Practitioner's Guide to Psychoactive Drugs for Children and Adolescents

by Werry, John S.; Aman, Michael G.

• ISBN13: 9780306458859
• ISBN10: 0306458853
• Edition: 2nd
• Format: Paperback
• Copyright: 1999-01-01
• Publisher: Plenum Pub Corp

Summary

Incorporating the latest developments in pharmacology and therapy, this fully revised Second Edition is an ideal quick reference for those who prescribe psychotrophic drugs for young people. New and notable features include: discussions of new drugs and health supplements; revised diagnostic terminology that accords with current DSM-IV nomenclature; reports on anti-epileptic medications; guidelines for the appropriate use of psychoactive medications; and instruction on the monitoring of physical, behavioral, and cognitive effects of various drugs. The handy spiral format makes the book easy to use.

Table of Contents

I General Principles	3	(210)
1. Introduction: A Guide for Practitioners, Professionals, and Public	3	(20)
John Scott Werry, M.D.
I. Introduction	3	(2)
A. Preamble	3	(1)
B. Definitions	3	(1)
C. The Multidisciplinary Team	4	(1)
D. Child Psychiatry, Behavioral Pediatrics, and Pediatric Neurology	4	(1)
II. Historical Overview	5	(3)
A. Foundations	5	(2)
B. Current Trends and Future Directions	7	(1)
III. Classification of Psychoactive Drugs	8	(2)
A. Names of Drugs	8	(2)
B. Look-Alike Drugs	10	(1)
IV. Drug Evaluation	10	(1)
V. Determinants of Prescribing	11	(3)
A. Medical Knowledge	12	(1)
B. Patient and Parent Factors	12	(1)
C. Physician Factors	13	(1)
D. Social Factors	13	(1)
E. Economic Factors	13	(1)
F. The Powerful Placebo	14	(1)
VI. Principles of Drug Use	14	(6)
A. First Do No Harm (Primum Non Nocere)	14	(1)
B. Know the Disorder and Use Drugs When Indicated	15	(1)
C. Choose the Best Drug	15	(1)
D. Understand the Drug and Its Properties	16	(1)
E. Minimize Drug Use and Dosage	16	(1)
F. Keep Things Simple	17	(1)
G. Avoid Polypharmacy	17	(1)
H. Don't Be a Fiddler	18	(1)
I. Don't Follow Fads	18	(1)
J. Take Particular Care with Children	19	(1)
K. Establish a Therapeutic Alliance	19	(1)
L. Compliance (Adherence) with Treatment	19	(1)
VII. Conclusion	20	(1)
References	21	(2)
2. Pharmacology	23	(28)
James William Paxton, Ph.D.
Michael Dragunow, Ph.D.
I. Introduction	23	(1)
II. Fate of Drugs in the Body	23	(12)
A. Passage of Drugs across Biological Membranes	24	(2)
B. Routes of Drug Administration	26	(1)
C. Distribution	27	(2)
D. Elimination	29	(6)
III. Pharmacokinetics	35	(4)
A. Apparent Volume of Distribution	36	(1)
B. Clearance	36	(1)
C. Multiple Dosing and Steady-State Drug Concentrations	37	(1)
D. Saturation Kinetics	38	(1)
IV. Time Course of Pharmacological Effect	39	(2)
A. Nonlinear Concentration-Response Curve	40	(1)
B. Slow Equilibration with Site of Drug Action	40	(1)
C. Presence of Active Metabolites	40	(1)
D. Indirect or Slow Biochemical Response	40	(1)
V. Pediatric Variations in Pharmacokinetics	41	(1)
A. Absorption	41	(1)
B. Distribution	41	(1)
C. Biotransformation and Excretion	42	(1)
D. Response	42	(1)
VI. Mechanisms of Drug Action (Pharmacodynamics)	42	(7)
A. Enzymes	43	(1)
B. Voltage-Gated Ion Channels	43	(1)
C. Reuptake Mechanisms	43	(1)
D. Receptors	43	(3)
E. Mechanisms of Receptor Action	46	(1)
F. Speed of Response of Receptors	47	(1)
G. Summary of Mechanisms of Receptor Activation	48	(1)
References	49	(2)
3. Prevalence of Drug Therapy	51	(18)
Kenneth D. Gadow, Ph.D.
