Mohammad Ali Sahebi

Child and adolescent psychiatrist

Which Factors Affect on Compliance in Children and

Adolescents?

Compliance:Patient adherence to a specific treatment plan.

The most common reasons for prematurely discontinuation of a potentially effective treatment

1-Side effects of treatment

2-Initial clinical improvement

3-Denial of illness

4-Family,peer or social

pressure 5-Confusion about the illness or its optional

treatment6-Idiosyncratic personal reasons(meaning of medication use)

7-Effects of illness itself(hopeless delusions about poisoning)8-Previous negative experience with medical treatment

9-previous negative experience with psychotropic

medications10-cost of treatment

11-misinformation about psychotropic (drugs are

addictive) 12-Unreliability of responsible adult(e.g. medication dispensing )

Psychopharmacologic treatment is not simply the act of prescribing medication.It is a comprehensive approach to the

physician-patient relationship

The most important principles of the physician-patient relationship :

1-competency

2-collaboration

3-Evaluative-based care

4-flexibility

5-Effective communication

Competency:The physician must demonstrate competency in a variety of areas

including diagnosis,course and prognosis and a variety of potential treatment(including biologic and non biological)

At the same time she must be able to recognize and acknowledge the limits of her knowledge.the phrases"I don't know" or "I'm not sure" need to be part of every physician's language which need to

be matched with "But I know of a way to find out “.

Collaboration:

The most useful framework of clinical care for psychopharmacologic treatment is collaboration between the physician,patient and family-shared

decision making-regarding treatment .

Essential components of collaborative model:

1-The physician respects the rights,abilities and limitations of each patient and her family

2-The physician provides clear and understandable information about rationale,efficacy and availability of a number of treatment alternatives

3-The physician provides advise as to potentially optimal treatment choices base on his knowledge of the expected outcome of various treatments,not his school or orientation

4-The patient and her family decides what type of treatment will be given

5-As long as this decision is reasonable,the physician supports the patient and family decision

6- The physician and parent/family identify the method by

which,and time frame within which,treatment efficacy will be determined

7-In case the selected treatment is not shown to be effective,alternative methods of treatments are discussed and provisionally agreed to before the outcome of the chosen method of treatment is evaluated

8-Responsibility for the proper maintenance of the chosen treatment is shared by the patient/family and the physician

9-Changes in the chosen treatment are to be made only following the agreement of all participating-physician,patient and family

Evaluative-Based care:

for all treatments it must be demonstrated using appropriate scientific methods that they:

1-Do what they are said to do2-Do so within a reasonable time

3-Do not cause more harm than good4-Do not deny the patient accessibility to other

proven helpful treatments5-Are cost effective

Flexibility:Psychopharmacologic treatment demands practitioner flexibility in the provision of care.

1-The practitioner must be able to support reasonable patient decision about treatment that in her opinion may not be the first choice

2-She must be flexible in the practical structure of clinical care that is delivered by her

Effective communication:clear,direct and supportive communication is necessary for effective psychopharmacologic treatment.