220. Bipolar Disorder in Youth Part 2: Medications and Monitoring

What does it truly mean to cultivate resilience and well-being in today's challenging world? In this insightful episode of Dr. Lia Gaggino's podcast (episode 227), she thoughtfully explores seven fundamental pillars of well-being while reflecting on the transition into 2025. Drawing from both professional expertise and personal experience, particularly while caring for her aging mother, Dr. Gaggino presents a comprehensive approach to health that encompasses sleep, nutrition, movement, family connections, friendships, creativity, and spirituality. She authentically acknowledges the struggles many face, from avoiding overwhelming news to managing daily stresses, while offering practical, judgment-free advice that balances aspiration with self-compassion. Her message resonates particularly strongly when she emphasizes that relationships are the ultimate antidote to loneliness, fear, and sadness, demonstrating a deep understanding of human nature and the complexities of modern life.Key Takeaways:1. Well-being is multifaceted and requires attention to both physical aspects (sleep, nutrition, movement) and emotional/social components (family, friends, creativity, spirituality).2. Perfection shouldn't be the enemy of progress - it's important to maintain healthy habits while showing yourself grace during challenging times.3. Strong relationships and social connections are crucial for emotional resilience and long-term health, whether these connections are with family of origin or chosen family.Let’s make 2025 the Best Year EVER!!

Ever wondered what it's like to blend personal traditions with familial expectations during the holidays? In this episode of Pediatric Meltdown, Dr. Lia Gaggino shares her experiences with Christmas celebrations, highlighting the unique blend of Polish traditions from her husband's heritage and her own family's rituals.Family Rituals: Dr. Gaggino discusses the significance of family rituals, such as sharing a wafer similar to the Catholic host and wishing each other well, despite some family members finding it cringey.Meal Traditions: She talks about the specifics of their holiday meal, including mushroom soup and homemade pierogies, and how these traditions evolve over time to accommodate changing family dynamics.Importance of Traditions: Dr. Gaggino reflects on the deeper meaning of traditions, emphasizing their role in creating predictability, routine, and reassurance for children.Merry Christmas and Happy holidays to all of you.

Ever wondered how a simple injury can change the course of one's life? This episode explores the fascinating journey of a sports enthusiast turned medical professional, inspired by a personal encounter with a sports medicine provider after a college injury. The conversation delves into the complex world of concussions, discussing the evolution of treatment protocols, the importance of individualized care, and the severe risks of prematurely returning to play. You'll learn about tools like the SCAT symptom score and the VOMS for monitoring recovery, and the often-overlooked psychological impacts of concussions on young athletes. But perhaps the most crucial takeaway is the stark reminder: concussions are no joke, and honesty about symptoms can be a matter of life or death. Are you ready to rethink what you know about concussions? [00:33- 10:59]Initial Assessment and Management of Concussions The SCAT (Sport Concussion Assessment Tool) is mentioned as a crucial tool for evaluating concussions.The importance of understanding the broad nature of concussions and their varied symptoms.Reassuring patients and their families about the management plan.An emphasis on the need for individualized treatment plans for concussions.[11:00 -16:47] Red Flags and Immediate ConcernsRed flags that indicate a more serious condition, such as worsening symptoms and unusual behavior.Specific symptoms like nausea, vomiting, and severe headaches that should raise concern.Trusting your instincts and gut feelings when assessing a concussion.Immediate action is needed if a patient's condition deviates from expected recovery patterns.   [16:48 - 44:47]  High-Risk Sports and Gender-Specific Risks    High-risk sports for concussions, including for men: wrestling, basketball, soccer: For women: cheerleadingThere is a potential for prolonged recovery in athletes with underlying medical issues.Initial visits should focus on identifying concerning symptoms and ruling out underlying conditions.A comprehensive approach to managing concussions is needed, especially in high-risk sports.[44:48- 58:16] Treatment Algorithm and Activity Management Treatment Algorithm and Activity ManagementAn outline of a general treatment algorithm for managing concussions in the first 48 hours and beyond.The importance of gradually returning to activity while ensuring symptoms do not worsen.Provide physical therapy orders and ensuring PT sites treat concussions effectively.Educate patients and families about the expected recovery process and potential setbacks.[58:17 - 01:10:00] TakeawaysResources:AAP Sports-Related Concussion Recommendations:AAP Concussion Recommendations AAP article and Amsterdam Consensus: Statement: AAP and Amsterdam Consensus StatementAAP Vision and Concussion:  Vision and...

