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Pediatric psychopharmacology: principles & practice
  1. D Cottrell

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    Edited by Andrés Martin, Lawrence Scahill, Dennis S Charney and James F Leckman. Oxford University Press, New York, 2002, £99.50, pp 755. ISBN 0-19-514173-3

    This is a weighty text—at nearly 800 pages and nearly 5½12 lbs in the hardback edition. Far more than just a textbook of psychopharmacology, this is an introduction to and update on the biological basis of pediatric psychopharmacology as well as its current practice. Organised into four sections, the first covers neurobiology, developmental psychopathology, and genetics, including a well written primer on molecular genetics for those child and adolescent psychiatrists (and there are probably many) who have lost contact with their biomedical roots. It was, however, disappointing to see little reference to some of the exciting new imaging studies that are exploring the links between neurobiology and attachment status. Attachment (or affiliation as it is termed here) is covered, but largely in relation to autism and related disorders.

    Section two collects together in one place as much information as anyone could want about individual psychotropic agents, but also finds room for chapters on complementary medicine and ECT—strange bedfellows in a subsection on other somatic interventions! The emphasis on placing pharmacological treatments in a developmental context is flagged up in the preface and is a theme that runs through the book. A holistic and integrated approach to assessment and the management of children’s problems is advocated clearly throughout.

    In the third section, the evidence for treatment of a range of different conditions is reviewed and explained—drug treatments are important but are not the only treatments available. The authors’ enthusiasm for the potential value of psychopharmacology is tempered with a clear, evidence based focus, and the different chapters in this section are cautious in their interpretation of the literature and open about the absence of good randomised controlled trial evidence in a number of important conditions. Helpful algorithms support clinical decision making and psychological treatments are recommended, alone or in combination with drug treatments when there is evidence to support this. The MTA study showed the superiority of methylphenidate over treatment as usual even when treatment as usual was usually methylphenidate. One possible explanation was the manner in which the prescribing was carried out in that large multicentre trial, a concept that is supported here with a chapter on the psychology of prescribing.

    The book concludes with a section on research and methodological considerations, including interesting chapters on changes in prescribing trends within the US and around the world. Pediatric psychopharmacology is a rapidly growing field with a burgeoning literature. This book, written by clinicians who understand the management of troubled children, brings together that literature in an accessible format. It is up to date and well written. Not perhaps a book for all clinicians to buy, but an essential reference work for any department.

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