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Straight Talk about Psychiatric Medications for Kids,

2003; Lippincott Williams & Wilkins; Volume: 24; Issue: 3 Linguagem: Inglês

10.1097/00004703-200306000-00014

1536-7312

Robin Hansen,

Pharmaceutical studies and practices

Straight Talk about Psychiatric Medications for Kids, by Timothy E. Wilens, New York, NY, Guilford Press, 1999, 279 pp, $14.95. Dr. Wilens has written a very comprehensive book on psychotropic medications for parents, based on his clinical and research experience. His approach is straightforward and collaborative, encouraging parents to become active participants in their child's treatment as a partner with the prescribing physician. He recognizes the concerns and challenges that parents face in making decisions about medications for their children and provides support throughout the book by using case examples and alternatives to be considered. This book is organized into three parts, with significant but helpful overlap. Part I, “What Every Parent Should Know About Psychiatric Medications for Children,” addresses important issues about evaluation and diagnosis, including expectations for parents and suggestions for preparation before the evaluation. It is presented in a question-and-answer format that is easy to read and repeatedly stresses the crucial role of parent involvement. Dr. Wilens encourages parents to focus on objective facts rather than subjective perceptions, particularly when children deny that a problem exists. He has several other helpful suggestions about keeping track of information regarding medication dosages, responses, and side effects, including several examples and suggested formats. Part II describes common childhood psychiatric disorders, again with excellent case examples and discussion of common presentations, comorbidities, assessment modalities, and treatment options. Dr. Wilens generally strikes a good balance between a general, but fairly comprehensive, summary of the disorders, although I found his description of autism and pervasive developmental disorder somewhat superficial and inaccurate regarding associated findings. He also claims that behavioral modifications, including mild aversive treatments such as minor shocks, are the most popular nonpharmacological treatment strategies, which is certainly not generally supported by any current treatment recommendations and should not be presented as such to parents. Part III presents more detailed information on specific medication categories (stimulants, antidepressants, and mood stabilizers, etc.). Dr. Wilens describes the presumed mechanism of action, desired effects and side effects, and the use of multiple drugs for overlapping symptoms. Unfortunately, the chapter on stimulants is quite out of date, because it was published before many of the current long-acting methylphenidate and amphetamine formulations were widely available, and he promotes Cylert as a first-line choice for longer-acting medication, without adequate discussion about the serious side effects of liver toxicity. Helpful summary charts are provided regarding medication formulations in each chapter; however, several of these are also out of date. For example, the liquid formulations of the serotonin reuptake inhibitors are not listed. In general, this is an excellent book for parents. It is comprehensive and well organized and very supportive of an active, collaborative role for parents in the diagnosis, treatment, and management of psychoactive medications for their children. I think parents would find this book empowering and helpful in many ways, both by providing an accessible fund of knowledge about mental health disorders and their treatment in children, as well as a model of collaboration with health care providers. The summary charts in each chapter are very helpful as references, and I think many physicians would also find this book helpful in formulating their thinking about treatment strategies for the disorders covered in this book. This is a broad, difficult subject to cover and one that is changing rapidly. I think Dr. Wilens has done an admirable job, and I would recommend this book to parents interested in becoming active and knowledgeable partners in their child's medical care. Robin Hansen M.D. Department of Pediatrics University of California at Davis Davis, California