Pediatric Psychopharmacology Evidence: A Clinician's Guide

Preface
Acknowledgments
Contents
Contributors
1: Introduction to the Fundamentals of Pediatric Psychopharmacology
	1.1	 General Psychopharmacology Principles
	1.2	 Evaluation of the Need
	1.3	 Need for an Interdisciplinary Family Approach
	1.4	 Considerations in Deciding for or Against Medication
	1.5	 Genetics and Response to Medications
	1.6	 Stigma/Negative Versus Positive Attitudes to Medications
	1.7	 Racial/Economic Disparities
	1.8	 Policy and Scientific Aspects of Medication Evidence
	1.9	 Considerations of the Treatment Targets —Applying the Evidence
	1.10	 Ethical/Legal Issues
	1.11	 Systemic Issues
	1.12	 Philosophical and Psychological Questions
	1.13	 Motivations to Prescribe More or Less
	1.14	 Conclusion
	References
Part I: Transdiagnostic Topics
	2: Pediatric Psychopharmacology Integration with Family Therapy
		2.1	 Introduction: Importance of Family Therapy Formulation
		2.2	 General Approach: Team Consensus on Expectations
		2.3	 Family Contributors to Treatment-Refractory Mental Illness
		2.4	 Structural Family Therapy (SFT)
			2.4.1	 Change Versus “Stuckness”
		2.5	 Structural Family Therapy (SFT)
			2.5.1	 Organization of Healthy Family Subsystems Based on Hierarchy/Power
		2.6	 Structural Family Therapy (SFT)
			2.6.1	 When Healthy Hierarchy/Power Is Subverted
		2.7	 Decision-Making
		2.8	 Healthy Control Versus Under-Control and Overcontrol
		2.9	 Structural Family Therapy (SFT)
			2.9.1	 Boundaries: Healthy Versus Diffuse or Rigid, Open Versus Closed Systems
		2.10	 Healthy Communication Versus Under- and Overcommunication
		2.11	 Homeostasis
		2.12	 Prescriber’s Role in Family Structure
		2.13	 Family-Based Barriers to Psychopharmacology: Assessment and Intervention
		2.14	 Barriers to and Strategies for Promoting Collaboration
			2.14.1	 Case Example: LT — Family’s Spiritual Beliefs About Medications
			2.14.2	 Other Related Issues
				2.14.2.1	 The Special Case of Domestic Violence
				2.14.2.2	 Attachment
				2.14.2.3	 Intentional and Unintentional Interference
				2.14.2.4	 Role of Trauma
				2.14.2.5	 Role of Family Therapy in Pediatric Psychopharmacology
		2.15	 Conclusion
		References
	3: Rationale for Integrating Psychodynamic Theory into Pediatric Psychopharmacology
		3.1	 Introduction
		3.2	 Key Concepts of Psychodynamic Psychopharmacology as Patient-Centered Medicine
		3.3	 Developmental Model and Biopsychosocial Formulation
			3.3.1	 Erickson’s Developmental Stages Applied to Pediatric Psychopharmacology
			3.3.2	 Case Example #1
			3.3.3	 Case Example #2
		3.4	 Therapeutic Alliance in Psychopharmacology
			3.4.1	 Holding Environment
			3.4.2	 Attachment Framework
			3.4.3	 Guidelines for Building Therapeutic Alliance in Psychopharmacology
				3.4.3.1	 Goals
				3.4.3.2	 Tasks
				3.4.3.3	 Bonds
			3.4.4	 Alliance with Caregiver
			3.4.5	 Alliance with Patient
		3.5	 Transference and Countertransference
			3.5.1	 Transference
			3.5.2	 Countertransference
				3.5.2.1	 Polypharmacy
				3.5.2.2	 Under-medicating
				3.5.2.3	 Managing suicidality
				3.5.2.4	 Medicating just right
				3.5.2.5	 Both the Parents and the Child Are Involved in Transference and Countertransference Dynamics
			3.5.3	 Guidelines for Recognizing and Managing Transference and Countertransference
			3.5.4	 Case Example #3
		3.6	 Complexity of Split Treatment and Collaboration
			3.6.1	 Guidelines for the Collaboration Process
		3.7	 Meaning of Medications
			3.7.1	 Medication and Developing Self
				3.7.1.1	 Case Example #4
			3.7.2	 Pill-Taking Can Serve Functions of a Ritual Process
				3.7.2.1	 Case Example #5 (Transference)
			3.7.3	 Medication Can Serve as a Self-Object Replacement
				3.7.3.1	 Case Example #6
			3.7.4	 Medication Can Serve as a Transitional Object
				3.7.4.1	 Case Example #7
			3.7.5	 Medication and Identity
				3.7.5.1	 Case Example #8
		3.8	 Summary
		3.9	 Conclusion
		References
	4: Ensuring Appropriate Use of Psychotropic Medications in Pediatrics: Best Practices in Medication Discontinuation (Deprescribing)
		4.1	 Introduction
		4.2	 Definitions and History
			4.2.1	 Deprescribing and Polypharmacy
		4.3	 Deprescribing: Evidence Base in Geriatrics
		4.4	 Application of Deprescribing to Psychiatry
		4.5	 Proposed Best Practices for Deprescribing by Pediatric Psychiatric Prescribers
		4.6	 Specific Considerations for Minimizing of Polypharmacy
		4.7	 Medication Discontinuation Safety Concerns and Clinical Pearls
			4.7.1	 Withdrawal-Emergent Syndromes
		4.8	 Conclusion
		References
	5: Psychopharmacology of “As-Needed” Medications (PRNS) for Pediatric Agitation in Inpatient and Emergency Settings
		5.1	 Introduction
		5.2	 Rating Scales Referenced in this Chapter
