Clinical Manual of Child and Adolescent Psychopharmacology

498 Pages·2007·5.05 MB·English

by  Robert L. Findling

Clinical Manual of
Child and Adolescent
Psychopharmacology
This page intentionally left blank
Clinical Manual of
Child and Adolescent
Psychopharmacology
Edited by
Robert L. Findling, M.D.
Professor of Psychiatry and Pediatrics and
Director, Division of Child and Adolescent Psychiatry
University Hospitals Case Medical Center
Discovery and Wellness Center for Children
Case Western Reserve University
Cleveland, Ohio
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical standards,
and that information concerning drug dosages, schedules, and routes of administration
is accurate at the time of publication and consistent with standards set by the U.S.
Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may change.
Moreover, specific situations may require a specific therapeutic response not included
in this book. For these reasons and because human and mechanical errors sometimes
occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
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Copyright © 2008 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
11 10 09 08 07 5 4 3 2 1
First Edition
Typeset in Adobe’s AGaramond and Formata.
American Psychiatric Publishing, Inc., 1000 Wilson Boulevard, Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Clinical manual of child and adolescent psychopharmacology / edited by Robert L.
Findling. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-250-4 (pbk. : alk. paper)
1. Pediatric psychopharmacology—Handbooks, manuals, etc. 2. Adolescent
psychopharmacology—Handbooks, manuals, etc. I. Findling, Robert L.
[DNLM: 1. Mental Disorders—drug therapy. 2. Adolescent. 3. Child. 4. Psychophar-
macology—methods. 5. Psychotropic Drugs—therapeutic use. WS 350.2 C6406
2007a]
RJ504.7.C558 2008
615′.78083--dc22
2007018820
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Robert L. Findling, M.D.
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . xxiii
1
Developmental Aspects of Pediatric
Psychopharmacology. . . . . . . . . . . . . . . . . . . . . . .1
Benedetto Vitiello, M.D.
Pharmacokinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Pharmacodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Efficacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ethical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Regulatory Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2
Attention-Deficit/
Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . .33
Natalya Paykina, M.A., and Laurence Greenhill, M.D.
Diagnosis of ADHD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Treatment of ADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Monitoring Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Choice of Medication. . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
3
Disruptive Behavior Disorders and
Aggression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Natoshia Raishevich, B.A., Elizabeth Pappadopulos, Ph.D.,
and Peter S. Jensen, M.D.
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Differential Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . 102
Course and Outcome. . . . . . . . . . . . . . . . . . . . . . . . . . 104
Rationale and Justification for
Psychopharmacological Treatment. . . . . . . . . . . . . . 105
Issues in Study Design and Interpretation. . . . . . . . . 106
Atypical Antipsychotics: Review of
Treatment Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Typical Antipsychotics: Review of Treatment Studies . 114
Stimulants: Review of Treatment Studies. . . . . . . . . . 119
Mood Stabilizers: Review of Treatment Studies . . . . 121
Other Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Safety Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Practical Management Strategies . . . . . . . . . . . . . . . . 128
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
4
Anxiety Disorders. . . . . . . . . . . . . . . . . . . . . . . .143
Moira A. Rynn, M.D., and Jennifer Regan, B.A.
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Course and Outcome. . . . . . . . . . . . . . . . . . . . . . . . . . 145
Rationale and Justification for
Psychopharmacological Treatment. . . . . . . . . . . . . . 146
Medications for Pediatric Anxiety Disorders:
Review of Treatment Studies. . . . . . . . . . . . . . . . . . . 147
Safety Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Practical Management Strategies . . . . . . . . . . . . . . . . 184
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
5
Major Depressive Disorder. . . . . . . . . . . . . . . .197
Boris Birmaher, M.D.
Assessment of Treatment Response. . . . . . . . . . . . . . 198
Treatment Phases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Treatment of Major Depressive Disorder With
Selective Serotonin Reuptake Inhibitors and
Other Novel Antidepressants. . . . . . . . . . . . . . . . . . . 199
Treatment of Major Depressive Disorder Subtypes. . 209
Treatment of Comorbid Conditions and Suicidality . . 214
Continuation Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . 215
Maintenance Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . 216
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
6
Bipolar Disorders. . . . . . . . . . . . . . . . . . . . . . . .229
Kevin W. Kuich, M.D., and Robert L. Findling, M.D.
Lithium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Anticonvulsants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Maintenance Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . 244
Atypical Antipsychotics. . . . . . . . . . . . . . . . . . . . . . . . . 244
Combination Pharmacotherapy . . . . . . . . . . . . . . . . . 256
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
7
Autism and Other Pervasive Developmental
Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265
Kimberly A. Stigler, M.D., Craig A. Erickson, M.D.,
David J. Posey, M.D., and Christopher J. McDougle, M.D.
Atypical Antipsychotics. . . . . . . . . . . . . . . . . . . . . . . . . 267
Serotonin Reuptake Inhibitors. . . . . . . . . . . . . . . . . . . 274
Mirtazapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Venlafaxine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Buspirone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Alpha -Adrenergic Agonists. . . . . . . . . . . . . . . . . . . . . 279
2
Psychostimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Atomoxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Beta-Adrenergic Antagonists . . . . . . . . . . . . . . . . . . . . 282
Mood Stabilizers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Cholinesterase Inhibitors. . . . . . . . . . . . . . . . . . . . . . . 283
Glutamatergic Agents. . . . . . . . . . . . . . . . . . . . . . . . . . 284
Naltrexone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Secretin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Safety Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Practical Management Strategies . . . . . . . . . . . . . . . . 288
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
8
Tic Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . .301
Lawrence Scahill, M.S.N., Ph.D.
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Diagnosis and Assessment . . . . . . . . . . . . . . . . . . . . . 303
Treatment of Tics in Children With
Tourette’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 306
Treatment of OCD in Children With
Tourette’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 313
Treatment of ADHD in Children With
Tourette’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 319
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
9
Schizophrenia and Psychotic Illnesses . . . . . .337
Judith L. Rapoport, M.D., Nitin Gogtay, M.D., and
Phillip Shaw, M.D., Ph.D.
History and Classification of
Psychosis in Children. . . . . . . . . . . . . . . . . . . . . . . . . 338
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Course and Outcome. . . . . . . . . . . . . . . . . . . . . . . . . . 339
Rationale for Psychopharmacological Treatment . . . 340
Pharmacotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Treatment of Comorbid Conditions . . . . . . . . . . . . . . 350
Side Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Early Intervention Studies . . . . . . . . . . . . . . . . . . . . . . 361
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
10
Disorders Primarily Seen in
General Medical Settings . . . . . . . . . . . . . . . . .375
John V. Campo, M.D.
Functional Somatic Syndromes and
Somatoform Disorders. . . . . . . . . . . . . . . . . . . . . . . . 376
Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Sleep Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
Elimination Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . 391
Agitation and Delirium. . . . . . . . . . . . . . . . . . . . . . . . . 393
Borderline Personality Disorder. . . . . . . . . . . . . . . . . . 404
General Medical Conditions and Organ Failure. . . . . 406
Clinical Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .425