A large body of research literature
exists on the topic of treatments for adults with psychiatric disorders.
Although this research does not always provide clear-cut answers to clinical
questions, by and large one can find a published study or opinion on most
topics and questions within adult psychiatry.

In the field of child psychiatry
the scene is quite different. There are far fewer child psychiatrists overall,
and child psychiatric researchers in particular, than there are adult
psychiatrists and researchers. In adult psychiatry there are at least four
major monthly journals devoted to publishing significant research findings; in
child psychiatry there is one. Many basic questions pertaining to the
psychiatric treatment of children and adolescents remain unanswered, or even
unasked.

Thus, the editors of Pediatric
Psychopharmacology faced a considerable challenge in assembling a
compendium of the accumulated knowledge pertaining to the psychopharmacological
treatment of children and adolescents. Three of the editors are on the faculty
of the Yale Child Study Center, while the fourth is a senior scientist at the
National Institute of Mental Health (NIMH). The volume is dedicated to the
memory of Donald J. Cohen, the late chairman of child psychiatry at Yale, who
was a major force behind the ascension of the neurobiological perspective in
child psychiatry over the past three decades.

The volume is divided into for
major sections: an introductory section on the neurobiological underpinnings of
current understanding of both mental illness and drug effects in the central
nervous system; a lengthy section on the classes of medications and other "somatic"
interventions most commonly used in child psychiatry; a section on issues and
recommendations in assessment and treatment of childhood mental disorders; and
a concluding section on issues in research, ethics, and epidemiology that
confront contemporary child psychiatrists. More than one hundred authors
contribute to the volume’s 56 chapters, and the table of contents contains a
virtual Who’s Who of American and international academic child psychiatry.
Most of the authors are the preeminent authorities on their subject matter–again
a reflection of the relatively small community that constitutes academic child
psychiatry.

A formal review of child
psychopharmacology forms only one quarter of the volume, and one wonders if a
more descriptive title would have been The Biological Basis of Child
Psychiatry. The book aspires to address nearly every aspect of child
psychiatric practice, covering aspects of the topic well beyond the realm of
medications and their use. The breadth and depth of coverage is quite
remarkable, ranging from musings on the influence of pharmaceutical companies
in a chapter on prescribing practices, to detailed description of the anatomy
of the bladder in a chapter on enuresis, to detailed and highly technical
descriptions of neuronal migration in the forebrain in a chapter on
neurological development. Detail about each of the medications in the child psychiatrists’
armamentarium is extensive without becoming overwhelming. The authors do a
good job of highlighting controversies and pitfalls in the field, such as the
reported association between valproic acid and polycystic ovary syndrome. At a
hefty 791 pages, the book appears better suited for use as a reference text to
be consulted selectively rather than an overview to be read cover-to-cover in a
few sittings. Additionally, the book appears to be aimed squarely at
psychiatrists and associated faculty in academic settings, as few clinicians in
private practice will likely appreciate the extensive content on non-clinical,
basic science aspects of psychopharmacology.

A particularly valuable and
unexpected feature of the book is the inclusion of more "philosophical"
chapters, which consider the context and larger meanings of psychiatric
medications for children. In chapters with titles such as "Psychopharmacological
Treatment of Preschoolers," "Thinking About Prescribing," "Who
Is Prescribing? And for Whom, How, and Why?," the authors take a step back
from the raw data of clinical trials and pharmacokinetic studies to consider
what the use of psychotropic medications implies about child psychiatrists, the
parents and children who seek treatment, and the role of medications in
society.

As with all medical textbooks,
there is a significant lag time between submission of the manuscript and
appearance of the work in print. Most of the research papers cited were
published during or before 2001, which is an impressive feat for a book
published in 2003. However, some important issues that have emerged since
2001, including the FDA’s recent precautions regarding SSRI’s in children, and
the withdrawal of nefazodone from European markets, are not addressed in this
volume. The citations and bibliographies at the end of each chapter are
extensive and up-to-date. An increasingly common practice in psychiatry texts
is for the most important two or three references to be marked with an
asterisk, and this would have improved the utility of the reference lists.

In summary, then, Pediatric
Psychopharmacology provides a well-written and nearly comprehensive guide
to the biology of mental illness in children and adolescents.

The editors manage to survey the
broad and sometimes contradictory corpus of literature in the field and to
organize current knowledge in a reader-friendly format and sequence. The
authors for the most part write in crisp and engaging prose. One wishes that
they could make more conclusive statements about clinical decision-making, but
the relative paucity of research in the field preclude definitive treatment
strategies for many conditions. Nevertheless, the book is likely to become a
landmark in the field and to set a new standard for research-driven
publications in child psychiatry.

© 2004 Michael
Brodsky

 Michael
Brodsky is a psychiatrist in training in Los
Angeles, California, and an avid reader.

Categories: ChildhoodDisorders, Medications, Psychology