Pharmacotherapeutics in General, Mental and Sexual Health (eBook)

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Donald E. Greydanus, Dilip R. Patel, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, United States; Hatim A. Omar, Division of Adolescent Medicine, University of Kentucky, Lexington, United States; Cynthia Feucht, Ferris State University, School of Pharmacy, Kalamazoo, United States; Joav Merrick, National Institute of Child Health and Human Development and Health Services, Ministry of Social Affairs, Jerusalem, Israel.

Forword 17
Contributors 19
Abbreviations 21
1 Introduction – Adolescent medicine: Pharmacotherapeutics in general, mental, and sexual health 27
2 Overview on adolescence 35
2.1 Introduction 35
2.1.1 Terminology 35
2.1.2 Demography of adolescent population 36
2.1.3 Normal adolescent sexuality stages 36
2.1.4 The process of CNS maturation 38
2.2 Puberty 38
2.3 Sexual behavior 41
2.3.1 Homosexuality 45
2.3.2 Prevalence 46
2.3.3 Caring for the gay, lesbian, bisexual, and transgendered (GLBT) youth 47
2.3.4 The adolescent sex offender 47
2.4 Health status of adolescents 47
2.4.1 Mental health 48
2.4.2 Youth violence 49
2.4.3 Mortality 50
2.4.4 Homicide and suicide 50
2.4.5 Motor vehicle accidents 51
2.4.6 Abuse 51
2.4.7 Dating violence 52
2.4.8 Runaway and homeless youth 52
2.5 Caring for adolescents 53
2.5.1 Involvement of parents 53
2.5.2 Confidentiality 59
2.6 Immunizations 60
2.7 Counseling 61
2.8 Conclusions 61
3 Concepts of health care in adolescents in the twenty-first century 65
3.1 Introduction 65
3.2 Adolescents: The population 65
3.2.1 Financing of the adolescent population 66
3.2.2 Subgroups of the adolescent population 66
3.2.3 Complexity of the adolescent population 67
3.3 Use of modern health-ITs 68
3.3.1 Text messaging 68
3.3.2 Internet 68
3.3.3 Multifaceted approaches 69
3.4 Challenges: Use of modern health-ITs 70
3.4.1 Accuracy and validity of data and data sources 70
3.4.2 Privacy and security responsibilities 70
3.4.3 Health literacy and health-IT literacy 71
3.4.4 Cost and lack of revenue 72
3.5 Opportunities: Use of modern health-ITs 73
3.5.1 Provider-adolescent engagement at visit 73
3.5.2 Provider-adolescent engagement between visits 73
3.5.3 Provider-provider engagement 75
3.6 Practicalities: Use of modern health-ITs 77
3.7 Conclusions 78
4 Principles of pharmacology 81
4.1 Introduction 81
4.2 Pharmacokinetics 81
4.2.1 Absorption 81
4.2.2 Distribution 82
4.2.3 Metabolism 83
4.2.4 Excretion 84
4.2.5 Drug dosing and therapeutic drug monitoring 85
4.3 Pharmacodynamics 86
4.4 Pharmacogenetics and Pharmacogenomics 87
4.5 Conclusions 90
5 Basic concepts of neurotransmission 93
5.1 Introduction 93
5.2 Neurotransmission 93
5.2.1 The neuron 93
5.2.2 The synapse 94
5.2.3 Chemical neurotransmission 95
5.3 Allosteric modulation 96
5.4 Nonsynaptic (volume) neurotransmission 96
5.5 Divergence and covergence 96
5.5.1 Agonists and antagonists 96
5.6 Major neurotransmitter systems 97
5.6.1 Cholinergic system 97
5.6.2 Dopaminergic system 97
5.6.3 GABAergic system 98
5.6.4 Glutamatergic system 99
5.6.5 Noradrenergic system 99
5.6.6 Serotonergic system 100