I. Introduction	51	(2)
A. Research Objectives	52	(1)
B. Scope of the Review	53	(1)
II. Hyperactivity (Attention-Deficit Hyperactivity Disorder)	53	(3)
A. Early Studies	53	(1)
B. Recent Surveys	54	(1)
C. Special Education	55	(1)
D. Socioeconomic Status	55	(1)
E. Treatment Practices	56	(1)
F. National Estimates of Treatment Prevalence	56	(1)
III. Mental Retardation	56	(2)
A. Institutional Settings	57	(1)
B. Community-Based Facilities	57	(1)
C. Public Schools	57	(1)
D. National Estimates of Treatment Prevalence	58	(1)
IV. Seizure Disorders	58	(2)
A. Autism	59	(1)
B. Mental Retardation	59	(1)
C. Preschool-Aged Children	60	(1)
V. Autism	60	(1)
VI. Depression	60	(1)
VII. Enuresis	61	(1)
VIII. Tourette Syndrome	61	(1)
IX. Other Disorders	62	(1)
X. International Variations in Prescribing	63	(1)
XI. Summary	63	(2)
References	65	(4)
4. Monitoring and Measuring Drug Effects. I. Physical Effects	69	(30)
Alan J. Zametkin, M.D.
Emily M. Yamada, M.S.
I. Introduction	69	(1)
II. Baseline Physical Assessment	69	(6)
A. Past Medical History	71	(2)
B. Immunizations	73	(1)
C. Hospitalizations	73	(1)
D. Trauma	73	(1)
E. Transfusions	73	(1)
F. Current Medications	73	(1)
G. Allergies	74	(1)
H. Substance Use History	74	(1)
I. Social History	74	(1)
J. Pregnancy and Birth History	74	(1)
K. Family Medical History	74	(1)
L. Family Psychiatric History	75	(1)
III. Medical Review of Organ Systems	75	(3)
A. General Health and Appearance	75	(1)
B. Eyes, Ears, Nose, and Throat	76	(1)
C. Respiratory	76	(1)
D. Cardiovascular	76	(1)
E. Gastrointestinal	76	(1)
F. Urinary Tract	77	(1)
G. Genital and Reproductive Systems	77	(1)
H. Musculoskeletal System	77	(1)
I. Integument (Skin)	77	(1)
J. Endocrine System	77	(1)
K. Central Nervous System	78	(1)
IV. Psychiatric Review	78	(1)
V. Physical and Neurological Exam	78	(1)
VI. Baseline Biochemical Assessment of Blood and Urine	79	(1)
VII. Speech and Language Assessment	80	(1)
VIII. Monitoring Side Effects	80	(10)
A. General Principles	80	(2)
B. Types of Measures	82	(1)
C. Formal Side-Effects Rating Scales	82	(7)
D. Compliance (Adherence) with Medication	89	(1)
IX. Laboratory Measures and Monitoring	90	(5)
A. Electrocardiogram	90	(1)
B. Blood Levels	91	(1)
C. Dexamethasone Suppression Test	91	(1)
D. Thyroid Function Tests	91	(1)
E. Electroencephalography	92	(1)
F. Catecholamine and Enzyme Assays	92	(1)
G. Lumbar Punctures	93	(1)
H. AIDS Screening	93	(1)
I. Toxicology	93	(1)
J. Genetic Studies	93	(1)
K. Brain Imaging	94	(1)
L. Routine Liver, Kidney, and Serum Measures	95	(1)
X. Conclusions	95	(1)
References	95	(4)
5. Monitoring and Measuring Drug Effects. II. Behavioral, Emotional, and Cognitive Effects	99	(66)
Michael G. Aman, Ph.D.
