Ask the Doctor

1. Ask the Doctor Presented by Peter Nierman, MD Medical Director Chicago Lakeshore Hospital

2. 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. 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 Dr. Peter Nierman, Medical Director

3. Psychiatric Evaluation • What are resources for referring children for Psychiatric Evaluation/med management with Medicaid? • 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. • Community Mental Health Centers may employ psychiatrists and may be able to schedule an appointment upon request. • 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 • It is not uncommon to be put on a three to six month waiting list at some of these institutions.

4. Continued Does he know any developmental pediatricians that take Medical Assistance? • 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. • 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.

5. Depression • What medications are approved/recommended for treating children for depression? • Fluoxetine – FDA approved • Other SSRI’s, SNRI’s, novel antidepressants • MAOI’s • Adjunct treatments for treatment resistant depression include • Lithium, synthroid, aripiprazole • Transcranial Magnetic Stimulation, ECT

6. ADHD and Aspergers • 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? • 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.

7. Attention Deficit Hyperactivity Disorder • Cardinal features: Inattention, Distractibility, hyperactivity, impulsivity • Best assessment involves school personnel and/or school observation • 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. • Stimulants work, they have stood the test of time and the rigors of research, but they are not the solution for everyone.

8. Autism and Aspergers Disorder • Autism spectrum is a disorder of imagination, stereotyped behavior, speech and communication, and socialization • Asperger’s Syndrome has similar but less pronounced findings but with relatively normal speech and language development • 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.

9. Trauma • 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? • 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. • PTSD in youth is a “neuro-developmental” disorder • Manifestation of PTSD always involves hyper-vigalence. Sleep problems, uncontrolled triggers to memories, distractibility, dissociation, and poor socialization also occurs.

10. PTSD cont. • 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? • 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. • 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.

11. 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?”

12. 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

13. Eating Disorders • Where is there an outpatient program for eating disorders in the city that accepts Medical Assistance? • Most of the Partial Hospital Programs in the city and suburban areas will take Medicaid. • Typically, eating disorders are treated in an outpatient setting. Families need to be involved. • 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.

14. Behavioral Health Hospital with services for children, adolescents and adults • Inpatient, partial hospitalization and intensive outpatient care • For a Free, Confidential Assessment & Referral • 24 hours a day, 7 days a week Call (800) 888-0560 • 4840 N. Marine Drive Chicago Il 60640 ChicagoLakeshoreHospital