Summer 2008

Med Services Update

New Guidelines for ADHD and ASD-PTSD

 

Magellan Approves New Guidelines for ADHD and ASD/PTSD

Magellan recently revised two clinical practice guidelines (CPGs) based on a clinical literature review for the following conditions:

Magellan writes and adopts clinical practice guidelines to serve as an evidence-based framework for practitioners’ clinical decision-making with child, adolescent, and adult patients. You can find links to these guidelines and Magellan’s introductions on the Clinical Practice Guidelines page on this website.

ALERT! ADHD CPG Adds Cardiac Screening for All Children

IMPORTANT EDITOR’S NOTE – Since publication of this article, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) issued a joint statement to clarify the April 2008 AHA recommendations. Therefore, Magellan revised its ADHD guideline to include this clarification. See our fall 2008 Provider Focus article for an update on this topic.

The recently revised Magellan Clinical Practice Guideline for the Treatment of Patients with Attention-Deficit Hyperactivity Disorder, Second Edition incorporates the evolving developments in pharmacotherapy, as well as developments in other areas of psychiatric management of individuals with ADHD. The most recent revision of the Magellan ADHD guideline was prompted by the release of new information from the American Heart Association (AHA) Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing (Vetter, 2008) refining recommendations for screening children who may be vulnerable to sudden cardiac death. The AHA now recommends that a baseline electrocardiogram (ECG) be given to all children in order to be able to identify those who may be at risk before giving them medication, and to monitor them safely if stimulant medication is needed to treat their ADHD. (View the complete AHA article.)

Details of Updates to Magellan’s ADHD CPG

Modifications made to the Magellan ADHD CPG include the following language in the section on Medications

“In a published scientific statement from the American Heart Association (AHA) Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing (Vetter, 2008) the recommendations for screening children who may be vulnerable to sudden cardiac death have been refined. The AHA now recommends that a baseline electrocardiogram (ECG) be given to all children in order to be able to identify those who may be at risk before giving them medication and to monitor them safely if stimulant medication is needed to treat their ADHD. These new AHA recommendations delineate for treating pediatricians new cardiovascular monitoring standards for patients on several classes of drugs used to treat ADHD and for those with structural heart disease and existing heart conditions. The AHA proposes parameters for patients currently taking medications (e.g., methylphenidate, amphetamine, and other stimulant agents) by recommending that the physician take a history, review the physical examination and order an ECG if these were not previously done. Finally, the AHA stresses that the clinician treating the child with ADHD needs to evaluate with the family and other treating physicians as appropriate the risks and alternatives to taking the medication, including the often significant risk associated with not taking the medication. (Vetter, 2008)”     

Using Magellan’s CPGs

The Magellan ADHD guideline covers the main areas of psychiatric management of patients with this disorder – including topics from clinical features and epidemiology, to various aspects of treatment approach and planning. Nonetheless, it is not intended to be exhaustive. In addition, the behavioral health field is rapidly evolving, and assessment and management techniques are continuously changing. So, while this guideline provides a brief overview, we encourage you to review other sources that may incorporate ongoing clinical developments, including the AACAP Practice Parameters for ADHD.     

Acute Stress Disorder and Posttraumatic Stress Disorder CPG

Magellan also recently reviewed and re-adopted the American Psychiatric Association’s (APA) Clinical Practice Guideline for the Assessment Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2004) and Treating Patients with Acute Stress Disorder and Posttraumatic Stress Disorder: A Quick Reference Guide.

Key relevant recommendations from this literature and points from the APA guideline are summarized in Magellan’s introduction to the ASD/PTSD guideline on this website.

Guideline Incorporates Changes in Pharmacotherapy and Psychotherapy

This guideline incorporates the evolving developments in pharmacotherapy, as well as developments in other areas of the psychiatric management of individuals with ASD and PTSD. We also added a new section to Magellan’s introduction to the CPG: Complementary and Alternative Treatment. The APA revision is a comprehensive evidence-based document that covers areas of the psychiatric management of patients with these disorders, from understanding the clinical features and epidemiology, to treatment approaches and planning.

View Details of Findings Highlighted in Magellan’s Introduction to the ASD/PTSD Guideline

Magellan encourages you to become familiar with all Magellan CPGs. As with clinical guidelines in general, Magellan’s adopted and developed guidelines are intended to augment, not replace, sound clinical judgment.

We welcome feedback on our CPGs. Submit your comments to your local Magellan medical director or to Kathleen Frampton at KKFrampton@MagellanHealth.com.