PSYCHOACTIVE DRUGS IN PEDIATRICS

Abstract

SINCE THE ADVENT of the so-called psychoactive drugs (tranquilizers, mood relievers, and stimulants) the large literature on their clinical uses has included relatively little research into the effects of these drugs upon children. In spite of this, experience with the younger age group seems to justify an attempt to establish a few rules of thumb for pediatric practitioners. In general, the tranquilizers have been divided into two categories: major and minor. The so-called major tranquilizers include the phenothiazines and Rauwolfia derivatives. Whereas in adults these drugs have an important role in alleviating the behavioral and thinking disturbances in psychoses, parallel results are not usually to be expected in psychotic children. Only occasionally does one see a psychotic child whose thinking disturbance or bizarre behavior has responded to tranquilization and then usually when the dosage is high. Often before any other effective changes would be available, the child will be so tranquilized as to be out of effective communication, usually in a sleep state. Where any useful effect has been obtained in the childhood psychoses, it has usually been from a phenothiazine rather than a Rauwolfia derivative. Children in whom phenothiazines have been found to be useful are usually those with acute, often overwhelming, anxiety. These drugs appear to be of little value in the chronic anxiety states or with chronically established symptoms such as habit disturbances, tics, enuresis, character disturbances, etc. In acute anxiety states and in the acute psychotic symptoms of early adolescence, the phenothiazines often will relieve crisis symptoms. With overwhelming postoperative anxiety or transitory psychotic states, these drugs have been helpful. They must, however, be given in adequate dosage, and this varies greatly from individual to individual. One must find for each child the dose which is clinically effective without so fully tranquilizing the individual that he cannot function. A common mistake is the administration of ineffectual small doses or even a single dose. It must be recognized that a sustained blood level is necessary for continuing effectiveness of the medication.