Abstract
Child Psychopharmacology is a recent independent monograph of the informative Review of Psychiatry Series. This series used to be published annually with individual sections incorporated into a large volume. Now, each monograph provides an update of a particular topical area.
The monograph is edited by B.T. Walsh, who also co-authors a chapter on eating disorders with L.E.S. Mayer. The other contributors are eminent clinical researchers, in their chosen fields, from the United States of America and from Canada.
F.X. Castellanos reviews ‘Tic Disorders and Obsessive-Compulsive Disorder’. This is a clear and concise account of the use of psychopharmacology, within both a developmental context and the context of psychotherapeutic interventions for these disorders. The art of managing multiple interventions is noted and practical prescribing guidelines are given. L.L. Greenhill reviews ‘Attention-Deficit/Hyperactivity Disorder’. Diagnostic issues, paediatric and adult forms of the disorder, comorbidity and its effects upon response to psychopharmacological interventions, guidelines for commencement of psychostimulant medication, longer term treatment issues, side effects of psychostimulant medication, current debates about the use of psychostimulant medication, and alternative medication treatments are presented. The NIMH Collaborative Multisite, Multimodal Treatment Study of Children with ADHD (1992-1997) is outlined clearly and the important current issue of cognitive responses, along with behavioural responses, to psychostimulant medication is raised. S. Kumra discusses ‘Children and Adolescents with Psychotic Disorders’. Diagnostic issues, particularly the relatively common group of children with brief psychotic symptoms who are impaired in a number of areas of functioning, are helpfully canvassed. Treatment principles, treatment non-response, acute phase and maintenance phase periods, and future clinical research directions are succinctly reviewed. S.P. Kutcher writes about ‘Affective Disorders in Children and Adolescents’ reviewing major depressive disorder and bipolar disorders, and appropriately emphasising the limitations of the current research literature to guide careful clinical decision-making. D.S. Pine and J. Grun review ‘Anxiety Disorders’. Diagnostic issues, continuity issues between childhood and adult forms of disorder, and psychopharmacological treatments are presented. In light of the acknowledged paucity of controlled investigations in child populations, the psychopharmacological literature in adult anxiety disorders is reviewed. ‘Eating Disorders’ is the final chapter of the book. Anorexia nervosa and bulimia nervosa are reviewed, with the potential roles of a range of medications noted in the context of practical recommendations.
Aside from its noted strengths, the text has a number of limitations. The focus is unashamedly North American, with North American and Canadian literature primarily reviewed. Important nosological debates, psychopharmacological dosage debates, and issues of efficacy versus effectiveness in respective research and clinical settings, are ignored or given cursory attention. The referencing is adequate but mistakes are evident. For example, the title of a 1997 paper by Gillberg et al. includes ‘Long-term Stimulant Treatment of Children With Attention-Deficit Hyperactivity Disorder Symptoms’ and not ‘Long-term central stimulant treatment of children with attention-deficit hyperactivity disorder’ (p.59). The difference is significant when the nosological debates, mentioned above, are considered.
Child Psychopharmacology is a useful contribution to the current clinical research literature. It is suitable for trainees in psychiatry, child psychiatry subspecialty trainees, and general psychiatrists with an interest in this burgeoning field of practice.