Psychotropic drug interactions in systemic disorders of children and adolescents

Psychiatric morbidity in chronic childhood illnesses is higher than general population ranging with 10–30%. Risk factors for morbidity are multiple admissions to hospital, adaptation to illness, physical disability, brain dysfunction, pain frequency, younger age, poverty, single parent family and increased psychological symptoms in the parents. In psychiatric consultation, patients receive psychotropic medication for broad-ranging diagnoses, including depression, anxiety, delirium, behavioral disturbances, and substance abuse and withdrawal. Potential for specific drug-disease and drug-drug interactions is enormous. The appropriate use of psychopharmacology in medically ill patients requires consideration of the underlying medical illness, potential alterations to pharmacokinetics and pharmacodynamics, drug–drug interactions, and contra indications. By recognition of these issues, there must be great consideration about the prescription, safety, and efficacy of psychopharmacological treatments in medically ill patients. Physical disease and organ failure can interfere with drug absorption, distribution, metabolism, and elimination. A physical condition and malfunction organ can also inşuence a variety of different aspects of drug handling. Therefore, these conditions are important in choosing and managing psychoactive medications. Psychopharmacological agents need monitoring and modifying drug dose or administration in seriously ill patients. While most psychoactive drugs are primarily subject to hepatic metabolism, hepatic disease or failure, mostly, challenges treatment of psychiatric disorder. Using drugs in patients with renal impairment needs careful consideration especially lithium. Moreover, medical conditions related with cardiovascular disease (congestive heart failure, cardiac conduction abnormalities, etc.), pulmonary disease and respiratory disorders (hypoxia and hypercarbia, cystic fibrosis), gastrointestinal disease (mucosal integrity or gut motility, lumen pH) and endocrine disease affect pharmacokinetic and pharmacodynamic properties of drug. We will discuss these drug-disease interactions with case illustrations in systemic disorders.