Transcript Ask the Doctor

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Ask the Doctor
Presented by Peter Nierman, MD
Medical Director
Chicago Lakeshore Hospital
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Chicago Lakeshore Hospital
Treatment Programs: Chicago Lakeshore
Hospital provides inpatient hospital services and
an intensive outpatient program for adolescents
with psychiatric, emotional, chemical
dependency, and behavior disorders. The
treatment experience provides the adolescent
with a secure and structured environment to work
through developmental, educational,
psychological and social problems.
Dr. Peter Nierman,
Medical Director
The treatment team works closely with families,
schools and the appropriate referral sources in
meeting the needs of the adolescent patient and
his/her family.
Program Features and Services May Include:
Individual therapy
Group or play therapy
Family therapy
Case management
Accredited school program
Medication management
Intensive Outpatient Program
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Psychiatric Evaluation
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What are resources for referring children for Psychiatric
Evaluation/med management with Medicaid?
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All children will be evaluated at Chicago Lakeshore Hospital
Intake Department on a case by case basis. This is true of
several other psychiatric hospitals in the area as well.
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Community Mental Health Centers may employ psychiatrists
and may be able to schedule an appointment upon request.
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Universities and Medical Centers provide mental health
services to outpatients with Medicaid (University of Chicago,
University of Illinois, Cook County Hospital, Mt Sinai Hospital,
Illinois Masonic Hospital, Evanston Hospital, and others
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It is not uncommon to be put on a three to six month waiting
list at some of these institutions.
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Continued
Does he know any developmental pediatricians that take
Medical Assistance?
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Developmental pediatrics is often practiced in the larger
medical centers. There are not many available to families
with Medicaid but the UIC may be a good option to pursue.
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There are several free-standing psychiatric hospitals that
treat youth in partial hospital programs – and these usually
will accept Medicaid. This also guarantees reasonably fast
access to psychiatric services.
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Depression
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What medications are approved/recommended for treating
children for depression?
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Fluoxetine – FDA approved
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Other SSRI’s, SNRI’s, novel antidepressants
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MAOI’s
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Adjunct treatments for treatment resistant depression include
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Lithium, synthroid, aripiprazole
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Transcranial Magnetic Stimulation, ECT
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ADHD and Aspergers
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What is the best way (as far as who to refer to) for a young
child (under 5 or 6) to be diagnosed with ADHD/Aspergers?
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The best way to diagnose ADHD, learning disabilities, or
Pervasive Developmental Delays is through a combination of
history, examination, mental status, genetics, psychological
testing, neurologic examination, imaging, school observation,
and other interdisciplinary modes of assessment such as
Physical and occupational therapy.
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Attention Deficit Hyperactivity
Disorder
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Cardinal features: Inattention, Distractibility, hyperactivity,
impulsivity
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Best assessment involves school personnel and/or school
observation
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Kids with ADHD commonly blurt things out or undertake
activities without regard for caution or risk, have short
attention spans, can’t wait in line, can’t sit still or stay seated,
can’t follow through on three-step commands because they
get distracted, have difficulty initiating purposeful activity,
talk excessively, stare out the window, behave as if they are
propelled by a motor, and they are disorganized.
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Stimulants work, they have stood the test of time and the
rigors of research, but they are not the solution for everyone.
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Autism and Aspergers Disorder
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Autism spectrum is a disorder of imagination, stereotyped
behavior, speech and communication, and socialization
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Asperger’s Syndrome has similar but less pronounced
findings but with relatively normal speech and language
development
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Asperger’s Syndrome may be detected by a pediatrician but
these children often come to the attention of psychologists as
part of a school evaluation.
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Trauma
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Almost all of the children we see at our school based sites
have experienced some sort of trauma related problems.
What seems to be the biggest physical/psychiatric
manifestation of trauma?
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Post traumatic stress disorder affects many children in the
CPS. Common causes of trauma are neglect, physical abuse,
sexual abuse, verbal/emotional abuse, exposure to domestic
violence, and witnessing violence in the community.
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PTSD in youth is a “neuro-developmental” disorder
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Manifestation of PTSD always involves hyper-vigalence.
Sleep problems, uncontrolled triggers to memories,
distractibility, dissociation, and poor socialization also
occurs.
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PTSD cont.
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Because violence is such a large part of our children's lives, I
often wonder of resources to help them feel safer. Are there
any resources or catch phrases that we could give in the
clinical setting when a patient says they do not feel safe in
the neighborhood in which they live?
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I believe it is essential that children be involved in as many
pro-social and pro-developmental activities as they can.
Youth who are “locked in” after school do not do well.
Exposure to positive events and activities is as important as
school.
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There is an evidence based prevention program I can
suggest that you look at entitled Families and Schools
Together – F.A.S.T. I think this program has much to
recommend to keep schools and communities engaged.
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Anxiety
Please talk about anxiety. We often work with families whose
children are having school related anxiety, panic attacks, etc.
Often it is hard to prescribe something for a child or young
adolescent for anxiety. Can you speak about your
recommendations and even just what you coach the families
to do? Please talk about cutting/self-injurious behavior,
something like, “if we see a youth who clearly has self-injury
behaviors, are there specific short term interventions a
medical provider can do with a youth before referring them
to a behavioral health provider?”
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ANXIETY
Anxiety is a state of heightened awareness, sensitivity, and fear.
There are several diagnoses in the Anxiety Disorder
category such as Generalized Anxiety, Panic Disorder with or
without Agoraphobia, Obsessive Compulsive Disorder,
Phobias, and Post Traumatic Stress Disorder.
Symptoms include shortness of breath, avoidance, tingling of
hands, dry mouth, dread, fear of death, hyperactive bowel,
urinary frequency, insomnia, and many more.
Research shows that a combination of medication paired with
cognitive-behavioral or behavioral therapy is the most
effective treatment.
Helping people to live with anxiety is the most appropriate
goal for therapy
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Eating Disorders
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Where is there an outpatient program for eating disorders in
the city that accepts Medical Assistance?
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Most of the Partial Hospital Programs in the city and
suburban areas will take Medicaid.
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Typically, eating disorders are treated in an outpatient
setting. Families need to be involved.
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These children require inpatient hospitalization when the
percentage of expected body weight falls below an agreed
upon threshold. These can be medical emergencies because
metabolites can be abnormal which can lead to cardiac
arrhythmias, and dehydration can lead to hypotension.
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Chicago
Lakeshore
Hospital
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Behavioral Health Hospital with
services for children, adolescents and
adults
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Inpatient, partial hospitalization and
intensive outpatient care
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For a Free, Confidential Assessment &
Referral
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24 hours a day, 7 days a week
Call (800) 888-0560
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4840 N. Marine Drive Chicago Il 60640