Podcasts about Methylphenidate

On this episode of the Top 200 drugs podcast from Real Life Pharmacology, I cover medications 131-135 which include enoxaparin, methylphenidate, rosuvastatin, denosumab, and dabigatran. Enoxaparin is an injectable anticoagulant that can cause heparin-induced thrombocytopenia. Methylphenidate is a stimulant medication that can be used to treat ADHD. Cardiovascular adverse effects are possible. Rosuvastatin inhibits HMG-CoA Reductase which helps lower LDL in the management of hypercholesterolemia. Denosumab is a monoclonal antibody that is indicated for osteoporosis and may cause hypocalcemia. Dabigatran was one of the first direct oral anticoagulants to be produced. It is dosed twice daily and has warnings about use in patients over the age of 75.

Send Me a Message! In this episode of The Dysregulated Podcast, I reflect on a successful two weeks of annual leave. For the first time in years, my car, room, and even the house is all clean—and have stayed that way for over a week! It might sound silly, but those with ADHD will understand this all too well. Not only that, but I also laminated a heap of podcast posters (mindfulness exercise) and put them all around Newcastle! I even looked after our family cat Mabel this week, and everything around me is in order. Unbelievable! I do thank my medication Vyvanse, along with my decision to create a vision for the two weeks, build some structure and routine into my days, as helping me navigate away from the blockages ADHD can cause.But ADHD remains a cruel disorder, as I reflect on a friend who just lost their job due to unmanaged ADHD challenges. This stark contrast reminds me how vital treatment and support are. Tune in for my raw, genuine and very real account of what life is like living with ADHD.

In this episode, we explore the long-term effects of methylphenidate on sleep in children and adolescents with ADHD. Can stimulant medication actually improve sleep in ADHD patients? We dive into surprising research findings that challenge common assumptions about ADHD treatment and sleep disturbances. Faculty: David Rosenberg, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: CAP Smart Takes Vol. 20 Long-Term Effects of Methylphenidate on Sleep in Children and Adolescents With ADHD

Text Dr. Lenz any feedback or questions Managing POTS: Insights and Treatments with Dr. Jeffrey BorisIn this episode, Dr. Jeffrey Boris, a pediatric cardiologist, delves into treatments for POTS, including specific medications and non-pharmacologic interventions. The discussion covers the roles of Pyridostigmine, IV saline infusions, fluid and salt intake, and stimulant medications like methylphenidate and dextroamphetamine. Dr. Boris emphasizes the importance of personalized care and highlights the complexities of POTS symptoms, noting gender-specific differences and the significance of premenstrual symptom variations. The necessity of education, social support, and nuanced medical approaches is also stressed, offering hope and guidance for patients, caregivers, and healthcare providers.00:00 Introduction and Overview00:36 Medications for POTS02:57 IV Saline Therapy07:18 Fluid and Salt Intake10:34 Caffeine and Sports Drinks11:54 Methylphenidate and dextroamphetamine for Cognitive Dysfunction13:58 Long-Term Outcomes Study17:11 Sex Differences in POTS21:48 Hope and Support for POTS Patients24:15 Telemedicine Practice and Services29:46 Conclusion and Key Takeaways Support the Show.A Fibromyalgia Starter Pack, which is a great companion to the book Conquering Your Fibromyalgia, is now available. Dr. Michael Lenz practices general pediatrics and internal medicine primary care, seeing patients from infants through adults. In addition, he also will see patients with fibromyalgia and related problems and patients interested in lifestyle medicine and clinical lipidology. To learn more, go to ConquringYourFibromyalgia.com. Remember that while Dr. Lenz is a medical doctor, he is not your doctor. All of your signs and symptoms should be discussed with your own physician. He aims to weave the best of conventional medicine with lifestyle medicine to help people with chronic health conditions live their best lives possible. Dr. Lenz hopes that the podcast, book, blog, and website serve as a trusted resource and starting point on your journey of learning to live better with fibromyalgia and related illnesses.

In this episode, we explore the fascinating connection between ADHD, pain sensitivity, and methylphenidate treatment in children. Could methylphenidate help reduce pain sensitivity in pediatric ADHD patients? Faculty: David Rosenberg, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: CAP Smart Takes Vol. 17 Effect of Methylphenidate on Pain Perception Thresholds in Children With ADHD

Join us as we discuss methylphenidate for the treatment of ADHD. This includes medications such as Ritalin, Concerta, Jornay, Daytrana, and Quillichew!

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Fund me please - I Work so Hard that my Feet start Bleeding and I Need to Infiltrate University, published by Johannes C. Mayer on May 18, 2024 on LessWrong. Bleeding Feet and Dedication During AI Safety Camp (AISC) 2024, I was working with somebody on how to use binary search to approximate a hull that would contain a set of points, only to knock a glass off of my table. It splintered into a thousand pieces all over my floor. A normal person might stop and remove all the glass splinters. I just spent 10 seconds picking up some of the largest pieces and then decided that it would be better to push on the train of thought without interruption. Some time later, I forgot about the glass splinters and ended up stepping on one long enough to penetrate the callus. I prioritized working too much. A pretty nice problem to have, in my book. Collaboration as Intelligence Enhancer It was really easy for me to put in over 50 hours per week during AISC[1] (where I was a research lead). For me, AISC mainly consisted of meeting somebody 1-on-1 and solving some technical problem together. Methylphenidate helps me with not getting distracted when I am on my own, though Methylphenidate is only the number 2 productivity enhancer. For me, the actual ADHD cure seems to be to take methylphenidate while working 1-on-1 with somebody. But this productivity enhancement is not just about the number of hours I can put in. There is a qualitative difference. I get better at everything. Seriously. Usually, I am bad at prioritization, but when I work with somebody, it usually feels, in retrospect, like over 75% of the time was spent working on the optimal thing (given our state of knowledge at the time). I've noticed similar benefits for my abilities in writing, formalizing things, and general reasoning. Hardcore Gamedev University Infiltration I don't quite understand why this effect is so strong. But empirically, there is no doubt it's real. In the past, I spent 3 years making video games. This was always done in teams of 2-4 people. We would spend 8-10 hours per day, 5-6 days a week in the same room. During that time, I worked on this VR "game" where you fly through a 4D fractal (check out the video by scrolling down or on YouTube). For that project, the university provided a powerful tower computer. In the last week of the project, my brain had the brilliant idea to just sleep in the university to save the commute. This also allowed me to access my workstation on Sunday when the entire university was closed down. On Monday the cleaning personnel of the University almost called the cops on me. But in the end, we simply agreed that I would put on a sign on the door so that I wouldn't scare them to death. Also, I later learned that the University security personnel did patrols with K-9s, but somehow I got lucky and they never found me. I did have a bag with food and a toothbrush, which earned me laughs from friends. As there were no showers, on the last day of the project you could literally smell all the hard work I had put in. Worth it. Over 9000% Mean Increase I was always impressed by how good John Wentworth is at working. During SERI MATS, he would eat with us at Lightcone. As soon as all the high-utility conversation topics were finished, he got up - back to work. And yet, John said that working with David Lorell 1-on-1 makes him 3-5x more productive (iirc). I think for me working with somebody is more like a 15-50x increase. Without collaborators, I am struggling hard with my addiction to learning random technical stuff. In contrast to playing video games and the like, there are usually a bunch of decent reasons to learn about some particular technical topic. Only when I later look at the big picture do I realize - was that actually important? Don't pay me, but my collaborators There are mu...

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Fund me please - I Work so Hard that my Feet start Bleeding and I Need to Infiltrate University, published by Johannes C. Mayer on May 18, 2024 on LessWrong. Bleeding Feet and Dedication During AI Safety Camp (AISC) 2024, I was working with somebody on how to use binary search to approximate a hull that would contain a set of points, only to knock a glass off of my table. It splintered into a thousand pieces all over my floor. A normal person might stop and remove all the glass splinters. I just spent 10 seconds picking up some of the largest pieces and then decided that it would be better to push on the train of thought without interruption. Some time later, I forgot about the glass splinters and ended up stepping on one long enough to penetrate the callus. I prioritized working too much. A pretty nice problem to have, in my book. Collaboration as Intelligence Enhancer It was really easy for me to put in over 50 hours per week during AISC[1] (where I was a research lead). For me, AISC mainly consisted of meeting somebody 1-on-1 and solving some technical problem together. Methylphenidate helps me with not getting distracted when I am on my own, though Methylphenidate is only the number 2 productivity enhancer. For me, the actual ADHD cure seems to be to take methylphenidate while working 1-on-1 with somebody. But this productivity enhancement is not just about the number of hours I can put in. There is a qualitative difference. I get better at everything. Seriously. Usually, I am bad at prioritization, but when I work with somebody, it usually feels, in retrospect, like over 75% of the time was spent working on the optimal thing (given our state of knowledge at the time). I've noticed similar benefits for my abilities in writing, formalizing things, and general reasoning. Hardcore Gamedev University Infiltration I don't quite understand why this effect is so strong. But empirically, there is no doubt it's real. In the past, I spent 3 years making video games. This was always done in teams of 2-4 people. We would spend 8-10 hours per day, 5-6 days a week in the same room. During that time, I worked on this VR "game" where you fly through a 4D fractal (check out the video by scrolling down or on YouTube). For that project, the university provided a powerful tower computer. In the last week of the project, my brain had the brilliant idea to just sleep in the university to save the commute. This also allowed me to access my workstation on Sunday when the entire university was closed down. On Monday the cleaning personnel of the University almost called the cops on me. But in the end, we simply agreed that I would put on a sign on the door so that I wouldn't scare them to death. Also, I later learned that the University security personnel did patrols with K-9s, but somehow I got lucky and they never found me. I did have a bag with food and a toothbrush, which earned me laughs from friends. As there were no showers, on the last day of the project you could literally smell all the hard work I had put in. Worth it. Over 9000% Mean Increase I was always impressed by how good John Wentworth is at working. During SERI MATS, he would eat with us at Lightcone. As soon as all the high-utility conversation topics were finished, he got up - back to work. And yet, John said that working with David Lorell 1-on-1 makes him 3-5x more productive (iirc). I think for me working with somebody is more like a 15-50x increase. Without collaborators, I am struggling hard with my addiction to learning random technical stuff. In contrast to playing video games and the like, there are usually a bunch of decent reasons to learn about some particular technical topic. Only when I later look at the big picture do I realize - was that actually important? Don't pay me, but my collaborators There are mu...

