{"title":"ADHD across the lifespan","authors":"","doi":"10.1016/j.mpmed.2024.05.015","DOIUrl":"10.1016/j.mpmed.2024.05.015","url":null,"abstract":"<div><p><span>Attention-deficit hyperactivity disorder (ADHD) is a common condition with neurodevelopmental origins that typically starts in early childhood and follows a persistent trait-like course. It is characterized by inattention, impulsivity<span> and hyperactivity that persist over time and lead to clinical and psychosocial impairments. Emotional instability is a common feature and sometimes the main presenting complaint. Neurodevelopmental and psychiatric co-morbidities are common. ADHD can be diagnosed and treated at all ages, and persists into adulthood in around two-thirds of individuals. Many adults with ADHD were not diagnosed as children. Psycho-education and environmental adaptations are recommended in all cases. If significant impairment remains in at least one domain after implementation and a review of environmental modifications, pharmacological treatments are recommended. Drug treatments are similar at all ages. </span></span>Methylphenidate<span> is the recommended first-line drug in children and adolescents. If ineffective or not tolerated, lisdexamfetamine<span><span> is recommended as second-line treatment, followed by atomoxetine and </span>guanfacine<span><span>. In adults, lisdexamfetamine or methylphenidate is recommended as first-line treatment, followed by </span>atomoxetine. Atomoxetine can be used as first line when there are concerns with potential drug abuse or diversion, or high levels of co-morbid anxiety. ADHD-focused groups should be offered if significant impairment remains after drug treatment.</span></span></span></p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dementia","authors":"","doi":"10.1016/j.mpmed.2024.05.013","DOIUrl":"10.1016/j.mpmed.2024.05.013","url":null,"abstract":"<div><p>Dementia is an umbrella term for a number of organic brain diseases that together affect approximately 940,000 people in the UK. Most diseases leading to dementia are characterized by processes that result in the abnormal build-up of proteins in the brain. The most common cause of dementia is Alzheimer's disease, but other important causes include vascular dementia, dementia with Lewy bodies and fronto-temporal dementia. The management of dementia largely focuses on helping patients and families to manage increasing care needs as the condition progresses, including the treatment of troublesome neuropsychiatric symptoms. Current pharmacological treatments are based on the neurochemical changes that are found in these diseases. Cholinesterase inhibitors and <em>N</em>-methyl-<span>d</span>-aspartate receptor antagonists offer a modest effect in ameliorating cognitive and neuropsychiatric symptoms in Alzheimer's disease. However, the treatment of neuropsychiatric symptoms in dementia is still largely empirical and is hampered by either limited efficacy of medication or troublesome adverse effects. Key potential future developments in dementia include anti-amyloid treatments for Alzheimer's disease and blood biomarkers to aid diagnosis.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intellectual disability","authors":"","doi":"10.1016/j.mpmed.2024.05.012","DOIUrl":"10.1016/j.mpmed.2024.05.012","url":null,"abstract":"<div><p>All doctors should expect to have some patients with intellectual disability. People with intellectual disability have high rates of physical and mental ill-health problems, and co-morbidity is typical. Frequently associated conditions such as epilepsy, aspiration and choking can cause avoidable death, and problems such as gastro-oesophageal reflux disorder, sensory impairments and injuries can cause recurrent symptoms, persistent disability and distressed behaviour. Other developmental conditions, psychosis and behavioural problems are common. Be aware of readily treatable associated physical conditions such as hypothyroidism in Down syndrome. Problem behaviour can be a sign of distress, which can be the result of physical ill-health, mental ill-health, environmental factors or a combination of these. Medical assessment requires well-developed communication skills and access to multiple sources of information, which must involve relatives and paid carers as well as the person with intellectual disability, so sufficient time should be allocated. Use a biopsychosocial–developmental framework. Avoid attributing symptoms of medical conditions to the person's developmental disabilities (‘diagnostic overshadowing’), which results in illness going untreated. People with intellectual disability face many barriers in accessing healthcare, and proactive approaches are required. Specialist intellectual disability teams, where available, are excellent resources for specialist multidisciplinary assessment and advice.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assessment of psychiatric disorders in children","authors":"","doi":"10.1016/j.mpmed.2024.05.009","DOIUrl":"10.1016/j.mpmed.2024.05.009","url":null,"abstract":"<div><p>The aim of this article is to draw attention to how the process of assessment, diagnosis, and formulation of children with suspected psychiatric disorder differs from that of adults. Development and the importance of context are two key concepts. These influence each stage of assessment: the gathering of clinical information, identification of symptoms, making of a diagnosis and development of a formulation.