Dr. Roy Q. Sanders

1
Basic Psychopharmacologyfor Children and
Adolescents
Dr. Roy Q. Sanders Director, Child and Adolescent
Psychiatry
2
Basic Psychopharmacologyfor Children and
Adolescents

• Prescribing psychoactive medication for
  children is controversial. However, at times it
  is necessary to assist children in controlling
  problems with mood, behavior, anxiety, aggression
  and other difficulties. As a clinician I have to
  be convinced that to not medicate would be more
  harmful than to proceed with medication
  treatment.

3

• Today we will discuss common reasons for
  prescribing medications and the specific
  medications prescribed for those problems.

4
Disorders of Concentration, Attention and
Hyperactivity

• One of the most common reasons psychoactive
  medication is prescribed in children is related
  to problems associated with disruptive behavior.
  In particular problems with concentration, and
  hyperactivity.

5

• Choices of medications for these problems
  include
• Stimulants
• Strattera
• Alpha adrenergic agonist
• Some antidepressants

6

• There are two basic types of stimulants
• Methylphenidates
• Amphetamines

7
Methylphenidate (Ritalin)

• Methylphenidate (Ritalin) is one of the
  oldest of the stimulant medications used in the
  treatment of attention and concentration
  problems.
• In general, methylphenidate is well
  tolerated and works well to increase
  concentration and attention and to decrease
  hyperactivity. It works about 80 of the time to
  reduce up to 80 of the symptoms a person is
  experiencing.

8
Methylphenidate (Ritalin)

• Side effects include decreased appetite,
  decreased or disturbed sleep, sometimes headaches
  and gastrointestinal pains. At times motor or
  vocal tics emerge. There can also be problems
  with mood instability and with irritability. In
  overdose you can see psychotic symptoms or
  symptoms of delirium.

9
Methylphenidate (Ritalin)

• Problems can also arise with methylphenidate
  because of the short half-life of the standard
  formulation. Theoretically dosing can occur
  every four hours but clinical experience leads to
  dosing as frequently as very 150 minutes. There
  are other forms of the medication that have
  longer duration of action including but not
  limited to Ritalin LA, Metadate CD, Concerta,
  Methylin and now Daytrana (a patch).

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Dextromethylphenidate

• Focalin and FocalinXR both prescribed in similar
  fashion to other stimulants. Side effects are
  similar. The difference is perhaps in
  specificity.

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Mixed Amphetamine SaltsAdderall and AdderallXR.

• Mixed amphetamine salts have also been
  available in the treatment of attention and
  concentration for many years. They are currently
  available in generic and under the trade name of
  Adderall and AdderallXR.  
• These medications are very effective in
  decreasing the symptoms of poor attention, poor
  concentration, and hyperactivity. Their
  effectiveness is similar to methylphenidate and
  they are very widely used.

12
Mixed Amphetamine SaltsAdderall and AdderallXR.

• Side effects are also similar to those listed
  above with methylphenidate but in clinical
  experience they are slightly more likely to
  create some mood lability and irritability than
  the other stimulant medications.
• A new amphetamine is Vyvanse a
• pro-drug.

13
Dextroamphetamine

• Dextroamphetamine has also been used for
  years in the treatment of problems with
  attention, concentration and the regulation of
  activity level. Sold under the trade name of
  Dexedrine or Dexedrine Spanules.
• Dextroamphetamine is effective in
  reduction of symptoms at a level consistent with
  the treatments listed above.
• Side effects are similar to those listed
  above.

14
Other Medication Options for Attention,
Concentration and Over activity

• The mainstay of therapy for problems with
  concentration and attention is stimulant
  medication. While stimulants are very effective
  medications there have been problems with their
  use because of the relatively short half life of
  each of these preparations. Even at their
  longest the medications rarely last greater than
  8 hours and often times patients can experience a
  sort of rebound hyperactivity once the medication
  has worn off.

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Atomoxitine (Strattera)

• A noradrenergic reuptake inhibiter that
  appears to have relatively good effectiveness in
  decreasing levels of hyperactivity and in helping
  with increasing attention, concentration, and
  organization. It has been approved for use in
  children as young as 6 years old weighing above
  forty pounds. It generally has lasting effects
  throughout the day and into the evening. Problems
  have included changes in appetite and also nausea
  along with some sleep problems

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Centrally acting alpha adrenergic agonist

• Clonidine and guanfacine have also been very
  useful in decreasing levels of hyperactivity and
  in increasing attention and concentration. They
  are not necessarily as effective as stimulant
  medications but they are effective in a group of
  very aroused patients. Side effects are limited
  to problems with drowsiness and with hypotension.
  

