Primary care clinic in office practice 34 (2007) ppt

[...]... dextroamphetamines (DEX), mixed amphetamine salts (levoamphetamine and dextroamphetamine) (AMP) and pemoline are the stimulants commonly used in the treatment of adult ADHD [89] They act by blocking the reuptake of dopamine and norepinephrine, resulting in their accumulation in the presynaptic cleft Amphetamines also increase these neurotransmitter levels in the presynaptic cleft by direct release of dopamine... amphetamine and methamphetamine Birth Defects Res B Dev Reprod Toxicol 2005;74(6):471–584 [126] Briggs GG, Freman RK, Yaffe SJ Drugs in pregnancy and lactation, 6th edition Baltimore: Lippincott Williams & Wilkins p 66–71, 909–10 Prim Care Clin Office Pract 34 (2007) 475–504 Recent Advances in the Understanding and Treatment of Anxiety Disorders Steven L Shearer, PhDa,b,* a Residency Training Program in. .. including conduct and disciplinary actions, to determine if symptoms (eg, losing homework, difficulty staying in one’s seat, excessive talking, difficulty playing quietly) of ADHD were present in childhood, and to discern the functional impact of the symptoms on performance [1,65] When possible, collateral information should be obtained; this may be done by way of reviewing school records or seeking input... Blood pressure Pregnancy risk: category Ca Contraindicated in lactation Intermediate-acting: (Ritalin SR, Methylin ER, Metadate ER) 3–8 h 20–80 mg/day Insomnia Loss of appetite Weight loss Headache Nervousness Increase in pulse rate and blood pressure Long-acting: (Metadate CD, Ritalin LA) Concerta Daytrana (patch) Dextroamphetamine (DEX) Short-acting (Dexedrine) 8–12 h 10–80 mg/day 10–12 h 10–12 h 18–72... lack of insight into and remorse regarding the behaviors seen in antisocial personality disorder can assist in differentiating the two disorders [1,85] (Table 2) Treatment The mainstay of adult ADHD treatment includes pharmacological interventions, behavioral interventions, or a combination of both, with the goals of symptom remission and return to full social functioning Studies in children indicate... screening result should prompt further questioning informed by the DSM-IV-TR criteria, a review of recent stressors, screening for affective disorders and substance abuse, and inquiry about the perceived danger in panic There are many other instruments for assessing panic disorder and agoraphobia [18], but most are too time consuming or redundant for routine use in primary care Assessment must include... anxiety disorders in primary care settings range from * Department of Family Medicine, Franklin Square Hospital Center, 9101 Franklin Square Drive, Suite 205, Baltimore, MD 21237 E-mail address: steve.shearer@medstar.net 0095-4543/07/$ - see front matter Ó 2007 Elsevier Inc All rights reserved doi:10.1016/j.pop.2007.05.002 primarycare.theclinics.com 476 SHEARER 14% to 30% [7] Most people suffering from anxiety... marked autonomic arousal (eg, tachycardia, palpitations, sweating, trembling, shortness of breath, chest pain, dizziness) that are accompanied by catastrophic thinking (eg, fear of fainting, going crazy, losing control, dying) and are not directly caused by a substance or medical condition Episodic, acute panic is the defining feature, but the ongoing impact of panic disorder is more a function of worry... explanation for under-diagnosis of adult ADHD is primary care physicians’ lack of knowledge of ADHD presentation in adults Rates of adult ADHD identification are significantly higher among psychiatric settings as compared with primary care settings (52% versus 27%), and ADHD is recognized at younger ages in primary care settings [2] Education and training may be necessary to overcome this discrepancy... functioning (when possible), and assessing current symptoms, providers will be able to identify these patients and provide treatment, including facilitating interventions to minimize patients’ functional impairment (eg, psychological intervention, vocational counseling) References [1] Faraone SV, Spencer TJ, Montano CB, et al Attention-deficit/hyperactivity disorder in adults: a survey of current practice in . Sloan Manning, MD 0095-4543/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.pop.2007.06.002 primarycare.theclinics.com Prim Care Clin Office Pract 34 (2007) xi–xii The. Moss). 0095-4543/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.pop.2007.05.005 primarycare.theclinics.com Prim Care Clin Office Pract 34 (2007) 445–473 (ie, ADHD symptoms among. medications with meals, lowering the dose, changing the timing of administration to earlier in the day, or using long-acting prepara- tions [89]. Stimulants are contraindicated mainly in patients who have