Helping the angels: a review of understanding and helping dying children.

According to the World Health Organization, 53,000 children die every year in United States because of a chronic medical condition. Physicians have to face various ethical and psychological challenges while managing these conditions. These challenges range from disclosure of diagnosis to effective grief counseling to the family. In this article we have discussed some of these challenges and strategies to effectively meet these challenges.

Adderall-induced Trichotillomania: A Case Report.

Adderall (dextroamphet-amine/amphetamine) is a psychostimulant medication approved by the United States Food and Drug Administration for the treatment of attention deficit hyperactivity disorder. This medication is usually well tolerated with minimal side effects. We report a case of a 12-year-old girl who was prescribed Adderall by her primary care physician to treat her attention deficit hyperactivity disorder and who subsequently developed trichotillomania. A short time following the initiation of the medication, the patient's family members noticed the patient displaying unusual hair-pulling behavior. The patient was referred to a psychiatrist for an evaluation of trichotillomania. Following a thorough evaluation, the decision was made to discontinue the Adderall and switch the patient to guanfacine. The urge to pull her hair along with her anxiety dissipated following this change. Close follow-up was maintained for over a year with both the psychiatrist and the primary care physician, and during this time the patient did not display any unusual hair pulling behaviors. This case appears to display a very unusual side effect of Adderall.

Topiramate-induced Dissociative Disorder.

Topiramate is associated with various psychiatric and neurocognitive side effects. We report a case of a 21-year-old woman who was prescribed topiramate for the treatment of migraine headaches by her neurologist. She developed episodes of dissociation while receiving topiramate. These episodes increased when the dose of medicine was increased. The frequency of these episodes decreased as the medicine dose was tapered down, and these episodes eventually stopped after the medicine was discontinued. There was no recurrence of symptoms during the 23-week follow-up period.