Munn Hammer (warpolish6)
What prescription for psychostimulants in children? The Attention Deficit and Hyperactivity Disorder (ADHD) is a frequent disorder in children and adolescents. The diagnosis is clinical with the input of several informants (child, family, teachers…). ADHD is a risk factor for academic difficulties, school dropout, social isolation, injury, oppositional behaviour. In school-age children and adolescents having moderate to high or persistent impairment despite psycho-educational support and environmental modification, the first-line treatment is methylphenidate. Group or individual cognitive behavioural therapy for parents and/or children and adolescents is recommended for co-occurring disorders and persistent impairment. In France, the initiation of methylphenidate requires an annual hospital prescription by a paediatrician or psychiatrist, and a regular medical supervision (weight, heart rate, blood pressure…). At least once a year, the indication of methyphenidate needs to be re-evaluated and confirmed at the hospital. In case of lack of efficiency and/or poor tolerance, therapeutic alternatives including non-psychostimulants should be considered.Review of the prescription of antipsychotics in children. In France, as in the rest of the world, prescribing of antipsychotic drugs increases in children and adolescentsIndeed, antipsychotics are frequently prescribed in children and adolescents for both psychotic and non-psychotic disorders, with 36 to 93%o fprescriptionsbeingoff-label in this population. In addition, a high number of adverse events have been reported in the literature under antipsychotic treatment. The consequences of these adverse events are still poorly documented. In France, a 12-months national prospective study (ETAPE) observed a high incidence rate, severity and persistence of adverse events during first-time antipsychotic treatment in pediatric patients. Therefore, a careful and continuous clinical and biological monitoring all over the treatment period is required to adapt treatment decisions based on benefice-risk-analysis.When should we use antidepressant medications in children? Antidepressant medication may not be considered as a first-line treatment in children; psychotherapeutic treatments should always be preferentially used. At this age, the efficacy of SSRI is regarded as low to moderate for depression, but moderate to high for Obsessive Compulsive Disorder (OCD) and anxiety disorders. When an antidepressant medication is prescribed, a SSRI should always be used first. In particular, fluoxetine is the most studied SSRI and the only medication who received approval by the French regulatory authority. Sertraline and fluvoxamine which have been approved for OCD should preferentially be used for that purpose. During the first 4 weeks, clinicians should actively monitor the onset of side effects, especially mood swings and suicidal behavior. The onset or increase of suicidal thoughts during SSRI treatment would concern about 1 out of 100 young patients treated. This risk is maximal during the first four weeks following the introduction of the SSRI and should progressively decrease after one month. When used in children, antidepressant medication can only be used in association with psychotherapeutic treatments and psychosocial interventions targeting the maintaining factors perpetuating the cycle of affective symptoms.Does the written press give a fair account of a complex medical question "The Vincent Lambert Case"? We have studid press articles referring to Mr. Vincent Lambert's situation from 2013 to 2017. Analysis using a reading grid (including 7 questions) of press articles from four French daily newspapers (Libération, Le Monde, Le Figaro and La Croix) and a specialized medical news site (Agence de presse médicale) so that they can build their own opinion. selleck products 341 articles were analyzed (61 articles from Libération, 65 articles from Le Monde, 86 articles from Le Figaro, 82 articl