Deborah A. Pearson, Ph.D.
I. Introduction	99	(1)
II. Measurement	100	(2)
A. Purposes	100	(1)
B. Diagnosis	100	(2)
III. Rating Scales	102	(40)
A. Some General Considerations	103	(2)
B. "General Purpose" Rating Scales	105	(4)
C. Hyperactivity (ADHD)	109	(8)
D. Oppositional, Conduct, and Aggressive Problems	117	(4)
E. Depression	121	(5)
F. Bipolar (Manic-Depressive) Mood Disorder (Mania)	126	(1)
G. Anxiety Disorders	127	(7)
H. Other Disorders	134	(3)
I. Mental Retardation	137	(2)
J. Autism	139	(1)
K. Preschool Rating Scales	140	(2)
IV. Direct Observation	142	(2)
A. General Considerations	142	(1)
B. Types of Direct Observation Methods	142	(1)
C. Some Illustrative Examples	143	(1)
V. Performance and Automated Activity Measures	144	(7)
A. Performance and Related Tests	145	(3)
B. Computer Testing	148	(3)
VI. Conclusions	151	(1)
References	152	(13)
6. Medicolegal and Ethical Issues in the Pharmacological Treatment of Children	165	(18)
Ronald Schouten, M.D., J.D.
Kenneth S. Duckworth, M.D.
I. Introduction	165	(1)
II. Obtaining Consent for Treatment	166	(7)
A. The Doctrine of Informed Consent	166	(1)
B. Elements of Informed Consent	166	(3)
C. Exceptions to the Requirements of Informed Consent	169	(1)
D. Special Consent Issues with Children and Adolescents	170	(2)
E. Consent Procedures in Practice	172	(1)
F. Documenting Informed Consent	173	(1)
III. The Right to Refuse Treatment	173	(2)
IV. Consent to Treatment and the Custody Problem	175	(1)
V. Confidentiality	176	(1)
VI. Risk Management in the Treatment of Children and Adolescents	177	(2)
VII. Conclusions	179	(1)
References	179	(4)
7. Disorders, Symptoms, and Their Pharmacotherapy	183	(30)
Kelly Botteron, M.D.
Barbara Geller, M.D.
I. Introduction	183	(2)
II. Disruptive Behavior Disorders	185	(3)
A. Attention-Deficit Hyperactivity Disorder	185	(2)
B. Conduct Disorders	187	(1)
C. Oppositional Defiant Disorder	187	(1)
III. Mood Disorders	188	(2)
A. Major Depressive Disorder	188	(1)
B. Bipolar Disorder	189	(1)
IV. Schizophrenia Disorders	190	(1)
A. Diagnostic Features and Pharmacotherapy	190	(1)
B. Potential Pharmacotherapeutic Mechanisms	191	(1)
V. Developmental Disorders	191	(2)
A. Mental Retardation	191	(1)
B. Specific Developmental Disorders	192	(1)
C. Pervasive Developmental Disorder	192	(1)
VI. Eating Disorders	193	(2)
A. Anorexia Nervosa	193	(1)
B. Bulimia Nervosa	194	(1)
C. Pica	195	(1)
D. Rumination Disorder of Infancy	195	(1)
VII. Sexual Disorders	195	(1)
VIII. Gender Identity Disorders	195	(1)
IX. Anxiety Disorders	196	(3)
A. Generalized Anxiety Disorder	196	(1)
B. Separation Anxiety Disorder	196	(1)
C. Panic Disorder	197	(1)
D. Selective Mutism	197	(1)
E. Social Phobia	197	(1)
F. Posttraumatic Stress Disorder	198	(1)
G. Reactive Attachment Disorder of Infancy or Early Childhood	198	(1)
H. Obsessive-Compulsive Disorder	198	(1)
X. Tic Disorders	199	(1)
A. Simple Tics	199	(1)
B. Tourette's Disorder	199	(1)
XI. Psychoactive Substance Abuse and Dependence Disorders	200	(1)
XII. Sleep Disorders	200	(1)
XIII. Elimination Disorders	201	(1)
A. Enuresis	201	(1)
B. Encopresis	201	(1)
XIV. Personality Disorders (Axis II Disorders)	201	(1)
XV. Dimensional Considerations	202	(1)
A. Aggression	202	(1)
B. Attention	203	(1)
XVI. Summary	203	(1)
References	204	(9)
II Specific Drugs	213	(258)
8. Stimulants	213	(36)
Russell A. Barkley, Ph.D.
