Medicating Children: The Case of Ritalin

In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well-founded.     

Use and abuse of psychoactive drugs in the elderly.

The elderly are susceptible to many psychiatric symptoms caused by the vast array of drugs they may take. Therefore, history-taking demands a very careful look at all their medicines. In this paper some dangers of over-the-counter drugs are described, and the paradox of psychotropic drugs sometimes causing psychiatric side effects is discussed. Several types of drugs and their side effects are outlined, and suggestions are made for appropriate drug treatment in this age group.     

Non-uptake of predictive genetic testing for BRCA1/2 among relatives of known carriers: attributes, cancer worry, and barriers to testing in a multicenter clinical cohort

BRCA1/2 test decliners/deferrers have received almost no attention in the literature and this is the first study of this population in the United Kingdom. The aim of this multicenter study is to examine the attributes of a group of individuals offered predictive genetic testing for breast/ovarian cancer predisposition who did not wish to proceed with testing at the time of entry into this study. This forms part of a larger study involving 9 U.K. centers investigating the psychosocial impact of predictive genetic testing for BRCA1/2. Cancer worry and reasons for declining or deferring BRCA1/2 predictive genetic testing were evaluated by questionnaire following genetic counseling. A total of 34 individuals declined the offer of predictive genetic testing. Compared to the national cohort of test acceptors, test decliners are significantly younger. Female test decliners have lower levels of cancer worry than female test acceptors. Barriers to testing include apprehension about the result, traveling to the genetics clinic, and taking time away from work/family. Women are more likely than men to worry about receiving less screening if found not to be a carrier. The findings do not indicate that healthy BRCA1/2 test decliners are a more vulnerable group in terms of cancer worry. However, barriers to testing need to be discussed in genetic counseling.     

The safety of psychotropic drug use during pregnancy: a review

A substantial number of women of childbearing age are prescribed psychotropic drugs, and because nearly 50% of pregnancies are unplanned, many women are still taking them upon becoming pregnant. This article reviews the various classes of psychotropic drugs that are commonly used to treat psychiatric disorders--antidepressants, benzodiazepines, antipsychotics, antiepileptics, lithium and monoamine oxidase (MAO) inhibitors--in terms of their safety during pregnancy. Evidence-based information from epidemiologic studies indicates that most psychotropic drugs are relatively safe for use during pregnancy. There is also an increasingly large body of evidence-based information in the literature indicating that it may be more harmful to both the mother and her baby if she is not treated appropriately when suffering from a severe psychiatric disorder. Therefore, it is important for women with psychiatric disorders and their healthcare providers to have access to evidenced-based information about the safety of these drugs when taken during pregnancy to ensure that women make an informed decision as to whether they should continue with the pharmacotherapy they have been using to treat their condition.     

The effect of newly synthesized psychotropic preparations on the "open field" behavior of rats]

The results of effect of some new synthesized psychotropic drugs of nootropic series on rats' behavior in "open field" are given. The increase of locomotive activity and decrease of emotional tension correlated with the rise of rats' ability to learning during working-out of avoidance reaction in shuttle-box, e.i. conditionally reflectory memory. It has been concluded that the study of dynamics of behavioral reactions in "open field" may be used for testing of new synthesized psychotropic drugs of nootropic series.     

The interaction of psychotropic preparations with immunocompetent targets as the basis for their future nontraditional use

Published data on interactions of some psychotropic drugs with immunocompetent target cells has been reviewed. The observed immunosuppressive, immunostimulating, and immunomodulating activities of the drugs are considered nontraditional. The necessity of more detailed study of mechanisms of such interactions is outlined. Possible use of psychotropic drugs as immunomodulators is proposed.     

Choosing to refuse: patients' rights and psychotropic medication

The author discusses the position of the plaintiffs in Rogers v. Okin, a legal case in which it was argued that involuntarily committed mental patients have the right to refuse psychotropic medication. She expresses reservations about paternalistic justifications for forced medication that are based on authority, on loss of autonomy by the mentally ill, on overriding autonomy for the patient's good, on the 'self paternalism' of the psychiatric will, and on intervention as restoring autonomy. Radden argues that the patient's right to choose is supported by an extension of the concept of competence to include competence to judge an issue. She asserts that neither patients nor physicians have sufficient knowledge of the side effects of psychotropic drugs to make rational decisions. Since neither possesses proper competence, the patient should choose.     

