scholarly journals Treating Comorbid Childhood Bipolar Disorder and ADHD

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 172-172
Author(s):  
Darlyne G. Nemeth ◽  
Kayla M. Chustz ◽  
Cody M. Capps
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Stimulant Medication ◽  
Treatment Options ◽  
Medication Management ◽  
Verbal Learning ◽  
Poor Response ◽  
Response To Treatment ◽  
Comorbid Diagnosis ◽  
Poster Paper

AbstractObjectivesPediatric mania is difficult to distinguish from childhood hyperactivity. Both share 3 common symptoms: distractibility, motoric hyperactivity, and talkativeness. Oftentimes, children are referred from their pediatrician due to a lack of appropriate response to stimulant medication. Pediatricians have learned that merely raising the dose or changing the stimulant does not work. A thorough neuropsychological evaluation often reveals bipolar mania. They may have comorbid bipolar disorder and ADHD. This poster paper will examine measures that can assist in this important differential diagnosis as well as offer treatment options, including medication management.MethodsThis case study includes three pediatric patients diagnosed with childhood bipolar disorder and ADHD. A comprehensive psychoeducational assessment was conducted for each of the patients, which resulted in this comorbid diagnosis.ResultsOne of the most helpful measures was the TOVA (i.e., Test of Variables of Attention). When a child’s attention and impulsivity scores are normal, and response time and variability scores are abnormal, both on and off medication, that is an indication of a mood disorder, These children also performed poorly on measures of processing speed, and verbal learning and interference tasks. Measures of affect and personality were important diagnostically. A combination of amantadine and either clonidine HCL ER or propranolol, as prescribed by a medical psychologist, were found to be effective in controlling the symptoms of this comorbid diagnosis.ConclusionsAn evaluation of children’s intellectual, attentional, behavioral, mood, and personality functioning is crucial for a differential diagnosis. In cases of comorbidity, ADHD and childhood bipolar disorder, the sooner the child is on appropriate medications, the better. When just the surface diagnosis of ADHD is medicated, the outcome is often problematic. There may be a poor response to treatment and a higher rate of suicide.

scholarly journals 132 Treating Comorbid Childhood Bipolar Disorder and ADHD

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 283-284
Author(s):  
Darlyne G. Nemeth ◽  
Kayla Mckenzie Chustz
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Stimulant Medication ◽  
Treatment Options ◽  
Medication Management ◽  
Verbal Learning ◽  
Poor Response ◽  
Response To Treatment ◽  
Comorbid Diagnosis ◽  
Poster Paper

Abstract:Objectives:According to Nemeth et al. (2011), pediatric mania is difficult to distinguish from childhood hyperactivity. Both share 3 common symptoms: distractibility, motoric hyperactivity, and talkativeness (Biederman, 2000). Oftentimes, children are referred from their pediatrician due to a lack of appropriate response to stimulant medication. Pediatricians have learned that merely raising the dose or changing the stimulant does not work. A thorough neuropsychological evaluation often reveals Bipolar Mania. They may have comorbid Bipolar Disorder and ADHD. This poster paper will examine measures that can assist in this important differential diagnosis as well as offer treatment options, including medication management.Methods:This case study includes three pediatric patients diagnosed with Childhood Bipolar Disorder and ADHD. A comprehensive psychoeducational assessment was conducted for each of the patients, which resulted in this comorbid diagnosis.Results:One of the most helpful measures was the TOVA. When a child’s attention and impulsivity scores are normal, and response time and variability scores are abnormal, both on and off medication, that is an indication of a mood disorder (Nemeth et al., 2007). These children also performed poorly on measures of processing speed, and verbal learning and interference tasks (Henin et al., 2007). Measures of affect and personality were important diagnostically. A combination of Amantadine and either Clonidine HCL ER or Propranolol, as prescribed by a medical psychologist, were found to be effective in controlling the symptoms of this comorbid diagnosis.Conclusions:An evaluation of children’s intellectual, attentional, behavioral, mood, and personality functioning is crucial for a differential diagnosis. In cases of comorbidity, ADHD and Childhood Bipolar Disorder, the sooner the child is on appropriate medications, the better. When just the surface diagnosis of ADHD is medicated, the outcome is often problematic. There may be a poor response to treatment and a higher rate of suicide.