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Venflaxamine (Effexor)

• Venflaxamine (Effexor) a mixed serotonin and
  noradrenergic reuptake inhibiter that has been
  used in the treatment of difficulties related to
  concentration, attention and regulation of
  activity level with some limited success.
  Recently, Venflaxamine has come under increasing
  scrutiny because of issues related to possible
  increased suicidal ideation and suicidal
  behaviors in children and adolescents taking
  serotonin reuptake inhibiters. Other problems
  have included increased irritability and possible
  increases in blood pressure.

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Buproprion (Wellbutrin)

• Buproprion (Wellbutrin) is an anti-depressant
  medication that is sometimes used in the
  treatment of problems with attention and
  concentration. Buproprion can be reasonably
  effective in the reduction of symptoms but must
  be used with caution in children or adolescents
  with history of seizures, head injury or bulimia.
  (This medication has also been included in the
  list of antidepressants where care as to be given
  secondary to fears of increased suicidal
  thoughts or behaviors.)

19
Tri-cyclic Antidepressants

Tri-cyclic antidepressants have also been used
successfully in the treatment of problems with
attention, concentration and regulation of
activity levels. The tri-cyclics used in children
most often include imipramine and nortrityline.
They generally have good effectiveness over
twenty four hours but they can have troublesome
side effects that include a widening of the QRS
as measured on EKG. Also they can lead to
drowsiness, weight gain, dry mouth and
constipation. It is also generally important to
check serum levels of these medications while a
child is being treated.
20
Anxiety

• Anxiety disorders as a group are very common
  in children in general and are often misdiagnosed
  or overlooked if a thorough history is not
  obtained. Misdiagnosis can be of particular
  concern where medications are concerned. The
  wrong medication can serve to exacerbate symptoms
  associated with anxiety and lead to increased
  morbidity for the child.

21
Serotonin Reuptake Inhibitors

• Since their introduction in the last several
  years the serotonin reuptake inhibitors have been
  the treatment of first choice in the treatment of
  anxiety. Fluoxetine (Prozac), sertraline
  (Zoloft), paroxitine (Paxil), citalopram
  (Celexa), escitalopram (Leapro), and fluvoxamine
  (Luvox). These medications taken as a whole have
  been very effective in reducing anxiety and also
  in decreasing anxiety related symptoms associated
  with perseveration and preoccupation. In general
  they should be used starting at low doses for
  most patients but especially with those diagnosed
  with pervasive developmental disorders. The
  medications should be gradually titrated to
  desired effect. Care should be given to look for
  the emergence of any agitation or irritability
  and these medications have been known to induce
  mania in predisposed patients. Also added care
  should be given to observe for any signs or
  symptoms associated with increased suicidal
  ideation or suicidal behaviors.        

22
Benzodiazepines

• Benzodiazepines as a class are excellent anti
  anxiety medications. They can be very effective
  in the treatment of anxiety related problems in
  the developmentally disabled. These
  medications include but are not necessarily
  limited to diazepam, alprazolam, lorazepam,
  chlordiazepoxide, clonazepam, chlorazepate,
  oxazepam, flurazepam, and temazepam. Problems
  arise in these medications most often relate to
  somulence, difficulty with short term memory,
  development of tolerance requiring increasingly
  higher doses, and also with the half life and
  active metabolites of some of the medications in
  this class leading to unwanted prolonged effects.
  

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Buspirone (Buspar)

• Buspirone (Buspar) is an anxiolytic that can
  have some success in the treatment of anxiety.
  While not always successful in relieving anxiety
  it is a medication with very few side effects and
  is well tolerated. Generally, problems arise
  from needing to dose up to three times a day and
  it has a relatively slower onset of action
  sometimes taking up to three weeks to achieve
  clinically significant effect.

24
Venflaxamine (Effexor)

• Venflaxamine (Effexor) is a combination
  serotonin reuptake inhibitor and noradrenergic
  reuptake inhibitor that has been clinically
  effective in decreasing anxiety symptoms. It has
  generally been well tolerated but there have been
  problems with sleep disturbance and even
  drowsiness on the medication. There have also
  been problems with elevations in blood pressure.

