Customer Reviews

Pediatric Psychopharmacology: Principles and Practice

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Just follow me for second here: Go back to the dawn of the Cenozoic Era, the Paleocene epoch, 65 million years ago, when the mammalian radiation happened. That was a big deal. And what was it all about? A couple small little animals changed made a major change in their life strategies (actually just the females of the species, the males remain reptilian), which was valuing quality over quantity. Instead of laying tons of eggs, let's make less embryos. But nurture them. Nurture them with all our bodily resources. Let them lay parasitically within us while their brains and other organs mature. Think of it! The emergence of Parenting! Must have been a good idea, within just four million years, mammals radiated stunningly fast, filling the empty ecological niches left by dinosaurs, hoofed mammals achieving a glorious diversity (though still no larger than today's dogs).

So what does that have to do with us? Glad you asked. Not too much until 57 million years ago when our family, the primates, was born. Let's do this: Longer gestation, longer dependencies, bigger brains, better brains.

I'd love to linger on the details, but I have to get around to my point, and reviewing this wonderful, beautiful book. So let's skip to the Pliocene, 5 million years ago, when hominids diverged from our cousins the chimpanzees and bonobos (oh those dirty, dirty bonobos). What made us unique at that point? Three things: 1) Bigger brains. 2) Even longer periods of dependency, with longer infancy, longer toddlerhood, longer latency. All necessary for brains that are too big to be fully developed at birth, with a wider capacity for learned behaviors relative to instinctual behaviors. This, more than ever, necessitates parenting, or at least some kind of nurturing from the older generation to the younger. Which then allows for a greater capacity for culture, shared communal behaviors and beliefs passed down through the generations. And probably helped contribute to uniqueness 3) tool use. Yes, I know other species use tools of a sort, but we've gotten more sophisticated than sticking pruned twigs into termite mounds.

So here we are, human beings. I will refrain from calling us the most evolved species on the planet, since technically everything alive today is equally evolved for its niche (my cat can jump, change directions in mid-air, catch a bird in his mouth. I can't do that but I consistently beat him in backgammon). We are entitled to some species chauvinism, we certainly seem to have the most complex brains on the planet.

The things, then, that make us uniquely human, all converge in the modern medical sub-specialty of child and adolescent psychopharmacology. Using the most sophisticated tools our species have designed to date (psychoactive drugs), we help care for children, help cultivate the potential within the larger, more complex brains of the modern human children. Child Psychiatry is therefore both the leading edge, the ultimate extension of the trajectory of human evolution, as well as also being the most primitive, natural endeavor in medicine, motivated by the most instinctual elements of human character.

Having completed the transition to lower quantity, higher quality offspring, we have extended the dependency of children, and the need for nurturing to it's extreme. So this is our duty, our obligation. Children are vulnerable, and therefore deserve the best efforts of the best among us to help protect and care for them.

This is why treating psychiatrically ill children is the single most intellectually challenging field in medicine. The most stamina-testing, the most ethically challenging, the most emotionally challenging. Children in crisis stir our paternal and/or maternal instincts, and working with them forces us to cultivate our own resilience and stability. There is no better or more important field in medicine right now. Oh sure, let the surgeons continue to preen about the hospital as if their butchery and carpentry skills gives them ownership of the entire field of medicine. Let these barely sublimated sadists have their glory, they certainly seem to need it. Meanwhile, we know who the real brain surgeons are.

So, if we are going to do this, let's do armed and equipped with the best, most accessible information possible. That is why I strongly and unreservedly give this textbook my highest possible recommendation (which, on Amazon, consists of 5 stars, the same recommendation I gave to Blueberry poptarts... Oh well). Children are not just little adults. They have different brains. Different tracts have been myelinated, different nuclei have relatively different densities of receptors, the ratio of cytochrome P450 enzymes differ. Drugs, even when dosage is adjusted for size and metabolism, can have different side effect profiles for children then adults. For mostly obvious ethical and practical reasons, drugs cannot be tested on children as easily and systematically as in adult trials. So we should be very careful when medicating children. But that doesn't mean we shouldn't do it. When diagnoses are made thoughtfully and accurately, medications can be tremendously helpful for children. It can give children their lives back. Some children, able to get their symptoms manageable, find their families interacting different, teachers interact with them different, and their self-confidence can begin to restore itself.

This is a great book, and as of this moment in time, I would say it is the single best comprehensive resource for doctors who are prescribing psychiatric medications to children or adolescents. I'd tell you more about the book but I'm already closing in on 1000 words just trying to convey my passion for the topic. But you get contributions from the best in the field, you have sections devoted to the biological bases of pediatric illness, different diagnoses and different somatic interventions, discussions on other somatic interventions such as complementary and alternative medicines and ECT, and plenty of chapters on assessment and treatment. There is a section on epidemiological, research, and methodological considerations and appendices with quick prescribing information "at a glance." It is a thorough text, worth the price. Even has decent discussions of special populations such as substance abusers, medically ill children, psychopharm during pregnancy, and individuals with MR. Trust me. If you are planning to do a fellowship in child and adolescent psychiatry, or if you are in one of the all too numerous underserved areas where non-specialists find themselves prescribing psychoactive medications to children, you owe it to yourself and to the patients and families you treat to have a copy of this book.