Psychiatric Drugs in Children and Adolescents: Basic Pharmacology and Practical Applications

540 Pages·2014·5.66 MB·English

by  Manfred Gerlach

Psychiatric Drugs
in Children
and Adolescents
Basic Pharmacology and
Practical Applications
Manfred Gerlach
Andreas Warnke
Laurence Greenhill
Editors
123
Psychiatric Drugs in Children
and Adolescents

Manfred Gerlach (cid:129) Andreas Warnke
Laurence Greenhill
Editors
Psychiatric Drugs
in Children
and Adolescents
Basic Pharmacology and Practical
Applications
Editors
Manfred Gerlach, PhD Andreas Warnke, MD
Department of Child and Adolescent Department of Child and Adolescent
Psychiatry, Psychosomatics Psychiatry, Psychosomatics
and Psychotherapy and Psychotherapy
Laboratory for Clinical Neurobiology University of Würzburg
and Therapeutic Drug Monitoring Würzburg
University of Würzburg Germany
Würzburg
Germany
Laurence Greenhill, MD
NYS Psychiatric Institute
New York Presbyterian Hospital
New York , NY
USA
ISBN 978-3-7091-1500-8 ISBN 978-3-7091-1501-5 (eBook)
DOI 10.1007/978-3-7091-1501-5
Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2014936293
© Springer-Verlag Wien 2014
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Preface
T his comprehensive book combines the scientifi c bases of psychopharmacol-
ogy and the methods of the application of psychotropic drugs in the treatment
of psychiatric disorders in children and adolescents. It is focused on up-to-
date knowledge necessary for state-of-the-art practice in pediatric psycho-
pharmacology. This volume that uses numerous tables, schemata, and
illustrations is both a textbook and a reference book for drug treatment of
psychiatric disorders in children, adolescents, and young adults. Our goal has
been to achieve the most integrated fl ow possible throughout the book, to
move seamlessly between basic psychopharmacology and the care of vulner-
able, suffering children and adolescents.
Psychotropic drug therapy in childhood and adolescence is always part of
an individual treatment program that is adapted to the personal development
of the patient, which also includes psychoeducation, psychotherapy, physical
interventions, and sociotherapeutic and rehabilitation measures. The experi-
ence gained from adult psychiatry is only partially transferable to pediatric
psychopharmacology, because young patients have special pharmacokinetic
and pharmacodynamic characteristics during their development as well as a
signifi cantly higher vulnerability to adverse drug reactions (ADRs). Thus
pediatric psychopharmacology is “developmental psychopharmacology” and
requires a specifi c curriculum.
W hen prescribing psychotropic drugs, there are a lot of questions being
raised. Is there a pharmacological treatment indication for the present mental
disorder? If so, what drugs are available for treatment? According to which
criteria the selection of the active substance is to be taken? Is there empirical
evidence for the effi cacy of a drug? Before prescribing drugs what has to be
taken into account diagnostically? What are the requirements for medical
information and compliance? How to dose, how long and when can the
desired effect and ADRs be expected? What drug interactions are to be
observed in combination treatments? To what extent can the monitoring of the
desired effect and ADRs be backed up in outpatient therapy? Is the medica-
tion in the acute phase of the disease different than used in the subsequent
course of the disease? Are short-term effects and ADRs identical to those
which can be expected during long-term treatment? When is a change of med-
ication indicated and how is this change to be carried out? When is the discon-
tinuance of the drug indicated and how should it be handled? What laboratory
tests are required during an increase of the dose and during prolonged medi-
cation? How is the medication to be integrated into the overall design of the
treatment? What are the legal and ethical issues that should be respected?
v
vi Preface
T hese are some of the questions that this book tries to answer by providing
systematic drug-specifi c (Part II, Chaps. 4, 5, 6, 7, and 8) and disorder-specifi c
or symptom-specifi c (Part III, Chaps. 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,
20, 21, 22, 23, 24, 25, 26, and 27) responses. The fi rst part of the volume pro-
vides in a compact form a foundation of psychopharmacology upon which the
rest of the book builds. The fi rst chapter includes information on neurotrans-
mitters and signal transduction pathways, and molecular brain structures as
targets for psychotropic drugs. The second and third chapters focus on age-
specifi c differences relevant to psychotropic drug actions, including variations
in response or ADR profi les as well as regulatory issues pertaining to children
and adolescents, and the pharmacotherapy in the outpatient setting.
The second and longest part reviews the current knowledge of the various
psychotropic drug classes routinely used in children and adolescents. The
chapters provide suffi cient background material to understand more easily
how these drugs work, and why, when, and in whom should they be used. For
each drug within a class, data on potential mechanisms of action, clinical
pharmacology, indications, dosages, and other related topics are reviewed.
In the third part, the disorder-specifi c and symptom-oriented medication is
described and discerningly evaluated from a practical point of view, providing
physicians with precise instructions on how to proceed. In this part, chapters
are also included that address psychotropic drug therapy in children and ado-
