Comprehensive information on potassium mineral supplements. Learn about the usage, dosage, side-effects of potassium.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Potassium is a mineral that helps the kidneys function normally. It also plays a key role in cardiac, skeletal, and smooth muscle contraction, making it an important nutrient for normal heart, digestive, and muscular function. A diet high in potassium from fruits, vegetables, and legumes is generally recommended for optimum heart health.

Having too much potassium in the blood is called hyperkalemia and having too little in the blood is known as hypokalemia. Proper balance of potassium in the body depends on sodium. Therefore, excessive use of sodium may deplete the body's stores of potassium. Other conditions that can cause potassium deficiency include diarrhea, vomiting, excessive sweating, malnutrition, and use of diuretics. In addition, coffee and alcohol can increase the amount of potassium excreted in the urine. Adequate amounts of magnesium are also needed to maintain normal levels of potassium.

For most people, a healthy diet rich in vegetables and fruits provides all of the potassium needed. The elderly are at high risk for developing hyperkalemia due to decreased kidney function that often occurs as one ages. Older people should be careful when taking medication that may further affect potassium levels in the body, such as nonsteroidal anti-inflammatories (NSAIDs) and ACE inhibitors (see section on Interactions for additional information). Taking potassium supplements, at any age, should only be done under the guidance of a healthcare provider.

 

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Uses

Hypokalemia
The most important use of potassium is to treat the symptoms of hypokalemia, which include weakness, lack of energy, muscle cramps, stomach disturbances, an irregular heartbeat, and an abnormal EKG (electrocardiogram, a test that measures heart function). Treatment of this condition takes place under the guidance and direction of a physician.

Osteoporosis
High dietary intake of potassium from fruits and vegetables throughout one's life helps to preserve bone mass thereby preventing bone loss that can lead to osteoporosis.

High Blood Pressure
Some studies have linked low dietary potassium intake with high blood pressure. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends adequate amounts of potassium in the diet, along with other measures such as dietary calcium and weight loss, to prevent the development of high blood pressure. Similarly, the Dietary Approaches to Stop Hypertension (DASH) diet emphasizes eating foods rich in fruits, vegetables, and low- or non-fat dairy products to provide high intake of potassium, as well as magnesium and calcium.

While appropriate and adequate dietary intake is necessary for preventing or improving blood pressure, potassium supplements are probably not. Some animal and early human studies did suggest that potassium supplements could help to lower blood pressure. More recent well-designed studies, however, suggest that potassium supplements do not improve blood pressure significantly. Use of potassium supplements for blood pressure, therefore, depends on the medications you are taking and the instructions of your doctor.

Stroke
In several population based studies evaluating very large groups of men and women over time, a diet rich in potassium was associated with a reduced risk of stroke. For the men, this seems to be particularly true among those with high blood pressure and/or those taking diuretics (blood pressure medications that help the kidneys eliminate sodium and water from the body). Potassium supplements, however, do not seem reduce the risk of stroke.

Inflammatory Bowel Disease (IBD)
Amongst other nutrient deficiencies, people with IBD (namely, ulcerative colitis or Crohn's disease) often have low levels of potassium. Your doctor will determine if supplementation with potassium is necessary.

Asthma
Several studies have suggested that diets low in potassium are associated with poor lung function and even asthma in children compared to those who eat normal amounts of potassium. Enhancing dietary intake of potassium through foods such as fish, fruits, and vegetables may, therefore, prove to be of value for preventing or treating asthma.

 

 

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Dietary Sources for Potassium

The best dietary sources of potassium are fresh unprocessed foods, including meats, fish, vegetables (especially potatoes), fruits (especially avocados, dried apricots, and bananas), citrus juices (such as orange juice), dairy products, and whole grains. Most potassium needs can be met by eating a varied diet with adequate intake of milk, meats, cereals, vegetables, and fruits.

 

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Available Forms of Potassium

There are several potassium supplements on the market, including potassium acetate, potassium bicarbonate, potassium citrate, potassium chloride, and potassium gluconate.

Potassium can also be found in multivitamins.

 

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How to Take Potassium

Potassium supplements, other than the small amount included in a multivitamin, should only be taken under the specific guidance and instruction of a healthcare provider. This is particularly true for children.

The recommended daily intakes of dietary potassium are listed below:

Pediatric

• Infants birth to 6 months: 500 mg or 13 mEq
• Infants 7 months to 12 months: 700 mg or 18 mEq
• Children 1 year: 1000 mg or 26 mEq
• Children 2 to 5 years: 1400 mg or 36 mEq
• Children 6 to 9 years: 1600 mg or 41 mEq
• Children over 10 years: 2000 mg or 51 mEq

Adult

• 2000 mg or 51 Meq, including for pregnant and nursing women.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider. In the case of potassium, this is particularly important in the elderly.

