A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy

Magdalena Romanowicz, Alastair J. McKean, Jennifer Vande Voort

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment. Case presentation: A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine. Conclusions: The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

Original languageEnglish (US)
Article number330
JournalBMC Psychiatry
Volume17
Issue number1
DOIs
StatePublished - Sep 11 2017

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Polypharmacy
Guanfacine
Thioridazine
Obsessive Behavior
Child Psychiatry
Behavioral Symptoms
Risperidone
Fluoxetine
Amphetamine
Aggression
Epigenomics
Psychiatry
Inpatients
Primary Health Care
Anxiety
Salts
Medicine
Drug Therapy
Food
Wounds and Injuries

Keywords

  • Adoption
  • Case report
  • Disinhibited social engagement disorder
  • Neglect
  • Polypharmacy

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. / Romanowicz, Magdalena; McKean, Alastair J.; Vande Voort, Jennifer.

In: BMC Psychiatry, Vol. 17, No. 1, 330, 11.09.2017.

Research output: Contribution to journalArticle

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