Practical Child and Adolescent Psychopharmacology

Half-title......Page 3
Series-title......Page 4
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Contributors......Page 11
Preface......Page 15
Acknowledgements......Page 16
The prototype treatment: psychostimulants for ADHD......Page 17
Evolution of child and adolescent psychopharmacology......Page 19
Lifting the taboo......Page 24
Confronting clinical uncertainty......Page 25
The rise of therapeutic empiricism......Page 26
Money-oriented medicine......Page 27
Changing training programs......Page 28
Academic child and adolescent psychopharmacology......Page 29
Efficacy and effectiveness......Page 30
Combined medication treatments......Page 31
Limited benefits......Page 32
Sudden death......Page 33
Rising expectations......Page 34
The role of industry and technology......Page 35
Medication advertisement......Page 36
Innovative treatments......Page 37
The turn of the millennium......Page 39
REFERENCES......Page 40
Models and concepts......Page 54
Plasticity and sensitive periods......Page 55
Apoptosis......Page 56
Cellular migration and growth......Page 57
Neurotransmitters......Page 58
Receptors......Page 60
Amino acids and neuropeptides......Page 63
Macrodevelopment......Page 65
Effects of stress, early experience, and hippocampal neurogenesis......Page 69
Genetic evidence for some psychiatric developmental disorders and pediatric pharmacogenetics......Page 70
Developmental psychopharmacology......Page 72
Conclusions and future directions......Page 75
REFERENCES......Page 78
Introduction......Page 86
Information gathering......Page 88
Structured and unstructured interviews......Page 92
The parental interview......Page 93
Baseline assessment for psychopharmacologic treatment......Page 94
Psychoeducational aspects......Page 99
Deciding which medication to use......Page 101
How long to treat......Page 103
Summary......Page 104
REFERENCES......Page 105
What is the naturalistic course? Is the course severe enough that treatment is warranted?......Page 107
Child and adolescent depression: diagnosis......Page 108
Psychopharmacologic treatments for depression in adults......Page 111
Psychopharmacologic treatment of depression in children and adolescents: efficacy and tolerability......Page 113
Clinical guidelines for psychopharmacological treatment of child depression......Page 116
Summary and conclusions......Page 117
REFERENCES......Page 118
Diagnosis and phenomenology......Page 122
Developmental issues......Page 123
Presentation in childhood and adolescence......Page 124
Misdiagnosis and underdiagnosis......Page 125
Comorbidity......Page 126
Genetics......Page 127
Neuroimaging......Page 128
Cognition......Page 129
Psychosocial factors......Page 130
Establishing a therapeutic relationship......Page 131
Psychoeducation and psychotherapy......Page 133
Acute mania, mixed states, and rapid cycling......Page 134
Bipolar depression......Page 137
Treatment in female-specific issues......Page 139
Treatment of bipolar disorder in the presence of comorbid symptom clusters or syndromes......Page 141
Maintenance treatment in juvenile bipolar disorder......Page 142
REFERENCES......Page 143
Overview......Page 150
Description of the disorder......Page 151
Differential diagnosis......Page 152
Substance abuse......Page 153
Schizotypal personality disorder and autistic spectrum disorders......Page 154
Epilepsy......Page 155
Diagnostic process......Page 156
Neurodegenerative theories......Page 158
Psychopharmacologic treatment of schizophrenia in adults......Page 159
Baseline data......Page 162
Choice of initial medication......Page 163
Parkinsonian side effects......Page 165
Anticholinergic side effects......Page 166
‘‘Atypical ’’neuroleptic use in children and adolescents......Page 167
Electroconvulsive therapy......Page 169
Intermediate and long-term management......Page 170
Conclusion......Page 172
REFERENCES......Page 173
Epidemiology......Page 175
Symptoms......Page 176
Course......Page 177
Comorbidity......Page 178
Diagnosis......Page 179
Etiology......Page 181
General comments......Page 185
Behavioral treatment......Page 186
Clomipramine......Page 188
SSRIs......Page 189
Dosage and duration of treatment......Page 192
Augmentation strategies......Page 193
Summary......Page 194
REFERENCES......Page 195
Introduction......Page 203
Trends in the classification of anxiety......Page 204
Prevalence and epidemiology of child and adolescent anxiety disorders......Page 205
Review of neurobiology of anxiety disorder......Page 210
Temperament, neuroevolutionary factors, and the neurobiology of environmental effects......Page 213
General......Page 214
Panic disorder......Page 215
GAD......Page 217
PTSD......Page 218
Evidence of efficacy......Page 219
Safety and tolerability......Page 221
Efficacy......Page 223
Efficacy......Page 224
Current role of TCAs......Page 225
Efficacy......Page 226
Moclobemide......Page 227
Clonidine......Page 228
GAD......Page 229
Assessment......Page 230
Prepharmacologic interventions......Page 232
Choosing and titrating medication......Page 233
Duration and tapering......Page 234
REFERENCES......Page 235
The pathophysiology of ADHD......Page 246
Stimulants......Page 248
Tricyclic antidepressants in ADHD......Page 256
Bupropion......Page 258
MAOIs......Page 259
SSRIs......Page 260
Alpha, noradrenergic agonists......Page 261
Beta, noradrenergic antagonists......Page 262
