Teaching Ethics in Child and Adolescent Psychiatry: Vignette-Based Curriculum

Introduction: Ethics is an integral component of child and adolescent psychiatry. While ethics can seem abstract or philosophical, its tenets are fundamental to the practice of medicine. Understanding relevant ethical principles shapes how practitioners make decisions in all activities, including clinical, administrative, research, and scholarly. Methods: Using the American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics as the framework, these vignettes serve as stimulus material to help teach the ethical principles relevant to child and adolescent psychiatry practice. Each vignette briefly describes a clinical situation in practice, followed by questions and possible appropriate responses. The teacher\u27s guide includes a discussion of the relevant ethical principles and perspectives on how to think about the issues involved. A supplementary overview of ethical issues in child and adolescent psychiatry and a list of resources are also provided. Results: We and other child and adolescent psychiatrists have used this curriculum at professional organizational meetings, in residency programs, and in teaching medical students with positive learner responses. Discussion: This curriculum was developed by members of the AACAP Ethics Committee with input from the entire committee in an effort to produce material that was easy to use and provided valuable content about an essential aspect of practice that is relevant to all practitioners at all levels. While designed for child and adolescent psychiatrists, the content is relevant to all physicians working with children, adolescents, and families

Clinical utility of the risperidone formulations in the management of schizophrenia

Risperidone is one of the early second-generation antipsychotics that came into the limelight in the early 1990s. Both the oral and long-acting injectable formulations have been subject to numerous studies to assess their safety, efficacy, and tolerability. Risperidone is currently one of the most widely prescribed antipsychotic medications, used for both acute and long-term maintenance in schizophrenia. Risperidone has better efficacy in the treatment of psychotic symptoms than placebo and possibly many first-generation antipsychotics. Risperidone fares better than placebo and first-generation antipsychotics in the treatment of negative symptoms. Risperidone’s long acting injectable preparation has been well tolerated and is often useful in patients with medication nonadherence. Risperidone has a higher risk of hyperprolactinemia comparable to first-generation antipsychotics (FGAs) but fares better than many second-generation antipsychotics with regards to metabolic side effects. In this article, we briefly review the recent literature exploring the role of risperidone formulations in schizophrenia, discuss clinical usage, and highlight the controversies and challenges associated with its use

New and extended-action treatments in the management of ADHD: a critical appraisal of lisdexamfetamine in adults and children

Diana Domnitei, Vishal MadaanDepartment of Psychiatry, Creighton University Medical Center, Omaha, NE, USAAbstract: Treatment guidelines from the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics state that stimulant medications have the most evidence for safety and efficacy in the treatment of childhood attention deficit hyperactivity disorder (ADHD). Longer-acting stimulants are thus considered as first-line for management of ADHD symptoms. Over the years, concerns about the abuse potential of stimulants have led to the development of alternative formulations of these agents. One such recent development, lisdexamfetamine (LDX) was FDA approved for treating ADHD in children in early 2007 and in adults in early 2008. LDX is a prodrug, which when orally ingested, is converted to l-lysine and active d-amphetamine, which is responsible for its therapeutic activity. This unique formulation may lead to a possible reduction of the abuse potential, by bypassing the first-pass metabolism. In fact, a statistically significant difference for the ‘liking’ effects on the Drug Questionnaire Response has been reported with intravenous LDX compared to d-amphetamine. LDX appears to have an efficacy and tolerability profile comparable to other extended-release stimulant formulations used to treat ADHD, but reduced potential for abuse-related liking effects when compared to equivalent amounts of immediate-release d-amphetamine. The most common adverse events include decreased appetite, insomnia, upper abdominal pain, headache, irritability, weight loss, and nausea.Keywords: lisdexamfetamine, attention deficit hyperactivity disorder, adults, childre