Psychotropics in Paediatrics or Adolescents

Psychotropics in Paediatrics or Adolescents Introduction Psychotropic drugs are medications and chemical formulations that cross the blood brain barrier to act on the central nervous system to stimulate the change of mood and behaviour of an individual. Schatzberg and Nemeroff (2009) underscore that it is important to note that these medications are not curative but rather palliative, and although they may improve symptoms associated with various mental disorders, they do not cure the primary cause of the disorders. According to Perry (2007), psychotropic medications include antidepressants, antipsychotic or neuroleptics, attention deficit hyperactivity disorder (ADHD) drugs, and antimanic or anxiolytics among others. This paper aims at discussing the physiological implications of using psychotropic medications in paediatric and adolescent populations with a bias on neuroleptic/antipsychotic, anxiolytic/antianxiety and ADHD drugs. While there may be reservations regarding the use of psychotropic medication in children and the physiologic effect of these drugs on young people’s central nervous system development, leaving mental disorders untreated is not a viable option as evidently supported by medical literature. This is because untreated mental illness may cause paramount long-term morbidity and even irreversible deficits in socio-emotional and cognitive functioning. Regardless of ethical and legal reservations surrounding the use of psychotropic drugs among paediatric and adolescent patients, analyses of data on their use reveals fast changing trends pointing to increased use. According to Hsia and MacLennan (2009) there was a three-fold increase of the number of children/adolescents taking any psychotropic drug between 1987 and 1996. Adolescent visit to physicians significantly increased psychotropic prescriptions as evidenced by an increase to 8.3% of the prescriptions in 2001, up from 3.4% in 1994 (Hsia MacLennan, 2009). In 2001, psychotropic prescriptions made up 8.8% of all psychopharmacological prescriptions among patients aged between 6 and 17 years (Hsia MacLennan, 2009). In terms of gender, more male paediatrics and adolescents are on these medications compared to their female counterparts. Due to increased incidences of anxiety, depressive, manic, and other psychotropic disorders in paediatrics and adolescents, there has been an increased acceptance and need for use of neuroleptics, anxiolytics and antidepressant drugs in these patients. Neuroleptics and their implications on paediatrics/adolescent Neuroleptics, also known as major tranquilizers or antipsychotic drugs are used primarily to treat psychoses and symptoms. In paediatrics and adolescents, they are also indicated in the treatment of other non-psychotic psychiatric disorders. They are the drugs of first choice in treatment of autism and schizophrenia in children and adolescence. Kalyna and Virani (2007) explain that neuroleptics are used in treatment of paediatrics and adolescents with severely aggressive conduct disorders, Tourette’s disorder, and chronic motor or vocal tic disorder. Antipsychotic drugs are also used in the treatment of ADHD but their use has decreased due to increased use of stimulant medications which are more effective for this disorder. Examples of antipsychotic drugs include haloperidol, chlorpromazine, molindone and fluphenazine. Newer formulations include olanzepine, clozapine, quetiapine, risperidone and ziprasidone (Hamrin, McCarthy Tyson, 2010). The use of neuroleptics on paediatrics and adolescents has several implications. Side effects associated with long-term use of these medications in this population include akathesia, acute dystonic reactions, parkinsonian symptoms, tardive dyskinesia, anticholinergic symptoms and sedation. They also lower seizure threshold in susceptible subjects and drugs such as Chlorpromazine should not be used in such patients. Tardive dyskinesia is a grave concern and has been reported in about 1 to 20% of paediatrics and adolescents on long-term use of neuroleptics (Kalyna Virani, 2007). It may occur as early as 5 months after commencement of treatment or may delay to up to 3 years. Since paediatrics and adolescents have more dopamine receptors than adults, they are more sensitive to side effects affecting the central nervous system. Long-term use of neuroleptics should be avoided in this population but †¦.contends that low doses may be recommended in selected difficult cases. Other side effects associated with neuroleptics include weight gain, irregular menses and breast enlargement in adolescents. Doran (2013) documents that second-generation anti-psychotic (SGA’s) drugs can cause metabolic disturbances and weight gain in paediatrics and adolescents even during first-time treatment. For instance, in a trial of treatment of schizophrenia with olanzapine, 30% of the paediatric/adolescent subjects gained weight compared to 6% in adult subjects (Doran, 2013). Other SGAs such as risperidone, quetiapine and clozapine also posted similar results with the paediatric/adolescent subjects gaining between 0.9 to 16.2 kilograms (Doran, 2013). Withdrawal of neuroleptics or lowering of the dosage may lead to withdrawal emergent syndrome with resultant aggravation of psychotic symptoms. This has been reported in paediatrics and symptoms include ataxia, vomiting and nausea. In a study by Vitiello (2008) as high as 51% of the paediatric patients showed the withdrawal symptoms, usually occurring after few days to few weeks after drug withdrawal. Clozapine has been associated with deaths of two paediatric patients with the mechanism being linked to