Psychotropics in Paediatrics or Adolescents

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

Class Inequality and Poverty as seen by Marx, Weber, and Lewis Essay

Our society today is currently experiencing a widening of the gap between the rich and the poor. As the saying goes, â€Å"the rich is getting richer and the poor is getting poorer,† our society attests to such truth, where the wealthy is gaining more money while the poor’s case is getting worse by the minute. Poverty is a big problem ever since the dawn of man. In an ideal world, the number of resources produced could feed more than any of the hungry mouths all over the world. But in reality, wealth is not distributed properly to every living individual. There are those who get more as compared to those who get less or get nothing at all. The sad reality If you take into consideration every living individual in a certain community, only a small fraction of its population enjoy living a well-off life, and a majority suffer from lack of resources or doesn’t have enough to fill their stomachs. A fraction of imbalance in the distribution of resources and wealth affects a greater number of people, wherein the sad reality lies on whom are the ones getting much and who are the ones gaining a lot. This is the sad reality in our society, where people thrive in a world filled with inequality and sadly, majority of the people suffer from the extra gains of some people. Class inequality can be traced way back in the history of men, when people learned to classify themselves, making some superior and some, well, rather inferior. Another sad reality is that the ones who are in the higher echelons of the society are the ones who are not doing actual hard labor. These people are the one’s capitalizing from the hard work of the poor working class, sweating their lungs out, literally giving their sweat and blood just to make money. This labor force is the one who is actually earning the money; it is their effort and strength that makes the real cash, not the ones bossing them around. But the harshness of life is reflected in this situation: the ones working hard gets paid less, barely enough to make a living out of it, while the ones bossing everyone around gets a much bigger share, wherein they have exerted minimal or no real effort in doing so. This is the present situation of the working class of the past, the present, and maybe of the future. There are some great thinkers who have pondered on these things so to speak. This people, though separated by different views, expressed their opinions about how inequalities in the classes happen and why poverty exists, depending on how they see the situation. Their take on the realities are reciprocated by approval or by rejection from the people looking at their ideas. Some may seem radical to others, but some deem that is the necessary thought for that certain specific topic. These great thinkers include Karl Marx, Max Weber and Oscar Lewis. Karl Marx’ views For Karl Marx, poverty is the outcome of the rampant class inequality that the society is suffering today. The working class, whom Karl Marx advocates, is the ones who are actually earning the money for the society. They are the ones who actually deserve to get much of the gains, rather those who are capitalizing from their labor. Marx stressed that capitalists are the ones bringing disarray in the society because they are actually contributing lesser work as compared to the laborers, yet they are getting most of the gains. In order to correct this, Marx strongly advocated the abolishing of capitalism and replaces it with communism. For him, it could be a way to alleviate poverty in the society today, rather than just letting the capitalists sit around and wait for the harvest of their money’s fruit, rather than giving the laborers the real fruits of their labors. In Marx’ belief, capitalism has been the root of the great class divide, the widening gap between different social strata, where the poor and the rich are distinctively apart from each other. This is because of the fact that a great part of the gains goes to the pockets and the bellies of the capitalists, who are theoretically â€Å"getting even richer,† the fact that they are the ones who have the money. On the other hand, the laborers, the ones who are exerting greater effort as compared to these capitalists, are not getting anywhere the definition of rich at all, hence, they are having the difficulty to cope with the increasing cost of living, thus worsening their status, with them experiencing the â€Å"poor is getting poorer† part (Hallas, 2002). Looking closely at Marx’ ideas, you could see that it could also be about freedom. It is being able to freely produce and receive what is rightfully yours, as for the part of the laborers, for their efforts, their hard work to be reciprocated with enough pay. It is about how the true â€Å"money-earners† – the laborers, be able to control various circumstances that could benefit them, and not the capitalists. They will be able to create a free society where their hard work will be equal to a good life for them and their families. Because of this, the society will be a better place as conceived by Marx. It will be an exploitation-free society, in the same time it will do away with oppression, racism, unemployment, war, from poverty and inequality. Max Weber’s views Max Weber’s idea revolved on the role of an authority when it comes to the distribution and allocation of the national resources. He also stressed out that the wealth of the country, the nation’s riches, came from the bureaucratic organizations present. They are clearly the ones influencing the allocation of these resources because as Weber sees it, they were the producers, not the common working class. His main idea stated that bureaucracy, an organizational arrangement of the people themselves, is to administration as compared to machine which is for production. Weber defines bureaucracy as an institutional method wherein the rules are applied to certain specific cases, thus justifying the government’s action as being fair and really predictable (â€Å"What Is Bureaucracy?† 2004). For Weber, poverty was not essentially a natural situation or condition. The situation of poverty could be broken, wherein the social status of the people could be alleviated from the poor to the not-so-poor, thus implying a chance for people to develop. But if you see the definition of poverty as being relative, there could still be people thriving below the poverty line. This is because of the margin of difference from the rich and the poor are also changing. But if you look closely, their way of life, their social standings, their lifestyles had been changed. Even though they are still considered to be poor, relative to the rich people, they are able to alleviate their way of life out of the slums and were able to live a normal and healthy lifestyle. Oscar Lewis’ views American born anthropologist Oscar Lewis created the social theory about the â€Å"culture of poverty.† This concept of social classifications justify the positioning of the poor in the society, wherein the concept explains that the poor people have a different value system. Because of this, the theory suggests that the poor are slumped in the situation of poverty because they are continually adapting from the burdens of poverty. For Lewis, the poor became â€Å"the poor† because they were transformed by poverty. Poverty became a standard in classifying a person’s social status, thus implying that the definition of being poor is relative. It depends on how you look at it. Being poor doesn’t necessarily mean that you are not eating well, not being able to enjoy life as much as others can, etc. etc. Being poor entail being placed in the lower part of the poverty line. If there are a lot of rich people, the poverty line could be changed, thus some of the rich people may be considered as poor (Burt, 2004). American situation The most applicable principle in the United States of America was the contribution of Oscar Lewis. The quality of life in America is far better than other countries in the world, yet there are still some poor people. This is relative to America’s situation as compared to the situation of another country. There is a possibility that a rich person in another country, when he goes to America, he will be considered poor. Another possibility could be that when a poor man in America goes to another country, he could be considered as rich. Lewis’ introduction of a culture of poverty could be applied in America’s situation, wherein the concept of the poor is just a creation of the concept of poverty. Creating an underclass could have resulted to the introduction of a higher class, thus there was a basis for comparison of the different classes that exist in a society. The poor existed because of the rich people’s existence and vice versa. Burt, D. S. (2004). Oscar Lewis. Retrieved February 21, 2007, from http://www.answers.com/topic/lewis-oscar Hallas, D. (2002). The legacy of Karl Marx. Retrieved February 21, 2007, from http://www.socialistworker.org/2002-2/423/423_08_HallasOnMarx.shtml What Is Bureaucracy? (2004). Retrieved February 21, 2007, from http://www.semp.us/biots/biot_145.html

