Stimulants and neuroleptics in hyperactive children

Case report: Exacerbation and provocation of tics by imipramine and sulpiride

This paper deals with the problem of overlapping clinical effects of neurotropic agents in treating children with complex comorbidity. An 8-year-old boy suffering from a complexity of symptoms such as chronic motor tics, compulsions, phobias, anxious inhibition, and stuttering displayed the totality of Tourette's syndrome while taking imipramine. Sulpiride also enhanced motor and vocal tics. In the discussion, a review on the neurometabolic mechanisms in tic disease actually known is given, and on drugs proven to precipitate tics, which is the case in a number of neurotropic agents. Psychodynamics and famility dynamics are another issue to be regarded independently.

Psychopharmacology of the psychiatric disorders of childhood and adolescence

The literature on the psychopharmacology of child and adolescent psychiatric disorders is reviewed. The scanty epidemiological data suggest that psychotherapeutic drugs are utilized more widely than research findings would warrant, especially in preschool-age children. With the exception of hyperactivity, the disorders of childhood and adolescence for which the use of psychopharmacological agents is well-established are rare. This highlights the need for careful prescribing, in which the child's rights, problems with compliance and developmental and behavioural adverse effects are important considerations.

Pharmacotherapy and the neurobehavioural sequelae of traumatic brain injury

Recent advances in clinical neuropharmacology are likely to improve the treatment and rehabilitation of traumatic brain injury (TBI) patients. Treatment may be directed to alleviate specific symptoms, to improve function in certain areas, or even to enhance the cortical recovery process. The author reviews pertinent issues in clinical neuropharmacology for the following drug classes: stimulants, other dopamine agonists, antidepressants, lithium, cholinergics, neuroleptics, anticonvulsants, beta-blockers, calcium channel blockers, nootropes, opiates and neuropeptides. Since the relevant research literature in TBI is so sparse, information and recommendations are extrapolated from some other patient groups, especially developmentally handicapped children and adults, and patients with dementia.