NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Sample Answer for NURS 6630 Assessing and Treating Patients With Bipolar Disorder Included After Question

NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Marcus, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which result in an initial diagnosis of depression. His mother later reports, however, that Marcus exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further evaluation, Marcus’ psychiatric nurse practitioner diagnoses him with bipolar disorder. 

Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provide all the information needed. In your role, as a psychiatric nurse practitioner, you must develop strategies for properly assessing and diagnosing these patients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders. 

This week, as you examine bipolar therapies, you explore the assessment and treatment of patients with bipolar disorder. You also consider ethical and legal implications of these therapies. 

Learning Objectives 

Students will: 

  • Assess patient factors and history to develop personalized plans of bipolar therapy for patients 
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring bipolar therapy 
  • Synthesize knowledge of providing care to patients presenting for bipolar therapy 
  • Analyze ethical and legal implications related to prescribing bipolar therapy to patients across the life span 

 

Learning Resources 

 

Required Readings (click to expand/reduce) 

 

Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier. 

Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier. 

Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier. 

Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.   

 

American Psychiatric Association. (2010b). Practice guideline for the treatment of patients with bipolar disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf 

 

Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: Comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835–841. https://doi.org/10.1007/s00228-015-1855-6 

 

Hirschfeld, R. M. A. (n.d.). Guideline watch: Practice guideline for the treatment of patients with bipolar disorder (2nd ed.).  https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf 

 

Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331–333. https://doi.org/10.1007/s40263-013-0060-3 

 

 

Medication Resources (click to expand/reduce) 

 

 

IBM Corporation. (2020). IBM Micromedex.  

https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537 

 

A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Title: NURS 6630 Assessing and Treating Patients With Bipolar Disorder

 

Mental health disorders are a crucial public health concern because of its rising rates and impacts on the health of the population. Mental health problems such a bipolar disorder affect the patient’s quality of life and productivity. Mental health nurse practitioners explore effective, evidence-based interventions that will promote recovery and prevent relapse among the affected populations. Often, pharmacological and non-pharmacological interventions are effective in facilitating bipolar disorder management and prevention of symptom relapse. Therefore, the purpose of this paper is to explore bipolar I disorder. It examines topics that include prevalence and neurobiology of bipolar I disorder, differences with bipolar II disorder, treatment in a special population and consideration, and monitoring drug use in the population.

Prevalence and Neurobiology

The selected type of bipolar disorder for analysis in the project is bipolar I disorder. Bipolar I disorder is a mental disorder characterized by patients experiencing episodes of irritable or highly elevated mood. The mood is referred to as mania. The expansive mood may be accompanied by other symptoms such as grandiosity, decreased need for sleep, racing thoughts, talkativeness, and engaging in risk-taking behaviors. The mood swings may shift between irritability, depression, anger and mania, resulting in mixed features in the bipolar disorder (Jones et al., 2022). Bipolar I disorder affects the health, wellbeing, and functioning of the patients, hence, the need for responsive strategies to optimize outcomes.

Bipolar I disorder has a lifetime prevalence of 0.6%. The prevalence is distributed equally between males and females. However, males tend to experience more manic episodes with the disorder while female experience more of depressive cycling episodes. The rates of bipolar I disorder is high in the developed countries (1.4%) as compared to the low-income countries (0.7%). Separated, widowed, or divorced individuals have the highest rate of bipolar I disorder. The cumulative prevalence of the three types of bipolar disorders is 1.8%. The onset of bipolar I disorder in the USA is at the age of 20 years while it is 29 years in the European countries (Psychdb.com, 2022). The prevalence rate among adults aged 18 years and above is 2.8%, with 4.4% of this population expected to develop it at some point in their lives. Adolescents have a lifetime prevalence of 2.9% of developing bipolar I disorder, with 2.6% of them suffering from severe impairment (Psychom.net, 2021). The risk factors for developing bipolar I disorder include genetics and environment risks such as traumatic experiences, substance abuse, and maternal vital infections during the prenatal period.

Bipolar I disorder has neurobiological basis. First, most studies have shown that individuals with bipolar disorder, including bipolar I experience death of neurons and glial cells. Persistent exposure to stress or traumatic events affects the functioning of glial cells and neurons, precipitating the onset of symptoms. There is also the role of neurotransmitters in the development of bipolar disorder. Accordingly, patients with bipolar disorder demonstrate changes in the regulation of dopamine, serotonin, and acetylcholine neurotransmitters (Young & Juruena, 2021). Alterations in the balance as well as their receptor systems affect functions such as behavior, endocrine regulation, and sleep-wakefulness.