Diarrhea and nausea are two common side effects from potassium supplements. Other potential adverse effects include muscle weakness, slowed heart rate, and abnormal heart rhythm.

Excessive amounts of the herb licorice (not licorice candy) and caffeine-containing herbs (such as cola nut, guarana, and possible green and black tea) can lead to loss of potassium.

Potassium must not be used by people with hyperkalemia.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use potassium without first talking to your healthcare provider.

Potassium levels may be increased by the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, piroxicam, and sulindac): This interaction is particularly likely to occur in people with decreased kidney function.
• ACE inhibitors (such as captopril, enalapril, and lisinopril): This interaction is particularly likely to occur in people who are taking NSAIDs, potassium-sparing diuretics (such as spironolactone, triamterene, or amiloride), or salt substitutes along with the ACE inhibitor. A rise in potassium from ACE inhibitors may also be more likely in people with decreased kidney function and diabetes.
• Heparin (used for blood clots)
• Cyclosporine (used following a transplant to suppress the immune system)
• Trimethoprim (an antibiotic)
• Beta-blockers (such as metoprolol and propranolol that are used to treat high blood pressure)

Potassium levels may be decreased by the following medications:

• Thiazide diuretics (such as hydrochlorothiazide)
• Loop diuretics (such as furosemide and bumetanide)
• Corticosteroids
• Amphotericin B
• Antacids
• Insulin
• Theophylline (used for asthma)
• Laxatives

Please refer to the depletions monographs related to these medications for additional information. A healthcare practitioner will determine whether potassium supplements are needed when individuals are taking these medications.

Other potential interactions include:

• Digoxin: Low blood levels of potassium increase the likelihood of toxic effects from digoxin, a medication used to treat abnormal heart rhythms. Normal levels of potassium should be maintained during digoxin treatment which will be measured and directed by the healthcare provider.

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Supporting Research

Alappan R, Perazella MA, Buller GK, et al. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med. 1996;124(3):316-320.

Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Clin Cardiol. 1999;22(Suppl. III):III1-III5.

Apstein C. Glucose-Insulin-Potassium for acute myocardial infraction: remarkable results from a new prospective, randomized trial. Circ. 1998;98:2223 - 2226.

Apstein CS, Opie Lh. Glucose-insulin-potassium (GIK) for acute myocardial infarction: a negative study with a positive value. Cardiovasc Drugs Ther. 1999;13(3):185-189.

Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among U.S. men. Circ. 1998;98:1198 - 1204.

Brancati FL, Appel LJ, Seidler AJ, Whelton PK. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. Arch Intern Med. 1996;156:61 - 72.

Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition. Am J Med. 1999;107(6A):65S-70S.

Burgess E, Lewanczuk R, Bolli P, et al. Lifestyle modifications to prevent and control hypertension. 6. Recommendations on potassium, magnesium and calcium. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999;160(9 Suppl):S35-S45.

Cappuccio EP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991;9:465-473.

Chiu TF, Bullard MJ, Chen JC, Liaw SJ, Ng CJ. Rapid life-threatening hyperkalemia after addition of amiloride HCL/hydrochlorothiazide to angiotensin-converting enzyme inhibitor therapy. Ann Emerg Med. 1997;30(5):612-615.

Gilliland FD, Berhane KT, Li YF, Kim DH, Margolis HG. Dietary magnesium, potassium, sodium, and children's lung funtion. Am J Epidemiol. 2002. 15;155(2):125-131.

Hermansen K. Diet, blood pressure and hypertension. Br J Nutr. 2000:83(Suppl 1):S113-119.

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Heyka R. Lifestyle management and prevention of hypertension. In: Rippe J, ed. Lifestyle Medicine. 1st ed. Malden, Mass: Blackwell Science; 1999:109-119.

Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000;55:775-779.

Howes LG. Which drugs affect potassium? Drug Saf. 1995;12(4):240-244.

Iso H, Stampfer MJ, Manson JE, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30(9):1772-1779.

Joint National Committee. Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Int Med. 1997;157:2413-2446.

Kendler BS. Recent nutritional approaches to the prevention and therapy of cardiovascular disease. Prog Cardiovasc Nurs. 1997;12(3):3-23.

Krauss RM, Eckel RH, Howard B, et al. AHA dietary guidelines. Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-2299.

Matsumura M, Nakashima A, Tofuku Y. Electrolyte disorders following massive insulin overdose in a patient with type 2 diabetes. Intern Med. 2000;39(1):55-57.

Newnham DM. Asthma medications and their potential adverse effects in the elderly: recommendations for prescribing. Drug Saf. 2001;24(14):1065-1080.

Olukoga A, Donaldson D. Liquorice and its health implications. J Royal Soc Health. 2000;120(2):83-89.