Ever wondered how to smoothly transition pediatric patients with complex conditions like ADHD into adult care? This episode talks about the challenges and strategies involved in this critical handoff. Dr. Peter Jensen and Dr. Lia discuss the importance of educating and empowering teens to manage their conditions independently, drawing parallels with other chronic illnesses like asthma and diabetes. They explore the nuances of preparing both the patients and the accepting providers to ensure a seamless transition. Additionally, they discuss resources for understanding adult ADHD and address some of the barriers to care when teens go out of state for college or careers. This episode highlights the importance of systematic, careful planning and open communication to prevent gaps in care during this transition period. [00:05- 17:16] Gender Differences in ADHD DiagnosisLater diagnosis of ADHD in females.Fewer hyperactive symptoms in females leading to delayed diagnosis.Quietly distracted children may be overlooked.Morphing of symptoms towards inattentiveness in teen and young adult years.   [17:17 -23:15] Adult ADHD and Mental Health Risks  Reduction of hyperactivity and impulsivity symptoms over time.Increased risk of anxiety, depression, and substance use in adults with ADHD.Challenges in recognizing adult ADHD due to comorbid mental health issues.The role of family practice providers in identifying adult ADHD.   [23:16 - 43:50]  ADHD Medication and Substance Use Concerns    There is diversion and misuse of ADHD medications.Holding patients accountable for lost or stolen medication.Comparing ADHD medication misuse to other substance abuse issues.Importance of clear communication between providers and patients.[43:51 - 48:50] Recommendations for ADHDMention of the book "Driven to Distraction" by Ned Hallowell.The importance of education and awareness about adult ADHD.The role of pediatricians in thinking about ADHD in adults.Emphasis on ensuring pediatricians and healthcare providers are aware of the Reach Institute.[48:51 - 57:47] Take AwaysConnect with Dr. Peter JensenWebsite: https://thereachinstitute.org/LinkedIn: https://www.linkedin.com/company/the-reach-institute-resource-for-advancing-children-health/Facebook: https://www.facebook.com/REACHInstitute/Twitter: https://twitter.com/reach4kidsRESOURCES MENTIONED IN THE EPISODEThe REACH Institute: www.thereachinstitute.orgDriven to Distraction" by Ned Hallowell. This book is highly recommended for understanding ADHD in adults. It is easily readable and includes stories and checklists of symptoms that can help readers identify ADHD traits in themselves or others.Go to https://lifeaftercorporatepodcast.com/ for all...

Have you ever wondered if ADHD is being misunderstood or misdiagnosed in children, leading to feelings of failure and unchecked anxiety?&nbsp;In this episode of Pediatric Meltdown, host Dr. Lia Gaggino and Dr. Norrine Russell talk about the complexities of ADHD, from its nuances to the pressing need for systemic change in how it's perceived and treated. They shed light on the importance of recognizing ADHD as non-willful behavior, the role of early intervention, and the imperative of individualized education plans. With data-backed insights and real-world anecdotes, this discussion underscores the urgency of a more equitable and comprehensive approach to ADHD treatment.&nbsp;This is a must-listen for educators, parents, and healthcare providers.[00:38 - 7:37] Unpacking ADHD and Common MisinterpretationsDefinition of "pure ADHD," described as a potential "gift," affecting a smaller segment of diagnosed children.Discussion on comorbidities like dyslexia, dysgraphia, mood disorders, and autism, affecting two-thirds of ADHD-diagnosed children.Issues of whether anxiety stems from late-diagnosed ADHD or contributes to its symptoms.Emphasis on early intervention to prevent ADHD from triggering anxiety and encourages proper diagnosis to avoid misunderstanding behaviors.[07:38 - 14:07] Individualized Educational Approaches and Social SkillsImportance of personalized educational strategies for neurodivergent children, avoiding a "one size fits all" methodology.Benefits of involving children in solution-finding processes for tailored educational support.Highlighting social delays in children with ADHD and the role of structured activities in fostering social interactions.Allowing children to build on their strengths and interests to enhance self-esteem and personal growth.[14:08 - 21:15] Challenges in Diagnosing and Treating ADHDDiscussion on the misconception of oppositional defiant disorder (ODD) and its potential misinterpretation as ADHD symptoms.Need for differential diagnosis to distinguish between ODD and ADHD, particularly in the context of trauma.Advocacy for multimodal ADHD treatment plans, integrating medication, parent education, and school plans as per American Academy of Pediatrics guidelines.Addressing systemic inequities in healthcare affecting children on Medicaid and the impact of racial biases on ADHD treatment.[21:16 - 28:22] Tools, Resources, and the Path ForwardDiscussing genetic links and familial patterns discovered during psychosocial intakes.Importance of early identification to prevent negative academic cycles and enhance engagement.Promoting ADHD acceptance and self-advocacy by normalizing brain differences.Recommendations for educational materials, like "ADHD is Awesome" and "The Anxious Generation," and promoting Norrine’s podcast for further insights.Resources Mentioned:Vanderbilt and Connors Symptom Trackers (Symptom Trackers)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Vanderbilt ADHD Diagnostic Rating Scale (VADRS) - Psychology ToolsBook: ADHD Is Awesome - ADHD is Awesome: A Guide To (Mostly) Thriving With ADHD: Holderness, Penn, Holderness, Kim, Edward Hallowell: 9781400338610: Amazon.com: BooksBook: <a href="https://www.example.com/" rel="noopener...

