Concluding Comments

The future of psychopharmacology within the pedi-atric consultation setting will be replete with needs and possibilities. There remains a paucity of information in the literature pertaining to the psycho-pharmacological treatment of children and adolescents with physical illness. Studies of psychotropic medications to date have excluded youngsters with comorbid general medical conditions. Clinical evidence must be grown through systematic, collaborative multisite study and reporting of current psy-chopharmacological practices in pediatric consultation settings. Possible associations and interactions between psychiatric and physical comorbidities and their treatments need to be delineated. These endeavors would be aided by refinements in psychiatric diagnostic classification that produce detailed, functional descriptions of disorders. Emerging research in pharmacogenetics and pharmacogenomics might eventually be translated to clinical settings to guide drug selection, improve prediction of pharmacological effects, and reduce rates of adverse drug reactions (de Leon et al. 2008; Rasmussen-Torvik and McAlpine 2007).

The current trend in the development of enantio-meric compounds has the potential to deliver the benefits of more precise symptom targeting and reduced side-effect burdens (Leonard 2001; Wainer 2001). Progress in understanding the basic patho-physiology of psychiatric disorders might soon be translated into clinical practice as psychopharma-cological interventions that target disordered physiology directly. Translational therapies seem particularly close for single-gene disorders affecting the central nervous system (Berry-Kravis et al. 2008). Consultants in pediatric psychosomatic medicine, because of their collaboration with the clinicians providing care to children with these disorders, are likely to be at the vanguard of applying translational therapies as they become available. Whether pursuing or awaiting such advances in the field, today's practitioners of pediatric psychosomatic medicine must make do with the best existing evidence that young persons distressed by comorbid psychiatric and physical illnesses can gain relief through the thoughtful integration of psychotropic medication into their clinical care.

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