Psychopharmakotherapie und Psychotherapie in der Kinder- und Jugendpsychiatrie unter Berücksichtigung neurobiologischer Aspekte

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Child and adolescent psychopharmacological treatment is much more than writing prescriptions, even if psychopharmacological interventions in various psychiatric diseases of children and adolescents have been helpful to reduce psychological suffering and improve quality of life. Psychopharmacological treatment for children and adolescents has to consider specific implications: the evaluation of psychopharmacological agents indicated for various psychiatric disorders is still insufficient and remains difficult in the child and adolescent age group, the majority of the drugs on the market are legally not yet approved for children und adolescents, the long-term effects of the psychopharmacological therapy on the development of children and adolescents are for most of the drugs still not known. In children and adolescents with a serious psychiatric symptomatology, knowledge and application of different treatment methods are mandatory. In most cases of severe psychiatric disorders psychopharmacological therapy is necessary, yet cannot be applied as the only therapeutic intervention. Combination with psychotherapy is indicated. The following question has to be asked: which symptoms or disorders should be treated in order to improve the child's relationship with its parents and to promote the child's psychological development? The autonomy of the patient and his or her parents has always to be respected. It is the task of the child and adolescent psychiatrist to integrate knowledge of the mechanisms of pharmacological treatment and the underlying neurobiological processes, and at the same time to offer a significant relationship and a meaningful dialogue in order to meet the need of the ill child and its family. The article discusses psychobiological aspects of early influences in brain development according to various research data, as well as effects on memory and the regulation of the hypothalamicpituitary-adrenal axis. The differences of psychopharmacological treatment of psychiatric disorders in children and adolescents with respect to adult psychopharmacotherapy are described: the child's symptomatology is closely related to its emotional, cognitive and psychosocial developmental process, as well as to the context in which the child is living. The differences in pharmacological efficacy in children are due to numerous factors such as differential expression of neurotransmitters and receptors in childhood. The importance of a therapeutic concept for each individual ill child and its family and the necessity to consider multiple factors are presented. The author deals with depressive syndromes and their treatment modalities in children and adolescents. Various interventions - psychopharmacology, different forms of psychotherapy - have shown their efficacy, demonstrating the complexity of the interactions of neurobiological processes and environmental influences, as well as the plasticity of neuronal structures and functions. Coping with a psychiatric but also a somatic disease shows a great individual variability and depends on a multitude of individual psychological resources as well as external circumstances such as parental or family support.