Psychiatrists’ views on pharmacology use for aggression in under 18s: a qualitative study

There is little guidance on the clinical management of aggression, violence, agitation and irritability (AVAI) in children and young people, and is more restricted when the young person has an intellectual disability. Psychotropic medication for managing AVAI is a challenging area with a small evidence base. This study explored the prescribing characteristics, beliefs and attitudes of psychiatrists working with young people presenting with AVAI. Semi-structured interviews were conducted with 10 experienced consultant psychiatrists working with young people under 18 years of age in the UK NHS. Participants were purposively recruited from two mental health trusts in the North-East of England. Data were analysed using a framework method derived from Thematic Analysis. Data analysis generated of 1169 primary codes, organised into categories due to similarity of ideas. Six interlinked themes emerged: purpose of AVAI, nature of request, impact of medication, clinician factors, knowledge base and baseline threshold for prescribing. The study’s findings show the complex thought processes involved in managing AVAI in children and young people. The shared themes amongst psychiatrists emerging from this analysis illustrate the role medication plays within holistic approaches to managing AVAI and introduce the concept of ‘prescribing threshold’ at the centre of medication decision-making.