Pharmacotherapy for Child and Adolescent Psychiatric Disorders, Second Edition, (Medical Psychiatry, 18)

767 Pages·2002·3.56 MB·English

by  David Rosenberg

PHARMACOTHERAPY
CHILD ADOLESCENT
for and
PSYCHIATRIC DISORDERS
Second Edition, Revised and Expanded
edited by
David R. Rosenberg
Children’s Hospital of Michigan and
Wayne State University
Detroit, Michigan, U.S.A
Pablo A. Davanzo
University of California, Los Angeles
Los Angeles, California, U.S.A.
Samuel Gershon
Western Psychiatric Institute and Clinic
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, U.S.A
Marcel Dekker, Inc. New York Basel
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Copyright ©2002 by Marcel Dekker,Inc. All Rights Reserved.
The first edition of this book was published as Textbook of Pharmacotherapy for Child
andAdolescentPsychiatricDisorders,byDavidR.Rosenberg,JohnHolttum,andSamuel
Gershon(Brunner/Mazel,Inc.,1994).
ISBN: 0-8247-0779-6
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PRINTED INTHEUNITEDSTATESOFAMERICA
Medical Psychiatry
SeriesEditor
WilliamA.Frosch,M.D.
WeillMedicalCollegeofCornellUniversity
NewYork,NewYork
1. Handbook of Depression and Anxiety: A Biological Approach, edi-
tedbyJohanA.denBoerandJ.M.AdSitsen
2. Anticonvulsants in Mood Disorders, edited by Russell T. Joffe and
JosephR.Calabrese
3. Serotonin in Antipsychotic Treatment: Mechanisms and Clinical
Practice, edited by John M. Kane, H.-J. Möller, and Frans Awou-
ters
4. Handbook of Functional Gastrointestinal Disorders, edited by
KevinW.Olden
5. ClinicalManagementofAnxiety,editedbyJohanA.denBoer
6. Obsessive-Compulsive Disorders: Diagnosis (cid:0) Etiology (cid:0) Treat-
ment,editedbyEricHollanderandDanJ.Stein
7. Bipolar Disorder: Biological Models and Their Clinical Application,
editedbyL.TrevorYoungandRussellT.Joffe
8. Dual Diagnosis and Treatment: Substance Abuse and Comorbid
Medical and Psychiatric Disorders, edited by Henry R. Kranzler
andBruceJ.Rounsaville
9. GeriatricPsychopharmacology,editedbyJ.CraigNelson
10. Panic Disorder and Its Treatment, edited by Jerrold F. Rosenbaum
andMarkH.Pollack
11. ComorbidityinAffectiveDisorders,editedbyMauricioTohen
12. Practical Management of the Side Effects of Psychotropic Drugs,
editedbyRichardBalon
13. Psychiatric Treatment of the Medically Ill, edited by Robert G.
RobinsonandWilliamR.Yates
14. Medical Management of the Violent Patient: Clinical Assessment
andTherapy,editedbyKennethTardiff
15. Bipolar Disorders: Basic Mechanisms and Therapeutic Implica-
tions,editedbyJairC.SoaresandSamuelGershon
16. Schizophrenia: A New Guide for Clinicians, edited by John G.
Csernansky
17. PolypharmacyinPsychiatry,editedbyS.NassirGhaemi
18. Pharmacotherapy for Child and Adolescent Psychiatric Disorders:
Second Edition, Revised and Expanded, David R. Rosenberg,
PabloA.Davanzo,andSamuelGershon
19. BrainImagingInAffectiveDisorders,editedbyJairC.Soares
20. Handbook of Medical Psychiatry, edited by Jair C. Soares and
SamuelGershon
ADDITIONALVOLUMESINPREPARATION
Aggression: Psychiatric Assessment and Treatment, edited by Emil
F.Coccaro
Series Introduction
ChildrenhavebeentheorphansofAmericanhealthcare.Inasystemdominated
bythepoliticsofwhowillpaythebills,thosewithoutvotesgetshortshrift.Thus
wehaveMedicareratherthanPedicare,andmillionsofAmericanswithouteither
health insurance or other means of paying for care. While some communities
have an adequate safety net, most do not. In the absence of funded care, drug
companieshaveseenlittlereasontoinvestin thenecessary anddifficulttaskof
evaluating the safety and efficacy of drugs in the treatment of children. Until
recently, guesswork and ‘‘clinical judgment’’ were the only guides to medicat-
ing children suffering from major depression or anxiety. Fortunately, pressured
by pediatric groups and children’s advocates, the National Institutes of Health
recently mandated the inclusion of children in clinical trials unless contraindi-
cated, and Congress has attempted to induce drug companies to participate by
grantinganadditionalsixmonthsofpatentprotectionwhentheyhavedetermined
the appropriate dosing for children.
Anothermajorproblemaffectingchildrenhasbeentherelativeabsenceof
clinicalresearch.Theyarenotmerelysmalladultsbuthaveacomplexevolving
development,achangingphysiologyand(psychology),andoftendifferentclini-
