Dr. Henry Paul, MD

Psychiatrist, Author and Educator

PSYCHOTROPIC MEDICATION USE AMONG ADOLESCENTS

March 18th, 2015

I came across an interesting study this week that I want to share. Although, it has been out about a year, the information provided in it is quite interesting and still relevant. At the end of 2013, it was reported that more than six percent of adolescents were taking psychotropic medications. These medications are to help treat the symptoms of a mental disorder. Depression and ADHD are the most common mental health disorders among adolescents.

I have often stated that these drugs are not a cure-all but rather aid in alleviating symptoms. Suppressing the symptoms provides a child the opportunity to develop better life-skills and strategies to deal with their disorder. The hope is that, with time and teaching, they will develop the ability to manage their disorder without medication.

Remember, a mental disorder is a group of signs or symptoms the psychotropic drugs treat. Many psychiatrists, myself included, see these signs and symptoms as only part of the overall problem. Much like a fever – signs and symptoms are an indicator of an underlying and not so obvious condition. I believe, as do many of my peers, that the underlying condition is as important to diagnose and treat, as are the signs and symptoms.

So what are underlying conditions? To believe in the concept of “underlying”, you must be open to another concept: the unconscious mind – the belief that we have thoughts and feelings of which we are unaware. Freud’s discovery of the unconscious mind entered mainstream psychiatry over a century ago. My clinical experience, as well as that of my thousands of colleagues who work every day in the curious world of underlying issues, makes it clear that signs and symptoms have their origins deeper in the personality.

What is their cause? In a nutshell, I believe that stresses in early life can lead to unresolved conflicts and anxiety. Many of us outgrow these difficulties as we mature. For others, the underlying tension leads to signs and symptoms that we call mental disorders. Which signs and symptoms we develop are based mostly on our genetic makeup. We can treat the symptoms very well with psychotropic medication, but it is almost always necessary to explore the underlying issues to free a person to develop to their full potential.

I believe that parents should not be afraid to give their adolescent medication when it is recommended by a medical professional. I almost never prescribe medication without a recommendation for psychotherapy, too. For many children and teenagers, the symptoms are so bad that therapy can’t even take place until the medication brings some relief.

After treating children and adolescents for more than 30 years, I can tell you first-hand that medication is most helpful to symptom relief. It will often give an adolescent enough of a reprieve from their symptoms to gain from other therapies. From talk therapy to special educational settings, these therapies can lead to a better quality of life for the adolescent and the family.

Click here to read the report.

When Kids Need Meds; Everything a Parent Needs to Know About Psychiatric Medication and Youngsters

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

POLICE AND SCHOOLS PARTNERING TO BETTER UNDERSTAND MENTAL HEALTH ISSUES

February 9th, 2015

Police and school officials in Fort Wayne, Indiana, are teaming-up to understand the basics of mental illness in young people in an effort to cut back on arrests of children in a mental health crisis. This partnership is inspiring to see because it is through collaborative efforts like this that young people who are at risk will get the best help.

The greatest way to help young people who have mental illness is to get them treatment and not to incarcerate them. The problem is that the symptoms of a mental health crisis are mistaken for delinquent behavior, and that can lead to arrest and possibly jail time.

There has been an ongoing debate in the medical community for years about the link between mental illness and criminal behavior. So why do so many Americans associate mental illness with criminal behavior? Because that is what is in the media and that’s what people remember. Think Sandy Hook. I’m sure what comes to mind for many is that the shooter was on the autism spectrum.

Behavior disorders in young people are often disrupting and bothersome to parents and teachers. It is normal for parents of teens to worry about their behavior, concerned that episodes of “acting up” may be harbingers of future antisocial, sociopathic development, or that their teens are on the road to violent criminality, substance abuse, living on the “edge,” and ending up in jail or prison.

The reality is that most normal teenagers do act up from time-to-time, sometimes in very disturbing and destructive ways. Adolescence is a time of testing limits. In young people who are still developing it remains self-evident that abnormal behaviors are often part of normal developmental progression, and they are temporary. In other instances it can be part of a disruptive behavior disorder, and if that’s the case the most important thing to do is to get the teen the proper treatment.

Young people with disruptive behavior disorders such as ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), do occasionally break laws, especially those young people with Conduct Disorder. If your teen’s behavioral problems have proven to be intransigent, they may suffer from a behavioral disorder that requires greater attention and more specific help. The upside is that these disorders in young people can more easily be treated than the adult syndrome of “Antisocial Personality” (the Psychopath), which is notoriously resistant to psychiatric intervention. Youth carries with it more hope of intervention and possible change. Thus schools, police and mental health professionals working together offer the most fruitful hope.

