Practice Guidelines for ADHD and Suicide Re-Adopted
Magellan recently updated and re-adopted two clinical practice guidelines to serve as the evidence-based framework for practitioners’ clinical decision-making for attention deficit / hyperactivity disorder (ADHD), and for assessing and managing the suicidal patient.
ADHD
Magellan re-adopted a revised version of the Magellan Clinical Practice Guideline for Patients with Attention Deficit/Hyperactivity Disorder. This is a Magellan-developed guideline that incorporates information from numerous sources, including the American Academy of Pediatrics (AAP) and the American Heart Association (AHA). Additionally, we updated references throughout based on a literature search through January 2010.
Significant revisions include:
- Added new information from the 2001-2004 National Health and Nutritional Examination Survey (NHANES) on prenatal lead and tobacco exposure and association with ADHD.
- Added information on new drugs developed since the last update, e.g., triple-bead mixed amphetamine salts (MAS) - an enhanced extended-release amphetamine formulation and lisdexamfetamine dimesylate, which is the first prodrug stimulant used in the treatment of ADHD.
- Included recent clinical trial findings of medications used for ADHD – stimulants, atomoxetine, antidepressants, and clonidine.
Suicide
Magellan also re-adopted a revised version of the Magellan Clinical Practice Guideline for Assessing and Managing the Suicidal Patient. Some of the more significant additions and revisions include:
- Updated U.S. suicide statistics and information on questions used to evaluate suicide and make prevalence estimates.
- Added new clinical findings on strong evidence that lithium has a protective effect on suicide for mood disorders.
- Reviewed findings of a systematic review from U.S Preventative Services Task Force and others who have studied SSRI treatment and suicide risk in the pediatric population.
- Provided new information from clinical studies on suicide prevention
- Added new clinical research on the positive effects of psychodynamic treatment that is integrated into a partial hospital program for borderline personality.
- Added research studies that provide data on new high-risk groups.
- Summarized two meta-analyses showing that risk of suicide associated with use of antidepressants is strongly age dependent.
- Provided study findings on overdose safety of antidepressants.
Accessing Guidelines
The above items are only a sample of the modifications to these two Magellan clinical practice guidelines. We encourage you to be familiar with the information in the guidelines, as well as the information in the Magellan Introductions to guidelines adopted from professional organizations.
Use of Guidelines
All Magellan-adopted clinical practice guidelines are intended to augment, not replace, your sound clinical judgment. However, when you provide care that does not adhere to a Magellan-adopted guideline, the clinical record should reflect that you weighed the recommendations in the guideline against the member’s clinical status and needs, and that you planned a clinically appropriate course of action.
Provider Feedback
We welcome your input on our adopted clinical practice guidelines. We will take all suggestions and recommendations into consideration in our next review. Submit comments to your local Magellan provider advisory group or local Magellan medical director, or e-mail comments to Kathleen Frampton at KKFrampton@MagellanHealth.com.