Anaplastic thyroid cancer: A report of six consecutive cases treated successfully with nab-paclitaxel.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17586-e17586 ◽  
Author(s):  
Nicholas Travers ◽  
Eleanor Cronin ◽  
Mira Marinova ◽  
Peter Smith ◽  
Andrew Peter Dean
Keyword(s):  
Thyroid Cancer ◽  
Primary Tumour ◽  
Treatment Options ◽  
Poor Response ◽  
Anaplastic Thyroid Cancer ◽  
Response To Treatment ◽  
Phase 2 Trial ◽  
Local Disease ◽  
Radiological Response ◽  
Number Of Cycles

e17586 Background: Advanced anaplastic thyroid cancer is a disease with very few treatment options. Poor response rates have been reported with cisplatin / doxorubicin and modest response noted in a single phase 2 trial with 24 hour paclitaxel infusion. The 50% response rate has not been reproduced by other investigators but raises questions about the possible utility of taxanes. Although paclitaxel is not approved for this indication in Australia, nab-Paclitaxel is available on a compassionate access scheme. We report 6 consecutive cases treated with nab-paclitaxel (as an alternative to paclitaxel infusion) who all exhibited a response to treatment. Methods: 6 consecutive patients with histologically proven advanced anaplastic thyroid cancer were assessed and imaged to document extent of disease. They were all treated with nab-paclitaxel 100mg/M2 given weekly either continuously or for 3 weeks out of every 4. Clinical and radiological response to treatment was documented. Results: The number of cycles given ranged from 3 to 8. Two patients required dose reductions due to neuropathy. Of the 6 patients; 5 had measurable metastatic disease and 5 had measurable local disease. Four patients showed clinical response to treatment with shrinkage of measurable local disease. One patient showed response to treatment with shrinkage of the primary tumour. Three patients with stridor developed considerable relief from this distressing symptom. Three patients with inoperable disease subsequently became operable and were resected to obtain local disease control. One patient with no evaluable disease after resection (Stage 4B) who received adjuvant nab-paclitaxel remains free of recurrence at 4 years. Conclusions: Anaplastic thyroid cancer is generally regarded as malignancy untreatable by chemotherapy. Our pilot series suggests nab-Paclitaxel warrants further evaluation and should be considered as a chemotherapy backline for combination with targeted agents.

scholarly journals Keratosis Lichenoides Chronica – a Case Report and Literature Review

2014 ◽  
Vol 6 (3) ◽  
pp. 120-137
Author(s):  
Mirjana Paravina ◽  
Predrag Cvetanović ◽  
Miloš Kostov ◽  
Slađana Živković ◽  
Ivana Dimovski ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
Rare Disease ◽  
Clinical Picture ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Poor Response ◽  
Unknown Etiology ◽  
Distinct Entity

Abstract Keratosis lichenoides chronica represents a distinct entity, a rare disease of unknown etiology and pathogenesis, with clinical manifestations which, although typical, require extensive differential diagnosis. The course of the disease is chronic, progressive, and it is resistant to various treatment options, so despite variations in the clinical picture it is really easier to diagnose than to treat. This is a case report of a male patient in whom the diagnosis of keratosis lichenoides chronica was based on typical clinical picture, repeated biopsies and histopathological findings, course of the disease and poor response to any therapy.

scholarly journals Management Of Childhood Lichen Planus

2016 ◽  
Vol 12 (1) ◽  
pp. 1-6
Author(s):  
DM Thapa ◽  
M Malathi
Keyword(s):  
Lichen Planus ◽  
Treatment Options ◽  
Poor Response ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Direct Immunofluorescence ◽  
Topical Steroids ◽  
Indian Children ◽  
Lichen Planopilaris ◽  
Oral Steroids

