Book review: Clinical Manual of Child and Adolescent Psychopharmacology Robert L Findling, APP Inc, paperback, 2008, 473 pages, ISBN: 978-1-58562-250-4

Dr Findling introduced the Clinical Manual of Child and Adolescent Psychopharmacology as a book designed to meet the needs of clinicians who want to provide state-of-the-art care to their patients; this idea is more intriguing bearing in mind the rapidly changing knowledge of psychopharmacology and the complexity of psychiatric presentations in the paediatric age group. The manual, divided into 10 chapters with contributions from an array of experts, makes an easy read with each chapter opening with a concise epidemiology of paediatric psychiatric disorders to be considered. This is then followed by a compendium of referenced research findings compiled in an easy to read format. Each chapter ends with clear summaries – Clinical Pearls – serving the function of an aide memoir to a rather detailed chapter. The book contains easy-to-read tables, a treatment algorithm and graphical representation. It is completed with a detailed index for quick and easy searches. The first chapter opens a discussion on the preclinical science of paediatric pharmacology, ethical considerations and the rather controversial issues of off-label prescribing. There are three successive chapters on behavioural and emotional disorders, each chapter authors used statistical information, contemporary diagnostic debates/controversies and research findings to discuss pharmacological interventions, and of particular interest was the concept of reactive and proactive aggression with suggestions of different pharmacological interventional approach. The two chapters on mood disorders in childhood (major depressive and Bipolar affective disorders) touched on amongst other things a number of knotty issues – such as ‘psychotic depression and antidepressants management’, ‘treatment resistant depression and augmentation strategies’ and the ‘use of invasive treatments, for example, electroconvulsive therapy, i.v. clomipramine, vagal nerve stimulation and transcranial magnetic stimulation in paediatric affective disorders’ – the authors stating clearly the paucity of evidence on some of these interventions in the Paediatric population. The chapter on Schizophrenia and psychotic illnesses was quite interesting; these disorders, though rare, could present diagnostic and treatment challenges. The authors went through step by step the diagnostic maze, treatment rationale, side effects monitoring and prognosis of these extremely debilitating illnesses. Starting from the historical to the contemporary the chapter authors laid out various interventions in the diagnosis and treatment of autism and other developmental disorders; this was beautifully summarised with an algorithm table – on target symptom approach to treatment. The chapter on tic disorders also discussed common co-morbidities such as Obsessivecompulsive and attention deficit hyperactivity disorders especially in the context of Tourette’s syndrome and the pharmacological interventions in the various presentations. A key aspect to the book is the chapter on what can be loosely called Liaison Paediatric Psychiatry, that is, the interface between physical and psychiatric presentations. Taking a direct quote from the book, ‘functional or medically unexplained physical symptoms are a common presentation of psychiatric disorders in primary care and specialty medical settings, where they are associated with high levels of health service use’. The chapter touches on common presentations like functional abdominal pains, cyclical vomiting syndrome and unexplained fatigues. It debunked the commonly made assertion on tricyclic antidepressants superior efficacy over other antidepressants in management of pain syndromes especially in the paediatric population. It also considered issues with psychotropic use in general medical conditions coexisting with mental health problems. Eating, elimination (enuresis and encopresis) and sleep disorders were given considerable pharmacological review. Unlike many other prescriptive texts, the Clinical Manual of Child and Adolescent Psychopharmacology presents the reader with a balanced wealth of scientific arguments, alternative nonpharmacological therapeutic options and view points reflecting current evidence-based practice. A downside to the book is the non-inclusion of discussions on service users’ views on paediatric psychopharmacology. Another limitation is the non-involvement of authors from outside the North America bearing in mind subtle differences in clinical practice and sometimes diagnostic criteria. The Clinical Manual of Child and Adolescent Psychopharmacology indeed answers the many paediatric psychopharmacological conundrums faced regularly. It is a practical manual with high relevance in the modern day practice of child and adolescent psychiatry.