Dr. Shannon Westin and her guest, Dr. Patrick Stone, discuss the article, Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial, recently published in JCO. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we go in depth on manuscripts and research published in the Journal of Clinical Oncology. I am your host, Shannon Westin, Social Media Editor for JCO and a Gynecologic Oncologist by trade. I am thrilled today to present Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial. This manuscript is a dual publication in the Journal of Clinical Oncology and presentation at the European Association of Palliative Care Congress here on May 17, 2024.   And to review this incredible research with us will be Professor Patrick Stone, the Head of Department of Marie Curie Palliative Care Research Department, Division of Psychiatry at University College London. Welcome, Dr. Stone. Dr. Patrick Stone: Thank you very much. Thank you. Shannon Westin: Let's get right to it, we'll level set. Can you speak a bit about the definition of cancer-related fatigue and how common it is in people with advanced cancer? Dr. Patrick Stone: Sure. I think fatigue is a difficult thing to nail down really and define it clearly, and there are lots of definitions out there. In many ways, the simplest definition is the EAPC, the European Association of Palliative Care's definition of just a subjective sensation of weakness, feeling tired, and exhaustion. The reality is that that symptom is very common in the general population. And so if you really want to get a handle on it, I think a good way to do it is to think about taking an operational definition and say, “Look, if fatigue is normally distributed approximately in the general population, then we should consider severe fatigue or pathological fatigue could be defined as fatigue that is worse than 95% of the general population. And if you think that definition, then prevalence of fatigue in patients with newly diagnosed breast or prostate cancer, for instance, is around 15%, so three times as common as the most severe fatigue in the general population. If you come to patients with newly diagnosed non-small cell lung cancer, it's up to about 50%. And if you come to my area, which is palliative care and you go to a hospice and you ask people to complete a fatigue questionnaire, 78-80% of people complain of fatigue that is more severe than 95% of the general population. So that I think gives us a good handle on sort of the severity of this problem in cancer patients and how it progresses as disease progresses. Shannon Westin: I love this because I think we always struggle with exactly how to nail down the definition and exactly how to treat it. So I think that it's a really nice transition to existing treatment options for this issue and exactly how they might work. Dr. Patrick Stone: The first thing to say is in medicine if you can find a cause then you give a treatment directed at the cause and obviously that applies to fatigue as well. So the first thing is to do a thorough assessment of your patient, and if you can find an easily remediable cause such as anemia, hypocalcemia, or hypomagnesemia, or maybe other things like depression, which might manifest as fatigue, then you should try and give a treatment directed at that cause. But, for many patients, there won't be a single clearly identifiable cause you can target. And then people use more broad spectrum approaches if you like. The most well-studied I think is exercise. And exercise, there have been lots of randomized controlled trials in different types of exercise and it's a well attested treatment, which I think has good evidence of effectiveness, certainly in patients who are on treatment and in disease-free survivors. There is less evidence in advanced cancer because the trials are fewer. I would still say that there's moderate quality evidence that exercise is effective in advanced cancer.  The other group of treatments, broadly speaking, would be psychological therapies, cognitive behavioral therapy and psychoeducational approaches, mindfulness based stress reduction, that sort of thing. And again, in earlier stage disease and in patients on treatment and in survivors, there's more quality evidence that that sort of approach can help, if not alleviate fatigue, allow people to cope better with fatigue. But the evidence in advanced cancer is weaker than for exercise. So I think the evidence for the effectiveness of those psychological therapies is not so strong.  And then you come on to pharmacological therapies and there have been lots of trials of different agents. I won't list them all because most of them are negative and don't show any benefit. A few things which perhaps still show promise from previous trials, there have been, for instance, a few trials looking at ginseng as a herbal therapy. One very good quality trial showed benefit. Although another trial in advanced cancer didn't replicate that finding, so that ginseng is out there. Steroids, widely used in advanced cancer for general relief of many symptoms like fatigue, lack of energy, low moods, appetite. But although widely used, surprisingly little hard evidence or effectiveness, specifically for fatigue, but one relatively recent, well conducted randomized control trial, provides us with some firm evidence, also, that dexamethasone can help in the short term in advanced cancer patients. It obviously wouldn't be a recommended treatment longer term because of its side effects.   And then we really come on to the crux of this study which is probably the most widely studied single agent beyond that, is methylphenidate, which is a psychostimulant agent, raises central dopamine catecholamine levels in the brain. And there's probably a thousand or so randomized control trials sort of being conducted looking at that prior to prize of this study that we're talking about. Shannon Westin: I would love to hear a summary of the data that were pre-existing in this study. So how well does methylphenidate seem to work, or what were the conflicting results that were seen prior? Dr. Patrick Stone: I think the rationale for this study was that it was the perfect background to justify another randomized controlled trial, which there have been– Well, I can't remember exactly how many there were in existence before my trial started, but when I last looked, there were 10 studies, 10 randomized controlled trials in cancer patients. Most of those trials have been neutral. They've shown no benefit over placebo, so most of the individual trials are negative. But meta-analyses always tend to show a positive result. So when you count the trials together, it gets you over the finishing line and you can see a positive benefit. But individually, the trials were quite heterogeneous, they're quite different. There were only four trials prior to the publication of this one that were done specifically in advanced cancer patients. One of them was published only a couple of years ago while my study was going on. And of those four trials, three of those have also been neutral, not showing a benefit over placebo. One study involving 28 patients and using a PRN as required dosing schedule showed some benefit. But the other studies with a total of about 330 odd patients have been neutral.   Shannon Westin: I think that brings us to a great transition, just to talk a little bit about the design and objectives of your current study. Dr. Patrick Stone: Well, what we wanted to do was take the best bits, if you like, of the previous studies, and try to give ourselves the best chance of finding a clinically meaningful improvement in fatigue in patients with advanced cancer. And I was focusing on advanced cancer, principally because I'm a specialist in palliative medicine. That's the group of patients I'm most working with, whereas a lot of the studies have involved mixed groups of cancer patients or patient's disease-free or on treatment. But we looked at patients who were under the care of palliative care services, with incurable cancer, with a prognosis estimated to be less than a year or around a year.  We wanted to try to get the dose of the medication up to a good level because some of the other studies which have shown benefit have got up to quite high levels of methylphenidate, approximating to about 40 to 60 milligrams of methylphenidate a day or equivalent. And we wanted to give the drug in an individually titrated dose because that would reflect the way it is used in clinical practice. You would adjust the dose like you might with morphine for pain relief. You would expect to adjust the dose of this medication up to get a therapeutic benefit. So we had this titration period where we adjusted the dose of the drug every week. We reviewed whether patients were feeling better, worse, or the same. We asked about side effects. And on the basis of the response to those questions, we either went up with the drug or kept the dose the same, or, if necessary, would come down. The primary endpoint was designed to be fatigue after six weeks of dose titration, plus or minus a window of two weeks, accepting the fact that we might miss a few patients at the six-week mark, for whatever reason. So we had a little window around that. That's what we were looking to do.  Shannon Westin: And why did you choose the six-week time point? Dr. Patrick Stone: Well, there was no obvious time point to choose. One of the biggest positive studies previously was by Lower and colleagues back in 2009, and they had found their maximum benefit at around four weeks, or it took rather four weeks to reach the maximum benefit. So we wanted to give the patients in our trial every chance of demonstrating the benefit, and they'd also escalated the doses in their study up to above 40 milligrams or equivalent. And so we wanted to go up as high as we could, and we didn't feel that if we were adjusting the dose every week, that we could get up to a sufficiently high dose in any shorter time span. So six weeks sort of fitted, allowing us to titrate the dose up to a maximum of 60 milligrams a day, which is where we wanted to get up to. Shannon Westin: And what about a little bit more detail on the population you included, and maybe give us a sense of how well you think that represents your general population affected by fatigue in the setting of advanced cancer? Dr. Patrick Stone: We recruited patients from hospices, so that's inpatient palliative care units in the UK, but also from hospital palliative care services, from oncology outpatient services as well, oncology patients who are under the care of palliative care services, and we also recruited from some community palliative care services. So we had quite a good spread of settings, and all of our patients had advanced incurable cancer under the care of palliative care services. But I would say, I think by the nature of doing this randomized controlled trial, inevitably we ended up with quite a selected population, just because of the inclusion and the exclusion criteria that we had to apply. And the regulators were quite clear about who we shouldn't be putting on the drugs. And I think by the time you've excluded all the potential adverse consequences of using methylphenidate, we probably have ended up with a group of patients who were relatively fit compared to the general run-of-the-mill palliative care population, I would say. So I think that that is a limitation with regards to the generalizability of our result. Shannon Westin: How did you measure fatigue in this study? What was the mechanism for that objective? Dr. Patrick Stone: It's a subjective rating scale. We use a very well-established and well-validated measurement instrument. It's the Functional Assessment of Chronic Illness Therapy FACIT-F which is the fatigue subscale of their anemia subscale, which is a 13-item questionnaire, very well validated and widely used in lots of previous studies. Higher scores represent better quality of life and, therefore, lower levels of fatigue. So that's the scale that we used. Shannon Westin: Got it. So let's get to it. How well did methylphenidate work to impact fatigue compared to placebo? And were there any groups that seemed to have a bigger impact? Dr. Patrick Stone: Well, the bottom line, of course, is that at six weeks, plus or minus two weeks, there was no statistically significant benefit for methylphenidate over placebo. There was a two-point improvement in fatigue scores, but it wasn't statistically significant. And two points on the FACIT-F did not reach our predetermined five-point difference that we regarded as representing a minimally clinically important difference. We looked at lots of secondary fatigue endpoints. We measured fatigue every week over the whole course of the study. And actually, at weeks 2, 3, 4, 5, and 6, there was indeed a statistically, nominally statistically significant difference in fatigue scores. But I really would not want anybody to read anything over much into that finding because it was not a pre-stated hypothesis of our study. It wasn't a pre-stated endpoint, it was a secondary outcome. And moreover, even if this was regarded as a statistically significant finding, and as I say, it was only nominally statistically significant finding, the magnitude of the change was still not sufficiently large that I think it would want to influence your clinical decision making. With other groups just to say, we did look specifically at whether patients with the most severe fatigue would experience benefit over and above other patients, because in a previous study, that looked at modafinil, an agent that promotes vigilance, although the overall finding was neutral in a subgroup of patients with the most severe fatigue, modafinil seemed to work. So we thought we better check in this study whether patients with the most severe fatigue had a differential benefit. But we found no such effect. We found no difference in patients who were on or off treatment or indeed among the patients who scored highest with the depression subscale on the hospital anxiety and depression scale. None of these subgroups showed any benefit over placebo. Shannon Westin: How did patients tolerate methylphenidate? Was it tolerable? Dr. Patrick Stone: That was the thing I think that I was most relieved about. I am a cautious and anxious investigator, and the last thing I wanted to do was to put palliative care patients at risk by giving them a drug which might cause some harm. So I was very relieved when we analyzed the results to confirm that methylphenidate was very well tolerated. There was no real pattern of evidence for any increase in adverse effects over placebo. In fact, when we looked at just people who self-reported severe adverse effects, we found a higher rate in the placebo group than in the methylphenidate group in fact. And in terms of serious adverse events, there were 25 serious adverse events in both groups, so there was, again, no pattern that suggested methylphenidate was causing harm. So, yes, it was well tolerated, but did not result in a clinically important improvement in fatigue. Shannon Westin: Were you surprised by the results?  Dr. Patrick Stone: I honestly went into this with an open mind. I didn't come in with a real fixed agenda that I want to prove that this thing works. In fact, although methylphenidate was being used by some of my colleagues around the country and I know it's used by some colleagues internationally, personally I was not using it because I didn't feel the evidence was strong enough to justify using it. So I was waiting for the results of my own trial before making my decision. And I don't plan now to be using it on the basis of the results of the study. Shannon Westin: Sounds pretty definitive. It's always frustrating, and I know our patients, when we tell them to exercise when they're exhausted, they're like, “Are you kidding me?” Right? So it would be wonderful if there is like the perfect pill that we can give them. It's certainly disappointing. What do you think we should be exploring next for the resolution of fatigue in this patient population?  Dr. Patrick Stone: Well, I think one thing. Going back to your very first question to me about defining fatigue, I think one problem is we don't really have a mechanistic understanding of what we're talking about here necessarily with cancer related fatigue. And it's a bit of an umbrella term, I suspect, for a lot of different things, and may have a common endpoint in terms of the symptom. But maybe if we could better define, if you like, for want of a better word, the phenotype of fatigue, it may be that we could actually target a treatment in certain subgroups of patients that may be of more benefit. So maybe some greater basic science pinpointing what is causing fatigue, so that we can design the treatments, rather than just try repurposing existing drugs on the off chance that they work. And the other thing is okay, maybe we can't pinpoint a particular cause, we think it's multi factorial. If we think it's multifactorial, then perhaps we ought to be using a multimodal treatment approach and maybe it's actually exercise, psychological therapies, and diet, plus or minus a drug, and that's the approach if we can't pinpoint a specific cause. Shannon Westin: I love the idea of incorporating the  translational work to really try to understand the etiology better and then use something more targeted. It's that version of precision medicine but for palliative care as well. I really like that.   Well, this has been awesome. Thank you so much, Dr. Stone. I think that your insight is so much appreciated, and thank you for putting together this definitive work to help us treat our patients better every day. I really appreciate the time you took.  Dr. Patrick Stone: Thank you very much. Shannon Westin: You're so welcome.  And thank you to our listeners. This has been methylphenidate versus placebo for treating fatigue in people with advanced cancer, randomized, double-blind, multicenter, placebo-controlled clinical trial. And again, this is a dual publication in the JCO as well as a presentation at the European Association of Palliative Care Congress on 5/17/24. And we are so thrilled that you could join JCO After Hours and we hope you will check out our other offerings wherever you get your podcasts. Have an awesome day.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Fiddle your fidgisauruses and dammit, get ready to learn, because we're bringing you a meat-forward episode that's sure to get the brain juices flowing.   In an episode brought to you by Adderall, Professor Kristin is shimmying into her trusty lab coat and educating us on the chemistry behind ADHD stimulant medications. She's covering the mechanism of action of amphetamines and methylphenidates, evaluating the potential cross interactions, benefits, and side effects of each stimulant type, and ranting about the current medication shortage that's affecting so many of us.    Plus, will taking drugs dampen your sparkle? Is Vyvanse the Oldsmobile of ADHD medications? Do centaurs sleep standing up, and if so, does their spine health suffer the consequences? Come ponder these questions and more with your two favorite podcasters who are definitely not pharmacists, so technically you can't sue us. Resources: Tiktok: @your.psych.pharmacist  Amphetamine - StatPearls - NCBI Bookshelf (nih.gov) Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder - PMC (nih.gov) Enantiomers: Definition, Characteristics, and Examples (chemistrylearner.com) Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review - PMC (nih.gov) Methylphenidate - StatPearls - NCBI Bookshelf (nih.gov)

Roland Verment is a neuropsychologist, biohacker, and the owner of Neurobics, an at-home neurofeedback service. In this interview, we discuss how to understand and change the brain via neurofeedback and nootropics.We talk about brain waves (delta, theta, alpha, beta, and gamma) and how they correspond to various brain states, regions, neurochemicals, and disorders, including: OCD, ADHD, autism, bipolar disorder, schizophrenia, anxiety, depression, PTSD, Gilles de la Tourette's syndrome, and visual neglect). Learn how to manipulate these brain waves in order to increase your creativity, organization, productivity, memory, happiness, focus, flexibility, calm, balance, and overall brain health. We also discuss: EEG, fMRI, sleep, resurrecting old childhood memories ("time traveling"), alcohol, meditation, medications, VR, emerging tech, and nootropics (including: caffeine, rhodiola, alpha GPC, Huperzine A, and  cerebrolisin). *CONNECT & LEARN MORE*Instagram: @neurobicsneurofeedback     or               @rolandsnapFacebook: @Neurobicswebsite: neurobics.careRESOURCESNEUROANATOMY- anterior cingulate cortex - frontal lobe- hypothalamus- occipital lobe- parietal lobe- temporal lobe- visual cortexCOMPANIES - AppliedVR- BrainBit- Cleverpoint- Divergence Neuro- GrayMatters Health - Headspace - Kernel- Muse- Tripp PEOPLE- Andrew Huberman - Cody Rall - Jay Gunkelman- Josh Sackman- Kirill Krasnogir - Tim Ferris SUPPLEMENTS & DRUGS - alpha-GPC - CDP-Choline-  Cerebrolysin -  Huperzia serrata (Huperzine A) -  lithium -  Methylphenidate (brand names: Ritalin and Concerta)-  rhodiola (active compound: salidroside) Learn more at: neurobics.care (or on Instagram @or send me a text message here

Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions ADHD vs.anxiety. This challenge is further compounded by the similarities in symptoms and the potential for misdiagnosis. However, understanding the nuances and interconnections between these conditions can empower individuals to seek appropriate treatment and improve their quality of life. ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While commonly diagnosed in childhood, ADHD persists into adulthood for many individuals, affecting various aspects of their daily lives, from academic performance to personal relationships. On the other hand, anxiety disorders encompass a range of conditions marked by excessive fear, worry, and physical symptoms such as heart palpitations and dizziness. The intersection of ADHD and anxiety is a topic of significant interest within the mental health community. Individuals with ADHD often experience anxiety, partly due to the challenges and frustrations stemming from ADHD symptoms. Similarly, the constant struggle with focus and organization can exacerbate feelings of anxiety, creating a cyclical relationship between the two conditions. A critical aspect of differentiating ADHD from anxiety involves examining the onset and progression of symptoms. ADHD is present from an early age, with symptoms often becoming noticeable during childhood. In contrast, anxiety can develop at any point in life, triggered by stressors or traumatic events. Therefore, a thorough evaluation of an individual's history is vital in distinguishing between the two. Moreover, the manifestation of symptoms can offer clues. For example, while both ADHD and anxiety can lead to concentration difficulties, the underlying reasons differ. In ADHD, the inability to focus is often due to intrinsic attention regulation issues. In anxiety, however, the concentration problems may arise from excessive worry or fear that consumes cognitive resources. Understanding the unique and overlapping aspects of ADHD and anxiety is crucial for effective treatment. For ADHD, interventions typically include medication, such as stimulants, alongside behavioral strategies to enhance executive functioning skills. Anxiety disorders, meanwhile, may be treated with a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and, in some cases, medication to manage symptoms. The integration of treatment modalities is paramount, particularly for individuals experiencing both ADHD and anxiety. Addressing the ADHD symptoms can often alleviate anxiety by improving self-esteem and coping mechanisms. Similarly, managing anxiety can reduce the overall stress load, making ADHD symptoms more manageable. In conclusion, ADHD and anxiety represent two distinct yet interrelated conditions within the spectrum of mental health. The complexity of their relationship underscores the importance of personalized, comprehensive treatment plans. By fostering a deeper understanding of these conditions, individuals can navigate the path to wellness with greater clarity and confidence. This journey, though challenging, is a testament to the resilience and strength inherent in the human spirit, as we seek to understand and overcome the obstacles that lie within our minds. TRANSCRIPT Kimberley: Welcome, everybody. We are talking about ADHD vs anxiety, how to tell the difference, kind of get you in the know of what is what.  Today, we have Dr. Ryan Sultan. He is an Assistant Professor of Clinical Psychiatry at Columbia University. He knows all the things about ADHD and cannabis use, does a lot of research in this area, and I want to get the tea on all things ADHD and anxiety so that we can work it out. So many of you listening have either been misdiagnosed or totally feel like they don't really understand the difference. And so, let's talk about it. Welcome, Dr. Sultan. ADHD vs. ANXIETY  Ryan: Thank you. I really like doing these things. I think it's fun. I think psychiatrists, which is what I am, I think one of the ways that we really fail, and medical doctors in general don't do well at this, which is like, let's spend some time educating the public. And before my current position, I did epidemiology and public health. And so, I learned a lot about that, and I was like, “You know how you can help people? We have a crisis here. Let's just teach people things about how to find resources and what they can do on their own.” And so, I really enjoy these opportunities.  WHAT IS ADHD vs. WHAT IS ANXIETY?   I was thinking about your question, and I was thinking how we might want to talk about this idea of ADHD versus anxiety, which is a common thing. People come in, and they see me very commonly wanting an evaluation, and they think they have ADHD. And I understand why they think they have ADHD, but their main thing is basically reporting a concentration or focus issue, which is a not specific symptom. Just like if I'm moody today, that doesn't mean I have a mood disorder. If I'm anxious today, it doesn't mean I have an anxiety disorder. I might even feel depressed today; it doesn't mean I have a depression disorder. I could even have a psychotic symptom in your voice, and it does not mean that I have a psychotic disorder. It's more complicated than that.   I think one of the things that the DSM that we love here in the United States—but it's the best thing we have; it's like capitalism and democracy; it's like the best things that we have; we don't have better solutions yet—is that it describes these things in a way that uses plain language to try to standardize it. But it's confusing to the general public and I think it's also confusing to clinicians when you're trying to learn some of these conditions.  WHEN IS ADHD vs. ANXIETY DIAGNOSED?  And certainly, one of the things that have happened in my field that people used to talk a lot about is the idea that, is pediatric, meaning kid diagnosis of ADHD, which often in my area here in the United States will be done by pediatrician, are they adequately able to do that? Because poor pediatricians have to know a lot. And ADHD, psychiatric disorders are complicated. Mental health conditions are super complicated. They're so complicated that there are seven different types of degree programs that end up helping you with them. PsyD, PhD, MD, clinical social worker, mental health counselor, and then there's nurse practitioner. So, like super complicated counseling. So, how do we think about this?  The first thing I try to remind everyone is, if you're not sure what's going on with you, please filter your self-diagnosis. You can think about it, that's great. Write your notes down, da-da-da, but I would avoid acting purely on that. You really want to do your best to get some help from the outside. And I know that mental health treatment is not accessible to everyone. This is an enormous problem that existed before the pandemic and still exists now. I say that because I say that all the time, and I wish I had a solution for you. But if you have access to someone that you think can help you tease this throughout, you want to do that.  SYMPTOMS OF ADHD vs. ANXIETY  But what I would like us to do, instead of listing criteria, which you can all Google on WebMD, let's think about them in a larger context. So, mental health symptoms fall into these very broad categories. And so, some of them are anxiety, which OCD used to be under, but it's now in its own area. Another one, would be mood. You can have moods that are really high, moods that are really low. Another one you could take ADHD, you could lump it in neurodevelopmental, which would mix it with autism and learning disorders. You could lump it with attention, but the problem with that is it would also get lumped with dementia, which are processes that overlap, but they're occurring at different ends of the spectrum.   So, let's think about ADHD and why someone might have ADHD or why you might think someone has ADHD, because this should be easier for people to tease out, I think. ADHD is not a condition that appears in adulthood. That's like hands down. Adult ADHD is people that had ADHD and still have ADHD as adults. And most people with ADHD will go on to still have at least an attenuated version, meaning their symptoms are a little less severe, maybe, but over 60% will still meet criteria. It's not a disorder of children. Up until the ‘90s, we thought it was a disorder of kids only. So, you turned 18, and magically, you couldn't have ADHD anymore, which didn't make any sense anyway.   So, to really get a good ADHD diagnosis, you got to go backwards. If you're not currently an eight-year-old, you have to think a little bit about or talk to your family, or look at your school records. And ideally, that's what you want to do, is you want to see, is there evidence that you have, things that look like ADHD then? So, you were having trouble maintaining your attention for periods of time. Your attention was scattered in different ways. Things that are mentally challenging that require you to force yourself to do it, that particularly if you don't like them, this was really hard for you. You were disorganized. People thought that things went in one year and out the other.   Now this exists on a spectrum. And depending on the difficulty of your scholastic experience and how far you pushed yourself in school, these symptoms could show up at different times. For example, it's not uncommon for people to show up in college or in graduate school. Less so now, but historically, people were getting diagnosed as late as that, because now they have to write a dissertation. For those of you guys who don't know, a dissertation is being asked to write a book, okay? You're being asked to write a book. And what did you do? You went to college. Okay, you went to college, and then you had some master's classes, and then you get assigned an advisor, and you just get told to figure out what your project is. It is completely unstructured. It is completely self-sufficient. It is absurd. I'm talking about a real academic classic PhD. That is going to bring it. If somebody has ADHD, that's going to bring it out because of the executive functioning involved in that, the organization, the planning. I got to make an outline, I got to meet with my mentor regularly, I got to check in with them, I got to revise it, I got to plan a study or a literature review. There's so many steps involved. So, that would be something that some people doesn't come up with then.   Other kids, as an eight-year-old boy that I'm treating right now, who has a wonderful family that is super supportive, and they have created this beautiful environment for him that accommodates him so much that he has not needed any medication despite the fact that there's lots of evidence that he is struggling and now starting to feel bad about himself, and he has self-esteem issues because he just doesn't understand why he has to try so hard and why he can't maintain his attention in this scenario, which is challenging for him.   So, ADHD kids and adults, you want to think of them as their brains as being three to five years behind everyone else in their development, okay? And they are catching up, but they're more immature, and they're immature in certain ways. And so, this kid's ability to maintain his attention, manage his own behaviors, stay organized, it's like mom is sitting with this kid doing his homework with him continuously, and if she stops at all, he can't hold it together on his own. So, when we think about that with him, like, okay, well, that's maybe when it's showing up with him. That's when it's starting to have a struggle with him.   But let's relate it to anxiety. One problem would be, do you have ADHD or do you have anxiety? Well, there's another problem. Another problem is having ADHD is a major risk factor for developing an anxiety disorder, okay? So now I'm the eight-year-old boy, and this eight-year-old boy does not have the financial resources to get this evaluation, or the parents that are knowledgeable enough to know that, it might even have been years ago where there was less knowledge about this. And he's just struggling all the time, and he feels bad about himself, and he's constantly getting into trouble because he is losing things because he can't keep track of things because he's overwhelmed. And now he feels bad about himself. Okay. He has anxiety associated with that. So now we're building this anxiety. So he might even get mood symptoms, and now we have a risk for depression.   So, this is just one of the reasons why these things are like these tangled messes. You ever like have a bunch of cords that you have one of the dealies, you keep throwing them in a box, and now you're like, “What do I do? Do I just throw the cords out or entangle them?” It's a very tangled mess. Of course, it takes time to sort through it. The reason I started with ADHD is that it has a clear trajectory of it when it happens. And in general, it's a general rule, symptomatology, meaning like how severe it is and the number of symptoms you have and how impairing it is. They're going to be decreasing as you get older. At least until main adulthood, there's new evidence that shows there might be a higher risk for dementia in that population.   But let's put geriatric aside. There's a different developmental trajectory. Whereas anxiety, oh God, I wish I could simplify anxiety that much. Anxiety can happen in different ways. So, let's start with the easy thing. Why would you confuse them in this current moment? If I am always worried about things, if I'm always ruminating about things, I'm thinking about it over and over again, I'm trying to figure out where I should live or what I should do about this, and I just keep thinking about it over and over again, and I'm in like a cycle. Like, pop-pa-pa pop-pa pop-pa-pa-pa. And then you're asking me to do other things. I promise you, I will have difficulty concentrating. I promise you, I can't concentrate because it's like you're using your computer and how many windows do you have open? How many things are you running? I mean, it doesn't happen as much anymore, but I think most of us, I meant to remember times where you're like, “Oh, my computer is not able to handle this anymore.” You're using up some of your mind, and you can call that being present.   So, when people talk about mindfulness and improving attention, one of the things that they're probably improving is this: they're trying to get the person to stop running that 15, 20% program all the time. And it's like your brain got upgraded because you can now devote yourself to the task in front of you. And the anxiety is not slowing you down or intruding upon you, either as an intrusive thought in an OCD way or just a sort of intrusive worry that's probably hampering your ability to do something concentration-intensive. And then if you have anxiety problems and you're not sleeping right, well, now your memory is impaired because of that. So, there's this cycle that ends up happening over and over again.  IS HYPERACTIVITY ANXIETY OR ADHD? Kimberley: Yeah, I think a lot of people as well that I've talked to clients and listeners, also with anxiety, there's this general physiological irritability. Like a little jitteriness, can't sit in their chair, which I think is another maybe way that misdiagnosis can -- it's like, “Oh, they're hyperactive. They're struggling to sit in their chair. That might be what's going on for them.” Is that similar to what you're saying?  Ryan: Yeah. So, really good example, and this one we can do a little simpler. I mean, the statement I'm going to say is not 100% true, but it's mostly true. If you are an adult, like over 25 for sure, and you are physically jittery, it is very unlikely that that is ADHD. Because ADHD, the whole mechanism as we understand it, or one of the mechanisms causing the thing we call ADHD, which of course is like a made-up thing that we're using to classify it, is that your prefrontal cortex is not done developing. So, it needs to get myelinated, which is essentially like -- think about it like upgrading from dial up to some great, not even a cable modem. You're going right to Verizon Fios. Like amazing, okay. It's much faster, and it's growing. And that's the part of you that makes you most human. That's the most sophisticated part of your brain. It's not the part that helps you breathe or some sort of physiological thing, which, by the way, is causing some of those anxiety symptoms. They're ramped up in a sympathetic nervous system way, fight or fight way. It's the part that's actually slowing you down. That's like, “Whoa, whoa, whoa, whoa, whoa, calm down, calm down, calm down.” This is why, and everyone's is not as developed. So, we're all developing this thing through 25, at least ADHD is through 28.   Car insurance goes down to 25 because your driving gets better, because your judgment gets better, because you can plan better, because you are less risk-taking. So, your insurance has now gone down. So, the insurance company knows this about us. And our FMRI scans, you scan people's brains, it supports that change. These correlate to some extent with symptomology, not enough to be a diagnosis to answer the person's question that they're going to have that. I wish it was. It's not a diagnosis. We haven't been able to figure out how to do that yet.   So, by the time you're 25, that's developed. And the symptoms that go away first with ADHD are usually hyperactivity, because that's the inability to manage all the impulses of your body, not in an anxious, stressed-out way, but in an excited way. You think of the happy, well-supported, running around ADHD kid is kind of silly and fun. It's a totally different mood experience than the anxiety experience. Anxiety experience is unpleasant for the most part. Unless your anxiety is targeting you to hyper-focus to get something done, which is bumping up some of your dopamine, which is again the opposite experience of probably having ADHD, it's a hyper-focus experience, certainly, the deficit part of ADHD, you're going to be feeling a different physiological, the irritability you talked about 100%. You're irritable because you are trying so hard to manage this awful feeling you have in your body. You physically feel so uncomfortable. It is intolerable.   I have this poor, anxious young man that has to do a very socially awkward thing today. Actually, not that socially awkward. He created the situation, which is one of the ways we're working on it with him in treatment. And I'm letting him go through and do this as an exposure because it'll be fine. And he's literally interacting with another one of our staff members. But he finds these things intolerable. He talks about it like we are lighting him on fire. So, he's trying to hold it together, or whatever your physiological experience is. It may not have been as dramatic as I described. You're irritable when people are asking things of you because you don't have much left. You're not in some carefree mood where you're like, “Whatever, I'm super easygoing. I don't care.” No, you're not feeling easygoing right now. You're very, very stressed out.   Stress and anxiety are very linked. Just like sadness and depression are very linked, and like loneliness and depression are linked, but they're not the same thing. Stress and anxiety are very, very linked, and they're similar feelings, and they're often occurring at the same time and interacting with each other. ADD vs. ADHD  Kimberley: Right. One question really quick. Just to be clear, what about ADD vs. ADHD?  Ryan: We love to change diagnostic criteria. People sit around. There's a committee, there's a whole bunch of studies. And we're always trying to epidemiologically and characterologically differentiate what these different conditions are. That's what the field is trying to do as an academic whole. And so, there's disagreements about what should be where. So, the OCD thing moving is one of them.   The ADD thing, it's like a nomenclature thing. So, the diagnosis got described that the new current version of the diagnosis is attention deficit hyperactivity disorder, and then you have three specifiers, okay? So, that's the condition you have. And then you can have combined, which is hyperactive and inattentive. Just inattentive, just hyperactive. And impulsive is built in there. So, it's really not that interesting. People love to be like, “No, no, I have ADD. No, I don't have the hyperactive.” And I'm like, “I know, but from a billing point of view, the insurance company will not accept that code anymore. It doesn't exist.” DOES ADHD OR ANXIETY IMPACT CONCENTRATION?  Kimberley: Yeah. So, just so that I know I have this right, and you can please correct me, is if you have this more neurological, like you said, condition of ADHD, you'll have that first, and then you'll get maybe some anxiety and some depression as a result of that condition. Whereas for those folks, if their primary was anxiety, it wouldn't be so much that anxiety would cause the ADHD. It would be more the symptoms of concentration are a symptom of the anxiety. Is that what you're saying? Ryan: Yes, and every permutation that you can imagine based on what you just said is also an option. Like almost every permutation. Like how are they interacting with each other? How are they making each other worse? How are they confusing each other? Because you can have anxiety disorders in elementary school. I mean, that is when most anxiety disorders, the first win, like the wave of them going up is then. And you think about all the anxiety you have.   I got a friend of mine who's got infants. And it's fun to see like as they're developing, when they go through normal anxiety, that that is a thing that they're going to pass. And then there's other things where, at some point, we're like, actually, now we're saying this is developmentally inappropriate, which means, nope, we were supposed to have graduated from this and it's still around.   