From the Editor-in-Chief's Desk

G reetings. I can't help but begin this message with the acknowledgment that it is not business as usual here in New York City in the aftermath of Hurricane Sandy. And because we know of the potential devastating effects of such a disaster on the child population, I have invited my colleague at the Child Mind Institute, Dr. Jamie Howard, to contribute a guest editorial with advice for mental health professionals on mitigating traumatic stress reactions in young people. Though Dr. Howard's extensive experience is in behavioral and psychotherapeutic interventions, not psychopharmacology, we know that the readership is involved in the care of children and that there is no sense in limiting the toolkit available when responding to such a dramatic event.

I urge you to read her editorial and share it with parents, your pediatric colleagues, and with the educators you work with in the schools in your community. Going forward, senior editor Dr. Ron Steingard and I hope that we may more regularly integrate other topics in child and adolescent psychiatry research into the journal. In addition, from time to time I will ask Dr. Steingard to contribute the editorial.

In this issue we have a few cautionary tales that I would like to highlight. In a landscape with so much need for care and so few specialists, it is important that we share our knowledge widely and work to ensure that the prescribers fully understand psychotropic medications and can dependably educate patients and families. As we search for new and better treatments and the evidence required to support evolving best practices, it is critical that the community remember how important monitoring is in medicine in general, and psychiatric medication treatment in particular.

In Star et al., the authors uncover a risk associated with antipsychotic treatment that could elude treating professionals in the absence of strict monitoring. In evaluating adverse drug reaction reports, the researchers found that a great majority of rhabdomyolisis cases associated with antipsychotics occurred in the absence of neuroleptic malignant syndrome, a common marker. Their suggestion is that any change in medication be accompanied by a rigorous monitoring regime so that “seemingly nonserious events” are not ignored, leading to the very real if rare possibility of renal failure.

Roke et al. also looked at antipsychotics, in particular the treatment of adolescent males on the autism spectrum with risperidone. Their study reinforces the anecdotal evidence that this antipsychotic is associated with sexual dysfunction and the risk of hyperprolactinemia, and goes further to suggest that though gynecomastia is associated with risperidone, there is not likely a correlation with hyperprolactinemia.

Finally, Arcieri et al. amounts to a dispatch on the continued debate in Europe over cardiovascular monitoring in children on medications for attention-deficit hyperactivity disorder (ADHD). The idea that an electrocardiogram (ECG) is a central part of monitoring for these patients is no longer popular in the United States, of course, but it is a question in Europe, and seeing the evidence accrue in this debate is fascinating. Interestingly in this case, the authors' conclusions are silent on ECG, stressing instead the need for history and baseline monitoring given the “small but significant impact on the cardiovascular system.” Their Italian sample is quite robust, and because of the prescribing habits there, the article also affords us information about the cardiovascular effects not only of stimulant medications but also of atomoxetine.

Taken together, these articles urge caution but also demonstrate a healthy optimism about our ability to smartly and safely administer these effective medications while maintaining respect for their unwanted effects.