Pharmacotherapy (use of medications)

Pharmacotherapy (use of medications)

Persistent problematic behaviour like self-harming can be very distressing and therefore needs to be treated. 

It should first be considered if there are some physical, mental, and environmental issues that are leading to the problematic behaviour This should be by careful assessments and solutions should be looked for by changes in the environment such as softer lighting, and behavioural therapy. 

If these solutions are not enough, medication should be considered. There is not much scientific proof that psychotropic medication is effective in children with PTHS, and there have been no controlled studies. Still, in a survey on medication during the PTHS World Conference 28 families gave their experience on different types of medication and their effects and side effects. 

Melatonin and/or gabapentin was used for sleep problems, methylphenidate and clonidine were used for irritability, agitation and hyperactivity, and lorazepam had been used for agitation. Antipsychotic agents, pipamperon and promethazine, were used to help with challenging behaviour. These antipsychotics should be carefully monitored, evidence for effectiveness is limited and long-term use may result in significant harmful effects such as weight gain, high blood pressure and diabetes. Overall, parents reported satisfaction with medications prescribed and noted few significant side effects, but no single medication was found to be extraordinarily effective. 

In general prescriptions should start at low doses and gradually give more or less medication, in a slow way, to obtain the best effectiveness. One should monitor health before starting and while giving medications, and consider from time to time if stopping of continuing medication is useful. One should ask for the opinions of the caregivers on the effects of medications (R40).