And so, one of the earlier ways that psychiatric conditions were conceptualized, and it's still a useful way to conceptualize them, is the normal behavior version of it versus the non-normal behavior version of it. And again, I hate non-normal, I don't want to pathologize people, but non-normal being like, this is causing problems for you. And if you think about it from an evolutionary point of view, all of these conditions have pretty clear evolutionary bases of how they would be beneficial. Anxiety is going to save your ass, okay? Properly applied anxiety, it'll save your tribe. You want someone who's anxious, who's going to be like, “We do not have enough from this winter.” An ADHD person was like, “It'll be fine. I'm just going to go find something else.” And you're like, “No.” And then when that winter's really bad and you save that little bit of extra food, that 30% that the anxious person pushed for, maybe you didn't eat all 30% of it, but you know what, it probably benefited you and it might've actually made the whole tribe survive or more people survive or better health condition. So, it's approving everyone's outcomes.   The ADHD individual, you get them excited about something—gone. They're going to destroy it. They're going to find all the berries. They're going to find all the new places. They're going to find all the new deer. They're going to run around and explore. It's great. Great, great, great.   Depression is like hibernation. And if you look at hibernation in a mammal, like what happens, there's a lot of overlaps. Lower energy, maybe you store up some food for the winter. It's related to the seasons. You're in California, right? This is not a problem you have, but for those of us in New York, where we have seasonality, seasonal depression is a thing. It's very much a thing. It's very noticeable, and it's packed on top of these conditions everyone else is having.  But the idea is that the hibernation or the pullback is like something happens to you that upsets you, which is the psychosocial event that's kicking you in the face that might set off your depression. That's why people always say, “Oh, depressions just don't come out of nowhere. This biochemical thing isn't true.” What they're saying is something has to happen to start to kick off the depression, but that's not enough. It's that you then can't recover from it.   And so, a normal version of it is that you get knocked out and you spend a week or two, you think about it. Rumination is a part of depression for many people. You reevaluate, and you say, “You know, I got kicked in the face when I did that. That was not a good plan for me. I need a new plan. I either need to do something different or I need to tackle that problem differently.” And so, that would be the adaptive version of a depressive experience. Whereas the non-adaptive version is like, you get stuck in that and you can't get out.  Kimberley: Or you avoid.  Ryan: The avoiding doing anything about it, and then that makes it worse. So, you started withdrawing. I mean, that's the worst thing you can do. This is a message to everyone out there. The worst thing that you can do is withdraw from society for any period of time. Look, I'm not saying you can't have a mental health day, but systematic withdrawal, which most of us don't even realize is happening, is going to make you worse because the best treatment for every mental health condition is community. It is really. All of them. All of them, including schizophrenia.   I used to work in Atlanta. I did my residency. There'd be these poor guys that have a psychotic disorder. They hear voices. The kinds of people that, here in New York City, are homeless, they're not homeless there. Everyone just knows that Johnny's just a little weird and his mom lives down the street. And if we find Johnny just in the trash can or doing something strange, or just roving, we know he's fine, and someone just takes him back to his mom's house and checks on him. Because there's a community that takes care of him, even though he's actually quite ill from our point of view. But when you put him in an environment where that community is not as strong, like a city, it does worse, which is why mental health conditions are much higher rates in urban areas. Probably why psychiatry and mental health in general is such a central thing in New York City. TREATMENT FOR ADHD vs. ANXIETY  Kimberley: Yeah. Okay, let's talk quickly about treatment for ADHD. We're here always talking about the treatment for anxiety, but what would the research and what's evidence-based for ADHD if someone were to get that clinical diagnosis?  Ryan: So, you want to think about ADHD as a thing that we're going to try to frame for that person as much as how is it an asset, because it historically has made people feel bad about themselves. And so, there are positive aspects to it, like the hyper focus and excitability, and interest in things. And so, trying to channel into that and then thinking about what their deficits are. So, they're functional deficits. If you're talking adult population, functional deficits are going to be usually around executive functioning and organization planning. Imagine if you're like a parent of small children and you have untreated ADHD, you're going to be in crazy fight-or-flight mode all the time because there's so many things to keep track of. You have to keep track of your wife and their life. Kimberley: I see these moms. My heart goes out to them. Ryan: And they're probably anxious. And the anxiety is probably protecting them a little bit. Because what is the anxiety doing? You think about things over and over and over again, and you double check them. You know what that's not a bad idea for? Someone who's not detail-oriented, who's an ADHD person, who forgets things, and he gets disorganized. So, there's this thing where you're like, “Okay, there may actually be a balance going on. Can we make the balance a little bit better?” So, how do you organize yourself?  MEDICATIONS FOR ADHD Right now, there's a stimulant shortage. Stimulants are the most effective medication for reducing ADHD symptoms. They are the most effective biological intervention we have to reduce the impact of probably any psychiatric condition, period. They are incredibly effective, like 80, 90% resolution of symptoms, which is great. I mean, that's great. That's great news. But you also want to be integrating some lifestyle changes and skills alongside of that. So, how do you organize yourself better? I mean, that's like a whole talk, but like lists, prioritizing lists, taking tasks, breaking them down into smaller and smaller pieces. Where do you start? What's the first step? Chipping away. You know what? If you only go one mile a day for 30 days, you go 30 miles. That's still really far. I know you would have gone 30 miles that day, especially if you have ADHD, but you're still getting somewhere.  And so, that kind of prioritization is really, really important. And so, you can create that on your own. There are CBT-based resources and things to try to help with that. There are ADHD coaches that try to help with that. It's consistency and commitment around that. So, how do you structure your life for yourself? That poor PhD candidate really needs to structure their life because there is no structure to their life.  The other things we want to think about with that, I mean, really good sleep, physical exercise. People with ADHD, we see on FMRI scans when you scan someone's brain, there's less density of dopamine receptors, less dopamine activity. You want to get that dopamine up. That's what the medications are doing, is predominantly raising the dopamine. So, physical activity, aerobic exercise, in particular, is going to do that. Get that in every day, and look, it's good for you. It's good for you. There is no better treatment for every condition in the world other than exercise, particularly aerobic. It basically is good for everything. If you just had surgery, we still want you to get out and walk around. Really quickly, that actually improves your outcome as fast as possible. So, those are the things I like people to start with if they can do that, depending on the severity of what's going on, the impact, what other things have already been tried. Stimulant medications or non-stimulant medications like Wellbutrin, Strattera, Clonidine are also pretty effective. Methylphenidate products, which is what Ritalin is. Adderall products mixed in amphetamine salts, Vyvanse, these are very effective medications for it. There's a massive shortage of these medications that people are constantly talking about, and is really problematic and does not appear to have an endpoint because the DEA doesn't seem ready to raise the amount that they allow to be made because they are still recovering from the opioid crisis, which is ongoing. And so, they're worried about that. Really, they want to be very thoughtful about this. These medications have a very low-risk potential for misuse. In fact, people with ADHD, they appear to reduce the risk of developing a substance use disorder. It's the most common thing that people worry about. So, treatment actually reduces that.  That said, the worst -- I mean, I don't want to say the worst thing. I mean, people hate me. The really not great way to get psychiatric treatment is to show up to someone once and then intermittently meet with them where they write a prescription for a medication for you that's supposed to help you, and stimulant medications are included on that. So, that's probably why I didn't lead with that, even though there's actually more science to support them, is that by themselves, it's really going to limit how much help you're going to get. Kimberley: Can you share why? Ryan: Because you need to understand your condition, because you need to spend time with your clinician learning about your condition and understanding how it's affecting your life, and understanding how the medication is actually meant to be a tool. It should be like wearing glasses. It doesn't do the work for you. It doesn't solve all your problems, but it's easier to read when you put your glasses on than without it. It supports you. You still need to figure out how to get these things done. It lowers the activation energy associated with it. But you also want to monitor it. You can't take these medications 24 hours a day and just be ready to go and work, which is things that people have tried. It doesn't work because you need to sleep, because you will die. They've tried this. We know that you will literally die, like not sleeping. And in the interim, you are damaging yourself significantly. So, taking it and timing it in an appropriate way, still getting sufficient sleep, prioritizing other things—they are like a piece of a puzzle, and they are a really powerful piece. But you really don't want that to be the only thing driving your decision-making, or that be what the interaction is really about. And by the way, the same thing is true for all psychiatric medications. Kimberley: I was going to say that's what we know about OCD and anxiety disorders too. Medication alone is not going to cut you across the line.  Ryan: And for most people, therapy alone is also not going to cut the line. You have to have a mild case for therapy alone to be okay. And I can trouble for that statement. But the other thing is lifestyle. What lifestyle changes can I make? And those together, all three, are going to mean that you get better faster, you get more better than you would have, you're more likely to stay better. And they start to interact with each other in a good way, where you get this synergistic effect of ripples of good things happening to you and personal growth. You look back, and you're like, “Geez, I'm on version 3.0 of me. I didn't know that there was a new, refined personal growth version of me that could actually function much better. I didn't actually believe that.” DOES ADHD IMPACT SELF-ESTEEM?  Kimberley: Well, especially you talked about this impact to self-esteem too. So, if you're getting the correct treatment and now you're improving, as you go, you're like, “Okay, I'm actually smart,” or “I'm actually competent,” or “I'm actually creative. I had no idea.”   Ryan: Yes. “I'm not stupid.” Lots of people with ADHD think they're stupid.   Kimberley: Yeah. So, that's really cool. One question I have that's just in my mind is, does --  Ryan: And that should be part of your treatment, is the working through. That was essentially a complex trauma. It's the complex trauma of having this condition that may not have been treated that made you think that you were an idiot because you were being shoved into a situation that you did not know how to deal with because your ADHD evolved to be an advantage for you as a hunter-gatherer for the hundreds of thousands of years that we had that, and that modern world is not very compliant for. It doesn't experience you as fitting into it well. And then you feel bad about yourself. ADHD IN MALES vs. FEMALES  Kimberley: Right. You're the class clown, or you're the class fool, or the dumb girl, or whatever. Now, my last question, just for my sake of curiosity, is: does ADHD look different between genders?  Ryan: This is an area of significant research. So, historically, the party line has been that ADHD is significantly more common in boys and girls. And the epidemiology, the numbers, the prevalence have always supported that. Like 3 to 1, 2 to 1, like a much more, much more common. Refining of that idea has come up with a couple of thoughts. One, for whatever reason, I don't know how much of this is genetic. I have no idea how much of this is environmental, sociological. All other things being equal, after a certain young age, girls just always seem to be ahead of boys in their development. I mean, talk to any parent that's had a lot of kids, and they'll tell you that they're like, “I don't know why the girls are always maturing faster.” So, that's a bias that is going to always make at any given point. The boys look worse because their brains are not developed. So, they're going to be -- remember that immature younger thing? They're going to be immature and younger. And so at any given marker is that.  The other thing that's come up is that the hyperactivity seems to be something we see a lot more in males than in females. That's another thing. And versus inattentiveness, which you see in both and is usually the predominant symptom. And the kid who gets noticed is the little boy who's like -- I mean, not that you could do this in today's world, but has scissors and is about to cut a kid's cord. I'm trying to make a silly imagery. That kid's getting a phone call. No one didn't notice that. The whole class called that. Whereas like daydreaming, I'm not really listening—this is a more passive experience of ADHD. And they're not disrupting the room. Forget about the gender thing. Just that presentation is also less noticed.   So, I think the answer is the symptomology presentation is a little different. It tends to be predominantly hyperactive. Are the rates different? Yes, they're probably not as wide of a difference as we think they are, because we're probably missing a good number of girls. Are we missing enough girls to make it 50/50? I don't know. That would be a lot of -- it's a big gap. It's not close. It's a pretty big gap. Maybe we're certainly missing some.   And then the other aspect of it is particularly post-puberty. Even before puberty, there's hormonal changes going on. And these hormones, particularly testosterone, which is present in everyone, we think about it as a male thing, but it's really just like a balance thing. You have significant amounts of both. It affects a number of things, and attention is one of them. So, there's so many complexing factors to it. That's why I said, it's something we're still trying to sort out.   One of the things that's really interesting that goes back to the hormone thing is that if you talk to young women— so postmenstrual, they've gone through puberty—they will tell you over and over again that their symptomology, just like we have mood symptoms tend to be worse during that time period of when you're ovulating, the ADHD symptoms will be worse as well. And so, there's increasing evidence that if you're on ADHD medication and you have ADHD, which again, we're making lots of presumptions here, go get that confirmed, guys. But if you're on that time period just leading up to ovulation a little bit after, you may actually need a higher dose of your medication to get the same effect. That there's something about the way progesterone and whatever is changing that it affects functionally your attention and your experience of your symptomatology.   Kimberley: Interesting. Yeah, thank you for sharing that. Is there anything you feel like we've missed or a point you really want to make for the folks who are listening who are trying to really untangle, like you said, that imagery of untangle, anxiety, ADHD, all of the depression, self-esteem?  Ryan: This is like a sidebar that's related. So, one of my other areas of interest is cannabis. And here in New York, we've had a lot going on with cannabis. And there's a lot of science going on around, can cannabis be used to treat things, particularly psychiatric disorders? And I know that a lot of people are interested in that.  One of the things that I've been really trying to caution people around with it is that the original thing that I was probably taught in the ‘90s about cannabis, marijuana being like this incredibly unsafe thing, is not true. But the narrative that it's totally fine and benign is also not true. And that it is probably going to be effective in reducing anxiety acutely, and it will probably be effective in maybe even improving your mood. And some people with ADHD even think it improves their attention by calming their mind. I am very cautious about people starting to use that as part of their treatment plan. And I can tell you why.  Kimberley: Because you did say there's an increase in substance use.  Ryan: The problem is that it's not rolled out in a way that reflects an appropriate medical treatment. So, if you do it recreationally, obviously, it's basically like alcohol. You just get what you want, and you decide what you want. If you do it medically, depending on the state, as a general rule, you just get a medical card and then you decide what you're going to do, which just seems crazy to me. I mean, you don't do that. You don't send people home with an unlimited amount of something that is mind-altering and tell them to use as much as they need. And the potencies, the strength of it has gotten stronger and stronger.   And so, I really caution people around this because when you use it regularly, what ends up happening is you get this downregulation, particularly daily use. You get this downregulation of your receptors, your cannabinoid receptors. We all have cannabinoid receptors. And you have fewer and fewer of them. And because you have so much cannabinoid in your system because you're getting high that your body says, “I don't need these receptors.” So then when you don't get high, those cannabinoid receptors that modulate serotonin, dopamine—so functionally, your attention, your mood, your anxiety level—there's none of them left because they've been getting bound like crazy to this super strong thing. And you're making almost none yourself, so you're going to feel awful. You're going to feel awful. And it's not dosed in any kind of appropriate way. We're not giving people guidance on this.   So, I really caution people when they're utilizing this, which the reality is that a lot of people are, that they be thoughtful about that and thoughtful about the frequency that they're using and the amounts that they're using, and if they're at a point where they're really trying to self-medicate themselves, because that can really get out of control for people. They can get really out of control. And I think it's unfortunate that we don't have a better system to help people with that. That is more like the evaluation of an FDA-approved medication or something like that has a system through it.   So, I just wanted to add that because I know this is something that a lot of people are thinking about. And I think it can be hard to get really good science information on since there's a big movement around making this change. When we're doing a big movement around pushing for a change, we don't want to talk about the reasons that the change might be a little problematic, and therefore slow the change down. So, we forget about that. And I think for the general public, it's important to remember that.  Kimberley: Yeah, I'm so grateful that you did bring that up. Thank you. Where can our listeners learn more about you or be in touch with you?  Ryan: So, if they want to learn more about my practice, my clinical practice, integrativepsych -- no, integrative-psych.org. We changed. We wrote .nyc. There we go. And then if you want to learn about my science and my lab and our research, which we also love, if you just go to Sultan (my last name) lab.org, it redirects to my Columbia page, and then you can see all about that and send some positive vibes to my poor research assistants that work so hard.   Kimberley: Wonderful. I'm so grateful for you to be here. Really, I am. And just so happy that you're here. So much more knowledgeable about something that I am not. And so, I'm so grateful that you're here to bring some clarity to this conversation, and hopefully for people to really now go and get a correct assessment to define what's going on for them.  Ryan: Yeah, I hope everyone is able to digest all this. I said a lot. And can hopefully make better decisions for themselves for that. Thank you so much.  Kimberley: Thank you.