Patients with bipolar I disorder also have problems with intracellular signaling in their brains. Studies have found the existence of macroscopic changes in brain regions and circuits, which are accompanied by chemical and histopathological brain changes. Stressors promote oxidative processes, which destroy brain cells, neurons, and cause imbalance in chemicals causing symptoms of bipolar I disorder (Scaini et al., 2020). For instance, there is an increase in the activity of chemical superoxide dismutase, which can depression and manic episodes in the affected patients.

Differences

A comparison is made between bipolar I and bipolar II disorder. The both types of bipolar have periods of depressive symptoms and elevated mood. The disorders also share similar symptoms during manic episode such as euphoria, insomnia, excessive talking, racing thoughts, and inflated self-esteem.  They also have the same symptoms of depression such as low energy, sadness, decreased appetite, feelings of guilt, and isolation (Jones et al., 2022). However, they have some differences. The first one is that patients experience full manic episodes in bipolar I disorder. They experience extreme shifts in energy and mood. The symptoms are severe to affect the functioning of the patients in the social and occupational roles. The symptoms of mania and depression are less severe in bipolar II disorder. For example, hypomanic symptoms in this disorder such as elevated mood are not intense to affect the individual’s functioning. The depressive symptoms in bipolar I disorder lasts at least two weeks while in bipolar II they last at least two weeks but longer than bipolar I. Patients experiencing bipolar I disorder also have at least an episode of mania while there is no mania in bipolar II disorder (Coda, 2022). There is also the experiences of delusions and hallucinations in bipolar I disorder, which are not evident in bipolar II disorder.

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NURS 6630 Assessing and Treating Patients With Bipolar Disorder
NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Special Population and Considerations

Treatment of bipolar I disorder in special populations present unique challenges to mental health practitioners. The special populations include children, adolescents, pregnant mothers, post-operative adults, and the elderly. Each of this populations have unique needs that influence the selection of treatment in bipolar disorders. Children and adolescents have immature organs such as the liver and kidneys. These vital organs are involved in the metabolism and excretion of the different drugs used in treating bipolar disorders. Psychiatric mental health nurse practitioners must weigh the benefits and risks of the different options for treatment before prescribing them. Most of the treatments utilized for children and adolescents are also off-label. This places them at an increased risk of harm due to the use of drugs with unknown safety and efficacy index. The elderly patients also experience considerable functional declines that affect the options of treatment for bipolar disorders (Healthcare, 2023; Skidmore-Roth, 2022). For example, the decline in renal and hepatic functions affect the dosing of different medications for use in treating bipolar I disorder. Psychiatric mental health nurse practitioners must also assess the efficacy of the different drugs to prenatal mothers to eliminate risks of teratogenicity.

One of the legal consideration when treating bipolar I disorder is the psychiatric mental health nurse practitioner providing care within her scope. This includes ensuring the prescription of drugs for bipolar I disorder within her prescriptive authority. Practicing within the scope eliminates potential issues that may arise due to harm from the provided care. PMHNP should also make decisions based on ethical considerations. This includes seeking informed consent, and promoting privacy and confidentiality of the patients’ data. The nurse must also ensure safety in the care process. The prescribed treatments should not predispose the special populations to any harm. The decisions made should also aim at safeguarding the rights and needs of the patients, hence, non-maleficence and benevolence. PMHNP should also adopt patient-centered interventions in bipolar I disorder management. This includes utilizing interventions that align with the values, beliefs, practices, and expectations of the patients and their families (Healthcare, 2023; Williams, 2021). The consideration of patient factors in the treatment process promotes outcomes such as enhanced adherence to the prescribed interventions.

FDA and or Clinical Practice Guidelines

The Food and Drug Administration (FDA) is mandated with the responsibility of recommending drugs for use in treating conditions in different populations. The FDA has approved olanzapine-fluoxetine combination for treatment of bipolar disorder with depressive symptoms. The other approved drugs for acute treatment of bipolar depression include quetiapine and lurasidone. The FDA has also approved Risperdal, quetiapine, and aripiprazole for use in children and adolescents experiencing any stage of bipolar disorder. Lithium is approved for use in adolescents aged 12 and above years (Skidmore-Roth, 2022). Olanzapine recommendations is used for adolescents aged 13 years and above. The FDA also recommends lithium and aripiprazole use in children and adolescents to prevent symptom relapse. The FDA has also approved caplyta for treating bipolar disorder in the elderly population. The FDA approved treatment for mixed bipolar disorder entails the use of quetiapine and combination of fluoxetine and olanzapine (Citrome, 2020; Wang & Osser, 2020). Healthcare providers may also consider antipsychotics such as aripiprazole, asenapine, risperidone, and ziprasidone for maintenance treatment, as they are FDA approved.