George J. DuPaul, Ph.D.
Daniel F. Connor, M.D.
I. Pharmacological Aspects of Stimulant Medication: Definition and Nomenclature	214	(2)
A. Pharmacology	214	(1)
B. Pharmacokinetics	215	(1)
II. Clinical Effects: Short-Term	216	(5)
A. General Clinical Effects	217	(1)
B. Physical Effects	217	(1)
C. Effects on Behavior and Emotion	218	(1)
D. Effects on Cognition, Learning, and Academic Performance	219	(1)
E. Effects on Social Systems	220	(1)
F. Dose Effects on Behavior and Learning	220	(1)
III. Clinical Effects: Long-Term	221	(1)
IV. Predicting the Clinical Response to Stimulants	221	(1)
V. Side Effects and Toxicity	222	(6)
A. Lethal Dose	222	(1)
B. Short-Term Side Effects	223	(3)
C. Long-Term Side Effects	226	(2)
VI. Clinical Indications and Usage	228	(9)
A. Standard Indications	228	(1)
B. Probable Indications	228	(1)
C. Usage	229	(6)
D. Monitoring Response to Medication	235	(1)
E. Discontinuing Medication	236	(1)
VII. Contraindications and Drug Interactions	237	(1)
VIII. Drug Combinations	238	(1)
A. Combined Stimulant/Antidepressant Therapy	238	(1)
B. Combined Stimulant/Clonidine Therapy	238	(1)
IX. Management of Stimulant Overdoses	239	(1)
X. Summary	239	(1)
XI. Conclusion	240	(1)
References	241	(8)
9. Antidepressant and Antimanic Drugs	249	(48)
John O. Viesselman, M.D.
I. Introduction	249	(1)
II. Diagnosis and Epidemiology of Depression in Children and Adolescents	249	(1)
III. Antidepressants	250	(26)
A. Types	250	(1)
B. Tricyclic (TCAs) and Heterocyclic Antidepressants	250	(13)
C. Monoamine Oxidase Inhibitors (MAOIs)	263	(4)
D. Selective or Specific Serotonin Reuptake Inhibitors (SSRIs)	267	(7)
E. Combinations	274	(1)
F. Other	275	(1)
G. Summary of Antidepressant Treatment of Children and Adolescents	275	(1)
IV. Antimanics	276	(21)
A. Introduction	276	(1)
B. Lithium	277	(5)
C. Carbamazepine	282	(2)
D. Valproate	284	(1)
E. Clonazepam	285	(1)
F. Summary of Antimanics in Child and Adolescent Disorders	286	(1)
References	287	(10)
10. Antipsychotics (Neuroleptics)	297	(32)
Monique Ernst, M.D., Ph.D.
Richard P. Malone, M.D.
Amy B. Rowan, M.D.
Regina George, M.D.
Nilda M. Gonzalez, M.D.
Raul R. Silva, M.D.
