Pharmacotherapy of Child and Adolescent Psychiatric Disorders (3^rd Ed.)

This book fulfils an urgent need for an updated text on pediatric psychopharmacology. It takes a unique approach in discussing recent findings within the context of current issues, including economic and political ones. The book covers the emerging question of treating children who do not yet meet diagnostic criteria for psychosis, e.g, schizophrenia or bipolar disorder, but who are deemed to be at high risk. This is an active area of debate: such children are being treated in certain centers, while others reject this completely. The book addresses the antidepressant controversy, the placebo response and unique strategies for delineating this, and ways to optimize the differential between active medication and placebo. It reviews the impact of recent American Heart Association guidelines for monitoring children on stimulants and other psychotropics. It adheres closely to DSM-IV diagnostic criteria throughout. The book describes the use of newly approved drugs such as Lexapro for treating adolescent depression and the novel compound Intuniv. It covers the TADS and CAMS studies, which evaluated the use of SSRIs alone and in combination with cognitive behavioral therapy for adolescent depression. Other topics include treatment of bipolar disorders, the increasing popularity of generic equivalents, combination pharmacotherapy and the potential dangers of psychotropic medications.

• Third edition of the first ever book published on pediatric psychopharmacology from renowned editors.
• Incorporates current developments with regard to SSRIs, their indications and their safety issues, including possible associated suicidal behavior.
• Addresses concerns about cardiovascular side effects of the new stimulant medications available, and compares to other FDA-approved medications for ADHD.
• Features many tables, figures and pictorials, making it highly accessible and reader friendly.

List of Contributors, xv

Foreword, xix

Chapter 1 Historical Perspectives on Child and Adolescent Psychopharmacology, 1
Samuel Gershon

References, 4

Chapter 2 Pharmacoepidemiology of Psychotropic Medications in Youth, 7
Daniel J. Safer & Julie Magno Zito

Introduction, 7

Prevalence and trends for medications prescribed for ADHD, 8

Nonstimulant medications for ADHD, 11

Antidepressant medication, 11

Antipsychotic medication, 13

Alpha-agonists, 14

Anticonvulsant "mood stabilizers", 15

Concomitant psychotropic medication, 15

Preschool psychotropic medication use, 17

International patterns of psychotropic medication for youth, 17

Conclusion, 18

References, 18

Chapter 3 Off-Label Prescribing of Drugs in Child and Adolescent Psychiatry, 25
C. Lindsay DeVane

Introduction, 25

Extent of off-label prescribing, 27

Need for psychoactive drug treatments for children and adolescents, 31

Legislation supporting pediatric drug development, 33

Recommendations to follow when considering off-label prescribing, 35

References, 36

Chapter 4 The Use of Generic Drugs in Pediatric Psychopharmacology, 39
Richard I. Shader & Christopher-Paul Milne

What is a generic drug?, 39

Why are we discussing generic drugs?, 39

Basic requirements for generic drugs, 40

The status of regulations regarding generic drugs and children, 41

Abbreviated new drug application (ANDA) requirements, 42

Pediatric assessments of adult drugs (history up to current status), 43

Best Pharmaceuticals for Children Act, 44

Pediatric Research Equity Act, 45

Intersection of requirements for generics and pediatric assessment, 46

Future directions, 48

Concluding thoughts, 49

References, 49

Chapter 5 Psychoactive Drug Use in Children: Basic Concepts in Clinical Pharmacology, 51
David J. Edwards

Introduction, 51

Basic concepts in pharmacokinetics, 52

Dosing considerations for psychoactive drugs in children, 55

Summary, 60

References, 60

Chapter 6 Psychostimulants, 65
Steven R. Pliszka

Introduction, 65

Epidemiology of stimulant use, 66

Structure and biochemical mechanism of action, 66

Neuroimaging studies of stimulant effects, 67

Studies of short-term efficacy, 72

Studies of long-term efficacy, 76

Clinical use, 79

Common side-effects, 84

Cardiovascular safety issues, 86

Growth suppression, 88

Substance use and diversion, 88

Comparison with nonstimulant treatment, 89

Treatment of comorbidity, 92

Pharmacogenetics, 93

Conclusions, 94

References, 94

Chapter 7 Tricyclic Antidepressants and Monoamine Oxidase Inhibitors for the Treatment of Child and Adolescent Psychiatric Disorders, 105
Charlotte M. Heleniak, Tejal Kaur, Kareem D. Ghalib & Moira A. Rynn

