title: Nocturnal Anxiety in a Youth with Rapid-onset Obesity, Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD).
abstract: OBJECTIVE
  Behavioral and psychiatric disorders are common in youth with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD). We outline a rational approach to psychiatric treatment of a patient with a complex medical condition.
  
  
  METHODS
  We report the course of symptoms in a teen with ROHHAD, the inpatient treatment, and review current evidence for use of psychopharmacologic agents in youth with sleep and anxiety disturbances.
  
  
  RESULTS
  A 14-year-old female began rapidly gaining weight as a preschooler, developed hormonal imbalance, and mixed sleep apnea. Consultation was requested after a month of ROHHAD exacerbation, with severe anxiety, insomnia, and auditory hallucinations. Olanzapine and citalopram were helpful in controlling the symptoms. Following discharge, the patient gained weight and olanzapine was discontinued. Lorazepam was started in coordination with pulmonary service. Relevant pharmacologic considerations included risk of respiratory suppression, history of paradoxical reaction to hypnotics, hepatic isoenzyme interactions and side effects of antipsychotics.
  
  
  CONCLUSIONS
  Core symptoms of ROHHAD may precipitate psychiatric disorders. A systematic evidence-based approach to psychopharmacology is necessary in the setting of psychiatric consultation.
authors: Department of Psychiatry, Zucker Hillside Hospital, North Shore-LIJ Health System, New York, New York, USA ; Hofstra School of Medicine, New York, New York, USA.
authors: Eugene
authors: E
authors: Grudnikoff
authors: Carmel
authors: C
authors: Foley
authors: Claudette
authors: C
authors: Poole
authors: Eva
authors: E
authors: Theodosiadis
keywords: ROHHAD; insomnia; nocturnal anxiety
references: J Am Acad Child Adolesc Psychiatry. 2007 Feb;46(2):224-32
references: 17242626
references: Arch Gen Psychiatry. 2000 Oct;57(10):960-7
references: 11015814
references: J Am Acad Child Adolesc Psychiatry. 2009 Feb;48(2):213-33
references: 20040826
references: Am J Psychiatry. 1994 Jun;151(6):864-70
references: 8184995
references: Pediatrics. 2007 Jul;120(1):e179-88
references: 17606542
references: Schizophr Res. 2001 Mar 1;48(1):137-44
references: 11278160
references: BMJ Case Rep. 2011 Mar 01;2011:
references: 22715259