Fiziksel Hastalığı Olan Çocuk ve Ergenlerde Psikofarmakolojik Tedavi İlkeleri
Özet
Kitabın bu bölümünde, fiziksel hastalıkları olan çocuk ve ergenlerde temel psikofarmakolojik yaklaşımlar gözden geçirilecektir. Konsültasyon psikiyatristinin birincil rolü, hastada fiziksel hastalığa eşlik eden psikiyatrik bozukluğu saptamaktır. Hedef belirtiler açıkça tanımlanmalı ve bu belirtilerin tedaviye yanıtları izlenmelidir. Psikotrop ilaç tercihleri yapılırken çocukların “küçük yetişkinler olmadığını” hatırlamak önemlidir. Psikotrop ilaç seçimi, ilacın farmakokinetik ve farmakodinamik süreçleri, hedeflenen etkileri, potansiyel yan etkileri ve ilaçların hastalık seyrindeki etkileşimleri dikkate alınarak yapılmalıdır. Fiziksel hastalıkları tedavi etmek için uygulanan ilaçların ve psikiyatrik bozukluk için kullanılması planlanan ilaçların etkileşimleri gözden geçirilmeli, hastanın genel tıbbi durumu için en yararlı kombinasyon uygulanmalıdır. İlacın titrasyonunda “düşük başlangıç dozu ve yavaş ilerleme” kuralı uygulanmalıdır. Tedavide mümkün olduğunca az sayıda ilacın kullanılması tercih edilmelidir.
In this chapter, fundamental psychopharmacological approaches for children and adolescents with physical illnesses will be reviewed. The primary role of the consultation psychiatrist is to identify psychiatric disorders accompanying the physical illness. Target symptoms should be clearly defined, and their response to treatment should be closely monitored. It is crucial to remember that children are not "little adults" when selecting psychotropic medications. The choice of psychotropic drugs should consider the pharmacokinetic and pharmacodynamic properties of the medication, the intended therapeutic effects, potential adverse effects, and interactions with the course of the physical illness. The interactions between medications used to treat the physical illness and those planned for psychiatric disorders should be carefully evaluated to ensure the most beneficial combination for the patient’s overall medical condition. During titration, the principle of “start low and go slow” should be followed. Whenever possible, the use of the minimal number of medications should be prioritized in treatment.
Referanslar
Gleason MM, Egger HL, Emslie GJ, et al. Psychopharmacological treatment for very young children: contexts and guidelines. Journal of the American Academy of Child & Adolescent Psychiatry. 2007;46: 1532-1572. doi:10.1097/chi.0b013e3181570d9e
Oesterheld J, et al. Clinical And Developmental Aspects Of Pharmacokınetıcs And Drug Interactıons. In: Martin A, Volkmar F R, Michael H Bloch, Lewis M (eds). Lewis's child and adolescent psychiatry: A comprehensive textbook. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins; 2017. p. 1975-2050.
Frank B, Gupta S, McGlynn DJ. Psychotropic medications and informed consent: a review. Annals Of Clinical Psychıatry. 2008;20: 87-95. doi:10.1080/10401230802017076
Shaw R, Gosselin G, Guild D, et al. Psychopharmacology in the Physically Ill Child. In: Shaw R, Demaso D (eds) Textbook Of Pediatric Psychosomatic Medicine. American Psychiatric;2010. p. 440-475
Buxton IL. Pharmacokinetics and pharmacodynamics: the dynamics of drug absorption, distribution, action, and elimination. In: Brunton LL, Lazo JS, Parker KL (eds) Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006. p.1-52.
Han T, Harmatz JS, Greenblatt DJ, et al. Fentanyl clearance and volume of distribution are increased in patients with major burns. The Journal of Clinical Pharmacology. 2007;47: 674-680. doi: 10.1177/0091270007299756
Sandson NB, Armstrong SC, Cozza KL. An overview of psychotropic drug-drug interactions. Psychosomatics. 2005;46: 464-494. doi: 10.1176/appi.psy.46.5.464
Beliles KE. Psychopharmacokinetics in the medically ill. In: Stoudemire A, Fogel BS, Greenberg DB (eds) Psychiatric Care of the Medical Patient. Oxford, UK: Oxford University Press; 2000. p. 272-394.
