Medication can be an effective part of the treatment for several psychiatric
disorders of childhood and adolescence. A doctor's recommendation to use
medication often raises many concerns and questions in both the parents
and the youngster. The physician who recommends medication should be
experienced in treating psychiatric illnesses in children and adolescents. He
or she should fully explain the reasons for medication use, what benefits
the medication should provide, as well as unwanted side-effects or dangers
and other treatment alternatives.
Psychiatric medication should not be used alone. As undertaking a medication
trial may mean adjusting doses of medicine over time and/or the use of
additional medications to meet an individual youngster's needs, the use of
medication should be part of a comprehensive treatment plan, usually including
psychotherapy, as well as parent guidance sessions.
Before recommending any medication, the child and adolescent psychiatrist
interviews the youngster and makes a thorough diagnostic evaluation. In
some cases, the evaluation may include a physical exam, psychological testing,
laboratory tests, other medical tests such as an electrocardiogram (EKG) or
electroencephalogram (EEG) , and consultation with other medical specialists.
Child and adolescent psychiatrists stress that medications which have beneficial
effects also have unwanted side effects, ranging from just annoying to very
serious. As each youngster is different and may have individual reactions to
medication, close contact with the treating physician is recommended. Do not
stop or change a medication without speaking to the doctor. Psychiatric medication
should be used as part of a comprehensive plan of treatment, with ongoing
medical assessment and, in most cases, individual and/or family psychotherapy.
When prescribed appropriately by a psychiatrist (preferably a child and
adolescent psychiatrist), and taken as prescribed, medication may reduce
or eliminate troubling symptoms and improve the daily functioning of
children and adolescents with psychiatric disorders.
Medication may be prescribed for psychiatric symptoms and disorders, including,
but not limited to:
Bedwetting-if it persists regularly after age 5 and causes
serious problems in low self-esteem and social interaction.
Anxiety (school refusal, phobias, separation or social fears,
generalized anxiety, or posttraumatic stress disorders)-if it
keeps the youngster from normal daily activities.
Attention deficit hyperactivity disorder-marked by a
short attention span, trouble concentrating and restlessness.
The child is easily upset and frustrated, often has problems
getting along with family and friends, and usually has
trouble in school.
Obsessive-compulsive disorder-recurring obsessions
(troublesome and intrusive thoughts) and/or compulsions
(repetitive behaviors or rituals such as handwashing,
counting, checking to see if doors are locked) which are
often seen as senseless but which interfere with a
youngster's daily functioning.
- Depressive disorder-lasting feelings of sadness,
helplessness, hopelessness, unworthiness and
guilt, inability to feel pleasure, a decline in school
work and changes in sleeping and eating habits.
- Eating disorder-either self-starvation (anorexia
nervosa) or binge eating and vomiting (bulimia),
or a combination of the two.
- Bipolar (manic-depressive) disorder-periods of
depression alternating with manic periods, which
may include irritability, "high" or happy mood,
excessive energy, behavior problems, staying up
late at night, and grand plans.
- Psychosis-symptoms include irrational beliefs, paranoia,
hallucinations (seeing things or hearing sounds that don't
exist) social withdrawal, clinging, strange behavior,
extreme stubbornness, persistent rituals, and deterioration
of personal habits. May be seen in developmental disorders,
severe depression, schizoaffective disorder, schizophrenia,
and some forms of substance abuse.
- Autism-(or other pervasive developmental disorder
such as Asperger's Syndrome)-characterized by
severe deficits in social interactions, language, and/
or thinking or ability to learn, and usually diagnosed
in early childhood.
- Severe aggression-which may include assaultiveness,
excessive property damage, or prolonged self-abuse,
such as head-banging or cutting.
Sleep problems-symptoms can include insomnia, night
terrors, sleep walking, fear of separation, anxiety.
For additional information about psychiatric medications see Facts
#29 Psychiatric Medication for Children and Adolescents:
Part II-Types of Medications, and
#51 Psychiatric Medications for Children and Adolescents:
Part III-Questions to Ask.
For additional information see Facts for Families:
#00 Definition of a Child and Adolescent Psychiatrist,
#25 Know Where to Seek Help for Your Child, and
#52 Comprehensive Psychiatric Evaluation.
See also: Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins).
Article #21 Updated 11/99
Postgraduate Medicine: Psychotropic drugs
Modern medicine's alternative to purgatives, straitjackets, and asylums
Preview: Clearly, the use of antipsychotic drugs can be extremely
helpful in elderly patients to reduce psychotic symptoms and agitation.
However, these drugs may produce serious side effects, such as
parkinsonism, akathisia, dystonia, and tardive dyskinesia, that can
range in intensity from mild to severe.
In this article, the authors describe how to use antipsychotic
agents in the most careful fashion possible.
Preview: More antidepressant options are available than ever
before, but inappropriate dosing and trial durations of these drugs
may decrease their efficacy.
How do primary care physicians choose the best medication and
determine appropriate dosage adjustments for each patient?
Drs Nielsen, Witek, and Hurwitz discuss ways to optimize
antidepressant benefits and minimize side effects.
The National Alliance for the Mentally Ill (NAMI) is a nonprofit, grassroots,
self-help, support and advocacy organization of consumers, families, and
friends of people with severe mental illnesses, such as schizophrenia,
major depression, bipolar disorder, obsessive-compulsive disorder, and
prescribed medications categorized by the mental illnesses they are used
to treat as well as alphabetically by generic name.