Janssen ADHD Online – Free webinars Planning for transition - Challenges of secondary and tertiary education Presented by Dr Dilip Nathan Monday, 24 June 2013 7-8pm GMT ADHD, a lifelong disorder presents challenges at different stages of life but research illustrates particular difficulty at transition. Young people often develop coping mechanisms in addition to a scaffold of adults (parents teachers and peers) at each stage of education, but this is disrupted during transition. This webinar aims to illustrate the background issues affecting young people with ADHD and focus upon practical strategies around transition. Dr Nathan is a consultant paediatrician who has worked with children and young people with ADHD for 16 years. He has expertise in medical education and leads on a project to Train professionals across the East Midlands, UK. Sign up today for free > Or go to: http://dotr.im/24June Janssen ADHD Online – Free webinars ADHD and Technology Presented by Professor Amanda Kirby Monday, 8 July 2013 7-8pm GMT ADHD is a life long developmental disorder. Many children and adults have executive functioning difficulties making organisation, time management and daily planning hard to do. This webinar will discuss the different ways that technology can provide support for individuals, parents and professionals and demonstrate a range of free resources. Professor Amanda Kirby has a chair in developmental disorders at the University of South Wales and also is the CEO of Do-IT Solutions Ltd. She has had a long term interest in the use of technology in this area and has assisted in the development of a wide range of resources including websites and apps. Sign up today for free > Or go to: http://dotr.im/8July Janssen ADHD Online – Free webinars ADHD and Girls Presented by Dr Deborah Judge Monday, 15 July 2013 7-8pm GMT The patterns of substance misuse in childhood which lead to high risk behaviour and morbidity and mortality in adolescence are complex. ADHD is one of the most significant mental health disorders associated with increased risk of substance use, sexual health risks and offending behaviour in adolescence. Of course, not all children growing up with ADHD will develop these problems, but this talk highlights a range of social, emotional and relationship issues for girls, to raise awareness of potential risks and describe practical ways to engage adolescent girls with supportive services and thus improve their outcomes in adulthood. Why focus on girls? …well let’s face it, there has been a significant gap in our thinking about girls growing up with ADHD, so let’s get thinking now about better engagement in a range of services and about the wider issues that impact on girls’ health and educational success. Dr Deborah Judge has been employed as a Consultant Child and Adolescent Psychiatrist within the NHS for 13 years. She has developed special interests within CAMHS in ADHD, conduct disorders, ADHD and girls, depressions, anxiety disorders, autistic spectrum disorders and self harm and eating disorders. Deborah chairs the Royal College special interest group on young people of substance misuse and present nationally and internationally on developing services for young people with substance misuse problems. Sign up today for free > Or go to: http://dotr.im/15July Janssen ADHD Online – Free webinars Transition to Adult Services Presented by Professor Phillip Asherson Monday, 9 September 2013 7-8pm GMT This webinar will explore the options available for those with ADHD progressing into adulthood. Professor Asherson is a Professor of Molecular Psychiatry at the Institute of Psychiatry, King's College, London and consultant psychiatrist at the Maudsley Hospital. He is the Present of the UK Adult ADHD Network, www.UKANN.org a professional network which aims to support clinical research, education and service provision for adults with ADHD. He was a member of the guideline development group for NICE and contributed to published guidelines from NICE, the British Association of Psychopharmacology and the European Network Adult ADHD consensus paper. Sign up today for free > Or go to: http://dotr.im/9Sept Janssen ADHD Online – Free webinars Diagnostic issues of ASD/ADHD in young people Presented by Dr Lenny Thornton Monday, 7 October 2013 7-8pm GMT Autism Spectrum Disorder (ASD) frequently coexists with ADHD and the combination of these two conditions is associated with a high level of psychosocial impairment and caregiver strain. However ASD is often unrecognised/misdiagnosed in the child with ADHD and may not be considered until they are much older. Unfortunately establishing the diagnosis of ASD in young people is not always a straightforward process. This webinar will cover how ASD can present in adolescence, and the assessment difficulties associated with this age group. Dr Lenny Thornton is an independent consultant in Child and Adolescent Psychiatry based in Chester. He worked as a consultant in the forensic secure unit in Manchester before becoming a consultant in Chester. He has a particular clinical interest in autism and until his recent retirement from the NHS in 2011 he ran the West Cheshire Autism Disorders Assessment Service. Since then he has developed an independent autism diagnostic service in Cheshire. Sign up today for free > Or go to: http://dotr.im/7Oct Janssen ADHD Online – Free webinars ADHD and NHS Reform Presented by Richard Ellis Monday, 4 November 2013 7-8pm GMT This webinar will summarise the main changes in the NHS clinical and organisational landscape over the last 12 months and identify some opportunities and potential pitfalls for clinicians working with child and adolescent mental health services and ADHD. Richard Ellis is an independent NHS advisor, working for over 20 years with NHS Trusts, GPs, commissioning organisations and local authorities to develop best value pathways. He has worked in London, Lancashire, East Midlands, Thames Valley and across the South of England and has helped many organisations to negotiate their service and financial journey through the ever choppy waters of the NHS reorganisations. Sign up today for free > Or go to: http://dotr.im/4Nov • • • • • • • • • • • • • • • • • • • CONCERTA® XL PRESCRIBING INFORMATION CONCERTA® XL Prolonged Release Tablets (18mg, 27mg and 36mg) ACTIVE INGREDIENT: Methylphenidate hydrochloride. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATION(S): Indicated as part of a comprehensive treatment programme for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 years of age and over, when remedial measures alone prove insufficient. DOSAGE & ADMINISTRATION: Children under 6 years: Do not use. Children over 6 years and adolescents: Once daily in the morning, increase weekly by 18 mg to max. 54 mg daily. A 27 mg tablet is available for dosing between 18 mg and 36 mg. New patients: Limited clinical experience. Start 18 mg daily. Patients taking 3 times daily formulations: 18 mg Concerta XL ≡ 5 mg methylphenidate tds; 36 mg Concerta XL ≡ 10 mg tds; 54 mg Concerta XL ≡ 15 mg tds. Swallow whole with liquid. Pre-treatment screening: conduct baseline evaluation of patient’s cardiovascular status including blood pressure and heart rate, record pre-treatment height/weight on growth chart. Adults : Where symptoms persist and a clear benefit of treatment has been shown in adolescents, treatment can continue into adulthood. Starting treatment with Concerta XL in adulthood is not appropriate. Elderly: Should not be used in the elderly. CONTRAINDICATIONS: Known sensitivity to methylphenidate or any excipients. Glaucoma, phaeochromocytoma, during treatment with non-selective, irreversible, monoamine oxidase inhibitors (MAOIs) or discontinuation within 14 days. Hyperthyroidism or thyrotoxicosis, pre-existing cardiovascular disorders including angina, heart failure, severe hypertension, occlusive disease, haemodynamically significant congenital heart disease, cardiomyopathies, myocardial infarction, potentially life threatening arrhythmias and channelopathies, diagnosis/history of severe depression, anorexia nervosa, psychotic symptoms, suicidal tendency, severe mood disorders, mania, schizophrenia, psychopathic/borderline personality disorder, diagnosis/history of severe and episodic (Type I) Bipolar Disorder, pre-existing cerebrovascular disorders, cerebral aneurysm, vascular abnormalities including vasculitis/stroke . SPECIAL WARNINGS & PRECAUTIONS : Discontinue treatment at least once yearly to assess child’s condition. Not recommended in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities or other serious cardiac problems. Caution with underlying