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bipolar disorder","authors":"","doi":"10.1016/j.mpmed.2024.06.003","DOIUrl":"10.1016/j.mpmed.2024.06.003","url":null,"abstract":"<div><p><span><span><span>Bipolar disorder (BD) is characterized by the episodic disturbance of mood into depression or elation. </span>Bipolar I disorder<span><span> (BD-I) is defined by mania, bipolar II disorder (BD-II) by </span>major depression and </span></span>hypomania<span><span><span>. BD is heritable; many gene variants of small effect contribute to risk. Anxiety co-morbidity is common. The management of BD usually requires long-term medical treatment, and psycho-education is also key to management. Severe manic episodes, with or without mixed features, should be treated by an oral dopamine receptor antagonist/partial agonist. The treatment of bipolar depression is currently controversial. For an early treatment effect, </span>quetiapine<span>, lurasidone<span> or olanzapine can be useful. </span></span></span>Lamotrigine<span><span> is underused. An antidepressant is not recommended as monotherapy for patients with BD but can be given with additional treatment to protect them from manic relapse. Relative or even marked treatment resistance can occur in depressed bipolar patients. The burden and pattern of illness should dictate the treatment choice and combination. If it is predominantly mania, the most </span>antimanic agents (e.g. lithium, </span></span></span>valproate<span>, a dopamine receptor antagonist/partial agonist) are combined; for predominantly depressive BD, lamotrigine, quetiapine<span><span>, lurasidone or </span>olanzapine can be more appropriate. Long-term use of antidepressants can be justified if patients relapse on their discontinuation.</span></span></p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2024.06.004","DOIUrl":"10.1016/j.mpmed.2024.06.004","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical assessment and investigation in psychiatry","authors":"","doi":"10.1016/j.mpmed.2024.05.005","DOIUrl":"10.1016/j.mpmed.2024.05.005","url":null,"abstract":"<div><p>Assessment of patients with mental health problems is often seen as different from assessment in other areas of medicine. However, it has much in common with any area of medicine in which taking a good history is vital. It should be conducted in a systematic way using good interview techniques. A clear knowledge and understanding of the signs of mental illness is essential for accurate assessment, which should allow the clinician to reach a differential diagnosis, and to estimate how much confidence can be placed in the primary diagnosis. Although there are few diagnostic tests in psychiatry, the appropriate investigation of patients includes an assessment of their physical health (and whether this might relate to their psychiatric presentation), formal and detailed assessment of their cognitive function (which can help characterize or localize possible brain pathology), objective ratings of the severity of symptoms and neuro-imaging if indicated.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Substance use disorders","authors":"","doi":"10.1016/j.mpmed.2024.06.010","DOIUrl":"10.1016/j.mpmed.2024.06.010","url":null,"abstract":"<div><p>Drug misuse is widespread in the UK and causes significant morbidity and mortality. It is clearly important to know how to assess and manage substance use disorders, particularly to know about treatments for heroin addiction. In this article, we examine the principles of identifying and managing drug addiction, and consider in some detail the presentation, risks, harms and treatment for the misuse of opioids, stimulants, benzodiazepines, cannabis and novel psychoactive substances, which constitute the main classes of substance misused in the UK.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ten principles of good psychotropic drug prescribing","authors":"","doi":"10.1016/j.mpmed.2024.06.006","DOIUrl":"10.1016/j.mpmed.2024.06.006","url":null,"abstract":"<div><p>Psychopharmacology is not the sole province of psychiatrists. General practitioners (GPs) should be familiar with the management of common psychiatric conditions, especially anxiety and depression, as most people with these disorders are treated in primary care. Hospital physicians also encounter many patients who are prescribed psychiatric drugs, reflecting the increased prevalence of anxiety and depressive disorders in individuals with chronic medical disorders and the increased prevalence of diabetes mellitus and cardiovascular disease in people with schizophrenia and bipolar disorder. Psychotropic drugs can cause a wide range of adverse effects that can present to GPs and physicians. This article describes 10 principles of good psychotropic drug prescribing for non-specialists.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mood stabilisers","authors":"","doi":"10.1016/j.mpmed.2024.07.003","DOIUrl":"10.1016/j.mpmed.2024.07.003","url":null,"abstract":"<div><p>Mood stabilisers (mainly lithium, valproate, lamotrigine and carbamazepine) are used to treat patients with bipolar affective disorder. Some antipsychotic agents also have mood-stabilising properties. This article gives general advice on when each medication might be used, how to monitor patients, and common adverse effects and drug interactions.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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