Verbeck RK. Pharmacokinetics and dosage adjustments in patients with hepatic dysfunction. European Journal of Clinical Pharmacology. 2008;64: 1147-1161. doi:10.1007/s00228-008-0553-z
Brown TM, Stoudemire A, Fogel B. Psychopharmacology in the Medical Patient. In: Fogel B, Greenberg D (eds) Psychiatric Care of the Medical Patient. Oxford, UK: Oxford University Press; 2015. p. 381-500.
Taylor DM, Barnes TRE, Young AH (eds) The Maudsley prescribing guidelines in psychiatry 13th edition. Hoboken, NJ: John Wiley & Sons; 2018. p. 635-690.
Stahl SM. Guanfacine. In: Grady MM (ed) Stahl’s Essential Psychopharmacology: Prescriber’s Guide: Children and Adolescents. New York: Cambridge University Press; 2018. p. 243-294.
Nair B. Psychopharmacology in Medically Ill Patients. In: Leigh H, Streltzer J (eds) Handbook of consultation-liaison psychiatry, 2nd edition. Cham:Springer; 2015. p. 99-115.
Kunishima Y, Masumori N, Kadono M, et al. A case of neuroleptic malignant syndrome in a patient with hemodialysis. International Journal of Urology. 2000;7: 62–64. doi: 10.1046/j.1442-2042.2000.00138.x
Nadkarni A, Oldham MA, Howard M, et al. Drug-drug interactions between warfarin and psychotropics: updated review of the literature. Pharmacotherapy. 2012;32(10):932-942. doi: 10.1002/j.1875-9114.2012.01119.
Doğangün B, Demirdöğen E. Çocuk ve Ergende Konsültasyon Liyezon Psikiyatrisinde Tedavi Seçenekleri. Türkiye Klinikleri Çocuk Psikiyatrisi Özel Dergisi. 2016;2: 95-100.
Honig A, Kuyper AM, Schene AH, et al. Treatment of postmyocardial infarction depressive disorder: a randomized, placebocontrolled trial with mirtazapine. Psychosomatic Medicine. 2007;69(7): 606-613. doi: 10.1097/PSY.0b013e31814b260d
İnce C, Karakuş M. Çocuk ve Ergende Kardiyolojik ve Respiratuar Hastalıklarda Konsültasyon Liyezon Psikiyatrisi. Türkiye Klinikleri Çocuk Psikiyatrisi Özel Dergisi. 2016;2: 29-36.
Hennissen L, Bakker MJ, Carucci S, et al. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS Drugs. 2017;31(3): 199–215. doi: 10.1007/s40263-017-0410-7
Volkow ND, Wang G, Fowler JS, et al. Cardiovascular effects of methylphenidate in humans are associated with increases of dopamine in brain and of epinephrine in plasma. Psychopharmacology. 2003;166(3): 264-270. doi: 10.1007/s00213-002-1340-7
Stiefel G, Besag FMC. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Safety. 2010;33(10): 821-842. doi: 10.2165/11536380-000000000-00000
Hammerness PG, Perrin JM, Shelley-Abrahamson R, et al. Cardiovascular risk of stimulant treatment in pediatric attention-deficit/hyperactivity disorder: update and clinical recommendations. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(10): 978-990. doi: 10.1016/j.jaac.2011.07.018
Power C, Freeman NC, Costello S. ADHD Assessment Recommendations for Children in Practice Guidelines: A Systematic Review. Psych. 2022;4(4): 882-896. doi:10.3390/psych4040065
Haddad PM, Dursun SM. Neurological complications of psychiatric drugs: clinical features and management. Human psychopharmacology. 2008;23: 15-26. doi: 10.1002/hup.918
25. Verrotti A. The Challenge of Pharmacotherapy in Children and Adolescents with Epilepsy-ADHD Comorbidity. Clinical Drug Investigation. 2018;38(1): 1-8. doi: 10.1007/s40261-017-0585-1
Torres AR, Whitney J, Gonzalez-Heydrich J. Attention deficit/ hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment. Epilepsy & Behavior. 2008;12: 217-233. doi: 10.1016/j.yebeh.2007.08.001
Kathol RG, Mutgi A, Williams J, et al. Diagnosis of major depression in cancer patients according to four sets of criteria. American Journal of Psychiatry. 1990;147:1021–1024. doi:10.1176/ajp.147.8.1021