‘THEY SAY ISLAM HAS A SOLUTION FOR EVERYTHING,SO WHY ARE THERE NO GUIDELINES FOR THIS?’ ETHICAL DILEMMAS ASSOCIATED WITH THE BIRTHS AND DEATHS OF INFANTS WITH FATAL ABNORMALITIES FROM A SMALL SAMPLE OF PAKISTANI MUSLIM COUPLES IN BRITAIN

This paper presents ethical dilemmas concerning the termination of pregnancy, the management of childbirth, and the withdrawal of life-support from infants in special care, for a small sample of British Pakistani Muslim parents of babies diagnosed with fatal abnormalities. Case studies illustrating these dilemmas are taken from a qualitative study of 66 families of Pakistani origin referred to a genetics clinic in Southern England. The paper shows how parents negotiated between the authoritative knowledge of their doctors, religious experts, and senior family members in response to the ethical dilemmas they faced. There was little knowledge or open discussion of the view that Islam permits the termination of pregnancy for serious or fatal abnormality within 120 days and there was considerable disquiet over the idea of ending a pregnancy. For some parents, whether their newborn baby would draw breath was a main worry, with implications for the baby's Muslim identity and for the recognition of loss the parents would receive from family and community. This concern sometimes conflicted with doctors' concerns to minimize risk to future pregnancies by not performing a Caesarean delivery if a baby is sure to die. The paper also identifies parents' concerns and feelings of wrong-doing regarding the withdrawal of artificial life-support from infants with multiple abnormalities. The conclusion considers some of the implications of these observations for the counselling and support of Muslim parents following the pre- or neo-natal diagnosis of fatal abnormalities in their children.     

Some problems of radiation diagnosis of colon cancer

The paper gives the view of the author who is based on his many-year experience in studying a role of radiation diagnosis of colon cancer. It shows it necessary to enhance the significance of radiation diagnosis. More attention should be given to the traditional section on the current radiation study of the large bowel: to irrigoscopy and single double contrasting. By taking into account the labor-consumption of irrigoscopy, the author suggests that the procedure should be simplified without losing its diagnostic capacities. However, he considers single double contrasting of the bowel to be the optimum technique of traditional X-ray study of the bowel in detecting its tumors. Pneumocolonoscopy and iliocecal node study of the ileocecal angle are given in the paper as supplementary techniques of traditional X-ray study of the large bowel. Emphasis is also placed on the role of radiation diagnostic techniques, such as ultrasound diagnosis, X-ray computed tomography, and magnetic resonance imaging. By highly appreciating their significance in the diagnosis of colon cancer, the author believes that they should play a role of important, but additional ways of detecting this pathology. By pointing out the excellent capacities of fibrocolonoscopy, as applied to the problem discussed in the paper, the author does emphasize the certain limitations of this technique, by taking into account that its application can cause some complications. The author's opinion that the obvious increase in the incidence of endophytic carcinomas drastically enhances the role of their radiation diagnosis, but by obligatorily correcting currently available principal methodic and semiotic directives, runs through the entire paper.     

Altruism or solidarity? The motives for organ donation and two proposals

Proposals for increasing organ donation are often rejected as incompatible with altruistic motivation on the part of donors. This paper questions, on conceptual grounds, whether most organ donors really are altruistic. If we distinguish between altruism and solidarity--a more restricted form of other-concern, limited to members of a particular group--then most organ donors exhibit solidarity, rather than altruism. If organ donation really must be altruistic, then we have reasons to worry about the motives of existing donors. However, I argue that altruism is not necessary, because organ donation supplies important goods, whatever the motivation, and we can reject certain dubious motivations, such as financial profit, without insisting on altruism. Once solidaristic donation is accepted, certain reforms for increasing donation rates seem permissible. This paper considers two proposals. Firstly, it has been suggested that registered donors should receive priority for transplants. While this proposal appears based on a solidaristic norm of reciprocity, it is argued that such a scheme would be undesirable, since non-donors may contribute to society in other ways. The second proposal is that donors should be able to direct their organs towards recipients that they feel solidarity with. This is often held to be inconsistent with altruistic motivation, but most donation is not entirely undirected in the first place (for instance, donor organs usually go to co-nationals). While allowing directed donation would create a number of practical problems, such as preventing discrimination, there appears to be no reason in principle to reject it.     

Dysfonction érectile d’origine médicamenteuse: effet indésirable sous-estimé en pharmacovigilance

Some drugs can induce erectile dysfunction (priapism or impotence) due to their pharmacological properties. Some adverse effects (ADRs) are only detected after marketing of the drug with a low frequency (unexpected ADRs). Pharmacovigilance and pharmacoepidemiologic studies collect data about real drug use and contribute to a better evaluation of the benefit/risk ratio. Data about cases of erectile dysfunction spontaneously reported to the French Pharmacovigilance system were collected over a 5-year period (2000 to 2004). 39 cases of drug-induced priapism were identified, 25 of which were classified as serious (62.5%), mainly due to anticoagulants (12 cases), psychotropic drugs (8 cases), phosphodiesterase inhibitors (8 cases) and beta-blockers (2 cases). During the same period, 214 cases of impotence either isolated or associated with ejaculation dysfunction were reported, mainly with antiretroviral drugs, fibrates and HMG CoA reductase inhibitors, psychotropic drugs and beta-blockers. Our data indicate that some ADRs, such as erectile dysfunction, are severely under-reported. Spontaneous reporting and pharmacoepidemiologic studies could contribute to a better knowledge of drugs and their rational use.     