25
Tri-cyclic antidepressants

• Tri-cyclic antidepressants such as imipramine
  and nortriptyline can also be effective
  anxiolytics. However, they may take up to 4
  weeks to work effectively once an adequate serum
  level has been obtained. As when using in these
  medications in the treatment of other symptoms,
  care must be given to monitor the EKG to insure a
  QTc that is within acceptable clinical
  parameters. Also as stated above problems with
  high anticholinergic side effects can lead to
  problems like dry mouth, constipation, and
  drowsiness.

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Antihistamines

• There are times when anti-histamines such as
  hydroxyzine or diphenhydramine are prescribed to
  relief anxiety. While these medications may be
  effective in the short run sedating a patient and
  calming the crisis they are generally not good
  medications for long-term use in the treatment of
  ongoing anxiety symptoms.

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Mood Problems

• Depression and mood disorders certainly
  exist in children and often times psychotropic
  medications can be of assistance. More
  controversial currently is the diagnosis of
  Bipolar Disorder in a pediatric population.
  Great care is needed to ensure an accurate
  diagnosis so that appropriate treatment is given,
  especially when it comes to medications.

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Depression

• The generally accepted first line of treatment
  for depression is the choice of a selective
  serotonin uptake inhibitor.                     
                                                    
                               
•      

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Serotonin Reuptake Inhibitors 

• These medications that were listed above
  include fluoxetine (Prozac), sertraline (Zoloft),
  citralopram (Celexa), escitralopram (Lexapro),
  fluvoxamine (Luvox), and paroxetine (Paxil). All
  of these medications have generally the same
  level of effectiveness in the treatment of
  depression and choices are often made based upon
  side effect profiles or the past response to a
  particular medication by the patient or a close
  relative of the patient. These are generally
  considered safe and effective medications
  although their use in children has not been
  extensively studied.

30
Serotonin Reuptake Inhibitors 

• Side effects in this class of medication are
  generally related to gastrointestinal problems,
  sometimes problems with sleep, and all generally
  tend to create problems with sexual function (in
  adults) that is usually related to decreased
  orgasm but there can also be decreased desire.

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Serotonin Reuptake Inhibitors

• These medications can also cause problems
  with increased irritability and at times they can
  induce mania in individuals with that
  predisposition. Care should be given especially
  when giving to individuals with a strong family
  history of Bipolar Disorder. Individuals with
  Pervasive
• Developmental Disorders as well can be very
  susceptible to side effects of irritability and
  mood instability. These medications should be
  used at low doses and with appropriate caution.
  Care also should be given as mentioned above to
  issues associated with potential suicidal
  ideation and behavior.

32
Buproprion (Wellbutrin)

• Buproprion (Wellbutrin) is effective in the
  treatment of depression and in general has been
  well tolerated. It has advantages over the other
  anti depressants used in adults in that it is
  generally accepted that it has fewer sexual side
  effects. This medication has also appeared to be
  less likely to create difficulties with inducing
  mania in individuals that may be vulnerable.

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Buproprion (Wellbutrin)

• Buproprion must be used in caution with
  individuals that have a history of head injury or
  those with seizure disorder or history of
  bulimia. These individuals may be at higher risk
  for seizure on this medication. Newer
  formulations of buproprion have lengthened the
  half-life of the medication and this has led to
  less risk of seizure in individuals. It still
  should not be given to individuals with the risk
  factors noted above.

34
Venflaxamine (Effexor)

• Venflaxamine (Effexor) is a combination
  selective serotonin reuptake inhibitor and
  noradrenergic reuptake inhibitor. It has been
  effective in the treatment of depression and is
  generally well tolerated. There have been
  problems as noted above with increase blood
  pressure and there have also been complaints
  related to sexual function.

35
Tri-cyclic antidepressants

• Tri-cyclic antidepressants have long been and
  in some circles continue to be the gold standard
  for the treatment of depression. These
  medications while they do have quite a few side
  effects in general have been well tolerated and
  are effective in relieving symptoms. These
  medications include imipramine, nortriptyline,
  amitriptyline, and clomipramine. They all work
  in varying degrees on the same neurotransmitter
  systems that have been mentioned above but each
  to a different degree and with a different level
  of specificity for a particular neurotransmitter.
  This difference in neurotransmitter effect and
  the side effect profiles of each allows a
  clinician to attempt a good match for treatment
  with these medications.

