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Child and adolescent psychiatry is the medical specialty that works with children, young people, and families with emotional and behavioural problems. As children and young people are still developing and grow–ing, their emotional wellbeing and functioning needs to be thought about in this context, making it different from adult psychiatry. Communication with people of all ages is vital within the specialty and information from a wide variety of sources, including parents or carers, school, and peers, is used to inform the clinical picture, in addition to history-taking and direct observations of the child’s behaviour. Play is often used to understand younger children’s thoughts and feelings. In theory, the specialty covers children and young people from birth up to the teenage years, although different services cover slightly different age ranges. The spectrum of difficulties covered within the specialty include psy–chiatric disorders also seen in adults (such as psychosis); problems spe–cific to the age group (such as separation anxiety); lifelong conditions which start in childhood (such as ADHD); and conditions that may pre–sent in different ways in childhood or adolescence (such as phobias). Approaches to treatment include psychopharmacological interven–tions, and numerous therapeutic modalities including family therapy and CBT, which can be modified for different age groups. Most work is community based, although there are specialist inpatient units which offer on-going educational opportunities to young people who need the intensive support and risk reduction of a hospital admission. Work tends to be done within MDTs using a range of knowledge and expertise to offer the most appropriate care.

There are many different medications used for ADHD, and these should only be prescribed by a medical specialist experienced in this field. Many children with ADHD do not need to take their medication every day of the week. The availability of long-acting medication means that most children with ADHD do not need to take medication at school. This chapter presents a detailed guide to specific medicines for ADHD, including short-acting stimulant medicines (Ritalin, Focalin, dexamphetamine, and Adderall IR), long-acting stimulant medications (Concerta, Ritalin LA, Focalin XR, Daytrana, Adderall XR, Metadate CD, and Vyvanse), and non-stimulant medications (imipramine [Tofranil], Clonidine, guanfacine [Intuniv], and atomoxetine [Strattera]).

Persons with HIV and AIDS are often prescribed a plethora of medications, all of which require special attention and are based on well-defined principles. In the first part of this chapter, Drug Interaction Principles, we provide a short but essential review of these principles in order to prepare the reader to critically weigh the potential for drug interactions between psychotropics and antiretroviral therapy (ART) and those between ART and other medications. In the second part, Psychotropics and HIV, a brief review of the available literature on the effectiveness of psychotropics in treating patients with HIV is provided, followed by an overview of issues relating to drug interactions for each psychotropic or class of psychotropic. The third part of the chapter, Antiretrovirals, provides an introductory overview of currently available antiretrovirals and of medications prescribed in treating HIV/AIDS. Readers are referred to an excellent review of pharmacological treatment for persons with addictions and HIV/AIDS, by Wynn and colleagues (2005), and to Chapters 2, 6, 8, and 10 of this handbook for more information on treating substance abuse and dependence. Understanding drug–drug interactions in the care of HIV patients is essential. For a full explanation of psychotropic pharmacology and drug interactions, the reader is referred to additional texts on the subject (Cohen and Gorman, 2008; Schatzberg and Nemeroff, 2009; Wynn et al., 2009). Pharmacodynamic interactions are those that occur at the intended receptor site of a medication and involve absorption, distribution, metabolism, and excretion. ART drugs may be affected by timing with food or buffers, which is relatively predictable. Metabolic interactions are a bit more complex, as they are affected by metabolic inhibition, induction, and pharmacogenetics (the particular metabolic enzymes that a patient is born with). Metabolic interactions may occur in either phase I or II metabolic enzymes and also may include the cell membrane transporter enzymes (also known as p-glycoproteins). For a complete explanation of pharmacokinetic interactions, the reader is referred to the text by Wynn et al. (2009).