Click here to read about the partnership between police and school administrators in Fort Wayne.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

ARE YOU CONSIDERING MEDICATION FOR YOUR CHILD?

August 11th, 2014

As a child psychiatrist for over 30 years, I fully understand why parents are often anxious, hesitant, and concerned about giving medication to their child. All too often, such feelings arise from the biased, misleading, and even fabricated stories that are conveyed through the media. You wonder if you’re doing the right thing, what the long-term effects might be and should you try something more holistic. You read all kinds of posts and information on the Internet that, quite frankly, can be scary. The reality, though, is that your child needs this medication, and you need to be able to sleep at night and not worry that you are harming your child.

I have evaluated, treated, and prescribed medication for thousands of young people in settings that include hospitals, outpatient public clinics, residences, foster agencies, and in private practice, and I have followed the progress of many of them over the course of many years. I have plenty of experiences prescribing all of the current psychotropic drugs, and I have treated children and teenagers with all the various disorders including ADHD, bipolar disorder, Oppositional Defiant Disorder (ODD), Asperger’s, and more. I have seen the therapeutic effects of medication when administered properly, the harmful effects when they are abused or prescribed incorrectly, and I have observed the side effects that occur on a rare occasion.

In 2013, I wrote the book When Kids Need Meds: Everything a Parent Needs to Know about Psychiatric Medication and Youngsters. Look, I don’t believe every child with a mental disorder needs medication, but I strongly feels that some do. To withhold these important therapeutic agents can be harmful and, in some cases, tragic. In When Kids Need Meds, I discuss mental disorders, explain the process of psychiatric evaluation, answer many questions, and talk about stimulants, antidepressants, antipsychotics, mood stabilizers, sleep medications, anti-anxiety drugs and others. I also stress the importance of non-medication therapies and provide references for readers to obtain more information. My goal is to provide a guide that covers almost every aspect of an extremely important and very prevalent topic as it educates, comforts, and provides support. I hope you will find it a resource and that it helps you to make peace with having to give your child medications.

Click the picture to purchase a copy of the book!

Hashtags: #drpaul #drhenrypaul #henrypaulmd #whenkidsneedmeds #mentalhealthteens #Kidsmeds #childmeds #teenmeds

WHAT ARE THE LONG-TERM EFFECTS OF THE MEDICATIONS MY CHILD IS TAKING?

January 30th, 2014

Naturally, parents worry about long-term negative effects of psychotropic medication on children. We have very little data since most of the psychotropic drug explosion has been relatively recent, and not enough time has passed to see any long-term effects on the brain or development in general, but even for very common psychotropic drugs like Ritalin, which has been used for fifty years, there has been no evidence that there are long-term dangers. At this time, there is no documented reason to worry about psychotropic drugs causing death or long-term damage to our children. While some of the side effects like drowsiness, mood changes, or other symptoms can affect our children, these are easily recognized and treated if the medication is being monitored correctly. Even for drugs that have been used for fifty years there is no evidence of long-term damage to children except for relatively minor issues like a very small height diminution in children who have taken some of the ADHD medications and even in this case it is not known if the decrease lasts into adulthood.

Lastly, there are always the newspaper headlines about famous or not so famous people dying from psychotropic drugs. This is very different from dying from proper prescribing. In these cases, there is usually an overdose of the drug, either intentionally or otherwise, a combination of drugs, or an interaction with illicit drugs or alcohol.

CAN MY PEDIATRICIAN PRESCRIBE PSYCHIATRIC MEDICATION?

January 28th, 2014

In the United States, doctors without special psychiatric training write the great majority of prescriptions for psychotropic medications. Although it is difficult to quantify, it appears that psychiatrists write only about 20 to 25 percent. It would be preferable to have all of these prescriptions written by a psychiatrist and particularly with children and teenagers it be done by a child and adolescent psychiatrist. Why? Because the practice of prescribing these specialized medications requires specific knowledge of children and teenagers that is only gained by those who have completed special training in child and adolescent psychiatry in approved residency programs.

A general (adult) psychiatrist goes to medical school and then completes postgraduate specialty training of four years of general psychiatry. A child and adolescent psychiatrist goes on for an additional two years receiving additional training in child and adolescent psychiatry.

