Первый слайд презентации: Overprescription of ADHD Medication
Prepared by: Vladislav Fesenko, the 2 nd year student of 16 th group, General Medicine Faculty
Слайд 2: Overprescription
Overprescription is a practice of prescription of a drug more frequently, than appropriate. It is especially dangerous when the practice involves potentially addictive or harmful substances. The first recorded use of the word was in 1946.
Слайд 3: Attention Deficit Hyperactivity Disorder
ADHD is a mental disorder of a neurodevelopmental type. It can impair person's capacity to perform various work that requires long periods of unbroken concentration, impacts their development, school, work and relationships. Symptoms of ADHD: difficulty paying attention trouble concentrating on tasks at hand acting recklessly and inappropriately difficulty controlling emotions hyperfocus
For a reliable diagnosis, the symptoms should have appeared before a person is 12 years old, been present for more than half a year and cause problems in at least two life settings (school, home, work, or recreation). In children symptoms of ADHD may cause poor school performance. In adults it manifests itself more like a constant state of inner restlessness and less like hyperactivity, leading to development of various coping mechanisms.
Слайд 5: ADHD Medication
Methylphenidate Brand names – Ritalin, Concerta Type – stimulant Mechanism – norepinephrine -dopamine reuptake inhibitor Amphetamine Brand names – Adderall, Vyvanse Type – stimulant Mechanism - norepinephrine -dopamine reuptake inhibitor, releasing agent
Слайд 6: Legal Status of Stimulants
Symptoms of ADHD are usually treated with stimulants such as methylphenidate, lisdexamphetamine and amphetamine. All of them are classified as restricted drugs in various jurisdictions as they carry a high risk of addiction and/or substance abuse In Russia and CIS countries they are prohibited from use as ADHD medication and free sale, but illegally imported Adderall or Ritalin are still being used by those who were diagnosed with ADHD, but are unwilling to use antidepressants.
Слайд 7: General Consensus on the Problem
There are advocates for both sides: those who think that it is overprescribed and should be strictly regulated, and those who think that current usage of ADHD medication is justified. The current consensus is as follows: while there are a lot of adverse effects to amphetamine or methylphenidate, the pros far outweigh the cons. However, this opinion is shaped by those who accept usage of addictive substances for treatment of non-life-threatening conditions. In actuality the scope of overprescription is fairly difficult to measure and quantify. The data is inconclusive at best and unreliable at worst.
Слайд 8: Patient-centred Model
Results of analysis: Evidence is flawed – Adderall and Ritalin prescribed not only to patients suffering from ADHD, based on the evaluation of a physician Estimate prevalence of disorder (around 7%) Compare prevalence of disorder with amount of the medication prescribed (8-10% of school population in certain states of the USA) Overprescription
Слайд 9: Physician-centred Model
Results of analysis: Overprescription based on lack of time to evaluate the evidence and general incompleteness of ADHD criteria (edge cases and complications are not considered) Review of physicians’ evaluation of patients in case of prescription of stimulants Physicians often skip the steps necessary to fully diagnose ADHD Physicians don’t have the time to fully evaluate the patients in one appointment Overprescription
Слайд 10: Possible Solutions to the Problem
Solution 1 Capitalization on behavioural therapy as first-line treatment Solution 2 Discovery and usage of non-addictive ADHD medicine ( atomoxetine ) Solution 3 Review of physicians’ schedules to accommodate for longer time needed for accurate evaluation Atomoxetine Brand name – Strattera Type – antidepressant, sympathomimetic Mechanism – selective norepinephrine reuptake inhibitor, dopamine reuptake inhibitor in specific areas of the brain