Review of Clinical Handbook of Psychotropic Drugs for Children and Adolescents,3rd Ed.,edited by Dean Elbe,Kalyna Z. Bezchlibnyk-Butler,Adil S. Virani,and Ric M. Procyshyn

For most child and adolescent psychiatrists, psychopharmacology is challenging because of the need to stay current while new information is constantly added. Psychotropic medications are powerful agents that treat many disorders, but also can impose a great risk if not used accordingly. We need to keep dry minutiae in our knowledge base and, therefore, there is a great value of a book to serve as a practical resource guide to quickly access relevant information.

Dean Elbe, PharmD, a Canadian clinical pharmacist specialist at British Columbia Children's Hospital and colleagues have written a user-friendly book about prescribing psychotropic medications for children and adolescents. This handbook contains prescribing information for the United States and Canada. It fills a void for Canadian practitioners since most other psychopharmacology books readily available in North America only contain prescribing information for the United States. This book is targeted toward multiple disciplines, including child and adolescent psychiatrists, pediatricians, and nurses. Also this book acknowledges indications for adults and is suitable as an adult reference. FDA-approved indications for children and adolescents are emphasized, but nonapproved indications are also included.

This book makes dry material more interesting and is pleasing to the eye. There are several things that make this book different from other psychopharmacology resources as opposed to an online reference. As it is spiral bound with text written in landscape format, it is easy to lay the book flat and read both pages at once. As a book, it can be left open on the table; it does not require toggling between screens as with a computerized medical record. Thus, it is easy to highlight and make notations on paper. There are online resources available, but they do not have the easy digestibility of this color-coded volume.

The majority of the book is organized into chapters per class of drugs, such as chapters on antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics/sedatives, and drugs for attention-deficit/hyperactivity disorder (ADHD). There are chapters dedicated to drugs/substances of abuse and its substance abuse treatment, electroconvulsive therapy, unapproved treatments of psychiatric disorders, and natural health products. In each chapter there are color-coded sections such as Indications, Dosing, Pharmacokinetics, Switching Formulations, Adverse Effects, Discontinuation Syndrome, Contraindications, Toxicity, Monitoring, Use in Pregnancy, and Nursing Implications. There is also a set of caregiver information sheets available online.

Many of the chapters function as review articles about a class of medications. Basic psychopharmacology is covered well. For example, the chapter on antipsychotics contained an excellent clinical description of dopaminergic rebound in two sentences. “If a high D2 affinity medication (e.g., risperidone) is abruptly replaced with a low D2 affinity medication or a rapid on/off fast-dissociating antipsychotic (e.g., quetiapine) or a partial D2 agonist (e.g., aripiprazole), dopaminergic rebound may result. In the mesolimbic tract, this could lead to supersensitivity psychosis; in the nigrostriatal tract, treatment-emergent EPS and TD may materialize” (p. 194).

The many tables in each chapter are one of the best features. The chapter on hypnotics and sedatives (p. 243) has a table that compares many properties of that class, including onset of action and effect on sleep architecture. It is easy to find specific information about that class of medication, such as Zolpidem does not affect stages 3 and 4, but Ramelteon causes small decreases in those stages. Among the mood stabilizers and anticonvulsants, lithium causes the most weakness and fatigue and lamotrigine has the least of those symptoms in that class of medications (p. 270).

As the author brings the prospective of a pharmacist, there are many useful tables that aggregate of pharmacokinetic data and drug comparisons. Information on discontinuation syndromes, drug–drug interactions, drug toxicity, and nursing implications makes this book relevant to daily practice. The chapter on anticonvulsants includes information on anticonvulsant hypersensitivity syndrome, osteoporosis as a side effect with carbamazepine and divalproex. This chapter provides a good framework on laboratory testing and monitoring for this class of drugs.

The book contains many pearls for clinicians. For example, it emphasizes the importance to checking serum ferritin levels as they are reported to be low in high proportion of children with ADHD, and correlated with greater cognitive deficits; therefore, iron supplementation is recommended (p. 347). In addition to the pearls, the book provides a compendium of case reports and studies. It references a unique study on using mirtazapine to treat akathisia (p. 207). The book described case report about “Priapism reported in 16 year old each time he forgot to take his dose of extended-release methylphenidate (Concerta) 54 mg” (p. 27).

There is an abundance of new and old ideas even for very savvy clinicians. Our attention was caught by a well-organized chart comparing different agents that are used to treat extrapyramidal symptoms (p. 210), like cyproheptadine for akathisia and procyclidine for tremor (available in Canada but not in the United States). SSRI-induced sexual dysfunction can be treated with amantadine or cyproheptadine, which is something really not well known in mainstream practice, but warrant a consideration. There is also unique information in this book, such as prazosin dosing for children in treatment of posttraumatic stress disorder and the use of melatonin in infants. This book extrapolates information from different sources, encompassing vitamins and natural health supplements. Zinc, vitamin D, and vitamin B6 have been indicated in certain cases.

Although this is an excellent book on psychopharmacology, there are some limitations. This book is a desk reference, not a lightweight pocket reference. The first chapter on psychiatric disorders in children and adolescents could be avoided since it does not bring any new information. Some data get outdated easily—the indication of Vyvanse for binge eating disorder and monitoring guidelines of corrected QT interval in antipsychotics. In addition, this book has less utility as a reference about a specific medication.

The primary role of this book is to serve as a reference that helps the reader to compare medications within a class. Also the excessive subclassification of antidepressants gets a little tedious and hard to follow. As our psychiatric practice has matured, we have learned that psychosocial issues are usually the most important focus of treatment. Paradoxically this book helps us focus more on psychosocial interventions because it provides a strong underlying framework for psychopharmacology. Overall, this book is an excellent purchase for clinicians who need a desk reference that provides a comprehensive review of child and adolescent psychopharmacology.