Abstract
When the first edition of Practitioner's Guide to Psychoactive Drugs for Children and Adolescents was published in 1993, there were few available textbooks on paediatric psychopharmacology and the only specialist journal in the field, Journal of Child and Adolescent Psychopharmacology, was in its infancy. Werry and Aman's premier edition filled a void, and filled it extremely well. The scene is now quite different with the Journal of Child and Adolescent Psychopharmacology firmly established, Child and Adolescent Psychopharmacology News entering its fourth year and several textbooks on the topic having been published recently, some very good ones (e.g. [1,2]) among them. Any review of the new edition of Practitioner's Guide to Psychoactive Drugs for Children and Adolescents must determine how it stacks up against the competition.
Like its predecessor, the second edition of Werry and Aman's book is a multi-author volume. There are 15 chapters, including a historical overview, classification of psychoactive drugs, principles of drug prescribing for young persons, discussion of basic pharmaco-sciences, epidemiological aspects of drug prescribing and use, measurement of drug effects, ethical issues, detailed discussion of specific drugs and drug classes, pharmacological treatments according to DSM-IV disorder, and psychoactive effects of medical drugs.
In some areas, especially the discussion of individual drugs and the overview of pharmacotherapy for the individual DSM-IV disorders, this book is on a par with other texts. Subjects dealt with particularly well in the book or seldom broached elsewhere but found here include pharmacokinetics and pharmacodynamics, the ethical aspects of drug prescribing in young persons, prescribing patterns, the newer anticonvulsants (e.g. gabapentin, lamotrigine and vigabantrin), and use of ‘alternative medicines’. In this reviewer's experience, St John's Wort and other ‘natural’ remedies are sometimes used by teenagers with psychiatric disorders and it is encouraging to see objective discussion of this in a mainstream text.
There are only a few weaknesses or omissions and they are generally minor. Many of the omissions are unavoidable, because psychopharmacology is a rapidly developing field with new products being regularly introduced and new uses being found for established agents. It is thus not surprising that, for example, there is no discussion of citalopram and no mention of pindolol as a potential augmenting agent in depression. Isotretinoin, a drug commonly used in the treatment of acne, has been recently linked with secondary depression (the association has not been fully evaluated) but this does not appear in the section on drug-induced psychiatric syndromes. The classification of venlafaxine as a selective serotonin reuptake inhibitor (SSRI) is unorthodox. The book makes no mention of electroconvulsive therapy in young persons. Admittedly, this is a book on paediatric psychopharmacology, but some rival texts are devoting space to convulsive therapy and there have been several recent studies on the subject.
For me, the biggest disappointment in an otherwise valuable book was the lack of a step-by-step approach to the treatment of each disorder. Most of the other books on the market, bar one [2], are also deficient in this regard, but in this day and age of treatment algorithms, flowcharts, practice guidelines, clinical pathways and strategies for ‘treatment-resistant’ cases, this would have been very useful, especially for a text purporting to be a ‘practitioner's guide’.
The book is clearly written. The style is confident, ‘punchy’ and surprisingly uniform for a multi-author book, which indicates good editing. I believe the book is best used as a ‘ready reference’. The consistent format across chapters, abundant subheadings and concise prose mean that it does not take long for the reader to find what he or she is looking for.
Despite its shortcomings, this book can be confidently recommended to all health professionals who prescribe psychotropics to young people: child psychiatrists and child psychiatry trainees, ‘behavioural paediatricians’, general psychiatrists whose practice may includes young persons, and many general practitioners. All medical libraries and pharmacies should also have a copy.
Finally, John Werry has been a leading international figure in paediatric psychopharmacology for many years and remains its doyen in these parts. Let's hope he has the stamina and will to co-edit the next edition or, if not, that he passes the baton on to someone local. Because psychopharmacology is developing so rapidly, another five years should not be allowed to elapse before the next edition. On a practical note, should the book increase any further in size (the new edition brings with it both a larger page dimension and an extra 62 pages), then the spiral binding system may prove unwieldy and succumb; another form of binding next time, please.