Child Psychopharmacology: Is It More Similar Than Different from Adult Psychopharmacology?

By Sareen, Himanshu; Trivedi, Jitendra | Indian Journal of Psychiatry, July-September 2013 | Go to article overview

Child Psychopharmacology: Is It More Similar Than Different from Adult Psychopharmacology?


Sareen, Himanshu, Trivedi, Jitendra, Indian Journal of Psychiatry


Byline: Himanshu. Sareen, Jitendra. Trivedi

Despite having a large chunk of human population, Asian countries face shortage of mental health professionals. There is further shortage of doctors dealing with special groups of population like the children, the elderly, and the medically ill. However, in this era of super-specializations, are the basic principles of general psychopharmacology being forgotten? Dealing with child population is different and often more difficult than adult population but are management guidelines for the two populations vastly divergent? A close look at this paints a different picture. Psychotherapies applied in adults and those in children and adolescents are disparate owing to cognitive, social, emotional, and physical immaturation in children and adolescents. But the drugs for the treatment of pediatric psychiatric disorders are mostly similar to those prescribed for adults (case in point -bipolar disorders, obsessive compulsive disorder, schizophrenia). Rather than focusing energy on propagating the differences in assorted subgroups of population, honing of skills regarding intricacies of psychopharmacology is required to be emphasized. Detailed history taking, careful evaluation of the patient, sound diagnostic formulation, and prescribing medications which are tailor made to the patient will all go a long way in ensuring a functional recovery of the patients irrespective of the group they belong to.

Introduction

Asia has some of the largest conglomerations of human populations and also the fastest growing economies of the world. The south Asian region alone houses one-fifth of the psychiatrically ill population of the world. Despite these widely known facts, there is a serious shortage of mental health professionals in this region. The ongoing "brain drain" to greener pastures (i.e., the western/developed world) is only adding insult to the injury.

The ratio of mental health personnel to population is nowhere near the WHO recommended levels in the less developed countries of the Asian continent. In China, there are about 15 000 psychiatrists for 1.2 billion people (about 1:80 000). In India, with 1 billion people, there are but 3000 psychiatrists (about 1:330 000), Indonesia has about 450 psychiatrists for 210 million people in over 13 000 islands. [sup][1] Doctors dealing with children's psychiatric problems are still lesser in number. Formal training in child psychiatry is still in its nascent stage in India and in other countries of the region as well. There is a widely held belief that child psychiatry is vastly different from adult psychiatry. Propagating this fact might eschew many a capable psychiatrists from taking up cases belonging to this age group.

As is known in medical circles, dealing with children is quite different than dealing with adults; pertaining to history taking (from subjects as well as care givers), physical examination (anthropometry forms an important component of examination of a child, other findings can be depressed anterior fontanel in a case of acute gastroenteritis with dehydration, bulging fontanel as a mark of raised intra-cranial pressure, wrist widening as a sign of vitamin D deficiency, or any dysmorphic features like low set ears or mongoloid slant pertaining to a particular syndrome), and interpretation of laboratory findings.

Besides, certain diseases are known to affect children in much larger numbers than they do the adults (meningitis, pneumonia, and upper respiratory tract infections) and certain symptoms might be unique to this population (febrile convulsions, infantile tremor syndrome, cerebral palsy, rheumatic fever, breath holding spells, manifestation of congenital heart diseases) or its presentation might be different than that of the adults.

However, pivotal question to be asked at this point is, once a diagnosis has been arrived at, do pharmacological interventions differ so much? …

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