Tricyclic antidepressants (TCAs), 105

Drug interactions, contraindications, 116

Monoamine oxidase inhibitors (MAOIs), 117

General summary, 122

References, 123

Chapter 8 Selective Serotonin Reuptake Inhibitors (SSRIs), 131
Dara Sakolsky & Boris Birmaher

Pharmacokinetics, 131

Initiation and titration, 133

Indications and efficacy, 134

Adverse effects, 146

Withdrawal, 149

References, 149

Chapter 9 Novel (Atypical) Antidepressants, 155
Heidi R. Bruty, Graham J. Emslie & Paul Croarkin

Novel (atypical) antidepressants, 155

General overview, 155

Bupropion, 157

Duloxetine, 162

Mirtazapine, 164

Trazodone, 166

Venlafaxine, 170

Desvenlafaxine, 173

Alternative treatments, 174

Summary, 175

References, 176

Chapter 10 Antipsychotic Agents, 181
Brieana M. Rowles, John L. Hertzer & Robert L. Findling

Introduction, 181

Chemical properties, 182

Typical antipsychotics, 183

Atypical antipsychotics, 186

Ethical issues: treatment of at-risk populations, 212

Conclusions, 213

References, 213

Chapter 11 Lithium, 221
Garrett M. Sparks & David A. Axelson

Introduction, 221

Pharmacology, 222

Potential mechanisms of action, 222

Evidence for the use of lithium in children and adolescents, 232

Dosing and drug monitoring, 239

Contraindications, precautions, and drug interactions, 242

Side-effects, 246

References, 250

Chapter 12 Anticonvulsants Used in Child and Adolescent Psychiatric Disorders, 261
Mani Pavuluri & Tushita Mayanil

Introduction, 261

Divalproex sodium, 261

Carbamazepine, 271

Oxcarbazepine, 275

Lamotrigine, 279

Gabapentin, 284

Topiramate, 285

Conclusion, 288

References, 288

Chapter 13 Anxiolytics, 301
Barbara J. Coffey & Amanda L. Zwilling

Chemical properties, 301

Indications, 305

Contraindications, 320

Adverse effects, 321

Overdose, 324

Abuse/dependence, 324

Drug interactions, 325

Available preparations and cost, 325

Initiation and maintenance of treatment, 325

Management of specific side-effects, 330

How to withdraw medication, 332

References, 332

Chapter 14 Adrenergic Agents in Child and Adolescent Psychiatry, 341
Lawrence David Scahill

Clonidine and guanfacine, 341

Guanfacine, 349

Beta-blockers, 355

Acknowledgements, 361

References, 361

Chapter 15 Atypical Psychopharmacologic Strategies, 365
Jess Shatkin & Aron Janssen

Opiate antagonists, 365

Memantine, 368

Riluzole, 369

Secretin, 371

Topiramate, 372

Herbal medications and dietary supplements, 373

Ginkgo (Ginkgo biloba), 375

Melatonin, 381

Omega-3 fatty acids, 383

St. John's wort (Hypericum perforatum), 384

Valerian (Valeriana officinalis), 387

Conclusion, 388

References, 389

Chapter 16 Psychopharmacology in Preschool Children, 399
Mini Tandon & Joan Luby

Introduction, 399

Developmental considerations, 400

Rise in psychopharmacology use, 402

Psychotherapy before psychopharmacology, 403

When psychopharmacology may be considered as a first line: pragmatic considerations, 404

Psychopharmacology in preschool disorders: administration and monitoring, 404

Off-label prescribing: special considerations, 407

Use of psychotropics in specific disorders, 408

Summary, 415

References, 415

Chapter 17 Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents, 421
Gagan Joshi & Anna M. Georgiopoulos

Bipolar disorder, 422

Major depressive disorder, 429

Attention-deficit hyperactivity disorder, 431

Obsessive-compulsive disorder, 433

Tics and Tourette's syndrome, 434

Pervasive developmental disorders, 434

Conclusion, 434

References, 435

Index, 439

David Rosenberg MD, Miriam L. Hamburger Endowed Chair of Child Psychiatry and Professor & Chief of Child Psychiatry and Psychology at Wayne State University and the Children's Hospital of Michigan, Detroit, MI , USA

Samuel Gershon MD, Emeritus Professor of Psychiatry, University of Pittsburgh, PA, USA