PAL Monthly Newsletter | December 2019
From the PAL Psychiatrist

Antipsychotic Use in Primary Care
The use of second generation antipsychotics in the pediatric population is commonplace on inpatient psychiatric units and outpatient psychiatric clinics. Should this class of medications be in the primary care provider’s “toolbox” of medications for their patients with behavioral and/or mood symptoms when the first and second-line medications fail?

There are currently seven second generation, or atypical, antipsychotics approved for use in children and adolescents. These include risperidone (irritability associated with autism, schizophrenia, bipolar disorder), aripiprazole (irritability associated with autism, schizophrenia, bipolar disorder), quetiapine (schizophrenia and bipolar disorder), olanzapine (schizophrenia and bipolar disorder), lurasidone (schizophrenia and bipolar disorder), paliperidone (schizophrenia), and asenapine (bipolar disorder).

The child or adolescent with schizophrenia or bipolar disorder is typically having medications managed by a psychiatric provider. However, children with autism spectrum disorder and major depressive disorder are often managed by primary care. 

You may notice that augmentation of a SSRI medication with a second generation antipsychotic such as aripiprazole for major depression is not an FDA-approved use for adolescents. This use is only FDA approved for adults, so this would be off-label use, but also a reasonable strategy for augmenting treatment of depression in adolescent patients in the primary care clinic. I have found this to be helpful in adolescents who have partial benefit from SSRI or SNRI medication, but with residual symptoms of depression, especially irritability. A typical starting dose of aripiprazole for antidepressant augmentation is 1mg, which can be titrated to 2-5mg... (click below for full article)

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!