The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (IV): Non-Pharmacologic Treatment

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in early childhood and can persist throughout adulthood. ADHD causes difficulties in various area of life, such as academic achievement, peer relationships, family functioning, employment and marriage. Although ADHD is known to respond well to medication, such treatment is more effective when combined with psychosocial (non-pharmacologic) therapy in terms of alleviating the core symptoms and improving appropriate functions. Psychosocial treatment interventions are divided into psychoeducation, behavioral parent training, school intervention, cognitive behavior therapy, social skill training, parent-child interaction therapy, play therapy, other treatments (coaching, complementary and alternative medicine), neurofeedback and Cogmed. Adult ADHD cognitive behavioral therapy is described separately. These practice parameters summarize the evidence for psychosocial treatment. Based on this evidence, specific recommendations are provided for psychosocial interventions.

Exercício físico controla pressão arterial e melhora qualidade de vida / Exercise control blood pressure and improvement quality of life

INTRODUÇÃO: Para o tratamento correto da hipertensão arterial, é plausível a hipótese de que diante da prática regular de exercícios físicos estes pacientes não necessitariam de fármacos anti-hipertensivos. OBJETIVO: Avaliar o efeito do tratamento exclusivo com exercício físico na pressão arterial (PA) e qualidade de vida (QV) de hipertensos. MÉTODO: Ensaio clínico com 32 hipertensos sedentários, 55±9 anos, que estavam sob tratamento farmacológico (TF) aleatoriamente alocados em Grupo Exercício (GE) e Grupo Controle (GC). No GE, 18 indivíduos (50% mulheres) após pelo menos dez dias de interrupção do TF iniciaram programa de exercício de dez semanas, 3x/semana, 30 minutos de exercício aeróbio seguidos por exercícios resistidos, enquanto 14 do GC (57% mulheres) se mantiveram sob TF. Foi verificada PA sistólica (PAS) e diastólica (PAD) no início e final do estudo pelo método auscultatório clássico e QV pelo questionário MINICHAL. Os dados foram expressos por M±DP, usou-se teste t de Student, U de Mann-Whitney e Wilcoxon, considerando-se p < 0,05 significativo. RESULTADOS: No início e final da pesquisa, não foram observadas diferenças na PA entre os grupos. Intragrupos, a PA no GE manteve-se semelhante aos valores antes da retirada dos fármacos (PAS 132,2 ± 13,3 x 134,4 ± 10 mmHg; PAD 85,0 ± 9 x 85,3 ± 10 mmHg p = ns), assim como no GC (PAS 127,2 ± 19 x 130,2 ± 16 mmHg; PAD 82,1 ± 16 x 85,3 ± 12 mmHg p = ns). Para a QV, entregrupos não foi observada diferença dos escores no início e final, intragrupos melhora significativa no aspecto emocional do GE (p = 0,02). CONCLUSÃO: A terapêutica anti-hipertensiva, exclusivamente por meio do exercício físico na comparação com tratamento farmacológico convencional, possibilitou idêntico controle da PA e melhor percepção de QV.

BACKGROUND: Hypertension can be correctly treated when exercise is regularly practiced and hence, patients would not need anti-hypertensive drugs. PURPOSE: To evaluate the effect of treatment exclusively with exercise on blood pressure (BP) and quality of life (QL) of hypertensive subjects. METHODS: Clinical trial with 32 sedentary hypertensive subjects, aged 55 ± 9 years, under pharmacological treatment (PT) randomly allocated to Exercise Group (EG) and Control Group (CG). At EG, 18 subjects (50% women) at least 10 days after the cessation of PT started the exercise program of 10 weeks, 3x/week, 30 minutes of aerobic exercise followed by resistance exercises, while 14 CG (57% women) remained under PT. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated by auscultation at the beginning and end and QL was evaluated using the questionnaire MINICHAL. Data were expressed as mean ± SD and statistical analysis was performed using t test, Mann Whitney U and Wilcoxon tests. RESULTS: At the beginning and end of the study, no significant differences in were observed in BP between groups. Within groups, BP in EG remained similar to the values before drugs were removed (SBP 132.2 ± 13.3 x 134.4 ± 10 mmHg, DBP 85.0 ± 9 x 85.3 ± 10 mmHg p = ns) and the CG (SBP 127.2 ± 19 x 130.2 ± 16 mmHg, DBP 82.1 ± 16 x 85.3 ± 12 mmHg p = ns).For QL, no inter-group difference was observed in scores at the beginning and end; intra-group significant improvement in the emotional aspect of the EG (p = 0.02). CONCLUSION: The anti-hypertensive therapy with exercise only in comparison to conventional pharmacological treatment allowed the same BP control and better QL perception.