36
Tri-cyclic antidepressants

• All of these medications generally have high
  anticholinergic profiles. Side effects are
  usually problems with sleepiness, weight gain,
  dry mouth, constipation, etc.
• These medications also generally cause an
  increase in the time interval associated with the
  QRS complex as measured with an EKG. This can
  lead to dangerous arrhythmias during the course
  of treatment.

37
Tri-cyclic antidepressants

• Because of each of the side effect
  difficulties listed above these medications can
  be fatal in overdose. This is generally not seen
  with the other medications that have been listed
  above for the treatment of depression. Given
  that by its very nature depression can have as a
  core symptom of morbid preoccupation and
  suicidality these medications must be given
  cautiously and monitored closely.

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Other medications

• Other medications have been used effectively
  as adjuncts to those listed above when treating
  depression. So called mood stabilizers such as
  lithium or valproic acid or other anticonvulsants
  have been used to try and decrease symptoms in a
  marginally responsive or non-responsive patient.
  Other medications that have been used with some
  effectiveness include stimulants and even thyroid
  hormone supplementation.                          
                          
• Adolescent girls, who have achieved menarche,
  and women sometimes respond well to adjuncts of
  oral or depo contraceptive medications for
  depressive symptoms.

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Electroconvulsive Therapy

• While medications have been very effective in
  relieving the symptoms of depression it should
  also be noted that electroconvulsive therapy is
  also a very effective somatic treatment. There
  are side effects associated with short-term
  memory problems and the risk associated with
  anesthesia but overall the patients respond well
  and quickly to this somatic treatment. Many
  centers have even moved to offering this
  treatment in a day hospital setting with no over
  night stays.  

40
Bipolar Disorder

• Bipolar Disorder is seen in children and
  while it is a discussion not within the scope of
  this discussion it can often present in an
  atypical fashion. Determining core symptoms of
  grandiosity, racing thoughts or flight of ideas
  with increased goal oriented pursuits may be
  difficult to discern and features related to
  irritability and hypersexuality may be difficult
  to tease from behaviors of other disorders or
  problems.
• Medications used to treat bipolar disorder
  are generally called mood stabilizers but there
  are mood stabilizers in several different
  classes of medications.

41
Lithium

• Lithium has long been the treatment standard
  in the psychopharmacologic treatment of bipolar
  disorder. It is an exceptionally effective mood
  stabilizer and is generally well tolerated. It
  does however have several side effects and has a
  very narrow therapeutic window making it
  potentially dangerous in overdose. 

42
Lithium

• Side effects include weight gain, diarrhea,
  acne and less commonly problems with renal
  function, possible hypothyroidism, and cardiac
  rhythm problems.

43
Lithium

• Blood levels need to be monitored carefully
  and care has to be taken in patients that are on
  medications or participate in activities that
  would potentially increase the drugs serum
  level.

44
Divalproex (Depakote)

• Divalproex (Depakote) is also a very effective
  mood stabilizing medication. It is generally
  used as an anticonvulsant but it does currently
  have approval from the FDA for use as a treatment
  of acute mania.     

45
Divalproex (Depakote)

• Most patients tolerate divalproex (Depakote)
  with few problems but there can be side effects.
  It can lead to some gastrointestinal problems and
  there can be increased appetite with weight gain.
  Additionally, in women there has been a
  correlation between divalproex (Depakote) use
  and polycysitic ovaries. There have also been
  problems with liver function, bone marrow changes
  usually with a decrease in megakaryocytes and
  subsequently platelets. In very rare cases
  critical pancreatitis has been a problem. Blood
  levels need to be monitored while the patient is
  on divalproex (Depakote) in addition to
  laboratory investigation of other systems that
  might be affected.

46
Other anticonvulsants

• Other anticonvulsants used to treat bipolar
  disorder include but are not necessarily limited
  to Neurontin, Lamictil, Tegretol, Trileptal, and
  Topomax. These medications have been generally
  helpful in treating some of the symptoms of
  Bipolar Disorder. They have been generally well
  tolerated, some more than others. They have
  varying side effects and require different levels
  of monitoring but all are currently part of the
  armentareum used for treatment.

47
Atypical Anti-Psychotic Medications

• Some of the new so-called atypical anti
  psychotic medications are also being used in the
  treatment of Bipolar Disorder especially to treat
  acute manic phase. These include Zyprexa,
  Geodon, Abilify, Risperdal, and Seroquel. These
  medications too have been well tolerated by
  patients but there are some concerning side
  effects. While they do not have the risk of
  tardive dyskensia associated with them that the
  so-called typical anti psychotics possess there
  is still a risk of this potentially irreversible
  movement disorder. Also each carries risk of
  acute extra pyramidal side effects including
  acute dystonias, parkinsonism, and akathesia. All
  have generally been associated with increased
  appetite and weight gain and possible increase in
  baseline glucose levels and lipid levels.

