Abstract
While psychiatrists have long espoused bio-psychosocial models of disorder and multimodal treatment interventions, many Victorian child psychiatrists have preferred to avoid the use of pharmacological treatment where possible. This practice has gradually changed with increasing numbers of reports of the effectiveness of interventions that include medications for specific conditions, more comprehensive teaching and training about brain sciences and psychopharmacology, and rising consumer demands for evidence-based treatment. As consumers are also demanding more detailed and sophisticated information about the treatments being offered, all child psychiatrists must possess up-to-date knowledge of brain function in psychopathology and the role of medication in best-practice treatment. Some knowledge of pharmacology, pharmaco-dynamics and pharmacokinetics also helps prescribing practice to be more sensible and gives authority to psychiatric advice, making it more plausible to others.
In response to this need, there has been an increase in the numbers of texts on pharmacotherapy and psychopharmacology in childhood and adolescence. Children are different to adults in their pharmacokinetics, sideeffects, and their responses to some medications, so one cannot simply extrapolate from adult experience. This book is one of a series by American publisher Marcel Drekker that addresses the need for specific information reasonably well. Chapters are written by American academics and psychiatrists who are well-enough informed to include unpublished studies and studies in press. Part one addresses general matters, including the ethics of using therapeutic drugs with children, epidemiology, pharmacology and risks, while part two presents more detailed, evidence-based information about all the major classes of therapeutic drugs, including psycho-stimulants, SSRIs, atypical antidepressants and antipsychotics, anticonvulsants and mood stabilizers, adrenergic agents, adjunctive therapies and combination treatments.
Unsurprisingly, I found the subject very dry with few jokes and insufficient narrative for a satisfying bed-time read, but the contents did provide a wealth of useful information for reference. I have not sampled enough of these texts to give a valid comparison with other competitors, but it was good for my purpose of guiding the treatments I offer to patients. The chapter on pharmacoepidemiology gave useful data on the eightfold rise in the use of psycho-stimulants in the past 24 years and on differential usage patterns in different populations. This increase in the use of psychotropics in the US, from 9% to 18% of all youths receiving medication in 1990 to 49% in some states, is being followed in a smaller more cautious way in Australia. I happily admit that my personal practice has become more ready to consider whether there could be a role for medication in a comprehensive treatment plan with all my patients, but not necessarily as the first option.
The chapter on SSRIs was a detailed best attempt to summarize recent research with children and adolescents, supplementing with data and extrapolations from adult studies when appropriate childhood data was not available, into information about indications, complications, guidelines and advice for application and withdrawal. The other chapters follow a similar pattern, and I found the chapters on antipsychotics and adrenergics to have useful content. I confess that some of the complex neuro-anatomical and neural-chemical explanations of interacting neurotransmitter systems, with accompanying diagrams, were lost on this reader, but could imagine that better educated readers who fully understand phrases like ‘glutamatergically mediated thalamocorticalstriatal dysfunction type of SCD’ might find themselves in seventh heaven. Nonetheless, I found much useful information that will affect my prescribing practice in this volume and will refer to it frequently, until a better text comes along.