Risks, Benefits, and Diagnosis

Response 1

Introduction

The research focuses on the risks and benefits related to the use of psychiatric drugs with an appropriate and inappropriate diagnosis of a psychiatric disorder in children.

Discussion

The research is about the effect of psychiatric drugs on children. The main factor associated is the appropriate or inappropriate treatment of the psychiatric disorder. Investigators believe that the current epidemic of child psychiatric disorders is due to inappropriate diagnoses. The drugs that are given for any disorder have multiple effects on the body. The psychiatrist needs to understand the risk and benefits of drugs in children. Risks and benefits are not only associated with the treatment of a drug. Rather this has to be seen when the treatment is not given due to wrong or simply no diagnosis of the psychiatric disorder. Ethics in the field of psychiatry is very important. The patient and his family must respect and regard the efforts of the psychiatrist, and he must keep all the history and patient treatment confidential.

Literature review

The issue of misdiagnosis or overdiagnosis is a common and prevailing issue in the field of child psychiatry. Cases of wrong or misdiagnosis have been reported more in the past few years as compared to overdiagnosis. In the recent study by Merten et al. 2017, the issue of misdiagnosis has been elaborated on, and many factors have been identified. The reasons for misdiagnosis have been a lack of availability of appropriate history and behavior patterns by the caregivers of the patient, and the right interpretation of the collected data for a certain case has been seen. This puts a question mark on the diagnostic techniques and the issues related to health care systems. Psychiatric drug patterns of children show that the most common drug used is related to hyperactivity or attention deficit disorder.

Examples

Several psychotic drugs have adverse effects on the metabolic system, such as weight gain, increased glucose level and insulin resistance. All these factors lead the body towards type II diabetes mellitus. Studies have shown that the use of the psychiatric drug becomes the cause of diabetes type II in children and young adults with ages ranging from 6 to 17 years. The common psychiatric disorders observed in children are schizophrenia, bipolar disorder and affective disorder. Most of the disorders are related to behavior and conduct. The majority of prescriptions are related to the mentioned disorders. (Bobo et al., 2013)

Conclusion

Studies have shown that controlled psychotic medication is less likely to become the cause of diabetes mellitus type II disease, whereas misdiagnosis is completely devastating. Treating a patient with the wrong medicine due to misdiagnosis affects the patient health and is likely to get the bad effects related to the psychotic drug. Other than this, there is a need to emphasize the importance of tools and techniques used for the appropriate diagnosis. In psychiatry, recording relevant patient history and relating it to the relevant disorder is the crux of all procedures. A wrong diagnosis doesn’t leave the patient to get the worst of the disease, but the patient also gets exposed to the risks of the wrong drug by which he is treated.

 

 

References

McKENNA, K. A. T. H. L. E. E. N., Gordon, C. T., Lenane, M., Kaysen, D., Fahey, K., & Rapoport, J. L. (1994). Looking for childhood-onset schizophrenia: the first 71 cases screened. Journal of the American Academy of Child & Adolescent Psychiatry, 33(5), 636-644.

Merten, E. C., Cwik, J. C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and adolescent psychiatry and mental health, 11(1), 1-11.

Lissak, G. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental research, 164, 149-157.

Bobo, W. V., Cooper, W. O., Stein, C. M., Olfson, M., Graham, D., Daugherty, J., ... & Ray, W. A. (2013). Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA psychiatry, 70(10), 1067-1075.

Oto, M. M. (2017). The misdiagnosis of epilepsy: appraising risks and managing uncertainty. Seizure, 44, 143-146.

Björkenstam, E., Hjern, A., Mittendorfer-Rutz, E., Vinnerljung, B., Hallqvist, J., & Ljung, R. (2013). Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults. PloS one, 8(1), e53551.