Side Effects, FDA Warnings and Monitoring

Safety and quality should be upheld when treating patients with bipolar disorder. As a result, patients should be monitored closely for side effects and adverse reactions to the above treatments. The healthcare providers should monitor patients prescribed Risperdal, quetiapine, and aripiprazole for side effects that include weight gain, dizziness, akathisia, tiredness, nausea, night tremors, and decreased libido. They should also assess for increased appetite, drowsiness, and heartburn. Rare side effects that must be reported include seizures, parkinsonian side effects such as tremors and muscle stiffness, changes in ECG, and neuroleptic malignant syndrome (Healthcare, 2023; Williams, 2021). The signs to monitor related to neuroleptic malignant syndrome include fainting spells, racing heart rate, fever, and muscle stiffness.

Patients prescribed lithium should be monitored for side effects that include drowsiness, bradycardia, fainting, confusion, and weight gain. The additional side effects include diarrhea, seizures, blurred vision, tinnitus, and vomiting. Patients prescribed fluoxetine should be monitored for side effects such as weight gain, decreased libido, and insomnia. The use of antidepressants such as fluoxetine carriers the risk of suicidal thoughts, attempts, or plans. Patients and family members should be educated about the importance of monitoring mood and sudden surge in the patient’s energy. Such observations are clues to potential intent of self-harm by the patient. Weight gain in already obese or overweight patients should also be considered an issue of concern (Skidmore-Roth, 2022). Patients should be referred to a nutritionist for dietary recommendations and be educated about the importance of healthy lifestyles and behaviors such as engaging in active physical activity.

Proper Prescription

Name: Mr. V

Age: 35

Diagnosis: Bipolar I disorder

Treatment: po risperidone 2 mg od 1/12

Refills: none

Signature:

Name: AA

Age: 15

Diagnosis: Bipolar I disorder

Treatment: po Lithium 300mg od 1/12

Refills: none

Signature:

Name: Mrs. W

Age: 25

Diagnosis: Bipolar I disorder

Treatment: po risperidone 3mg od 1/12

Refills: none

Signature:

Conclusion

In summary, bipolar I disorder is a type of a mental health disorder associated with severe mania and hypomania. It affects negatively patient’s health, wellbeing, and functioning. Bipolar I disorder is severe than bipolar II. The FDA has approved several drugs for use in bipolar disorder. Psychiatric mental health nurse practitioners should monitor patients for side and adverse reactions to the prescribed treatments.

 

 

References

Citrome, L. (2020). Food and Drug Administration–Approved Treatments for Acute Bipolar Depression: What We Have and What We Need. Journal of Clinical Psychopharmacology, 40(4), 334. https://doi.org/10.1097/JCP.0000000000001227

Coda, F. (2022). 2023 Foundations of Psychiatric-Mental Health Nursing. Amazon Digital Services LLC – Kdp.

Healthcare, S. (2023). Pharmacology, Nutrition, Paediatric Nursing—2023. Svastham Healthcare.

Jones, D. J. S., Jones, J. S., & Beauvais, D. A. M. (2022). Psychiatric Mental Health Nursing: An Interpersonal Approach. Jones & Bartlett Learning.

Psychdb.com. (2022, January 16). Bipolar I Disorder. PsychDB. https://www.psychdb.com/bipolar/bipolar-i

Psychom.net. (2021, July 14). Prevalence of Bipolar 1 Disorder. https://pro.psycom.net/assessment-diagnosis-adherence/bipolar-disorder/bipolar-disorder-prevalence-and-risks

Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., & Quevedo, J. (2020). Neurobiology of bipolar disorders: A review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42, 536–551. https://doi.org/10.1590/1516-4446-2019-0732

Skidmore-Roth, L. (2022). Mosby’s 2023 Nursing Drug Reference—E-Book. Elsevier Health Sciences.

Wang, D., & Osser, D. N. (2020). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on bipolar depression. Bipolar Disorders, 22(5), 472–489. https://doi.org/10.1111/bdi.12860

Williams, L. (2021). Nursing 2022: Drug Handbook. Independently Published.