In this episode, we review the high-yield topic of ⁠Methylphenidate⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Psychiatry section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

The Promise of Discovery Season 4, Episode 2 Manganese is essential for brain development and human health. However, excess manganese can be toxic. The Harrison lab discusses how manganese exposures can alter the response to some drugs currently used to treat intellectual and developmental disabilities. Featuring: Adriana Tienda, Lab Manager, Harrison Lab Interviewer: Fiona Harrison, Ph.D., assistant professor of Medicine; Director, IDDRC Behavioral Phenotyping Core (Core D); Mouse Behavioral Phenotyping Faculty Coordinator; VKC Member

Ritalin is a central nervous system stimulant. Methylphenidate affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.Ritalin is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy. it is one molecue away from being crack cocaine but yet black children are given this drug so they canlearn in school while their fathers are locked up for selling cocaine.Become a supporter of this podcast: https://www.spreaker.com/podcast/conspiracy-theories--5194379/support.

The Cochrane Developmental, Psychosocial and Learning Problems Group produced several reviews relevant to the treatment of attention deficit hyperactivity disorder and the update for one of these, investigating the drug methylphenidate, was published in March 2023. Here's one of the authors, Maja Storm from the Psychiatric Research Unit, Region Zealand in Denmark, to tell us about the latest evidence.

The Cochrane Developmental, Psychosocial and Learning Problems Group produced several reviews relevant to the treatment of attention deficit hyperactivity disorder and the update for one of these, investigating the drug methylphenidate, was published in March 2023. Here's one of the authors, Maja Storm from the Psychiatric Research Unit, Region Zealand in Denmark, to tell us about the latest evidence.

Can you treat >95% of all patients with mood, anxiety, and psychotic disorders with just ten meds? Dr. H says YES.Here he posits his top ten, based on efficacy, safety, tolerability, and cost.BFTA on Instagram. @backfromtheabysspodcasthttps://www.instagram.com/backfromtheabysspodcast/BFTA/ Dr. Hhttps://www.craigheacockmd.com/podcast-page/

Trigger warning Klaxx-ON... due to a mental health issue james is only partly involved in this episode.In Episode 92, The ADHD Adults discuss the process of titrating medication (or effectively getting the dose right).  As usual, the episode includes Alex the Psycho.....education Monkey's vomit-inducing information on the topic, personal reflections from all three ADHD adults (James was up to this bit) about their titration experience and what Mrs ADHD now apparently calls 'wanking' or 'top tips'.  'What has James HISTORICALLY lost, forgotten or mislaid ?" returns, and Alex reads out the usual 'definitely real' correspondence.  No one checks on Alex, James has really bad hair and  Mrs ADHD has a titration 'officer'...Support the showWritten by Alex Conner and James BrownProduced by James Brown and Afatscientist Ltd.Social media contacts: @theadhdadultsMusic by Sessionz

Professor Ian Wong joins Sophia Davis to discuss the research on methylphenidate for children and adolescents with ADHD.Read the full article:Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) studyContinue this conversation on social!Follow us today at...https://twitter.com/thelancethttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay. In this episode, I will be giving details of different Mixed Action Sympathomimetic drugs like Ephedrine, Methylphenidate, Pemoline and miscellaneous groups of drugs like Naphazoline, Xylometazoline, Phenylephrine, Pseudoephedrine and Phenylpronolamine, etc Basic characteristic features like mechanism, drug action, effect, pharmacokinetic details, indications and adverse effects are discussed thoroughly. Food for thought is like a gift of contemplation and is expressed in words of Blaise Pascal in beginning of the conference as well as in my own poetic word rhyme in the end! For all the updates and latest episodes of my podcast, please visit www.ispharmacologydifficult.com where you can also sign up for a free monthly newsletter of mine. It actually contains lot of updates about the medical sciences, drug information and my podcast updates also. You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". If you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts, stay safe, stay happy, stay enlightened, Thank you!! You can access various links via- https://linktr.ee/ispharmacologydifficult Please leave Review on Apple podcasts! My E-Newsletter sign up at Website! Connect on Twitter & Instagram! My books on Amazon & Goodreads!

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay.In this episode, I will be giving details of different Mixed Action Sympathomimetic drugs like Ephedrine, Methylphenidate, Pemoline and miscellaneous groups of drugs like Naphazoline, Xylometazoline, Phenylephrine, Pseudoephedrine and Phenylpronolamine, etcBasic characteristic features like mechanism, drug action, effect, pharmacokinetic details, indications and adverse effects are discussed thoroughly.Food for thought is like a gift of contemplation and is expressed in words of Blaise Pascal in beginning of the conference as well as in my own poetic word rhyme in the end!For all the updates and latest episodes of my podcast, please visit www.ispharmacologydifficult.com where you can also sign up for a free monthly newsletter of mine.It actually contains lot of updates about the medical sciences, drug information and my podcast updates also.You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". If you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts, stay safe, stay happy, stay enlightened, Thank you!!You can access various links via- https://linktr.ee/ispharmacologydifficultPlease leave Review on Apple podcasts!My E-Newsletter sign up at Website!Connect on Twitter & Instagram!My books on Amazon & Goodreads!

JAACAP January 2023: Contributing Editor Dr. Desiree Shapiro interviews Dr. Giorgia Michelini on the investigation of the neural mechanisms underlying medication effects using cortical source analysis of electroencephalography (EEG) data.

JAACAP January 2023: DESCRIPTION

In this episode, we review the high-yield topic of Methylphenidate (Ritalin) from the Psychiatry section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/MethylphenidateConcertaNursingConsiderations    Generic Name methylphenidate Trade Name Ritalin, Concerta Indication ADHD, narcolepsy Action improves attention span in ADHD by producing CNS stimulation Therapeutic Class central nervous system stimulant Pharmacologic Class none Nursing Considerations • can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia • may decrease effects of Warfarin and Phenytoin • do not use with MAOIs • monitor cardiovascular system • monitor for behavioral changes • monitor for dependence • do not consume caffeinated beverages “Drug Holiday” used to assess dependence and status

Is it safe to use stimulants in preschool children with ADHD? In this episode, we discuss the long-term symptom control and safety of an ER methylphenidate compound in preschool children 4 to

What other medications can we offer to our patients with BPD? This episode discusses some novel medication approaches used in borderline personality disorder, including omega-3 fatty acids, methylphenidate, clonidine, doxazosin, memantine, and oxytocin.  Faculty: Paul Links, M.D.  Host: Jessica Diaz, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Pharmacologic Management of BPD: Recent Developments Omega-3 Fatty Acids, Methylphenidate, Clonidine, Doxazosin, Memantine, and Oxytocin for BPD

This episode discusses the evidence and benefits of topiramate and stimulant replacement therapy for cocaine use disorder. It also addresses the use of these medications when there are comorbidities, such as alcohol use disorder and ADHD.  Faculty: Andrew Saxon, M.D.  Hosts: Jessica Diaz, M.D. Learn more about Premium Membership here Earn 1 CME: Experimental Pharmacotherapies for Stimulant Use Disorder Topiramate and Methylphenidate for Cocaine Use Disorder and Its Comorbidities

FIrstly about 1 in 10 children have ADHD and about half will grow out of it leaving 1 in 20 adults with ADHD. The long term studies in adults have not been done but the oldest patient I have diagnosed and treated with ADHD was 68.There is a strong genetic component and it is almost certain that other members of the family will have symptoms of ADHD. There is also a greater than average association of ADHD with bipolar disorder and dyslexia.People with ADHD often present with an inexplicable failure to succeed in life. In other words they are intelligent and affable and try to apply themselves but they fail.ADHD can make is so difficult to function that there is a high incidence of depression and anxiety alcohol and substance use.It is also not an uncommon cause of relationship problems amongst couples as the ADHD person will be impatient and irritable and impulsive and difficult to communicate with.often appearing not to listen.Notably of patients diagnosed with clinical depression then 25% will have ADHD and unless it is treated the depression will not resolve.As a child ADHD can have severe direct and indirect consequences on self esteem, socialisation and general ability to function and be consistent which are all hugely involved in success in life.One can imagine a child with ADHD being relentlessly hyperactive impulsive and inattentive will be hard to manage for the parents who typically chastise verbally and physically. This negativity erodes the green shoots of self esteem . The child gets used to criticism, and also gets used to failure and comes to expect both.  One patient was so out of control that his father used to take him out into the garden and hose him down with cold water. They will have difficulty with socialisation and will tend misbehave as a consequence of the ADHD at school and be punished.There are two issues as far as schools are concerned. ADHD -unless it is very mild- is a disability and is covered under the Disablity discrimination act 2010. Additionally even if the child is treated with medication the disability criterion applies as if the child is not on medication. Therefore if the school is sanctioning a child for behaviour as a result of disability or if they are insisting on behavioural targets such as a behavioural contract then they are setting up the child to fail.Not making reasonable adjustments is part of disability discrimination and is illegal.The second is abuse by neglect. If either parent or school knowingly do not take steps to help their child once they know they have ADHD then that is abuse by neglect.Parents should be wary of the paradoxical reinforcement of shouting or physical punishment. Either may arouse the child so much that their dopamine goes up producing a compliant calm child. The parent in desperation learns this is an effective way of curbing unruly ADHD behaviour and the child gets used to being scolded criticised and punished and absorbs that into their self esteem and personality. One of my patients as a child was so hyperactive the only way his father could get him to calm down was to take him out and turn the high pressure water hose on him. That raised his dopamine.This is also the rational when an occupational therapist recommends ‘Play breaks' at school if an ADHD is getting unrully or for quiter play ‘hard putty'. All these provide physical stimulation hence raising dopamine.Far preferable of course to take a simple tablet rather than treating the child differently to the others.Medication for ADHD:Stimulants: Methylphenidate and different types of preparation of this. They come is standard release or sustained release (modified release)In the USA there is also Dexedrine (adderall) which is a mixture of standard and slow release salts.All these are Class B drugs and have to be prescribed with a CD Pad (controlled drug pad)National Institute of Clinical Excellence Guidlines state that one a consultant psychiatrist has made the diagnosis and continues supervision of the patient then the GP can prescribe it. Many GPs however do not. Either because they dont understand it, or they are anxious about a class B drug or they don't believe in ADHD.Unlicensed stimulant : Modafanil (Provigil) is a histaminergic agent which at high dose has been shown to treat ADHD. note that antihistamines sedtate so histaminergic agents will stimulate.Non stimulant medications:Atomoxetine (Strattera) : this raises dopamine and noradrenaline but it is a cumulative effect similar to an antidepressant and needs to be taken constantly . Stimulant medication can be taken according to the requirements and then not taken if not required.Guanfacine: a central alpha 2 receptor agonist which raises dopamine in the Pre Fronatl Cortex.Psychological:This is required often due to the direct negative effects of ADHD and the indirect  effects eg therapy will teach good habits such as reflection, communication, impulse control. We also have to fix fractured self esteem. All this is almost completely useless -although it depends on the precise degree of ADHD-  if the patient is not on medication as they cannot concentrate enough to cooperate.Family Therapy is important as the parents need to be educated on how to best help their child and also be reassured they are not bad parents.I help them try and be mindful using a visualisation based on the film the Mask with Jim Carrey who played a gentle hopeless romantic with no confidence. Putting on the Mask exponentially magnified these qualities restoring his confidence and turning him into a mischievous charming hyper energetic caricature of himself. I say they are are getting angry with the Mask of ADHD not their child but their child absorbs all negative input and chastisement into their personalities.Parents also benefit from education about the law as it applies to their child's eduction:All publicly funded nurseries, per-schools, state schools and local authorities must try and identity and assess children with Special Education Needs(SEND).There must usually then be an Educatinoal Health Care Plan (EHCP) which must be reviewed annually and from Year 9 there must be a full review preparing the child for adulthood.From the age of 5 onwards it is the law that every child has a right to full time education.Schools will need to take appropriate steps such as expert assessment by educational psychologists, occupational therapists, speech therapists and referral to local child and adolescent mental health services. If necessary the EHCP will be submitted to the local health authority for extra funding if one to one is required although most schools do have some extra budget themselves for this but of course they dont like using it and usually need ‘encouragement' by an ‘informed' parent. The trouble is not all parents are informed. I remember seeing a Polish mother picking up her 7 year old son at lunchtime as the school had enforced half day attendance. This is illegal and refers back to one my basic rules of human behaviour: people do what you let them.Private schools are bound by OFSTEAD and usually align themselves on their website to rights of equal access to full time education for all. I recently had to write a report for a 15 year old with ADHD -and the school knew he had ADHD- who had been put by the school on a behavioural contract which he broke as he could not stick to it and was sanctioned for it. This is not only failure to make reasonable adjustments but direct harm to the child. It is disability discrimation and therefore illegal. As far as physical treatment goes the American Text Book of Psychiatry states that after assessing for diagnostic criteria in DSM V then a definitive diagnosis is obtained by a positive trial of treatment with a stimulant, the point being that only someone with ADHD would become calm and focused on a stimulant and everyone else without ADHD would experience the stimulant effect.Indeed many people with ADHD will self medicate with some kind of stimulant ie sippling coffee or coca cola throughout the day. Many will resort to Cannabis that does not so much focus the mind as give a blanket of relaxation that some equate with better functioning but it is not a direct cognitive effect and in some results in an amotivational syndrome.Highly suggestive of ADHD is someone who has no difficulty getting to sleep after an espresso. Some people with ADHD also report paradoxical responses to cocaine so that while everyone was partying the night away after a line of coke they sat quietly on the sofa. (this will depend on the dose of cocaine as I will explain later).Indeed Donald Trump drinks 6 diet cola day and will well known to not be able to sit through meetings and tends to be impulsive and disinhibited. Look at Boris Johsnon, impulsive and disinhibited and who apparently is not interested in the roll of prime minister, just the position of power. Since the work of the prime minister is not interesting to him he actually genuinely cannot do it. However he is a classic scholar and self professed lover of ancient Greece the writings of which have been the basis of study of oratory and because he likes the classics he has no difficulty writing a book on Ancient Greek.The neurotransmitter deficit is dopamine. People with ADHD do not have enough dopamine and treatment seeks to bring dopamine levels back into the normal range. Taking too much stimulant may push dopamine above normal levels whereupon overstimulation would occur.Precisely because the idea is to bring dopamine back to normal levels there should be few if any side effects.Since dopamine is the pleasure neurotransmitter then this is why people with ADHD can focus if they like something  their dopamine goes up into the normal range so performance at school can be starkly binary being either great or awful at something. Indeed if they like something they can hyperfocus.

The use of the combination of stimulants and antipsychotic medications is increasing in pediatric patients who suffer from Attention Hyperactivity Disorder (ADHD). In this podcast, Dr. Mohamed Mohamoud discusses how this combination may result in acute hyperkinetic movement disorder in children. Using the FDA Adverse Event Reporting System database, Dr. Mohamoud and his colleagues conducted a case series analysis and identified 36 instances where a pharmacodynamic drug-drug interaction may have resulted in the disorder. Their report is published in the May/June 2022 issue of the Journal of Clinical Psychopharmacology. Prescribing information has recently been updated and this podcast discusses the data upon which that information was changed. Dr. Mohamoud is being interviewed by FDA press officer Charlie Kohler.

