Abstract
The desire to conceive and produce a text that aids young people, their parents and their teachers in the process of understanding psychopharmacological treatments for a range of emotional and behavioural dimensional problems is laudable. The potential importance of effective communication between clinicians, patients, their families and their teachers to aid compliance with medication regimens and thereby to facilitate recovery is manifest. Yet, there are few published works that address this important area of child and adolescent psychiatric clinical practice.
Dr Dulcan and her collaborators have attempted to devise such a resource manual for clinicians that manage patients who require psychopharmacological treatments. There are three sections for parents, youth and teachers, respectively. Each section contains pages of clinical information that can be removed from the manual and given to the recipient, and a CD-ROM is also provided. A series of questions are addressed in turn that cover the areas of ‘general information’, definition, ‘how the [particular medication] can help’, ‘how the [particular medication] works’, ‘how the doctor monitors the [particular medication]’, ‘the side-effects of the [particular medication]’, ‘what could happen if the [particular medication] were stopped suddenly’, ‘how long will the [particular medication] be needed’, and ‘how to explain the [particular medication] to others’. The following medication groups are covered: benzodiazepines, buspirone, common ‘anti-convulsants’, common ‘antihistamines’, common ‘β-blockers’, common ‘tricyclic antidepressants’, common ‘SSRIs’, serzone, venlafaxine, bupropion, lithium, common ‘neuroleptics’, and ‘stimulants’.
The advantages of this publication are the simplicity of its layout, the ease with which information can be extracted from the manual and given to the recipient, and the attempt by the authors to be comprehensive in the range of medications discussed and the particular pertinent issues addressed for each. Yet, the primary disadvantages arise from the reductive simplicity of the explanations given, which may not enlighten the young person, their parent or their teacher sufficiently to aid compliance and facilitate recovery. For example, the following explanation is given to teachers about ‘stimulants’: ‘In children and adolescents, stimulant medicines stimulate parts of the brain that are not working as well as they should. An example would be the part that controls impulsive actions (‘the brakes’)’. This form of linear reductive model of psychostimulant medication action is inaccurate and archaic. Rather, a systemic model that emphasised the need for appropriate functional balance between the major neurotransmitter systems in the prefrontal cortex would be more realistic and helpful to explain its cognitive, emotional and behavioural regulatory effects in young people with attention deficit hyperactivity disorder (ADHD). Further disadvantages are the difference in medication availability and the different trade names of particular medications in the United States of America and Australia.
Nevertheless, this publication may be of interest to child and adolescent psychiatrists and paediatricians in clinical practice.