Counseling Points - January 2009 - (Page 11)

and co-morbid substance use and to prescribe stimulants with lower abuse potential.51,59 ADHD and Depression If depression is present, it is generally treated first, afterwhich ADHD symptoms are reassessed and treated.TCAs can moderate ADHD symptoms in adults, but are less effective than stimulants. 51 Clinicians today are using more SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) to treat co-morbid depression. Their side-effect profiles are “cleaner” than those for TCAs, and the chance for drug interactions is minimal.51,54 Join APNA today… Together we can make a difference! The American Psychiatric Nurses Association (APNA) is committed to the specialty practice of psychiatric-mental health nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders. Member Benefits • Obtain continuing education contact hours for psychiatric mental health nursing • Network and interact with peers • Participate in APNA committees to further the goals of psychiatric nursing • Achieve recognition through APNA’s awards program • Attend the APNA Annual Conference featuring nationally recognized speakers and state-of-the-art workshops • Participate in health policy initiatives • Formally network with peers through APNA Councils of interested groups • Apply for American Psychiatric Nursing Foundation awards and scholarships Go to www.apna.org for membership application. 3. Canadian Attention Deficit Disorder Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines for 2007/2008. Accessed 10/14/08 at www.caddra.ca. 4. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108:1033-1044. 5. Jensen P, Arnold L, Richters J, et al. 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. Arch Gen Psychiatry. 1999;56:1073-1086. 6. MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics. 2004;113: 754-761. 7. U.S. Food and Drug Administration. 2005p-0115—Immediately remove from market pemoline CYLER-Abbott Laboratories, and all generic versions, a stimulant drug for the treatment of attention deficit hyperactivity disorder. Accessed 12/13/08 at http://www.fda.gov/ohrms/dockets/ dockets/05p0115/05p0115.htm. 8. Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook. Thirteenth Edition. Hudson, Oh:Lexi-Comp. 2005. 9. King S, Griffin, Hodges Z, et al. A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents. Health Technol Assess. 2006;10: iii-iv,xiii-146. 10. Efron D, Jarman F, Barker M. Side effects of methylphenidate and dextroamphetamine in children with attention deficit hyperactivity disorder: A double-blind, crossover trial. Pediatrics. 1997;100:662-666. 11. Samuels JA, Franco K, Wan F, et al. Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial. Pediatric Nephrol. 2006;21:92-95. ADHD and Bipolar Disorder In the treatment of bipolar disorder (especially mania or hypomania), mood stabilizers and/or atypical antipsychotics are typically administered to stabilize the individual’s mood prior to considering treatment for the ADHD. Opinions are mixed as to whether stimulants should be used in these individuals even after stabilization.The benefits of treating the ADHD with stimulants on the person’s impairments versus the potential for triggering or worsening the mood instability must be weighed carefully. Hence, nonstimulant medications should be tried before stimulants in adults with ADHD and bipolar disorder.51,54 ADHD and Anxiety Likewise, opinion is mixed about whether to treat comorbid anxiety or ADHD first. Some adults with anxiety respond well to the treatment of ADHD with stimulants and their anxiety decreases, while others experience an increase in anxiety related to the use of stimulants. It is even more important in individuals with ADHD and anxiety to initiate treatment with low doses and to titrate more slowly.51,54 If anxiety persists, augmentation to treat the remaining anxiety may be appropriate. Summary Pharmacologic treatment of ADHD has advanced over the past couple of decades so that there are now a number of medications that can effectively manage symptoms in children, adolescents, and adults. The primary goal of pharmacologic treatment is to improve the individual’s functioning in society (e.g., reduce disruptive behaviors, inattentiveness, and impulsity, improve academic/work performance, and better relationships with others). References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Text Revision 4th ed. Washington, DC: American Psychiatric Association; 2000. 2. Pliska S, and the AACAP Work Group on Quality Issues. 21. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:894-921. 11 JANUARY 2009 http://www.apna.org http://www.caddra.ca http://www.fda.gov/ohrms/dockets/dockets/05p0115/05p0115.htm http://www.fda.gov/ohrms/dockets/dockets/05p0115/05p0115.htm

Table of Contents Feed for the Digital Edition of Counseling Points - January 2009

Counseling Points - January 2009

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.