Child and Adolescent Psychiatry patient management involves a systemic, holistic approach requiring a multidisciplinary team. A skilled clinician performs a thorough clinical diagnostic evaluation in keeping with a recognised classification system like DSM 5 and then includes the pharmacological management as part of a holistic treatment plan.
- Multiple aspects need to be considered when prescribing psycho-active medication for children and adolescents e.g. co-morbidities, home environment stability.
- Complicated cases, uncertain diagnoses and poor treatment response are indications for referral to a Child and Adolescent Psychiatrist for evaluation.
- Children and adolescents may require higher dosages of psychoactive medication per unit of body weight compared to adults to achieve similar blood levels and therapeutic efficacy.
- Psychoeducation of the patient and the family is vital.
- Regular monitoring of effectiveness and the need to continue medication should be done with the view to tapering and discontinuing medication after 6 months to a year, unless the medication is for a chronic condition e.g. ADHD, epilepsy.
- Baseline assessments require a medical history and physical examination. Baseline laboratory investigations, pregnancy testing, drug screening, EEG and ECG should be done where indicated.
- Psychotropic medication is generally well tolerated by children and adolescents. Lowest dosages should be initiated and increased as clinically indicated. Side effects and adherence should be monitored. Monotherapy is ideal. However, childhood-onset psychiatric disorders can be severe and may present with multiple co-morbidities needing polypharmacy. Preferably add one medication at a time to monitor side effects and effectiveness. Change medications one at a time.