Can a doctor's strongest medicine be kindness to themselves?&nbsp;In this candid conversation, Dr. Kathy Stepien, physician coach and advocate for medical wellness, challenges the notion that self-criticism leads to better performance. Speaking with host Dr. Lia Gaggino, she unpacks how physician coaching has evolved from executive suites to mainstream medicine, backed by clinical trials from institutions like Mayo Clinic and Stanford. Dr. Stepien shares powerful stories about identity transitions in medicine, from early-career challenges to retirement questions, while offering practical ways to find the right support.&nbsp;Her remarkable work in bringing hidden struggles to light proves that no physician needs to walk their professional journey alone.&nbsp;[00:05- 15:07] Challenges Physicians Face in Their CareerIsolation despite being surrounded by accomplished colleagues, leading to internal strugglesDemanding nature of the profession requiring significant self-sacrifice beyond typical 9-to-5 hoursStruggle with maintaining autonomy, especially when transitioning from private practice to employed positionsDifficulty in managing time and energy while trying to balance multiple responsibilities&nbsp;&nbsp;&nbsp;[15:08 -26:02] Navigating Challenges in Medical Training and Practice &nbsp;Seek safe persons to confide in when facing discrimination or difficult situations, particularly those slightly removed from your immediate environmentRecognize that no medical professional needs to handle struggles alone - it's acceptable and beneficial to ask for helpAddress issues strategically and wisely, especially in situations with significant power differentialsRemember that supporting each other is crucial - medical professionals need connection and understanding from peers who share similar experiences&nbsp;&nbsp;&nbsp;[26:03 - 39:24] &nbsp;Power Dynamics and Professional Growth in Medicine &nbsp;&nbsp;&nbsp;Early career physicians often feel vulnerable during training periods, but gain more ability to advocate for change as they advance in their careersThe transition from clinical practice to administration reveals different cultural challenges, including slower decision-making processes and risk aversionThe importance of speaking up against inappropriate behavior, such as public humiliation, despite the professional risks involvedThe value of having witnesses and support systems when addressing workplace issues[39:25 - 57:43] Benefits of Physician Coaching&nbsp;&nbsp;Data shows solid evidence of improved physician well-being and quality of lifeLeads to profound improvement in emotional exhaustion reductionEnhances self-compassion among medical professionalsResults in better patient outcomes when physicians are well-supportedConnect with Dr. Kathy Stepien&nbsp;Website: https://www.instituteforphysicianwellness.com/Instagram: www.instagram.com/kathystepienmdFacebook: https://www.facebook.com/physicianwellnessLinkedIn:https://www.linkedin.com/in/kathystepienmd/Important Links To Share:&nbsp;Anti-Burnout Program for Women Physicians: <a...

