IMMATURE BETA-ADRENERGIC OVER-ACTIVITY CAN CAUSE RAGE BEHAVIOR IN - - PowerPoint PPT Presentation


 IMMATURE BETA-ADRENERGIC OVER-ACTIVITY CAN CAUSE RAGE BEHAVIOR IN
 CHILDREN

Elisha R. Injeti, Ph.D. Assistant Professor of Pharmacology Director of Research & Development Cedarville University School of Pharmacy Cedarville, OH 45314


 IMMATURE BETA-ADRENERGIC OVER-ACTIVITY CAN CAUSE RAGE BEHAVIOR IN
 CHILDREN

Ralph Ankenman, M.D. Medical Director & Psychiatrist Medical Missionary Madison County Hospital London, OH 43140

Outline:

• 1. Background and Literature Review
• 2. Pharmacological Basis for Therapy
• 3. Clinical Case Studies
• 4. Results and Conclusions
• 5. Implications for Health Policy

Background:

▪ Rage is characterized by physically overactive, agitated, violent & aggressive outbursts in behavior ▪ Rage behavior is generally associated with psychiatric illness like ADHD, autism & schizophrenia ▪ Psychotropic medications are commonly used to treat these conditions ▪ In recent years psychotropic medication use has significantly increased

Literature Review:

Children 1.10 3.4% 3.73 8.2%

Literature Review:

Pharmacological Basis for Therapy:

Pharmacological Basis for Therapy:

Pharmacological Basis for Therapy:

Clinical Case #1:

▪ History:

• 4 year old boy with terrible rage behavior
• 1 to 3 outbursts a day for about 20 minutes
• Abusive to parents and siblings; no ADHD

history

• High pulse rate and high blood pressure

▪ Treatment:

• Propranolol @ 60mg/day
• After 4 months rage behavior gradually

decreased

Clinical Case #2:

▪ History:

• 3 year old girl with intense & frequent rage

behavior

• 4 to 8 outbursts a day for about 15 minutes
• Temper tantrums followed by profuse sweating
• Pupil dilation, high pulse rate & high blood

pressure

▪ Treatment:

• Propranolol @ 60mg/day titrated to 160mg/day
• Treatment for a year and then discontinued

Clinical Case #3:

▪ History:

• 6 year old hyperactive girl with violent

behavior

• Self abusive with severe hair pulling habits
• High pulse rate and high blood pressure

▪ Treatment:

• Propranolol @ 120mg/day
• Tapered off after 2 years without any relapse

Results and Conclusions:

▪ Adrenergic activity is involved in “fight or flight” response under normal conditions ▪ Over-activity of adrenergic system causes rage behavior in children ▪ Over-activity may be due to immature function

• f regulatory feedback mechanisms in children

Implications for Health Policy:

To promote judicious use of psychotrophic medications among children, assessment of adrenergic function may be included in diagnostic process of behavioral health

Acknowledgements:

▪ Elizabeth Ankenman, M.D.

Physician, Madison County Hospital, London, Ohio

▪ Marc Sweeney, M.Div., Pharm.D.

Dean & Professor, Cedarville University School of Pharmacy

▪ American Scientific Affiliation

Questions?