title: Priority mental health disorders of children and adolescents in primary-care pediatric settings in India 2: diagnosis, pharmacological treatment and referral.
abstract: The advent of pediatric psychopharmacology has enormously improved psychiatric care of children and adolescents. Nonetheless, our practice of diagnosis, treatment and referral in primary-care pediatric settings is not optimum as current evidence based knowledge is not regularly applied in the actual clinical circumstances. To help primary-care pediatricians minimise this in research-clinical practice, pharmacological treatment and referral in their clinical practice, they need to follow a two-tier diagnostic and multi axial treatment approach. The two-tier diagnostic approach of using a screening measure followed by confirmation of the screen positive cases with reference standard clinical criterion, improves the sensitivity and specificity. The multiaxial treatment has the advantage of offering a holistic approach to the intervention and improve prognosis from the interacting axes. The primary-care physician should be aware of the medications of choice for the Priority Mental Health Disorders and their drug interactions. Finally, referral of cases with atypical presentations, multiple comorbidities and poor response to the first-line of treatment needs referral to the next tier in the system.
authors: Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 004, India. russell@cmcvellore.ac.in
authors: P S
authors: PS
authors: Russell
authors: M K C
authors: MK
authors: Nair
authors: P
authors: P
authors: Mammen
authors: S R
authors: SR
authors: Shankar
references: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD005040
references: 17253538
references: J Am Acad Child Adolesc Psychiatry. 2000 Jul;39(7):841-9
references: 10892225
references: Psychiatr Serv. 2001 Jun;52(6):800-4
references: 11376228
references: Intensive Care Med. 2007 Jun;33(6):1033-40
references: 17457571
references: Cochrane Database Syst Rev. 2003;(3):CD002117
references: 12917922
references: Psychopharmacology (Berl). 2007 Oct;194(2):197-209
references: 17572882
references: Am J Psychiatry. 2003 Jun;160(6):1071-7
references: 12777264
references: Neuropsychopharmacology. 2004 Jan;29(1):133-45
references: 14583740
references: Neurology. 2003 Apr 8;60(7):1130-5
references: 12682319
references: J Pediatr Psychol. 2002 Mar;27(2):167-76
references: 11821500
references: Child Psychiatry Hum Dev. 2006 Fall;37(1):55-64
references: 16927177
references: Pediatrics. 1993 Mar;91(3):649-55
references: 8441575
references: J Am Acad Child Adolesc Psychiatry. 2005 Dec;44(12):1263-70
references: 16292118
references: J Child Adolesc Psychopharmacol. 2005 Apr;15(2):311-7
references: 15910215
references: Paediatr Drugs. 2002;4(11):697-703
references: 12390041
references: Pediatr Clin North Am. 1998 Oct;45(5):1037-52
references: 9884674
references: Arch Pediatr Adolesc Med. 1999 Mar;153(3):254-60
references: 10086402
references: Lancet. 2004 Apr 24;363(9418):1341-5
references: 15110490
references: Pediatrics. 2002 Jul;110(1 Pt 1):e8
references: 12093989
references: J Affect Disord. 2004 Oct;82 Suppl 1:S103-11
references: 15571784
references: Ambul Pediatr. 2006 Nov-Dec;6(6):352-5
references: 17116610
references: J Child Psychol Psychiatry. 1988 May;29(3):289-300
references: 3417805