Добавил:
Upload
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Case Studies_ Stahl's Essential - Stephen M. Stahl.docx
X
- •Table of Contents
- •Case Studies
- •Volume 2 Stephen m. Stahl
- •Thomas l. Schwartz
- •It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence.
- •Information on this title: www.Cambridge.Org/9781107607330
- •Illness – Chemotherapy – Examinations, questions, etc. |
- •Isbn 978-1-107-60733-0 Paperback
- •Introduction
- •Learning objectives
- •Accreditation and credit designation statements
- •Optional posttest and cme credit instructions (see p. 441) Peer review
- •Disclosures
- •Authors/developers
- •Disclosure of off-label use
- •Disclaimer
- •Cultural and linguistic competency
- •Provider
- •Support
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Case outcome: second interim follow-up visit at two months
- •Attending physician’s mental notes: interim follow-up visit at three months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months
- •Case outcome: interim follow-up visits through six months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through 12 months
- •Case outcome: interim follow-up visits through 24 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Psychotherapy moment
- •Psychopharmacology components
- •Psychotherapy
- •Documentation
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through six months
- •Question
- •Attending physician’s mental notes: nine months
- •Case outcome: interim follow-ups through nine months
- •Question
- •Attending physician’s mental notes: nine-month follow-ups
- •Question
- •Attending physician’s mental notes: interim follow-up through nine months (continued)
- •Case outcome and multiple interim follow-ups to 24 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Tardive dyskinesia
- •Tardive dyskinesia facts
- •Tardive dyskinesia treatments
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through four months
- •Question
- •Attending physician’s mental notes: nine months
- •Case outcome: interim follow-ups through nine months
- •Question
- •Attending physician’s mental notes: 9–12 month follow-ups
- •Question
- •Case outcome: interim follow-ups through 12 months
- •Case outcome: multiple interim follow-ups through 16 months
- •Attending physician’s mental notes: 16-month follow-ups
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Abnormal Involuntary Movement Scale (aims)
- •Aims instructions
- •Case outcome: use of outcome measures
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Question
- •Case outcome: interim follow-ups through three months
- •Question
- •Attending physician’s mental notes: four months
- •Question
- •Case outcome: interim follow-ups through six months
- •Attending physician’s mental notes: interim follow-up, nine months (continued)
- •Case outcome and multiple interim follow-ups to 12–120 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Mechanism of action moment How does vns theoretically work?
- •Vns side effects
- •Neurostimulation and neuromodulatory devices other than vns
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through one month
- •Question
- •Case outcome: interim follow-ups through two months
- •Case outcome: interim follow-ups through three months
- •Question
- •Attending physician’s mental notes: four-month follow-ups
- •Question
- •Case outcome: interim follow-ups through four months (continued)
- •Attending physician’s mental notes: interim follow-ups through four months
- •Case outcome and multiple interim follow-ups to six months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Is quetiapine (Seroquel) an antipsychotic, anti-manic, antidepressant, anxiolytic, or a hypnotic?
- •Pharmacodynamics of quetiapine and norquetiapine
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through one month
- •Case outcome: interim follow-ups through two months
- •Attending physician’s mental notes: two months
- •Question
- •Case outcome: interim follow-ups through two months
- •Case outcome: interim follow-ups through three months
- •Question
- •Case outcome and multiple interim follow-ups up to six months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Pharmacodynamic moment
- •What is worse in causing escalated mania or mixed features, antidepressants or stimulants?
- •Should unipolar antidepressants be used in bipolar disorder?
- •Does clonazepam (Klonopin) work in bipolar mania?
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Question
- •Case outcome
- •Case debrief
- •Take-home points
- •Tips and pearls
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through three months
- •Question
- •Attending physician’s mental notes: four months
- •Case outcome: interim follow-ups through six months
- •Case outcome: interim follow-ups through nine months
- •Question
- •Attending physician’s mental notes: nine-month follow-ups
- •Attending physician’s mental notes: interim follow-up, nine months (continued)
- •Case outcome and multiple interim follow-ups to 24 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Treating aawg with metformin
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through six months
- •Attending physician’s mental notes: six months
- •Case outcome: interim follow-ups through nine months
- •Case outcome: interim follow-ups through 18 months
- •Attending physician’s mental notes: through 20 months
- •Question
- •Case outcome: interim follow-ups through 24 months
- •Question
- •Attending physician’s mental notes: 24-month follow-ups
- •Case outcome: interim follow-up, 36 months
- •Attending physician’s mental notes: 48-month follow-ups
- •Question
- •Case outcome and multiple interim follow-ups to 48 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Techniques for switching antipsychotics
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Question
- •Case outcome
- •Case debrief
- •Clozapine sialorrhea statistics and etiology
- •Possible antidotes for cis
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Further investigation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim follow-ups through three months
- •Attending physician’s mental notes: six months
- •Case outcome: interim follow-ups through nine months
- •Case outcome: interim follow-ups through 12 months
- •Case outcome: interim follow-ups through 12 months (continued)
- •Question
- •Attending physician’s mental notes: 12 month follow-ups
- •Case outcome: interim follow-up, 24 months
- •Attending physician’s mental notes: 36-month follow-ups
- •Case outcome and multiple interim follow-ups to 60 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •A pharmacodynamic moment
- •Antihistamine and the sleep–wake switch
- •Serotonin receptor antagonism and sleep
- •What about 5-ht1d receptor antagonism?