Dr. H sits down with Dr. Usha Udupa, a Colorado-based child and adolescent psychiatrist, to explore the complexities of working with patients in the context of the family.  They discuss topics such as:How and when family members should be included in treatmentWhat if the patient refuses family involvementWhen the identified patient isn't the problemHow and when to break confidentiality, especially with substance abuseWhat are the hidden stories behind what people believe about medsWhy so many young men are failing to launchWhat to do when one or more family members don't believe in treatmentDr. H talks all things ADD/ADHD, meds/stimulants, treatment optionshttps://anchor.fm/apositivepodcast/episodes/Episode-24-Everything-ADDADHD--Medication--with-Dr--Craig-Heacock-e1fj85mPlease take the BFTA listeners poll--we really want your input!https://bit.ly/3eQ8DdyBFTA on Instagram. @backfromtheabysspodcasthttps://www.instagram.com/backfromtheabysspodcast/BFTA/ Dr. Hhttps://www.craigheacockmd.com/podcast-page/

Methylphenidate Trade – Concerta Use – ADHDEstradiol Trade – Climara Use – Menopaus Losartan Potasium Trade – CozaarUse – High cholesterol 

Methylphenidate comes in many dosage forms with a variety of brand names but this drug is most commonly known as Ritalin. Some of the dosage forms are as immediate release (IR) tablets, extended release (ER) capsules, patches, orally disintegrating tablets (ODT), and solutions. When treating ADHD, dosing is highly variable and based on dosage form but a common between most all of the oral dosage forms is to not take a dose after 6 pm and to take 30-45 minutes before a meal. Methylphenidate can be used in treating both children and adults with ADHD but there is one other indication for this drug being for treating narcolepsy. The mechanism of action is not fully understood but it is proposed to have CNS sympathomimetic effects which increase norepinephrine and dopamine release while blocking reuptake. This medication is poorly protein bound up to 33%. Common side effects are insomnia, weight gain, and irritability but the most serious concern is the black box warning for abuse and dependence. CNS stimulant abuse risk should be assessed and monitored in patients. Go to DrugCardsDaily.com for episode show notes which consist of the drug summary, quiz, and link to the drug card for FREE! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. The main goal is to go over the Top 200 Drugs with the occasional drug of interest. Also, if you'd like to say hello, suggest a drug, or leave some feedback I'd really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on twitter @drugcardsdaily --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

ADHD treatment for adults can often include medication. We continue our conversation about ADHD medications, their place in treatment and our role as therapists. Check out this episode of the All Things Substance podcast.

What medications are used to treat ADHD? What are the different kind of medications? How do stimulants work in treating ADHD?  The number of ADHD diagnoses are rising. Prescriptions numbers for ADHD medications are higher than ever too. What impact do these things have on our work? Check out this week's episode of the All Things Substance podcast.

Summarizing the recent science that’s been done on Mitochondria along with some salient insights and knowledge coming out of the Biohacker community online.Impressively in the past year, there have been over 230 scientific papers published specifically on Mitochondria, including 11 clinical trials. Mitochondria is a hot area of research, this article will not summarize every single one but some of the more interesting findings of the current year.Read meta-analysishttps://www.limitlessmindset.com/blog/576-meta-analysis-mitochondria-science5:31 Caloric Restriction in Healthy Individuals7:49 Resveratrol10:05 Elamipretide11:45 Mitochondrial Nootropics15:50 Mitochondrial Eye Drops?17:50 Mito-TEMPO21:48 Coenzyme Q1027:54 Methylphenidate a Mitochondrial Hack for ADHD?29:01 Pyrroloquinoline Quinone30:46 B Vitamins33:20 Creatine36:00 Magnesium38:30 D-Ribose40:47 MitoQ45:40 Mitochondrial Function and Cramping46:37 Mitochondrial Nootropics take time48:09 mtDNA and Knee Osteoarthritis49:22 Vs Leukemia52:30 Pharmaceuticals vs Mitochondria 53:39 ConclusionConfused?If you invest at least $100 in your Biohacking via LimitlessMindset.com, I will include a 30-minute free Biohacking consulting call with you. See my recommended Nootropics sources and Biohacking products here:https://www.limitlessmindset.com/membership/secret-societyForward a receipt of at least $100 to Consultations@LimitlessMindset.comJoin the Limitless Mindset email newsletterhttps://www.limitlessmindset.com/membership/community-membershipSupport My WorkMy bookshttps://www.limitlessmindset.com/jr-booksDonate cryptocurrencyhttps://www.limitlessmindset.com/support#cryptocurrencyConnect with Jonathanon Facebookhttps://www.facebook.com/limitlessmindseton Twitterhttp://twitter.com/jroselandon Instagramhttps://www.instagram.com/roselandjonathan/on Gabhttps://gab.com/jroselandon Mindshttps://www.minds.com/jroselandon LBRYhttps://lbry.tv/@jroseland:fon Telegramhttps://t.me/limitlessjrI'm not a doctor, medical professional, or trained therapist. I'm a researcher and pragmatic biohacking practitioner exercising free speech to share evidence as I find it. I make no claims. Please practice skepticism and rational critical thinking. You should consult a professional about any serious decisions that you might make about your health.

This week, we're discussing ADHD: attention deficit hyperactivity disorder. It can lead to difficulty concentrating and focusing on tasks, and many adults don't actually realise they have it. So what is it, and what can we do to help people who have it? Plus, news of the Indian variant of Covid-19, new discoveries from the 40 year old Voyager 1 probe, and bats made from bamboo - but is that cricket? Like this podcast? Please help us by supporting the Naked Scientists

This week, we're discussing ADHD: attention deficit hyperactivity disorder. It can lead to difficulty concentrating and focusing on tasks, and many adults don't actually realise they have it. So what is it, and what can we do to help people who have it? Plus, news of the Indian variant of Covid-19, new discoveries from the 40 year old Voyager 1 probe, and bats made from bamboo - but is that cricket? Like this podcast? Please help us by supporting the Naked Scientists

Dr. Travis Mickle President and CEO KemPharm describes the development of AZSTARYS, the stimulant-based methylphenidate prodrug treatment for ADHD one of the most common central nervous system diseases. This prodrug stimulates the norepinephrine dopamine reuptake inhibitor improving concentration, executive function, and irritability and provides for long-acting effect and protection from abuse as it is broken down in the lower GI. Travis' personal experience with ADHD and raising children with ADHD gives him a deep understanding of the challenges facing patients as well as their physicians. @kempharm #Kempharm $KMPH #ADHD #CNS KemPharm.com Listen to the podcast here.

Dr. Travis Mickle President and CEO KemPharm describes the development of AZSTARYS, the stimulant-based methylphenidate prodrug treatment for ADHD one of the most common central nervous system diseases. This prodrug stimulates the norepinephrine dopamine reuptake inhibitor improving concentration, executive function, and irritability and provides for long-acting effect and protection from abuse as it is broken down in the lower GI. Travis' personal experience with ADHD and raising children with ADHD gives him a deep understanding of the challenges facing patients as well as their physicians. @kempharm #Kempharm $KMPH #ADHD #CNS KemPharm.com Download the transcript here.

Here are the links for everything discussed in Episode 54. Times are also below so feel free to skip around and get to the drugs that interest you. (1:15) - Azstarys approved for ADHD (4:44) - Approval of Fotivda as new RCC treatment option (8:12) - Added indication for Yescarta in follicular lymphoma CDC updates on COVID-19 & influenza reporting Connect with The Rx Daily Dose:Twitter      Instagram      YouTube      Linkedin       WebsiteEmail: therxdailydose@gmail.comConnect with Ian Parnigoni PharmD. on social media:Twitter       Instagram       Linkedin  ★ Support this podcast on Patreon ★

Alcohol can affect the way methylphenidate is meant to function. Hence it is not safe to drink while on methylphenidate.https://recoverypartnernetwork.com/alcohol/effects/mixing-alcohol-with-other-drugs

Today's show will take a leaning to the French people and their culture. First off, I want to thank all my fans from France. I was checking out my dHarmic Evolution Podcast download stats, and right behind America, France is the country with the 2nd highest download stats. So thank you to all you French fans of the podcast! Weird enough though, I don't think I've hosted any French guests on the show before. Having hosted artists from over 35 different countries, I am still looking to host a French artist. So if you're listening to the show and know a French singer/songwriter, author, speaker, or thought leader, kindly recommend them to me and I'd love to have them on the show. They can reach me at james@thejamesoconnoragency.com With the quarantine going on, I've been spending a lot of my extra time running, praying, and reading books. Running is really helping me keep fit since there aren't any yoga studios open just yet. I've also discovered and learned so much info in front of the recent Tech books I've been reading. I'm a new student of Cryptocurrency and the book “Crypto Facts” alongside George Gilder's “Life After Google” are some of the masterpieces that I've been reading to help increase my knowledge of this new space. Thank you, France! Having dedicated the show to my French fans, I figured I'd entertain all of you with some top, interesting facts about the French and their culture, most of which just might blow your mind! But before that, I wanna share an off the book fact that I recently learned from a World War 2 documentary I was watching. Did you know that the Germans, when attacking France, were pumped up on Methylphenidate to keep them up and running for 3 straight days? A task the French thought it would take the Germans at least 2 weeks to accomplish, the Germans were able to break through into Paris in just 3 days! With that said, here are some of the top facts about the French and their culture that I bet you didn't know. • France is sometimes known as The Hexagon due to the fact that it has six sides • When all of French's possessions worldwide are taken into account. France occupies 12 time zones. The most of any country. • Paris was a roman city originally. It was known as Lutetia • In addition to being the most studied language in the world after English. Alongside, Italian and Spanish, French is one of the most romantic languages. The duo has origins in Latin. • The French army was the first to use camouflage as a war tactic in world war 1 • Over one-half of the traffic roundabouts worldwide is located in France. • In the Second World War, when Hitler visited the Eiffel Tower, the French cut all of the lift cables. This forced him to climb the stairs if he wanted to enjoy the view from the top. • King Louis the 19th had the shortest reign in history: 20 minutes. His father had abdicated the throne, and Louis followed him in abdicating in favor of his nephew. • France made history in 2016 by banning supermarkets from throwing out unsold food items. These stores are now required to donate food to charities and food banks. • During the Second World War, the Mosque of Paris protected French Jews from the Nazis by supplying them with Muslim Identification cards. • The famous Lascaux Caves in France have rock paintings in them dating back over 17,000 years. • The Louvre Museum in Paris is consistently the most visited museum in the world. Over 9 million visitors go through their doors annually. • By the 1660s France already had a form of public transportation. It consisted of horse-drawn wagons that followed a set schedule along specific routes. • For 214 years it was illegal in Paris for women to wear pants. This ended in 2012. • The highest mountain in France is Mont Blanc. At 15,780 feet, Mont Blanc is a part of the French Alps. • Despite France's reputation as a culinary mecca, French males have the lowest percentage of obesity in Europe. • In order to be a taxi driver in Paris, you would have to pay almost 200,000 Euros to get your license. • France is divided into 13 Regions, which are divided into 101 Departments. There are also 5 ROMs or overseas regions which are part of France. In December 2015, the regions were reorganized to the 13 current regions, down from the previous number of 22. • The oldest person in the world was (according to the Guinness Book of World Records), a French woman who lived to be 122 years and 164 days old. • No country has won more Nobel Prizes for Literature than France. • The French rail system, at 29,000 km, is second only to Germany's in length. • The actual name France came from a Germanic tribe. They used the word “frank”, which meant “free” in their native tongue. •Champagne comes exclusively from the Champagne region of France. If it doesn't come from there, it is simply referred to as a sparkling wine. Timestamps (3:58) Reading my way through the quarantine (10:11) Honoring my French fans (15:07) German soldiers - The original Meth users (16:20) About the French culture from my trip (18:36) Interesting facts about France and the French (32:57) Listen to “Tango On” Selected Links and Mentions Life After Google: The Fall of Big Data and the Rise of the Blockchain Economy Cryptofacts Vol 1 Just Mercy: A Story of Justice and Redemption 111Interesting facts about France Hitler, Meth, and the War: Sleepless on the Western Front As always, thanks a lot for being a part of the dHarmic evolution podcast, be sure to subscribe to the podcast and connect with us on social media. Follow our Podcast on Facebook Twitter Instagram  You can also see the show on The James O'Connor Agency YouTube channel and join our community on dHarmic Evolution Community Facebook Group

This episode is choc full of information. I do a quick review of the difference between the Authorized Generic and Generic drugs then delve into the rabbit hole with questions like:why should I care about the difference? how do I find who makes/sells the authorized generic?how do I ask my doctor for the authorized generic?how do I request approval from my insurance?how do I find out if my pharmacy carries the authorized generic?Check out the episode ADHD or not you will learn something about your prescriptions you probably didn't know. I am uploading the full show notes to my website because there are just so many links everything will be posted by Wednesday 3/11/2020.

Vous êtes toujours parmi nous? La fin approche! Dans ce 47ème épisode du Pharmascope et dernier de la série sur le TDAH, Nicolas, Isabelle et leur invitée discutent entre autres des options de traitement pharmacologiques autres que les psychostimulants. Les objectifs pour cet épisode sont : Comprendre les risques et les bénéfices associés à la prise de l’atomoxetine et de la guanfacineÉvaluer la place de l’atomoxetine et la guanfacine dans l’algorithme de traitement du TDAHAdapter le traitement pharmacologique du TDAH en fonction du patient Ressources pertinentes en lien avec l’épisode Lignes directrices canadiennesCADDRA - Canadian ADHD Ressource Alliance : Lignes directrices canadiennes pour le TDAH, quatrième édition, Toronto (Ontario); CADDRA 2018. Lignes directrices américainesWolraich ML et coll. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Subcommittee on children and adolescents with attention-deficit / hyperactive disorder. Pediatrics 2019. 144(4). pii:e20192528. Revues du TDAHThapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016;387(10024):1240-50. Auclair M, Elalami M. Traitement du TDAH chez l’enfant. Québec Pharmacie. Septembre 2018. 28p. Revue systématique globale Stuhec M, Lukic P, Locatelli I. Efficacy, Acceptability, and Tolerability of Lisdexamfetamine, Mixed Amphetamine Salts, Methylphenidate, and Modafinil in the Treatment of Attention-Deficit Hyperactivity Disorder in Adults: A Systematic Review and Meta-analysis. Ann Pharmacother. 2019; 2:121-133. Liens utiles pour ressourcesCanadian ADHD Ressource Alliance (CADDRA). 2020. Centre for ADHD awareness, Canada (CADDAC). 2017. Clinique FOCUS. 2020. Annick Vincent. TDAH, informations, trucs et astuces. 2020. Méta-analyse comparant l’atomoxétine aux psychostimulants en TDAHLiu Q, Zhang H, Fang Q, et coll. Comparative Efficacy and Safety of Methylphenidate and Atomoxetine for Attention-Deficit Hyperactivity Disorder in Children and Adolescents: Meta-analysis Based on Head-To-Head Trials. J Clin Exp Neuropsychol. 2017; 39(9): 854-65. Évaluation de la guanfacine en TDAH par l’INESSSInstitut national d’excellence en santé et services sociaux. INTUNIV XRMC – Trouble du déficit de l’attention avec ou sans hyperactivité. Février 2014. Étude portant sur des doses de 1 à 7mg de guanfacine en TDAH chez l’adolescentWilens TE, Robertson B, Sikirica V, et coll. A Randomized, Placebo-Controlled Trial of Guanfacine Extended Release in Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2015;54(11):916–925.

