Somatic and Neurologic Considerations, including Psychopharmacology
Somatic and neurologic considerations, including psychopharmacology
Before attributing symptoms to psychiatry, screen for medical mimics: seizures, sleep apnea, thyroid disease, anemia, delirium, autoimmune/endocrine disorders, genetic syndromes, hearing/vision problems, and substance effects. Neurologic findings-focal deficits, headache with red flags, regression, abnormal movements-require evaluation. Psychopharmacology in youth demands developmental dosing, FDA labeling awareness, off-label consent, baseline and follow-up monitoring, and attention to interactions. Know black-box warnings (suicidality with antidepressants), metabolic monitoring with antipsychotics, ECG/QT concerns, prolactin, movement disorders, serotonin syndrome, NMS, and discontinuation syndromes. Stimulants can affect appetite, sleep, growth, and blood pressure.
Traps: assuming a new behavioral change is "just psychiatric" and missing delirium or a seizure; starting antipsychotics without metabolic baseline; combining serotonergic agents without asking about OTC drugs; and ignoring adherence or diversion. Questions often ask the next step when a child on medication develops new symptoms-first check vitals, adherence, interactions, and medical causes.
Worked example/rule of thumb: An adolescent on risperidone becomes more sedated and gains weight. Check metabolic parameters, sedation, and alternative causes; do not simply increase the dose. Rule: new or atypical symptoms on psychotropics warrant a medication review and medical workup before a psychiatric explanation.