		5.3	 Highest Quality Studies Referenced in this Chapter
		5.4	 Overview
		5.5	 Intramuscular Formulations
		5.6	 Oral Formulations
		5.7	 First-Generation Antipsychotics
			5.7.1	 Chlorpromazine
				5.7.1.1	 Influences on Medication Decision-Making
				5.7.1.2	 Medication Evidence
				5.7.1.3	 Balance Between Clinical Practice and Evidence
				5.7.1.4	 Medication Choice
				5.7.1.5	 Practical Information
			5.7.2	 Haloperidol
				5.7.2.1	 Influences on Medication Decision-Making
				5.7.2.2	 Medication Evidence
				5.7.2.3	 Balance Between Clinical Practice and Evidence
				5.7.2.4	 Medication Choice
				5.7.2.5	 Practical Information
			5.7.3	 Droperidol
				5.7.3.1	 Influences on Medication Decision-Making
				5.7.3.2	 Medication Evidence
				5.7.3.3	 Balance Between Clinical Practice and Evidence
				5.7.3.4	 Medication Choice
				5.7.3.5	 Practical Information
		5.8	 Second-Generation Antipsychotics
			5.8.1	 Aripiprazole
				5.8.1.1	 Influences on Medication Decision-Making
				5.8.1.2	 Medication Evidence
				5.8.1.3	 Balance Between Clinical Practice and Evidence
				5.8.1.4	 Medication Choice
				5.8.1.5	 Practical Information
			5.8.2	 Olanzapine
				5.8.2.1	 Influences on Medication Decision-Making
				5.8.2.2	 Medication Evidence
				5.8.2.3	 Balance Between Clinical Practice and Evidence
				5.8.2.4	 Medication Choice
				5.8.2.5	 Practical Information
			5.8.3	 Quetiapine
				5.8.3.1	 Influences on Medication Decision-Making
				5.8.3.2	 Medication Evidence
				5.8.3.3	 Balance Between Clinical Practice and Evidence
				5.8.3.4	 Medication Choice
				5.8.3.5	 Practical Information
			5.8.4	 Risperidone
				5.8.4.1	 FDA Approval
				5.8.4.2	 Medication Evidence
				5.8.4.3	 Balance Between Clinical Practice and Evidence
				5.8.4.4	 Medication Choice
				5.8.4.5	 Practical Information
			5.8.5	 Ziprasidone
				5.8.5.1	 FDA Approval
				5.8.5.2	 Medication Evidence
				5.8.5.3	 Balance Between Clinical Practice and Evidence
				5.8.5.4	 Medication Choice
				5.8.5.5	 Practical Information
		5.9	 Antihistamines
			5.9.1	 Diphenhydramine
				5.9.1.1	 FDA Approval
				5.9.1.2	 Medication Evidence
				5.9.1.3	 Balance Between Clinical Practice and Evidence
				5.9.1.4	 Medication Choice
				5.9.1.5	 Practical Information
		5.10	 Benzodiazepines
			5.10.1	 Lorazepam
				5.10.1.1	 FDA Approval
				5.10.1.2	 Medication Evidence
				5.10.1.3	 Balance Between Clinical Practice and Evidence
				5.10.1.4	 Medication Choice
				5.10.1.5	 Practical Information
		5.11	 Alpha-Adrenergic Agents
			5.11.1	 Clonidine
				5.11.1.1	 FDA Approval
				5.11.1.2	 Medication Evidence
				5.11.1.3	 Balance Between Clinical Practice and Evidence
				5.11.1.4	 Medication Choice
				5.11.1.5	 Practical Information
		5.12	 Conclusion
		References
	6: Over-the-Counter Medications and Nutritional Supplements in Child Psychiatry
		6.1	 Introduction
		6.2	 Rationale for Nutritional Supplements and CIM Treatments
		6.3	 Treatments
			6.3.1	 Melatonin
			6.3.2	 Coenzyme Q10
			6.3.3	 Carnosine
			6.3.4	 Curcumin
			6.3.5	 Methyl B12
			6.3.6	 N-Acetylcysteine
			6.3.7	 Sulforaphane
			6.3.8	 Omega-3
			6.3.9	 Folic/Folinic Acid
			6.3.10	 Vitamin D
			6.3.11	 Oxytocin
			6.3.12	 Micronutrients
			6.3.13	 Diet
			6.3.14	 Iron
		6.4	 Treating the Microbiome
			6.4.1	 Probiotics
			6.4.2	 Digestive Enzymes
			6.4.3	 Microbiota Transfer Therapy
		6.5	 Conclusion and Future Directions
		References
			Further Reading
Part II: Neurodevelopmental and Impulsive-Compulsive Spectrum Disorders
	7: Psychopharmacology for Autism and Neurodevelopmental Disorders
		7.1	 General Guidelines for Use of This Chapter
		7.2	 Methylphenidate: Grade 1B
			7.2.1	 Efficacy
				7.2.1.1	 Evidence of Efficacy
				7.2.1.2	 Lack of Efficacy
				7.2.1.3	 Estimate of How Much We Do Not Know About Efficacy
				7.2.1.4	 Medication Target Symptoms
				7.2.1.5	 Suggested Strategies for Tracking Target Symptoms
			7.2.2	 Safety
				7.2.2.1	 Evidence of Safety
				7.2.2.2	 Lack of Safety
			7.2.3	 Other Practical Clinical Considerations
				7.2.3.1	 Conclusion
		7.3	 Atomoxetine: Grade 1B
			7.3.1	 Efficacy
				7.3.1.1	 Evidence of Efficacy
				7.3.1.2	 Lack of Efficacy
				7.3.1.3	 Estimate of How Much We Do Not Know About Efficacy
				7.3.1.4	 Medication Target Symptoms
				7.3.1.5	 Suggested Strategies for Tracking Target Symptoms
			7.3.2	 Safety
				7.3.2.1	 Evidence of Safety
				7.3.2.2	 Lack of Safety
			7.3.3	 Other Practical Clinical Considerations
				7.3.3.1	 Conclusion
		7.4	 Alpha-2 Agonists
			7.4.1	 Efficacy
				7.4.1.1	 Evidence of Efficacy
					Guanfacine: Grade 1B
					Clonidine: Grade 2C
				7.4.1.2	 Lack of Efficacy
				7.4.1.3	 Estimate of How Much We Do Not Know About Efficacy
