Adults with autism spectrum disorder: Updated considerations for healthcare providers.

Children with autism spectrum disorder (ASD) eventually grow up and need to make the transition from pediatric services to adult. This is a diverse patient population.

Identifying, evaluating, diagnosing, and treating ADHD in minority youth.

OBJECTIVE: This literature review describes evaluation and treatment of minority youth with ADHD. METHOD: A search of databases for reports of ADHD in minority children was conducted. RESULTS: Interpretation of behavior varies among parents, as does their trust in health care providers and school personnel. Parents desire to avoid stigmatization of their children from diagnostic labels and medications. They may not understand the sequelae of inadequate treatment or fear side effects of treatment. Children respond to stimulant medication but fare better when it is combined with regularly scheduled psychosocial treatment, including education and support for parents. Financial struggles affect access, evaluation, and treatment. Community support is desperately needed to gain parental trust. Creative planning allows health care providers and neighborhood leaders to join in, benefiting the children. CONCLUSION: Quality evaluation by a competent provider, careful choice of assessment tools, clear communication with parents, and close follow-up of progress are all needed.

Deficits in diagnosis, treatment and continuity of care in African-American children and adolescents with ADHD.

Despite the evidence that attention-deficit/hyperactivity disorder (ADHD) is not just a diagnosis of whites, it often goes undiagnosed and is underresearched in the African-American population. There are higher rates of delinquency, incarceration, teen pregnancy and sexually transmitted diseases associated with inadequate or delayed treatment of ADHD. Afrcan Americans generally respond well to treatments, but access to evaluation, medication and psychotherapy is limited or absent for many, The purpose of this research is to compare descriptive characteristics of African-American children with ADHD to age-matched Caucasian children with the same diagnosis. Age at diagnosis, treatment offered, perception of outcome, adherence, comorbid symptoms and frequency of follow-up were collected retrospectively from charts of children treated in the sections of child and adolescent psychiatry and pediatric neurology.

Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.

STUDY DESIGN AND OBJECTIVE: Systemic review of double-blind, placebo-controlled, randomized controlled trials (RCTs) and meta-analyses of medication efficacy in the treatment of patients diagnosed with dementia and experiencing neuropsychiatric symptoms(hallucinations, delusions, agitation, aggression, combativeness, wandering). EXCLUSION CRITERIA: Studies were excluded if they reported only depression, if the medication was not available no longer used in the United States, or duplicated another study already included. DATA SOURCES: Medline of English articles between 1966 and June 2004, Cochrane Database of Systematic Reviews, and a manual search by the authors for other relevant articles. OUTCOMES: Diverse outcome measures ranging from global benefit to behavioral rating scales. Some of the 29 reports listed several instruments; in total, 24 rating scales were used. Statistical outcome was described and some, but not all, noted clinical impression. Adverse outcomes were listed. RESULTS: The results were clustered in groups: conventional antipsychotics, atypicals, antidepressants, cholinesterase inhibitors, mood stabilizers, and others. Treatment duration ranged from 17 days to 16 weeks. Types of dementia and levels of severity varied. The authors reported little benefit and some evidence for harm for typical (or conventional) agents. In contrast, some RCTs of atypical antipsychotics reported "modest" benefit, with olanzapine and risperidone leading others. Although trials reported minimal side effects at low doses, authors acknowledged an increased risk for stroke. No studies adequately compared benefit of typical with atypical agents. With the possible exception of citalopram, antidepressant agents did not reduce agitation, but did improve depression. Cholinesterase inhibiting agents demonstrated significant efficacy toward behavior, while memantine had mixed results. Valproate did not prove to be efficacious, and results for carbamazepine were conflicting.

Heart disease and depression: don't ignore the relationship.

Evidence is mounting that depression is a risk factor for the development of cardiovascular disease and portends a worse outcome in cardiac patients. Depression can be easily diagnosed and safely treated in cardiac patients, but it is undertreated.

Recognizing, managing medical consequences of eating disorders in primary care.

Eating disorders can lead to serious health problems, and as in many other disorders, primary care physicians are on the front line. Problems that can arise from intentional malnutrition and from purging affect multiple organ systems. Treatment challenges include maximizing weight gain while avoiding the refeeding syndrome.

Review of adjunctive glutamate antagonist therapy in the treatment of catatonic syndromes.

Catatonia is a common neuropsychiatric syndrome which may arise from GABA-A hypoactivity, dopamine (D2) hypoactivity,and possibly glutamate NMDA hyperactivity. Amantadine and memantine have been reported as effective treatments for catatonia in selected cases, and probably mediate the presence of catatonic signs and symptoms through complex pathways involving glutamate antagonism. The authors identified 25 cases of catatonia treated with either agent. This article provides indirect evidence that glutamate antagonists may improve catatonic signs in some patients who fail to respond to established treatment, including lorazepam or electroconvulsive therapy. Further study of glutamate antagonists in the treatment of catatonia is needed.