5.7 Conclusions 100
6 Genetics and adolescent medicine 105
6.1 Introduction 105
6.2 How genetic disease occurs 105
6.3 Chromosomal inheritance 105
6.4 Single gene disorders 106
6.5 Multifactorial inheritance and complex traits 107
6.6 Other etiologies 109
6.6.1 UPD 109
6.6.2 Imprinting 109
6.6.3 Mitochondrial disorders 109
6.6.4 Syndromes associated with SCD as an example 109
6.6.5 Syndromes associated with the structurally normal heart 110
6.6.6 Syndromes associated with the structural heart disease 110
6.6.7 Factors to be considered regarding the syndromes associated with SCD 111
6.7 Complex disorders: Behavioral phenotypes as an example 111
6.7.1 Smoking behavior 111
6.7.2 Alcohol and drug use 112
6.7.3 Eating disorders 113
6.8 Predispositional testing 114
6.9 Conclusions 115
7 Concepts of emergency care 119
7.1 Introduction 119
7.2 Advanced cardiac life support (ACLS) 120
7.3 Anaphylaxis 121
7.4 Asthma 122
7.5 Conclusions 124
8 Concepts of surgical disorders in adolescents 125
8.1 Introduction 125
8.2 Abdominal surgery 125
8.2.1 Esophagus 125
8.2.2 Stomach 132
8.2.3 Small bowel 136
8.2.4 Billiary system 147
8.3 Bariatric surgery 151
8.3.1 Etiology 151
8.3.2 Clinical presentation 151
8.3.3 Workup 151
8.3.4 Treatment 152
8.3.5 Follow-up 154
8.4 Abdominal wall hernias 154
8.4.1 Etiology 154
8.4.2 Clinical presentation 154
8.4.3 Differential diagnosis 155
8.4.4 Workup 155
8.4.5 Treatment 155
8.4.6 Follow-up 156
8.5 Breast disease 156
8.5.1 Breast mass 156
8.5.2 Gynecomastia 157
8.6 Endocrine surgery 158
8.6.1 Thyroid disorders 158
8.6.2 Adrenal tumors 161
8.7 Skin and soft-tissue lesions 162
8.7.1 Benign skin lesions 162
8.7.2 Malignant lesions 163
8.7.3 STSs 165
8.8 Conclusions 167
9 Concepts of psychotherapy in adolescents 171
9.1 Introduction 171
9.2 Definition 171
9.3 Epidemiology 174
9.3.1 Controversey surrounding the use of evidence-based treatment approaches 175
9.3.2 Obstacles to psychopharmacotherapy 175
9.3.3 Obstacles to psychotherapy 176
9.3.4 Insurance providers 176
9.3.5 Access to therapists 176
9.3.6 Differential diagnosis 177
9.3.7 Treatment modalities used with adolescents 177
9.4 Management 179
9.5 Conclusions 179
MENTAL HEALTH 181
10 Substance abuse disorders 183
10.1 Introduction 183
10.2 Alcohol 188
10.2.1 Alcohol abuse management 194
10.3 Tobacco 197
10.3.1 Management of tobacco abuse 198
10.4 Marijuana 205
10.5 Amphetamines 207
10.5.1 Methamphetamine 208
10.6 Cocaine 209
10.6.1 Management of cocaine addiction 209
10.7 Opioids 211
10.7.1 Heroin 212
10.7.2 Naltrexone 215
10.7.3 Methadone 215
10.7.4 Buprenorphine 216
10.7.5 LAAM 216
10.8 Hallucinogens 216
10.9 MDMA (Ecstasy) 217
10.10 Date rape drugs 218
10.10.1 Flunitrazepam (Rohypnol®) 219
10.10.2 GHB 219
10.10.3 Ketamine 219
10.11 Inhalant drugs 219
10.12 Sedatives 222
10.12.1 BZDs 222
10.12.2 Barbiturates 222
10.13 Conclusions 223
11 Pharmacotherapy of adolescent attention deficit/hyperactivity (ADHD) disorder 227
11.1 Introduction 227
11.2 Assessment and treatment principles 228
11.2.1 Diagnosis 228
11.2.2 Diagnostic workup 228
11.2.3 Discussing treatment options, medications, and monitoring with patients and caretakers 228