sudden cessation of treatment (Vitiello, 2008). Haloperidol has been demonstrated to interfere with the children and adolescent’s daily routine including social and school activities. Neuroleptics increase sedation, lethargy and somnolence in paediatrics and adolescents than in adults; for instance, this was demonstrated in 30% to 49% of paediatric patients being treated with Risperidone in contrast to 7% of adults taking the same drug for bipolar mania (Hamrin, McCarthy Tyson , 2010). Anxiolytics and their implications on paediatric/adolescents Anxiolytics are psychopharmacologic drugs used to treat anxiety disorders in paediatrics and adolescents. Other conditions for which they may used include sleep disorder, aggressive behaviours and psychosis. They include selective serotonin-reuptake inhibitors (SSRIs) benzodiazepines, tricyclic antidepressants (TCAs) and busipirone. Anxiety disorders are greatly predominant in adolescence; between 6 and 20% of children have a type of anxiety disorder (Kalyna Virani, 2007). Doran (2013) documents that use of benzodiazepines in paediatrics and adolescents has tripled over the last 10 years. Anxiolytics are recommended to be used only after an aftermath of an event e.g. traumatic event and should be used for short periods (not more than two weeks) to avoid the risk of developing addiction or diminished efficacy. A recent review shows that SSRIs have become the preferred pharmacological intervention for paediatric anxiety disorders. They have very potent anxiolytic effects and their tolerance among paediatrics and adolescents is high. However, this class of psychotropic drugs has been associated with increased suicidal ideation. A well-documented controversy in paediatric and adolescent psychopharmacology occurred in 2003 when FDA issued public alert warning prescribers of increased ideation and attempts of suicide among patients below 18 years on anxiolytics (Vitiello, 2008). This contributed to a substantial drop in rates of diagnosis and prescription of these drugs among paediatric and adolescent population. Later, after a meta-analysis of numerous clinical trials of nine drugs in this class, it was demonstrated that there was only a marginal increase (0.7%) increase in the suicidal ideation with no actual increase in completed suicides (Schatzberg Nemeroff, 2009). However, this has led to adoption of a multidisciplinary approach towards management of paediatric and adolescent depression to encompass both pharmacological and non-pharmacological interventions. Cardiovascular adverse effects are often reported with most anti-anxiety medications because these drugs act on the autonomic system. Such side effects include increase in heart rate and changes in blood pressure. Although these side effects are generally not of major clinical significance while taking psychotropic medications, tricyclic antidepressants (TCAs) such as desipramine have been inconclusively linked to sudden death among paediatric patients (Kalyna Virani, 2007). Therefore, it is imperative for the prescribing physicians to take a comprehensive patient history, as well as monitor the electrocardiograms, heart rate and blood pressure changes of the paediatric and adolescent patients before and during treatment with psychotropic agents such as TCAs. Lamotrigine manifestly increases the risk for severe skin reactions and hives in paediatrics and adolescents (Dulcan, 2010). Another critical consideration in anxiolytic use of drugs in these subjects is drug interactions. Drugs that inhibit the cytochrome P450 enzyme system could have adverse effects on the subjects if concomitantly administered with anxiolytics (Perry, 2007). Antifungal drugs and some antibiotics such as erythromycin when co-administered with SSRIs such as fluoxetine can cause cardiac arrhythmias (Perry, 2007). Others such as imipramine and Lamotrigine can cause toxic delirium (Hamrin, McCarthy Tyson, 2010). The prescribers must document all medications that may have drug-drug interactions with psychotropics as well as those that have direct or indirect effect on the cytochrome P450 enzyme system. ADHD drugs and their implications on paediatrics/adolescents Stimulants used in management of ADHD are some of the most used psychotropic drugs among paediatrics and adolescents. However, trepidation persists due to concerns of the adverse effects of these drugs on the growth rate in paediatrics. Use of stimulant psychotropic drugs has been associated with stunted growth rates. The Multimodal Therapy of ADHD study demonstrated that stimulant psychotropic drugs, especially in high doses, reduce growth velocity and weight (Gelder et. al, 2009). This is due to appetite loss, a common adverse effect associated with these stimulant drugs. However, in most cases normal growth seems to rebound once the psychostimulant agents are withdrawn with no significant suppression of ultimate height attained. Nevertheless, some studies have revealed that pyschostimulants continue to suppress growth in early and late adolescence. Rosenberg and Gershon (2002) explain that pyschostimulants such as methylphenidate may permanently cause stunted growth by affecting e piphyseal closing of long bones if used between ages 17 and 21 years. However, Cheng and Myers (2010) outline that suppression of growth could be because of the underlying mental disorder, for instance, ADHD rather than the treatment. One disconcerting physiological implication of ADHD drugs especially in paediatrics being treated for hyperactivity or outbursts is the aggravation of the condition with the medication, a phenomenon referred to as paradoxical response. Doran (2013) explains that in a small number