Child and Adolescent Clinical Psychopharmacology, 4th ed.

by Wayne Hugo Green
Philadelphia: Lippincott Williams & Wilkins, 2007
379 pages • $64.95 (hardcover)

Each edition of this book, beginning with the first in 1991, has received much use while sitting on my office shelf. The editions have spanned the modern era of child psychopharmacology and, along with the works of S. P. Kutcher, have offered practical clinical guidance in choosing and monitoring medications in children and teenagers while also providing an overview of the literature that supports child psychopharmacology.

The fourth edition of Child and Adolescent Clinical Psychopharmacology follows its previous format of an initial section focusing on general principles of psychopharmacology with children and adolescents, including an overview of psychiatric diagnosis and target symptoms; a detailed discussion of both physical and cognitive development issues that impact prescribing; and a lengthy discussion of baseline information to be considered prior to initiating medication.

The next section discusses research paradigms and placebos and then systematically reviews each major class of medication used in child and adolescent psychiatry. Summaries of the indications for each available medication, dosing guidelines, and preparations are particularly helpful for the busy clinician. Similarly, the back cover provides an index of DSM-IV diagnoses in childhood and adolescence for which psychopharmacological treatment may be indicated, with page numbers of the relevant subsections. Much of each chapter is devoted to "Reports of Interest" that summarize research studies addressing efficacy and tolerability questions for each compound or delivery system.

The preface of the first edition is reprinted here in the fourth and wisely discusses that psychopharmaco-therapy, while necessary, is often not sufficient for proper psychiatric treatment of children and teenagers. Similarly, it discusses the ongoing issue of the strong feelings engendered by the topic of child psychopharmacology and warns against the extremes of opinion.

The current preface addresses the trends of growing awareness of adverse medication effects, especially in prescribing SSRIs and second-generation antipsychotics; the introduction of delivery systems that significantly decrease or eliminate the need of multiple daily doses, especially for the patient with attention-deficit/hyperactivity disorder; and the rapidly growing addition of indications or use in different age populations. Interestingly, since this book went to press, risperidone (Risperdal) now has added indications for irritability in autism and for minors with schizophrenia.

Many more books are now available in pediatric psychopharmacology and may serve different purposes better than this text. Pediatric Psychopharmacology (Oxford Press, 2003) offers a more thorough scholarly presentation of principles of neurobiology and psychopharmacology and also offers a more in-depth discussion on assessment of the specific disorders and syndromes. In contrast, the newly published Pediatric Psychopharmacology: Fast Facts (WW Norton, 2006) offers concise data on basic pharmacology, the medications, and the disorders and their treatment in an easy-to-read format.

The current edition of Child and Adolescent Clinical Psychopharmacology has sections, such as the medicological discussion about prescribing, in which major references are out of date. Similarly, some clinical recommendations, such as observing patients for 7 to 10 days before prescribing, do not comply with current practice, in which those in inpatient units may have average lengths of stay of less than 1 week.

This text remains a valuable tool for the prescribing clinician and trainee. However, it will now be one of the many texts on my shelf related to child psychopharmacology.