Adolescent medicine (Philadelphia, Pa.)最新文献

The use of medication is an important element in the management of attention deficit-hyperactivity disorder (ADHD). An overview of basic psychopharmacologic principles is presented, followed by a review of medications that are well-documented as effective in the amelioration of ADHD symptomatology. These include stimulants (methylphenidate, amphetamines, and pemoline), tricyclic antidepressants (imipramine, desipramine, and nortriptyline), alpha2-agonists (clonidine and guanfacine), and bupropion. Medications used to treat comorbidities of ADHD (e.g., depression, anxiety, disruptive disorders) are not considered in this review. Psychopharmacology is a very useful tool as part of the overall management of ADHD in adolescents.

Sports-related head injuries in young athletes can have both acute and long-term complications. Concussions are the most common type of diffuse brain injury in young athletes. Research on concussions in young athletes is limited. Most current management guidelines are based on expert opinion and consensus. The role neuropsychological testing as an objective measure is increasingly being recognized in the management of concussions. This article reviews practical aspects of concussion management. The implications for sport participation by athletes with epilepsy, sport-related headaches, and burner syndrome are also reviewed.

Migraine headaches are common in adolescents. Characterized by recurring attacks of intense, pounding, and nauseating frontal or temporal head pain, migraine headaches are a significant contributor to school absences and lost productivity during the adolescent years and beyond. A systematic management program can be instituted to minimize these deleterious effects. The first step is to establish the diagnosis and reassure the patient that there is no serious underlying cause such as a brain tumor. The next step involves identification of lifestyle contributors followed by appropriate modification of sleep, activity, stress, diet, and other provocative influences, often with behavioral therapies. There is a vast, new pharmacologic armamentarium for the acute and preventative management of migraine. The choices depend on the headache burden: the individual patient's pattern, frequency, intensity, disability, and pain tolerance. This chapter reviews the phenomena of adolescent migraine with emphasis on office management.

Syncope in the adolescent is a common dilemma and can be frightening to patients, families, and physicians. An evidence-based approach to the evaluation of syncope in the adolescent is presented, with the emphasis on neurally mediated syncope (NMS). NMS does not actually lead to the youth's death; however, leaving such adolescents in unprotected situations (e.g., swimming or driving) can lead to considerable danger. Also, recurrent episodes of NMS have been shown to be associated with diverse psychosocial difficulties, either as a cause or a consequence of them.

Patients with developmental disorders, including adolescents, comprise a large and heterogeneous group of individuals who vary in underlying diagnosis and degree of disability. The largest numbers of patients are those with cerebral palsy and with traumatic brain injury. While these conditions themselves do not directly cause airway or parenchymal lung dysfunction, consequences of neuromuscular dysfunction, especially aspiration and ineffective cough, may lead to lung damage. Poor nutritional status, impairment of airway clearance by muscular weakness or incoordination and poor pulmonary reserve (due to chest wall or spine deformity) increase the risk of significant morbidity and mortality from respiratory infections. Individuals who were premature infants or who had prolonged neonatal courses may also have residual chronic lung disease (bronchopulmonary dysplasia) contributing to their pulmonary problems. This review discusses conditions that have adverse effects on the airway and lung (drooling, feeding problems, gastroesophageal reflux, aspiration, spasticity, scoliosis) and some of the consequences of these insults (disordered airway clearance, pneumonia, sleep apnea). Also discussed are issues important to the prevention or amelioration of respiratory difficulties, including preventive care, the effects of exercise, dental hygiene, and surgical intervention.

Community acquired pneumonia (CAP) is defined as pneumonia acquired outside of the hospital setting. Extensive studies of CAP in adolescents that characterize the true incidence of various etiologic pathogens are not available. However, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae appear to be the most frequently encountered pathogens. These organisms often cause CAP in adults as well; other infections are noted as well, including Legionella. "Atypical pneumonia" refers to pneumonia not presenting with the usual clinical picture of pneumococcal infection (which includes high fever, productive cough, chills, and other "classic" features). The term is frequently used in adolescents with CAP. However, this classification may not help in individual patients, who often show a high degree of variability in the clinical presentation of pneumonia; also it does not always predict microbial cause. There is currently a trend away from the concept of atypical pneumonia syndrome and more discussion of atypical pathogens as commonly causes of CAP. This article reviews recent literature on CAP with special emphasis on its diagnosis and management in adolescent patients.

Up to 10% of children and adolescents in the United States may have asthma and up to 40% may be affected by allergic rhinitis. Most people know that asthma is a serious disease, but "hay fever" is often mistakenly considered trivial. However, hay fever symptoms can significantly influence a patient's quality of life, causing fatigue, headache, and even cognitive impairment. Both asthma and allergic rhinitis can result in lost sleep, many missed school days, and the inability to participate in sports and other recreational activities in which young people engage. An appropriate diagnosis is the first step toward improving quality of life for these young patients. This article reviews diagnostic procedures for allergic disease, and-because compliance is frequently an issue with school-aged patients-it also reviews current thinking on allergen immunotherapy, a treatment that provides effective long-term control in appropriately selected patients.

The problems of tobacco addiction have evolved over centuries. The possible relationship between smoking and oral cancer was recognized as early as the 19th century. The use of tobacco results in an estimated 4 million deaths each year worldwide. Approximately 3,000 adolescents start smoking every day; 4.5 million children and adolescents smoke cigarettes; 1 million use smokeless tobacco. This article reviews the effects of environmental tobacco smoke and primary smoking on lung health and maturation and the pathophysiology of smoking-related pulmonary disease. Smoking prevention and timely smoking cessation will significantly reduce the risk of not only lung diseases (chronic obstructive pulmonary disease, cancer, chronic bronchitis, asthma, etc.) but also suboptimal lung growth during preadolescent and adolescent years.

Smoking-prevention efforts can be undertaken at a national level, with enactment and enforcement of laws on the use of tobacco products by youth; at the state and local level, with involvement of community organizations; and through school systems, with education regarding the harmful effects of tobacco use. This review, however, focuses on the role of individual practitioners who also can make significant contributions by working at an individual level to incorporate prevention and treatment strategies in their daily medical practice. This article reviews two types of smoking cessation interventions-behavioral and pharmacologic. Currently available data on the prevention and treatment of nicotine addiction in adolescents, particularly pharmacotherapy, are quite limited. The individual clinician can contribute to prevention and treatment of tobacco use among children and adolescents by using many of the known behavioral and pharmacologic strategies.

Sleep disorders are quite common in adolescents and sleep disturbances occur most often during the mid-adolescent years. These disorders result in considerable negative consequences in terms of increased accidents, decreased academic performance, and increased behavioral difficulties. Over the past 25 years, the evaluation, diagnosis, and treatment of sleep-related breathing disorders has undergone dramatic changes. The diagnosis and treatment of pediatric sleep disorders are now the focus of more complex and collaborative research efforts. This article discusses the differences between childhood and adolescent sleep cycles, delayed sleep phase syndrome, sleep-related breathing disorders, narcolepsy, parasomnias, and behavior-related sleep problems.