- •What about 5-ht7 receptor antagonism?
- •Patient evaluation on intake
- •Psychiatric history
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Case outcome: second interim follow-up visit at two months
- •Attending physician’s mental notes: second interim follow-up visit at two months
- •Question
- •Case outcome: interim follow-up visits through seven months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through seven months
- •Case outcome: interim follow-up visits through 24 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Mechanism of action moment
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit eight weeks later
- •Question
- •Case outcome: second and third interim follow-up visits at three months
- •Attending physician’s mental notes: second interim follow-up visit at three months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months (continued)
- •Case outcome: interim follow-up visits through five months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through nine months
- •Case outcome: interim follow-up visits through 12 months
- •Attending physician mental notes
- •Case outcome: interim follow-up visits through 15 months
- •Question
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Pharmacoeconomic and regulatory moment
- •How many ways can a drug be turned into a slow-release preparation?
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Medication history
- •Psychotherapy history
- •Social and personal history
- •Medical history
- •Family history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four to six weeks later
- •Question
- •Attending physician’s mental notes: interim follow-up visits through three months
- •Case outcome: interim follow-up visits through three months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through three months (continued)
- •Case outcome: interim follow-up visits through six months
- •Attending physician’s mental notes: interim follow-up visits through six months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Overview
- •Classification
- •Clinical manifestations
- •Therapy and management
- •Posttest self-assessment question and answer
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit six weeks later
- •Question
- •Attending physician’s mental notes: interim follow-up visits through six months
- •Case outcome: interim follow-up visits through six months
- •Question
- •Attending physician’s mental notes: interim follow-up visit through six months (continued)
- •Case outcome: interim follow-up visits through nine months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through nine months
- •Case outcome: interim follow-up visits through 15 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Neurocircuitry moment
- •Treatments for ocd
- •Posttest-self assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Social and personal history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at two months
- •Case outcome: second interim follow-up visit at two months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at two months (continued)
- •Case outcome: interim follow-up visits through four months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through four months
- •Case outcome: interim follow-up visits through nine months
- •Attending physician’s mental notes: interim follow-up visits through 12 months
- •Case outcome: interim follow-up visits through 18 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Mechanism of action moment
- •Diagnosis
- •Etiology
- •Rls and comorbidity
- •Rls treatment
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at two months
- •Case outcome: second interim follow-up visit at two months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at two months (continued)
- •Case outcome: interim follow-up visits at three months
- •Question
- •Case outcome: interim follow-up visit at four months
- •Attending physician’s mental notes: interim follow-up visits through four months
- •Case outcome: interim follow-up visits through six months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Pharmacokinetic moment
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months
- •Case outcome: second interim follow-up visit at three months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months (continued)
- •Case outcome: interim follow-up visits through 12 months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through 24 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Patient evaluation on intake
- •Psychiatric history
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit three months later
- •Question
- •Case outcome: first interim follow-up visit three months later (continued)
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at six months
- •Case outcome: second interim follow-up visit at six months
- •Question
- •Case outcome: interim follow-up visits through nine months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through nine months
- •Case outcome: interim follow-up visits through 36 months
- •Question
- •Case outcome: interim follow-up visits through 48 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Patient evaluation on intake
- •Psychiatric history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visits four and eight weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months
- •Case outcome: second interim follow-up visit at three months
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three months (continued)
- •Case outcome: interim follow-up visits through six months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through six months
- •Case outcome: interim follow-up visits through nine months
- •Attending physician’s mental notes: interim follow-up visits through nine months
- •Question
- •Case outcome: interim follow-up visits through 15 months
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Neuropsychiatric moment
- •Causes, incidence, and risk factors
- •Symptoms
- •Signs and tests
- •Treatment
- •Prognosis
- •Pharmacodynamic moment
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visit four weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at two months
- •Case outcome: second interim follow-up visit at two months
- •Question
- •Case outcome: interim follow-up visits through five years
- •Question
- •Attending physician’s mental notes: interim follow-up visits through five years
- •Case outcome: interim follow-up visits through six years
- •Question
- •Attending physician’s mental notes: interim visits through year six
- •Case outcome: interim follow-up visits through six years (continued)
- •Question
- •Attending physician’s mental notes: interim visits through year six (continued)
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Mechanism of action moment
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visits one to two weeks later
- •Question
- •Attending physician’s mental notes: second interim follow-up visit at three to four weeks
- •Case outcome: second interim follow-up visit at three to four weeks
- •Question
- •Case outcome: interim follow-up visits through four to six weeks later
- •Question
- •Attending physician’s mental notes: interim follow-up visits through six weeks
- •Case outcome interim follow-up visits through 10 weeks
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Chronic risks
- •Acute risks predictive of future suicide attempt include*
- •Summary
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Further investigation
- •Case outcome: first interim follow-up visits through six months
- •Question
- •Case outcome: second interim follow-up visits through 12 months
- •Question
- •Case outcome: second interim follow-up visits through 12 months (continued)
- •Question
- •Attending physician’s mental notes: interim visits through 18 months
- •Case outcome: interim follow-up visits through 18 months
- •Question
- •Case outcome: interim follow-up visits through 24 months
- •Question
- •Attending physician’s mental notes: interim follow-up visits through 24 months
- •Case outcome: interim follow-up visits through 24 months (continued)
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Gaba-a receptors and the positive allosteric modulation of the bZs
- •Gaba-a receptors: desensitization, tachyphylaxis, and tolerance
- •Why does this happen?
