Transcript Mohammad Ali Sahebi

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 treatment
6-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 medications
10-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
a comprehensive approach to is
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
psychopharmacologic treatment is for
between the physician,patient collaboration
decision making-regarding
and family-shared
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 do
2-Do so within a reasonable time
3-Do not cause more harm than good
4-Do not deny the patient accessibility to other
proven helpful treatments
5-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.