11.3 Psychopharmacology of ADHD 230
11.4 FDA-approved stimulant agents 231
11.4.1 AMP preparations 233
11.4.2 Short-acting AMP formulations (about 6 hours’ duration) 233
11.4.3 Long-acting AMP formulations (about 8–10 hours’ duration) 233
11.4.4 Prodrug formulation 234
11.4.5 MPH preparations 235
11.4.6 Oral short-acting MPH formulations (about 3–5 hours’ duration) 236
11.4.7 Oral intermediate-acting MPH formulations (about 8 hours’ duration) 237
11.4.8 Long-acting MPH formulations (about 12 hours’ duration) 237
11.4.9 MPH transdermal formulation 238
11.5 Special safety considerations regarding stimulants 238
11.5.1 Growth 238
11.5.2 Tics 239
11.5.3 Cardiovascular effects 239
11.6 FDA-approved nonstimulant agents 240
11.6.1 Atomoxetine (Strattera) 240
11.6.2 Guanfacine XR (Intuniv) 242
11.6.3 Clonidine XR (Kapvay) 242
11.7 Non-FDA-approved treatments 243
11.8 General treatment guidelines 243
11.8.1 Child versus adolescent symptom presentation 243
11.8.2 ADHD and driving 244
11.8.3 Abuse potential 244
11.8.4 Differential diagnosis versus comorbidity 244
11.8.5 Pretreatment procedures 245
11.8.6 Choosing a starting agent 245
11.8.7 Short-versus long-acting stimulant formulations 245
11.8.8 AMP versus MPH 245
11.8.9 Medication titration 246
11.8.10 What to do when side effects develop 246
11.8.11 Nonimprovement using FDA-approved treatments 246
11.8.12 Duration of successful treatment 246
11.9 Summary 247
12 Disorders of disruption, violence, and cognitive abilities 253
12.1 Introduction 253
12.2 Definitions 253
12.2.1 Disruptive behavior disorders 253
12.2.2 ODD 253
12.2.3 CD 254
12.2.4 Developmental disorders (DDs) 254
12.2.5 Aggression and violence 254
12.3 Epidemiology 255
12.4 Differential diagnosis 256
12.4.1 SUDs 256
12.4.2 GMCs 258
12.4.3 Psychiatric disorders 259
12.4.4 DDs 260
12.5 Management 261
12.5.1 SUDs 262
12.5.2 GMCs 262
12.5.3 Psychiatric disorders 263
12.5.4 DDs 264
12.6 Summary 264
13 Mood disorders 269
13.1 Introduction 269
13.2 Epidemiology 269
13.3 Differential diagnosis 271
13.4 Management 271
13.4.1 Depressive disorders 271
13.4.2 BDs 274
13.4.3 Mood disorder NOS 278
13.5 Conclusion 278
14 Anxiety disorders 281
14.1 Introduction 281
14.1.1 SAD 281
14.1.2 Panic disorder 282
14.1.3 GAD 282
14.1.4 Social anxiety disorder 283
14.1.5 OCD 283
14.1.6 Specific phobia 283
14.2 Epidemiology 284
14.3 Differential diagnosis 284
14.4 Management 285
14.4.1 Role of parents 285
14.4.2 Role of teachers 285
14.4.3 Psychotherapy 286
14.4.4 Pharmacotherapy 286
14.4.5 SSRIs 286
14.4.6 Other agents 288
14.4.7 Treatment of comorbidities 290
14.5 Conclusions 291
15 Schizophrenia 295
15.1 Introduction 295
15.1.1 Delusions 296
15.1.2 Hallucinations 296
15.1.3 Disorganized speech 296
15.1.4 Disorganized behavior 296
15.1.5 Negative symptoms 296
15.2 Diagnosis 296
15.2.1 Premorbid symptoms 297
15.3 Epidemiology 297
15.4 Differential diagnosis 298
15.4.1 Substance use disorders (SUDs) and drug intoxications 298
15.4.2 Bipolar disorder (BD) 299
15.4.3 Anxiety disorder 300
15.5 Treatment 300
15.5.1 Consultations 300
15.5.2 Atypical antipsychotics 302
15.5.3 Clozapine 303
