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General Considerations in Psychiatric Management

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Psychotropic medications may be effective in the management of emotional and behavioral problems that accompany medical illness. Frequently, psychopharmacological interventions are instituted when the medical team believes that the psychiatric symptoms in the child are affecting the patient's care. The diagnosis of a psychiatric disorder is rarely made in these situations, and the treatment targets specific symptoms rather than syndromes (Shaw and DeMaso 2006). For example, a stem cell transplant patient becomes despondent and discouraged as she suffers through treatment complications and medication side effects. Members of the oncology team notice her lack of participation, social isolation, minimal eye contact with staff, and pessimistic assessment of her prognosis. They fear that she is depressed and that her mood problems are complicating an already difficult hospital course. A decision is made to start the patient on a combination of stimulants (short-acting methylphenidate) and a selective serotonin reuptake inhibitor (SSRI). The stimulant almost immediately improves her level of participation in treatment and her compliance on the transplant unit. The antidepressant gradually takes effect over the course of 3–4 weeks, improving her mood and her relationships with family and medical staff. With her progress on the antidepressant, the methylphenidate is eventually discontinued, and she is maintained on the SSRI alone.

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