- •Patient evaluation on intake
- •Psychiatric history
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Further investigation
- •Case outcome: first interim follow-up visits through three months
- •Question
- •Case outcome: interim follow-up visits through four months
- •Question
- •Case outcome: interim follow-up visits through six months
- •Question
- •Attending physician’s mental notes: visits through six months
- •Case outcome: interim follow-up visits through nine months
- •Question
- •Case outcome: interim follow-up visits through nine months (continued)
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Case outcome: via telephone
- •Further investigation
- •Case outcome: first interim follow-up six hours later
- •Question
- •Attending physician’s mental notes: six hours later
- •Question
- •Attending physician’s mental notes: interim follow-up information through 72 hours
- •Case outcome: interim follow-up information through 72 hours
- •Case outcome: interim follow-up visits through 80 hours
- •Attending physician’s mental notes: interim follow-up information through 72 hours (continued)
- •Question
- •Case outcome: interim follow-up information through 92 hours
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Delirium primer
- •Posttest self-assessment question and answer
- •Pretest self-assessment question (answer at the end of the case)
- •Patient evaluation on intake
- •Psychiatric history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current psychiatric medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: initial visit
- •Further investigation
- •Question
- •Case outcome: first interim follow-up visit one week later
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Mechanism of action moment
- •Disulfiram (Antabuse)
- •Naltrexone (ReVia)
- •Acamprosate (Campral)
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Social and personal history
- •Medical history
- •Family history
- •Medication history
- •Psychotherapy history
- •Patient evaluation on initial visit
- •Current psychiatric medications
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: initial visit
- •Further investigation
- •Case outcome: first interim follow-up visit two months later
- •Question
- •Case outcome: interim follow-up visits three to six months later
- •Attending physician’s mental notes: follow-up visit, six months
- •Case outcome: interim follow-up visits eight to 12 months later
- •Case debrief
- •Take-home points
- •Performance in practice: confessions of a psychopharmacologist
- •Tips and pearls
- •Medication management of adhd in children versus adults
- •Posttest self-assessment question and answer
- •Patient evaluation on intake
- •Psychiatric history
- •Patient evaluation on initial visit
- •Question
- •Attending physician’s mental notes: initial evaluation
- •Case outcome: initial visit
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim visit at six weeks
- •Case debrief
- •Take-home points
- •Patient’s genetic summary
- •Case outcome: initial visit
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim visit at four weeks
- •Case debrief
- •Take-home points
- •A short tutorial on the scientific background of this case
- •Patient’s genetic summary
- •Case outcome: initial visit
- •Question
- •Attending physician’s mental notes: initial evaluation (continued)
- •Case outcome: interim visit through 16 weeks
- •Case debrief
- •Take-home points
- •Cme online posttest and certificate instructions
- •Index of drug names
- •Index of case studies
Medication management of adhd in children versus adults
First-line treatments for ADHD in children (Figure 27.1, left) include slow-release stimulants, while immediate-release stimulants, atomoxetine, and alpha-2a agonists (guanfacine-ER, clonidine-ER) are second-line options
The classical stimulants have the largest effect sizes and greatest evidence base for ADHD efficacy
The slow-release stimulants likely lower side-effect rates, given their lower and more consistent plasma levels, and improve compliance by once-daily dosing
Third-line options include antidepressants with noradrenergic properties
Adjunctive options include atypical antipsychotics or behavioral therapy
For adults (Figure 27.1, right), first-line treatments include nonstimulants such as atomoxetine, guanfacine-ER, or perhaps off-label modafinil (Provigil), as well as slow-release stimulants
Immediate-release stimulants and noradrenergic antidepressants are second-line options
Adjunctive options may include atypical antipsychotics or drug-abuse treatments for patients with SUD
In adults, there is greater risk of stimulant abuse or diversion, which warrants often starting with nonstimulant preparations despite their lower effectiveness at times
Figure 27.1. Attention deficit hyperactivity disorder pharmacy.