On today's episode of Your Thoughts, you think about the answer to the question: What adventure would you start if you had 4 hours of intense focus and abundant resources?Today's episode is sponsored by Methylphenidate. To learn more, complain to your doctor about not being able to focus.To share what you thought on today's episode or to send in a suggested prompt, visit https://yourthoughts.fm

Restez concentrés parce que ce n’est pas terminé! Après un premier épisode sur le diagnostic et la prise en charge non-pharmacologique du TDAH, on porte cette fois toute notre attention sur les pilules. Dans ce 46ème épisode du Pharmascope, Nicolas, Isabelle et leur invitée discutent donc du traitement pharmacologique du TDAH, plus spécifiquement des psychostimulants. Les objectifs pour cet épisode sont : Identifier les différentes formulations de psychostimulants disponibles dans le traitement du TDAHComprendre les risques et les bénéfices associés à la prise de psychostimulants dans le traitement du TDAHComparer l’efficacité et l’innocuité des différents psychostimulants entre eux en TDAH Ressources pertinentes en lien avec l’épisode Lignes directrices canadiennesCADDRA - Canadian ADHD Ressource Alliance : Lignes directrices canadiennes pour le TDAH, quatrième édition, Toronto (Ontario); CADDRA 2018. Lignes directrices américainesWolraich ML et coll. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Subcommittee on children and adolescents with attention-deficit / hyperactive disorder. Pediatrics 2019. 144(4). pii:e20192528. Revues du TDAHThapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016;387(10024):1240-50. Auclair M, Elalami M. Traitement du TDAH chez l’enfant. Québec Pharmacie. Septembre 2018. 28p. Revues systématiques portant sur les mesures non-pharmacologiquesGood AP et coll. Nonpharmacologic Treatments for Attention-Deficit / Hyperactivity Disorder: A Systematic Review. Pediatrics. 2018;141(6). Pii:e20180094. Lopez PL et coll. Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2018,23(3):CD010840. Études portant sur l’effet des amphétaminesPunja S et coll. Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev.2016;2:CD009996. Castells X et coll. Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev.2018;8:CD007813. Études portant sur l’effet du méthylphénidateStorebo OJ et coll. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev. 2015;11:CD009885. Epstein T et coll. Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2014;9:CD005041. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56:1073-86. Revue systématique globale Stuhec M, Lukic P, Locatelli I. Efficacy, Acceptability, and Tolerability of Lisdexamfetamine, Mixed Amphetamine Salts, Methylphenidate, and Modafinil in the Treatment of Attention-Deficit Hyperactivity Disorder in Adults: A Systematic Review and Meta-analysis. Ann Pharmacother. 2019; 2:121-133. Liens utiles pour ressourcesCanadian ADHD Ressource Alliance (CADDRA). 2020. Centre for ADHD awareness, Canada (CADDAC). 2017. Clinique FOCUS. 2020. Annick Vincent. TDAH, informations, trucs et astuces. 2020.

Methylphenidate has an FDA approved indication for ADHD. In this podcast episode, I cover the pharmacology, adverse effects, kinetics, and drug interaction. Because methylphenidate has stimulant type effects, it can raise blood pressure and heart rate. Weight, blood pressure, and pulse are important monitoring parameters in patients taking a stimulant type medication like methylphenidate. There are numerous dosage forms of methylphenidate which can help accommodate many different patients' needs.

Methylphenidate (dat onder meer in Ritalin zit) is een veel gebruikt stofje dat als medicatie dient voor kinderen met ADHD. Een nieuw experiment van het Amsterdam UMC bij Nederlandse jongens en volwassen mannen met ADHD laat zien dat het stofje de ontwikkeling van het brein van jongens met ADHD beïnvloedt. De jongens die het middel namen ontwikkelden een hogere dichtheid in zogenaamde witte materie in de hersenen in vergelijking met jongens met ADHD die een placebo (nepmedicijn) namen. Bij volwassenen trad het effect niet op. Witte materie zorgt voor de overdracht van signalen in het brein en speelt een belangrijke rol in het aanleren van zaken. Het onderzoek, gepubliceerd in het wetenschappelijke tijdschrift Radiology, ligt in lijn met eerdere studies over het effect van methylphenidate op de witte materie in de hersenen van jonge kinderen. We spreken hoofdonderzoeker Liesbeth Reneman, (hoogleraar neuroradiologie aan het Amsterdam UMC) over de implicaties van de studie.

Jamie Durrani diverts his attention to the rise of Ritalin, a drug first identified as a way of improving tennis performance

The post Methylphenidate (Ritalin) Nursing Pharmacology Considerations appeared first on NURSING.com.

PROJECT RECLAMATION Episode 27: Complacency In this episode we discuss complacency.  We dive into how easy it can be to slip into, and how dangerous it can be to our development, growth, and success.  1:52      Cobra Kai https://www.youtube.com/channel/UCe9DTWmhhxeKyYHL4mldGcA 2:52       How I Met Your Mother https://www.imdb.com/title/tt0460649/ 8:24       Wainscoting https://en.wikipedia.org/wiki/Panelling 12:05    McGriddles https://en.wikipedia.org/wiki/McGriddles 12:10    Ritalin https://en.wikipedia.org/wiki/Methylphenidate 20:43   Rupert Murdoch https://en.wikipedia.org/wiki/Rupert_Murdoch 23:30    Lukla Airport https://en.wikipedia.org/wiki/Tenzing%E2%80%93Hillary_Airport 23:33    Mt. Everest https://en.wikipedia.org/wiki/Mount_Everest 25:56    Baywatch https://www.imdb.com/title/tt1469304/ 25:59    Skyscraper https://www.imdb.com/title/tt5758778/ 26:03    The Rock Says 28:09    Simms Original Smoked Snack Sticks https://www.aldireviewer.com/2017/09/11/simms-mild-smoked-snack-sticks/ 29:18    Intermittent Fasting https://en.wikipedia.org/wiki/Intermittent_fasting 30:03    Nestle https://www.zmescience.com/science/nestle-company-pollution-children/ 33:04    Jean Paul Getty https://en.wikipedia.org/wiki/J._Paul_Getty 39:37    X Games http://xgames.espn.com/xgames/ 39:52    Red Bull Cliff Diving http://cliffdiving.redbull.com/en_US 56:36    Quote of the Show 57:20    Trent Reznor https://en.wikipedia.org/wiki/Trent_Reznor Project Reclamation Links Website: http://projectxreclamation.com Email: projectxreclamation@gmail.com Facebook: https://www.facebook.com/Project-Reclamation-395831667534101/ YouTube: https://www.youtube.com/channel/UCihrXohOFuDTZh1BM_HwiJw Instagram: https://www.instagram.com/projectxreclamation/?hl=en Twitter: https://twitter.com/ProjectReclama2 Jax the dog:  https://www.facebook.com/jax.frickmovicz.9 Page the dog:  https://www.facebook.com/page.frickmovicz.3 Tim's Links YouTube: https://www.youtube.com/channel/UCHCxAUPtoaoagQKW7lOdZSg Facebook: https://www.facebook.com/tim.frick.92 Instagram: https://www.instagram.com/t_k_ultra/?hl=en Twitter: https://twitter.com/TheTimFrick

What wrong with school and how could we make it better?

Jonathan Levi is an experienced entrepreneur and angel investor from Silicon Valley. After successfully selling his Inc 5,000 rated startup in April of 2011, Jonathan enlisted the help of speed-reading expert and university professor Anna Goldentouch, who tutored him in speed-reading, advanced memorization, and more. He saw incredible results while earning his MBA from INSEAD, and later went on to teach a best-selling online course on the subject. With this unique skill, Jonathan has become a proficient life hacker, optimising and “hacking” such processes as travel, sleep, language learning, and fitness. I recently had the privilege of featuring as a guest on Jonathan’s Becoming Superhuman podcast where we talk about an engineering approaching to creating health versus the medical approach for episodic illness. You could listen to this podcast to find out why and how to become a better learner. After all, “learning is the only skill that matters.”--Jonathan Levi. Here’s the outline of this interview with Jonathan Levi: [00:00:35] Becoming Superhuman podcast. [00:00:44] Podcast with Robb Wolf. [00:01:24] Problems learning in an academic setting. [00:01:55] ADD. [00:02:34] Unhappy adolescence. [00:02:49] Methylphenidate hydrochloride (Ritalin). [00:03:51] MBA program. [00:04:46] Professor Anna and Dr Lev Goldentouch. [00:06:15] Ted Talk: What If Schools Taught Us How To Learn? [00:07:12] Humans have a heavy preference for visual learning. [00:07:32] Newtonian physics. [00:09:10] Dr Ben Lynch, ND. [00:09:25] Organic acids testing, dopamine and tyrosine. [00:10:11] Learning is the only skill that matters. [00:10:26] Book: Becoming a Supple Leopard by Kelly Starrett. [00:10:42] Book: The Game by Neil Strauss. [00:11:12] Keto for brain health, fasting. [00:11:42] Magnesium deficiency. [00:12:09] Movement & exercise, norepinephrine. [00:13:19] Machine learning. [00:14:08] Book: Surely You're Joking, Mr Feynman! [00:14:56] Harry Lorayne. [00:15:07] Steve Jobs. [00:16:18] Debating. [00:19:18] Udemy. [00:22:31] Book: Moonwalking with Einstein by Joshua Foer. [00:25:37] Method of loci. [00:26:04] Neurons & synapses. [00:27:20] Hippocampus. [00:28:59] 5-HT4 serotonin receptor. [00:30:00] Book: The Adventures of Tom Sawyer by Mark Twain. [00:30:32] Ron White memory champion. [00:31:34] Anki flashcard software. [00:33:16] PageRank. [00:34:02] Clarke, Robert, et al. "Effects of homocysteine lowering with B vitamins on cognitive aging: meta-analysis of 11 trials with cognitive data on 22,000 individuals." The American journal of clinical nutrition 100.2 (2014): 657-666. [00:34:24] Spritzlet. [00:35:25] Evelyn Wood speed reading technique. [00:35:52] Pre-reading. [00:37:08] “Give me six hours to chop down a tree and I will spend the first four sharpening the axe.”--Abraham Lincoln. [00:38:39] The visual abstract. [00:40:27] Caring about the thing that you're trying to remember. [00:40:50] AcroYoga. [00:43:21] Malcolm Knowles. [00:43:58] Book: The China Study by T. Colin Campbell and Denise Minger rebuttal. [00:46:17] Become a SuperHuman: Naturally & Safely Boost Testosterone. [00:47:12] jle.vi/drugs [00:47:37] Sam Harris. [00:47:50] jle.vi/kombucha [00:48:13] Book: Stealing Fire by Steven Kotler. [00:49:39] Funktion-One sound system. [00:50:55] Meditation. [00:51:54] Modulating cortisol response. [00:53:17] becomeasuperlearner.com [00:53:42] becomingasuperhuman.com [00:54:49] Wim Hof. [00:55:38] Dr Bryan Walsh, ND.

