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It is our impress i o n that b e c a u s e the older medications often led to troubling extrapyramidal side effects, clinicians frequently delayed initiation o f treatment. B e s i d e s their suboptimal side effect profile, another shortcoming o f the typical antipsychotics w a s that not all youths w h o were prescribed these agents w e r e noted to have an adequate response to treatment. In fact, there 26 PSYCHOTIC DISORDERS is evidence to suggest that younger patients m a y be at particularly high risk for treatment resistance to these typical antipsychotics.
However, in individuals w h o are afflicted with episodes o f greater symptom severity, the ability to attend to the most basic o f tasks (such as maintaining personal hygiene) m a y be profoundly affected. M a k i n g a diagnosis o f M D D is not always an easy task to undertake. This is because patients with M D D can manifest the s y m p t o m s o f their illness in a variety o f w a y s . M o s t adult patients with M D D state that they feel sad, depressed, hopeless, or discouraged. H o w e v e r , s o m e patients m a y simply complain that they feel empty, are devoid o f feelings, or m a y simply state that they feel as if they have no motivation.
T h e m o n o amine oxidase inhibitors are drugs from an older class o f agents, s o m e o f w h i c h have been s h o w n to have efficacy in the treatment o f depression in adults. H o w e v e r , due to the difficulties associated with the dietary restrictions with w h i c h a patient must c o m p l y to safely take these agents, the m o n o a m i n e oxidase inhibitors have only b e e n minimally investigated in depressed pediatric patients. It should also be noted that w h e n psychotic features are present in y o u n g patients with M D D , combination pharmacotherapy with an antidepressant and antipsychotic is often e m p l o y e d .