Abstract
Although paediatric psychopharmacology is over 60 years old, commencing with Bradley's studies on benzedrine in the 1930s [1], until recently there has been a paucity of books on the subject. In the past few years this situation has changed with the appearance of several texts (e.g. [2–5]) on the topic.
Many of the books adopt the standard ‘formula’ of historical overview, followed by examination of developmental pharmacokinetics and pharmacodynamics, followed by discussion of the various drug classes and their use in various psychiatric disorders. Kutcher's text is refreshingly different: a ‘hands-on’ style, replete with vignettes and worked examples, and emphasising how to incorporate pharmacotherapy into overall management. The book is a successful combination of ‘practice manual’ and personal philosophy of treatment.
Most of the first quarter of the book (chapters 2 to 7) is devoted to the general issues of baseline assessment, and planning and initiation of psychopharmacological treatment. The importance of a comprehensive assessment of identified patient, family, school, community and environment is highlighted. A collaborative approach to deciding on medication is outlined, and the importance of selecting and tracking target symptoms is stressed. Chapters 8 through 17 deal with the individual psychiatric disorders and their pharmacological treatment; necessary scientific information is woven into the narrative. Chapter 18 is a historical overview of child and adolescent pharmacology. The appendices (140 pages worth!) provide a multitude of handouts, scales and questionnaires that can be incorporated into clinical practice or research.
The book is not free from controversy. For example, one can quibble with Kutcher's recommendation that the initial evaluation of antidepressant effectiveness should occur at 8 weeks post commencement: too long in my view. Similarly, laboratory work-up of patients prior to starting selective serotonin re-uptake inhibitors is probably unnecessary [6]. Some of the terminology falls a bit flat: ‘meducation’ (Kutcher's term for psychoeducation in relation to drug treatment) doesn't do much for me. Australian and New Zealand readers may be disappointed that some of the newer agents, for example nefazodone, citalopram and olanzapine, receive no mention.
Overall, however, this is an excellent book. The continual introduction of new psychotropic drugs and drug classes has meant that, nowadays, psychopharmacology texts are prone to date quickly. Unlike many of its rivals, Kutcher's book has a timelessness about it because the author ultimately provides fundamental prescribing principles. The book is clearly written and in a discursive style. References are included only at the end of chapters so that the flow of text is not interrupted. Boxed ‘practice points’ help to synthesise much of the material. This book will be of value to child and adolescent psychiatrists who prescribe psychotropic drugs (the vast majority in Australia [7]), to other psychiatrists treating patients in this age group and to paediatricians who, increasingly, are using these agents. Kutcher's Child and adolescent psychopharmacology will ‘lift the game’ of all these clinicians. It is highly recommended.