				7.4.1.4	 Medication Target Symptoms
				7.4.1.5	 Suggested Strategies for Tracking Target Symptoms
			7.4.2	 Safety
				7.4.2.1	 Evidence of Safety
				7.4.2.2	 Lack of Safety
			7.4.3	 Other Practical Clinical Considerations
				7.4.3.1	 Conclusion
		7.5	 Atypical Antipsychotics
			7.5.1	 FDA Approval
				7.5.1.1	 Risperidone: Grade 1A
				7.5.1.2	 Aripiprazole: Grade 1A
			7.5.2	 Efficacy
				7.5.2.1	 Evidence of Efficacy
				7.5.2.2	 Lack of Efficacy
				7.5.2.3	 Estimate of How Much We Do Not Know About Efficacy
				7.5.2.4	 Medication Target Symptoms
				7.5.2.5	 Suggested Strategies for Tracking Target Symptoms
			7.5.3	 Safety
				7.5.3.1	 Evidence of Safety
				7.5.3.2	 Lack of Safety
					Risperidone
					Aripiprazole
			7.5.4	 Other Practical Clinical Considerations
		7.6	 Anticonvulsants
			7.6.1	 Efficacy
				7.6.1.1	 Evidence of Efficacy
				7.6.1.2	 Lack of Efficacy
				7.6.1.3	 Estimate of How Much We Do Not Know About Efficacy
				7.6.1.4	 Medication Target Symptoms
				7.6.1.5	 Suggested Strategies for Tracking Target Symptoms
			7.6.2	 Safety
				7.6.2.1	 Evidence of Safety
				7.6.2.2	 Lack of Safety
			7.6.3	 Other Practical Clinical Considerations
		7.7	 Antidepressants
			7.7.1	 Efficacy
				7.7.1.1	 Evidence of Efficacy
				7.7.1.2	 Lack of Efficacy
				7.7.1.3	 Estimate of How Much We Do Not Know About Efficacy
				7.7.1.4	 Medication Target Symptoms
			7.7.2	 Safety
				7.7.2.1	 Evidence of Safety
				7.7.2.2	 Lack of Safety
			7.7.3	 Other Practical Clinical Considerations
		7.8	 Melatonin: Grade 1B
			7.8.1	 Efficacy
				7.8.1.1	 Evidence of Efficacy
				7.8.1.2	 Lack of Efficacy
				7.8.1.3	 Estimate of how Much we Do Not Know about Efficacy
			7.8.2	 Safety
				7.8.2.1	 Evidence of Safety
				7.8.2.2	 Lack of Safety
			7.8.3	 Other Practical Clinical Considerations
		7.9	 Other Medications
		7.10	 Conclusion
		References
8: Psychopharmacology for Pediatric ADHD
	8.1	 Introduction
	8.2	 Diagnosis
	8.3	 Course, Prognosis, and Comorbidity
	8.4	 Treatment
		8.4.1	 Stimulants (Norepinephrine-Dopamine Releasing Agents, NDRAs)
			8.4.1.1	 Influences on Medication Decision-Making
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharma Marketing
				Influence of Cost, Generic vs Branded Status
				Public Perception of Medication by Patients and Providers
				Other Influences
			8.4.1.2	 Medication Evidence
				Efficacy
				Safety/Tolerability/Side Effects
			8.4.1.3	 Balance Between Clinical Practice and Evidence
			8.4.1.4	 Medication Choice
			8.4.1.5	 Practical Information
			8.4.1.6	 Advanced Challenges
			8.4.1.7	 When to Consult and Scope of Practice
		8.4.2	 Guanfacine, Clonidine (Norepinephrine Receptor Agonists, Alpha-2)
			8.4.2.1	 Influences on Medication Decision-Making
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharma Marketing
				Influence of Cost, Generic vs Branded Status
				Public Perception of Medication by Patients and Providers
			8.4.2.2	 Medication Evidence
				Efficacy
				Safety/Tolerability/Side Effects
			8.4.2.3	 Balance Between Clinical Practice and Evidence
			8.4.2.4	 Medication Choice
			8.4.2.5	 Practical Information
			8.4.2.6	 Advanced Challenges
			8.4.2.7	 When to Consult and Scope of Practice
		8.4.3	 Atomoxetine (Norepinephrine Reuptake Inhibitor, NRI)
			8.4.3.1	 Influences on Medication Decision-Making
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharma Marketing
				Influence of Cost, Generic vs Branded Status
				Public Perception of Medication by Patients and Providers
			8.4.3.2	 Medication Evidence
				Efficacy
				Safety/Tolerability/Side Effects
			8.4.3.3	 Balance Between Clinical Practice and Evidence
			8.4.3.4	 Medication Choice
			8.4.3.5	 Practical Information
			8.4.3.6	 Advanced Challenges
			8.4.3.7	 When to Consult and Scope of Practice
	8.5	 Non-FDA-Approved Medications for ADHD
		8.5.1	 Bupropion (NbN2 — NET and DAT Reuptake Inhibitor / NE and DA Releaser, NDI / NDR)
			8.5.1.1	 FDA Approval
			8.5.1.2	 Medication Evidence
				Efficacy
				Safety/Tolerability/Side Effects
			8.5.1.3	 Balance Between Clinical Practice and Evidence
			8.5.1.4	 Medication Choice
		8.5.2	 Modafinil (Dopamine Reuptake Inhibitor, DRI)
			8.5.2.1	 FDA Approval
			8.5.2.2	 Medication Evidence
				Efficacy
				Safety/Tolerability/Side Effects
			8.5.2.3	 Balance Between Clinical Practice and Evidence
			8.5.2.4	 Medication Choice
		8.5.3	 Other Agents (Arranged Alphabetically)
	8.6	 Conclusions and Future Directions
	References
9: Psychopharmacology for Pediatric Tics and Tourette’s Disorder
	9.1	 Treatment Overview
	9.2	 Psychoeducation and CBIT
	9.3	 Pharmacological Treatment
		9.3.1	 First-Line: Alpha-Adrenergic Agonists (Guanfacine or Clonidine)
		9.3.2	 Second-Line
