Post by Kristy Amores on Dec 16, 2015 23:06:49 GMT -4
This article is very eye opening to me. I’m stunned that these very young children were prescribed psychiatric medications. Dr. Gleason explains that these children have brains that are developing in ways that we don’t understand yet. I completely agree that it is too risky to use psychiatric medications because of this. When risks like these presents, we should find as many alternatives as possible. Children are being diagnosed with attention deficit hyperactivity disorder as young as the age of two? If someone had to diagnose me at the age of two, maybe I would have been diagnosed with ADHD. Maybe there was more patience in the past. We should try to get some of that patience back. Observe the children; let them develop a little more. We need to postpone any medications as much as possible because they are still developing and we don’t want to mess with that. It is articles like these that make me want to go into research and reminds me that there is so much more to learn and so much that still needs to be learned.
|
|
Ann Mary Kalapurakal
Guest
|
Post by Ann Mary Kalapurakal on Dec 16, 2015 23:50:37 GMT -4
The field of medicine has come a long way with many new changes and advances. It seems to be moving so fast that practitioners are crossing boundaries and pushing limits. They fail to remember that they are treating human beings, not "an interesting case" to experiment with. It may be stressful for parents to deal with children who suffer from neurological conditions such as seizures, however prescribing antipsychotics is a poor approach at tackling the problem. It may be a quick solution, but it's an inconsiderate action because it alters the child's neurotransmitters, which does not allow the child to develop their inborn personality and identity. I personally believe that children less than 8 should not be given psychiatric medications because they should be given a chance to grow on their own. Children change throughout time; they go through shy stages, tempter tantrums, and once they become an older sibling they gain a sense of responsibility at a young age. Exposing children to anti-psychotic medications at such a young age is a form of unnatural growth. These children should be given a chance to develop through a natural course. I agree with Dr. Tronick where he states that, "there are behavioural ways of working with the problems rather than medications". Doctors are quick to solve problems with medications, however it is not always the answer. Its necessary for practitioners to take a step back from the advances of medicine and technology and try tackling the psychiatric/neurological problem at a more basic human level; empathy and psychotherapy.
|
|
|
|
Post by agrover85 on Dec 17, 2015 1:09:35 GMT -4
This article adequately brings light to the unfortunate and growing practice of the over prescribing of psychiatric medications, especially to infants and toddlers. The numbers presented in this article are astounding. The article suggests that one of the reasons of this growing practice is the shortage of trained child psychiatrist who can adequately assess the child’s mental health and provide an individualized, titrated modality of treatment. I believe another contributing factor may be the growing impatience of new busy young parents. In a society where young professionals with demanding stressful jobs have difficulty managing their own selves, compounded with the added stress of a temper tantrum throwing 2 year old, impatience is inevitable. That impatience leads the eagerness to medicate the child to bring about an immediate change to the child’s behavior. This practice severely interferes with the rapid development of the child’s neurological network. This will only change when physicians exercise greater responsibility and make sure the child is appropriately assessed before jumping the gun with such dangerous and potent medications.
-AG MS3
|
|
|
|
Post by Ankita jain on Dec 17, 2015 1:10:19 GMT -4
This article raises an important issue about the usage of psychotropic drugs prescribed to kids 2 years or younger. Drugs like risperdal which is used to treat bipolar disorder and schizophrenia have severe side effects such as seizures in little kids. There is very little research on the efficacy of these types of drugs to help treat these conditions. The antipsychotics that are used today are second and third generation and include many side effects such as weight gain, shuffling walk, drooling, inability to speak and stopping the medication often involves withdrawal period of nausea, vomitting, insomnia, tremors, dizziness and even hallucinations. This is a terrifying listory even adults let alone for little children. This makes me ponder about other alternatives such as psychotherapy and behavioral therapy for parents and children with neglected background.
|
|
|
|
Post by Josiane Asaba on Dec 17, 2015 1:53:55 GMT -4
Risperidone and quetiapine are atypical antipsychotic medications which have mechanism of actions that are not completely understood. They are used to treat schizophrenia, bipolar disorders and other conditions like OCD, depression and Tourette syndrome. These medications have varied effects 0n 5-HT2, dopamine, alpha and H1 receptors. They are meant for adult so why are they being used for children as young as 2 years old? This is very concerning to me especially due to the side effects these medication have. Risperidone in particular can cause problems with infertility and gynacomastia as well as long QT interval. Andrews’s story is a sad one and with a growing brain like his, who knows what damage these drugs can cause? In my opinion, drugs that are meant for adult disorders should not be given to children. Children’s medication should be made in the doses that are appropriate for their growing bodies.
|
|
|
|
Post by Dhaval Ray on Dec 17, 2015 10:46:31 GMT -4
This article is quite concerning. To start with when pharma companies test and research their medication they typically test the drugs on MEN, not women or children. Most drugs are meant to treat adults not children unless specifically recommended for such. We have to give babies baby aspirin and children child aspirin, with our strict adherence to giving children amended drugs, how can we rationalize giving children drugs meant for adults? The point of a drug is to in some way chemically alter the brain, whether it be by increasing or decrease the amount of receptors, neurotransmitters, etc. Children, babies and toddlers have drastically different brains than adults in terms of the connections formed as well as the amount of connections which they have. Giving children drugs to alter the formation of their brains at a young age, when it has never been tested, seems to speak towards a serious breach of duty, and potentially serious harm.
|
|
|
|
Post by Soham Patel on Dec 17, 2015 14:33:42 GMT -4
Comparatively, the problem of psychotropic drug use in children younger than the recommended age is not an epidemic by any means. However, the fact that this is a growing trend highlights all the different factors that play a role in perpetuating this problem and the different ways in which we may be able to reach a solution. First and foremost, I personally cannot think of any reason to prescribe psychotropic medicines to young children for a long period of time outside of current guidelines. I have always believed that psychotropic medications are used to balance an individual's naturally unbalanced state. Using medications this early in a child's development does not allow us to ascertain whether there are actual deficiencies in the child's neurochemical pathways, or if they are simply signs and symptoms of a developing neural network. The article does a good job of highlighting the complexity of factors that may contribute to the astonishing numbers surrounding this practice. The lack of child psychiatrists and good alternative options are especially concerning. Part of this problem could simply be a lack of expertise, in which overmatched pediatricians may simply be doing the best they can. In this regard, two solutions come to mind: better training on psychiatric disorders for pediatricians and better incentive for specialization in child psychiatry. The other issue would be a lack of good alternative management plans. People tend to seek out the path of least resistance, and it is no different in managing their medical conditions. Many parents (and physicians alike) would rather give their child a pill than make the necessary behavioral and environmental changes that may result in the same positive outcomes. Pursuing alternatives to medication can be difficult as it requires a good physician-patient working relationship, time-commitment from parents, and the willingness of all involved parties to commit to a long-term endeavor. While these alternative methods pose their own issues, I believe that treating the disorder at its cause with a more stable environment would likely be more beneficial in the long-term and undoubtedly less dangerous to the child than early psychotropic intervention.
|
|
