Adhd

[StevenStallings]

I have recently been made aware of a newer medicine for ADHD named Strattera (atomoxetine hcl). The literature and studies I have seen make a strong case for this over Ritalin. Perhaps the biggest problem with ADHD kids is that period of time in the evening when they are trying to do homework (7-9pm) and the Ritalin or Concerta has worn off. Strattera has a much longer effect without insomnia. Any one else?

[Guest nlstephany]

I have heard of this new drug as well. I am in the Psychiatry field, and everyone is talking about it. In fact, I am supposed to go to a lecture/dinner presentation on this drug tomorrow night. I will let you know what I hear.

[Guest ckppac]

I have not found it very helpful at all. There are also significant GI side effects in some patients. It may have a role with patients who are not able to tolerate stimulants, but I do not think that it is even close to being as effective for most patients. Just my two cents.

[goldenbodhi]

Oh boy have I been waiting for a question on this.

 

HOW ABOUT NO DRUGS FOR ADHD? How about teaching a child how to funnel their energy? How about teaching a parent how to give their child the appropriate attention? Why are we the largest consumers of Ritalin compared to the other developed nations? Why do we diagnose this "disease" so readily and why at such nt astronimical rate compared to the other develops nations. I have a friend who practices in Austrailia and he has never seen a child (he is a generalist and 40% of his patient base is peds) with this "disease." He has never writtne a Rx for ritalin or any other ADHD drugs. NEVER

 

This disease was created by us just as we have created the resistence to Abx for writting Rx for URI's in 2 years olds and treating "sinusitis" with Augmentin after two days of nasal congestion.

We need to stop prescribing drugs just because we can.

 

I'm sure I'll be trashed on this thread but this is a problem in my eyes. I work in EM and the kids i see come in here on meds for ADHD, for whatever reason more often than not, it's their parents that should have been put on meds. This was also my experience in my peds rotation and I did a roation with a Doc that was a supposed "expert" on ADHD. His practice was over-filled with parents trying to get in for an ADHD work-up by this Doc.

[lingeringmind]

Atomoxetine is a failed SNRI that has some utility in ADHD. It acts primarily at 2C19 & 2D6 substrates. It can be helpful and is one drug in a field of pharmacologic responses. Baring contraindications, stimulants are the gold standard in the psychotropic management of ADHD. If behavioural problems recur as the long acting stimulant poops out, a small rescue dose of an immediate release stimulant toward the end of the day can gentle the offset of action slope. Other good choices are central alpha blockers such as guanficine or clonidine. Both those have extended release forms.

 

ADHD is the most studied mental health disorder of childhood. It isn't a simple disorder with homogenous roots. Many advocate (as the above writer) that ADHD is a social construct, others champion educational weakness, limited parenting skills, etc. Those hypotheses have tremendous merit and are a part of the pathophysiologic makeup of the disorder. In addition, Single Nucleotide Polmorphism studies, coupled fMRI and PET imaging clearly demonstrate sound evidence that ADHD is a biological, neuro-psychiatgric disorder. With the completion of the Human Genome Project and advanced imaging, it is clear that psychiatric disorders can not be explained by debating Nature vs Nuture. Nature & Nurture in inextricably enmeshed. The reader is referred to the diathesis-stress model: http://en.wikipedia.org/wiki/Diathesis%E2%80%93stress_model

ADHD exists, as do all psychiatric disorders; along a continuum. Many with ADHD will do well with psychotherapy and environmental intervention without psychotropics. That is one of the issues that makes Psychiatry very hard; who does or does not need a med? What med do they need? What dose? For how long, etc?

Cheers,

Keir

[alleycat]

lingeringmind.........nicely done.

[ventana]

Oh boy have I been waiting for a question on this.

 

HOW ABOUT NO DRUGS FOR ADHD? How about teaching a child how to funnel their energy? How about teaching a parent how to give their child the appropriate attention? Why are we the largest consumers of Ritalin compared to the other developed nations? Why do we diagnose this "disease" so readily and why at such nt astronimical rate compared to the other develops nations. I have a friend who practices in Austrailia and he has never seen a child (he is a generalist and 40% of his patient base is peds) with this "disease." He has never writtne a Rx for ritalin or any other ADHD drugs. NEVER

 

This disease was created by us just as we have created the resistence to Abx for writting Rx for URI's in 2 years olds and treating "sinusitis" with Augmentin after two days of nasal congestion.

We need to stop prescribing drugs just because we can.

 

I'm sure I'll be trashed on this thread but this is a problem in my eyes. I work in EM and the kids i see come in here on meds for ADHD, for whatever reason more often than not, it's their parents that should have been put on meds. This was also my experience in my peds rotation and I did a roation with a Doc that was a supposed "expert" on ADHD. His practice was over-filled with parents trying to get in for an ADHD work-up by this Doc.

