March 24, 2023

Please watch this in conjunction with the MRCPsych CASC Video Methylphenidate Tutorial on our YouTube channel.

Hello mr smith uh my name is dr mishra i’m one of the psychiatrists that work here in the application for me and i’ve got a little bit of information just regarding your your sun toby and i know that um the plan was to look at um medication to help managing moving forward mm-hmm um i know i think you have some concerns around around yeah yeah he seems very young

To go on to medication okay yeah i can understand that that is a common concern the parents that parents have i mean could you just share with me how tobe has been recently um very difficult i mean we’ve tried um all the sort of behavioral stuff that has been suggested so we’ve used star charts and lots of outside activities um and although we liked using them

It gave us a bit of structure they just didn’t work with toby at all and you know he’s still very very difficult at home and really his behavior is dreadful at school as well okay so there’s lots of problems yeah no no sure so it sounds as if you’ve obviously tried your best in using what we call these behavioral strategies to try to manage things and and uh and

Then in terms of it sort of the impact it’s having on is being at school it’s very difficult i mean they’ve talked about excluding him occasionally because yeah and then and then things at home as well yeah yeah all right so normally in those situations when we know that we’ve really exhausted all those possibilities um to try children without medication that’s

When medication is considered and then the medication that we’re considering is one called um methylphenidate or or commonly known as ritalin oh it’s the same okay yeah okay um so so uh so you’ve looked it up i mean yeah and one of the concerns i’ve got is that it’s a stimulant apparently and that’s kind of seems strange a hyperactive child yes similarly no

And it can that can sound um it can be a sort of counter-intuitive um uh sort of feeling that okay why is my kid gonna be prescribed a stimulant but the um but retaliate or methylpenidate is actually the the first-line treatment that we we give in terms of medication for for children who have been diagnosed with with adhd and there’s very good evidence that when

Children take it it actually increases their level of attention and and can reduce their level of um hyperactivity and impulsivity so although is classed as a as a stimulant it actually doesn’t make things worse in that in that way in terms of business levels of of um agitation or inattention those kinds of things that actually helps reduce those things in in

That way so so i hope that um reassures you in that from that regard but as i said it is the the first line treatment for for for this condition so that would be the one that we would want to try try to be on right you know and um what are the side effects of it okay so so i mean there are there are a number of side effects that do occur with um without benedict

It because of it being a stimulant um i mean the i’m not suggesting that toby’s going to have all of these side effects um in terms of the ones that i that i do describe and then for any of the ones that he for any side effects that he um he does have i mean we’d be monitoring him vigilantly you know as soon as he started on the vacation for any kind of any kind

Of side effects but some of the the common ones that can occur can be um just an initial disruption to the to the sleep pattern oh wow that could be difficult he only gets four or five hours a night at the moment right okay i mean i mean what what’s um what the the sort of principle there is that if if we can improve his levels of concentration and reduces levels

Of um of hyperactivity and and really get more of a structure to his day the longer that we can we can start to do that with the with the help of medication and with the other uh behavioral things that he had been doing yeah um that he will have a structure to his day and that it and that then a sort of regular sleep and wake cycle can start to okay and so he’ll

Go to school yeah so he’d go to bed at this um set time wake up at that time and that can start to help his regulators regulated but but there may be an initial disruption to sleep which as i said we can we can look out for okay yeah the other the other side effects that kanika can be a reduction in appetite and so we’d be monitoring his his his weight as well

As his height to make sure that there are no um gross reductions in those whilst he’s on written and again if there’s any concerns we’d be looking at either reducing the amount of medication or stopping as medication uh the other the other the other side effect is uh said because it’s a stimulant it can increase um blood pressure uh in children so again we’ll be

Monitoring toby regularly for that yeah that’s great isn’t it yeah and i said we’ll be doing this in in um in close earlies and with with with his gp and yeah yeah and so in terms of the height and weight be monitoring that every three to six months and the blood pressure will be doing uh at least once a month to make sure he’s you know there’s no changes there okay

And so those are the main common side effects that we would be monitoring him for okay um another question i had is he hates taking tablets so you know okay yes there are various preparations of of um of meet off benedict so there can be there’s a longer acting preparation that he can take so he so he can we can um look at him having just to take a tablet once a

Day good yeah okay that’s good and you know is this something that he’s likely to grow out of or yeah i mean i mean the evidence suggests is that a third of of um children who have childhood age childhood adhd go on to have to have that in adulthood and so so the the aim is that toby would be on if he’s on medication beyond this for a period if he’s finding it

Effective to carry on with it but generally we’re looking at him um stopping this medication later in his life okay uh because he said i think only a third of um children go on to carry on with it in in adult lives so okay and are there other things that we can do and my husband has found stuff about diet my help there’s there’s no direct evidence about diet

And and adhd together but i think if you if you notice that certain things in history are causing this behavior to be more agitated then i think by all means you can you can monitor that for yourself um uh to to look at what um particular things might be worsening his behavior yeah all right um okay okay um is there anything any other queries that you have at

The moment i i don’t think so i think just presuming you don’t have to decide today no no you don’t need time no you deserve exactly yes you don’t need to decide to damn i’ll give you some patient information leaflets around um ritalin as well and um i mean the other thing is that we can also just look at um what we call drug holidays which basically which just

Means that toby doesn’t have to take his medication all throughout the year it can only be done on specific times in the year but that will be in the information guide as well okay thank you

Transcribed from video
MRCPsych CASC Video Methylphenidate By Pass The CASC – The Complete MRCPsych CASC Course