In a child and adolescent residency, one learns about the details of child/teenage/family development in all areas: biological, neurological, educational, psychological, emotional, and physical realms. One learns about the field of pediatrics and is able to integrate physical illness and its effects into diagnostic and treatment expertise. There is detailed exposure to the diagnosis of all the mental disorders that occur in the formative years, both in outpatient and hospital settings. One studies feelings, behaviors, and thinking patterns. In addition, there is exposure to all the various modes of therapeutic intervention including individual, family, and group talk therapy.

In a child and adolescent psychiatry residency, one scrutinizes the use of psychotropic drugs for the many disorders of childhood and teenagers; not only the helping effects of medications but the side effects, the use of multiple medications, the emotional repercussions of taking medication on the child and family, and the introduction of medication to school personnel when necessary. Most importantly, one learns about the unique metabolism of medication by young people.

Only about eight thousand doctors are trained in child and adolescent psychiatry in the United States. This is a small amount, and the field is considered very understaffed. Because of this, it will not always be possible to see a trained child and adolescent psychiatrist, especially if you live in a rural area. Pediatricians, clinic nurse practitioners, and general psychiatrists are the other major prescribing groups for the child and adolescent psychotropics and, although the great majority has the skill in this area, it is best to find out how much experience in prescribing to young people in particular they have. You can simply ask your doctor directly about their education, continuing education, and of course, direct patient care experience. Additionally you can search the Internet, consult with local mental health associations, and with the referring person (pediatrician) to learn more about the doctor in question.

MEDICATION FOR ADD/ADHD

December 24th, 2013

Medication is one of the core treatments for ADD/ADHD and has a history in child psychiatry going back over fifty years. Although stimulant medications (called stimulants because they cause stimulation in non-ADD/ADHD persons and, paradoxically, the opposite in those with the disorder(s)), are by far the most effective and widely used drugs, currently the treatment of ADD/ADHD also includes other classes of psychotropic medications. These are far less effective but might be necessary when stimulants alone don’t work or cannot be tolerated. These include some antidepressants and blood pressure medications.

ADD/ADHD medications have received a lot of publicity over the years, mostly because of the millions of children who have received them. Reports have ranged from raves about their effectiveness to diatribes against their safety that instill the fear of death in parents. In fact, these medications are the most widely used in child psychiatry and have been the most studied, so they are some of the safest medications out there, although there are some side effects which are usually transient and mild. The stimulants are not only effective agents to treat ADD/ADHD, but also work quickly.

There are two major classes of stimulant medications; methylphenidate (i.e. Ritalin) and its derivatives, and amphetamine (i.e. Adderall) and its derivatives. (See lists below).

All the stimulants are approved for children six years old and over. Adderall, Dexedrine, and Dextrostat are also approved for children as young as three years old. Having said that, each psychiatrist develops his own style for prescribing within the overall safe parameters of the profession, and personally, I try to be as flexible as possible and make sure that the parents and the children that I work with understand why I am prescribing the medication and all the possible complications involved with it. My goal is to decrease the resistance or fear. The important thing is for parents to do their homework and to understand actually what these drugs can and cannot do.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

ADD/ADHD DIAGNOSIS & TREATMENT

December 17th, 2013

Now that you suspect that your child may be suffering with ADD or ADHD it is important to get a proper diagnosis. The diagnosis of ADD or ADHD is best made by a child psychiatrist. There is no particular psychological or blood test to diagnose the disorder. The most effective way to diagnose ADD or ADHD is by gathering a history about your child from you, your child’s teachers, and others who interact with your child on a regular basis including coaches, tutors, childcare personnel, and so on.

Thus a lengthy history gathering is necessary. Care has to be taken to rule out other disorders that can look similar, especially anxiety disorders, depression with agitation, and post-traumatic stress disorder. Also remember sometimes children can react to situations that exhibit some of the symptoms of ADD or ADHD, but these symptoms are only short-term and passing and do not make the diagnosis.

Once the diagnosis is made, a multimodal or combination approach is usually necessary including some form of therapy such as:

Behavioral therapy
Individual talk therapy
Educational help
Family therapy
Parent education
Skills training
Medication

It is important to remember that therapy for common secondary effects of ADD/ADHD such as feelings of isolation, alienation, depression is every bit as important as treating the syndrome itself.

Once you have the proper treatment in place there will be ongoing monitoring to make sure that your child is responding well to treatment. This is the beginning of treatment for your child and you will be working closely with your child’s psychiatrist over however long a period of time is needed to make sure that your child is responding well to treatment.