cal expressions of the same pathology. Proper diagnosis requires understanding
the ever-changingchild in his or her lifecontext. Young investigatorsand new,
iii
iv SeriesIntroduction
less invasive techniques are leading to an exciting growth in knowledge about
the pathophysiology of childhood illness.
The editors of this volume have brought together an impressive group of
experts who have been able to summarize what we know—and what we can
only guess at but need to know—and who are able to make it all clear. Impor-
tantly among the chapters is one on the ethical issues of research in children, a
reassurance to all.
IwouldliketoaddaspecialtributetoDr.SamuelGershon.AfterAmerica’s
disastrousexperiencewithlithiumasasaltsubstituteforpatientswithhyperten-
sion, there was reluctance to use this ‘‘dangerous’’ compound in the treatment
of psychiatric patients. Dr. Gershon helped to change that attitude with his elo-
quence,data,andhismanystudents.Hehasremainedintheforefrontofpharma-
cology among the first to study geriatric pharmacotherapy and now well en-
sconced in the world of children. Our profession owes him much.
William A. Frosch, M.D.
Weill Medical College of Cornell University
New York, New York
Foreword
The second edition is a timely contribution to this rapidly developing field as
newtherapeuticopportunitiesbecomeavailable.Inassessingthefactorscurrently
driving research, it appears that several factors are primarily responsible. There
has been an increased emphasis on developmental aspects in making childhood
andadolescentdiagnoses.ThisisparticularlytrueasthetimeforDSM-Vgrows
nearer.Improvedassessmentproceduresandbetterrecognitionofsymptomclus-
ters and functional impairment have increased intervention, consequently, ex-
ertingpressureonthepharmaceuticalindustrytoprovidenewdrugsforchildren
andadolescents.Furthermore,thegrowthofadvocacyandfamilygroupspushing
for more studies, which may even involve randomized clinical trials, is a new
issue.Suchdevelopmentsareincreasingtheneedforimprovedpsychopharmaco-
logical training for clinicians.
Drs. Rosenberg, Davanzo, and Gershon have improved and expanded the
firstedition,enablingbothcliniciansandstudentstofindinoneplaceacompre-
hensive and essential set of guidelines for psychopharmacological intervention
in childhood and adolescent disorders. They have updated the rapidly emerging
areasofinterestdiscussedinPartIandexpandedthediscussionofethicalissues,
as well as pharmacoepidemiology. In Part II the editors have added two new
v
vi Foreword
chapters to break-out serotonin-reuptake inhibitors from other novel (atypical)
antidepressants.Inaddition,theyhaveaddedachapteroncombinationtherapies.
Thebookiseasytofollow,user-friendly,andaninvaluableresourceforclinical
specialists,regardlessofdiscipline,whoareinvolved inthediagnosis andtreat-
ment of child and adolescent psychiatric disorders.
David J. Kupfer, M.D.
Western Psychiatric Clinic
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Foreword
Itisgenerally acknowledgedthatpsychiatryas amedicaldisciplinehasbeenlate
in embracing evidence-based medicine, and there seems to be little debate that
childpsychiatryhasbeentheslowestdisciplineinadoptingthismodel.Thereare
manyreasonsforthis,rangingfromhistoricaltraditiontoethicalissuesinresearch
involvingchildren.Nevertheless,ifwearetoprovidechildrenwiththebesttreat-
mentofpsychiatricdisorders,thenwemustelucidatethepathophysiologyofthese
disordersandconductstate-of-the-artplacebo-controlledrandomizedclinicaltrials
to measure the effectiveness of the purported treatments. This book summarizes
the state-of-the-art in the field and points out the many lacunae that exist in our
database concerning the treatment of childhood psychiatric disorders.
Drs. Davanzo and Rosenberg are members of a new generation of child
psychiatrists unburdened by the tradition of a hierarchy in child psychiatry that
requiredpsychoanalyticaltrainingofitsleadership.Theeditorsandchaptercontrib-
utors have reviewed the literature with a critical eye. There are, of course, other
comprehensive textbooks of child psychiatry, but this is one of the few that suc-
cinctly reviews pharmacotherapy for child and adolescent psychiatric disorders.
Thereismuchvaluablematerialhereforboththepractitionerandtheinves-
tigator. Dr. Vitiello’s chapter on ethical issues in research involving children
vii