Barbara Geller MD of Washington University (St Louis), who has tracked a cohort of kids over the years, once told a psychiatric conference that a manic kid is sicker than a manic adult.

As for the second assumption, at this year's American Psychiatric Association's annual meeting, one of the world's leading psychopharmacologists, Stephen Stahl MD PhD of UCSD, reminded his audience that the FDA regulates the sale of medicine, not the practice of medicine. The medical profession, he said, regulates the practice of medicine.

Different psychiatric illnesses typically share some of the brain's biochemical pathways. For the medical part of treatment, it's all about matching the symptom to the compound. It's not about waiting for the DSM or the FDA to catch up to clinical reality.

So is there any reason to be cynical over the FDA approving Risperdal in children? Yes. Risperdal went off-patent this year. Johnson & Johnson is now promoting "Son of Risperdal" marketed as Invega. The new indication breathes new life into the old drug.

Further, the industry has been guilty of over-hyping new generation antipsychotics such as Risperdal as kinder and gentler and more effective versions of old meds such as Haldol. Psychiatrists and patient/family groups have bought into the hype, but are now reappraising their positions, especially with their significant side effects and metabolic risks. For many, antipsychotics are miracle meds, but for long term use it is wise to employ them advisedly

Significantly, the FDA indication is for short-term use of the drug in children, not long-term.

Any parent has the right to give their kid's psychiatrist the third degree when prescribing an antipsychotic, but in the final analysis, when your kid is in serious danger with a serious illness, do you act or do nothing?

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