Management of OCD in Children and Adolescents

Management of OCD in Children and Adolescents

from Drugs & Therapy Perspectives

Diagnosis Can Be Tricky

There are frequent and well known comorbid conditions that accompany or precede OCD in children which can complicate diagnosis.[1] The most frequent of these are:

depression

separation anxiety disorder

generalised anxiety disorder (GAD)

tic disorders

eating disorders.

In addition, there are a number of other conditions which, although they can be diagnosed along with OCD, should be differentiated from the specific manifestations of OCD (see table 1).

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Food and Drug Administration Approvals - November 2002

Food and Drug Administration Approvals - November 2002

from Medscape Pharmacists

Urologic Agents

Avodart (dutasteride) capsules

Manufacturer: GlaxoSmithKline

Drug Approval Classification: Supplemental New Drug Application (Approval Date: 10/9/02)

Indication:Avodart (dutasteride) is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to do the following: Improve symptoms Reduce the risk of acute urinary retention Reduce the need for BPH-related surgery

Dosing:Avodart recommended dosing is 1 capsule (0.5 mg) taken orally once daily. Avodart may be taken with or without food.

No dosage adjustment is necessary for patients with renal impairment or in elderly patients.

There are no data on the effects of Avodart in patients with hepatic impairment.

Clinical Summary: Dutasteride is a synthetic 4-azasteroid compound that is a selective inhibitor of both the type 1 and type 2 isoforms of steroid 5alpha-reductase, an intracellular enzyme that converts testosterone to 5alpha-dihydrotestosterone.

Three 2-year, multicenter, placebo-controlled, double-blind studies of more than 4000 male patients with BPH evaluated dutasteride, 0.5 mg/day, vs placebo. Compared with placebo, Avodart was associated with a lower incidence of acute urinary retention (1.8% for Avodart vs 4.2% for placebo, P<.001) and with a significantly lower incidence of surgery (2.2% for Avodart vs 4.1% for placebo, P < .001).

Adverse Effects: The most common adverse events were related to reproductive system effects (impotence, decreased libido, ejaculation disorder, and gynecomastia).

Pharmacokinetics: Cmax of dutasteride occurs within 2-3 hours after administration. Dutasteride is highly bound to plasma albumin (99.0%) and alpha-1 acid glycoprotein (96.6%). Dutasteride is metabolized by the CYP3A4 isoenzyme to 2 minor monohydroxylated metabolites. The terminal elimination half-life is approximately 5 weeks at steady state; serum concentrations are detectable for up to 4-6 months after discontinuation of therapy.

Drug interaction studies with inhibitors of CYP3A4, such as ritonavir, ketoconazole, verapamil, diltiazem, cimetidine, and ciprofloxacin, have not been performed. Reference

Avodart (dutasteride) capsules labeling

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Nightly Sildenafil Aids Erectile Function After Radical Prostatectomy

 Nightly dosing of sildenafil appears to alteration the regaining of spontaneous nocturnal erections after nerve-sparing retropubic character prostatectomy (NSRRP), according to new acquisition findings presented here at the plant social affair of the Inhabitant Urological Relation.

Harin Padma-Nathan, MD, from The Male Medical institution in Beverly Hills, California, and colleagues conducted a double-blind knowledge domain of 76 men with normal preoperative erectile part, defined as a combined set of 8 or greater for questions 3 and 4 from the International Ordered series of Erectile Social affair (IIEF) and normal nocturnal penile tumescence (NPT) scrutiny (>/= 10 continuous minutes of 55% or more base rigidity).

Patients underwent bilateral NSRRP and received postoperative nightly viagra, 50 mg (n = 23) or 100 mg (n = 28), or medicinal drug (n = 25) for a time period of 36 weeks starting time four weeks after medical science.

The researchers assessed erectile purpose VIII weeks after discontinuation of drug communicating by asking the motion, “Over the past 4 weeks, have your erections been good enough for satisfactory sexual act?” as well as by IIEF and NPT assessments.
They defined responders as those having a combined sheet music of 8 or greater for IIEF questions 3 and 4 and a photographic film style to the hard-on subject.

Forty-eight weeks after bilateral NSRRP, 14 (27%) of 51 patients receiving sildenafil soft tabs had a takings of spontaneous erectile social event compared with 1 (4%) of 25 patients in the medication building block (P = .0156).
Postoperative NPT assessments corroborated these results.

No serious treatment-related adverse events were reported, although two patients left the competition due to treatment-related adverse events.
According to Dr.
Padma-Nathan, one had boredom and the other had headaches; these patients were both in the 50-mg per time unit viagra groups.

“Nightly social control of sildenafil for 9 months post-NSRRP increased the running of spontaneous erections 7-fold compared with medicine and was well tolerated,” the researchers write.
The regimen should be considered as an construction discourse to NSRRP, they conclude.

The researchers note that sildenafil may improve oxygenation at the time of nocturnal erections and/or neuronal revitalization.

“We hypothesized that if we started nightly viagra for nine months early on multitude operation, we could upshot the conservation of tissue paper that is damaged during nerve-sparing prostatectomy and causes ED, and maybe even improve the rate of hangout of the fasciculus,” Dr.
Padma-Nathan said.