Pasic S, Flannagan L, Cant AJ. Liposomal amphotericin is safe in bone marrow transplantation for primary immunodeficiency. Bone Marrow Transplant. 1997;19(12):1229-1232.

Perazella MA. Trimethoprim-induced hyperkalemia: clinical data, mechanism, prevention and management. Drug Saf. 2000;22(3):227-236.

Perazella M, Mahnensmith R. Hyperkalemia in the elderly. J Gen Intern Med. 1997;12:646 - 656.

Physicians' Desk Reference. 55th ed. Montvale, NJ: Medical Economics Co., Inc.; 2001:1418-1422, 2199-2207.

Poirier TI. Reversible renal failure associated with ibuprofen: case report and review of the literature. Drug Intel Clin Pharm. 1984;18(1):27-32.

Preston RA, Hirsh MJ MD, Oster, JR MD, et al. University of Miami Division of Clinical Pharmacology therapeutic rounds: drug-induced hyperkalemia. Am J Ther. 1998; 5(2):125-132.

Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13(10):717-720.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40:754-760.

Sacks FM, Willett WC, Smith A, et al. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertens. 1998;31(1):131 - 138.

Shionoiri H. Pharmacokinetic drug interactions with ACE inhibitors. Clin Pharmacokinet. 1993;25(1):20-58.

Singh RB, Singh NK, Niaz MA, Sharma JP. Effect of treatment with magnesium and potassium on mortality and reinfarction rate of patients with suspected acute myocardial infarction. Int J Clin Pharmacol Thera. 1996;34:219 - 225.

Stanbury RM, Graham EM. Systemic corticosteroid therapy - side effects and their management. Br J Ophthalmol. 1998;82(6):704-708.

Suter PM. Potassium and Hypertension. Nutrition Reviews. 1998;56:151 - 133.

Tucker KL, Hannan Mt, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727-736.

Whang R, Oei TO, Watanabe A. Frequency of hypomagnesia in hospitalized patients receiving digitalis. Arch Intern Med. 1985;145(4):655-656.

Whelton, A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure. A prospective, randomized, crossover comparison. Ann Intern Med. 1990;112(8):568-576.

Young DB, Lin H, McCabe RD. Potassium's cardiovascular protective mechanisms. Am J Physiology. 1995;268(part 2):R825 - R837.

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Discover what causes premature ejaculation and techniques to treat premature ejaculation. Along with comments on having an orgasm.

Rarely a physiological problem, premature ejaculation can result from over-excitement, positioning or rate of intercourse. "The roots of it go back to the way men learn to orgasm, which is typically through masturbation," suggests Kaminetsky. "A lot of young boys masturbate quickly, because they don't want their mom to walk in on them. It becomes a trained behavior." To treat premature ejaculation, experts suggest changing positions, breathing deeply, thinking about something other than sex or simply stopping for a moment. Here, Kaminetsky offers two additional techniques for delaying orgasm:

• Practice this before reaching "ejaculatory inevitability," the point when ejaculation cannot be stopped; most men recognize it as a sensation of deep warmth or pleasure: Squeeze the head of the penis for about four seconds or until the sensation subsides, then resume.
• During intercourse, the man should press his pelvic bone against the woman's and rock rather than thrust his body. "It won't be as stimulating for him so he'll last longer, and it may be more stimulating for the woman."

HIS BENEFITS

• Long life: Men who have two or more orgasms a week tend to live significantly longer than do those who have only one or none, according to research at Cardiff University in Wales.
• Less cancer: Breast cancer is rare in men, but once developed, the mortality rate is high. Fortunately, a study published in the British Journal of Cancer found that men who have more than six orgasms a month are significantly less likely to develop breast cancer than are those who have less frequent sex.
• Healthy hearts: A study of 2,500 men at the University of Bristol and Queens University of Belfast found that men who have at least three or more orgasms a week are 50 percent less likely to die from heart failure or coronary heart disease.
• Good health: Having sex once or twice a week also fights off the flu and other viruses by strengthening the immune system, psychologists at the University of Pennsylvania recently found.
• Youthful looks: A study of 3,500 aging people at the Royal Edinburgh Hospital in Scotland found that those who looked the youngest also had the most vigorous sex life. The effects were even greater if the subjects were emotionally satisfied as well.

READ MORE ABOUT IT: The Good Girl's Guide to Bad Girl Sex Barbara Keesling, Ph.D. (M. Evan and Co., 2001)

Sexual Fitness: 7 Essential Elements of Optimizing Your Sensuality, Satisfaction and Well-Being Hank C.K. Wuh, M.D. (G.P. Putnam's Sons, 2001)

Personal Comments

Bee, 25, Copywriter

Masturbating is the easiest way for women to learn how to have an orgasm. Women who masturbate will be a lot more likely to have an orgasm during sex. I think it helps you learn the actual mechanics of what turns you on, where things need to happen.

