24.09.2010: New rules for the prescription of methylphenidate
In the treatment of ADHD children may not at first with the drug methylphenidate, a drug may be prescribed. This has the Federal Joint Committee (G-BA) on 16 September decided. Then it is not permitted, children who are suffering from attention deficit and hyperactivity disorder (ADHD), to be immediately treated with medication.
"What all the experts have long and demanding, is now also set by policy: ADHD children need specialists for behavioral problems so that treatment is successful," says Peter Lehndorfer, Chairman of the Federal Chamber of Psychotherapists (BPtK) found. "The G-BA has to the negligent prescription of Ritalin and Co a stop to advanced. "
The diagnosis and treatment of ADHD in children and adolescents has for years been seriously flawed." ADHD is diagnosed prematurely and treated on one side with medication, "criticizes BPtK Board Lehndorfer. From 1997 to 2006, the volume the prescribed daily doses tenfold. Now the G-BA set the criteria for better diagnosis and treatment. The revised drug policy requires now that
- treatment start of ADHD without drugs must
- methylphenidate may be used only when the non-drug treatment is not successful,
- Methylphenidate may also be maintained within a therapeutic multimodal overall strategy that utilizes both pharmacological measures, in particular psychological, educational and social therapy concepts
- the treatment can be carried out under the supervision of a specialist in behavioral disorders in children must
- of drug use especially to document, especially in a continuous therapy over twelve months,
- least once a year the drug treatment interrupted and must be re-evaluated,
- the ADHD diagnostic criteria on the DSM-IV or ICD-10 classification must be based.
"ADHD is thus no longer the domain of drug therapy, child and adolescent psychotherapist Peter Lehndorfer summarizes the new rules which may be prescribed methylphenidate. "In the diagnosis of ADHD it is not enough to identify one or two symptoms and then to reach for the prescription pad. Risks and benefits of drug therapy must now be considered much more carefully." Side effects of methylphenidate occur: insomnia, anorexia, emotional lability ("whining") and a lower body long term growth. "Now there is the risk that other drugs, especially Atomoxetine (Stratera "), we will switch," warns BPtK Board Lehndorfer. "This has highlighted the manufacturers themselves have an increased risk of suicide while taking atomoxetine."
ADHD is the most common behavioral disorders in childhood. ADHD currently at about five percent of children and adolescents in Germany diagnosed (KiGGS, 2007). Many abnormalities of ADHD children can be traced back to the infant and toddler. Many were in the earliest age eating or sleeping problems ("cry baby"). serious difficulty arises, however, usually only with enrollment, because the focus is shorter than other children and to facilitate be distracted. Recent U.S. studies indicate, however, that above all the younger children in a class of an ADHD diagnosis. "Children develop very differently," said board member BPtK Lehndorfer. "Young children are naturally restless than their older classmates. You may therefore not diagnosed as ill." However, if ADHD before, a one-sided enough medication is not enough. Guidelines (eg NICE Clinical Guideline, 2009) recommend a multimodal ADHD treatment. This includes
- education and counseling of parents of the child or young person and the educator or teacher, parent training
- and family therapy,
- interventions in kindergarten or school,
- psychotherapy of the child or youth,
- pharmacotherapy with careful consideration of the benefits and risks.
"Now the chance to be used in the diagnosis and treatment of ADHD more use of the skills of child and adolescent psychotherapist, recommends Lehndorfer. "The cooperation between pediatricians and psychotherapists should be intensified so that the severity of the symptoms of restless children is assessed properly and in the case of drug co-treatment expertise of psychotherapists in the assessment of the disease process flows. "
The G-BA follows with the change of regulation ability of methylphenidate-containing medicines in the drug policy to a European Commission decision of 27 May 2009 and the admission restricted by the Federal Institute for Drugs and . Medical Devices (BfArM), with effect from 1 September 2009
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