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Basics of Psychotropic Medication Use

Clinical Pearls Video Series

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Video Chapters

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  • Assessment
    • What are the factors related to the patient and their presentation I need to consider in terms of assessing the appropriateness of a medication? (0:07–2:35)
    • What is the role of therapy, education, and other non-pharmacologic management when patients are on medications? (2:37–3:49)
  • Management
    • What are some reasons I might want to start a psychotropic medication on a child or adolescent? (3:51–5:09)
    • What are the things I should be considering as a primary care provider when I start a pediatric patient on a psychotropic medication? (5:10–5:58)
    • What are some SSRIs to have in my tool box? Can you discuss the differences, transitioning between different SSRIs, dosing, time to effect, and managing side effects? (5:59–7:51)
    • When should I think about using antipsychotics and what considerations should I have when prescribing them? (7:52–10:10) 
  • Key Takeaways (10:11–11:08)

photo of Paresh Patel, M.D., Ph.D.

Paresh Patel, M.D., Ph.D., Child & Adolescent Psychiatrist, University of Michigan

There are many treatment strategies for the management of mental health concerns in youth. These include:

  • Psychoeducation
  • Environmental adaptations
  • Changes to scheduling or routine
  • Psychotherapy and behavioral therapy
  • Family therapy
  • School and community-based interventions
  • Psychotropic medications

Successful medication use can help decrease symptoms and enable the youth, as well as their family, to better utilize non-pharmacologic resources. As primary care providers, you may often be asked to:

  • Prescribe medications
  • Titrate medications
  • Assess the potential for side effects of medications
  • Counsel families on medications
  • Taper off medications

Medications should be prescribed after careful diagnostic evaluation and consideration of the entire biopsychosocial framework of the child or adolescent’s presentation, as well as the predisposing, precipitating, and perpetuating factors contributing to psychopathology.

Psychiatric diagnoses in youth can vary over time. It is important to:

  • Re-evaluate periodically
  • Reflect on the diagnostic presentation over the evolving course
  • Be mindful that some youth demonstrate a chronic relapsing course that has varying contributors and requires flexibility in management strategies

Look for opportunities to reduce or discontinue medications when:

  • A child is doing well
  • The medication management does not match the underlying diagnostic conceptualization of their presentation

Remember to:

  • Reassess often and get collaterals to inform your understanding of the patient and their treatment
  • Always screen for trauma and stressors, as many psychiatric conditions in youth are triggered or perpetuated by them

In almost all cases, psychotherapy and medication together are more effective than medication alone.

Riddle M. Pediatric Psychopharmacology for Primary Care. 3rd ed. American Academy of Pediatrics; 2021.

Walkup J, Work group on quality issues. Practice parameter on the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2009;48(9):961-973. 

Test your knowledge with an optional 8-question quiz below. (Note: If you wish to receive a certificate of completion for this MC3 Clinical Pearl, you must receive a passing score of  75%.)


Basics of Psychotropic Medication Use Quiz

1. Psychiatric nosology was developed to prioritize diagnostic accuracy, i.e., the criteria are designed to confidently arrive at a definitive and stable diagnosis.

2. It is important to start a medication at the first encounter for a behavioral health problem because this demonstrates to the caregivers that you are taking their child’s mental health concerns seriously.

3. Structured questionnaires such as the PHQ-9 or GAD-7 are diagnostic tools with high predictive value when used to screen for mental illness in the general population.

4. All SSRIs are equally effective, so if a youth fails their first SSRI trial, one should next try a non-SSRI class medication.

5. Metabolic monitoring for a youth on an antipsychotic is only necessary for the 2nd generation (newer) antipsychotics like risperidone, olanzapine, aripiprazole, and quetiapine.  The first generation antipsychotics, like haloperidol, fluphenazine, and chlorpromazine, do not increase the risk for metabolic syndrome.

6. One of the goals of psychotropic treatment in children is to help decrease symptoms and enable the youth and caregiving system to better utilize non-pharmacologic resources.

7. Common indications for psychotropic treatment in youth include (select all that apply):

8. Which of the following are appropriate indications for initiation of an antipsychotic? (Select all that apply.)

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