Childhood lichen planus (LP) is a rare entity, with less than 2–3% of all cases seen in patients under 20 years of age. LP in childhood is common in subtropical countries such as India. The most common clinical type of LP in Indian children is the classic form. Approximately 1–15% of patients with LP demonstrate nail involvement, but disease of the nails without skin involvement is rare. LP is diagnosed by historical and physical findings, biopsy results, and, in some cases, features on direct immunofluorescence (DIF). LP tends to have a chronic course. Depending on disease severity, however, LP may respond to a combination of topical or systemic therapies. The response to therapy may be similar to that seen in adults. Moderately potent or super potent steroids are the treatment of choice. Topical steroids can be combined with oral steroids in tapering doses over 2-12 weeks period. This is useful for children with widespread involvement or cutaneous LP lesions associated with significant morbidity. Intralesional steroid is effective for hypertrophic LP unresponsive to topical steroids. Topical steroids in adhesive base used several times a day for several months is a treatment of choice for symptomatic oral LP. Topical steroids in combination with systemic steroids can be given in a tapering dose over 3-6 weeks in very symptomatic cases in early stages. In severe unresponsive cases of both cutaneous and oral LP, oral retnoids are the preferred option. Treatment options for the nail LP in young children are oral steroids given as tapering dose over 4-12 weeks and oral retinoids. Intralesional steroids as nail matrix injection are the third option for older children. Most pediatric patients with LP respond to treatment with full clearance over 1-6 months. Poor response to treatment is a feature of hypertrophic LP and lichen planopilaris. DOI: http://dx.doi.org/10.3126/njdvl.v12i1.10588 Nepal Journal of Dermatology, Venereology & Leprology Vol.12(1) 2014 pp.1-6

Successful allografting for relapsing pediatric ALL: The results of two decades.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e22000-e22000
Author(s):  
O. Bulent Zulfikar ◽  
Basak Koc
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Treatment Options ◽  
Poor Response ◽  
Response To Treatment ◽  
Laboratory Findings ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct

e22000 Background: The prognosis of children and adolescents with acute lymphoblastic leukemia (ALL) has dramatically improved. This success is associated with both by multiagent chemotherapy regimens and by definition of clinical, biological and treatment response that allow the administration of risk-adapted therapy, including allogeneic hematopoietic stem cell transplantation (HSCT). In treatment of relapsed and resistance ALL, allogeneic HSCT continues to play a major curative role. In the present study, we desciribed the patients who underwent HSCT in our clinic in the last 21 years. Methods: From 1999 to 2020, 147 patients who diagnosed with ALL and treated with the COG protocols at the Istanbul University Oncology Institute were retrospectively reviewed and 17 of them relapsed. HSCT was applied 7 of the relapsed cases and also 3 resistant cases who had suitable matched donors. The demographic features, laboratory findings and treatment responses of 10 patients were recorded from the patients’ medical records. Results: All 10 patients were B-ALL with median diagnosis age of 79.5 months (range: 32-195) and 5 were male. Characteristics of patients given in Table 1. HSCT was performed due to late relaps in 7 patients. Three of the 7 relaps were only bone marrow and other 4 had combined. Patient #2 had both breast, conjunctiva and bone marrow for the 1st relaps and only conjunctiva for the 2nd one and this patient had also t(9;22) in the 1st relaps. Patient #3 had bone marrow+central nervous system relaps and patient #7 had bone marrow for the 1st relaps and testis and bone marrow for the 2nd one. Other 3 had poor response to treatment and Minimal Residual Disease (MRD) was high in End of Introduction (EoI) and End of Consolidation (EoC)). All patients had allogeneic HSCT and 8 are alive. Conclusions: HSCT remains the standard-of-care treatment for ALL patients who carry high-risk features predicting leukemia recurrence and for those experiencing high-risk first relapse or multiple relapses. Additionally, defining the indications of HSCT are dynamic and it could change according to treatment options as well as new molecular and biological findings. It is important to identify the patients who have high relapse risk and HSCT should have priority in patients whom MRD is high in EoI and EoC.[Table: see text]

scholarly journals Dissociative Symptoms and Psychotic Features in Bipolar Disorder: Impact on Clinical Course and Treatment Response

2021 ◽  
Author(s):  
Luca Steardo ◽  
Elvira Anna Carbone ◽  
Enrica Ventura ◽  
Renato de Filippis ◽  
Mario Luciano ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Treatment Response ◽  
Close Association ◽  
Poor Response ◽  
Structured Interview ◽  
Mood Stabilizers ◽  
Response To Treatment ◽  
Future Perspective ◽  
Psychotic Symptoms ◽  
Dissociative Symptoms

