Psychopharmacology in Pediatric Critical Care

Frederick J. Stoddard, Craigan Usher, Annah N. Abrams

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices. Treatment is guided by the knowledge bases in pediatric physiology, psychopharmacology, and treatment of critically ill adults. Pharmacologic considerations include pharmacokinetic and pharmcodynamic aspects of specific drugs and drug classes, in particular elimination half-life, developmental considerations, drug interactions, and adverse effects. Evaluation and management of pain is a key initial step, as pain may mimic psychiatric symptoms and its effective treatment can ameliorate them. Patient comfort and safety are primary objectives for children who are acutely ill and who will survive and for those who will not. Judicious use of psychopharmacolgic agents in pediatric critical care using the limited but growing evidence base and a clinical best practices collaborative approach can reduce anxiety, sadness, disorientation, and agitation; improve analgesia; and save lives of children who are suicidal or delirious. In addition to pain, other disorders or indications for psychopharmacologic treatment are affective disorders; PTSD; post-suicide attempt patients; disruptive behavior disorders (especially ADHD); and adjustment, developmental, and substance use disorders. Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior; relieving acute stress, anxiety, or depression; and improving sleep and nutrition. In palliative care, psychopharmacology is integrated with psychologic approaches to enhance children's comfort at the end of life. Defining how best to prevent the adverse consequences of suffering and stress in pediatric critical care is a goal for protocols and for new psychopharmacologic research [23,153].

Original languageEnglish (US)
Pages (from-to)611-655
Number of pages45
JournalChild and Adolescent Psychiatric Clinics of North America
Volume15
Issue number3
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Psychopharmacology
Critical Care
Pediatrics
Practice Guidelines
Critical Illness
Therapeutics
Psychiatry
Anxiety
Adolescent Psychiatry
Attention Deficit and Disruptive Behavior Disorders
Social Adjustment
Pain
Confusion
Child Psychiatry
Somatoform Disorders
Preexisting Condition Coverage
Knowledge Bases
Delirium
Psychotropic Drugs
Pain Management

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pediatrics, Perinatology, and Child Health

Cite this

Psychopharmacology in Pediatric Critical Care. / Stoddard, Frederick J.; Usher, Craigan; Abrams, Annah N.

In: Child and Adolescent Psychiatric Clinics of North America, Vol. 15, No. 3, 07.2006, p. 611-655.

Research output: Contribution to journalArticle

Stoddard, Frederick J. ; Usher, Craigan ; Abrams, Annah N. / Psychopharmacology in Pediatric Critical Care. In: Child and Adolescent Psychiatric Clinics of North America. 2006 ; Vol. 15, No. 3. pp. 611-655.
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