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Obsessive compulsive Disorder (OCD)

• Obsessive compulsive disorder usually
  responds well to an appropriate medication
  regimen. In addition to medication treatment
  however cognitive and behavioral therapies are
  important. Also symptoms of preoccupations and
  perseveration are not necessarily OCD.  
• Psychopharmacologic treatment for OCD
  revolves around the use of medications that
  affect the serotonergic functions in the brain.

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Obsessive compulsive Disorder (OCD)

• Any of the selective serotonergic reuptake
  inhibitors can be very useful in the treatment of
  OCD. As noted above these medications are well
  tolerated and possess few side effects. Dosages
  used to treat OCD are sometimes greater than
  those used for the treatment of depression and
  other anxiety disorders.

50
Selective Serotonergic Reuptake Inhibitors

• These medications include the ones listed
  above, fluoxetine (Prozac), paroxetine (Paxil),
  sertraline (Zoloft), fluvoxamine (Luvox),
  citalopram (Celexa), and escitalopram (Lexapro).
  As noted above, care should be taken in
  prescribing these medications related to recent
  concerns about increased suicidal ideations
  and/or suicidal behavior in children and
  adolescents taking these medications.  

51
Clomipramine (Anafranil)

• Clomipramine (Anafranil) is a Tricyclic
  antidepressant medication that has a primary
  serotonergic action in the brain that has been
  used for many years in the treatment of
  Obsessive/Compulsive Disorder symptoms.

52
Clomipramine (Anafranil)

• Side effects with clomipramine (Anafranil)
  include the usual side effects associated with
  Tricyclic antidepressants. These are
  anticholinergic side effects that include
  increased appetite and weight gain, dry mouth,
  and constipation. There are also the same
  concerns associated with a widening in the QRS
  complex as seen on an EKG. Such a widening in
  the QRS complex as noted above can lead to
  problematic arrhythmias. This medication is also
  extremely toxic in overdose and can lead to death
  because of the anticholinergic and cardiac side
  effects associated with it.

53
Clomipramine (Anafranil)

• Routinely, Clomipramine (Anafranil) serum
  levels should be evaluated periodically.
  Baseline EKG with routine follow up EKG should be
  part of the post-prescription care given with
  this medication

54
Other medications

• Other medications are used to treat symptoms
  associated with OCD. These medications include
  other medications that help relieve anxiety.
  These medications are medications in the
  Benzodiazepine class and medications, in addition
  to Clomipramine, that are in the tricyclic
  antidepressant class. There are at times severe
  OCD symptoms that seem to be helped by the
  addition of antipsychotic medications, in
  particular the newer atypical antipsychotic
  medications that we have discussed above.

55
Tourettes Disorder

• Tourettes Disorder is a collection of
  symptoms associated with chronic vocal and motor
  tics. Sometimes these tics can be very complex.
  In addition to the chronic vocal and motor tics,
  comorbid issues associated with emotional
  lability and attention/concentration problems can
  also be present. OCD is also likely to be
  comorbid in individuals and in families of
  individuals with Tourettes. Both Tourettes
  Disorder and OCD can be the result of a
  post-strep infection autoimmune syndrome.

56
Tourettes Disorder

• Medications that have been used to treat
  Tourettes Disorder include medications that
  inhibit tic production and also those that
  decrease anxiety. Of the medications that inhibit
  tic symptoms whether vocal or motor, the most
  effective group of medications is the
  antipsychotic group. These seem to be helpful
  because they block dopamine activity in the
  subcortical structures of the brain that are
  associated with movement. They are generally
  quite effective in reducing tics, both vocal and
  motor but do have substantial side effects, as
  have been noted above.

57
Risperdal

• A frequently used antipsychotic medication in
  the treatment of Tourettes is Risperdal. Just
  as in the treatment of other disorders with
  antipsychotic medications, care has to be given
  to monitor for both short-term acute side effects
  that include extrapyramidal symptoms of
  parkinsonism, akathisia, and acute dystonias as
  well as longer-term side effects such as tardive
  dyskinesia. Additionally, with the chronic use
  of Risperdal as well as most of the older
  so-called typical antipsychotics, prolactin
  levels are increased and this can lead to
  difficulties associated with possible
  gynecomastia in males, particularly adolescents,
  and possible lactation and decreased menstruation
  in females. These atypical antipsychotics, as
  noted above, are also possibly linked to
  increased glucose levels in individuals taking
  the medication and possible increased lipid
  levels.

