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The aim of this paper is to assess the monitoring standards of methylphenidate prescribed by general practitioners (GPs) against the NICE guidelines.

The data on methylphenidate prescribing by GPs in Chorley and South Ribble were collected using a custom designed proforma from patient records held at GP surgeries and interviews with GPs. The data were then analysed using descriptive statistics.

The study finds that the majority (96 per cent) of the subjects who were on methylphenidate prescription from GPs were monitored by specialist services. This included both the National Health Service and the private sector. Only 62.5 per cent had documentation on physical monitoring and psychosocial intervention.

The results of the study showed that the monitoring of children on methylphenidate did not conform to the NICE guidelines. This highlighted the need for clear communication of responsibility of monitoring across the services. This is more important in regions where there are not optimal functioning child and adolescent mental health services.

As far as the authors know this was the first audit of its kind assessing the standards of methylphenidate prescribing done by general practitioners.

The purpose of the paper was to show that in October 2000 NICE issued guidance on the use of methylphenidate for ADHD in children. Agreed standards based on NICE guidance were finalised in May 2002 in East Kent. Authors conducted a multidisciplinary multisite audit across East Kent in 2001/2002. The audit demonstrated that practices met some of the standards but deficiencies were identified. There was also variation in practice across the region. A time bound action plan was agreed.

The paper aims to re‐audit the use of methylphenidate in children with ADHD and complete the audit cycle loop.

The paper finds a retrospective case notes review of children diagnosed with ADHD between 1 January and 30 June 2004 and subsequently started on short/long acting methylphenidate.

The paper shows that a total of 58 notes were audited. Re‐audit showed an increase in the use of Conners' rating scales to 91 vs 66 percent in the previous audit. More children had their pulse and blood pressure recorded before start of medication (84 vs 51 percent). GPs, schools and parents received written information respectively in 93 vs 89 percent, 71 vs 60 percent, and 69 vs 64 percent cases at start of methylphenidate and in 69 vs 75 percent, 57 vs 53 percent, and 59 vs 57 percent cases about the most recent visit. There has been no significant change in the shared care with GPs (3 vs 4 percent). “Trial‐off” medication was considered in 82 vs 16 percent in the previous audit.

This paper showed improvements in some areas identified in the previous audit. Professionals still need to communicate more with those involved with the child, as this was an issue highlighted through carer involvement. Shared care arrangements with GPs continue to be an issue and work is ongoing. A new time limited action plan is being developed. There are now regular multidisciplinary ADHD team meetings and much less variation in practice across the region as a direct result of this audit.

The assessment and management of ADHD is a significant issue in terms of resources for child psychiatric services, and increasingly Community Paediatricians and General Practitioners are becoming involved. This practice of shared care is amongst recommendations in the NICE guidelines on the use of methylphenidate for ADHD, published in 2000. Following the establishment of an ADHD Assessment Clinic in Peterborough, its performance was audited in light of these guidelines and recommendations from other publications. Audit standards for assessment and stimulant medication initiation procedures were set and evaluated in 63 children seen during the first year. There was success in achieving multi‐disciplinary assessments, carefully supervised initiation of medication and subsequent shared care with GPs. Problem areas included waiting times, follow‐up of problems detected on psychometric screening, physical screening, especially prior to medication, and communication with schools. Changes are now being implemented to address these issues.

European studies have shown lower prevalence rates of prescription stimulant use for cognitive enhancement, especially among student populations, compared to North America. This difference requires more cross-country research of the various factors involved. To find out whether other parts of the globe are witnessing similar increases in extra-medical stimulant use, and how this might relate to cognitive enhancement, requires empirical study of local contexts. This paper aims to argue that the academic and public discussion on cognitive enhancement should consider the specific country context of drug policy and research and rethink which drugs are included under the term cognitive enhancement drugs.

This paper offers a general review and a sociological country comparison between the Netherlands and Finland, focusing not only on prescription stimulants used to treat attention deficit hyperactivity disorder but also illicit amphetamines among young adults and methylphenidate use among Dutch and Finnish participants of the Global Drug Survey. This paper emphasises sociocultural perspectives and the importance of context in cognitive enhancement in general as the line between therapeutic and enhancement use can often be blurred. Data is drawn from global, European and national sources, including the International Narcotics Control Board, European Monitoring Centre for Drugs and Drug Addiction and Global Drug Survey.

There are hardly any national empirical studies done on cognitive enhancement drug use in Finland. On the other hand, there have been studies in the Netherlands showcasing that the use of prescription stimulants and other drugs for enhancement purposes is something that is happening among young people, albeit yet in a relatively small scale. Illicit and licit stimulant use and drug policy action in relation to cognitive enhancement drugs in the two countries varies, emphasising the importance of country context.

Given that cross-country research is scarce, this general review provides one of the first glimpses into cognitive enhancement drug use by comparing the country context and research in Finland, where the phenomenon has not been studied, with the Netherlands, where the topic has received more research and public attention. Further research areas are suggested.

The purpose of this paper is to investigate the body-mind problem from a mathematical invariance principle in relation to personality dynamics in the psychological and the biological levels of description.

