Abstract
Psychopharmacotherapy in children and adolescents is characterized by an increased
susceptibility for adverse events and an increased risk of ineffective treatment due
to specific age-dependent and developmental characteristics in comparison to adults.
Dosing in paediatric psychiatric patients requires careful handling, since the dose
recommendations for adults can not simply be extrapolated to minors because of pharmacokinetic
and pharmacodynamic differences. In addition, psychopharmacotherapy in children and
adolescents is hampered by lack of high quality evidence on efficacy and safety in
many indications and subsequently a high degree of off-label use. Therapeutic Drug
Monitoring (TDM) is an established and useful tool in psychiatry to individualize
and optimize the outcomes (efficacy/safety balance) of psychopharmacological drug
treatment in the individual patient by dose adjustments based upon measured serum
concentrations. In children and adolescents the administration of psychotropic drugs
is a general indication for performing TDM. However, TDM studies specific in these
age groups are necessary to identify age and indication specific therapeutic ranges
of serum concentrations. Systematic collection of data on drug exposure, serum concentrations
and clinical characteristics as well as outcomes can generate such practice-based
evidence. A German-Swiss-Austrian competence network for TDM in child and adolescent
psychiatry using a multi-centre internet-based data infrastructure was founded to
document and collect demographic, safety and efficacy data as well as blood concentrations
of psychotropic drugs in children and adolescents (further information: www.tdm-kjp.com).
Key words
therapeutic drug monitoring - child and adolescent psychiatry - psychopharmacotherapy
- developmental psychopharmacology