Response 2

Child psychiatric disorders:

When a person gets treated for a psychiatric disorder, it is hard enough for them to get the correct diagnosis and treatment. It seems even more difficult for a child to have the proper diagnosis and treatment. There appears to be a large amount of inappropriate diagnosis or even treatment for children, and at the same time, there has been undiagnosed and undertreatment for severe problems. (Merten, E. C., et al. 2017). We have seen that more people, including children, can get help than they in mental health. However, how can someone be inappropriate diagnosed? First off, you are working with a child. They might not tell you everything that they are having issues with, or the parent is giving information that might not match the child, or if even there are notes from school stating that the child is suffering from ADHA, for instance, that is the teachers view but they cannot diagnose. So, the information they might write might be more focusing on ADHD, but the child could be suffering from something else such as anxiety or depression. When an assessment is completed, there are bound to be discrepancies since the information comes from multiple sources. (Srinath, S. et al., 2019) We can see this having various sources, and they are stating different symptoms or what the child may be doing. This is one reason a child could be missed diagnosed in the first place. Another thing to look at is the genic factor; the child might have this in their family and was never told about it, or if they know about they might have been told not to speak about it, or even the parents might not even say anything about it when they complete an assessment on the child and the family history. Even though we are in 2022, there still is some stigma surrounding the psychiatric disorder. 

If we have a child that has been diagnosed and they are put on medication, what can it do, and how can it affect the child. Several psychotropics have been proven effective for treatment in a child, such as stimulants that can treat ADHD, and SSRIs are approved to treat OCD, depression, and anxiety disorders in children. (Lakhan, S. E., & Hagger-Johnson, G. E. 2007). With that being stated, there still can have some issues with giving a child these types of medications. For instance, some stimulants might be used for a child until a certain age, and maybe SSRIs can be treated for OCD at one age, but for depression or anxiety, it might be a later age in the child's life that they can take them. There are some myths about treating children and adolescents; sometimes, there are few adults, children have no reason to develop depression or anxiety, psychiatric disorders are the same as adults & children, children can be prescribed a lower dose, and drugs are successful treating psychiatric disorders. (Lakhan, S. E., & Hagger-Johnson, G. E. 2007).

With those statements, we know that is not true when thinking of the idea that a child is a little adult; when it comes to the development of the brain and body, that is way far from the truth. We know that medications can give us side effects for taking any medication as an adult, so it will still happen with a child, and sometimes it can be way worse for them. In the article that Lakhan and Hagger-Johnson write, they stated, “Rather, they represent distinct subpopulations, each with their unique characteristics, and, thus, the response to drug therapy from birth to adolescence and adulthood is a function of developmental processes that affect drug disposition and the interaction of drugs with their pharmacologic targets ."To give a child SSRI suffering from depression, you would not want to provide them with that because it can increase suicidal risk in children or adolescents. We know that the adult brain is developed, and the brain areas that might be affected are the neurotransmitters. In a child or adolescence, they have not whole developed, and the neurotransmitters are still learning their functioning. Stimulants can be addictive, and if a child was on Ritalin, it could desensitize the brain and cause addiction problems later. (Lakhan, S. E., & Hagger-Johnson, G. E. 2007).

  Looking if a medication could help a child from some of the disorders they are suffering from, such as ADHA, can help, but other things should be with the drug, such as CBT or other therapy. Medication alone cannot fix the problem; it's like with any other disease or disorder; there are things that a person needs to do to get better. To conclude or wrap up this topic, we know that children can have mental health issues or other disorders like ADHD that need some medication to help them because they are showing signs and symptoms. However, we must look at the doses that we are giving them because they are still small, their CNS with the neurotransmitter is still developing, and we don't want to cause more damage to them that can affect them in adulthood. When it comes to a child that might display symptoms like ADHD or anxiety, we should do assessments with the child, talk to the child, and look for other avenues of helping the child, and medication is way in the background. It's an option, but it should be the last and first option.

 

Reference

Lakhan, S. E., & Hagger-Johnson, G. E. (2007). The impact of prescribed psychotropics on

youth. Clinical practice and epidemiology in mental health: CP & EMH, 3, 21. https://doi.org/10.1186/1745-0179-3-21

Merten, E. C., Cwik, J. C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental

disorders in children and adolescents (in developed countries). Child and adolescent psychiatry and mental health, 11, 5. https://doi.org/10.1186/s13034-016-0140-5 (Links to an external site.)

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for

Assessment of Children and Adolescents. Indian journal of psychiatry, 61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18