58
Other Atypical Antipsychotics

• Other atypical antipsychotics that have been
  used in the treatment of Tourettes Disorder
  include Geodon, Seroquel, and Zyprexa. The newer
  atypical antipsychotic Abilify, would probably
  also be useful in decreasing tics in these
  patients. 

59
Older So-Called Typical Antipsychotics or
Neuroleptics

• Older so-called typical antipsychotics such
  as Pimozide and Haloperidol have also been shown
  to be very effective in the treatment of
  Tourettes Disorder. These medications decrease
  disruption secondary to tics, both vocal and
  motor. Both Haloperidol and Pimozide have
  substantial side effects. These side effects
  occur at a somewhat higher rate than the typical
  antipsychotic group. They have been associated
  with permanent, long-term side effects such as
  tardive dyskinesia and at a much higher rate than
  the atypical antipsychotics. Older antipsychotics
  are also much more likely to have problems
  associated with acute extrapyramidal side
  effects. At times, adjunctive anticholinergic
  medications are needed to decrease some of the
  worrisome acute side effects of movement
  associated with the older antipsychotics. Such
  medicines as Cogentin, Vistoril, Artane, and
  Benadryl have been used.

60
Other Medications To Treat Tourettes Disorder

• Other medications have also been used with
  relative success in decreasing tics in patients
  with Tourettes Disorder. They also may have
  some adjunctive effect in decreasing some of the
  anxiety associated with Tourettes Disorder and
  in helping with some of the comorbid
  symptomatology associated with decreased
  attention and concentration. The medications
  most often used in this particular category are
  the alpha adrenergic agonists that are centrally
  acting. These include Quanfacine and Clonidine.
  Both of these are essentially antihypertensives
  and acting centrally seem to have some effect on
  the decrease in tic production. Also by
  decreasing the overall arousal level, they seem
  to have a mild anxiolytic effect and seem to
  increase concentration and attention. Side
  effects associated with these medications include
  sleepiness and/or feelings of being tired, both
  associated with a somnolent effect of the
  medications and their ability to decrease blood
  pressure. Care has to be given to monitor blood
  pressure to ensure that blood pressure does not
  drop too precipitously. Usually, patients need
  to be slowly titrated onto these medications and
  then subsequently slowly titrated off.

61
Other Medications To Treat Tourettes Disorder

• These include the anxiolytics that have been
  noted above, including but not limited to,
  Benzodiazepines, selective serotonin reuptake
  inhibitors, Tricyclic antidepressants, and other
  more atypical anxiolytics, including BuSpar.

62
Psychotic Disorders

• Psychotic disorders do occur in children and
  adolescents but they are not seen as often in
  this population as in adults.

63
Anti-psychotic medications

• Anti-psychotic medications, both the
  newer atypical antipsychotic medications and the
  older typical antipsychotic medications are the
  mainstays for treatment of psychosis in any
  individual. The medications that are used in the
  treatment of psychotic disorders are those that
  have been mentioned above, including but not
  limited to, Risperdal, Zyprexa, Geodone,
  Seroquel, Abilify, and the older more typical
  antipsychotic medications that include Haldol,
  Thorazine, Prolixin, Mellaril, Loxitane, and many
  others. All of these medications, as has been
  noted above, have substantial side effects
  associated with them, not the least of which is
  the possibility of permanent movement difficulty
  associated with syndromes of tardive dyskinesia.

64
Benzodiazepines

• In addition to these antipsychotic
  medications in the treatment of psychosis.
  Benzodiazepines can also sometimes be helpful in
  treating agitation and irritability that exists
  alongside the psychotic symptomatology. The use
  of Benzodiazepines such as Ativan, Klonopin,
  Valium, etc., can be very helpful in decreasing
  the morbidity associated with psychotic symptoms.
  

65
Conclusion

• Psychotropic medications can be helpful
  adjuncts to mental health treatment in children
  and adolescents but care needs to be given to
  ensure appropriate diagnosis and follow up by a
  professional trained to evaluate and use these
  medications.
• Judicious use in a collaborative atmosphere is
  essential to success and safety.