15.5.4 Typical antipsychotics 303
15.5.5 Psychosocial interventions 305
15.6 Conclusions 305
SEXUAL AND GYNECOLOGIC HEALTH 309
16 The adolescent breast 311
16.1 Introduction 311
16.2 Clinician’s breast examination 311
16.3 Congenital anomalies 312
16.3.1 Athelia and amastia 312
16.3.2 Polythelia and polymastia 312
16.3.3 Other nipple anomalies 312
16.4 Asymmetric breast development 313
16.5 Underdeveloped breasts 313
16.5.1 Tuberous breasts 314
16.6 Virginal hypertrophy 314
16.7 Breast masses 314
16.7.1 Cystosarcoma phylloides 316
16.7.2 Cystic breast disease 317
16.7.3 Fibrocystic change 318
16.8 Nipple discharge 319
16.9 Summary 324
17 Menstrual disorders in the adolescent female 327
17.1 Introduction 327
17.1.1 Adolescent menstrual patterns 327
17.2 Amenorrhea 328
17.2.1 Amenorrhea in adolescent athletes 334
17.2.2 Management of amenorrhea 335
17.2.3 Management of PCOS 336
17.2.4 DUB 337
17.2.5 DUB management 340
17.2.6 Absence of anemia or mild anemia 340
17.2.7 Moderate anemia 341
17.2.8 Management of DUB due to coagulation disorders 342
17.2.9 Other DUB management options 343
17.3 Dysmenorrhea 343
17.3.1 Etiology 345
17.3.2 Primary dysmenorrhea management 345
17.3.3 Secondary dysmenorrhea 347
17.4 Endometriosis 348
17.4.1 Symptomatology 348
17.4.2 Diagnosis 349
17.4.3 Management of endometriosis 351
17.5 PMS 352
17.5.1 Management of PMS 354
17.6 Summary 355
18 Sexually transmitted diseases (STDs) 357
18.1 Introduction 357
18.2 C. trachomatis 360
18.3 Cervicitis 361
18.4 Urethritis and epididymitis 362
18.5 N. gonorrhoeae 362
18.6 PID 363
18.7 Fitz-Hugh-Curtis syndrome 366
18.8 DGI 366
18.9 HSV 367
18.10 T. vaginalis 369
18.11 BV 370
18.12 HPV 371
18.13 Vulvovaginitis 374
18.14 Physiological leukorrhea 375
18.15 C. albicans 375
18.16 Miscellaneous STDs 377
18.17 Homosexuality and STDs in adolescents 380
18.17.1 HIV/AIDS 380
18.18 Conclusions 385
19 Contraception in adolescents 387
19.1 Introduction 387
19.2 Oral contraceptives (OCPs combined oral contraceptives [COCs])
19.2.1 Contraindications to OCPs/COCs 393
19.2.2 Cardiovascular risks and OCPs 395
19.2.3 OCPs and miscellaneous risks 396
19.3 Transdermal hormonal contraception 396
19.4 NuvaRing vaginal ring 397
19.5 POPs 397
19.6 ECs 397
19.7 Injectable contraceptives 398
19.8 IUD 400
19.9 Barrier methods 401
19.9.1 Diaphragm and vaginal spermicides 401
19.9.2 Cervical cap 402
19.9.3 Vaginal contraceptive sponge 403
19.9.4 Female condom 403
19.9.5 Male condom 403
19.10 Summary 403
19.11 Internet sites 403
20 Adolescent pregnancy 413
20.1 Introduction 413
20.2 Risks of adolescent pregnancy 415
20.3 Risks for children of adolescents 418
20.4 Adolescent fathers 420
20.5 Abortion 420
20.6 Prevention of adolescent pregnancy and pregnancy complications 420
20.7 Mental health 421
20.8 Conclusions 422
ACKNOWLEDGMENTS 425
21 About the editors 427
22 About the Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, United States 429
23 About the Division of Adolescent Medicine at the University of Kentucky, Lexington, Kentucky, United States 431
24 About the National Institute of Child Health and Human Development in Israel 433
Index 437