These occur only rarely in children but more frequently in adolescents. There have been no extensive studies of drug treatments of this condition in young patients, but anecdotal reports suggest that tricyclic antidepressants such as clomipramine may be as effective as they are in adults but the SSRI antidepressants should be considered as first line treatments.
In SUMMARY, the relatively small number of psychotropic drugs which have been used for the treatment of psychiatric diseases in children and adolescents reflects the diagnostic uncertainty regarding the clinical status of the patients, the lower frequency of established psychiatric disorders in these groups of patients and, as a consequence, the paucity of good clinical trials in which the efficacy of drug treatments may be established. Nevertheless, there is good evidence that psychostimulants, particularly methylphenidate, are of value in the treatment of hyperkinetic disorders, while conventional neuroleptics and tricyclic antidepressants may have an application in the treatment of a diverse group of disorders ranging from depression to separation anxiety and aggression. In view of the well-established side effects and toxicity of such drugs, it is to be hoped that they will soon be superseded by safer drugs whose efficacy has already been established in adult patients.
It is apparent from the discussion of the drugs used in the treatments of childhood psychiatric disorders that the role of psychotropic drugs is far from clear. Many of the drugs in use were developed long before the strict guidelines of the regulatory authorities became mandatory and therefore the few drug treatments which are available have not always been subjected to the rigorous assessments which all other drugs are subject to. Clearly there is a need for more extensive research not only into the psychiatric disorders and their possible aetiologies but also into the efficacy of the drugs used to treat the disorders. There is very little evidence concerning the potential value of the second generation of antipsychotics and antidepressants that are increasingly replacing the older drugs at least in the industrialized countries. Hopefully not only will more research into the nature of childhood disorders be undertaken but also more attention given to the new psychotropic drugs that have an improved safety profile, at least in adult patients.
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