Qualitative interview study of communication between parents and children about maternal breast cancer

Objective To examine parents'' communication with their children about the diagnosis and initial treatment of breast cancer in the mother. Design Qualitative interview study within a cross-sectional cohort. Setting Two breast cancer treatment centers. Participants 32 women with stage I or stage II breast cancer with 56 school-aged children. Main outcome measures Semistructured interview regarding timing and extent of communication with children about the diagnosis and initial treatment of the mother''s illness, reasons for talking to children or withholding information, and help available and requested from health professionals. Results Women were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a few waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was to avoid children''s questions, particularly those about death. Although most women had helpful discussion with a physician concerning their illness, few were offered help with talking to their children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children. Conclusion Parents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.     

The "sensory" safety of drugs: photosensitizing damage to the structures of the eye]

Phototoxic side effects of a number of different drugs and natural photosensitizers [correction of photosensors] (psoralenes, psychotropic phenotiazines, anti-malaria drugs, porphirines, adriamycine, etc.) have been analyzed. The ways of study of sensory harmlessness of drugs have been discussed.     

Een kwalitatieve exploratie van het chronisch gebruik van psychofarmaca in woonzorgcentra

Background

Although guidelines put forward non-pharmacological therapies and advise against the chronic use of psychotropic drugs, these are still being prescribed regularly in Belgian nursing homes.

Goal

To explore the reasons for initiation, continuation and cessation of psychotropic drug treatment of elderly with dementia and behavioral problems, residing in the nursing home.

Method

Twenty-seven interviews from an earlier project were used, in which a semi-structured interview was conducted with the nursing staff, the physicians and the caretakers of eleven randomly selected residents from three nursing homes. A qualitative analysis was performed by three independent researchers according to ‘The Qualitative Analysis Guide of Leuven (QUAGOL)’. A first analysis focused on the process of initiation, continuation and cessation of medication. A second analysis compared the different participants of each interview and looked for similarities and differences.

Results

Seventeen codes were developed for four themes: (1) To initiate, to continue or to cease?; (2) Behavior; (3) Therapy; and (4) Alternatives. The reasons for initiating psychotropic drugs were reducing disruptive behavior and improving the quality of life of the resident. A comparison between the interviewed showed that psychotropic drugs were initiated at the request of the nursing staff. Neither doctors nor nurses considered the monitoring of the drug therapy their task, and tended to pass on this responsibility. Once psychotropic drugs were started, the treatment was chronic but remained part of a dynamic process in which a balance was sought between benefits and adverse effects. More insights into the behavior of the resident led to a better treatment of the behavioral problems.

Conclusion

Nurses play an important role in the initiation and continuation of psychotropic drugs. Physicians should take a more active role in the process of indication and monitoring of psychopharmaceuticals. Discontinuation of psychotropic drugs and the use of non-pharmacological alternatives are important bottlenecks in nursing homes. Education and training, updated practice guidelines, appropriate research, professionalization and management elements can, in a complex interaction, change this situation for the better.

     

Human adoption in evolutionary perspective

Exploitation is a fundamental element of the parental strategies of many species of birds. Cuckoos, for example, lay their eggs in the nest of other birds, who often unwittingly rear the alien nestlings as their own. Nest parasitism is an efficient reproductive strategy for cuckoos, who do not have to worry about building a nest, incubating their eggs, or feeding their nestlings. But not all hosts respond passively to such intrusions. In response to parasitic cowbirds, for example, robins have evolved the ability to detect and selectively eject alien young from their nests. Human parenting strategies differ sharply from the strategies of cuckoos and robins. Unlike cuckoos, we are reluctant to allow our children to be raised by others. Unlike robins, we knowingly rear strange young. What makes human behavior toward children so different from that of cuckoos and robins? Humans seem to share a number of predispositions that facilitate successful adoptive relationships, and the desire to raise children seems to be pervasive among modern humans. Despite these commonalities, patterns of adoption transactions vary greatly among contemporary human societies. This paper considers the origins and causes of cross-cultural variation in human adoptive behavior from an evolutionary perspective.