Impact of psychiatric comorbidity in the pharmacotherapy of ADHD......Page 263
Combined pharmacotherapy......Page 265
Cholinergic drugs......Page 267
REFERENCES......Page 268
Introduction......Page 281
Current diagnostic concepts......Page 283
Asperger’s disorder......Page 286
PDDs: hypothesized central nervous system mechanisms......Page 287
Theoretical concepts......Page 288
Neurocognitive deficits......Page 289
The cerebellum......Page 290
The limbic system and subcortical brains areas......Page 291
Dopamine......Page 292
Noradrenaline and adrenaline......Page 293
Overview of known psychopharmacologic treatment for an adult PDD......Page 296
Potent serotonin transport inhibitors......Page 299
Partial serotonin agonists......Page 302
Neuroleptics......Page 303
Sympatholytic agents......Page 305
Opioid antagonists......Page 306
Principles of assessment and management......Page 307
Neurologic......Page 309
Long-term psychopharmacologic treatment......Page 310
REFERENCES......Page 311
11 Aggressive behavior......Page 321
Biologic and developmental markers of aggression......Page 322
Lithium......Page 325
Side effects......Page 326
Buspirone......Page 327
Selective serotonin reuptake inhibitors......Page 328
Anticonvulsant drugs......Page 329
Adrenergic drugs......Page 330
Clonidine......Page 331
Antipsychotic drugs......Page 332
Psychostimulants......Page 333
The use of PRN medications......Page 334
Case vignette 1......Page 335
The biopsychosocial approach......Page 336
REFERENCES......Page 338
Introduction......Page 344
Substance abuse (DSM-IV)......Page 345
Harmful use......Page 346
The independence of the criteria of impairment of social functioning......Page 347
Definition of SUD: a neurobiologic perspective......Page 348
Epidemiology of SUD in young people......Page 349
Studies of comorbidity in adults......Page 350
Studies of comorbidity in adolescent populations......Page 351
Comorbidity: explanatory models......Page 352
Neurobiology of SUD......Page 353
Genetic studies......Page 355
Mesolimbic and mesocortical dopamine pathways: the ‘‘reward pathways’’......Page 356
‘‘Emotional circuits’’ – role of limbic system and basal ganglia structures......Page 357
Dopamine......Page 358
Serotonin (5-HT)......Page 359
GABA and glutamate......Page 360
Neurobiologic hypothesis of addictive behavior......Page 361
Clinical implications......Page 364
Pharmacologic treatment of SUD......Page 365
Medications that decrease the reinforcing effects of drugs of abuse......Page 366
Treatment of comorbid psychiatric disorders......Page 367
Other drugs......Page 368
Medications that decrease reinforcing effects of alcohol and/or reduce craving......Page 369
Acamprosate and other GABAergic agents......Page 371
Treatment of comorbid psychiatric disorders......Page 372
Management of withdrawal......Page 373
Medications to decrease the reinforcing effects of opiates......Page 374
Methadone......Page 375
LAAM......Page 376
Management of withdrawal......Page 377
Drugs to block the subjective effects of cocaine......Page 378
Management of withdrawal and nicotine replacement therapy......Page 379
Treatment of comorbid psychiatric disorders......Page 380
Guidelines for psychopharmacotherapy in adolescent SUD......Page 381
Schizophrenia......Page 382
Conclusions......Page 383
REFERENCES......Page 384
Introduction......Page 398
Overview......Page 399
Comorbid conditions......Page 400
Obsessive–compulsive symptoms......Page 401
Other psychiatric disorders......Page 402
Neuroanatomic location......Page 403
Neurochemical abnormalities in TS......Page 404
Noradrenaline......Page 405
GABA......Page 406
TS as a neuropsychiatric sequela of group A, Beta-hemolytic streptococcal infection......Page 407
Patient and parent education......Page 408
Tic suppression–pharmacologic......Page 409
Haloperidol......Page 410
Pimozide......Page 411
Clonidine and guanfacine......Page 412
Antiandrogen agents......Page 413
Immunologic treatments......Page 414
Psychosocial treatment of TS......Page 415
Treatment of comorbid conditions in TS......Page 416
REFERENCES......Page 418
Introduction......Page 426
Anorexia nervosa: overview of the disorder......Page 427
Psychopharmacologic treatment of anorexia nervosa......Page 428
Antidepressants......Page 429
Appetite enhancers......Page 430
Prokinetic agents......Page 431
Zinc......Page 432
Clinically useful treatment guidelines for anorexia nervosa......Page 433
Bulimia nervosa: overview of the disorder......Page 434
Anticonvulsants......Page 435
Lithium......Page 436
Antidepressants......Page 437
Medication and psychotherapy......Page 438
Clinically useful treatment guidelines for bulimia nervosa......Page 440
Binge eating disorder......Page 441
REFERENCES......Page 442
Introduction......Page 447
Neurologic and psychiatric illness in children......Page 448
Perinatal brain injury......Page 449
Epilepsy......Page 452
Headache......Page 453
Immunologic and psychiatric illness in children......Page 454
Respiratory and psychiatric illness in children......Page 455
PANDAS......Page 456
Respiration and anxiety......Page 457
Serotonin and behavior......Page 458
Conclusions......Page 459
The search for medical problems in the child with psychiatric problems......Page 460
Focal brain lesions and psychopathology......Page 462
Endocrine disorders......Page 464
Conclusions......Page 465
REFERENCES......Page 466
Index......Page 471