of paediatric/adolescent patients may severely increase nervousness and agitation instead of reducing it (disinhibition). These subjects may become giddier, act sillier or even manic. Similarly, some younger patients may be more depressed after being put on antidepressants. Studies have shown paediatrics and adolescents getting more moody and agitated after receiving mood treatment psychotropic drugs in ADHD treatment (Kalyna Virani, 2007). Others on stimulants may become more hyperactive and fail even to respond to sleep-inducing drugs. Research by Hamrin, McCarthy and Tyson (2010) shows that if a paediatric or adolescent patient shows paradoxical effect to one class of psychotropic drugs, there is a 50% o f similar reaction if he or she is given another drug of the same class. Paediatrics and adolescents have a lower albumin binding capacity and reduced adipose compartment, leading to a higher percentage of unbound compound than adults. Similarly, their drug biotransformation rates are higher, and this could reduce the half-life of the drugs relatively increasing the risk for toxic metabolite levels. This may contribute to physiological rebound effect where the paediatric and adolescent patients present with exacerbation of symptoms than original symptomatology (Dulcan, 2010). This often occurs when drug plasma levels decrease due to increased hepatic elimination and subsequent renal excretion. The subjects show symptoms such as hyperactivity, irritability, insomnia, over talkativeness, excitability and non-compliance (Dulcan, 2010). Schatzberg and Nemeroff (2009) explain that this can be remedied by adding a small afternoon dose or using slow-release preparations. The physician may also opt to use short- and long acting medications. Other implications of ADHD drugs on paediatrics and adolescents are the drug’s adverse effects. In a meta-analysis review, 32% of the doctors were concerned with decreased appetite and loss of weight association with these drugs. Half of them raised concerns about disturbed sleep while 22% were apprehensive of the increased anxiety. Other physicians indicated that they were concerned about possible diversion of ADHD drugs and felt burdened by prescribing these controlled drugs for paediatrics and adolescents. There is a high potential for abuse of controlled stimulant drugs used in ADHD treatment which can be achieved by crushing and snorting the medication. However, this abuse potential has been addressed through extended release formulations and introduction of skin patches which are less susceptible to abuse. Conclusion Psychopharmacological treatment in paediatrics and adolescents is an area of on-going ethical discussion, as these subjects affected by mental disorders are a vulnerable class of patients. The use of psychotropic drugs in children below 8 years is under-researched; this is because most of these drugs are developed and researched in adults. In addition, it could also be due to existing ethical and legal considerations that hamper access of research to such studies. Paediatrics and adolescents with psychotic disorders will classically be put on psychotropic drugs while those with other disorders will be put on non-pharmacological treatment. Sometimes, both approaches may be used simultaneously. Logically, the benefits of pharmacological intervention must outweigh potential risks associated with use of these drugs in these young people. An important consideration is the proof of the efficacy and safety of the drug for the age of the patient and the specific disorder. Psychopharmacothera py in paediatrics and adolescents requires a holistic, multidisciplinary approach. Pharmacovigilance in use of psychotropic agents among these subjects as well as their long-term efficacy and adverse effects are indispensable. It is evident that paediatric and adolescent patients are, to say the least, more vulnerable to adverse effects of psychotropics than adults are. With the increasing adoption of psychopharmacological interventions in treatment of paediatrics and adolescents with mental disorders, novel research is vital to come up with clear evidence-based recommendations on use psychotropics in these subjects. References Cheng, K. Myers, K. M. (2010). Child and Adolescent Psychiatry: The Essentials. Philadelphia: Lippincott Williams Wilkins. Dulcan, M. K. (2010). Dulcan’s Textbook of Child and Psychiatry. Arlington, VA: American Psychiatric Publishing, Inc. Doran, C. M. (2013). Prescribing Mental Health Medication: the Practitioner’s Guide. Oxon: Routledge Publishers, Inc. Hamrin, V., McCarthy, E. M. Tyson, V. (2010). Paediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory. Journal of Child and Adolescent Psychiatric Nursing, 23, pp. 233-242. Hsia, Y. MacLennan, K. (2009). Rise in psychotropic drug prescribing in children and adolescents during 1992-2001: A population-based study in the UK: European Journal of Epidemiology, 24(4), pp. 211-216. Rosenberg, D. Gershon, S. (2002). Pharmacotherapy for child and psychiatric disorders. New York: CRC Press. Gelder, M., Andreasen, N., Lopez-Ibor, J. Geddes, J. (2009). New Oxford textbook of Psychiatry. Oxford: Oxford University Press. Kalyna, Z. B. Virani, A. S. (2007). Clinical Handbook of Psychotropic Drugs for Children and Adolescents. Boston, MA: Hogrefe Publishing GmbH. Perry, P. J. (2007). Psychotropic Drug Handbook. Philadelphia: Lippincott Williams Wilkins. Schatzberg, A. F. Nemeroff, C. B. (2009). Textbook of Psychopharmacology. Arlington, VA: American Psychiatric Publishing, Inc. Vitiello, B. (2008). An international perspective on paediatric psychopharmacology. International Review of Psychiatry, 20, pp. 121-126.

