Diagnosis and treatment of ADHD in children vs adults: What nurses should know.

Attention-deficit/hyperactivity disorder (ADHD) commonly occurs in childhood and may persist into adulthood. Important differences exist between pediatric and adult ADHD with regard to symptoms, comorbidities, diagnosis, and management. Both patient populations benefit from a treatment plan tailored to individual patient needs, and the availability of new stimulant formulations contributes to treatment personalization. To guide nurses' clinical practice in improving ADHD treatment outcomes, this review examines the differences between pediatric and adult ADHD and new treatment options.

Caution is Key When Prescribing for Older Adults.

The end of the year can trigger the recognition that aging adults are no longer as independent as they once were. Psychiatric nurses and other mental health professionals may see an increase in older adults being referred for treatment. As the most appropriate psychosocial/psychotherapeutic and psychopharmacological treatments are identified for older adults, there are some unique challenges inherent in coordinating the care of this population. It is especially important for prescribing psychiatric advanced practice nurses to update, review, and cross-reference older patients' lists of medications at every appointment. Although the obstacles to treating older adults may appear daunting, prudent, responsible, cautious practice should be exercised to ensure they achieve improved functionality, maintain safety, reduce risks, and enhance their quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 7-10.].

In Search of a Good Night's Sleep.

A good night's sleep is essential to overall physical, cognitive, and emotional well-being. Sleep deprivation, whether general or related to time changes (e.g., daylight saving time), contributes to decreased cognition, impaired memory, poor coordination, mood fluctuations, increased risk of heart disease and diabetes, and weight gain, among others. The sleep cycle is defined by five stages and two distinct parts-rapid eye movement (REM) and non-REM sleep-that work to promote not only the quantity of sleep but also the quality of sleep, which impacts overall health. Each stage of sleep is influenced by various neurochemical actions among the brain regions. The neurochemistry and neuropath-ways related to the sleep/wake cycle as well as the mechanisms of action of sleep-inducing and wake-promoting medications are explored. [Journal of Psychosocial Nursing and Mental Health Services, 55(10), 19-26.].

Overcoming Seasonal Affective Disorder.

Seasonal affective disorder (SAD) significantly impacts the lives of individuals around the world. The mood fluctuations that occur are not only exhibited during the winter months but also during the spring and summer. The key to identifying SAD is the distinct seasonal onset and spontaneous remission of symptoms over the course of a season. Nurses are in a unique position to identify the symptoms of SAD and offer treatment recommendations to reduce the negative impact of these seasonal mood fluctuations. As holistic health care practitioners, nurses provide patient education regarding healthy lifestyle interventions, which can aid in minimizing the disruptive symptoms of SAD. Advanced practice nurses can offer pharmacotherapy interventions to address symptoms contributing to the individual's inability to function across domains-individual, family, and social. Finally, after reading the article, nurses of all disciplines will have a better understanding of the evidence-based bright light therapy (also known as light box therapy) and how to incorporate this treatment when caring for patients with SAD. [Journal of Psychosocial Nursing and Mental Health Services, 55(11), 10-14.].

Medication-Assisted Weight Loss in the Age of Obesity.

Obesity is a complex and potentially deadly health concern; yet, there are few medications available to treat this chronic, recurrent disease. Patients are frequently told to "lose weight" and change their diet and exercise habits. For many, making behavioral lifestyle changes is not enough to enhance weight loss efforts and improve overall health and quality of life. Medication-assisted weight loss must be considered as an adjunct treatment to lifestyle changes, as neither alone may provide the sustainable reduction in weight necessary to decrease the medical and psychiatric comorbidities associated with obesity. Short- and long-term medications are available to assist patients in losing excess weight. These agents are safe when taken as prescribed and monitored by a health care professional and incorporated into a plan to create and sustain a healthy lifestyle. Weight loss medication is not a "quick fix" but rather a tool in the kit of resources to combat obesity and improve patients' quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 21-26.

Attention-Deficit/Hyperactivity Disorder: A Historical Review (1775 to Present).

As a new school year approaches, nurses will find themselves faced with students with symptoms of attention-deficit/hyperactivity disorder (ADHD). Navigating the diagnostic label changes and numerous psychopharmacological treatment options can prove time-consuming and confusing. The current article explores the early years of symptom identification, various diagnostic labels, and subsequent psychopharmacological treatments from psychostimulants to non-stimulant alternatives (including a prescription medical food). The current article also serves as a discussion guide for nurses and clinicians when providing education to patients and their loved ones, teachers, coaches, and others who may question the diagnosis and treatment of ADHD. This disorder can have a significant impact on one's ability to function within family, school, work, and social settings. A historical context is provided for the evolution of today's diagnostic criteria and the pharmacotherapy used in the treatment of ADHD. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 10-16.].

Vitamin B Supplementation: What's the Right Choice for Your Patients?

