Pediatric Psychopharmacology: Principles and Practice

The ever-expanding field of psychopharmacology in child and adolescent psychiatry seems to be hungry for more books summarizing and categorizing new findings and developments. The latest arrival among such books is this imposing volume, an enormous editorial feat. Just a brief look at the list of 56 chapters authored by 117 experts would fill the reader with enthusiastic expectation to read the latest synopsis of our knowledge and understanding of pediatric psychopharmacology.

The book is divided into four major sections. The first, Biological Bases of Pediatric Psychopharmacology, provides “a foundation of neurobiology upon which the rest of the volume is built.” This section consists of three subsections—Developmental Principles of Neurobiology and Psychopharmacology, Genetic Principles, and Developmental Psychopathology. The second section, Somatic Interventions, reviews psychotropic agents used in pediatric psychopharmacology as well as other somatic treatments, such as complementary and alternative medicine approaches, ECT, and transcranial magnetic stimulation. The third section, Assessment and Treatment, begins with general principles such as clinical assessment, clinical instruments and scales, the psychology of prescribing, and combining pharmacotherapy and psychotherapy. It continues with a focus on treatment of specific disorders and syndromes and discussions of special clinical populations such as substance-abusing youth, individuals with mental retardation, medically ill children and adolescents, and preschoolers. The section closes with a focus on other areas of clinical concern such as aggression, agitation, and elimination disorders. The last section, Epidemiological, Research, and Methodological Considerations, reviews issues such as the methodology and design of clinical trials, regulatory issues, ethical issues in research, and international perspectives. An appendix titled Pediatric Psychopharmacology at a Glance provides a summary table of medications used in pediatric psychopharmacology.

The general approach to treating children and adolescents proposed in this book is developmental and integrative, which the editors point out is the legacy of the late Donald Cohen, to whom the book is dedicated. Psychopharmacology is not seen in vacuum but as “one (albeit a powerful one) among the many tools available for the treatment of psychiatrically ill children and adolescents.” The book is well arranged, well organized, and easy to read (with the exception of the first section, which most of the clinicians who are a few years out of training may have to read with a lot of effort).

Any deficits? As with any volume of this scope, there are some. I understand that any book will be at least 2–3 years behind the current state of knowledge. Nevertheless, I missed some discussion and warning regarding the use of atypical antipsychotics and the possible development of diabetes mellitus. This is an important and troublesome issue in this population, and the first reports appeared almost 5 years ago. For obvious reasons, the latest controversy regarding selective serotonin reuptake inhibitors and suicidality could not be addressed either. There are occasional misquotes. I also think that the readers would welcome some specific guidelines or a brief outline for the treatment of each disorder at the end of each chapter on a specific disorder. Thus, my initial overenthusiasm was a bit tempered at the end of the day. Nevertheless, these small issues would be easily correctable in another edition and take away nothing from the usefulness and comprehensiveness of this excellent book. It is a well-edited, well-referenced, fairly user-friendly (in spite of its weight!), encyclopedic volume that will be appreciated by many in the field. It would be a very useful and well-appreciated reference volume for anybody treating children and adolescents.