31.18e Psychiatric Treatment of Adolescents
1301
than 0.12) may necessitate lowering the dosage. FDA guidelines
limit dosages to a maximum of 5 mg/kg a day. The drugs can
be toxic in an overdose, and in small children, ingestion of 200
to 400 mg can be fatal. When the dosage is lowered too rapidly,
withdrawal effects occur, mainly gastrointestinal symptoms—
cramping, nausea, and vomiting—and sometimes apathy and
weakness.
Antipsychotics
The SGAs have generally replaced the conventional antipsy-
chotics as first-line agents in the treatment of all psychotic dis-
orders in children and adolescents. Historically, the best-studied
antipsychotics given to pediatric age groups are chlorpromazine
(Thorazine) and haloperidol. High-potency and low-potency
antipsychotics are thought to differ in their adverse-effect
profiles. The phenothiazine derivatives (chlorpromazine and
thioridazine) have the most pronounced sedative and atropinic
actions, whereas the high-potency antipsychotics are com-
monly believed to be associated with extrapyramidal reactions,
such as parkinsonian symptoms, akathisia, and acute dysto-
nias. The risk of tardive dyskinesia in relation to antipsychotics
leads to caution in the use of drugs. Tardive dyskinesia, which
is characterized by persistent abnormal involuntary move-
ments of the tongue, face, mouth, or jaw and sometimes the
extremities, is a known hazard when giving antipsychotics to
patients of all age groups. No known treatment is effective.
Because transient choreiform movements of the extremities
and trunk are common after abrupt discontinuation of antipsy-
chotics, clinicians must distinguish these symptoms from per-
sistent dyskinesia.
R
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31.18e Psychiatric Treatment of
Adolescents
Adolescence, biologically beginning with puberty, is a period
in which social, intellectual, and sexual development take place
alongside specific brain processes that enhance teens’ abili-
ties for increased abstract reasoning and greater sensitivity to
social nuances. However, the developmental brain processes
are spread over many years, and maturation is subject to indi-
vidual variation. Inherent in development is continuing change;
however, most adolescents adapt to changes gradually, and their
path toward greater autonomy and independence is not charac-
terized by perpetual crises and struggle. Milestones achieved
by adolescents during their developmental journey to adulthood
are typically reached without overwhelming strife or interven-
tion. However, psychiatric treatment is indicated for an adoles-
cent who develops a disturbance of thought, affect, or behavior
that disrupts normal functioning. In adolescents, disruption of
functioning influences eating, sleeping, and school function, as
well as relationships with family and peers. A variety of serious
psychiatric disorders, including schizophrenia, bipolar disorder,
eating disorders, and substance abuse typically have their onset
during adolescence. In addition, the risk for completed suicide
drastically increases in adolescence. Although some degree of
stress is virtually universal in adolescence, most teenagers who
do not develop serious mental disorders cope well with environ-
mental demands. Teenagers with preexisting mental disorders
often experience exacerbations during adolescence and may
become frustrated, alienated, and demoralized.
Clinicians and parents seeking a window into an adolescent’s
viewpoint should be sensitive to their self-perceptions. A range
of emotional maturity exists in teens of the same chronologi-
cal age. Issues characteristic of adolescence are related to new
evolving identities, the development of sexual activity, and
developing plans to meet future life goals.
Diagnosis
Adolescents can be assessed with a focus on general progress in
accomplishing the tasks of individuating and developing a sense