WHAT IS ADD & ADHD?

December 13th, 2013

The number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) continues to climb, according to new data from the Centers for Disease Control and Prevention. http://thechart.blogs.cnn.com/2013/11/22/adhd-diagnoses-rise-to-11-of-kids/

Today, 6.4 million children between the ages of 4 and 17 – 11% of kids in this age group – have received an ADHD diagnosis, according to a recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry, which is based on a survey of parents. That’s 2 million more children than in 2007. http://www.medicaldaily.com/adhd-diagnoses-reach-64-million-us-35-million-children-prescribed-medication-cdc-report-263545

The links above show the new numbers that were released in November showing a significant rise in the number of school aged children diagnosed with ADD (or ADHD).

Attention Deficit Disorder (ADD) ranks among the most frequently diagnosed behavior disorder today. ADD affects about eight percent of school aged children in the United States. There are three types of ADD:

Attention Deficit Hyperactivity Disorder (ADHD) where the hyperactivity/impulsive characteristics predominate.
Attention Deficit Disorder (ADD) where inattention predominates and there are fewer behavioral problems characteristic of children with ADHD.
Combined Type where there are both inattentive and hyperactive/impulsive characteristics.

The syndrome is characterized by more than expected degrees of:

INATTENTION

Trouble focusing on activity
Trouble sustaining attention
Seeming not to listen
Trouble following instructions
Easily distracted
Easily bored
Trouble Organizing
Making careless errors
Not finishing or not doing homework
Losing things
Having to have things repeated

IMPULSIVITY

Inability to wait her turn
Blurting out answers in class
Interrupting
Bossiness
Acting like the class clown
Having little control of his actions and not being able to put thought between feelings and actions
Having hair-trigger tempers
Bullying

HYPERACTIVITY

Trouble sitting still
Fidgeting
Rarely slowing down
Talking too much
Rarely finding quiet time

It’s true that many of these characteristics, to some degree, are common to all children. This in no way lessens the validity of the disorder. A child’s ability to focus, sit still, follow commands, control activity, show patience, and manage feelings develops at different rates. There is no such thing as a perfectly normal timeline and because of this, it’s important not to jump to conclusions. A good measure is that by kindergarten these areas of development should be growing, and by the end of first and second grade, they should be well along. If not, then chances are your child is in a great deal of discomfort and might be suffering from ADD. Don’t be fearful of an ADD diagnosis. There are many ways to treat it and children can find success in school and their daily lives with the proper help and support.

In my next blog I will discuss diagnosing ADD, what causes it and how it is treated.

HOW TO CHOOSE A THERAPIST FOR YOUR CHILD

December 4th, 2013

Once you realize that your child needs professional help the next step is finding that help. There are various types of therapy that are generally recommended for specific psychiatric disorders. At first glance, those therapies cover a bewildering range not only of the conditions they are designed to treat but of the philosophies and techniques they employ to treat them. What criteria does a parent use to choose?

Help is relatively easy to find; through your doctor, your child’s school, your local hospital or medical clinic, your religious organization or the local mental health organization in your municipality. Ideally every child or teen should receive a broad based clinical mental health evaluation. This entails the family and child being interviewed. A child/teenage psychiatrist (one who has done a residency or fellowship in child/adolescent psychiatry) is the most broadly trained of all the child mental professionals and can spot the need for possible medication right away. They can also provide psychotherapy if needed. Many locales do not have a psychiatrist, and in that case other mental health professionals can perform the evaluation and therapy as well. Licensed psychologists, social workers, psychiatric nurse specialists and mental health counselors all work in this area. The important thing to remember is that they need to have had special training and experience in working with young people. Do the research before you choose.

The next thing to consider is recommendations from others who have sought help from the individual. Did it help? Was he/she available when needed?

Lastly, trust your gut. After meeting with the therapist ask yourself how comfortable you and your child are. What was the atmosphere? Was he/she flexible regarding times? Ask about his/her understanding of the problem. How long should the treatment last? What will you look for as far as progress is concerned? Ask all you can if medication is prescribed– side effects, how to take it, what symptoms are being targeted and how to go off it.

Sometimes just one visit can be clarifying – the therapist may have so much knowledge of your child’s minor problem that direction can be given on the spot, and that may be all the therapeutic advice you need. Maybe just the parents need some education and counseling. For more serious issues, longer-term therapy for the child/teen might be needed. The family is usually included especially for pre-teens. Ask about fees and insurance, too.