John D. Preston - Child and Adolescent Clinical Psychopharmacology Made Simple

Many thanks to our publisher, Dr. Matthew McKay, freelance copy editor Gretel Hakanson, and our most excellent editors, Melissa Kirk, Catharine Meyers, Karen ODonnell Stein, and Kayla Sussell.

Thanks to our families, with deep appreciation for their patience and encouragement.

Finally, a heartfelt thanks to our patients.

May this book help our fellow mental health clinicians in our shared and ongoing struggle to reduce emotional suffering in young people.

Introduction

Facts without values, fragmentary specialties with no integrating philosophy of life as a whole, data with no ethical standards for their use, techniques with no convictions about lifes ultimate meaning here a panacea has turned out to be a problem.

Harry Emerson Fosdick The Living of These Days(1956)

Many young people experience considerable emotional suffering. Oftentimes this psychological pain is associated with poverty, poor prenatal care, racial or other forms of discrimination, serious family dysfunction, traumatic life events, or any of a host of neuropsychiatric disorders. Only certain types of emotional distress are appropriate for treatment with psychiatric medications.

Psychiatric medication treatment of children and teenagers began in the 1960s. Yet only recently have large-scale medication trials been conducted. The research in child psychiatry is still considered to be limited. Clearly advances have been made, both in the safety of medications and in the development of treatment guidelines. In this book we summarize basic information regarding classes of psychological disorders for which medications are often prescribed, and we present current guidelines for the use of medications. However, we first want to state three important and overarching concerns.

The first concern is that in the current era of managed care, it is common for insufficient time or attention to be given to conducting a comprehensive history and diagnostic evaluation. Such an evaluation is essential before any recommendation can be made regarding treatment. Second, it is clear that when psychiatric medications are used to treat particular disorders, close follow-up is warranted and essential for addressing problems of treatment adherence, managing side effects, and monitoring response to treatment. Third, most children and teenagers suffering from psychological problems do not require medication treatment; instead, they may need psychosocial interventions, often involving the family as well as the individual. Even in those conditions that are judged to be largely neurobiological in nature and responsive to medication treatments, psychotherapy is alwaysindicated.

In voicing these three issues, it may seem as if we are just stating the obvious; however, our concern is that with the quick-fix and get-on-with-your-life mentality in our social culture and the health care industrys focus on cost containment, the knee-jerk reaction of too many providers may be to reach for the prescription pad whenever they see psychological symptoms. While the appropriate use of psychiatric medications has helped many young people, we feel its important for us to strongly endorse a comprehensive approach to treatment. This approach should be based on careful evaluations, close monitoring, and the use of psychotherapy, with medications prescribed only if warranted.

It is also important for clinicians, consumers, and parents alike to be aware of the risks and benefits of all treatments. Because of the enormous complexity of human psychological functioning, most problems are multidimensional and require interventions on a number of levels. And it is equally important to be humble regarding our approaches to treatment. Psychiatric drugs, as we shall see in this volume, can reduce rates of suicide, may decrease the risk of substance abuse, and in some instances may prevent certain kinds of brain damage. But medical treatments also have clear limits; there are no panaceas. No drug can mend a broken heart, fill an empty life, or teach parents how to love their children.