		9.3.3	 Topiramate
		9.3.4	 Third-Line: Dopamine Antagonists
		9.3.5	 Quezada (2018) Algorithm
		9.3.6	 The American Academy of Neurology (AAN) Evidence Grading
	9.4	 Novel Treatments Requiring Additional Research
		9.4.1	 Vesicular Monoamine Transporter (VMAT2) Inhibitors (Valbenazine, Deutetrabenazine)
		9.4.2	 Cannabinoids
	9.5	 Conclusion
	References
10: Psychopharmacology for Pediatric OCD and Related Disorders
	10.1	 Introduction
		10.1.1 Definitions
		10.1.2 Epidemiological and Clinical Course
		10.1.3 Treatment Overview
	10.2	 SRI (SSRIs and TCAs) Psychopharmacology Background
		10.2.1 History
		10.2.2 Mechanism of Action
		10.2.3 FDA Approval
		10.2.4 Influence of Pharmaceutical Marketing
		10.2.5 Influence of Cost, Generic, and Branded Status
		10.2.6 Public Perception of Medication
	10.3	 SRI Medication Evidence (Table 10.2)
		10.3.1 Evidence of Efficacy
		10.3.2 Lack of Efficacy
	10.4	 Augmentation Trials for Treatment-Refractory OCD (Table 10.3)
		10.4.1 In Pediatric Populations
		10.4.2 In Adult Populations
	10.5	 Knowledge Gaps in Efficacy
	10.6	 Suggested Strategies for Tracking Target Symptoms
	10.7	 Medication Target Symptoms and Typical Responder Symptoms
	10.8	 Time to Response
	10.9	 Dosing Strategies
	10.10	 Tapering Off Medication
	10.11	 Safety
		10.11.1 Side Effects and Safety Background
		10.11.2 Evidence of Safety
		10.11.3 OCS as Side Effects
	10.12	 Balance Between Clinical Practice and Evidence
		10.12.1 SSRIs
		10.12.2 Clomipramine
		10.12.3 Why We Treat
	10.13	 Ancillary Prescribing Information
		10.13.1 Role of Pharmacogenetic Testing
		10.13.2 Advanced Interactions
		10.13.3 Using Clomipramine
	10.14	 When to Consult and Scope of Practice
	10.15	 Monitoring
	10.16	 Medication Choice and Practical Prescribing Information
		10.16.1 Alternatives to Medication
	10.17	 Deciding When to Use Medication
	10.18	 Factors Affecting Initial Medication Choice
		10.18.1 Regarding Particular SSRIs (e.g., Sertraline, Fluoxetine, Fluvoxamine)
		10.18.2 Following First-Line Medication Initiation
	10.19	 Guidance on Advanced Challenges
		10.19.1 OCD and Co-occurring Conditions
		10.19.2 OCD and Co-occurring Tics
		10.19.3 OCD and Co-occurring Depression
		10.19.4 OCD and Co-occurring Mood Dysregulation/Bipolar Spectrum Disorder
		10.19.5 OCD and Co-occurring ADHD
		10.19.6 OCD and Co-occurring ASD
		10.19.7 OCD and Co-occurring Anxiety
	10.20	 Sudden-Onset OCD Symptoms
	10.21	 Algorithm
	10.22	 Other OCD-Related Disorders
		10.22.1 Body Dysmorphic Disorder (BDD)
		10.22.2 Body-Focused Repetitive Behavior (BFRB) Disorders
		10.22.3 Hoarding Disorder
	10.23	 Conclusion and Future Directions
	References
11: Adolescent Substance Use Disorders
	11.1	 Introduction
	11.2	 Alcohol Use Disorder (AUD)
		11.2.1	 Naltrexone
		11.2.2	 N-Acetyl Cysteine
	11.3	 Cannabis Use Disorder (CUD)
		11.3.1	 N-Acetyl Cysteine
		11.3.2	 Topiramate
	11.4	 Tobacco Use Disorder (TUD)
		11.4.1	 Nicotine Replacement Therapy
		11.4.2	 Bupropion
		11.4.3	 Varenicline
		11.4.4	 Electronic Nicotine Delivery Systems (ENDS)
	11.5	 Opioid Use Disorder (OUD)
		11.5.1	 Buprenorphine
	11.6	 Methamphetamine Use Disorder
	11.7	 Conclusion
	References
12: Psychopharmacology for Pediatric Eating Disorders
	12.1	 Introduction
	12.2	 Treatment Approaches, Background
	12.3	 Treatment Approaches, Specifics
	12.4	 Psychotropic Medications (Table 12.2)
		12.4.1 SSRI Antidepressant Medications and Anorexia, Evidence
		12.4.2 SSRI Antidepressant Medications and Bulimia, Evidence
		12.4.3 SSRI Antidepressant Medications and Comorbid Anxiety/Depression
		12.4.4 SSRI Antidepressant Medications Side Effects in Eating Disorders
		12.4.5 Malnutrition and Response to SSRI Antidepressant Medications
		12.4.6 Antidepressant Medications: Bupropion
		12.4.7 Antidepressant Medications: TCAs and MAOIs
		12.4.8 Antidepressant Medications: Mirtazapine
		12.4.9 Anxiolytics
		12.4.10 Atypical Antipsychotics and AN
		12.4.11 Atypical Antipsychotics Evidence: Mostly Olanzapine
		12.4.12 Mood Stabilizers
		12.4.13 Stimulants and BED
	12.5	 Conclusion
	References
13: Psychopharmacology for Pediatric Aggression
	13.1	 Introduction
	13.2	 Injurious Behavior and Psychopathology
		13.2.1	 Definitional Issues
		13.2.2	 Are Aggression and Emotion Dysregulation “Transdiagnostic” Entities?
		13.2.3	 Implications and Principles for the Pharmacotherapy of Aggressive Behavior
	13.3	 ADHD and Impulse Control Deficits
		13.3.1	 Association with Aggressive Behavior
		13.3.2	 Pharmacotherapy and Other Approaches to Aggression in the Context of ADHD
			13.3.2.1	 Optimization of First-Line Pharmacotherapy for ADHD [Monotherapies: see Tables 13.1, 13.2, 13.3, 13.4]
				[Two-agent, stepped pharmacotherapy: see Tables 13.5, 13.6, 13.7]
		13.3.3	 Additional Treatment Steps
			13.3.3.1	 Keep or Discontinue Stimulant Medication?
			13.3.3.2	 Psychosocial Treatment
			13.3.3.3	 Antipsychotics [Tables 13.5, 13.6, 13.8, 13.9, 13.10, 13.11]
			13.3.3.4	 Mood Stabilizers [Tables 13.12, 13.13, 13.14]
			13.3.3.5	 Noradrenergic α2 Agonists [Table 13.3]
	13.4	 Mood Disorders [Tables 13.7, 13.9, 13.14]
		13.4.1	 Disruptive Mood Dysregulation Disorder
			13.4.1.1	 Association with Aggressive Behavior
			13.4.1.2	 Pharmacotherapy Approach
		13.4.2	 Major Depressive and Bipolar Disorders
			13.4.2.1	 Association with Aggressive Behavior
	13.5	 Anxiety Disorders and Trauma Exposure
		13.5.1	 Association with Aggressive Behavior
		13.5.2	 Pharmacotherapy Approaches to Managing Aggression in the Context of Primary Anxiety Disorders
	13.6	 Developmental Disorders [Tables 13.8, 13.13]
		13.6.1	 Association with Aggressive Behavior
		13.6.2	 Pharmacotherapy Approaches to Managing Aggression in the Context of Developmental Disorders
	13.7	 Psychosis
	13.8	 Conclusion
	References
Part III: Anxiety Spectrum Disorders
14: Psychopharmacology for Pediatric Anxiety Disorders
	14.1	 Introduction
	14.2	 Medication Treatment of Pediatric Anxiety
		14.2.1	 General Influences on Antianxiety Medication Decision-Making
	14.3	 Selective Serotonin Reuptake Inhibitors (SSRIs)
		14.3.1	 General Influences on Medication Decision-Making
			14.3.1.1	 History
			14.3.1.2	 Mechanism of Action
			14.3.1.3	 FDA Approval
			14.3.1.4	 Influence of Pharmaceutical Marketing
			14.3.1.5	 Influence of Cost
			14.3.1.6	 Public Perception of SSRIs
		14.3.2	 SSRI Evidence
			14.3.2.1	 Efficacy
			14.3.2.2	 Safety/Tolerability/Side Effects
				Evidence of Risks/Side Effects
		14.3.3	 Balance Between Clinical Practice and Evidence
		14.3.4	 Practical Information
		14.3.5	 When to Consult and Scope of Practice
		14.3.6	 Medication Choice and Dosing Strategies
	14.4	 Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
		14.4.1	 General Influences on Medication Decision-Making
		14.4.2	 Medication Evidence
			14.4.2.1	 Efficacy
			14.4.2.2	 Safety/Tolerability/Side Effects
	14.5	 Buspirone
		14.5.1	 General Influences on Medication Decision-Making
			14.5.1.1	 History
			14.5.1.2	 Mechanism of Action and Names
			14.5.1.3	 FDA Approval
		14.5.2	 Medication Evidence
			14.5.2.1	 Efficacy
			14.5.2.2	 Safety/Tolerability/Side Effects
		14.5.3	 Balance Between Clinical Practice and Evidence
		14.5.4	 Practical Information
	14.6	 Guanfacine Extended Release (ER)
		14.6.1	 General Influences on Medication Decision-Making
			14.6.1.1	 History
			14.6.1.2	 Mechanism of Action and Names
		14.6.2	 Medication Evidence
			14.6.2.1	 Efficacy
			14.6.2.2	 Safety/Tolerability/Side Effects
		14.6.3	 Balance Between Clinical Practice and Evidence
		14.6.4	 Practical Information
	14.7	 Benzodiazepines (Alprazolam, Clonazepam, Diazepam, Lorazepam, Oxazepam)
		14.7.1	 General Influences on Medication Decision-Making
			14.7.1.1	 History
			14.7.1.2	 Mechanism of Action and Names
			14.7.1.3	 FDA Approval
			14.7.1.4	 Influence of Pharma Marketing
			14.7.1.5	 Influence of Cost, Generic Vs. Branded Status
			14.7.1.6	 Public Perception of Medication
		14.7.2	 Medication Evidence
			14.7.2.1	 Efficacy
			14.7.2.2	 Safety/Tolerability/Side Effects
		14.7.3	 Balance Between Clinical Practice and Evidence
		14.7.4	 Practical Information
	14.8	 Atomoxetine
		14.8.1	 General Influences on Medication Decision-Making
			14.8.1.1	 History
			14.8.1.2	 Mechanism of Action and Names
		14.8.2	 Medication Evidence
			14.8.2.1	 Efficacy
			14.8.2.2	 Safety/Tolerability/Side Effects
		14.8.3	 Balance Between Clinical Practice and Evidence
		14.8.4	 Practical Information
	14.9	 Tricyclic Antidepressants (TCAs): Imipramine, Clomipramine
		14.9.1	 General Influences on Medication Decision-Making
			14.9.1.1	 History
			14.9.1.2	 Mechanism of Action and Names
		14.9.2	 Medication Evidence
			14.9.2.1	 Efficacy
			14.9.2.2	 Safety/Tolerability/Side Effects
		14.9.3	 Balance Between Clinical Practice and Evidence
		14.9.4	 Practical Information
	14.10	 Mirtazapine
		14.10.1	 General Influences on Medication Decision-Making
			14.10.1.1	 History
			14.10.1.2	 Name and Mechanism of Action
		14.10.2	 Medication Evidence
			14.10.2.1	 Efficacy
			14.10.2.2	 Safety/Tolerability/Side Effects
		14.10.3	 Balance Between Clinical Practice and Evidence
		14.10.4	 Practical Information
	14.11	 Antihistamines (Hydroxyzine and Diphenhydramine)
		14.11.1	 General Influences on Medication Decision-Making
			14.11.1.1	 History
			14.11.1.2	 Name and Mechanism of Action: Histamine Antagonist (NbN-2)
		14.11.2	 Medication Evidence
			14.11.2.1	 Efficacy
			14.11.2.2	 Safety/Tolerability/Side Effects
		14.11.3	 Balance Between Clinical Practice and Evidence
		14.11.4	 Practical Information
	14.12	 Vortioxetine
		14.12.1	 General Influences on Medication Decision-Making
			14.12.1.1	 History
			14.12.1.2	 Name and Mechanism of Action: Multimodal Serotonin Modulator (NbN-2)
		14.12.2	 Medication Evidence
			14.12.2.1	 Efficacy
			14.12.2.2	 Safety/Tolerability/Side Effects
		14.12.3 Balance Between Clinical Practice and Evidence
		14.12.4 Practical Information
	14.13	 Propranolol
		14.13.1 General Influences on Medication Decision-Making
			14.13.1.1	 History
			14.13.1.2	 Mechanism of Action and Names
		14.13.2 Medication Evidence
			14.13.2.1	 Efficacy
			14.13.2.2	 Safety/Tolerability/Side Effects
		14.13.3 Balance Between Clinical Practice and Evidence
		14.13.4 Practical Information
	14.14	 Summary and Future Directions
	References
15: Psychopharmacology for Pediatric PTSD
	15.1	 Introduction
	15.2	 Assessing Quality of Research Evidence
	15.3	 General Principles of Pharmacotherapy in Pediatric PTSD
	15.4	 Efficacy
	15.5	 Practical Information
	15.6	 Medication Choice
	15.7	 Tricyclic Antidepressants (TCA)
		15.7.1	 Imipramine (Tofranil)
	15.8	 Alpha-1 Antagonist
		15.8.1	 Prazosin (Minipress)
