Change in Psychotropic Prescribing Patterns Among Youths in Foster Care Associated With a Peer-to-Peer Physician Consultation Program.

There has been growing concern about the safety and efficacy of psychotropic prescribing practices for children enrolled in Medicaid and in foster care. In response, accreditation organizations and policymakers have developed standards for optimal use of psychotropic medications among children. In addition, federal legislation has prompted states to implement monitoring programs to address quality and safety issues among vulnerable pediatric subpopulations.

Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders.

Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves.

Psychotherapy and medication management strategies for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT) and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response.

Pharmacological strategies for trichotillomania.

Pharmacotherapy for trichotillomania (TTM) is not well established, due to a paucity of positive, controlled, long-term studies. Although selective-serotonin re-uptake inhibitors (SSRIs) seem to be the safest and best-established medication choices, positive treatment response is not consistent in the literature. Treatment response is often disrupted by significant relapse.

Pharmacological augmentation strategies for treatment-resistant obsessive-compulsive disorder.

First-line treatment for obsessive-compulsive disorder (OCD) has been well-established for over a decade, although newer medications, such as citalopram and venlafaxine, have emerged to take a place among the older, more established serotonin re-uptake inhibitors (SRIs). Unfortunately, as many as 50% of all patients with OCD will have symptoms refractory to a single medication treatment trial, and a smaller percentage will remain refractory after two or more trials. The optimal dosage and duration for first-line trials have been established.