Case Report: Deprescribing psychotropic medication with an adolescent boy with complex emotional and behavioural challenges

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Abstract
Background: The prescription of psychotropic drugs to children and youth has been on the rise. Polypharmacy—the act of prescribing multiple medications—is a risk for children and youth with emotional and behavioural challenges, as prescribers may administer multiple medications to treat persistent symptoms or the side effects of other medications without solid evidence. The use of psychotropic medications with children and youth has been linked to several negative health outcomes, and further risks exist in cases of polypharmacy such as increased and more severe medication side effects, toxicity, and non-compliance. Objective: This case report shares the treatment approach of medication deprescribing coupled with attachment-focused psychosocial intervention for managing emotional/behavioural challenges. Case presentation: An adolescent boy in foster care experiencing persistent behavioural disturbance, neurodevelopmental disorders, and attachment disruption presented for treatment at a tertiary care agency for children and youth with complex combinations of mental health, developmental, and behavioural needs having been prescribed five psychotropic medications. By the end of his treatment, he was on no medications and had shown behavioural gains (more co-operative, calmer, reduced impulsivity, aggression, and irritability) with no concerning changes in symptoms. Conclusions: The current case serves as an example for clinicians to critically consider the risks and benefits of patients' medication regimen and the value of deprescribing with psychosocial supports to manage symptoms.

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