Creative Psychopharmacotherapy in Child and Adolescent Psychiatry and Experiences from Bosnia and Herzegovina.

INTRODUCTION: Paediatric psychopharmacology involves the application of psychotropic agents to the treatment of children and adolescents with mental disorders and gathered knowledge from child and adolescent psychiatry (CAP), neurology, paediatrics and pharmacology. Defining elements of this discipline are: the metabolism of drugs is different in children than in adults (pharmacokinetics), the developing brain reacts specifically to the drug (pharmaco dynamics), and psychopathology itself is not differentiated yet. To make and overview of specifics in psychopharmacological use in CAP and emphasize some experiences from Bosnia and Herzegovina in that field. METHODS: Through insight in current literature, we presented comprehensive findings and compare it with situation in Bosnia and Herzegovina. RESULTS: The most common conditions in which psycho pharmaceuticals are used in CAP were attention deficit hyperactivity disorders (ADHD), depressive and bipolar disorder, obsessive compulsive disorder and the treatment of early psychosis. Psycho pharmaceuticals were also used to treat agitated conditions in various causes. We made an overview of psycho pharmaceuticals use in Bosnia and Herzegovina CAP and emphasized the fact that psycho stimulants are not approved for the use yet, although they are mostly prescribed medicament in CAP over the world. That limits us in the effectiveness of the treatment in ADHD and put us in the situations to use other medicaments instead (anxiolytics, antipsychotics, mood stabilizers) which are not approved for that condition. CONCLUSION: The use of psycho pharmacotherapy in CAP is justified in cases where it is necessary to reduce the suffering of children and to improve their functionality at the time when cognitive, social and emotional advancement is most pronounced. Further research and clinical monitoring of efficacy and safety in the use of psycho pharmaceuticals in youngsters are necessary.

Psychological Consequences in Abused and Neglected School Children Exposed to Family Violence.

Although family should be the basis for the development and formation of a child's personality, violence is mostly done in the family, and remains undiscovered for a long time. The real number of abused children is much more than that displayed in the registered cases. The secrecy of the problem is an important feature of this phenomenon. Families in which abuse takes place are mostly isolated. Social isolation does not come about by chance; secrecy is usually encouraged by an abuser to control over famoly members. In most cases, social reaction to violence is late, inadequate and focused on the consequences, but not on the causes. "Abuse implies an act of execution that directly inflicts damage, while neglect implies an act of non-fulfillment of something that is necessary for the well-being of a child". The most common forms of domestic violence are physical, emotional abuse in the presence of violence against the mother, and in a lesser extent sexual abuse. In addition, there is physical, emotional, educational and medical neglect. The presence of violence against the mother and the feeling of impotence leave the same consequences as the endured violence. It is considered that children living in violent families are likely to live under cumulative stress. Traumatic responses include a wide range of conditions from acute stress reactions through post-traumatic stress disorder to complex long-lasting, repeated trauma syndrome. All children will not react to this kind of experience in the same way, with the protective and risk factors in developmental psychopathology having a significant role to play. Because of their developmental vulnerability and dependency, children are at greater risk of violence than adults. Researches point to the need for a multidisciplinary approach to treatment and prevention of child abuse, with greater interaction between health institutions, relevant centers for social work, police, court, government and non-governmental sector, and the existence of adequate family and criminal laws.