 

 

this goes to one of the very basic problems I see with american society today

 

1) their is some type of "perfect" state we need to all be in

2) if you find the right mix of drugs and pills you can some how enter this perfect state

3) are you CRAZY you can't possibly get to the perfect state with living healthy and exercise and acceptance of humanities own shortcomings....

 

 

WAY to many pills and meds given in this county - we all need to work less, spend less, consume less, and be more active......

[NewtonsApple]

this goes to one of the very basic problems I see with american society today

 

1) their is some type of "perfect" state we need to all be in

2) if you find the right mix of drugs and pills you can some how enter this perfect state

3) are you CRAZY you can't possibly get to the perfect state with living healthy and exercise and acceptance of humanities own shortcomings....

 

 

WAY to many pills and meds given in this county - we all need to work less, spend less, consume less, and be more active......

 

I agree that many people put a lot of stock in medicine, however, having worked with many ADHD children I also understand that medicine gives many of these kids a fighting chance to control what can be extremely disruptive and caustic behavior which can lead to life long learning and social disorders. Further, while it helps the child to learn how to inhibit behavior, it also allows the damaged family dynamic to refocus priorities from being centered around the child. On the flip side, you can see a change (or loss) in personality in some children. I agree that pills are too often times the front line instead of taking care of the body and mind, however, for many patients and their families it is necessary. I have seen families try to control ADHD through diet and behavior modification. It can be a long, draining, and futile task. Studies also indicate that children who are medicated in adjunct to behavior modification have less symptoms and are better at controlling behavior as adults. I am not saying 100% medicate, however, I have seen the destruction to families and the self esteem of the child when they refuse to medicate and attempt to control it on their own. I have also seen the relief when they bypass the stigma and ridicule for being parents who are "failures, lazy, and uninformed" by people who think they can judge someones situation.

 

1. Not to say they are not out there, but I have not worked with a doc, PA, nurse, or therapist that believes in "the perfect state." The goal of treatment

was always to help the patient better manage behavior. Medicine was always looked as an adjunct to non pharmacological treatment and never approached as a

an permanent solution.

2. Again, I have never heard anybody preach this mantra in psych. Further in the pysch hospital I worked, no medication was always the ideal situation

3. I may be wrong, but It seems to me you are saying in point 1 and 2 there is no perfect state, however, in point 3 you allude to the fact a perfect state can be

achieved with proper diet and nutrition. I say this, as I like you do not believe in 'normal' but not sure what your final point was on 3.

 

Psych will always be in the middle of discussion like since the damage cannot be seen and objectively diagnosed like a broken ankle. Of course the distrust towards big pharm is always an issue. ;)

[sk732]

Not putting words in people's mouths, but I think that what a few people are getting at is it's an over diagnosed entitiy. Let's face, there are kids out there that clearly have ADHD - but there are an awful lot of kids out there that are just normal kids. Normal kids are very energetic and have the attention span of a melted ice cube. If you look at some societies other than our own in North America, kids' lives are very structured and have plenty of time where they are encouraged or outright made to be active. That helps burn the excess energy off, and exercise is shown to increase some focus by helping change brain neurotransmitter chemistry. Also, we do live in a society that prefers that something else other than ourselves does the work for us - it's easier to take a pill for something than to do the work required yourself for the same effect. That has crept a bit into how some folks practice medicine - it's easier to write the script than to do a work up or explain to the patient or patient's family why a medication isn't actually needed, especially if we know they're just going to go somewhere else and get filled by someone else that they pay or they're just going to ignore what you say full stop.

 

$0.02

 

SK

[mikejfox]

I have personal experience with this Rx.

 

I have AADD, and I am on Straterra. It has done wonders for me.

[lingeringmind]

There are many who are tightly wedded to the social construct model. There is much to be critical of the Medical-Pharmacological-Industrial-Complex.

 

Regarding "over diagnosis;" we must all be on guard and watchful of the medicalization of normal behaviours. What if a child is a goofy, quirky, active, exurberant, bounding with vitality kid? Maybe thats just the way she/he is supposed to be? Should a PA prescribe a drug? No, I doubt any thinking PA would. What if another child comes along who is also goofy, quirky, active, exurberant, etc; and that child's behaviour causes impairment? That same goofy, quirky, active stuff impairs that child from living a healthy, productive & meaningful life? Should psychotropics be considered? Yes, without a doubt.

 

It all comes down to the Axis V GAF. You have to consider all the information in the first 4 Axes. Goofy, quirky, active kids with a GAF > 80 probably do not need any medication. As you descend lower down the GAF scale, the more likely a psychotrope is needed.

 

The main purpose of Psychiatric interventions is improvement in GAF, right? If the GAF isn't being maintained or improving, it is incumbent on the PA to reassess and probably change therapies.

 

My $0.02

Cheers,

Keir