			15.8.1.1	 Influences on Medication Decision-Making
	15.9	 Medication Evidence
	15.10	 Safety
	15.11	 Practical Information
	15.12	 Medication Choice
	15.13	 Advanced Challenges
	15.14	 When to Consult and Scope of Practice
	15.15	 Alpha-2 Agonists
	15.16	 Practical Information (See Table 15.10)
	15.17	 Medication Choice
	15.18	 Beta-Blockers
	15.19	 Second-Generation Antipsychotics (SGAs)
	15.20	 Mood Stabilizers
	15.21	 Opioid Agonists
	15.22	 Miscellaneous Other Medications
	15.23	 Medication Summary
		15.23.1	 SSRIs
		15.23.2	 Imipramine
		15.23.3	 Prazosin
		15.23.4	 Alpha-2 Agonists
		15.23.5	 Propranolol
		15.23.6	 Second Generation Antipsychotics
		15.23.7	 Mood stabilizers
		15.23.8	 Morphine
		15.23.9	 Other medications
	15.24	 Conclusion
	References
Part IV: Mood and Psychosis Spectrum Disorders
16: Psychopharmacology for Pediatric Depressive Disorders
	16.1	 Introduction
	16.2	 General Information About Antidepressants
		16.2.1 Background
			16.2.1.1	 History
			16.2.1.2	 Mechanism of Action
			16.2.1.3	 FDA Approval
			16.2.1.4	 Influence of Pharmaceutical Marketing
			16.2.1.5	 Influence of Cost, Generic, and Branded Status
			16.2.1.6	 Public Perception of Medication
			16.2.1.7	 Other Influences
		16.2.2 Medication Evidence
			16.2.2.1	 Background
				Evidence of Efficacy
				Lack of Efficacy
				FDA-Indicated Medications for Pediatric Depression
				Estimate of Knowledge Gaps in Efficacy
				Medication Target Symptoms
				Suggested Strategies for Tracking Target Symptoms
		16.2.3 Safety
			16.2.3.1	 Background for all Antidepressants
			16.2.3.2	 Evidence of Tolerability
			16.2.3.3	 Evidence of Side Effects
		16.2.4 Balance Between Clinical Practice and Evidence
		16.2.5 Ancillary Prescribing Information
			16.2.5.1	 Role of Pharmacogenetic Testing
			16.2.5.2	 Guidance on Advanced Challenges
			16.2.5.3	 When to Consult and Scope of Practice
			16.2.5.4	 Monitoring/Tests
		16.2.6 Medication Choice and Practical Prescribing Information
			16.2.6.1	 Factors Affecting Medication Choice
			16.2.6.2	 Medication Choice Discussion with Patient/Guardian
	16.3	 Selective Serotonin Reuptake Inhibitors
		16.3.1 Background
			16.3.1.1	 History
			16.3.1.2	 Mechanism of Action
			16.3.1.3	 FDA Approval
			16.3.1.4	 Influence of Pharmaceutical Marketing
			16.3.1.5	 Influence of Cost
		16.3.2 Evidence of Efficacy (See Individual Medications Sections for More Details)
		16.3.3 Safety
		16.3.4 Balance Between Clinical Practice and Evidence
		16.3.5 Ancillary Prescribing Information
			16.3.5.1	 Consulting and Scope of Practice
			16.3.5.2	 Monitoring
		16.3.6 Medication Choice and Practical Prescribing Information
			16.3.6.1	 Selection of a Specific SSRI for Treatment
			16.3.6.2	 Clinical Considerations for Use of SSRIs
		16.3.7 Fluoxetine: Grade 1A
			16.3.7.1	 Evidence of Efficacy
			16.3.7.2	 Safety
			16.3.7.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.8 Escitalopram: Grade 1B
			16.3.8.1	 Evidence of Efficacy
			16.3.8.2	 Safety
			16.3.8.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.9 Sertraline: Grade 1B
			16.3.9.1	 Evidence of Efficacy
			16.3.9.2	 Safety
			16.3.9.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.10 Citalopram: Grade 1B
			16.3.10.1	 Evidence of Efficacy
			16.3.10.2	 Safety
			16.3.10.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.11 Fluvoxamine: Grade 1C
			16.3.11.1	 Evidence of Efficacy
			16.3.11.2	 Safety
			16.3.11.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.12 Paroxetine: Grade 2A
			16.3.12.1	 Evidence of Efficacy
			16.3.12.2	 Safety
			16.3.12.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.13 Vilazodone: Grade 2C
			16.3.13.1	 Evidence of Efficacy
			16.3.13.2	 Safety
			16.3.13.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.3.14 Vortioxetine: Grade 2C
			16.3.14.1	 Evidence of Efficacy
			16.3.14.2	 Safety
			16.3.14.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
	16.4	 Serotonin Norepinephrine Reuptake Inhibitors
		16.4.1 Background
			16.4.1.1	 History
			16.4.1.2	 Mechanism of Action
			16.4.1.3	 FDA Approval
			16.4.1.4	 Influence of Pharmaceutical Marketing
			16.4.1.5	 Influence of Cost
		16.4.2 Evidence of Efficacy
		16.4.3 Safety
		16.4.4 Balance between Clinical Practice and Evidence
		16.4.5 Ancillary Prescribing Information
		16.4.6 Medication Choice and Practical Prescribing Information
		16.4.7 Venlafaxine: Grade 1B
			16.4.7.1	 Evidence of Efficacy
			16.4.7.2	 Safety
			16.4.7.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.4.8 Duloxetine: Grade 1C
			16.4.8.1	 Evidence of Efficacy
			16.4.8.2	 Safety
			16.4.8.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.4.9 Desvenlafaxine: Grade 1C
			16.4.9.1	 Evidence of Efficacy
			16.4.9.2	 Safety
			16.4.9.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.4.10 Levomilnacipran (No Grade Assigned)
			16.4.10.1	 Evidence of Efficacy
			16.4.10.2	 Safety
			16.4.10.3	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
	16.5	 Other Antidepressant Medications
		16.5.1 Bupropion: Grade 1C
			16.5.1.1	 Background
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharmaceutical Marketing
				Influence of Cost, Generic, and Branded Status
				Public Perception of Medication
		16.5.2 Evidence of Efficacy
		16.5.3 Safety
		16.5.4 Balance Between Clinical Practice and Evidence
		16.5.5 Ancillary Prescribing Information
			16.5.5.1	 Consulting and Scope of Practice
			16.5.5.2	 Monitoring
		16.5.6 Medication Choice and Practical Prescribing Information
			16.5.6.1	 Medication Choice
			16.5.6.2	 Practical Prescribing Information
		16.5.7 Mirtazapine: Grade 2C
			16.5.7.1	 Background
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharmaceutical Marketing
				Influence of Cost, Generic and Branded Status
				Public Perception of Medication
			16.5.7.2	 Evidence of Efficacy
			16.5.7.3	 Safety
			16.5.7.4	 Balance Between Clinical Practice and Evidence
