Mood and Anxiety Disorders in Children and Adolescents: A Psychopharmacological Approach

119 Pages·2001·0.63 MB·English

by  David J. Nutt

Mood and Anxiety Disorders in Children
and Adolescents
A psychopharmacological approach

Mood and Anxiety
Disorders in Children
and Adolescents
A psychopharmacological approach
David Nutt
Caroline Bell
Christine Masterson
Clare Short
Martin Dunitz
©2001 Martin Dunitz Ltd, a member of the Taylor & Francis group
First published in the United Kingdom in 2001 by
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Contents
About the authors vii
1 Introduction 1
2 The basics 3
3 Drugs and how they work 13
4 Mood disorders 37
5 Anxiety disorders 65
References 95
Index 101

About the authors
David Nutt
David Nutt is currently Professor of Psy-
chopharmacology and Dean of Clinical Medi-
cine and Dentistry, in the University of Bristol.
He is also a member of the Advisory Council
on the Misuse of Drugs, the MRC Neuro-
science Advisory Board and the CSM (Com-
mittee on Safety of Medicines). In addition, he
is Advisor to the British National Formulary, the
editor of the Journal of Psychopharmacology
and the Past-President of the British Association of Psychopharmacology.
His particular research interests include the areas of anxiety, depression,
sleep and addiction.
Caroline Bell
Caroline Bell is a Specialist Registrar in General
Adult Psychiatry and a research fellow at the
Psychopharmacology Unit, Bristol University.
Her research interest has been in the field of the
psychopharmacology of anxiety and depres-
sion. This has involved work on projects examin-
ing the role of serotonin in these disorders and
clinical studies testing the efficacy of drugs in
the treatment of these conditions in adults.
Christine Masterson
Christine Masterson is a Consultant Child and
Adolescent Psychiatrist based within a multi-
disciplinary team at Ashford and St Peter’s
NHS Trust, Chertsey, Surrey. Her interests
include paediatric liaison and psychopharma-
cology.
viii About the authors
Clare Short
Clare Short is a Specialist Registrar on the
Child and Adolescent Psychiatry training
scheme in Bristol. During her training she has
balanced the clinical practice of these disci-
plines by developing knowledge and experi-
ence in both the biological aspects of mental
illness together with the practice of psy-
chotherapeutic techniques.
1
Introduction
This book discusses the current state of knowledge of mood and anxiety
disorders in children and adolescents from a psychopharmacological
perspective and gives clinicians practical advice on the use of medica-
tion in this age group. This is a rapidly evolving field, and it is apparent
that many questions remain unanswered. What is clear, however, is that a
psychopharmacological way of thinking often provides a useful model for
explaining the nature of disorders to children and their families, why they
need to take medication, and how these drugs may work. For the clini-
cian, a similar understanding makes the process of knowing why, when,
what, and how to prescribe much more logical.
Recent advances have led to a rapid increase in our knowledge of the
neurobiological processes underlying these conditions. This has been
paralleled by an ever-increasing number of available treatment options
appearing on the market. Choosing the right drug or therapy for each
child may at first seem a daunting prospect, but understanding the psy-
chopharmacology and neurochemistry involved makes the choice much
more straightforward. Of course, there is nothing quite like clinical experi-
ence; but this in combination with a scientific approach means that treat-
ment can be tailored to specific symptoms and disease profiles, and
side-effects can be anticipated and explained.
Although in this book we concentrate on psychopharmacological
approaches, we are not advocating the use of drug treatments in isola-
tion or their use in every young person. Medication is most effective when
incorporated into a carefully thought-out management plan based on a
clearly established diagnosis. The key to this is a thorough assessment of
all the factors involved (psychological, biological and social) and the
impact these have on every area of the child’s life. This also includes time
spent educating the child and family about the nature of the illness, the
aetiological factors involved, the likely time course of recovery, and any
potential side-effects that may be experienced. At least initially, young-
sters should be seen frequently (i.e. once or twice weekly) during treat-
ment to allow the careful monitoring of response and side-effects, and for
1