Gay Men And The Covert World Of Working Class Homosexuality

Gay men and women in the 1940s learned very early on in life just how detrimental it was to keep their homosexual identities a secret. It was not as simple as playing a fun, innocent game of secret identity, but rather a tactic employed to avoid the violence, the discrimination, and the many other ways that heterosexual Americans attacked homosexual Americans. Hiding their true selves was the only way for gay people to ensure their safety in at least one manner during the 1940s. In The Evening Crowd at Kirmser’s, Ricardo Brown implicated the secretive nature of gay men in the 1940s as imperative to their survival. Brown continually acknowledged the challenges accompanying the concealment of their true identities and divulged some of the various complications that arose both within and outside of the gay community, contributing to the need for their secrecy. Ricardo Brown dove headfirst into the covert world of working class homosexuality in 1940s Minnesota, reliving his own ex periences of discrimination as well as recounting the tales of his homosexual friends and their adversities. In describing one of the ways homosexuals slid under the radar, Brown asserted, â€Å"We always had to keep our guard up. We all learned to get by on lies, deceit, illusions.† It was a constant charade and they often kept it up by pretending to date the kind of girls who would not expect or pressure them into sexual activity. Of course, this type of cover could only last for so long, subsequentlyShow MoreRelatedThe Crucible : An Allegory For The Red Scare2011 Words   |  9 Pagesthe threat of Black Americans being equal in status to White Americans during the Civil Rights movement. Although the crucible takes place in 1692, Salem, it reflects the concerns of 1950?s American life and is an allegory for the Red Scare, and Homosexuality. [2: Wall, Wendy. Anti-Communism in the 1950s. www.gilderlehrman.org. N.p., n.d. Web. 21 Apr. 2016. .] The Crucible takes place in Salem, Massachusetts, which was a puritan town.[endnoteRef:3] Reverend Parris is praying over his daughter,Read MoreHistory of Transgender9448 Words   |  38 Pagestwo-gender system evolved from a one-gender system in the late middle ages. This two-gender system started to produce â€Å"third genders† during the eighteenth century. It also discusses how current day gender transitions differ in depth and dilemma from a gay of lesbian coming out. Part I discusses how during it’s first fifty years (1860-1910) psychiatry replaced sin with diagnosis, and the multifaceted image of the 18th century sodomite, with a host of very specific inverted gender-identities. AmongRead MoreCurriculum Development10775 Words   |  44 Pagesdesigned to ensure that all students, regardless of their previous achievement are able to achieve their full potential. This section examines the diversity of students in the LLS and some of the factors that affect learning and achievement such as race, class, gender and sexuality. Section Three: Curriculum Design for Inclusive practice identifies three current approaches to curriculum design and asks a fundamental philosophical question: What counts as an educated 19 year old today? It then examinesRead MoreCalculus Oaper13589 Words   |  55 Pagess essay constitutes a powerful challenge to some of our least examined sexual assumptions. Rich turns all the familiar arguments on their heads: If the first erotic bond is to the mother, she asks, could not the natural sexual orientation of both men and women be toward women? Rich s radical questioning has been a major intellectual force in the general feminist reorientation to sexual matters in recent years, and her conception of a lesbian continuum sparked especially intense debate. DoesRead MoreThe Hours - Film Analysis12007 Words   |  49 PagesDalloway is also set on a single day (in June 1923) and weaves together several narrative perspectives, which are organised in two parallel-running stories: one of them centres on Septimus Warren Smith, a soldier suffering shell shock after the First World War, while the other -- and Cunningham mainly focuses on this strand of the dual narrative -- recounts Clarissa Dalloways preparations for a party she will give the same evening. During the day, she now and then reminisces on the time she was eighteen

Should The New Ordinance Be Banned - 896 Words

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