What happens when a pediatrician hands a free book to a parent and changes the trajectory of a life?&nbsp;Meet Claudia Aristy whose first encounter as a new immigrant mother with “Reach Out and Read” sparked a remarkable transformation. Through her work with the Health Education and Literacy for Parents (HELP) Project, Claudia demonstrates how pediatricians can encourage literacy through books while supporting immigrant families. Her personal story describes the power of how parent-child reading led to her own high school completion and college graduation.&nbsp; Her work showcases how simple interventions can create lasting impact on children's development.&nbsp; Her conversation with Dr. Lia Gaggino explores innovative ways to promote bilingual literacy and to strengthen parent-child interactions through reading, while turning waiting room time into valuable learning opportunities.This episode proves that when healthcare meets literacy, extraordinary changes happen in families' lives.&nbsp;[00:05- 17:39] Impact of Early Reading Programs in Pediatric Settings&nbsp;A powerful moment of transformation occurs when pediatricians gift books to families during well-child visits, creating a bridge between healthcare and literacyThrough programs like Reach Out and Read, medical providers effectively communicate how daily reading routines contribute to brain development and school readinessFree book distribution in medical settings removes financial barriers, especially beneficial for immigrant families who may find traditional bookstores inaccessible or unaffordablePediatricians serve as trusted messengers, helping parents understand the connection between early reading and cognitive development&nbsp;&nbsp;&nbsp;[17:40 -24:13] Bridging Healthcare and Literacy Through Reach Out and Read &nbsp;Pediatricians serve as crucial advocates for child literacy by incorporating books into medical visits, creating meaningful connections with families beyond just medical careThe program transforms routine medical checkups into opportunities for promoting parent-child reading interactions, making healthcare settings more welcoming and educationalFree book programs integrated into medical visits help break down barriers to literacy, especially for families with limited resourcesPediatric literacy initiatives become more effective when healthcare providers take time to make genuine connections and offer encouragement to parents&nbsp;&nbsp;&nbsp;[24:14 - 35:20] &nbsp;Effective Parent-Child Reading Engagement &nbsp;&nbsp;&nbsp;Positive interactions during reading sessions go beyond literacy - making eye contact and smiling are simple yet powerful ways to connect, requiring no formal education or special trainingParents don't need advanced degrees to make meaningful contributions to their children's development through reading and storytellingCreating joyful memories around books is more valuable than perfect reading skills, especially for parents who may struggle with literacy themselvesDaily reading can be adapted to busy family schedules, acknowledging real-world challenges like multiple jobs and time constraints[35:21- 53:07] Empowering Parents Through Healthcare-Based Literacy Initiatives&nbsp;&nbsp;The HELP (Health Education and Literacy For Parents) project maximizes waiting room time by conducting health literacy activities, transforming passive waiting into active learningPediatricians serve as trusted authority figures who can effectively encourage and validate parents' roles as their children's first teachersFree resources are available through greenlighthelp.org, offering evidence-based information aligned...

How can we help teens with bipolar disorder manage their symptoms and transition successfully into adulthood?&nbsp;In this (part 2) episode of Pediatric Meltdown, host Dr. Lia Gaggino and child psychiatrist Dr. Jeanette Scheid discuss managing bipolar disorder in young adults during major life transitions. From medications for bipolar disorder in youth to support resources, they explore how parents and healthcare providers can identify early signs of a bipolar manic or depressive episode and implement effective treatments. Dr. Scheid shares practical strategies for maintaining stability, including sleep schedules, substance use prevention, and the vital role of college support services.&nbsp;Whether you're a healthcare provider or parent seeking to understand bipolar disorder treatment for teens, this conversation offers clear guidance for helping young people thrive.&nbsp;[00:33 -10:28] &nbsp; Critical Warning Signs and Transition Risks for Young Adults with Bipolar DisorderPoor sleep patterns often emerge as one of the earliest indicators of potential manic episodesEarly symptom recognition training for both parents and youth helps prevent severe episodesRegular psychoeducational conversations with everyone in the youth's support system enhance management successLiving independently introduces new challenges that require careful monitoring and support[10:29 - 19:29]&nbsp; FDA-Approved Medications for Youth Bipolar Disorder: A Primary Care Guide&nbsp;&nbsp;Key antipsychotics including aripiprazole, quetiapine, risperidone, olanzapine, asenapine, and lurasidone are FDA-approved, for adults with bipolar disorders.&nbsp; There are fewer medications approved for youth due to lack of clinical studies.&nbsp;&nbsp;No anti-seizure medications currently hold FDA approval for bipolar disorder in youth, though some are approved for adultsMost common lithium side effects include headache, nausea, increased thirst, and mild tremorsRegular thyroid function monitoring is essential, often requiring collaboration between pediatricians, endocrinologists, and psychiatrists[19:30 -39:22]&nbsp; Understanding Lithium Treatment in Youth Bipolar ManagementTherapeutic window for lithium is narrow, ranging from 0.6 to 1.2 milliequivalents per liter, requiring careful monitoring and frequent lab workDehydration and changes in salt balance can trigger dangerous lithium toxicity levelsFamily medical history plays a crucial role in treatment decisions, as demonstrated by cases where lithium proved more effective than second-generation antipsychoticsRegular lithium level monitoring (1-2 times yearly) is necessary for stable patients, with more frequent checks during dose adjustments[39:23 - 50:50] Building Knowledge Bridges: What Primary Care Needs to Know About Youth Bipolar CareUtilizing child psychiatry access programs as learning resources for medication managementUnderstanding safety profiles of common medications, even when not directly prescribingRecognition of medication effects similar to monitoring diabetes care in primary practiceValue of ongoing consultation with psychiatric specialists for medication questions[50:51 - 1:04:37]&nbsp; Closing segment TakeawayLinks to resources mentioned on the showResources Part 1:AACAP Facts for Families:&nbsp; Facts for...

