Symptoms target

Drugs Starting Dose (mg) Maintenance Dose in Dementia (mg/day) Target Symptoms... 

Because target symptoms of psychiatric disorders may respond differently in demented patients, a detailed list of symptoms to be treated should be documented to aid in monitoring. 

Patients and family members should be actively involved in treatment to monitor target symptoms, response, and side effects. 

The goals of treatment include the following alleviation of target symptoms, avoidance of side effects, improvement in psychosocial functioning and productivity, compliance with the prescribed regimen, and involvement of the patient in treatment planning. 

Patients should be monitored regularly for reduction in severity of identified target symptoms and the presence of side effects. 

Histrionic Personaiity Disorder (HPD). HPD has also received remarkably little study, but we can perhaps extrapolate from our experiences with BPD. HPD shares with BPD the target symptom of mood instability. Although medications seldom play a significant role in the treatment of HPD, SSRIs/SNRIs may provide some benefit in alleviating depression as well as in reducing affective lability. 

Narcissistic Personaiity Disorder (NPD). Medications have not been studied to any extent in the treatment of NPD. In our experience, antidepressants are often used to treat these patients, but more so for the common comorbid depression than for the personality disorder itself. It is not clear to what extent, if any, medications may be helpful in treating the target symptoms of NPD itself. 

The target symptoms of psychoneurosis that respond to doxepin include anxiety, tension, depression, somatic symptoms and concerns, insomnia, guilt, lack of energy, fear, apprehension, and worry. 

The interview might start by asking the child if he or she knows why this appointment has been scheduled. Family members can be asked to join in as the problem begins to be defined. Everyone s perceptions are important for determining the family context of the target symptoms. The definition of these target symptoms builds the therapeutic alliance and identifies for everyone the symptoms that are the focus of potential change. 

Additional information from the parent(s) or primary care taker(s) should include the child s medical and developmental history and the family s history of mental disorders and stressors. Reports of the direct observation of the youngster s behavior from the parent(s) or primary caretaker(s), school personnel, and others who have had contact with the child can help guide the definition of the most pressing target symptoms. 

Once the family and the physician agree to use a pharmacological intervention to treat the child s disorder, the identified target symptoms should be reviewed and the medication options to treat these symptoms described. The prioritized problem list should be matched with appropriate interventions based on evidence from the research literature regarding the potential of the medication to benefit the target symptoms, as well as its side effects. The experience of the child or family members with other medication treatments, ease of administration, and length of time for treatment response should also be considered. 

The ongoing treatment plan should (1) monitor target symptoms (2) evaluate efficacy and need for additional interventions (3) include ongoing, supportive contact with the family, school, and patient (4) continue psychoeducation and (5) suggest school and/or educational interventions (see Table 31.1). 

Target symptoms—inattention, impulsivity, affect, anxiety, aggression, cognitive disorganization... 

For each targeted symptom, symptom-rating scales can be utilized before treatment and at appropriate intervals after treatment is initiated. Whenever possible, it is helpful to combine self-report measure(s) with observer report measure(s). 

Key elements to be covered in the medication followup visit include (2) a change in target symptoms from baseline, (2) a review of side effects, (3) compliance and resistance, and (4) discussion of the concerns of the child and the parents (see Table 31.1). The medication follow-up visit also includes dosage adjustment and laboratory monitoring. Guidelines for specific disorders and medications are contained in the relevant chapters in this text. 

Pervasive developmental disorder, severe with pharmacological target symptoms 1. Parent 2. Teacher 3. Drivers, other caregivers 4. Child, if he or she communicates 1. Parent 2. Teacher 3. Adolescent, if he or she communicates 4. Drivers, other caregivers... 

SPECIFIC TAILORED ASSESSMENT TARGET SYMPTOM QUANTIFICATION... 

Arnold, L.E., Wender, P.H., McCloskey, K., and Snyder, S. (1972) Levoamphetamine and dextroamphetamine comparative efficacy in the hyperkinetic syndrome assessment by target symptom. Arch Gen Psychiatry 27 816-822. 

Drugs that have primary effects on the core social impairment of autistic disorder and other PDDs have not yet been developed. Currently, the pharmacotherapy of this group of disorders involves the identification and treatment of associated symptoms, including motor hyperactivity, inattention, irritability, aggression toward self, others, or the environment, and interfering repetitive thoughts and behavior. Improvement in some aspects of social behavior can occur as a result of a reduction in these associated target symptoms. 

The opioid antagonist naltrexone was subsequently investigated as a treatment for the associated target symptoms of autistic disorder, in addition to the core social impairment. Results from open-label trials and... 

In a retrospective case analysis, fluoxetine (20 to 80 mg daily) and paroxetine (20 to 40 mg daily) were found to be effective in approximately one-quarter of adults (mean age, 39 years) with intellectual disability and autistic traits (Branford et al., 1998). The sample consisted of all intellectually disabled subjects who had been treated with a SSRI over a 5-year period within a health-care service in Great Britain. The mean duration of treatment was 13 months. Target symptoms were perseverative behaviors, aggression, and self-injurious behavior. Six of 25 subjects treated with fluoxetine and 3 of 12 subjects given paroxetine were rated as much improved or very much improved on the CGI. 

Mirtazapine is an antidepressant with a novel mechanism of action affecting both 5-HT and noradrenergic function. A recent systematic, open-label study found that 9 (34.6%) of 26 subjects (5 females, 21 males mean age, 10.1 +/— 4.8 years, age range 3.8-23.5 years) with autistic disorder and other PDDs were much improved or very much improved on the CGI after a mean duration of treatment of 5 months (Posey et al., 2001). The dosage range for mirtazapine was 7.5 to 45 mg/day with a mean daily dose of 30.29 mg +/— 12.64 mg. Target symptoms of aggression, self-injury, irritability, hyperactivity, anxiety, depression, and insomnia showed improvement. Adverse effects were transient and minimal and included increased appetite, irritability, and sedation. Based upon these preliminary data, a double-blind, placebo-controlled trial appears warranted. 

FIGURE 42.1 Treatment algorithm for pharmacotherapy of target symptoms associated with autistic and other pervasive developmental... 

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