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Minerva Psichiatrica 2014 December;55(4):181-91

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Psychopharmacology for youth with medical illness

Forgey M., Bursch B.

Division of Child Psychiatry, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Youth diagnosed with a serious or chronic medical illness may experience inadequate sleep/insomnia, iatrogenic medical trauma, anxiety, depression, and/or delirium. Family-focused cognitive-behavioral interventions are often effective in addressing psychological distress in this population. However, some children and adolescents require adjunctive medication to adequately address their suffering. The current evidence base for the psychopharmacological treatment of psychiatric symptoms in medically ill youth is limited. Recommendations are based on the available child and adult literature, pharmacokinetics, and/or clinical experience. Selective serotonin reuptake inhibitors sertraline, citalopram, or escitalopram are first line for anxiety, post-traumatic stress disorder, or depression in medically ill children and adolescents. For severe anxiety or trauma symptoms, low dose of risperidone or quetiapine can be a useful second line adjunct. To prevent the development of iatrogenic trauma symptoms, aggressive opiate pain management, if appropriate, should be recommended. While insomnia and other sleep-related issues can be difficult to treat, melatonin, diphenhydramine, or trazodone may be useful. In addition, a low dose of the sedating neuroleptic quetiapine can be helpful for short term insomnia treatment, especially if delirium or severe anxiety are also an issue. For medically ill youth with hypoactive/mixed delirium, risperidone should be considered. Haloperidol may be useful for hyperactive delirium.