Medication can be an effective part of treatment for several psychiatric disorders of childhoodand adolescence but its use should be based on a comprehensive psychiatric evaluation andtreatment plan. The aim of this study was to evaluate psychotropic medication use for childrenand adolescents treated as inpatients and to compare it with principles of rational pharmacotherapy,thus identifying possible downsides of current practices and pointing a way towards saferand more efficient practices. This is a descriptive study of prescribing trends at the Clinical Department forChildren and Adolescents of the Institute of Mental Health in Belgrade, during the period from September2009 to September 2010. Analyzed demographic data (age, gender) and the number of hospitalizationswere obtained from medical histories, while diagnoses were obtained from discharge notes. Prescribedtherapy was copied from medication charts. Drug dosages were analyzed as average daily doses prescribedduring the hospitalization. Psychiatric diagnoses were classified according to The International Classificationof Diseases and Related Health Problems, 10th Revision (ICD-10). During the examined time period, 264patients were hospitalized (61.4% males), with an average age of 11.4±5.1 years. We have found that 66.3%of admitted patients were treated with pharmacotherapy in addition to other treatment modalities. Therewas a highly significant correlation between the age of patients and the prescribed dosage (Spearman’srho=0.360, p<0.001) as well as the number of prescribed drugs (Spearman’s rho=0.405, p<0.001). The mostcommonly diagnosed psychiatric disorders were: autism spectrum disorders (20.8%), conduct disorders(19.7%), mixed developmental disorder (14.8%), adjustment disorder (7.2%), mental retardation (7.2%),acute psychosis (4.5%), and ADHD (2.3%). The most commonly prescribed medications were antipsychotics(45.9%), followed by antidepressants (17.2%), mood stabilizers (16.1%), benzodiazepines (14.4%), and otherpsychotropic drugs (6.4%). The most commonly prescribed antipsychotic was risperidone, used for morethan 50% of the patients treated with antipsychotics. Taken together risperidone and chlorpromazine weremore than 75% of all prescribed antipsychotics. 98.4% of prescribed antidepressants belonged to the SSRIs,with sertraline and fluoxetine accounting for almost 90% of them. All prescribed dosages were in accordancewith the official guidelines. This is the first survey in Serbia to document the practice of prescribingpsychotropic medication in the field of child and adolescent psychiatry. Current drug-prescribing practicesat the Clinical Department for Children and Adolescents of the Institute of Mental Health in Belgrade are inaccordance with current practices in the United States and Europe. Not every child with symptoms of mentalhealth problems needs pharmacological treatment; when they do, the general rule of thumb should be “start low, go slow, and taper slowly”. Follow-up studies are necessary to assess the change of trends, as wellas studies in different patient populations and health centers, in order to globally evaluate psychotropicmedication use in children and adolescents in Serbia.
Key words: Phsychopharmacology, medication, children, adolescents, inpatients
M. Pejovic-Milovancevic, V. Miletic, S. Popovic-Deusic, S. Draganic-Gajic, D. Lecic-Tosevski, V. Marotic (page 314) - Full article