I. Definition, Classes, Individual Drugs, and Generic and Trade Names	297	(1)
II. Clinical Indications	298	(9)
A. Introduction	298	(2)
B. Schizophrenia	300	(2)
C. Major Depression with Psychotic Features and Bipolar Disorder	302	(1)
D. Conduct Disorder and Conduct Problems	303	(1)
E. Autistic Disorder and Other Pervasive Developmental Disorders (PDD)	303	(2)
F. Tourette's Disorder	305	(1)
G. Mental Retardation Associated with Disruptive Behavior or Psychiatric Disorder	305	(1)
H. Attention-Deficit Hyperactivity Disorder (ADHD)	306	(1)
III. Pharmacology	307	(4)
A. Pharmacodynamics	307	(2)
B. Pharmacokinetics	309	(2)
IV. Side Effects	311	(7)
A. Effects on the Central Nervous System	311	(5)
B. Effects on the Autonomic Nervous System	316	(1)
C. Neuroleptic Malignant Syndrome	316	(1)
D. Cardiovascular Effects	316	(1)
E. Endocrine Effects	317	(1)
F. Effects on the Eye	317	(1)
G. Skin Reactions and Photosensitivity	317	(1)
H. Blood Dyscrasias	317	(1)
I. Hepatic Dysfunction	317	(1)
J. Tissue Necrosis and Vasculitis	318	(1)
K. Clozapine: Special Considerations	318	(1)
V. Overdose and Management	318	(1)
VI. Summary/Conclusions	319	(1)
References	320	(9)
11. Drugs of Abuse	329	(26)
Andrea Eisner, M.D.
Jon McClellan, M.D.
I. Introduction	329	(1)
II. Definitions	329	(1)
III. Epidemiology	330	(2)
A. Frequency and Type of Substance Abuse	330	(1)
B. Risk Factors for Abuse	331	(1)
IV. Etiology	332	(1)
A. Predisposing Personality and Cognitive Traits	332	(1)
B. Biological "Markers"	332	(1)
V. Patterns of Abuse and Outcome	333	(1)
VI. Principles of Diagnosis	333	(2)
A. Accurate History	333	(1)
B. Comorbid Psychiatric Conditions	334	(1)
C. Health Problems	334	(1)
D. Laboratory Evaluation	335	(1)
E. Social Assessment	335	(1)
VII. Substances of Abuse	335	(14)
A. CNS Depressants	337	(4)
B. Stimulants	341	(2)
C. Nicotine and Tobacco	343	(1)
D. Dissociative Agents	344	(1)
E. Hallucinogens	345	(2)
F. Opiates	347	(2)
G. Miscellaneous Agents	349	(1)
VIII. Principles of Treatment	349	(3)
A. Treatment Programs	350	(1)
B. Pharmacotherapy	351	(1)
C. Treatment Outcome	352	(1)
IX. Conclusions	352	(1)
References	352	(3)
12. Antiepileptics (Anticonvulsants)	355	(32)
Eileen P.G. Vining, M.D.
Richard O. Carpenter, M.D.
Michael G. Aman, Ph.D.
I. Introduction	355	(1)
II. The Use of Drugs in Epilepsy	355	(5)
A. When to Prescribe	356	(1)
B. Rationale for Prescription	357	(1)
C. The Treatment Plan	358	(2)
III. Pharmacology of Drugs Used in Epilepsy	360	(5)
A. AEDs in General	360	(1)
B. Bromides	360	(1)
C. Barbituates	360	(1)
D. Hydantoins (Phenytoin, Mephenytoin, Ethotoin)	361	(1)
E. Succinimides	362	(1)
F. Carbamazepine (Tegretol(R))	362	(1)
G. Valproic Acid (Depakene(R), Depakote(R), Epilim(R))	363	(1)
H. Benzodiazepines (Diazepam, Clonazepam, Lorazepam, Clorazepate)	363	(1)
I. Felbamate	363	(1)
J. Gabapentin	364	(1)
K. Lamotrigine	364	(1)
L. Topiramate	364	(1)
M. New Drugs	365	(1)
IV. Cognitive and Behavioral Function and Epilepsy	365	(6)
A. The Role of Epilepsy	365	(1)
B. The Role of Psychosocial Factors	366	(1)
C. The Role of AEDs	366	(5)
V. Unintended Cognitive/Behavioral Effects of AEDs	371	(8)
A. Phenobarbital	372	(1)
B. Phenytoin	373	(1)
C. Carbamazepine	374	(1)
D. Valproate	375	(1)
E. Benzodiazepines	376	(1)
F. Felbamate	376	(1)
G. Gabapentin	377	(1)
H. Lamotrigine	377	(1)
I. Topiramate	378	(1)
K. Vigabatrin	378	(1)
VI. Psychotropic Effects of AEDs	379	(3)
A. Carbamazepine	380	(1)
B. Valproate	381	(1)
C. Other AEDs	381	(1)
VII. Summary	382	(1)
References	382	(5)
