Sections
Psychopharmacology | Medication Use in Specific Illnesses | Psychosocial Interventions
Excerpt
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.