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The parents' principal areas of concern help
define the goals for psychiatric pharmacotherapy.
History of present illness
Certain psychiatric symptoms and responses to psychosocial
stressors may be amenable to psychopharmacological treatment. Target
symptoms can be identified and monitored to determine drug effectiveness.
Psychiatric review of systems
Comorbid disorders may require modified psychopharmacological
Past psychiatric history
Information on past psychotropic medication trials
(reason prescribed, highest dose achieved, effectiveness, side effects,
duration of treatment, and reason for discontinuation) can guide
future medication choices and dosing. Current psychotropic medications
may need to be adjusted or discontinued if new medications are initiated
in order to prevent toxicity or drug-drug interactions.
Suicidality and homicidality history
Past and current safety concerns may require certain
precautions as pharmacotherapy is initiated (choosing drugs that
are less toxic in overdose, prescribing limited amounts of medication,
or monitoring patient particularly closely for behavioral changes).
Substance abuse and chemical dependency history
Past chemical dependency may necessitate caution when
prescribing controlled substances. Current abuse of medications,
illicit drugs, or alcohol can cause drug-drug interactions with
psychotropic medications. Current chemical dependency may require
detoxification. Comprehensive chemical dependency treatment may
be necessary before psychopharmacotherapy for comorbid psychiatric
disorders is initiated.
Developmental and early childhood history
A history of maternal drug or alcohol abuse may theoretically
be associated with alterations in the effects of psychotropic medications.
A patient's slow growth may raise concern over potential
negative effects on stature associated with the long-term use of
certain psychotropic medications.
General medical history
Known drug allergies may limit psychopharmacotherapy
options. Past and current medical conditions may affect choice of
psychotropic medications (avoiding psychostimulants in youth with
cardiac problems, valproic acid in children with hepatic disease,
or lithium in youth with renal insufficiency).
Psychotropic medication that is effective for a patient's
close relative may be more effective for the patient than other
Younger children or older children with low intellectual
functioning may require increased parental monitoring of psychotropic
medication. The timing of a child's ADHD symptoms throughout
the school day may require certain adjustments in dosing the child's
psychostimulant medication. Adverse medication effects such as sedation
may interfere with academic performance.
Peer relationships and attitudes may affect a youth's
adherence to psychotropic medication. Adverse medication effects
such as sedation may interfere with leisure activities.
Complete blood count with differential
Screening for anemia, which can cause decreased energy; baseline
for drugs that may affect blood counts
Screening for purging or restricting of food for patients
in whom an underlying eating disorder is suspected
Blood urea nitrogen, creatinine
Screening for renal dysfunction, which may alter psychopharmacotherapy
options; baseline for lithium treatment
"Liver function tests" (aspartate aminotransferase,
alanine aminotransferase, alkaline phosphatase, bilirubin)
Screening for hepatic problems, which may affect psychopharmacotherapy
options; baseline and for subsequent monitoring
Fasting glucose level
Screening for metabolic syndrome and/or diabetes
mellitus, especially if second-generation antipsychotics are being considered
Fasting lipid profile (high-density and low-density
Screening for hyperlipidemia and/or hypercholesterolemia, especially
if weight-gain-inducing agents are being considered
Screening for renal disease and/or diabetes
Urine toxicology screen
Screening for illicit drug abuse
Thyroid-stimulating hormone (TSH) level
Screening for thyroid dysfunction, which can contribute
to symptoms of depression, anxiety, and psychosis; baseline for lithium
Urine pregnancy test
Screening for pregnancy in females of reproductive
Serum lead level
Screening for lead toxicity, especially in children
under 7 years of age