Psychopharmacology and juvenile delinquency

The miserable have no other medicine, but only hope William Shakespeare, Measure for Measure, Act III, Scene I. Introduction Psychopathology among juvenile offenders is widely considered to be a significant problem and has been examined in recent, broad psycho-epidemiological studies (Teplin et al., 2002; Vermeiren, 2003; Wasserman et al., 2003; Vermeiren et al., 2006). These estimates of psychiatric illness may partially overestimate the prevalence of psychopathology among all offenders due to the fact that incarcerated juveniles are more likely to have illness and to have greater morbidity than first-time offenders or those in diversion programs. Nevertheless, the high prevalence rates for psychopathology among juvenile offenders should be a cause of concern. The best approach to this population entails taking a developmental perspective which takes into account that despite their crimes these children continue to mature, grow, and change in profound ways (Frick, 2006; Karnik et al., 2006). Treatment of confined juveniles has certain ethical and moral problems due to the unique consent and assent issues at play for this potentially vulnerable group of patients. A recent consensus report recommends behavioral management and psychotherapy be used where clinical indications clearly allow these as first-line interventions (Pappadopulos et al., 2003). Only after these approaches have failed should psychopharmacological interventions be considered (Pappadopulos et al., 2003; Schur et al., 2003). For example, an acutely manic offender who presents with pressured speech, aggressive behavior, and delusional thoughts would merit anti-psychotic medications for stabilization followed by psychotherapy and medications if needed, whereas a youth offender presenting with mild anxiety symptoms might merit psychotherapy as initial treatment.