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About yburaj

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  1. hi, if you still hav the DVD, please text me 07900924258 , thanks Raj
  2. Dear Umesh, i must say, ur suggestions are very valid. thank you very much for all your help and guidance.
  3. thanks darknight, yes stimulants can also be many. so ans is atomexitine
  4. so the answer should be a stumulant
  5. NICE Guidance on ADHD 30 October 2008, 10:30am This summary looks at ADHD in children and young people. For ADHD in adults refer to the full guideline IDENTIFICATION AND REFERRAL TO SECONDARY CARE Determine the severity of behavioural and/or attention problems suggestive of ADHD and how they affect the child or young person and their parents or carers in different domains and settings. If the problems are having an adverse impact on development or family life, consider: - watchful waiting for up to 10 weeks. - offering referral to a parent-training/education programme; this should not wait for a formal diagnosis of ADHD. If the problems persist with at least moderate impairment, refer to secondary care (paediatrician, child psychiatrist or specialist ADHD child and mental health services [CAMHS]). If the problems are associated with severe impairment, refer directly to secondary care. If a child or young person is currently receiving drug treatment for ADHD and has not yet been assessed in secondary care, refer to secondary care as a clinical priority. DIAGNOSIS For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should: - meet the diagnostic criteria in DSM-IV or ICD-10 (hyperkinetic disorder) and; - be associated with at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings, and; - be pervasive, occurring in at least two settings. Note: Diagnosis should be made only by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of ADHD. Drug treatment should not be started in primary care. ADVICE AFTER DIAGNOSIS Consider providing parents and carers with self-instruction manuals and other materials such as videos, based on positive parenting and behavioural techniques. Stress the value of a balanced diet, good nutrition and regular exercise for children and young people with ADHD. Advise parents or carers to keep a diary if there are foods or drinks that appear to affect behaviour - if the diary supports a link, offer referral to a dietician. Note: Use of dietary fatty acids supplements and/or elimination of artificial colouring and additives from the diet are not recommended. TREATMENT AND MANAGEMENT Drug treatment is not recommended for preschool children or as first-line treatment for school-age children and young people with moderate ADHD. School-age children and young people with severe ADHD should be offered drug treatment first-line. Parents should also be offered a group-based parent-training/education programme. Drug treatment should: - be started only by a healthcare professional with expertise in ADHD. - be based on comprehensive assessment. - always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions. GPs may continue prescribing and monitoring drug treatment under shared care arrangements. When a decision to start drug treatment has been made the following options should be considered: - methylphenidate for ADHD without significant comorbidity. - methylphenidate for ADHD with comorbid conduct disorder. - methylphenidate or atomoxetine when tics, Tourette's syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present. - atomoxetine if methylphenidate has been tried and has been ineffective at the maximum tolerated dose, or the child or young person is intolerant to low or moderate doses of methylphenidate.
  6. The following features support the diagnosis, but are not necessary elements: Involvement of cortical functions as evidenced by aphasia, agnosia or apraxia; decrease of motivation and drive, leading to apathy and lack of spontaneity; irritability and disinhibition of social behaviour; evidence from special investigations that there is cerebral atrophy, particularly if this can be shown to be increasing over time. In severe cases there may be Parkinson-like extrapyramidal changes, logoclonia, and epileptic fits. so not sure if apthy or general cerebral atrophy
  7. In the care of individuals with panic disorder, any of the following types of intervention should be offered and the preference of the person should be taken into account. The interventions that have evidence for the longest duration of effect, in descending order, are: psychological therapy (see 1.4.12–1.4.18) pharmacological therapy (antidepressant medication) (see 1.4.19–1.4.31) self-help (see 1.4.32–1.4.34). [2004]
  8. its haloperidol. its clealry mentioned in maudsley. olanzapin e is a good option but first generation have been extensively researched.
  9. benzo
  10. autism
  11. combination of antipsychotic with antidepressant is most effectice. and the antidep is TCA. maudsely guidelines
  12. Treating tics Although a wide range of medications has been used to treat tics, there have been relatively few published RCTs of their use. Until recently, haloperidol, pimozide and, in the UK, sulpiride, were the mainstays of treatment. In RCTs, all three have been shown to be efficacious in reducing tics. Haloperidol is the most efficacious, leading to improvement in approximately two-thirds of cases, with pimozide and sulpiride improving tics in just over one-half. However, haloperidol is associated with frequent adverse reactions including disabling extrapyramidal effects. Pimozide, although associated with fewer adverse events than haloperidol, can lead to ECG abnormalities, particularly prolongation of the QT interval. Sulpiride is also associated with a lower, but not absent, rate of extrapyramidal side-effects. Recently, there has been much interest in the potential use of the atypical antipsychotics in treating Tourette syndrome. The increase in their use outstripped the available evidence and was based on case reports and case series rather than RCTs. However, over the past 2 years, RCTs have begun to appear in the literature. Sallee et al(2000) demonstrated that ziprasidone was superior to placebo and, at a mean dose of 30 mg/day, was efficacious in reducing tics by an average of 35% in a group of 28 children and adolescents with moderate-to-severe tic symptoms. Dion et al(2002) found that risperidone, at a median dose of 2.5 mg/day, was significantly superior to placebo in reduction of tics, with 60% in the risperidone group showing clinically significant improvements. Risperidone did not increase symptoms of obsessive–compulsive disorder. Bruggeman et al(2001) compared risperidone and pimozide in a comparative double-blind parallel-group study. At the end-point, 54% of the patients on risperidone and 38% of those taking pimozide were rated as having only very mild or no symptoms. Both treatment groups had improved significantly with regard to Global Assessment of Functioning and Clinical Global Impressions scale outcomes. Symptoms of anxiety and depressive mood had also improved significantly from baseline in both groups but improvement in obsessive–compulsive behaviour reached significance only in the risperidone group. Finally, Onofrj et al(2000) reported the results of a very small 52-week double-blind crossover study of olanzapine v. low-dose pimozide in four adult patients. Although the size of the trial prevents detailed conclusions being drawn, it suggested that olanzapine was as efficacious as pimozide, with all four patients opting for olanzapine at the end of the study. All studies reported that the atypicals were associated with few adverse events, but larger, longer trials are needed before firm statements on safety can be made. Clinical experience suggests that a significant number of patients are unhappy about the amount of weight they gain while taking these drugs, although many commentators believe that the atypicals will soon become the first-line treatment for tics. Other pharmacological treatments for tics include: α-agonists such as clonidine and guanfacine; botulinum toxin; calcium antagonists such as nifedipine, flunarizine and verapamil; nicotine; and the selective androgen receptor antagonist, flutamide. All received some support in open use for decreasing tics. However, of these only flutamide has been shown in an RCT to reduce tics. The studies involving these drugs are helpfully summarised by Robertson & Stern (2000). Clearly, there still needs to be much more research into drug treatments of Tourette syndrome, including larger trials from which clinicians can truly plan treatment in an evidenced-based way. http://apt.rcpsych.org/content/9/4/289.full?sid=29a2bb86-3327-425d-b5ee-a04a44e9fcd9
  13. very vague but over all methadone is more commonly used and so its more effective as its the first choice