Drug-Induced Psychiatric Problemsin Children and Adolescence

Padideh Ghaeli, Pharm.D

Professor of Clinical Pharmacy

April 2014

Drug-Induced Psychiatric Problems

• Drug-induced psychiatric diseases can occur at therapeutic doses

• The psychiatric disturbances may interfere with the treatment of the primary illness

Drug-Induced Psychiatric Problems

• Many prescription drugs have not been tested in children. However, are prescribed for them

• Children bodies constantly change and grow

• Children need different doses compared with adults

Drug Induced Behaviour Change

• Affecting Neurotransmission

• Affecting Endocrine System– Testosterone- Insulin- Corticosteroids

• Exogenous Drugs– Anticholinergics, Stimulants, Montelukast

Drug-Induced Psychiatric Problems

Problems include

•Hallucination, Anxiety, Depression, Mania, Aggression, Disinhibition, Amnesia, Confession, Incompetence

Drug-Induced Depression• Antivirals (Efavirenz)

• CV agents (Clonidine, Methyldopa, Reserpine, Guanethidine)

• Retinoic Acid Derivatives (Isotretinoin)

• Antidepressants (SSRIs, TCAs, MAOIs)

• Anticonvulsants (Primidone, Phenobarbital, Vigabatrin, Topiramate, Levetiracetam, Tiagabine, Phenytoin)

• Antimigraine Drugs (Triptans)

• Hormones (Corticosteroids, Tamoxifen, GnRH agonists, OCs)

• Immunologic Agents (Interferon)

• Smoking Cessation Agents (Varenicline)

Drug-Induced Depression

• Reserpine

• Methyldopa

• Nifedipine

• Propranolol

• Interferon

• Ranitidine

• Bismuth Subsalicylate

• Anticholinergic Withdrawal

• ACTH (adrencorticotropic Hormone)

• Prednisone

Drug-Induced Anxiety

• Stimulants– Cocaine– Amphetamine– Methylphenidate

• Theophylline• Caffeine• Decongentant– Pseudoephedrine– Ephedrine

• Antidepressants– TCAs

– SSRIs

– MAOIs

• Thyroid Products

• Beta-agonists– Albuterol

Drug-Induced Mania

• Corticosteroids• Levodopa• Zidovudine• Oral Contraceptives• Isoniazid• Buspirone• Lamotrigine • Risperidone• Antidepressants

Drug-Induced Personality Change

• B12 Deficiency

• Hg Intoxication

Drug-Induced Catatonia

• Antipsychotics

• BZD Withdrawal

Drug-Induced Suicidality Suicidal Ideation and Behavior

Drug Related Suicidality Mostly Happens with Mood Changes and Significantly Increases the Risk to the Patients

•Antipsychotics

•BZD Withdrawal

Drug-Induced Psychiatric Problems

• Montelukast (Singular): Behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide

• Oseltamivir (Tamiflu): Hallucinations, delirium and abnormal behavior

• Antidepressant: Increased risk of suicidal thoughts and behavior in children and adolescents

• Accutane (isotretinoin): Increased risk of suicide ideation and suicide

Drug-Induced Psychiatric Problems

• Amoxicillin: Behavioral changes (hyperactivity, agitation)

• Prednisone: Mood changes, nervousness and insomnia.

• Diphenhydramine: Drowsiness, sedation and some times agitation

• Stimulants like methylphenidate: Insomnia, nervousness, headache and dizziness

• Metoclopramide: Insomnia, restlessness and decreased energy. Acute dystonic reactions and tardive dyskinesia have also been reported

• Lindane: Stimulation, dizziness, Seizure, headache, death