To What Degree Might Different Languages Shape In Their Speakers Differ

To What Degree Might Different Languages Shape In Their Speakers Different Concepts Of Themselves And The World? What Are The Implications Of Such Differences For Knowledge?   Ã‚  Ã‚  Ã‚  Ã‚  The difference in languages can cause different perceptions of various cultures leading to distinctions or possible clashes. When I lived in France I faced some of the problems a language barrier can cause. The most common and at the same time most irritating problem of language is the inability to translate word for word as some words just don’t have a direct translation into another language. These are normally colloquialisms for example â€Å"up the apples and pears† does not translate into â€Å"monter les pommes et les poires.† This would cause people to look at you in a very strange manner wondering what on earth you were talking about and it’s not only verbal language which creates different perceptions of people. Body language, such as hand movements and voice intonation can determine or change someone’s perception of a culture. The following paragraphs will illustrate the way language can be misconstrued.   Ã‚  Ã‚  Ã‚  Ã‚  The first point I would like to illustrate is the way body language can have different effects on people. For example, in England the use of hands when you are speaking is quite rare, the odd movement of the hand may be seen but the most common use of hand signals or motions is when someone is making an insult. I will use the Italians as an example of at times exaggerated and frequent use of hands. The Italians often use their hands as a way of secondary communication. As they speak they dramatise their conversations which can be mistakenly perceived by some people as confrontation when in fact they are having a simple conversation. This is where the lack of knowledge of a culture can cause a misunderstanding. Another example of communication which can cause raised eyebrows is the way the French acknowledge one another is doing something called the â€Å"bises.† This is where they give a kiss on each cheek. (Depending on the region this could be two, three even four kisses.) It is considered rude to just verbally greet someone so the â€Å"bises† is the norm for them. However when they are out of their country they could receive strange looks because people don’t understand their reasons and therefore could be perceived that French m... ...age on the planet, or to speak the universal language of Esperanto created in 1887 by Dr. Zamenhof which, if possible would bring an end to our cultural differences – how boring!   Ã‚  Ã‚  Ã‚  Ã‚  In conclusion, each country has the knowledge and understanding of its own culture and will therefore have a different perception of foreign cultures due to the possible lack of understanding. The argument â€Å"someone can only fully understand another culture if they speak their language† is I believe true. Language can not always be translated directly so the only way to fully understand a concept of a culture is to speak that language learning the subtle nuances. Ignorance, I believe causes misunderstanding, take for instance when Brits go on holiday unable to comprehend another language yet believing that everyone should understand them sometimes coming across as arrogant and rude. Understanding a culture needs patience, understanding and open mindedness. Respecting one-another’s differences can allows us to live together in harmony irrespective of our cultural upbringing and beliefs. I believe differences alleviate boredom as life would be mund ane if we were all the same.

