The fifth edition of Child and Adolescent Clinical Psychopharmacology is an update of Wayne H. Green’s seminal work and bears his strong influence. As in the previous editions, this book will review selected topics and most drugs used in child and adolescent psychopharmacology from a practical, clinically oriented perspective. It is intended primarily for clinicians actively engaged in treating children and adolescents with psychoactive medications. These include child psychiatrists, pediatricians, family physicians, residents in child and adolescent psychiatry, residents in general psychiatry, pediatric residents, and other health care professionals who may prescribe drugs to patients in this age group. In addition, other clinicians and mental health personnel who work with children receiving psychoactive medication may wish to review the medications their patients are receiving, as may some parents/caregivers of such children.

The first part of the book focuses rather intensively on the general principles of psychopharmacotherapy for children and adolescents. This section, although updated by the current editors, is unabashedly derivative of Dr. Green’s work, restating his enduring standards. The reader is presented with a clinically useful way of thinking about psychopharmacotherapy, beginning with the initial clinical contact and continuing through the psychiatric evaluation, psychodynamic formulation, diagnosis, and development of the treatment plan. For those cases in which psychoactive medication is recommended as a part of the treatment plan, the necessary medicolegal responsibilities of the clinician in introducing and explaining the purpose of medication to the relevant caretakers and the patient, steps to obtain informed consent and assent to administer medication, ways of maximizing the chances of the legal guardian’s and patient’s acceptance of a trial of the medication and cooperation with its administration, and the necessary documentation of these facts in the clinical record are reviewed. Following this, the entire process of administering medication is discussed. This begins with a consideration of which drug to choose for the initial trial of medication and subsequent medications, should the first choice(s) not result in adequate clinical improvement. Examples of algorithms, which are often helpful in medicating complicated clinical cases, are also included. The necessary
documentation of target symptoms and any baseline behavioral ratings that will be useful in assessing clinical response or the development of untoward effects and the baseline physical and laboratory assessments to be selected are then discussed. This part of the book ends with a detailed presentation of the principles of administering psychoactive medication from the initial dose, through titration and determining the optimal dose, to maintenance therapy, duration of treatment, and issues in terminating medication. These principles are generalizable and provide clinical guidelines for selecting and administering any psychoactive medication to children and adolescents.

The second portion of the book begins with a short chapter discussing the history of child psychopharmacology and some issues concerning psychopharmacological research in children and adolescents. The purpose of this review is to remind the reader where the information that follows is placed in the history of child psychopharmacology and of the importance of research and a critical assessment of the presented data for informed clinical practice.

After these brief introductory comments, the remainder of Section II focuses on specific psychopharmacological agents that are presently the most important in the clinical practice of child and adolescent psychiatry. This section necessarily is more extensively modified than is the first. The drugs are presented by their class. Many specific psychoactive medications are presently used to treat diverse psychiatric disorders or symptoms across psychiatric diagnoses (e.g., lithium for its antiaggressive effects), and this method of organization avoids repeating similar information under several diagnoses. In exception to this rule, one agent, topiramate, is treated twice, because of the two particularly divergent uses for it.

As we learn more about the etiopathogenesis of psychiatric disorders, it becomes increasingly useful and important, both scientifically and clinically, to think about how drugs affect basic neurotransmitter and psychoneuroendocrine functioning across diagnoses. Drugs may affect one or more neurotransmitter systems. For example, the atypical or second-generation antipsychotics have a very complex mixture of pharmacologic properties. They primarily influence not only the dopamine and serotonin systems as antagonists but also the noradrenergic and cholinergic systems and have antihistaminic and other properties (Stahl, 2000). Likewise, a specific neurotransmitter system may be important in one or more diagnostic categories. For example, there appears to be a relationship between the serotonergic system’s functioning and aggressive or violent behavior and self-destructive behavior among various diagnostic groups (Linnoila et al., 1989; Mann et al., 1989). Several books devoted solely to the behavioral pharmacology of serotonin have been published (e.g., Bevan et al., 1989; Brown and van Praag, 1991; Coccaro and Murphy, 1990).