13. Psychoactive Effects of Medical Drugs	387	(26)
L. Eugene Arnold, M.Ed., M.D.
Igor Janke, M.D.
Brent Waters, M.D., F.R.C.P., F.R.A.N.Z.C.P.
Antony Milch, M.B.B.S., F.R.A.N.Z.C.P.
I. Introduction	387	(7)
A. Use of Medical Drugs by Children	387	(1)
B. Prevalence of Psychoactive Effects of Medical Drugs in Children	388	(4)
C. General Principles of Managing Psychoactive Effects	392	(1)
D. Attribution of Psychoactive Effects	393	(1)
E. Classification of Psychoactive Effects of Medical Drugs	394	(1)
II. Types of Psychoactive Effects	394	(13)
A. Intoxication	394	(3)
B. Delirium	397	(3)
C. Substance-Induced Psychotic Disorder with Delusions	400	(1)
D. Substance-Induced Psychotic Disorder with Hallucinations (Hallucinosis)	401	(1)
E. Substance-Induced Mood Disorder	402	(4)
F. Substance-Induced Anxiety Disorder	406	(1)
III. Developmental Considerations	407	(1)
IV. Implications for Clinical Practice and Further Research	408	(1)
V. Summary	409	(1)
References	409	(4)
14. Nootropics and Foods	413	(20)
C. Keith Conners, Ph.D.
Elizabeth P. Sparrow, M.A.
I. Introduction	413	(1)
II. Nootropics	414	(2)
A. Definition	415	(1)
B. Mechanism of Action	415	(1)
C. Human Studies	415	(1)
D. Conclusions	416	(1)
III. Food	416	(10)
A. Food Constituent Effects	416	(4)
B. Precursors of Essential Metabolic Substances	420	(1)
C. Vitamins	421	(2)
D. Trace Minerals	423	(1)
E. Heavy Metals	424	(1)
F. Food Additives	424	(2)
IV. Some Clinical Guidelines for Working with Parents	426	(1)
A. Food Histories as Part of Regular History-Taking	426	(1)
B. Ally with Parental Biases, Not Against Them	426	(1)
C. Monitor Food Behavior during Treatment	427	(1)
V. Conclusions	427	(1)
References	428	(5)
15. Anxiolytics, Sedatives, and Miscellaneous Drugs	433	(38)
John Scott Werry, M.D.
Michael G. Aman, Ph.D.
I. Introduction	433	(1)
II. Anxiolytics and Sedatives	433	(13)
A. Anxiolytics and Sedatives Defined	433	(1)
B. CNS Depressants	434	(1)
C. Antihistamines and Anticholingerics	443	(1)
D. Atypical Anxiolytics	444	(1)
E. Summary of Anxiolytics and Sedatives	445	(1)
III. Miscellaneous Drugs	446	(18)
A. Alpha(2) Agonists (Clonidine, Guanfacine)	446	(6)
B. Melatonin	452	(2)
C. Hypericin (St. John's Wort)	454	(1)
D. L-Tryptophan and 5-Hydroxytryptophan	455	(1)
E. Fenfluramine	456	(3)
F. Beta-Adrenergic Blockers (Beta-Blockers)	459	(3)
G. Opiate Blockers	462	(2)
IV. Summary	464	(1)
References	465	(6)
Appendix A Psychoactive Medications Grouped by Drug Class and Foods Studied for Psychoactive Effects	471	(6)
Appendix B Major Psychoactive Medications Ordered by Trade Name	477	(4)
Index	481