Psychosocial treatment of psychiatric disorders of the elderly

Interest in psychosocial treatment as non-pharmacologic treatment in the elderly has been increasing, and this treatment has became an important therapeutic approach for the following common psychiatric disorders: depressive disorder, anxiety disorder, some psychological conditions, and some cognitive disorders. Some examples of the psychosocial treatments frequently used with older people with psychiatric disorders are cognitive behavior therapy, interpersonal therapy, individual psychotherapy, reality orientation, validation therapy, reminiscence therapy, and cognitive training. Those treatment options should be used carefully in light of individual needs and optimal objectives for the elderly and their caregivers. It is crucial for the clinician to understand the characteristics and clinical applications of each psychosocial treatment for the elderly in particular. Further studies are needed to demonstrate the feasibility and effectiveness of old and new psychosocial treatment modalities for older people with psychiatric disorders. Psychosocial treatments are very important with or without pharmacological treatment in the elderly with psychiatric problems. Clinician should become familiar with various psychosocial treatments.

The Effectiveness of School Based Short-Term Social Skills Training in Children with Attention-Deficit/Hyperactivity Disorder(ADHD)

OBJECTIVES: Children with attention-deficit hyperactivity disorder (ADHD) often have difficulties in social behavior. The aim of this study was to evaluate the effectiveness of a short-term training program for improving social skills, selfperception and attention deficits. METHODS: The subjects were nine children diagnosed with ADHD with (or without) other mental disorders using the Diagnostic Interview Schedule for Children (DISC-ADHD) module. Children were given eight sessions of a social skills training program. Parents of children simultaneously participated in their own training which was designed to support their children's generalization of skills. Assessments included child, parent and teacher ratings of social skills, self-perception and attention deficit at baseline and post-treatment. RESULTS: Social skills training led to significant improvements in child-reported measures of self-esteem, in teacherreported measures of social skills, and in parent-reported measures of attention deficit. CONCLUSION: This study suggests that short-term social skills training programs for children with ADHD may improve their social skills, self-perception and attention deficits.

The Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder(IV): Non-Pharmacologic Treatment

This practice parameter for non-pharmacological treatment for attention-deficit hyperactivity disorder(ADHD) review the domestic and international literature on the psychosocial treatment of children and adolescents with ADHD. This parameter include the parental training & education, cognitive behavior therapy(group or individual), social skill training, family therapy, play therapy(individual psychotherapy) and non-traditional therapy(art therapy, herbal therapy et al). Among them, there is some proven evidence only in parental training & education and cognitive behavior therapy. So, this parameter describes some details only in the field of parental training & education and cognitive behavior therapy. The efficacy or effectiveness, especially, cost-effectiveness of specific psychosocial treatment method for ADHD cannot be fairly assessed due to the scarcity of controlled clinical data. Based on the clinical expert consensus and limited evidence, we cautiously suggest the practice recommendations about the non-pharmacological psychosocial treatment for children and adolescents with ADHD.

Guidelines for Clinical Management of Premenstrual Syndrome

Premenstrual syndrome(PMS) refers to a group of menstruation-related symptoms that impair daily activity and interpersonal relationship. The therapeutic modality for PMS consists of non-pharmacologic and pharmacologic treatment. Generally, after confirmation of PMS, a set of non-pharmacologic treatments is recommended before pharmacologic treatment. Patients can be benefited from non-pharmacological treatments such as patient education, cognitive therapy, behavioral therapy, and dietary supplementation. Pharmacologic therapy including psychotropic agents, diuretics, and prostaglandin inhibitors may be used, when PMS symptoms are not sufficiently improved after non-pharmacologic treatments, or when symptoms fit the diagnostic criteria of premenstrual dysphoric disorder(PMDD). When treatment fails, hormonal therapy to manipulate menstrual cycle may be considered, and several trials showed improvement of physical and mood symptoms.