Young, A. H., & Juruena, M. F. (2021). The Neurobiology of Bipolar Disorder. Current Topics in Behavioral Neurosciences, 48, 1–20. https://doi.org/10.1007/7854_2020_179

In the provided case study, the 8-year-old Caucasian female patient came to the clinic accompanied by her parents for psychiatric evaluation. The patient’s teacher suggested that the patient might be having attention deficit hyperactivity disorder (ADHD). Their family physician also suggested that the patient should see a psychiatrist for further evaluation of her mental disorder. The patient parents came with a completed Conner’s Teacher Rating Scale-Revised screening tool, which revealed that the patient is easily distracted at school, and with a short attention span. The patient also displayed poor arithmetic, spelling, and reading skills in addition to being inattentive and forgetful most of the time. Her teacher claims that the patient even failing to complete her homework will lack interest in school activities. She also fails to follow instructions at times. Despite the patient’s parents being in denial that their daughter has ADHD, mental status examination results proved otherwise together with the Conner’s Teacher Rating Scale-Revised screening tool completed by the teacher, supporting the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.

Developing a treatment plan for pediatric patients with mental disorders is quite challenging given the safety issues associated with this age group. However, appropriate prescriptive practice will involve considering patient-specific factors that might affect the pharmacokinetic and pharmacodynamic processes. Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. The purpose of this discussion is thus to demonstrate the appropriate decision-making process in the selection of the most appropriate intervention in the treatment of the 8-year-old attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.

Decision Point One

Selected Decision and Rationale

            From the listed options, initiating Ritalin (methylphenidate) 10mg chewable tablets taken every morning was decided on as the initial intervention. Ritalin is recommended by most clinical guidelines as the first-line medication for the management of ADHD among both children and adults (Rodrigues et al., 2021). Despite the psychostimulant not being approved by the FDA, it has displayed great effectiveness in the management of ADHD with a desirable safety profile in most children from ages 6 to 15 years (American Psychiatric Association, 2013; Castells et al., 2021)). It has demonstrated a substantial impact in managing ADHD symptoms such as inattention, forgetfulness, impulsivity, diminished interest, and hyperactivity among children (Hodgkins et al., 2012). The chewable formulation is considered the best option for children with sweeteners to mask the bitter taste of the drug (Breaux et al., 2022). Consequently, the drug has a short onset of action of between 1 to 2 hours with a long duration of action of between 7.5 to 10.5 hours after oral administration (Mechler et al., 2021). This helps in the management of the patient’s symptoms all day long (Coghill et al., 2021).

Bupropion is associated with increased risks of seizures among children below the age of 10 years, hence not an appropriate decision (Coghill et al., 2021). Intuniv on the other hand is associated with cardiovascular side effects, hence should only be considered in case there is no other safer and more effective drug for use in the pediatric population (Rodrigues et al., 2021).

Expected Outcome

The patient will experience improved symptoms of ADHD in the next four weeks (Coghill et al., 2021). She should be able to improve her spelling, arithmetic, and language skills, in addition to being more attentive and able to concentrate on school work (Hodgkins et al., 2012). Her school performance will improve significantly within this period.

Ethical Considerations

            The patient is 8 years of age, which gives the parents legal responsibility of making decisions concerning the health of their child (American Psychiatric Association, 2013). As such, the PMHNP must educate them adequately regarding the patient’s diagnosis and potential treatment options, to promote sound decision-making in promoting the health of their child (Rodrigues et al., 2021).

Decision Point Two

Selected Decision and Rationale

            The second decision was to change the treatment regimen to long-acting Ritalin 20mg administered orally in the morning. Based on the treatment outcome, Ritalin displayed potential effectiveness given that the patient’s ADHD symptoms improved evidenced by her improved school performance (Breaux et al., 2022). However, since the medication was not able to manage the patient’s symptoms throughout the entire day, it was necessary to introduce a long-acting formulation to prolong the duration of action of the drug (American Psychiatric Association, 2013). Studies show that long-acting Ritalin lasts for between 8 to 12 hours hence, helps in managing the patient’s symptoms throughout the day (Castells et al., 2021). It is also administered once daily which is more convenient and much easier. The patient also reported a side effect of elevated pulse, which is a common self-limiting side effect of Ritalin that is expected to diminish with time (Coghill et al., 2021).

Continuing with the same drug at the same dosage was inappropriate as the patient would still exhibit ADHD symptoms later in the day, once the drug wears off from the body system (Mechler et al., 2021). Replacing Ritalin with Adderall is also inappropriate as Adderall is associated with increased incidences of suicidal events when used among children (Hodgkins et al., 2012).

Expected Outcome

            The long-acting formulation is expected to manage the patient’s symptoms all day long within the following four weeks (Breaux et al., 2022). The patient’s school performance will improve even further. The side effect of elevated heart rate will resolve completely within this time (Coghill et al., 2021).