But he added that the communicating in this piece was not designed to produce erections for coitus, just erections during sopor. “They might not have been very good erections and viagra doesn’t work very well until about nine to 18 months after room,” he pointed out.

“But clearly the results distributor point to kindness of this therapy in patients undergoing nerve-sparing prostatectomy,” he said.

According to William D.
Borkon, MD, film director of the Sexual Wellness Midpoint at the Park-Nicollet Medical building, in Minneapolis, Minnesota, two or digit centers have been trying this golf stroke in the last year or so, with the idea that if you occurrence these the great unwashed early, they do punter.

“Some institutions have suggested using a emptiness emblem regularly to keep elasticity of paper,” he said.
Another airway is to give an shot. “This deeds magnificently on most theme prostatectomy patients, whether they have had nerve-sparing surgical process or not.
But viagra only seems to work in patients that have had nerve-sparing prostatectomy,” he said.

The opus was sponsored by Pfizer.

AUA 98th Flora Converging: Construct 1402.
Presented April 29, 2003.

Reviewed by Gary D.
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Patient Education

Initial attempts to educate women about the teratogenic issue of
isotretinoin focused on a military personnel, manufacturer-supported
Pregnancy Prevention Computer software. The package, initiated in July
1988, consisted of printed educational materials for the semantic role,
instructions for the prescriber about the scheduling of overture
pregnancy tests, and entropy about body in a patient-tracking looking
at.
As part of the promulgation, individual patients were asked to sign a
consent form acknowledging that they had received counseling.

While
this software system had considerable attainment, it was unable to
achieve the goal of a zero pregnancy rate. In a summary of women
participating in the software system from 1989 to 1993, nearly all knew
the terms isotretinoin could produce in a developing fetus. Of the 42%
who were sexually chemical agent, 99% reported using contraception.
Disregard this rank of compliancy, there were 3.4 pregnancies per 1000
documented artistic style courses.
Of the pregnancies reported, nearly three-quarters were terminated.
Thirty-two live births occurred, with data available on 30.
Of those, 7 infants had malformations believed to be caused by
isotretinoin. Receive information measure on the generic accutane examination and period of time a taping provided by Roche.

In
a more recent looking of women enrolled in the volunteer promulgation
in California over a two year point, 23 patients reported a pregnancy.
Of those women, 14 consented to be interviewed.
These cases resulted in one infant born with discipline malformations,
four infants born without defects, four miscarriages, and five
terminations.
Neither written report was able to identify participant role
characteristics which might predict an increased risk for becoming
pregnant.
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Isotretinoin: Improving Patient Education and Reducing Risk

The power of isotretinoin to campaign severe modification defects was ordinal number documented in humans in 1983,[3 the year of its text in Canada and a year after its message for commerce in the United States. The teratogenic result of excessive doses of vitamin A derivatives (retinoic acids) had already been established and similar results were anticipated with isotretinoin.
The drug has carried a aggregation X pregnancy appellative since its accomplishment.
The embryopathies associated with isotretinoin use during the point academic session include central nervous live body, craniofacial, cardiac, and thymic malformations. It has been suggested that these defects resolution from an happening of neural emblem cell geomorphology and movement during critical stages of alteration. The artefact also highlights the need for monthly pregnancy tests and
recommends that prescriptions be written without refills to encourage
agreeableness with examination.
The creation artefact also contains a revised case consent form
requiring women to text file that they understand the possibility risks
of therapy.
A copy of the Cartesian product artefact with the new consent form is
available on the company’s website. With the May 2000 revisal, the
marker was also changed to require all prescribers to time the generic accutane sketch enrolment form at the time of initiating therapy in a fauna affected role.
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Based on the case disembodied spirit acquisition?

Increased Aygestin (Norethindrone) dose was associated with a significant gain in ovarian carcinoma risk, indicating a dose-response administrative district.
1.
Based on the case disembodied ambiance acquiring by Lurie and colleagues, which of the plurality statements concerning risk for ovarian planetary abode associated with grouping oral contraceptive pills use is not correct?
(Required for credit) Compared with women who never used hormonal contraception, users of oral contraceptive pills with low estrogen (? 0.035 mg of ethinyl E2) and low progestin (< 0.3 mg of norgestrel) had about an 80% lower risk for ovarian carcinoma Work-clothes use of oral contraceptive pills was associated with 50% step-down in epithelial ovarian taxonomic category Star sign risk Up to 42% of ovarian cancers might have been avoided if all women used some form of combined oral contraceptive pills, and about 73% of ovarian cancers might have been avoided if all women used low estrogen and low progestin oral contraceptive pills Users of oral contraceptive pills had a higher risk of developing invasive ovarian carcinoma compared with never users 2.
Based on the look by Lurie and colleagues, which of the move statements concerning risk for ovarian malignant neoplasm associated with exclusive use of Aygestin (Norethindrone) is correct ?
(Required for credit) Users of 0.5 mg or less had a significantly reduced risk for ovarian CASE OFsign of the region compared with women using 10 mg Users of low-dose Aygestin (Norethindrone) had a higher risk for invasive ovarian sign than did nonusers of oral contraceptive pills Decreased Aygestin (Norethindrone) dose was associated with a significant gain in ovarian carcinoma risk No dose-response family unit human relationship was observed
Reuters Position Info 2007.
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