The physician should choose the one most appropriate medication.
Current indications for the use of psychotropic medications in children and adolescents can be summarized briefly (Table l). The listing in Table 1 is by no means an exhaustive review of this rapidly emerging field. In two situations, autism and obsessive-compulsive disorders, there is only recent evidence of the possible usefulness of psychotropic medication.
| Table 1. Common Indications for Use of Psychotropic Medication in Childhood and Adolescence | |
| Diagnostic Category | Psychotropic Medication |
| Mental retardation | None with proven efficacy |
| Use drug for associated emotional disturbance or underlying organic disorder (e.g., cretinism) | |
| Attention deficit disorder (add) | Stimulants (firm evidence of efficacy) – Methylphenidate – Dexamphetamine – Pemoline – Deanol acetamidobenzoate |
| Conduct disorder | None with proven efficacy |
| Conduct disorder with add | Stimulants |
| Conduct disorder with impulsiveness or aggression | Major tranquilizers |
| Anxiety disorder or school phobia | Tricyclics Benzodiazepines |
| Obsessive-compulsive disorder | Clomipramine (early studies) |
| Gilles de la Tourette’s syndrome | Haloperidol Pimozide Clonidine Phenothiazines Tricyclics (may be used in conjunction with one of above) |
| Enuresis | Tricyclics |
| Bulimia | Tricyclics (in some cases) |
| Anorexia nervosa | Cyproheptadine (in some cases) |
| Autism | Fenfluramine (under investigation) |
| Pervasive developmental disorders and childhood schizophrenia | None with proven efficacy Major tranquilizers may ameliorate hyperactivity, mood lability, and excitability, but not social and language impairments |
| Depressive disorders | Tricyclics (in some cases) |
| Episodic dyscontrol with or without epilepsy | Carbamazepine (early studies) |
| Manic-depressive psychosis (rare in childhood and adolescence) | Lithium salts |
Certain psychotropic medications, such as lithium salts for manic-depressive disorders in children and adolescents, are best left in the hands of psychopharmacological specialists. The use of antihistamines, such as diphenhydramine, and benzodiazepines in treating anxiety disorders of children has not been clearly substantiated. These medications should be used in consultation with a child psychiatrist. They are, however, relatively safe in comparison to the major tranquilizers.
The physician should therefore become thoroughly familiar with a small number of psychotropic drugs in order to respond to parental questions. Three drugs, which are commonly used in pediatric psychiatry, are methylphenidate, imipramine, and thioridazine. The physician should have a certain range of knowledge about these drugs in order to provide appropriate care, although one may choose to use other drugs. One should know the indications, proper assessment procedures, optimum dosage, price, side-effects, drug interactions, contraintfications, common withdrawal effects, alternative therapy, and concurrent treatment recommended for the drug (Tables 2-4).
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