Abstract Background Dissociative symptoms are widely expressed in patients with bipolar disorder (BD) and may precede the onset of the disorder and be a marker of poor treatment response. In the present study we aimed: 1) to assess the relationship between dissociative symptoms and the onset of psychotic symptoms in patients with BD; 2) to assess clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and the response to treatment with mood stabilizers. Methods One-hundred patients diagnosed with BD were enrolled in this study. They underwent a semi-structured interview to collect socio-demographic and clinical characteristics. Dissociative Experiences Scale-II (DES-II) and ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers respectively. Results Forty-four percent of patients reported psychotic symptoms on the DES-II scale; BD I patients had a higher total DES-II score than BD II patients. Dissociative symptoms presented a direct correlation with the total number of episodes (p < .000), antidepressant switch to mania (p < .000), seasonality (p < .000), aggression (p < .000), and mixed states (p < .000). higher DES-II scores were reported by patients with poor response to treatment. Conclusions Dissociative phenomena are closely related to the presence of psychotic symptoms in BD, especially in BD I. In a future perspective, this association could represent a diagnostic indicator of BD I have given the close association with psychotic symptoms. Our study shows that several clinical variables transversely indicate a poor response to treatment with mood stabilizers, a worse course of illness, and the presence of dissociative symptoms.

scholarly journals Differential Diagnosis and Treatment of Comorbid PTSD and TBI in Combat Veterans

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Clees
Keyword(s):  
Differential Diagnosis ◽  
Combat Veterans ◽  
Treatment Options ◽  
Diagnostic Tools ◽  
Diagnostic Process ◽  
Traditional Treatment ◽  
Recommended Treatment ◽  
Comorbid Diagnosis ◽  
Treatment Plans ◽  
Larger Sample

The purpose of this paper was to summarize what is currently known about diagnosing and treating comorbid PTSD and TBI in combat veterans, beginning with a focus on differential diagnosis of the two disorders in order to elucidate any obfuscation by overlaps in symptomology, and concluding with possible treatment plans, as informed by the diagnostic process.  Differential diagnosis was evaluated via self-reported and clinician-administered questionnaires, oculomotor testing, and neuroimaging, while the discussion of treatment options acknowledged the necessity of adjustments to traditional treatment paradigms when a comorbid diagnosis is involved.  Self-reporting diagnostic tools are quick and easy to screen for PTSD and TBI, but these methods may over-report PTSD, and under-report TBI.   Clinician-administered questionnaires are longer and require a trained professional, but accuracy is gained. The oculomotor testing and SPECT scanning hold promise if the experiments can be repeated with larger sample sizes by additional researchers, but they do appease a more impartial evidence-based approach.  Psychotherapy is generally the number one recommended treatment for PTSD and TBI, due to its efficacy compared to pharmaceuticals, and further studies elucidating the efficacy of varieties of psychotherapy treatment may benefit individuals with this comorbid diagnosis. 

scholarly journals Pilot Evaluation of the Medication Integration Protocol for Adolescents With ADHD in Behavioral Care

2016 ◽  
Vol 24 (4) ◽  
pp. 223-234 ◽  
Author(s):  
Aaron Hogue ◽  
Emily Lichvar ◽  
Molly Bobek
Keyword(s):  
Behavioral Treatment ◽  
Stimulant Medication ◽  
Treatment Options ◽  
Medication Management ◽  
Psychiatric Evaluation ◽  
Community Clinic ◽  
Hyperactivity Disorder ◽  
Basic Protocol ◽  
Family Based ◽  
Family Centered

Although attention-deficit/hyperactivity disorder (ADHD) is prevalent among adolescents in outpatient behavioral care, one of the few evidence-based treatment options, stimulant medication, is significantly underutilized. The Medication Integration Protocol (MIP) is a family-based intervention designed to help behavior therapists assume a lead role in educating clients about ADHD in adolescents, promoting family-centered decisions about medication initiation, and integrating medication management activities within behavioral treatment planning. This pilot study evaluated treatment fidelity and medication utilization for inner-city teens receiving MIP ( n = 14) compared with a matched Historical Control (HC) group ( n = 21) in a community clinic. Observational analyses revealed that in comparison with HC, MIP demonstrated basic protocol fidelity with regard to adherence to the MIP protocol, therapeutic alliance with the adolescent, and clinical focus on ADHD in session. MIP showed greater psychiatric evaluation completion and ADHD medication initiation than HC. Next steps in the ongoing development of MIP are outlined.

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