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Childhood psychopharmacology: Current concepts
Book Reviews Childhood Psychopharmacology:
Current Concepts (Advances logical Psychiatry, Vol. 2) Edited by J. Mendlewicz and H.M. van Praag. New York: S. Karger, 1978, 102 pp., $23.50
343 in Bio-
In these days of informed consent and biological psvchiatry, the physician prescribing psychoactive medication for children finds himself in a special double bind. Symptoms seem to demand treatment but literature provides little support. for what to do. This 102 page paperback is a highly referenced international symposium which attempts to deal with some of the current problems in chiidhood psychopharmacofogy. The apparent aim of the symposium was to give noted researchers a forum in which to clarify what we know, what we don’t know, and how we ought to go about finding out. Michael Rutter begins the symposium with a beautifully developed and lucid summary of the difficulties in nosology which have plagued psychopharmacology in children. Rutter provides extensive references and up-to-date material. Rachel Gittelman-Klein follows Rutter with a stimulating discussion of hyperkinesis and other problems in chiidhood psychopharmacology. I found this article particularly enjoyable. The article is written in such a way that professiorlals from most disciplines could benefit and come away with a clearer understanding of some of the dilemmas and successes in treating this sometimes vague childhood difficulty. Now I must spend some time on perhaps the most disturbing article in this series. Eva Frommer selected as her topic “hlanagement of medical treatment in childhood psychiatric disorders.” To this end, Frommer uses depression as a prototype for childhood psychiatric problems, and this portion of the article is interesting. Hosvever, the following pages lead the reader through a somewhat glib. matter of fact world of anti-depressants, lithium, monoamine oxidase inhibitors, and even shock treatment. Somatic treatments are put forth as the primary intervention for psychosis, anorexia nervosa, h!.peractive children, obsessional depressive disorders. endogenou\ depressive illness, phobic depressive illness, paranoid and psychotic depressive illnesses, depression with developmental disorders, and reactive depression. Therapy, hospitalization, and other forms of trc’.ltmt’nt are seen as adjuncts to medication and (in “severe” casri shock treatment. The liberal sprinkling of lithium use b) Fr-omlller seems to be on an “as needed” basis. One gets the feeling of ;I L(JO~ irl the kitchen trying a dash of this and a dash of that to see \vh;!r tastes good or what works. Throughout, Frommer reports “good success” with all of these difficuities. Perhaps so, but her arti-
Book Reviews cle is the least documented of any in the symposium and I think for good reason. I would have grave concerns about pediatricians or other professionals using Frommer’s vague guidelines for treatment of the above-mentioned syndromes. Frommer ends her talk with this stated purpose “It is hoped that this paper will help to stimulate further interest and research into the classification of childhood psychiatric disorders, and so contribute indirectly to their better differentiation” (p. 47). I do not feel she has succeeded in her purpose. Her article does not belong in this otherwise exceiient symposium. The final four articles in the symposium are quite strong and provide a little bit of something for everyone from the basic scientist to the psychotherapist interested in the psychodynamics of medications and their use. Overall I found this collection of articles to be comprehensive, well written and an excellent reference, especially for child psychiatrists and pediatricians. The back cover of the book suggests that it is also valuable to “pharmacologists and psychologists.” I don’t think the symposium addresses itself to either specialty in particular, although both may find it useful. James S. Wicoff San Antonio Children’s Center
Social Order and Mental Health: The Florida Health Study By John J. Schwab, Roger A. Bell, George J. Warheit, and Ruby B. Schwab New York: Brunner/~azel, Publishers. 1979. ZIK+xv pp.* $15.00 Neither the title, So&l Order and Mental Health, nor the subtitle, The Florida Health Stud?, of this book makes the claim on reader attention that the book itself deserves. This is not to say that either title or subtitle is incorrect: The book reports on a health study funded by the Kational Institute of Mental Health and carried out in Alachua County in FLorida (which includes Gainesville and the university there); and the variables under studv are carefully defined indices of social order and of organismic (phvsical and mental) health and their correlates. Here is not so much ‘as a hint of the study’s central, recurring, and esscntiallv ineluctable finding: That there is a “strong inverse reIati~)nsl~ip between socioec~)n(~mic status (SES) and mean psychopathology scores. Almost live times as many in the low SES as
