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.

Children and Divorce.

Divorce is a life event with a high level of stress for the entire family. Research shows that the number of divorces is on a steady rise. Family is very important for development of the children and changes within the family, after the divorce, could make consequences on them. Children are dependent on parents and disadvantaged during divorce because it is out of their control. They cannot predict how long will it take and what will be the outcome of divorce which includes separation from close family members, school change, change of home, change of life style and so on. Children often lack information and skills to overcome the challenges that the divorce carries. Conflicting relationships between parents make up the biggest obstacle that makes it difficult for a child to successfully deal with changes in the family. Even though parents deal with heavy feelings, it is desirable to put them the child and his interests in the first place. In order to stabilize the family system it is needed 2 up to 4 years. Children differ from one another in the reactions to the divorce, but there are some emotional reactions that are characteristic for most children of divorced parents, and the most often children reactions are of depressive symptoms, anxiety, anger, lower self-esteem and so on. The emotional reactions of children during the divorce can vary relative to the gender and age of the child. However, the divorce of a parent does not necessarily have to be so negative for children, especially if parents behave in an adequate way and they endeavor to act in such a way to make this process as painless as possible for children.

Cannabis and psychiatric disorders.

There are connection between use of cannabis and many psychiatric disturbances in adolescents, especially "cannabis psychosis", depression, panic attacks and suicide. Negative effects could occur either as a result of a specific pharmacological effect of cannabis, or as the result of stressful experiences during the intoxication of cannabis in young people. Potentially is very dangerous high frequency suicidal ideation among cannabis users.

The relationship between suicidal thoughts and psychoactive substances.

In this study is represented the relationship between suicidal thoughts and psychoactive abuse. In study were involved 202 students of Banjaluka's secondary schools. By questioned for risky behaviour of adolescents was found 28.7% of them have suicidal thoughts, and 144 haven't suicidal thoughts. Students from both groups use alcohol but there are not statistically significant differences among groups. The representative sample was 202 students from Banjaluka's secondary schools. The results showed that 28.7% of them have suicidal ideas. From examined students 20.2% used cannabis, and 4% other psychoactive substances, 56.9% alcohol and 35.6% smoke cigarettes. In the group with suicidal ideas, use of psychoactive substances is 8.6%, alcohol use in 63.7% cases and cannabis 36.2%, and smoking cigarettes in 48.2% cases. We may conclude that misuse of psychoactive substances is more present in group with suicidal ideas, except in case of alcohol, which was also high in group with suicidal ideas, but without statistical significances. It is also possible to conclude that there is important connection between use of psychoactive substances and presence of suicidal ideas as first step toward a suicide in adolescents.