			16.5.7.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.7.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.8 Tricyclic Antidepressants (TCAs): Grade 2B
			16.5.8.1	 Background
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharmaceutical Marketing
				Influence of Cost, Generic and Branded Status
				Public Perception of Medication
			16.5.8.2	 Evidence of Efficacy*
			16.5.8.3	 Safety
			16.5.8.4	 Balance Between Clinical Practice and Evidence
			16.5.8.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.8.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.9 Monoamine Oxidase Inhibitors (MAOIs): Grade 2C
			16.5.9.1	 Background
				History
				Mechanism of Action
				FDA Approval
				Influence of Pharmaceutical Marketing
				Influence of Cost, Generic and Branded Status
				Public Perception of Medication
			16.5.9.2	 Evidence of Efficacy
			16.5.9.3	 Safety
			16.5.9.4	 Balance Between Clinical Practice and Evidence
			16.5.9.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.9.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.10 Second-Generation Antipsychotics (SGAs): Grade 1C
			16.5.10.1	 Background
				History
				Mechanism of Action
			16.5.10.2	 Evidence of Efficacy
			16.5.10.3	 Safety
			16.5.10.4	 Balance Between Clinical Practice and Evidence
			16.5.10.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.10.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.11 Lithium: Grade 1C
			16.5.11.1	 Background
				History
				Mechanism of Action
			16.5.11.2	 Evidence of Efficacy
			16.5.11.3	 Safety
			16.5.11.4	 Balance Between Clinical Practice and Evidence
			16.5.11.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.11.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.12 Triiodothyronine: Grade 1C
			16.5.12.1	 Background
				History
				Mechanism of Action
			16.5.12.2	 Evidence of Efficacy
			16.5.12.3	 Safety
			16.5.12.4	 Balance Between Clinical Practice and Evidence
			16.5.12.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.12.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.13 Omega-3-Fatty Acids: Grade 2B
			16.5.13.1	 Background
				History
				Mechanism of Action
			16.5.13.2	 Evidence of Efficacy
			16.5.13.3	 Safety
			16.5.13.4	 Balance Between Clinical Practice and Evidence
			16.5.13.5	 Ancillary Prescribing Information
				Consulting and Scope of Practice
				Monitoring
			16.5.13.6	 Medication Choice and Practical Prescribing Information
				Medication Choice
				Practical Prescribing Information
		16.5.14 Miscellaneous Agents
			16.5.14.1	 Ketamine and Esketamine: No Grade Given
			16.5.14.2	 Buspirone: Grade 2C
			16.5.14.3	 Other Potential Agents
			16.5.14.4	 Non-recommended Agents
	16.6	 Antidepressant-Related Special Topics
		16.6.1 Antidepressant Black Box Suicide Risk Warning
		16.6.2 Discussion of Psychopharmacological Study Design
		16.6.3 Continuation and Maintenance Treatment
		16.6.4 Treatment-Resistant Depression
		16.6.5 Treatment of Other Specified Depressive Disorders
	16.7	 Conclusion
	References
17: Psychopharmacology for Pediatric Bipolar Disorder
	17.1	 Introduction
		17.1.1	 Diagnosis
			17.1.1.1	 Differential Diagnosis
			17.1.1.2	 Identifying and Quantifying Target Symptoms
	17.2	 Treatment of Acute Episodes
		17.2.1	 Algorithms for Treatment of Manic and Mixed Episodes of Pediatric Bipolar Disorder (See Figs. 17.1 and 17.2)
			17.2.1.1	 Algorithm 1. Acute Manic/Mixed Episodes Without Psychosis (Fig. 17.1)
			17.2.1.2	 Algorithm 2. Acute Manic/Mixed Episodes with Psychosis (Fig. 17.2)
		17.2.2	 Algorithm for the Treatment of Depressive Episodes of PBD (See Fig. 17.3)
			17.2.2.1	 Algorithm 3. Acute Depressive Episodes (Fig. 17.3)
				Ancillary Prescribing Information
				Course, Prognosis, and Comorbidity
				Grading the Evidence
	17.3	 Medications for Pediatric Bipolar Mixed/Manic Episodes
		17.3.1	 Lithium: Grade 1A for Pediatric Bipolar I Disorder, Manic or Mixed Episodes
			17.3.1.1	 Influences on Medication Decision-Making
				History
				Mechanism of Action
				FDA Approval (See Table 17.1)
				Medication Evidence
					Efficacy
					Safety
				Practical Information
				Medication Choice
				Guidance on Advanced Challenges
		17.3.2	 Antiepileptic Medications
			17.3.2.1	 Summary of Antiepileptic Drugs/Medications (AEDs)
			17.3.2.2	 Lamotrigine: Grade 1B (as Adjunctive Maintenance Treatment)
				History
				Mechanism of Action
				Public Perception of Medication by Patients and Providers
				Medication Evidence
					Evidence Supporting Efficacy (See Table 17.5)
				Balance Between Clinical Practice and Evidence
				Practical Information
				Medication Choice
				Guidance on Advanced Challenges
			17.3.2.3	 Carbamazepine (Grade 2B) for PBD Mania/Mixed Mood
			17.3.2.4	 Oxcarbazepine (Grade 2C) for PBD Mania/Mixed Mood
			17.3.2.5	 Divalproex Sodium (Grade 2A) for PBD Mania/Mixed Mood
				Influences on Medication Decision-Making
					History
					Mechanism of Action
					FDA Approval (See Table 17.1)
					Influence of Pharmaceutical Marketing
					Medication Evidence
					Practical Information
					Medication Choice
		17.3.3	 Atypical (Second-Generation) Antipsychotics (SGAs)
			17.3.3.1	 Summary of Atypical Antipsychotics
				History
				Mechanism of Action of SGAs
				FDA Approval
				Influence of Cost
				Evidence of Efficacy
				Safety
					FDA Warnings and Precautions (Relevant for Pediatric Population)
				Medication Choice and Practical Prescribing Information
					Selection of a Specific SGA for Treat ment
		17.3.4	 Antipsychotics in the Treatment of PBD, Manic/Mixed Episodes
			17.3.4.1	 Aripiprazole: Grade 1A for PBD Mania/Mixed Mood
				Influences on Medication Decision-Making
					History
					Mechanism of Action
					Public Perception of Medication by Patients and Providers
					Medication Evidence
					Safety
					Balance Between Clinical Practice and Evidence
					Practical Information
						Pharmacodynamics (See Table 17.17)
						Drug–Drug Interactions