A Christmas Carol as an Allegory

A Christmas Carol as an allegory is a simple concept to grasp knowing the definition of allegory. An allegory is a story, poem, or picture that can be interpreted to reveal a hidden meaning, typically a moral or political one. The way Dickens was able to slip subtle messages into various character's persona is amazing. Using the mankinds children Ignorance and Want, the cheerful Fred, the infamous Scrooge, and many other characters, Dickens is able to create an allegorical masterpiece that delivers his message in a holiday-based setting— the perfect time to influence the masses.Ignorance and Want are, as referenced above, the metaphorical children of mankind. Dickens brings two traits that man will inherit to life; the affluent's incognizance and the poor's want. They are what has filtered down through generations, unchanged due to the negligence of the wealthy. The children's condition shocks Scrooge, he actually asks the Ghost of Christmas Present if the children happen to b e his to which the spirit replies, â€Å"‘They are Man's,' †¦ ‘And they cling to me, appealing from their fathers. This boy is Ignorance. This girl is Want.Beware them both, and all of their degree, but most of all beware this boy, for on his brow I see that written which is Doom, unless the writing be erased. Deny it!' †¦ ‘Slander those who tell it ye! Admit it for your factious purposes, and make it worse! And bide the end!'† This quote is an obvious depiction of a simplistic yet meanful message, the wealthy must change their ways for societies betterment.Not an upperclassmen, Fred is a representation of the middle class man who is not ignorant to the troubles of the poor and embraces the Christmas spirit. He is very similar to another – barely mentioned – character, Scrooge's old boss Fezziwig. The bring joy to their employees with a simple gesture, an invitation to a Christmas party. This shows that despite Fred is not a rich man he is still able to bring joy to his workers, dashing the concept that money brings happiness.Dickens uses Fred as a foil to Scrooge to display differences through both attitude and action. Fred's presence lightens the atmospere during the arguement between them and the fact that the ‘Man of Christmas Cheer' tops Scrooge in the squabble furthers his point. Through a well written novella Dickens delivers his message, that the wealthy must change, time and time again.Moving on to Mr. Ba-humbug himself, Scrooge is pictured as a parsimonious man even after he's changed. Scrooge symbolizes the wealthy, aristocratic society members who are ignorant to the poors suffering. Dickens goes far as humanly possibly to show how unforgiving Scrooge is towards the lower class, one quote says that Scrooge is so cold that, â€Å"No warmth could warm his soul.†Through a wordy tongue-lashing he gave to the men who asked for a donation for the poor Scrooge further shows his uncaring attitud e. Through his tirade he shows how truly ignorant and neglectful he, and the class he represents, is towards the poverty-stricken. Using such a detestable character gives Dickens the ability to call for a change of moral in the wealthy, thus putting a cherry on top of the allegorical sundae.Allegories have been written, read, forgotten, and remembered throughout the course of history but none such like A Christmas Carol. A strong moral message, simplistic with a deep impact, this novella embodies the meaning of allegory. By using well constructed characters and inlaid messages Dickens has thoroughly, and effectively, delivered a message to the masses.

