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[Prescription of neuroleptics for children]
M P Bouvard1, M C Mouren-Siméoni
1Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris.
Insights
Neuroleptics are widely used in child psychiatry, but careful prescription is crucial due to potential side effects. Balancing efficacy and adverse events guides treatment decisions for pediatric patients.
Area of Science:
- Child and Adolescent Psychiatry
- Pharmacology
Background:
- Neuroleptics are frequently prescribed for children, despite a lesser impact compared to adult psychiatry.
- Adverse effects are a primary concern, often leading to short-term discontinuation of treatment.
Purpose of the Study:
- To review the pharmacokinetic specificities of neuroleptics in children.
- To describe general prescription modalities for this age group.
- To discuss tolerance and side effects of neuroleptic use in pediatric populations.
Main Methods:
- Review of neuroleptic kinetics in children.
- Description of general prescription guidelines.
- Presentation of personal results as examples.
- Discussion of tolerance and adverse effects.
Main Results:
- Neuroleptic prescription in children follows specific rules, including dose titration and potential plasma level monitoring.
- Common short-term side effects include acute dyskinesia, sedation, hypotension, and weight gain.
- Long-term side effects like passiveness and tardive dyskinesia are rarely observed in children.
Conclusions:
- Caution is advised when prescribing neuroleptics to children.
- Alternative medications should be considered when feasible.
- Managing side effects is paramount for successful neuroleptic treatment in pediatric patients.
Abstract:
The discovery of neuroleptics has certainly not had the same impact in child psychiatry as it has had in adult psychiatry. Yet, these substances are widely used with children. Prescription is generally based on a few simple rules: treatment is started with low doses which are progressively increased, so as to reach an optimal posology which establishes a balance between clinical efficiency and side effects; plasmatic levels may be monitored on a regular basis. The emergence of adverse effects continues to remain the essential preoccupation of the clinical practitioner; it is the reason why so many treatment plans are discontinued (on a short term basis, acute dyskinesia, sedation, hypotension, weight gain; on a long-term basis, passiveness, tardive dyskinesia, but this is seldom observed in children). As a result, one must be careful in prescribing neuroleptics to youngsters and consider other drugs whenever possible. Following a brief review of the kinetic specificities of neuroleptics in children, we describe the general modalities of prescription for this age group and give some personal results as illustrative examples. We then discuss the issue of tolerance and side effects.