Myocardial infarction (MI) in children is uncommon, but underdiagnosed.  This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector!  Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known.  The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms.  There are usually some red flags with a careful H&P.  The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery.  This child is at risk for expected complications, as well as overdiagnosis and iatrogenia.  Risk stratify, collaborate with specialists. The fussy, sweaty feeder: ALCAPA Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is an example of what can go wrong during fetal development: any abnormality in the number, origin, course, or morphology of the coronary arteries can present as a neonate with sweating during feeds (steal syndrome), an infant in CHF, or an older child with failure to thrive or poor exercise tolerance. The stable child with chest pain: myocardial bridge Normal coronary arteries run along the epicardial surface of the heart, with projections into the myocardium.  If part of the artery’s course runs within the myocardium (i.e. the artery weaves into and/or out of the myocardium), then there is a myocardial bridge of the coronary artery.  With every systolic contraction, the artery is occluded.  Although a myocardial bridge may not cause symptoms (especially at distal portions), the area it supplies is at risk. With any minor trauma or exertion, demand may outpace supply, resulting in ischemia.  Diagnosis is made on coronary angiography. The unwell child post-cardiac surgery: Fontan problems The child with single ventricle physiology may have a Norwood procedure at birth (creation of a neoaorta, atrial septectomy, and Blalock-Taussig shunt), a Bidirectional Glenn procedure at 3-6 months (shunt removed, superior vena cava connected to pulmonary arteries), and a Fontan procedure at about 2-3 years of age (inferior vena cava blood flow is shunted into the pulmonary arteries). These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.  They are typically on an anticoagulant (often aspirin), a diuretic (e.g. furosemide), and an afterload reduction agent (e.g. enalapril).  Any disturbance in volume status (hyper- or hypovolemia), anticoagulation, or afterload may cause myocardial strain or infarction.  Take the child s/p Fontan seriously and involve his specialists early with any concerns. Autoimmune The body’s inflammatory-mediated reaction to a real or perceived insult can cause short- and long-term cardiac sequelae.  Find out how well the underlying disease is controlled, and what complications the child has had in the past. The red, hot, crispy, flaky child: acute Kawasaki disease Kawasaki disease (KD) is an acute systemic vasculitis, diagnosed by the presence of fever for five or more days accompanied by four or more criteria:  bilateral conjunctival injection, mucositis, cervical lymphadenopathy, polymorphous rash, and palmar or sole desquamation.  The criteria may occur (and disappear) at any time during the illness. Infants are under double jeopardy with Kawasaki Disease.  They are more likely to have incomplete KD (i.e. not fulfill strict criteria) and if they have KD, they are more likely to suffer the dangerous consequences of aneurysm formation (chiefly coronary arteries, but also brain, kidney).  Have a low threshold for investigation. Treatment includes 2 g/kg/day IVIG and high-dose aspirin (30-50 mg/kg/day) acutely, then low-dose aspirin (5 mg/kg/day) for weeks to months.  Regular and long-term follow-up with Cardiology is required. The aftermath: sequelae of Kawasaki disease The family and child with a history of KD may have psychological trauma and continuous anxiety about the child’s risk of MI.  Approximately 4.7% of children who were promptly diagnosed and correctly treated will go on to have cardiac sequelae. Children who have no detected cardiac sequelae by 8 weeks, typically continue to be asymptomatic up to 20 years later.  Smaller aneurysms tend to regress over time, especially those < 6 mm. Thrombi may calcify, or the lumen may become stenotic due to myofibroblast proliferation.  Children with any coronary artery dilatation from KD should be followed indefinitely. Giant aneurysms (≥8 mm) connote the highest risk for MI.  Parents often are concerned about recurrence, and any subsequent fever can be distressing.  There is a low rate of recurrence for KD: approximately 2%.  Infants who have coronary aneurysms are at the highest risk for recurrence. The older child with vague chest complaints and hypercoagulability: Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome Up to 15% of cases of SLE begin in childhood.  Adult criteria are used, with the caveat that the diagnosis of SLE in children can be challenging; many children only manifest a few of the criteria initially before going on to develop further systemic involvement. The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012.  The patient should have ≥4/17 clinical and/or immunologic criteria.  The clinical criteria are: acute cutaneous (malar); chronic cutaneous (discoid); oral; alopecia; synovitis; serositis; renal; neurologic; hemolytic anemia; leukopenia; or thrombocytopenia.  The immunologic criteria are: ANA; anti-dsDNA; anti-Sm; antiphospholipid; low complement; and/or Direct Coombs (in absence of hemolytic anemia).  At least one criterion should be clinical, and at least one should be immunologic.  Children with antiphospholipid syndrome (APS) may occur with or without SLE.  Patients are at risk for venous and arterial thrombi formation.  APS may also cause structural damage, such as valvular thickening and valvular nodes (Libman-Sacks endocarditis).  Mitral and aortic valves are at the highest risk. Although most children with chest pain will not have MI, those with comorbidities should be investigated carefully. Trauma Direct, blunt trauma to the chest can cause myocardial stunning, dysrhythmias, or an asymptomatic rise in Troponin I.  However, some children are at risk for disproportionate harm due to a previously unknown risk factor.  Clinically significant cardiac injury occurs in up to 20% of patients with non-penetrating thoracic trauma. The motor vehicle collision: blunt myocardial injury Direct trauma (steering wheel, airbag, seatbelt), especially in fast acceleration-deceleration injury, may cause compression of the heart between the sternum and the thoracic spine. Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury.  A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring. Elevation in troponin is common, but not predicted.  A solitary elevated troponin without ECG abnormality is of unclear significance.  Author’s advice: obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. MVC, baseball, high-velocity soccer ball) may cause damage to the left anterior descending artery or left circumflex artery, at the highest risk due to their proximity to the chest wall.  Thrombosis and/or dissection may result, often presenting in a focal pattern of ischemia on the ECG. Echocardiography may reveal valvular damage related to the injury, as well as effusion and ejection fraction.  Since there is often a need to investigate the coronary anatomy, percutaneous coronary intervention (PCI) is recommended. The minor trauma with disproportionate complaint: myocardial bridge As mentioned in the congenital section (above), a known variation of a coronary artery’s course involves weaving in and out of the myocardium, creating a baseline risk for ischemia.  Even minor trauma in a child with a myocardial bridge may cause acute thrombus, or slow stenosis from resulting edema.  Unfortunately, the presence of myocardial bridging is often unknown at the time of injury.  Approximately 25% of the population may have myocardial bridging, based on autopsy studies. Take the child seriously who has disproportionate symptoms to what should be a minor injury. Hematologic Coagulopathic and thrombophilic states may predispose children to focal cardiac ischemia.  The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The child with sickle cell disease and chest pain: when it’s not acute chest syndrome Sickle cell disease (SCD) can affect any organ system, although the heart is traditionally considered a lower-risk target organ for direct sickling and ischemia.  The major cardiac morbidity in sickle cell is from strain, high-output failure and multiple, serial increases in myocardial demand, causing left ventricular hypertrophy and congestive heart failure. However, there is mounting evidence that acute myocardial ischemia in sickle cell disease may be underappreciated and/or attributed to other causes of chest pain. Other cardiac sequelae from SCD include pulmonary hypertension, left ventricular dysfunction, right ventricular dysfunction, and chronic iron overload. Evidence of myocardial ischemia/infarction in children with SCD has been demonstrated on single-photon emission computed tomography (SPECT) scan. The puffy faced child with chest pain: nephrotic syndrome hypercoagulability Children who suffer from nephrotic syndrome lose proteins that contribute to the coagulation cascade.  In addition, lipoprotein profiles are altered: there is a rise in the very low-density lipoproteins (LDL), contributing to accelerated atherosclerosis.  Typically nephrotic patients have normal levels of high-density lipoproteins (HDL), unless there is profuse proteinuria. Children with difficult-to-control nephrotic syndrome (typically steroid-resistant) may form accelerated plaques that rupture, causing focal MI, as early as school age. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI.  However, the presence of PFO alone does not connote higher risk.  When paired with an inherited or acquired thrombogenic condition, the venous thrombus may travel from the right-sided circulation to the left, causing distal ischemia.  Many of these cases are unknown until a complication arises. The chronically worried, now with a reason: hypercholesterolemia A family history of adult-onset hypercholesterolemia is not necessarily a risk factor for early complications in children, provided the child does not have the same acquired risk factors as adults (e.g. obesity, sedentary lifestyle, smoking, etc).  Parents may seek help in the ED for children with chest pain and no risk factors, but adult parents who have poor cholesterol profiles. The exception is the child with familial hypercholesterolemia, who is at risk for accelerated atherosclerosis and MI. Infectious Myocarditis has varied etiologies, including infectious, medications (chemotherapy agents), immunologic (rheumatologic, transplant rejection), toxins (arsenic, carbon monoxide, heavy metals such as iron or copper), or physical stress (electrical injury, heat illness, radiation). In children, the most common cause of myocarditis is infectious (viruses, protozoa, bacteria, fungal, parasites).  Of these, viral causes are the most common (adenovirus, enterovirus, echovirus, rubella, HHV6). The verbal child may complain of typical chest complaints, or may come in with flu-like illness and tachycardia or ill appearance out of proportion to presumed viral illness. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’.  That may very well be true, but any virus can be invasive with myocardial involvement.  Infants are only able to increase their cardiac output through increasing their heart rate; they cannot respond to increased demands through ionotropy.  Look for signs of acute heart failure, such as hepatomegaly, respiratory distress, and sacral edema. The child with tachycardia out of proportion to complaint: myocarditis The previously healthy child with “a bad flu” may simply be very symptomatic from influenza-like illness, or he may be developing myocarditis.  Look for chest pain and tachycardia out of proportion to presumed illness, and constant chest pain, not just associated with cough. The “pneumonia” with suspicious chest x-ray: myocarditis Acute heart failure may mimic viral pneumonia.  Look for disproportionate signs and symptoms. Toxins Younger children may get into others’ medications, be given dangerous home remedies, take drugs recreationally, have environmental exposures (heavy metals), suffer from a consequence of a comorbidity (iron or copper overload) or have adverse events from generally safe medications. The hyperactive boy with a hyperactive precordium: methylphenidate Attention deficit hyperactivity disorder (ADHD) is growing in rate of diagnosis and use of medications.  As the only medical diagnosis based on self-reported criteria, many children are given stimulants regardless of actual neurologic disorder; with a higher proportion of children exposed to stimulants, adverse effects are seen more commonly. Methylphenidate is related to amphetamine, and they both are dopaminergic drugs.  Their mechanisms of action are different, however.  Methylphenidate increases neuronal firing rate.  Methamphetamine reduces neuronal firing rate; cardiovascular sequelae such as MI and CHF are more common in chronic methamphetamine use. Although methylphenidate is typically well tolerated, risks include dysrhythmias such as ventricular tachycardia. The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI.  Case reports include school-aged children on carbamazepine who have foamy cells in the coronary arteries, aorta, and vasa vasorum on autopsy.  It is unclear whether this is a strong association. The spice trader: synthetic cannabinoids Synthetic cannabinoids are notoriously difficult to regulate and study, as the manufacturers label them as “not for human consumption”.  Once reports surface of abuse of a certain compound, the formula is altered slightly and repackaged, often in a colorful or mysterious way that is attractive to teenagers. The misperceptions are: are a) synthetics are related to marijuana and therefore safe and b) marijuana is inherently “safe”. Both tend to steer unwitting teens to take these unknown entities.  Some suffer MI as a result. Exposure to tetrahydrocannabinol (THC) in high-potency marijuana has been linked to myocardial ischemia, ventricular tachycardia, and ventricular fibrillation.  Marijuana can increase the heart rate from 20-100%, depending on the amount ingested. K2 (“kush 2.0”) or Spice (Zohai, Genie, K3, Bliss, Nice, Black Mamba, fake weed, etc) is a mixture of plant leaves doused in synthetic chemicals, including cannabinoids and fertilizer (JWH-108), none of which are tested or safe for human consumption.  Synthetic cannabinoids have a higher affinity to cannabinoid receptors, conferring higher potency, and therefore worse adverse effects.  They are thought to be 100 to 800 times more potent as marijuana. Bath salts (Purple Wave, Zoom, Cloud Nine, etc) can be ingested, snorted, or injected.  They typically include some form of cathinone, such as mephedrone, similar to the substance found in the naturally occurring khat plant. Hallucinations, palpitations, tachycardia, MI, and dysrhythmias have been reported from their use as a recreational drug. Chest pain with marijuana, synthetic cannabinoid, or bath salt ingestion should be investigated and/or monitored. Riding that train: high on cocaine Cocaine is a well-known cause of acute MI in young people.  In addition to the direct stimulant causes acutely, such as hypertension, tachycardia, and impaired judgement (coingestions, risky behavior), chronic cocaine use has long-term sequelae.  Cocaine causes accelerated atherosclerosis.  That, in conjunction with arterial vasospasm and platelet activation, is a recipe for acute MI in the young. Cranky: methamphetamine Methamphetamine is a highly addictive stimulant that is relatively inexpensive and widely available.  Repeated use causes multiple psychiatric, personality, and neurologic changes.  Risky behavior, violence, and motor vehicle accidents are all linked to this drug.  Like cocaine, methamphetamine may cause fatal dysrhythmias, acute MI from demand ischemia, and long-term sequelae such as congestive heart failure. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Fontan Operation and the Single Ventricle. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. 2014; 14(1): 23-227. Andrews RE et al. Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart. 2004; 90:e17. Canale LS et al. Surgical treatment of anomalous coronary artery arising from the pulmonary artery. Interactive Cardiovascaulr and Thoracic Surgery. 2009; 8:67-69. Güvenç O et al. Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome. J Curr Pediatr. 2017; 15:47-50. Hastings RS et al. Embolic Myocardial Infarction in a Patient with a Fontan Circulation. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634. Hoffman JIE et al. Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants. Pediatr Cardiol. 2013; 34(3):489-491. Kei et al. Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism. Perm J.2015; 19(2):e107-e109. Liu Y, Miller BW. ALCAPA Presents in an Adult with Exercise Inlerance but Preserved Cardiac Function. Case Reports Cardiol. 2012; AID 471759. Möhlenkamp S et al. Update on Myocardial Bridging.Circulation. 2002;106:2616-2622. Murgan SJ et al. Acute myocardial infraction n the neonatal period. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. Myocardial infarction in grown up patients with congenital heart disease: an emergening high-risk combination. International Journal of Cardiology. 2016; 203:138-140. Schwerzmann M et al. Anomalous Origin of the Left Coronary Artery From the Main Pulmonary Artery in Adults. Circulation. 2004; 110:e511-e513. Tomkewicz-Pajak L et al. Arterial stiffness in adult patients after Fontan procedure. Cardiovasculr Ultrasound. 2014; 12:15. Varghese MJ et al. The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Images Paediatr Cardiol. 2010; 12(3): 3–8. Autoimmune Ayala et al. Acute Myocardial Infarction in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Turk J Rheumatol. 2009; 24:156-8. Nakano H et al. Clinical characteristics of myocardial infarction following Kawasaki disease: Report of 11 cases. J Pediatr. 1986; 108(2):198-203. Pongratz G et al. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. European Heart J. 1994. 15:1002-1004. Newburger JW et al.  Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747-2771. Son MB et al. Kawaski Disease. Pediatr Rev. 2013; 34(4). Yuan S. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med. 2012; 7:19796. Trauma Abdolrahim SA et al. Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection. J Clin Diagnost Res. 2016; 10(6):14-15. Galiuto L et al. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander. Signa Vitae. 2013; 8(2):61-63. Janella BL et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma. Arq Bras Cardiol. 2006; 87:e168-e171. Liu X et al. Acute myocardial infarction in a child with myocardial bridge World J Emerg Med. 2011; 2(1):70-72. Long WA et al. Childhood Traumatic Infarction Causing Left Ventricular Aneurysm: Diagnosis by Two-Dimensional Echocardiography. JACC. 1985; 5(6):1478-83. Smith S. Right Bundle Branch Block after Blunt Trauma: A Tragic Case. [Blog Post] July 22, 2012. Retrievable at: http://hqmeded-ecg.blogspot.com/2012/07/right-bundle-branch-block-after-blunt.html. Hematologic Carano N et al. Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated with Heritable Thrombophilia. Pediatr. 2004; 114(2):255-258.      Chacko P et al. Myocardial Infarction in Sickle Cell Disease. J Cardiovascl Transl Res. 2013; 6(5):752-761. De Montalembert M et al. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child. 2004; 89:359-362. Gladwin MT et al. Cardiovascular Abnormalities in Sickle Cell Disease. JACC. 2012; 59(13):1123-1133. Osula S et al. Acute myocardial infarction in young adults: causes and management. Postgrad Med J. 2002; 78:27-30. Silva JMP et al. Premature acute myocardial infarction in a child with nephrotic syndrome. Pediatr Nephrol. 2002; 17:169-172. Suryawanshi SP. Myocardial infarction in children: Two interesting cases. Ann Pediatr Cardiol. 2011 Jan-Jun; 4(1): 81–83. Infectious Cunningham R et al. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Ann Emerg Med. 2000; 35(6):618-622. De Vettten L et al. Neonatal Myocardial Infarction or Myocarditis? Pediatr Cardiol. 2011; 32:492-497. Durani Y et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009; 27:942-947. Erden I et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza virus. Cardiol J. 2011; 552-555. Hover MH et al. Acute Myocarditis Simulating Myocardial Infarction in a Child. Pediatr. 1191; 87(2):250-252. Lachant D et al. Meningococcemia Presenting as a Myocardial Infarction. Case Reports in Critical Care. 2015; AID 953826. Laissy JP et al. Differentating Myocardial Infarction from Myocarditis. Radiology. 2005; 237(1):75-82. Miranda CH et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. CID. 2013; 57:812-819. Rettig JS et al. Myocarditis in Children Requiring Critical Care Transport. In:  "Diagnosis and Treatment of Myocarditis", Milei J, Ambrosio G (Eds). DOI: 10.5772/56177. Toxins De Chadarévian JP et al. Epilepsy, Atherosclerosis, Myocardial Infarction, and Carbamazepine. J Child Neurol. 2003; 18(2):150-151. McIlroy G et al. Acute myocardial infarction, associated with the use of a synthetic adamantly-canabinoid: a case report. BMC Pharmacology and Toxicology. 2016; 17:2. Mir A et al. Myocardial Infarction Associated with Use of the Synthetic Cannabinoid K2. Pediatr. 2011; 128(6):1-6 Munk K et al. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate. Case Reports Pediatr. 2015; AID 905097. Rezkalla SH et al. Cocaine-Induced Acte Mycardial Infarction. Clin Med Res. 2007; 5(3):172-176. Schelleman H et al. Methylphenidate and risk of serious cardiovascular events in adults. Am J Psychiatry. 2012 Feb;169(2):178-85. Sheridan J et al. Injury associated with methamphetamine use: a review of the literature. Harm Reduction Journal, 2006; 3(14):1-18. Stiefel G et al. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010 Oct 1;33(10):821-42.   This post and podcast are dedicated to Edwin Leap, MD for his sanity and humanity in the practice of Emergency Medicine.  Thank you, Dr Leap for all that you do.

Attention-Deficit/Hyperactivity Disorder, or ADHD is a very common problem affecting about 10% of all adolescents. Children with ADHD have short attention spans, are hyperactive, talk a great deal, can be disruptive in the classroom etc.-features that are common in many adolescents. However, to have true ADHD, children must be significantly impaired by these problems. An array of medical and behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute. Articles discussed in this episode: Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents: A Systematic Review Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents  

Attention-Deficit/Hyperactivity Disorder, or ADHD is a very common problem affecting about 10% of all adolescents. Children with ADHD have short attention spans, are hyperactive, talk a great deal, can be disruptive in the classroom etc.-features that are common in many adolescents. However, to have true ADHD, children must be significantly impaired by these problems. An array of medical and behavioral treatments can successfully help manage ADHD. These are reviewed in a series of articles appearing in the May 10, 2016, issue of JAMA. In this podcast, we discuss ADHD with the authors of some of those papers, Eugenia Chan, MD, MPH from Harvard and Philip Shaw, MD, PhD from the National Human Genome Research Institute. Articles discussed in this episode: Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents
: A Systematic Review Quantifying the Benefits and Risks of Methylphenidate as Treatment for Childhood Attention-Deficit/Hyperactivity Disorder Methylphenidate for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Tina concentrates on the details of ADHD medications and invites your attention to the following: Non-pharmacological therapy behavioural therapy Stimulants methylphenidate amphetamines Non-stimulants atomoxetine clonidine other antidepressants and antipsychotics (to be covered in future episodes)   The post ADHD 2: medications appeared first on Family Pharm Podcast.