Forums » Off duty » Journal club » Methylphenidate (Ritalin) and your prescibing practice
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Methylphenidate (Ritalin) and your prescibing practice
posted at 16/1/2012 8:26 PM GMT
on bmj.com
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Posts: 1175
First: 25/1/2009 Last: 16/5/2012 |
Happy new year to the Paediatric Journal Club!
I thought I’d start off the year with this article brought to my attention by mbillingsley…
Methylphenidate has long been a controversial treatment either loved or hated by parents. A Google search of the word “Ritalin” brings up websites such as “ritalinsideeffects.net” and “Ritalindeath.com” ahead of the information from its manufacturers. The manufacturers themselves specify in the product information that there have been cases of sudden death and advise against its use in children with various cardiac conditions.
“Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians” is a study published in Pedaitrics looking at the practice of our American colleagues on their practice around prescribing methylphenidate (Ritalin) for children with ADHD. This seems particularly relevant as I spent part of today reviewing a history and ECG of a patient who the Child and Adolescent Mental Health (CAMHs) team want to start on methylphenidate.
Of their eligible respondents they found that 93% of clinicians would complete a routine history and examination before starting stimulant medications. Only 48% completed a specific in-depth cardiac history and examination and only 15% would order ECGs. 46% said they discuss cardiac risks of stimulants with parents before starting medication.
The NICE guideline recommends:
– Heart rate and blood pressure (plot on a centile chart) – Height and weight (plot on a growth chart) – Family history of cardiac disease and examination of the cardiovascular system
I was shocked by the outcome of Pediatrics paper in that 93% of clinicians would complete a routine history and examination – meaning that 7% would not! And that only 48% would take a specific cardiac history
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Re: Methylphenidate (Ritalin) and your prescibing practice
posted at 28/2/2012 10:56 AM GMT
on bmj.com
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*Moderator*
Posts: 623
First: 7/4/2011 Last: 16/5/2012 |
A study by the Department of Psychological Sciences and the Queensland Brain Institute, claims that Ritalin increases awareness of mistakes. The researchers found that Ritalin led to stronger activity in the brain's error monitoring network. From the news piece: "The results show the potential of the drug in addressing problems of awareness and insight evident in a variety of neurologic and psychiatric conditions. A weakened awareness of mistakes has been linked to loss of insight in several clinical syndromes." “For example, in conditions such as schizophrenia and Alzheimer’s disease, poor error awareness has been associated with delusions, paranoia and has been the cause of considerable distress to patients,” said Dr Rob Hester. “Failing to recognize your own error at the time can account for the difference between your recollection and the reality that confronts you. Understanding the brain mechanisms that underlie how we become conscious of our mistakes is an important first step in improving error awareness, and potentially reducing these symptoms.” http://psychcentral.com/news/2012/02/25/ritalin-increases-awareness-of-mistakes/35276.html |
Forums » Off duty » Journal club » Methylphenidate (Ritalin) and your prescibing practice
