Children on psych meds raise these ethical concerns

Desire for "quick fix"

It is vital for providers caring for pediatric patients not to jump to a diagnosis just because it is in the Diagnostic and Statistical Manual of Mental Disorders (DSM)V, argues Harold J. Bursztajn, MD, associate clinical professor of psychiatry at Harvard Medical School in Cambridge and co-founder of the Program in Psychiatry and the Law at Beth Israel Deaconess Medical Center. Bursztajn is president of the American Unit of the United Nations Educational, Scientific and Cultural Organization Bioethics Chair.

"The differential diagnosis needs to includes psychosocial or situational difficulties, rather than simply what is only in the main sections of the DSM," says Bursztajn. "There is also the problem of false positives, due to the search for a quick fix promoted by some pharmaceutical companies aimed at vulnerable families and clinicians desperate for help, and the problem of false negatives due to denial of major mental illness."

Providers should not overlook the possibility of Munchhausen syndrome or shared paranoid disorder in formulating the differential diagnosis, adds Bursztajn. "One needs to respect family values, as well as consider such fundamental values as maintaining children’s autonomy and authenticity — and the cumulative effects of both suffering from an illness and the increasing risk burden of many psychotropic medications when used chronically," he underscores.