Posttest self-assessment question and answer
Which of the following do not appear to have marked weight loss adverse effects when treating children with ADHD?
A. Guanfacine-ER (Intuniv)
B. Clonidine-ER (Kapvay)
C. Atomoxetine (Strattera)
D. Lisdexamfetamine (Vyvanse)
E. A and B
F. A, B, and C
G. All of the above
Answer: F
A, B, and C are considered nonstimulant-approved treatments for child and adolescent ADHD. A plus B are alpha-2a receptor agonists and C is an NRI.
Mechanistically and statistically, A, B, and C are associated with less apparent risk for abnormal weight and stature loss compared to the true stimulant medications such as lisdexamfetamine (D).
There does exist a controversy in that shorter-term studies of stimulants suggest weight and height loss, but prospective, longitudinal studies up to 10 years have most recently suggested no loss of weight or stature due to ADHD or stimulant use. Many initial studies followed biostatistics only for a few years or did not follow children into adulthood.
References
1.Stahl SM. Stahl’s Essential Psychopharmacology, 4th edn. New York, NY: Cambridge University Press, 2013.
2.Stahl SM. Stahl’s Essential Psychopharmacology: The Prescriber’s Guide, 5th edn. New York, NY: Cambridge University Press, 2014.
3.Biederman J, Wilens T, Mick E, et al. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. Am J Psychiatry 1995; 152:1652–8.
4.Wilens T, Faraone S, Biederman J, et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 2003; 111:179–85.
5.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Association Press, 2013.
6.Biederman J, Spencer T, Monuteaux M, Faraone S. A naturalistic 10-year prospective study of height and weight in children with attention-deficit hyperactivity disorder grown up: sex and treatment effects. J Pediatr 2010; 157:635–40.
7.Faraone SV, Biederman J, Morley CP, Spencer TJ. Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47:994–1009.
8.Swanson JM, Elliott GR, Greenhill LL, et al. Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007; 46: 1015–27.
9.Poulton A, Cowell CT. Slowing of growth in height and weight on stimulants: a characteristic pattern. J Paediatr Child Health 2003; 39:180–5.
10.Fluoxetine. FDA Package Insert 2007, Eli Lilly Inc. http://pi.lilly.com/us/prozac.pdf. Accessed August 10, 2015.
11.Sertraline. FDA Package Insert 2014, Pfizer Inc. http://labeling.pfizer.com/ShowLabeling.aspx?id=517#page=1. Accessed August 10, 2015.
12.DeBattista DMH, Schatzberg AF, eds. Black Book of Psychotropic Dosing and Monitoring, 10th edn. New York, NY: MBL Communications, 2006.
13.Schwartz TL, Nihalani N, Jindal S, et al. Psychiatric medication induced obesity: an epidemiologic review. Obes Rev 2004; 5:115–21.
14.American Academy of Pediatrics, Committee on Quality Improvement, and Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108:1033–44.
15.American Academy of Pediatrics. Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 2000; 105:1158–70.
16.Miller A, Lee S, Raina P, et al. A Review of Therapies for Attention-Deficit/Hyperactivity Disorder. Ottawa, ON: Canadian Coordinating Office for Health Technology Assessment (CCOHTA), 1998.
17.March JS, Swanson JM, Arnold LE, et al. Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD. J Abnorm Child Psychol 2000; 28:527–41.
18.Schelleman H, Bilker WB, Strom BL, et al. Cardiovascular events and death in children exposed and unexposed to ADHD agents. Pediatrics 2011; 127:1102–10.
19.Markowitz JS, Patrick AS. Pharmacokinetic and pharmacodynamic drug interactions in the treatment of attention-deficit hyperactivity disorder. Clin Pharmacokinet 2001; 40:753–72.
Patient file
The Case:
54-year-old with recurrent depression and “psychiatric” parkinsonism
The Question (Pharmacogenetics, Part 1):
How might psychopharmacology be delivered in the future?
The Dilemma:
Can genotyping help predict successful treatment selection
Pretest self-assessment question (answer at the end of the case)
A 54-year-old patient has depression with prominent cognitive symptoms and also has the Val/Val genotype for catechol-O-methyltransferase (COMT). Based only on this genetic result, what treatment might be preferred for this patient?
A. SSRI
B. SNRI
C. NDRI
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]