CHANGING WOMANS ROLE DURING COLD WAR AND NOW essays

CHANGING WOMAN'S ROLE DURING COLD WAR AND NOW essays Women are often defined by their ability to successfully juggle a career and family life. This fact is evidenced by the film Mildred Pierce. Though women's roles have changed significantly over the last several decades, certain facts related to women's roles remain the same. This includes society's vision of woman as a duplicitous creature; one that should be able to manage professional and personal aspirations with equal success and finesse. She is measured by society based on her ability to manage each of these roles successfully, despite trends in society that do not support a woman's role in neither the home nor the workplace to any great degree. Women have faced an upward battle defining their roles over the last several decades. These ideas and more related to the changing roles of women over the last 40 years are analyzed and described in greater In the movie Mildred Pierce Joan Crawford plays a woman who is divorced and ends up in a twisted tangle when her daughter becomes a miscreant Mildred's newfound success in the business world represents the beginning force in a long drive for women aspiring to become equal and even surpass the status of men in the working world, becoming creatures whose roles are defined by their success in business as well as their role as caretaker. Mildred fights against the stereotypical role woman has taken on in society, by establishing herself as an entrepreneur, taking a new lover, buying a car and creating a successful life for herself. This trend toward women aspiring to beat down traditional role stereotypes to become independent and successful yet still maintain a handle on their role as mother has continued for many years. Though women in many instances are still not represented entirely as equals in the business world, this movie portrayed the existing impetus and a lot of the momentum that lie behind much of the women's movements t...

Shelley essays

Shelley essays The Romantic Period, which lasted about 45 years, gave birth to a new genre of literature, political thought, and it began a new era of history. Many authors contributed to the new ideals that characterize The Romantic Period. One author in particular was Percy Shelley who had written during The Romantic Period. The romantic ideals and characteristics can be found in the writings of Shelley. One of the ideologies of The Romantic Period was the creativity of the imagination, and Shelleys writings are littered with examples of this ideology. One example of this is in Shelleys poem To Sidmouth and Castlereagh, in this poem Shelley refers to these men as Two vipers tangled into one (20). Through this description Shelley indicates what he thinks of these two men by attributing non-human characteristics to them, and thus gives an example of the use of Shelleys imagination. Another example of Shelley giving humans non-human characteristics is in the poem Ode to the West Wind in which Shelley gives himself these characteristics as What if my leaves are falling like its own! (58) Also in the poem The flower that smiles today, Shelley gives a flower positive human characteristic, The flower that smiles today. (1) Even in the poem O World, O Life, O Time, Shelley imagines that he must deal with the challenges that each brings to him, O World, O Life, O Time, On whose last ste ps I climb. (1-2) It can be seen that Shelleys imagination provided him with a strong basis for his writings. Another characteristic of The Romantic Period that is seen in Shelleys writings is the theme of the supernatural. The mention of gods, death, or characters of myth are present throughout Shelleys works. An example of the supernatural in Shelleys poems is in the poem Alastor ...

Define the major flora of the different regions of the human body and Essay

Define the major flora of the different regions of the human body and discuss the methods employed in preventing both exogenous and endogenous wound contamination - Essay Example The mutualistic tendencies these microorganisms exhibit aid in the protection of the individual’s immune system, respiratory system, and even gut (Price & Frey 2003, p. 67). This is especially when it comes to fighting off pathogens. However, they can also cause diseases when not properly monitored. Exogenous and endogenous infections occur as a result of the presence of these microorganisms. Exogenous infections occur when pathogens enter the body through portals such as the respiratory, intestinal, and even reproductive areas. Endogenous infections often occur as a result of the patient’s distorted resistance (immune). Some of the methods implemented to deal with exogenous infections include; sterilization, cleaning, and disinfection (Gruendemann & Mangum 2001, p. 43). In doing some of these operations, it is easier to reduce the manner in which an individual is exposed to a harmful external environment. A technique used to deal with endogenous infections includes; skin preparation, where the patient undergoes thorough screening to determine whether the skin may act as a contaminant or not. Antibiotic prophylaxis is also another method where the surroundings of the patient are treated to reduce or eliminate contamination (Gloster 2010, p.

Porter Novelli or Southern Company Case Study Example | Topics and Well Written Essays - 1250 words

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