					Medication Choice
			17.3.4.2	 Asenapine: Grade 1B for PBD Mania/Mixed Mood
				Influences on Medication Decision-Making
					History
					Mechanism of Action
					Public Perception of Medication by Patients and Providers
					Medication Evidence
					Safety
					Balance Between Clinical Practice and Evidence
					Practical Information
					Medication Choice
			17.3.4.3	 Olanzapine: Grade 2A for PBD Mania/Mixed Mood
				Influences on Medication Decision-Making
					History
					Mechanism of Action
					Medication Evidence
						Efficacy (See Table 17.23)
					Safety
					Balance Between Clinical Practice and Evidence
					Practical Information
						Dosing Range [134]
						Pharmacokinetics [134]
						Pharmacodynamics (See Table 17.24)
						Drug–Drug and Drug–Food Interactions [134]
						Tapering Off Options (See Sect. 17.3.3)
						Augmentation and Combinations (See Sect. 17.3.3)
						Managing Side Effects (See Sect. 17.3.3)
			17.3.4.4	 Quetiapine: Grade 1A for PBD Manic/Mixed Mood
				Background
					History
					Mechanism of Action
					Medication Evidence
						Efficacy (See Table 17.25)
						Safety
							Evidence Supporting Safety
							Lack of Safety
				Practical Information
			17.3.4.5	 Risperidone: Grade 2A for PBD Mania/Mixed Mood
				Background
					History
					Mechanism of Action
					Medication Evidence
						Efficacy (See Table 17.28)
						Safety
				Balance Between Clinical Practice and Evidence
				Practical Information
					Administration Options
					Dosing Range (See Table 17.30)
					Pharmacokinetics
					Pharmacodynamics
					Drug–Drug and Drug–Food Interactions
				Medication Choice
	17.4	 Treatment of Pediatric Bipolar Depression
		17.4.1	 Lamotrigine: Grade 1B as Adjunctive Maintenance Treatment for PBD Depression
		17.4.2	 Lurasidone: Grade 1B for PBD Depression
			17.4.2.1	 Background
				History
				Mechanism of Action
				Influence of Pharmaceutical Marketing
			17.4.2.2	 Medication Evidence
				Efficacy
				Safety
			17.4.2.3	 Balance Between Clinical Practice and Evidence
			17.4.2.4	 Practical Information
				Place in Overall Algorithm
				Administration Options
				Dosing Range for Depressive Episodes Associated with PBD (Ages 10–17)
				Pharmacokinetics
				Pharmacodynamics
				Drug–Drug and Drug–Food Interactions (See Table 17.33)
		17.4.3	 Olanzapine-Fluoxetine Combination: Grade 1B for PBD Depression
			17.4.3.1	 Background
				History
				Mechanism of Action
			17.4.3.2	 Medication Evidence
				Efficacy
				Safety
			17.4.3.3	 Balance Between Clinical Practice and Evidence
			17.4.3.4	 Practical Information
			17.4.3.5	 Medication Choice
		17.4.4	 Quetiapine: Grade 2B for PBD Depression
		17.4.5	 Lithium: Grade 2B for Bipolar I Disorder, Depressed Episodes
	17.5	 Treatment-Refractory Pediatric Bipolar Disorder
		17.5.1	 Electroconvulsive Therapy: Not Graded
		17.5.2	 Clozapine: Not Graded
	17.6	 Psychotherapy
	17.7	 Conclusion
	References
18: Psychopharmacology for Pediatric Schizophrenia and Psychotic Disorders
	18.1	 Introduction
		18.1.1	 Course, Prognosis, and Comorbidity
		18.1.2	 Diagnosis
		18.1.3	 Treatment
		18.1.4	 Overview
			18.1.4.1	 Efficacy of Antipsychotic Medications in Youth
			18.1.4.2	 Side Effects of SGAs in Youth
			18.1.4.3	 QT Interval Prolongation in Youth
	18.2	 Pediatric Psychopharmacology
		18.2.1	 Influences on Medication Decision-Making
			18.2.1.1	 History
			18.2.1.2	 Mechanism of Action
			18.2.1.3	 FDA Approval
			18.2.1.4	 Influence of Marketing
			18.2.1.5	 Influence of Cost
			18.2.1.6	 Public Perception of Medication by Patients and Providers
		18.2.2	 Medication Evidence
			18.2.2.1	 Efficacy
			18.2.2.2	 Safety
		18.2.3	 Balance Between Clinical Practice and Evidence
		18.2.4	 Medication Choice
		18.2.5	 Practical Information
		18.2.6	 Advanced Challenges
		18.2.7	 When to Consult and Scope of Practice
			18.2.7.1	 Background
				History
				Mechanism of Action
				FDA Approval
				Influence of Marketing
				Influence of Cost
				Public Perception of Medication by Patients and Providers
			18.2.7.2	 Medication Evidence
				Efficacy
				Safety
			18.2.7.3	 Balance Between Clinical Practice and Evidence
			18.2.7.4	 Medication Choice
			18.2.7.5	 Practical Information
			18.2.7.6	 Advanced Challenges
			18.2.7.7	 When to Consult and Scope of Practice
	18.3	 Conclusion
	References
Part V: Sleep Disorders
19: Practical Psychopharmacology of Pediatric Sleep Disorders
	19.1	 Introduction
	19.2	 Insomnia
	19.3	 Insomnia Psychopharmacology Background
	19.4	 General Principles
	19.5	 Medications Used for Pediatric Insomnia
		19.5.1	 Melatonin Receptor Agonists
			19.5.1.1	 Melatonin (Melatonin Receptor Agonist, MRA)
			19.5.1.2	 Ramelteon (Melatonin Receptor Agonist, MRA)
			19.5.1.3	 Tasimelteon (Melatonin Receptor Agonist, MRA)
		19.5.2	 Antihistamines
			19.5.2.1	 Diphenhydramine (Histamine Receptor Antagonist)
			19.5.2.2	 Hydroxyzine (Histamine Antagonist)
		19.5.3	 Alpha-2 Agonists (Anti-adrenergic Activity)
			19.5.3.1	 Clonidine (Alpha-2 Agonist)
		19.5.4	 Benzodiazepines (Benzodiazepine Receptor Agonists, BZDs; GABA Receptor Agonists)
			19.5.4.1	 Clonazepam (BZD, Nonselective GABA Receptor Agonist)
		19.5.5	 Selective GABA-A Receptor Agonists (Nonbenzodiazepine Receptor Agonists, BzRAs; GABA Receptor Agonists)
			19.5.5.1	 Zolpidem (BzRA; Selective GABA-A Receptor Agonist)
			19.5.5.2	 Eszopiclone (BzRA; Selective GABA-A Receptor Agonist)
		19.5.6	 Antidepressants Used as Hypnotics
			19.5.6.1	 Trazodone (Atypical Antidepressant)
			19.5.6.2	 Mirtazapine (Atypical Antidepressant)
		19.5.7	 Tricyclic Antidepressants
			19.5.7.1	 Amitriptyline
			19.5.7.2	 Doxepin
			19.5.7.3	 Trimipramine
		19.5.8	 Antipsychotics
	19.6	 Other Sleep Disorders
		19.6.1	 Pediatric Sleep-Disordered Breathing
		19.6.2	 Restless Legs Syndrome
			19.6.2.1	 RLS Management
		19.6.3	 Parasomnias
		19.6.4	 Narcolepsy
		19.6.5	 Circadian Rhythm Sleep-Wake Disorders
	References
Index