Monday, July 20, 2009

Increased Risk of Sudden Death in Children on Psychostimulants

Gould MS et al. - This case-control study provides support for an association between the use of stimulants and sudden unexplained death among children and adolescents. Although sudden unexplained death is a rare event, this finding should be considered in the context of other data about the risk and benefit of stimulants in medical treatment.

  • A matched case-control design was performed.
  • Mortality data from 1985–1996 state vital statistics were used to identify 564 cases of sudden death occurring at ages 7 through 19 years across the United States along with a matched group of 564 young people who died as passengers in motor vehicle traffic accidents.
  • The primary exposure measure was the presence of amphetamine, dextroamphetamine, methamphetamine, or methylphenidate according to informant reports or as noted in medical examiner records, toxicology results, or death certificates.
  • In 10 (1.8%) of the sudden unexplained deaths it was determined that the youths were taking stimulants, specifically methylphenidate; in contrast, use of stimulants was found in only two subjects in the motor vehicle accident comparison group (0.4%), with only one involving methylphenidate use.
  • A significant association of stimulant use with sudden unexplained death emerged from the primary analysis, which was based on exact conditional logistic regression (odds ratio=7.4, 95% CI=1.4 to 74.9).
  • A comprehensive series of sensitivity analyses yielded qualitatively similar findings.
There were 10 kids who died suddenly on stimulants over 10 years. Assume about a million children take amphetamines. That means the risk is 1 in a 1 million per year or 1 in a billion per dose. The comparison group chose a cause of death not under the child's control, auto crashes. If they had chosen accidental deaths caused by the child's behavior, the difference would have been twice as big, since treatment of ADHD cuts the accident rate in half.

Tuesday, April 22, 2008

Effect of Foster Care vs. Institutional Care

Here. Foster kids did better than institutionalized kids in this study of random assignment (in Bucharest). Control kids did better than both of those groups.

Saturday, April 19, 2008

Abilify Gets a Child FDA Approved Indication

Here. Other neuroleptic uses in children get covered.

1) Abilify is already number one for aggressiveness in young people.

2) Almost none have a mood disorder. Most have ADHD complicated by Oppositional Defiant Disorder or Conduct Disorder (ODD plus criminality).

3) Abilify is the greatest anti-anger medication in the history of mankind. It works like an amphetamine. It is not an amphetamine, and does not improve ADHD symptoms. It reduces impulsivity, and over-reactivity to trivial slights. It wears off like amphetamines. It is short acting like amphetamines. Parents speak of all symptoms recurring after forgetting it for one day, and their resolution upon receiving it late. It has an activiating property in most kids after initial sedation side effects.

4) The advice for its use in bipolar disorder is quite inappropriate. A doctor will only follow the directions once. Kids experience far more nausea, akathesia (restless legs), and rigidity. All patients receive prescriptions for benztropine 0.5 mg or 1 mg if over 120 lbs. Few will use it. However, parents must be warned about distressing Parkinsonian side effects. All patients, even big ones, get 5 mg for at least a week. The prudent clinician may wish to start 2 mg. About 70% of patients respond. Every 6 months or so, the dose has to get split into halves, then it has to get increased. Upon reaching 30 mg a day, the recommended maximum, one may increase the dose. However, one should get an Abilify blood level. In children, doses up to 80 mg may be needed to achieve the blood levels of others on 30 mg. If the blood level is that of average patients on 30 mg, and the response remains poor, Abilify does not work. The blood level may be run at a lab in Willow Grove, PA, for around $110.

5) These effects were discovered by clinicians across the nation. They did not communicate, nor influence each other. The patients and their long suffering, emotional, tearfully grateful parents taught it to the doctors.

6) Abilify is safer than all now available over the counter medications, both in use, and in overdose, accidental and intentional. The 2 mg dose should be available over the counter. Anger is a major public health problem. Most people with bad tempers will never submit to treatment. They may treat themselves at the urgings of their families or employers.

Pharmacotherapy of Aggression in Children and Adolescents

Here, and a case report ( JAACAP, 46:653-658.)

1) The doses are low. Kids have high rates of metabolism. If high doses do not work, check the blood levels of the neuroleptics before moving to a new one.

2) The use of medications for behavior management that lower blood pressure should preclude the use of restraints, except in a serious emergency. One has to choose, blood pressure lowering medication or restraints, not both. With the adoption of such a policy, the incidence of deaths in restraints without explanation drops.

3) Abilify would be the number one neuroleptic for aggression in people under 30 in the US. People with aggression, aged over 30, do not respond as well to it.

How About a Dollar a Day

The need to generate jobs blinded the researchers to a simple and cheap method of making anyone comply with any requirement.


They have tried a dollar a day to stay.