Current Concepts (Advances logical Psychiatry, Vol. 2) Edited by J. Mendlewicz and H.M. van Praag. New York: S. Karger, 1978, 102 pp., $23.50
343 in Bio-
In these days of informed consent and biological psvchiatry, the physician prescribing psychoactive medication for children finds himself in a special double bind. Symptoms seem to demand treatment but literature provides little support. for what to do. This 102 page paperback is a highly referenced international symposium which attempts to deal with some of the current problems in chiidhood psychopharmacofogy. The apparent aim of the symposium was to give noted researchers a forum in which to clarify what we know, what we don’t know, and how we ought to go about finding out. Michael Rutter begins the symposium with a beautifully developed and lucid summary of the difficulties in nosology which have plagued psychopharmacology in children. Rutter provides extensive references and up-to-date material. Rachel Gittelman-Klein follows Rutter with a stimulating discussion of hyperkinesis and other problems in chiidhood psychopharmacology. I found this article particularly enjoyable. The article is written in such a way that professiorlals from most disciplines could benefit and come away with a clearer understanding of some of the dilemmas and successes in treating this sometimes vague childhood difficulty. Now I must spend some time on perhaps the most disturbing article in this series. Eva Frommer selected as her topic “hlanagement of medical treatment in childhood psychiatric disorders.” To this end, Frommer uses depression as a prototype for childhood psychiatric problems, and this portion of the article is interesting. Hosvever, the following pages lead the reader through a somewhat glib. matter of fact world of anti-depressants, lithium, monoamine oxidase inhibitors, and even shock treatment. Somatic treatments are put forth as the primary intervention for psychosis, anorexia nervosa, h!.peractive children, obsessional depressive disorders. endogenou\ depressive illness, phobic depressive illness, paranoid and psychotic depressive illnesses, depression with developmental disorders, and reactive depression. Therapy, hospitalization, and other forms of trc’.ltmt’nt are seen as adjuncts to medication and (in “severe” casri shock treatment. The liberal sprinkling of lithium use b) Fr-omlller seems to be on an “as needed” basis. One gets the feeling of ;I L(JO~ irl the kitchen trying a dash of this and a dash of that to see \vh;!r tastes good or what works. Throughout, Frommer reports “good success” with all of these difficuities. Perhaps so, but her arti-
Book Reviews cle is the least documented of any in the symposium and I think for good reason. I would have grave concerns about pediatricians or other professionals using Frommer’s vague guidelines for treatment of the above-mentioned syndromes. Frommer ends her talk with this stated purpose “It is hoped that this paper will help to stimulate further interest and research into the classification of childhood psychiatric disorders, and so contribute indirectly to their better differentiation” (p. 47). I do not feel she has succeeded in her purpose. Her article does not belong in this otherwise exceiient symposium. The final four articles in the symposium are quite strong and provide a little bit of something for everyone from the basic scientist to the psychotherapist interested in the psychodynamics of medications and their use. Overall I found this collection of articles to be comprehensive, well written and an excellent reference, especially for child psychiatrists and pediatricians. The back cover of the book suggests that it is also valuable to “pharmacologists and psychologists.” I don’t think the symposium addresses itself to either specialty in particular, although both may find it useful. James S. Wicoff San Antonio Children’s Center
Social Order and Mental Health: The Florida Health Study By John J. Schwab, Roger A. Bell, George J. Warheit, and Ruby B. Schwab New York: Brunner/~azel, Publishers. 1979. ZIK+xv pp.* $15.00 Neither the title, So&l Order and Mental Health, nor the subtitle, The Florida Health Stud?, of this book makes the claim on reader attention that the book itself deserves. This is not to say that either title or subtitle is incorrect: The book reports on a health study funded by the Kational Institute of Mental Health and carried out in Alachua County in FLorida (which includes Gainesville and the university there); and the variables under studv are carefully defined indices of social order and of organismic (phvsical and mental) health and their correlates. Here is not so much ‘as a hint of the study’s central, recurring, and esscntiallv ineluctable finding: That there is a “strong inverse reIati~)nsl~ip between socioec~)n(~mic status (SES) and mean psychopathology scores. Almost live times as many in the low SES as