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 of 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
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