In this episode, child psychiatrist Dr. Jeanette Scheid joins Dr. Lia Gaggino to discuss the complexities of pediatric bipolar disorder, and sorting through the diagnostic possibilities is central to making an accurate diagnosis&nbsp; Dr. Scheid offers insights to tease out what are the childhood behaviors that are developmentally normal, for example imaginary friends, and&nbsp; what are concerning symptoms such as auditory hallucinations.&nbsp; Dr Scheid highlights the critical role pediatricians play in the early identification of youth bipolar disorder with enormous implications for decreasing serious illness in adulthood.&nbsp;With mental health in children becoming increasingly important, this conversation offers practical guidance for pediatric clinicians.[00:33 -10:49] Key Diagnostic Criteria for Bipolar DisorderMajor depressive episodes often appear as the first signs, lasting at least 2 weeks with predominantly low moodGrandiosity and racing thoughts are significant indicators, particularly when accompanied by uncharacteristic risk-taking behaviorsSleep patterns change dramatically, with some people feeling rested after less than 3 hours of sleepIncreased talkativeness, faster speech, and heightened distractibility are common symptoms[10:50 - 19:01]&nbsp; Challenges in Early IdentificationDistinguishing between normal childhood behavior and pathological symptomsComplexity increases when combined with autism or intellectual disabilitiesInitial misdiagnosis as oppositional defiant disorder or treatment-resistant ADHDNeed to differentiate between typical defiant behavior and true mood episodes[19:02 -31:42]&nbsp; Understanding Trauma's Relationship with Mental Health SymptomsTrauma symptoms can overlap with other mental health conditions, making diagnosis complexFlashbacks from trauma can present similarly to perceptual disturbances or hallucinationsContent of experiences often connects directly to past traumatic events and safety concernsBoth trauma and other mental health conditions can coexist - it's not an either/or situation[31:43 - 32:13]&nbsp; Adapting Primary Care to Modern Mental Health ChallengesPediatricians can't opt out of mental health care, just as they didn't opt out of COVID carePrimary care providers are being called upon to manage medications when psychiatric access is limitedProfessional relationships and collegial connections make difficult cases more manageableThere's a growing recognition that early intervention in mental health can prevent future complications, including involvement in the juvenile justice system[50:51 - 58:26]&nbsp; Closing segment TakeawayLinks to resources mentioned on the showAACAP Facts for Families:&nbsp; Facts for FamiliesAACAP Resource Center Bipolar DisorderOther episodes you may like:Episodes - Pediatric Meltdown161 Menstrual Equity Changes Lives: The Power of Days151 American...

What happens when the wealthiest nation in the world fails its children?&nbsp;In this short but important solo episode, Dr. Lia Gaggino, speaking as a mother, grandmother, and pediatrician, shares her concerns about the state of children's welfare in America. She addresses multiple challenges facing our youth today, from healthcare and poverty to gun violence and education. As the November 5th election approaches, Dr. Gaggino makes an impassioned plea to voters to consider the impact their choices will have on the next generation. Her message transcends political lines, focusing instead on fundamental human values and the moral imperative to protect and nurture our children.&nbsp;After all, as she poignantly asks, “who will lead, teach, build, and protect our nation if we continue to fail our children today?”Links to resources mentioned on the showCDC https://www.cdc.gov/maternal-infant-health/infant-mortality/index.htmlCommonwealth Fund:&nbsp; https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison#:~:text=Recent%20Maternal%20Mortality%20Trends,deaths%20per%20100%2C000%20live%20births.Annie E. Casey Kids Count:&nbsp; https://datacenter.aecf.org&nbsp;Other episodes you may like:Episodes - Pediatric Meltdown161 Menstrual Equity Changes Lives: The Power of Days151 American Indian/Alaskan Native Youth: Beyond AdversityKey quotes for Twitter:"In the United States, 25% of children live in poverty. 50% are covered by Medicaid insurance."... Dr. Lia Gaggino on the child poverty crisis"Should they bleed out on waiting room floors? Should they die of sepsis because they can't get the care they need to treat a miscarriage because doctors are afraid in states that ban all abortion?".... Dr. Lia Gaggino on the reality of abortion bansFULL TRANSCRIPTS AVAILABLE UPON REQUESTTHANK YOU FOR YOUR SUPPORT!Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.If you’d like to connect with me, you can find me on LinkedIn, Facebook, and Instagram, or email me at [email protected]. To learn more about me visit https://www.pediatricmeltdown.comLOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.