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Administration of a long-acting antipsychotic injection to a child while managing contraindicated polypharmacy

Gazala Akram1, Fiona Mitchell2

  • 1Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.

BMJ Case Reports
|June 17, 2019
PubMed

Insights

Second-generation antipsychotics, like aripiprazole long-acting injection, can treat complex child psychiatric conditions. This case highlights managing polypharmacy and inter-agency collaboration in child mental health services.

Area of Science:

  • Child and Adolescent Psychiatry
  • Pharmacology
  • Neurodevelopmental Disorders

Background:

  • Second-generation antipsychotics (SGAs) manage psychiatric symptoms and behavioral issues in neurodevelopmental disorders.
  • Long-acting injectable (LAI) SGAs face reluctance in child psychiatry services.
  • Polypharmacy presents challenges, including potential drug interactions.

Observation:

  • A 12-year-old child required aripiprazole long-acting injection for complex psychiatric symptoms.
  • The patient's medication regimen involved polypharmacy, raising concerns about CYP P450 enzyme interactions.
  • Inter-sectoral and inter-agency collaboration proved challenging.

Findings:

  • Aripiprazole LAI was successfully initiated in a pediatric case despite polypharmacy concerns.
  • The case underscores the complexity of managing medication interactions in pediatric patients.
  • Navigating multi-agency work in child mental health services requires careful coordination.

Implications:

  • This case supports the judicious use of aripiprazole LAI in pediatric psychiatry under specific circumstances.
  • It emphasizes the need for vigilant monitoring of polypharmacy and potential drug interactions in children.
  • Continuous Professional Development is crucial for child and adolescent mental health services nursing staff to manage complex cases and inter-agency collaboration effectively.

Keywords:
Child and adolescent psychiatry (paediatrics)Pharmacology and therapeuticsPsychiatry (drugs and medicines)

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