lescents with co-morbid intellectual disability and in psychiatric emergency.
The chapters include the attention to the importance of careful diagnostic
assessment, the therapeutic framework, the choice of pharmacotherapy, and
treatment strategies. Each of these chapters is in turn related back to the
underlying drug-specifi c principles previously presented.
Who will benefi t from this book? Child and adolescent psychiatrists,
psychotherapists and psychologists, pediatricians, general practitioners, psy-
chologists, nurses, teachers, social workers, and students of medicine and
pharmacy can all use it as a guide about medications and a guideline for
applying them to help their patients. We intend to provide a current, multidis-
ciplinary and comprehensive overview of this fi eld of knowledge.
We would fi rst like to thank the authors who, with great commitment and
professional knowledge – complemented by a lively academic exchange –
have contributed their clinical experience to this book. We want to thank
Springer publishing house and in particular Ms. Barbara Zöhrer and Mr.
Claus-Dieter Bachem for their trustful and fruitful cooperation in the formal
design and the publication of the book.
W e would like to thank Paul Foley for language editing and Christian von
Grafenstein for proofreading the manuscript. We are grateful to the Verein zur
Durchführung Neurowissenschaftlicher Tagungen for an unrestricted grant
which has made possible the work on this volume. And fi nally, our special thanks
go to our wives and families who have always lovingly supported our work.
W e hope that this book fi nds positive feedback and would appreciate any
advice on errors, suggestions for improvement and completion.
Würzburg, Germany Manfred Gerlach, PhD
Würzburg, Germany Andreas Warnke, MD
New York, NY, USA Laurence Greenhill, MD
Contents
Part I Essential Psychopharmacology
1 Fundamentals of Neuropsychopharmacology. . . . . . . . . . . . . . 3
Manfred Gerlach
2 Special Features of Psychopharmacological Therapy
in Children and Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Manfred Gerlach, Laurence Greenhill, and Andreas Warnke
3 Pharmacotherapy in the Outpatient Practice. . . . . . . . . . . . . . 77
Andreas Warnke, Christoph Wewetzer,
and Laurence Greenhill
Part II Special Psychopharmacology: Classes of Psychiatric
Treatments
4 Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Regina Taurines, Andreas Warnke,
Laurence Greenhill, and Manfred Gerlach
5 Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Manfred Gerlach, Claudia Mehler-Wex,
and Benno G. Schimmelmann
6 Anxiolytics and Sedative-Hypnotics. . . . . . . . . . . . . . . . . . . . . . 219
Manfred Gerlach and Andreas Warnke
7 Mood Stabilizers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Manfred Gerlach and Andreas Warnke
8 Psychostimulants and Other Drugs Used in the Treatment
of Attention-Defi cit/Hyperactivity Disorder (ADHD) . . . . . . . 293
Susanne Walitza, Marcel Romanos, Andreas Warnke,
Laurence Greenhill, and Manfred Gerlach
vii
viii Contents
Part III Symptomatic and Symptom-Oriented Pharmacological
Therapy of Psychiatric Disorders in Children
and Adolescents
9 Aggressive and Autoaggressive Behavior, Impulse Control
Disorder, and Conduct Disorder. . . . . . . . . . . . . . . . . . . . . . . . . 337
Claudia Mehler-Wex, Marcel Romanos,
and Andreas Warnke
10 Alcohol-Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Gerhard A. Wiesbeck and Rudolf Stohler
11 Anxiety Disorders and Phobias. . . . . . . . . . . . . . . . . . . . . . . . . . 359
Andreas Warnke
12 Attention-Defi cit/Hyperactivity Disorders. . . . . . . . . . . . . . . . . 369
Susanne Walitza, Marcel Romanos,
Laurence Greenhill, and Tobias Banaschewski
13 Autism Spectrum Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Christine M. Freitag and Tomasz A. Jarczok
14 Depressive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Regina Taurines and Christoph Wewetzer
15 Drug- or Substance-Related Disorders . . . . . . . . . . . . . . . . . . . 417
Rudolf Stohler, Manfred Gerlach,
and Gerhard A. Wiesbeck
16 Eating Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Beate Herpertz-Dahlmann and Christoph Wewetzer
17 Elective (Selective) Mutism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Karin Egberts and Jürgen Seifert
18 Encopresis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Alexander von Gontard
19 Enuresis and Functional Urinary Incontinence . . . . . . . . . . . . 449
Alexander von Gontard
20 Manic Episode and Bipolar Affective Disorder . . . . . . . . . . . . 459
Silke Rothenhöfer, Andreas Warnke,
and Christoph Wewetzer
21 Obsessive–Compulsive Disorders. . . . . . . . . . . . . . . . . . . . . . . . 469
Christoph Wewetzer and Susanne Walitza
22 Personality Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Marcel Romanos, Christoph Wewetzer,
and Klaus Schmeck
23 Psychiatric Disorders in Children and Adolescents
with Intellectual Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Andreas Warnke and Laurence Greenhill
Contents ix
24 Psychiatric Emergency Therapy in Children
and Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Andreas Warnke and Marcel Romanos
25 Schizophrenia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Benno G. Schimmelmann, Claudia Mehler-Wex,
and Christoph Wewetzer
26 Sleep Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Andreas Warnke and Christoph Wewetzer
27 Tic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Veit Roessner and Aribert Rothenberger
Disclosure of Financial Interests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529