The primary care companion for CNS disorders, 2012
To assess how frequently adolescents are clinically diagnosed with depression following hospitali... more To assess how frequently adolescents are clinically diagnosed with depression following hospitalization for traumatic fracture, with the assumption that a retrospective approach would yield lower rates of depression compared to those reported previously in prospective studies. We hypothesized that depression would be less common among adolescents whose injuries were primarily limited to fractures of the appendicular skeleton, vertebral column, and/or thoracic cage compared to those sustaining concomitant spinal cord and/or brain injuries and those suffering from facial/skull fractures. A patient population of 1,121 adolescents, aged 12 to 19 years, who were hospitalized overnight at the University of Virginia (UVA) Health System, Charlottesville, for fractures between 2000 and 2009, was generated using the health system's Clinical Data Repository. The number of these adolescents who received a new diagnosis of depression (per ICD-9 codes) at the UVA Health System within the firs...
Driving is a complex task that can be a significant challenge for individuals with attention-defi... more Driving is a complex task that can be a significant challenge for individuals with attention-deficit/hyperactivity disorder (ADHD). A slight lapse in attention or inhibition while driving (not uncommon in individuals with ADHD) can result in hazardous consequences for these individuals and their families. This is also an interesting clinical scenario for the treating physician, who is always trying to optimize the various treatment options for the patient. Despite such potentially perilous consequences for society, this subject only recently has received researchers' attention. This review paper highlights the psychological differences between drivers with and without ADHD and examines differences between these groups in various driving simulation models. Research updates involving pharmacologic and nonpharmacologic interventions are discussed at length. Although the long-term effects of such interventions may not be clearly defined, there is enough evidence to suggest the publi...
... study of 10 adults5 and, after completion of a 12 week trial, 9 of 12 pa-tients who received ... more ... study of 10 adults5 and, after completion of a 12 week trial, 9 of 12 pa-tients who received bupropion SR were rated ... and the Omaha Veterans Affairs Medical Center 4101 Woolworth Avenue Omaha, Nebraska 68105 fax 402/943-5543 ppadala@unmc.edu Vishal Madaan MD ...
With only two cases of hepatic injury reported among the more than 2 million patients treated wit... more With only two cases of hepatic injury reported among the more than 2 million patients treated with atomoxetine, severe hepatic damage with atomoxetine is rare. Both individuals who experienced elevations in hepatic enzymes recovered following discontinuation of atomoxetine. In one of these patients, elevated enzymes and jaundice recurred upon re-challenge, and again resolved with discontinuation. There are currently no recommendations for routine laboratory monitoring with atomoxetine treatment, but in the event signs or symptoms of hepatotoxicity develop (pruritis, dark urine, jaundice, upper right-quandrant abdominal tenderness, or unexplained "flu-like" symptoms), testing to determine liver enzyme levels should be conducted. Education of patients and families on the early warning signs of liver injury is recommended. A recent suspension of sale of Adderall XR® by Health Canada following U.S. post-marketing reports of sudden death has raised questions about the safety of this medication. The FDA's Adverse Event Reporting System database for the years 1999 through 2003 identified 12 cases of sudden death in pediatric patients who were being treated for ADHD with Adderall® or Adderall XR®. During this period an estimated 30 million prescriptions for these drugs were written. Five of the 12 deaths occurred in patients with underlying structural heart defects that increase the risk for sudden death, including abnormal arteries or valves, or abnormally thickened walls. In several other cases there were other risk factors, such as a family history of ventricular tachycardia, heat exhaustion, dehydration, recent rigorous exercise, fatty liver and type I diabetes mellitus. Since this data appeared to indicate that patients with underlying cardiac problems might be at an increased risk for sudden death, the labeling for Adderall XR® was changed in August 2004 to include a warning that these patients might be at particular risk, and should not ordinarily be treated with Adderall® products. The FDA's analysis, however, determined that the number of deaths reported was no Atomoxetine (Strattera™) and hepatic damage
Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition t... more Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition that affects significant numbers of children, adolescents and adults. Clinicians in a variety of practice settings (hospital, outpatient, residential, research) strive to diagnose, treat and monitor ADHD in an efficient and evidence-based manner. Tools that facilitate the gathering and interpretation of information from a variety of sources can effectively augment a diagnostic assessment, and can also be useful for longitudinal monitoring. Multiple assessment tools are available, with varying degrees of psychometric validity, clinical utility and overall feasibility (time and cost). This review provides an overview of several available ADHD rating scales and continuous performance tests, and offers a discussion of potential strengths and weaknesses of the instruments. While these tools do not in and of themselves make a diagnosis of ADHD, they can certainly assist in the diagnostic assess...
