Pharmacotherapy of Child and Adolescent Psychiatric Disorders

by Rosenberg, David; Gershon, Samuel

• ISBN13: 9780470973769
• ISBN10: 0470973765
• Edition: 3rd
• Format: Hardcover
• Copyright: 2012-03-12
• Publisher: Wiley-Blackwell

Summary

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.

Author Biography

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

Table of Contents

List of Contributors	p. xv
Foreword	p. xix
Historical Perspectives on Child and Adolescent Psychopharmacology,	p. 1
References	p. 4
Pharmacoepidemiology of Psychotropic Medications in Youth,	p. 7
Introduction	p. 7
Prevalence and trends for medications prescribed for ADHD	p. 8
Nonstimulant medications for ADHD	p. 11
Antidepressant medication	p. 11
Antipsychotic medication	p. 13
Alpha-agonists	p. 14
Anticonvulsant "mood stabilizers"	p. 15
Concomitant psychotropic medication	p. 15
Preschool psychotropic medication use	p. 17
International patterns of psychotropic medication for youth	p. 17
Conclusion	p. 18
References	p. 18
Off-Label Prescribing of Drugs in Child and Adolescent Psychiatry,	p. 25
Introduction	p. 25
Extent of off-label prescribing	p. 27
Need for psychoactive drug treatments for children and adolescents	p. 31
Legislation supporting pediatric drug development	p. 33
Recommendations to follow when considering off-label prescribing	p. 35
References	p. 36
The Use of Generic Drugs in Pediatric Psychopharmacology,	p. 39
What is a generic drug?	p. 39
Why are we discussing generic drugs?	p. 39
Basic requirements for generic drugs	p. 40
The status of regulations regarding generic drugs and children	p. 41
Abbreviated new drug application (ANDA) requirements	p. 42
Pediatric assessments of adult drugs (history up to current status)	p. 43
Best Pharmaceuticals for Children Act	p. 44
Pediatric Research Equity Act	p. 45
Intersection of requirements for generics and pediatric assessment	p. 46
Future directions	p. 48
Concluding thoughts	p. 49
References	p. 49
Psychoactive Drug Use in Children: Basic Concepts in Clinical Pharmacology,	p. 51
Introduction	p. 51
Basic concepts in pharmacokinetics	p. 52
Dosing considerations for psychoactive drugs in children	p. 55
Summary	p. 60
References	p. 60
Psychostimulants,	p. 65
Introduction	p. 65
Epidemiology of stimulant use	p. 66
Structure and biochemical mechanism of action	p. 66
Neuroimaging studies of stimulant effects	p. 67
Studies of short-term efficacy	p. 72
Studies of long-term efficacy	p. 76
Clinical use	p. 79
Common side-effects	p. 84
Cardiovascular safety issues	p. 86
Growth suppression	p. 88
Substance use and diversion	p. 88
Comparison with nonstimulant treatment	p. 89
Treatment of comorbidity	p. 92
Pharmacogenetics	p. 93
Conclusions	p. 94
References	p. 94
Tricyclic Antidepressants and Monoamine Oxidase Inhibitors for the Treatment of Child and Adolescent Psychiatric Disorders,	p. 105
Tricyclic antidepressants (TCAs)	p. 105
Drug interactions, contraindications	p. 116
Monoamine oxidase inhibitors (MAOIs)	p. 117
General summary	p. 122
References	p. 123
Selective Serotonin Reuptake Inhibitors (SSRIs),	p. 131
Pharmacokinetics	p. 131
Initiation and titration	p. 133
Indications and efficacy	p. 134
Adverse effects	p. 146
Withdrawal	p. 149
References	p. 149
Novel (Atypical) Antidepressants,	p. 155
Novel (atypical) antidepressants	p. 155
General overview	p. 155
Bupropion	p. 157
Duloxetine	p. 162
Mirtazapine	p. 164
Trazodone	p. 166
Venlafaxine	p. 170
Desvenlafaxine	p. 173
Alternative treatments	p. 174
Summary	p. 175
References	p. 176
Antipsychotic Agents,	p. 181
Introduction	p. 181
Chemical properties	p. 182
Typical antipsychotics	p. 183
Atypical antipsychotics	p. 186
Ethical issues: treatment of at-risk populations	p. 212
Conclusions	p. 213
References	p. 213
Lithium,	p. 221
Introduction	p. 221
Pharmacology	p. 222
Potential mechanisms of action	p. 222
Evidence for the use of lithium in children and adolescents	p. 232
Dosing and drug monitoring	p. 239
Contraindications, precautions, and drug interactions	p. 242
Side-effects	p. 246
References	p. 250
Anticonvulsants Used in Child and Adolescent Psychiatric Disorders,	p. 261
Introduction	p. 261
Divalproex sodium	p. 261
Carbamazepine	p. 271
Oxcarbazepine	p. 275
Lamotrigine	p. 279
Gabapentin	p. 284
Topiramate	p. 285
Conclusion	p. 288
References	p. 288
Anxiolytics,	p. 301
Chemical properties	p. 301
Indications	p. 305
Contraindications	p. 320
Adverse effects	p. 321
Overdose	p. 324
Abuse/dependence	p. 324
Drug interactions	p. 325
Available preparations and cost	p. 325
Initiation and maintenance of treatment	p. 325
Management of specific side-effects	p. 330
How to withdraw medication	p. 332
References	p. 332
Adrenergic Agents in Child and Adolescent Psychiatry,	p. 341
Clonidine and guanfacine	p. 341
Guanfacine	p. 349
Beta-blockers	p. 355
Acknowledgements	p. 361
References	p. 361
Atypical Psychopharmacologic Strategies,	p. 365
Opiate antagonists	p. 365
Memantine	p. 368
Riluzole	p. 369
Secretin	p. 371
Topiramate	p. 372
Herbal medications and dietary supplements	p. 373
Ginkgo (Ginkgo biloba)	p. 375
Melatonin	p. 381
Omega-3 fatty acids	p. 383
St. John's wort (Hypericum perforatum)	p. 384
Valerian (Valeriana officinalis)	p. 387
Conclusion	p. 388
References	p. 389
Psychopharmacology in Preschool Children,	p. 399
Introduction	p. 399
Developmental considerations	p. 400
Rise in psychopharmacology use	p. 402
Psychotherapy before psychopharmacology	p. 403
When psychopharmacology may be considered as a first line: pragmatic considerations	p. 404
Psychopharmacology in preschool disorders: administration and monitoring	p. 404
Off-label prescribing: special considerations	p. 407
Use of psychotropics in specific disorders	p. 408
Summary	p. 415
References	p. 415
Combination Pharmacotherapy for Psychiatric Disorders in Children and Adolescents,	p. 421
Bipolar disorder	p. 422
Major depressive disorder	p. 429
Attention-deficit hyperactivity disorder	p. 431
Obsessive-compulsive disorder	p. 433
Tics and Tourette's syndrome	p. 434
Pervasive developmental disorders	p. 434
Conclusion	p. 434
References	p. 435
Index	p. 439
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