Ethical Considerations

            In making this decision, the PMHNP had to consider several ethical principles including justice, beneficence, nonmaleficence, and respect for the patient’s autonomy (Breaux et al., 2022). The patient was quite comfortable with how the drug was working, but only concerned with the side effect, and effectiveness of the medication later in the day (Rodrigues et al., 2021). As such, it was necessary to respect the patient and display clinical judgment in making decisions that will promote the patient’s mental health.

Decision Point Three

Selected Decision and Rationale

            Maintaining the patient on the current medication and reevaluating after four weeks, seemed to be the most appropriate decision for the third intervention. The patient reported great effectiveness and tolerance to the medication, with resolved side effects of an elevated pulse (Mechler et al., 2021). Previous evidence shows that once the optimal dose of Ritalin has been attained, it can take between 8 to 12 weeks to completely manage the patient’s symptoms of ADHD (American Psychiatric Association, 2013; Castells et al., 2021). Consequently, at safe doses, long-term use of the drug has been associated with limited possibilities of side effects, hence the need to reevaluate the patient within 4 weeks (Hodgkins et al., 2012). Studies also show that long-term use of Ritalin normally reduces the risks of side effects as the patient will display further tolerance to the drug, enhancing its safety profile (Breaux et al., 2022).

Increasing the dose of Ritalin to 30mg was not necessary at this point, as studies suggest that low effective doses are safer to use to promote positive outcomes, with reduced risks of side effects (Mechler et al., 2021). Consequently, obtaining EKG at this point was not necessary given that the patient’s pulse had already resolved back to normal for her age, with a recording of 92 during the current visit (Rodrigues et al., 2021).

Expected Outcome

            With great compliance to the treatment regimen, the patient will report even further management of the ADHD symptoms over the following two weeks (Breaux et al., 2022). Her academic performance is also expected to improve (American Psychiatric Association, 2013). No side effects are expected.

Ethical Considerations

            The nurse’s main objective is to promote the health of the patient and not harm. At this point, the patient was satisfied with the treatment outcome (Hodgkins et al., 2012). It was thus necessary to respect the patient’s autonomy and maintain the dose for further evaluation of the treatment outcome (Mechler et al., 2021).

Conclusion

The 8-year-old patient in the case study presented with symptoms of ADHD. Formulating a treatment plan for the patient involved consideration of certain patient-specific factors which affect her pharmacokinetic and pharmacodynamic processes (American Psychiatric Association, 2013). Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. Based on these factors, the first decision was to initiate a 10mg Ritalin chewable table once daily as recommended by most clinical guidelines given its effectiveness in the management of ADHD and safety for pediatric use (Coghill et al., 2021). Intuniv and bupropion were neglected because of their increased risks of side effects among children as reported by most studies (Mechler et al., 2021). After 4 weeks, the patient came back to the clinic reporting improved symptoms but with side effects of increased pulse rate. The second decision was thus to change the treatment regimen to long-acting Ritalin 20mg once daily in the morning, to prolong the duration of action of the medication throughout the day (Castells et al., 2021). Maintaining the dose would still lead to ineffectiveness, while Adderall display increased risks of suicidality hence neglected (Breaux et al., 2022).

The patient reported further improvement in ADHD symptoms all day long, with resolved side effects of elevated pulse, which led to the final decision of maintaining the treatment regimen and reevaluating the patient after 4 weeks. Obtaining EKG and increasing the dose of Ritalin was not necessarily due to safety issues (Hodgkins et al., 2012). Finally, the PMHNP encountered several ethical considerations in each decision process with the observation of ethical principles such as justice, respect for patient autonomy, not harm, and beneficence (Rodrigues et al., 2021).

 

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Breaux, R., Dunn, N. C., Swanson, C. S., Larkin, E., Waxmonsky, J., & Baweja, M. D. (2022). A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD. Frontiers in Psychiatry, 151. https://doi.org/10.3389/fpsyt.2022.794044

Castells, X., Ramon, M., Cunill, R., Olivé, C., & Serrano, D. (2021). Relationship between treatment duration and efficacy of pharmacological treatment for ADHD: a meta-analysis and meta-regression of 87 randomized controlled clinical trials. Journal of attention disorders25(10), 1352-1361. https://doi.org/10.1177/1087054720903372

Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., … & Simonoff, E. (2021). The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry, 1-25. https://doi.org/10.1007/s00787-021-01871-x

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2021). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 107940. https://doi.org/10.1016/j.pharmthera.2021.107940

Rodrigues, R., Lai, M. C., Beswick, A., Gorman, D. A., Anagnostou, E., Szatmari, P., … & Ameis, S. H. (2021). Practitioner Review: Pharmacological treatment of attention‐deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry62(6), 680-700. https://doi.org/10.1111/jcpp.13305