Handbook of Schizophrenia Spectrum Disorders, Volume II, 2011
Early onset schizophrenia (EOS) describes onset of the first episode of psychosis before age 18 y... more Early onset schizophrenia (EOS) describes onset of the first episode of psychosis before age 18 years. Such an earlier onset of symptoms is often associated with a severe and chronic course of the illness, a poorer prognosis and a potentially significant negative impact on recovery and rehabilitation. A recent emphasis on early intervention by utilizing the advances in neurobiological and
The primary care companion for CNS disorders, 2012
To assess how frequently adolescents are clinically diagnosed with depression following hospitali... more To assess how frequently adolescents are clinically diagnosed with depression following hospitalization for traumatic fracture, with the assumption that a retrospective approach would yield lower rates of depression compared to those reported previously in prospective studies. We hypothesized that depression would be less common among adolescents whose injuries were primarily limited to fractures of the appendicular skeleton, vertebral column, and/or thoracic cage compared to those sustaining concomitant spinal cord and/or brain injuries and those suffering from facial/skull fractures. A patient population of 1,121 adolescents, aged 12 to 19 years, who were hospitalized overnight at the University of Virginia (UVA) Health System, Charlottesville, for fractures between 2000 and 2009, was generated using the health system's Clinical Data Repository. The number of these adolescents who received a new diagnosis of depression (per ICD-9 codes) at the UVA Health System within the firs...
Driving is a complex task that can be a significant challenge for individuals with attention-defi... more Driving is a complex task that can be a significant challenge for individuals with attention-deficit/hyperactivity disorder (ADHD). A slight lapse in attention or inhibition while driving (not uncommon in individuals with ADHD) can result in hazardous consequences for these individuals and their families. This is also an interesting clinical scenario for the treating physician, who is always trying to optimize the various treatment options for the patient. Despite such potentially perilous consequences for society, this subject only recently has received researchers' attention. This review paper highlights the psychological differences between drivers with and without ADHD and examines differences between these groups in various driving simulation models. Research updates involving pharmacologic and nonpharmacologic interventions are discussed at length. Although the long-term effects of such interventions may not be clearly defined, there is enough evidence to suggest the publi...
... study of 10 adults5 and, after completion of a 12 week trial, 9 of 12 pa-tients who received ... more ... study of 10 adults5 and, after completion of a 12 week trial, 9 of 12 pa-tients who received bupropion SR were rated ... and the Omaha Veterans Affairs Medical Center 4101 Woolworth Avenue Omaha, Nebraska 68105 fax 402/943-5543 ppadala@unmc.edu Vishal Madaan MD ...
With only two cases of hepatic injury reported among the more than 2 million patients treated wit... more With only two cases of hepatic injury reported among the more than 2 million patients treated with atomoxetine, severe hepatic damage with atomoxetine is rare. Both individuals who experienced elevations in hepatic enzymes recovered following discontinuation of atomoxetine. In one of these patients, elevated enzymes and jaundice recurred upon re-challenge, and again resolved with discontinuation. There are currently no recommendations for routine laboratory monitoring with atomoxetine treatment, but in the event signs or symptoms of hepatotoxicity develop (pruritis, dark urine, jaundice, upper right-quandrant abdominal tenderness, or unexplained "flu-like" symptoms), testing to determine liver enzyme levels should be conducted. Education of patients and families on the early warning signs of liver injury is recommended. A recent suspension of sale of Adderall XR® by Health Canada following U.S. post-marketing reports of sudden death has raised questions about the safety of this medication. The FDA's Adverse Event Reporting System database for the years 1999 through 2003 identified 12 cases of sudden death in pediatric patients who were being treated for ADHD with Adderall® or Adderall XR®. During this period an estimated 30 million prescriptions for these drugs were written. Five of the 12 deaths occurred in patients with underlying structural heart defects that increase the risk for sudden death, including abnormal arteries or valves, or abnormally thickened walls. In several other cases there were other risk factors, such as a family history of ventricular tachycardia, heat exhaustion, dehydration, recent rigorous exercise, fatty liver and type I diabetes mellitus. Since this data appeared to indicate that patients with underlying cardiac problems might be at an increased risk for sudden death, the labeling for Adderall XR® was changed in August 2004 to include a warning that these patients might be at particular risk, and should not ordinarily be treated with Adderall® products. The FDA's analysis, however, determined that the number of deaths reported was no Atomoxetine (Strattera™) and hepatic damage
Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition t... more Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition that affects significant numbers of children, adolescents and adults. Clinicians in a variety of practice settings (hospital, outpatient, residential, research) strive to diagnose, treat and monitor ADHD in an efficient and evidence-based manner. Tools that facilitate the gathering and interpretation of information from a variety of sources can effectively augment a diagnostic assessment, and can also be useful for longitudinal monitoring. Multiple assessment tools are available, with varying degrees of psychometric validity, clinical utility and overall feasibility (time and cost). This review provides an overview of several available ADHD rating scales and continuous performance tests, and offers a discussion of potential strengths and weaknesses of the instruments. While these tools do not in and of themselves make a diagnosis of ADHD, they can certainly assist in the diagnostic assess...
Handbook of Schizophrenia Spectrum Disorders, Volume II, 2011
Early onset schizophrenia (EOS) describes onset of the first episode of psychosis before age 18 y... more Early onset schizophrenia (EOS) describes onset of the first episode of psychosis before age 18 years. Such an earlier onset of symptoms is often associated with a severe and chronic course of the illness, a poorer prognosis and a potentially significant negative impact on recovery and rehabilitation. A recent emphasis on early intervention by utilizing the advances in neurobiological and
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