Single and combined psychotropic medication use in a child and adolescent mental health service

Objective: An audit of the extent and effectiveness of medication prescribing in a metropolitan child and adolescent mental health service (CAMHS) is presented, given the lack of data about medication effectiveness in CAMHS. Method: The audit involved: (i) determining the rates of prescription of different medications, the symptoms, syndromes and diagnoses for which they were used, and the profession of the medication prescriber; and (ii) a semistructured interview of clinicians using combination pharmacotherapy enquiring about the rationale for its use and the outcomes obtained. Results: Two hundred and thirty-five patients using medication were included in the study. A range of medications were prescribed, both alone and in combination. Indications for combination therapy were a single medication being ineffective or associated with adverse effects. They were targeted at symptoms and were associated with no increase in adverse effects. Trainees did relatively little prescribing. Conclusions: This study confirms earlier findings that medical practitioners are prescribing combination pharmacotherapy despite a lack of research to support this practice. Trainees working in CAMHS may be receiving inadequate experience in prescribing psychotropic medication.