PAL Monthly Newsletter | March 2020
From the PAL Psychiatrist
Obsessive Compulsive Disorder in Children: Frequently used scales, therapy, and medication

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder consisting of the presence of obsessions, compulsions or both. Content of obsessions can vary, but are intrusive and unwanted, and typically cause distress. Compulsions are repetitive behaviors or mental acts the individual feels driven to do to alleviate anxiety or prevent a dreaded event. Children may not realize these behaviors are unreasonable or excessive.
  
OCD has a strong genetic component, and even more pronounced with childhood-onset OCD. A first-degree relative of an individual with childhood-onset OCD has a risk 10-fold normal population. The point prevalence in children and adolescents is 0.5%. There is high comorbidity of OCD and Tourette's (or other tic disorder) and ADHD, and other anxiety disorders. Comorbidity rates of OCD and Autism Spectrum Disorder vary widely depending on the study. However, there is significant overlap between symptoms of OCD and rigidity/ritualistic behavior seen in Autism Spectrum disorders.
  
The most commonly reported obsessions in children and adolescents include fears of contamination, followed by worries related to harm coming to themselves, family or fear of harming others. Common compulsions include cleaning, counting, checking and repeating/rituals. The most-used clinical scale is the Children's Yale Brown Obsessive-Compulsive Scale (CYBOCS), which has both a checklist and a scale.
  
A typical first-line treatment for mild-moderate OCD in children and adolescents is cognitive-behavioral therapy (CBT). However, a multi-site NIH study, the Pediatric OCD Treatment Study (POTS), showed medication and CBT combination therapy as superior to either treatment alone.
  
Four medications are FDA approved for use in pediatric OCD. Sertraline for age >6 (50-200mg), Fluoxetine >7 (20-60mg), Fluvoxamine >8 (up to 200mg), and the tricyclic Clomipramine >10. Though not FDA-approved, atypical antipsychotic agents have evidence for efficacy as an adjunctive therapy for OCD as well.
  
Sources: Kaplan & Sadock's Synopsis of Psychiatry tenth edition, DSM-5, Child and Adolescent Clinical Psychopharmocology fourth edition, WH Green. 

-PAL psychiatrist Adam Klapperich, DO

Pediatric Psychiatric Med Management
& Trauma Care Trainings
"I feel more confident prescribing antidepressants, and calling the PAL with complex patients." - pediatrician
The PAL team and a Nationally Certified Trauma Therapist provide FREE and CME-approved trainings for primary care providers and healthcare professionals that are focused on pediatric mental health assessment and treatment. 

PAL will present from 8am-12pm:
  • Overview of the Psychiatric Consultation Service and the importance of early identification of mental illness
  • Psychopharmacology (eg. Stimulants, SSRI's, SGA's, and Mood Stabilizers)
  • Metabolic Monitoring
  • Pharmacogenomics testing
  • Community Resources, Fast-TrackerMN.org, and collaborative care models

Trauma Care therapist and trainer will present from 1-5pm:
  • Psychotherapeutic modalities with a particular focus on evidence-based practices
  • Appropriate screening, referral and treatment of traumatic stress in children and youth
  • Ensuring adequate assessment and the appropriate diagnosis and treatment of ADHD in children and youth (e.g., differential diagnosis, alternatives to pharmaceutical treatments, etc.)
PAL Psychiatrists
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Adam Klapperich, DO

Dr. Klapperich is a board certified child/adolescent and adult psychiatrist. He joined PrairieCare Medical Group in Edina in 2012. He has since worked in inpatient, partial hospitalization, and outpatient settings at PrairieCare. Dr. Klapperich attended the University of South Dakota before graduating from the Kirksville College of Osteopathic Medicine. He completed psychiatric residency and child and adolescent psychiatric fellowship training at the University of Minnesota. Dr. Klapperich works with children and adolescents in the newly opened Maplewood location.
Joshua Stein, MD

Dr. Stein is the clinical director and an attending clinician at the Brooklyn Park Partial Hospital Program (PHP) and operates a clinic out of the Brooklyn Park Medical Office Building. The clinic is used as a bridge for patient's leaving PHP until they can see their outpatient provider. The focus for care is not just on immediate obstacles and gains, but improving long term trajectory as well. As the president of the Minnesota Society for Child Adolescent Psychiatry he focuses on local and national advocacy for children's mental health with a goal to increase access to quality care.
Resources

Fast-Tracker is Minnesota's free, easy-to-use tool designed to connect people with resources and services. 

They connect individuals, families, mental health and substance use disorder providers, physicians, care coordinators, and others with a real-time, searchable directory of mental health and substance use disorder resources and their availability within Minnesota.

For more information, call Fast-Tracker 651-426-6347 or visit their website:
Mental Health Resources & Treatment Protocols for Primary Care

Child and adolescent psychiatric treatment protocols are available on our website under the Training & Education tab. The treatment protocols are specifically for medical providers, and the fact sheets are intended for caregivers/families. 

Please click here to view the Child and Adolescent Treatment Protocol Guides!