Safety and efficacy data are available for the use of single psychotropic medications for the treatment of a number of childhood psychiatric disorders, including depressive, obsessive-compulsive, attention-deficit/hyperactivity, anxiety (including separation anxiety, social phobia, generalized anxiety), bipolar, and tic disorders. There also is evidence supporting the use of psychotropic medications for aggression and serious problems with impulse control in disruptive behavior and pervasive developmental disorders.

The evidence for treatment using multiple psychotropic medications at the same time is much smaller. Combinations of medications are used to address complex comorbid conditions, manage side effects, increase treatment response, and/or address symptoms hypothesized to be associated with multiple underlying neurotransmitter abnormalities (e.g., dopamine agonists for hyperactivity and serotonin agonists for anxiety).

To ensure safe and appropriate use of psychotropic medications, prescribers should follow best practice principles that underlie medication prescribing (Table 19-1). The use of medication involves a series of interconnected steps including performing an assessment, deciding on treatment and a monitoring plan, obtaining treatment assent or consent, and implementing treatment. Cognitive, emotional, and/or behavior symptoms are targets for medication intervention when there is no response to available evidence-based psychosocial interventions, there is a significant risk of harm, and/or there is significant functional impairment. Commonly encountered target symptom domains include agitation, anxiety, depression, hyperactivity, inattention, impulsivity, mania, and psychosis (Table 19-2).

Table 19-2 TARGET SYMPTOM APPROACH TO PSYCHOPHARMACOLOGIC MANAGEMENT

Modified from Shaw RJ, DeMaso DR: Clinical manual of pediatric psychosomatic medicine: mental health consultation with physically ill children and adolescents, Washington, DC, 2006, American Psychiatric Press, p 306.