medical condition that might be compromised by increases in blood pressure or heart rate. Caution with known drug/alcohol dependency. Evaluate patients with suicidal ideation or behaviour immediately. Carefully monitor at every adjustment of dose, then at least every 6 months: cardiovascular status, blood pressure and pulse, development/worsening of psychiatric disorders, emergence worsening of psychotic or manic symptoms, aggressive behaviour, hostility, emergence/worsening of tics, anxiety, agitation, tension, symptoms of Bipolar Disorder in patients with co-morbid depressive symptoms. Record height, weight, appetite on growth chart. Assess neurological signs/symptoms in patients at risk of cerebrovascular disease. Discontinue if seizure frequency increases or new-onset seizures occur. Monitor for risk of diversion, misuse, abuse. Withdrawal: careful supervision required. When withdrawal is unsuccessful at 18 years old, treatment can continue into adulthood but should be reviewed annually. Avoid use in GI narrowing, dysphagia, difficulty swallowing. Use in renal or hepatic insufficiency: no experience. Haematological effects: long term safety: not known. Drug screening: possible false positive result for amphetamines during drug testing. Galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption: do not take. SIDE EFFECTS: Very common (> 1/10); Insomnia, nervousness, headache. Common (> 1/100 to <1/10); anorexia, decreased appetite, reduced weight and height gain (prolonged use in children), affect lability, aggression, depression, depressed mood, libido decreased, tension, bruxism, panic attack, agitation, anxiety, irritability, abnormal behaviour, dizziness, vertigo, dyskinesia, psychomotor hyperactivity, paraesthesia, tension headache, somnolence, initial insomnia, arrhythmia, tachycardia, changes in heart rate, palpitations, hypertension/changes in blood pressure, accommodation disorder, cough, oropharyngeal pain, abdominal discomfort and pain (upper), diarrhoea, nausea, vomiting, dry mouth, dyspepsia, alopecia, pruritus, rash, urticaria, arthralgia, muscle tightness/spasms, pyrexia, growth retardation during prolonged use in children, mood swings, tics, fatigue, nasopharyngitis, upper respiratory tract infection, sinusitis, erectile dysfunction, feeling jittery, asthenia, thirst, weight decreased, alanine aminotransferase increased. Serious side-effects: hypersensitivity reactions; suicidal ideation, attempt, completion; NMS; cerebrovascular disorders: cerebral vasculitis/arteritis, cerebral occlusion/haemorrhage, cerebrovascular accidents; myocardial infarction, chest pain, angina pectoris, cardiac arrhythmias, cardiac arrest, sudden cardiac death; convulsions including grand mal; psychotic disorders; abnormal liver function, hepatic coma; dependence, abuse. Refer to SmPC for other side effects PREGNANCY: Not recommended. LACTATION: Methylphenidate found in breast milk. INTERACTIONS: Inducers/inhibitors of cytochrome P450 not expected to impact methylphenidate pharmacokinetics, conversely methylphenidate does not relevantly impact Cytochrome P450, 1A2, 2C8, 2C9, 2C19, 2D6, 2E1 or 3A. May decrease effectiveness of anti-hypertensive drugs. Non-selective, irreversible MAOIs (currently or within 2 weeks). Caution with drugs that elevate blood pressure. May inhibit metabolism of coumarin anticoagulants, anticonvulsants (eg. phenobarbital, phenytoin, primidone), antidepressants (tricyclics/SSRIs). If starting/stopping Concerta XL, re-evaluate dose of these medicines. Halogenated anaesthetics: risk of sudden BP increase; do not use on day of surgery. Avoid alcohol. Long-term safety of combination with clonidine/other centrally acting alpha-2-antagonists not been systematically evaluated. Caution with dopaminergic drugs, including antipsychotics. LEGAL CATEGORY: POM (CD) Schedule 2. PRESENTATIONS, PACK SIZES, PRODUCT LICENCE NUMBERS & BASIC NHS COSTS 18 mg tablets (PL 0242/0372) 30: £31.19, 27 mg tablets (PL 0242/0400) 30: £36.81, 36 mg tablets (PL 0242/0373) 30: £42.45. FURTHER INFORMATION IS AVAILABLE FROM THE PRODUCT LICENCE HOLDER: Janssen-Cilag Ltd, 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG, UK. © Janssen-Cilag Ltd 2013 Date updated: February 2013 PIVER-201302 Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Janssen-Cilag Ltd on 01494 567447.