The relationship between the two mentioned levels of description is provided by two mathematical models as follows: the response model and the bridge model. The response model (an integro-differential equation) is capable to reproduce the personality dynamics as a consequence of a determined stimulus. The invariance principle asserts that the response model can reproduce personality dynamics at the two levels of description. The bridge model (a second-order partial differential equation) can be deduced as a consequence of this principle: it provides the co-evolution of the general factor of personality (GFP) (mind), the it is an immediate early gene (c-fos) and D3 dopamine receptor gene (DRD3) gens and the glutamate neurotransmitter (body).

An application case is presented by setting up two experimental designs: a previous pilot AB pseudo-experimental design (AB) pseudo-experimental design with one subject and a subsequent ABC experimental design (ABC) experimental design with another subject. The stimulus used is the stimulant drug methylphenidate. The response and bridge models are validated with the outcomes of these experiments.

The mathematical approach here presented is based on a holistic personality model developed in the past few years: the unique trait personality theory, which claims for a single personality trait to understand the overall human personality: the GFP.

Atomoxetine has been approved for the treatment of attention deficit/hyperactivity disorder in both adults and children. However, it is also being examined for several off-label uses in adults including mood disorders, eating disorders, cognitive dysfunction, and the treatment of addictions. Prior to such use it is important to examine the reported adverse events to see if this represents an appropriate level of risk. This is particularly important in the light of recent warnings from several regulatory bodies about an increase in blood pressure in a significant percentage of patients taking atomoxetine. To understand the risks a literature review was performed, and which identified the following potential problems. The first is that this drug should not be given in patients with known cardiovascular problems, and that all adult patients who receive atomoxetine should be monitored for changes in blood pressure throughout treatment. Secondly, there are several clinical situations in which atomoxetine should be closely monitored, or avoided, including patients who have a history or risk of narrow angle glaucoma, epileptic seizures, Tourette's syndrome, a history of urinary outflow obstruction, or who are pregnant or lactating. In conclusion, the current literature suggests that atomoxetine can be safely used off-label provided the above precautions are taken.

There needs to be an increased recognition of fetal alcohol spectrum disorder (FASD) in services that deal with young people with disruptive and offending behavior, not just those services that deal with adolescents with a recognized intellectual disability. The paper aims to discuss these issues.

This is a general review of the current available evidence on FASD and how it is likely to predispose affected young people to have contact with secure mental health services and the criminal justice system.

FASD is likely to have become a more common cause of intellectual disability and behavioral disturbance but the history of significant alcohol exposure in utero if often missed. There is evidence that the hyperactivity is less responsive to psychotropic medication and may represent a different condition to conventional ADHD. However the majority of those affected are in the low normal IQ range.

There is so far very limited research in what is likely to be a relatively common disorder with significant costs to criminal justice, mental healthcare and social services. Epidemiological information from the UK is lacking and urgently needed.

Professionals who work with mentally disordered young people need to be more aware of FASD and its potential contribution to the problems and disabilities in their population.

Social workers, foster carers and adoptive parents need to be more aware of FASD and how it can contribute to the breakdown of social care.

There is currently no other review of FASD and the implications for criminal justice, secure mental health and social care for young people.

The rise in the diagnosis of attention deficit hyperactivity disorder (ADHD) and the use of stimulant medication such as Ritalin to treat it raises important questions about how childhood is conceptualised in contemporary western society today. By focusing on within‐child explanations for behaviour, the diagnosis of ADHD divorces a child from their context; real life experiences, including traumatic ones, are marginalised or excluded from clinical consideration. This paper1 explores how ADHD manages to occupy and hold on to such a dominant position despite the lack of evidence supporting its supposed medical origins, and explores what the ADHD diagnosis reveals about cultural expectations of childhood and power hierarchies in the UK and North America.

Adult ADHD is a neuro-developmental disorder. The current prevalence of ADHD in adults is around 1.9-4 per cent. The service for adults with ADHD based on NICE guideline recommendation. Hence, the author decides to audit the Adult ADHD case loads against the gold standard set by the NICE. The paper aims to discuss these issues.

The study was based on a retrospective analysis and collection of data from electronic patient records for a duration of five months between October 2011 and February 2012. The data findings were matched against the NICE standards. There were 15 standards identified. On top of that we used six service outcome questions to improve the Quality of the service provided.

As the service outcomes were set for 100 per cent, the performance fell short in few areas. The service managed to achieve roughly 80-95 per cent in areas such as medication monitoring, transition service and care plan with shared care guidelines for prescription in primary care. The service under performed in areas on non-pharmacological interventions such as cognitive-behavioural therapy (CBT). The service continues to provide a exceptional service for adults with intellectual disability and ADHD.

The research was limited by information and recall bias due to the retrospective nature of data analysis. There was also over representation of the numbers in co-morbid cases due to more than two diagnosis.

The paper outlines the regional outcome of the audit. However the findings have wider implications. For example the prevalence rate is more common in males than females. CBT is an important resource in the management of ADHD in adults. Priority and importance need to be given for providing a service for CBT in adults with ADHD.

The cost of sickness and non-employment due to ADHD is significantly high. Treating this complex group with medications and CBT improves the outcome and get them back in employment and reduce recidivism rates in offenders.

The author feels the adult ADHD service audit has huge service implications. Currently it is a controversial diagnosis significantly under-resourced. The outcome survey had highlighted the areas of need as a neurodevelopmental disorder.