As many patients turn to vitamins and supplements to enhance energy, relieve fatigue, or generally feel better, it is important to understand the connection between the B vitamins and psychiatric symptomatology. Vitamins B6, B8, and B12 have been shown not only to reduce psychiatric symptoms but also shorten the duration of illness. Vitamin B9, also known as folate or folic acid, has also been associated with psychiatric symptoms. However, when patients lack a specific genetic enzyme, which converts folate/folic acid to its most usable form, L-methylfolate, the neuroprotective and neuropsychiatric benefits are lost. L-methylfolate allows for the synthesis of the three major neurochemicals-serotonin, nor-epinephrine, and dopamine-across the blood-brain barrier. Exploring the conversion of folate/folic acid into L-methylfolate and the various polymorphisms of the MTHFR gene and examining the B vitamins associated with the treatment of psychiatric symptoms will further allow nurses to comprehensively treat their patients with the appropriate B vitamins. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 7-11.].

Medication Safety: What Nurses Should Know About Black Box Warnings.

"Safety first" has always been a nursing priority-just as medication education has been an essential nursing function. Approximately 79 million individuals of all ages, birth-to-death, were prescribed psychotropic medications in 2013. Nurses of all disciplines and who work in all practice settings must be aware of the potential safety concerns related to medications patients may be taking. Black Box Warnings (BBWs) are the strictest labeling requirements that the U.S. Food and Drug Administration can mandate. Risks of increased suicidality, mortality in older adults, potential for abuse and drug dependence, and life-threatening hepatic failure are among the most significant BBWs attributed to psychotropic medications. As such, nurses must be aware of not only how medications will benefit patients in relieving symptoms of or preventing their disease but also the potential risks, adverse reactions, and BBWs. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 11-15.].

From Immediate Release to Long Acting Drug Delivery Systems: What Do They Mean and Why Do They Matter?

Understanding the varied delivery systems of today's medications can not only simplify dosing schedules but also improve medication adherence, reduce adverse events and polypharmacy, and increase patients' overall quality of life. Whether a medication is noted as immediate, controlled, delayed, or extended release can influence patient adherence as well as tolerability of the drug. New and novel delivery systems, such as long-acting weekly formulations or biweekly and monthly injectable agents, can offer steady blood levels of the drug, avoiding the daily fluctuations that may lead to side effects. Other delivery systems, such as transdermal patches and extended-release orally disintegrating tablets, may offer convenience for those with gastrointestinal concerns or the inability to swallow tablets or capsules. The current article serves as a primer on drug delivery systems and why they are important to consider when introducing medications to a patient's treatment regimen. [Journal of Psychosocial Nursing and Mental Health Services, 55(5), 19-23.].

Premenstrual Exacerbations: Achieving Stability All Month, Every Month.

Premenstrual syndrome, premenstrual dysphoric disorder, or premenstrual exacerbation of a psychiatric condition may disrupt 10 years of a woman's life over the course of her reproductive lifespan. As health care practitioners, nurses see women who experience these premenstrual symptom exacerbations in all treatment settings. Premenstrual exacerbation of psychiatric illness is a common phenomenon, and it is treatable; however, research is limited and evidence-based guidelines for treatment are sparse. The current article offers insights and an algorithm, extrapolated from the existing literature, into a lesser-known treatment strategy, semi-intermittent dosing, which will provide symptom stability all month, every month. [Journal of Psychosocial Nursing and Mental Health Services, 55(4), 9-13.].

Genetic Testing for Psychopharmacology: Is It Ready for Prime Time?

Genetic testing in psychiatric practice may be a beneficial adjunct to the nursing toolbox of considerations used to improve patient outcomes. Since 2004, the psychiatric community has used genotyping to personalize medication options for their patients. Although not a definitive or exact science, pharmacogenetic testing for psychopharmacological treatment options offers nurses and their patients insights into potential treatments that will reduce the current trial-and-error prescribing practices and more quickly improve patients' quality of life. The current article guides nurses through the process of conducting genetic testing, interpreting the results, and applying the results in clinical practice using a fictitious case example. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 19-23.].

Off-Label Prescribing and Polypharmacy: Minimizing the Risks.

Off-label prescribing and polypharmacy are commonplace in today's health care environment. Patients are treated with multiple medications obtained through multiple providers, and all too frequently, there is no collaboration amongst professionals. Nurses can address these issues by educating themselves and their patients regarding medication indications and uses, side effects, risks, and benefits. By exploring a patient's medication reconciliation, including over-the-counter agents, and identifying the U.S. Food and Drug Administration-approved indications, as well as potential off-label uses and overlapping side effects of the medications prescribed, nurses can facilitate collaboration among prescribers to reduce polypharmacy, minimize medication side effects, and alleviate drug-drug interactions, while improving patient outcomes and quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 55(2), 17-22.].

The Opioid Epidemic: What Does it Mean for Nurses?

The United States is facing a major crisis with the current opioid epidemic. Tens of thousands of individuals are dying each year due to abuse and misuse of heroin and prescription opiate drugs. Nurses play an integral role in these aspects of health care and offer solutions by providing education; preventive measures; treatments, including medication-assisted treatments (MATs); and ongoing recovery options for individuals with opioid use disorders. Nurses provide education, issue prescriptions and dispense medications, and provide overall physical and mental health care to patients struggling with this "disease of the brain," and with the signing of the Comprehensive Addiction and Recovery Act, advanced practice RNs will soon be able to include MATs related to buprenorphine as part of their treatment plan. The current article explores the anatomy, physiology, and genetics of addiction and how they relate to the pharmacological MATs used to treat opioid use disorders. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 18-23.].