ObjectiveAlthough adult attention deficit hyperactivity disorder (ADHD) often persists beyond childhood, daily clinical practices and transition of adult patients with ADHD into adult mental health services in Turkey are not well studied. The aim of this study was to provide data about the presentation of adult patients with ADHD and evaluate the treatment strategies of Turkish adult psychiatrists based on their personal clinical experience in different hospital settings.MethodsA cross-sectional online survey to be filled out by Turkish adult psychiatrists was designed and administered in May 2014. The survey focused on the treatment environment, patterns of patient applications and transition, treatment strategies, and medication management for adults with ADHD.ResultsSignificant differences were observed in the number of adult patients with ADHD in follow up, and a significant positive correlation was found between number of adult patients with ADHD in follow up and the clinician’s opinion about their level of self-competence to treat adult ADHD. A significant portion of adult psychiatrists have not received any information about their adult ADHD patients’ treatment during childhood. The most preferred medical treatment was stimulants and the majority of the participants always preferred psychoeducation in addition to medication treatment. A majority of participants did not define themselves competent enough to treat and follow up adult patients with ADHD.ConclusionThe findings of this study indicate the need to increase the knowledge, skills, and awareness of adult psychiatrists about adult ADHD. In addition, a more collaborative working relationship between child and adolescent psychiatrists and adult psychiatrists with a definite transition policy is required in order to help patients with ADHD more effectively.
Objective: It has been proposed that anything does not kill you make you stronger. Although it might be true in adult cases, children whose psychological life begin in the parental mind and shaped by the experiences during the early period of life are not as strong as adult against adverse effects of stressful events. Internalization of objects and emerging of internally working models, concept of normality and abnormality that will be the main ground for the understanding of the world in later life are emerged during childhood. That is why anything does not kill a child will shape its mind that might have everlasting effects on child. The clinical characteristics and pharmacological treatment process of a 10-yearold boy with Autism Spectrum Disorder who had drug refractory self-injurious behaviour Hasan Cem Aykutlu and Işık GörkerDepartment of Child and Adolescent Psychiatry, Trakya University School of Medicine, Edirne, Turkey E-mail address: hasancemay@hotmail.com ABSTRACT Objective: Irritability is the most common co-occurring symptom and common target of pharmacotherapy in children with Autism Spectrum Disorders (ASD) [1][2][3]. FDA-approved agents risperidone and aripiprazole are commonly used in irritability and became the firstline treatment, but the growing evidence has shown that a group of children with ASD comorbid, especially with intellectual disability, do not respond to the treatment [1,3]. In a recent research, drug refractory behaviours in children with ASD defined as aggression, selfinjury, and tantrums requiring medication adjustment despite trials of risperidone and aripiprazole or three or more psychotropic drugs targeting irritability [1]. In this presentation, it is aimed to review current literature with the case report of a child with ASD who had drug refractory self-injurious behaviour. Case presentation: Ten-year-old boy, who diagnosed with ASD and attention-deficit/hyperactivity disorder (ADHD) and intellectual disability, has been followed in our outpatient clinic since he was 3 years old. He had been prescribed risperidone up to 2 mg/day for irritability and hyperactivity between 3 and 9 years old, and had responded well to the treatment. At age 10, his family described the increase in irritability, aggression, tantrums, and severe self-injurious behaviour with his ongoing treatment. His Clinic Global Impression (CGI)-Severity score was 7/7, Aberrant Behaviour Checklist (ABC)-Irritability score was 41/45 and ABC-Hyperactivity score was 40/48. Neurological and medical comorbidities were not detected in the examination. There was limited or no response to the treatment with various trials of risperidone, aripiprazole, haloperidol, zuclopenthixol, benzodiazepines, methylphenidate, atomoxetine, valproate, and PSYCHIATRY AND CLINICAL PSYCHOPHARMACOLOGY, 2018 VOL. 28, NO. S1, 297-391 https://doi.org/10.1080/24750573.2018 naltrexone. After the combined treatment of risperidone 2 mg/day with clonidine 0.3 mg/day, well and sustainable treatment response of irritability and self-in...
Melatonin is an indoleamine often used in children and adolescents. Melatonin is considered to be an effective clinical management for dyssomnias, sleep disorders present in children with attention-deficit hyperactivity, autism spectrum disorders, developmental delays. Quickacting capsules, controlled-release (CR) capsules, sublingual tablets and liquid forms are available. Melatonin is generally very well-tolerated in children and adolescents. The pharmacology, therapeutic applications, and side effects of melatonin are discussed. Although stimulants have been used most frequently in ADHD treatment their long term effects did not investigate well. Methylphenidate which is the most frequently prescribed stimulant's long term side effects on growth-development, cardiovascular, psychiatric and neurological systems are very important 2 . Stimulant diversion or misuse in long term has growing up in recent years and lead important consequences on community health 3 . Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) consortium was established in 2012 and experts on ADHD, drug safety, neuropsychopharmacology and cardiology developed a programme which investigates the long term possible side effects of stimulants 2 . In this presentation, long term side effects of stimulants (methylphenidate) will be reviewed through the perspective of ADDUCE work group study results.
ÖZETPerinatal depresyon, akut ve uzun süreli sonuçları sadece anneyi değil, bebeği-ni ve aralarındaki ilişkiyi de etkileyen ama yeterince tanınıp tedaviye yönlendi-rilemeyen bir psikiyatrik rahatsızlıktır. Hem gebelik hem de postpartum dö-nem kişilerarası ilişkileri de etkileyen önemli fiziksel ve duygusal değişimlerin yaşandığı süreçlerdir. Yetersiz sosyal destek ve artmış sosyal çatışma gibi kişile-rarası risk etkenleri bu dönemde kadının ruhsal ve fiziksel sağlığı üzerine ciddi etkiler yapabilir. Çalışmalar bu dönemde kadınların psikolojik ve sosyal girişimleri farmakoterapiye tercih ettiklerini göstermektedir. Kişilerarası psikoterapi, kısa süreli, özellikle kişilerarası sorunlara odaklanan, depresif belirtilerin azalmasını ve kişilerarası işlevselliğin düzelmesini hedefleyen bir tedavi yaklaşımıdır. Gebelik ve doğum sürecinde ortaya çıkan sorunlar kişilerarası terapinin ele aldığı dört temel sorun alanı ile çok uyumlu olduğu için terapist hastanın bu çatışmalarını çözmek için kişilerarası psikoterapiyi rahatlıkla kullanabilir. Anahtar Sözcükler: Perinatal depresyon, kişilerarası psikoterapi, sosyal destek ABSTRACTPerinatal depression is a psychiatric disorder that is not sufficiently diagnosed and directed to treatment. Its acute and chronic outcomes influence not only the mother but also the infant and the relationship between them. Both pregnancy and the postpartum periods are the times of significant physiological and emotional changes which also influence interpersonal relationships. Interpersonal risk factors like insufficient social support and increased social conflict can have an important impact on the women's mental and physiological health during this period. Studies have shown that women prefer psychological and social management over drugs during this period. Interpersonal psychotherapy is a time-limited treatment approach, especially
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