Publication
Pediatric psychopharmacology: To use or not to use at the end of life
Pao M · Psycho-Oncology · 2016
PURPOSE: Psychological symptoms ranging from distress to more debilitating depression and anxiety with worsening somatic symptoms can hamper communication, particularly at the end-of-life. Treatment with psychotropic medications may be useful for symptomatic and syndromic relief. METHODS: A review of the evidence base for psychotropic medication use in pediatric psychooncolgy and of the Micromedex database regarding FDA indications and approvals for medications used in children was conducted. RESULTS: No published randomized controlled trials were found. Barriers to conducting such trials e.g. multiple medical diagnoses, multiple medical treatment regimens, severity of medical illness, psychosocial factors, stigma of psychiatric diagnoses, subthreshold psychiatric diagnoses and fear of psychiatric medications will be reviewed. FDA-approved psychotropic medications for use in children with delirium, depression, anxiety, psychosis, and symptom relief (i.e. insomnia), including off-label use, will be presented. Side effects and common drug-drug interactions will also be discussed. CONCLUSIONS: Approaches to help children address emotional and physical concerns at the end of life can include pharmacologic approaches which may enhance a child's ability to communicate or fully utilize other psychosocial interventions and therapies. Research Implications: To date, there are no randomized controlled trials using different psychopharmacologic interventions in pediatric oncology patients for mental health symptoms or disorders. A multidisciplinary effort could overcome barriers to undertake such trials which could add useful clinical information to the field. Clinical Implications: Appropriate and timely psychopharmacologic intervention can enhance overall psychosocial care of the child with cancer and may facilitate end of life communication for pediatric patients.
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.