Because the guy isn't going to know that; there's no reason he would. Every woman is different. Also, the bonding that goes on during sex seems most extreme with an orgasm. It's kind of like one or both people have gone completely over the edge; they're suspended in the other person's grasp, and they're completely surrendered to it. That intensifies any connection.

Gabriel, 25, Musician

There are guys who don't get a rise out of giving a woman an orgasm and would just prefer not to have someone else there. I've even heard some guys say they have better orgasms during masturbation than sex. The mere thought of it astounds me, but it makes sense if a guy has a fear of intimacy or, even more, a fear of performing (performance anxiety). It probably takes away from his own orgasm if he's overly concerned with his sexual performance or whether or not she's having one. It's ironic because an orgasm during sex is enhanced when it's with someone you truly care about.

Kamara, 27, Musician

I'm amazed when I talk to anyone who claims to have never had an orgasm, probably because I just can't imagine not having them or not being able to have them. At the same time, it doesn't surprise me: I was raised in a very conservative religious atmosphere that actually called masturbation "self-abuse," and all sexuality -- not to mention orgasms -- was beautiful and good only if it happened in a marriage bed. It takes a while to expel the load of guilt that piles up around your sexuality if you're raised in that kind of culture, and I'm sure some people never do. But there was no way I wasn't going to aim for the prize once I knew what it felt like. Maybe it depends on your sexual drive -- for me, the drive was strong enough that I could never feel guilty about an orgasm for long.

Steven, 28, Veterinarian

Some guys think sex has to include an orgasm. Orgasms are great, but there's so much more to sex. An orgasm is more of a physical experience; I guess there is an emotional aspect, but it's over in a second. I think anybody can give you an orgasm, but it's the person there after the orgasm that matters. But I think I'm the exception.

Does Orgasm Equal Sex

Our ever-changing definition of sex may hinge more on the climax than on the act itself; Psychologist L.M. Bogart, Ph.D., gave Kent State students a list of scenarios in which "Jim" and "Susie" engaged in vaginal, anal or oral intercourse and either did or did not achieve orgasm. Vaginal intercourse was considered sex 97 percent of the time, followed by anal intercourse (93 percent) and oral sex (44 percent). Researchers were surprised to find that orgasm occurrence dictated whether or not the activity was considered sex. Although the woman was more likely to label vaginal intercourse sex if neither partner climaxed, when it came to oral sex, the recipient was more likely to consider it sex than the partner performing the act, especially if the recipient achieved orgasm -- because the stimulator was unlikely to achieve orgasm. For anal sex, it was more likely to be called sex if Jim had the orgasm, but it was sex to Susie regardless of whether she achieved orgasm. In general, the lack of orgasm for women was less likely to affect her labeling the act sex. Although most sex therapists argue against using orgasm as an end-all definition of sex, Bogart's study indicates that orgasm is still an important gauge by which we measure sexual activity.

Source: Psychology Today

MUST HAVES for people with an eating disorder like anorexia, bulimia, compulsive overeating

Recommended for sufferers, friends and family

buy the book $15

"Eating with Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too"By: Laura Collins Read Laura's blog Eating Disorder Recovery: The Power of Parents, right here at HealthyPlace.

 

Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back
By: Shannon Cutts
buy the book 

 

Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too
By: Jenni Schaefer and Thom Rutledge
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Reader Comment: 'Life Without Ed truly guides the reader into the separation of self from ED.'

Intuitive Eating: A Revolutionary Program That Works
By: Evelyn Tribole, Elyse Resch
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Reader Comment: 'This book is the only "plan" you'll ever need to get off the dieting roller coaster and become a healthy eater.'

The Secret Language of Eating Disorders: How You Can Understand and Work to Cure Anorexia and Bulimia
By: Peggy Claude-Pierre
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Reader Comment: "In her book, Peggy describes anorexia as a very slow attempted suicide, a descent toward nothingness---I agree. Anorexia is not a diet, it is not a shallow attempt to be "model thin", and it is definitely not just about food."

Help Your Teenager Beat an Eating Disorder
By: James Lock, Daniel le Grange
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Reader Comment: "This book was not written as a self-help manual, but it was written for parents and contains loads of practical advice garnered from years of working directly with sufferers and their parents."

The Eating Disorders Sourcebook
By: Carolyn Costin
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Reader Comment: "This book provides an excellent overview of many aspects of eating disorders and their treatment. Carolyn Costin is extremely insightful and knowledgeable about the subject and she writes in a clear, accessible way."

Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food Through Myths, Metaphors, and Storytelling By: Anita A. Johnston PhD.
buy the book 

Reader Comment: "This is a deeply insightful book that speaks to women with disordered eating of all types and severities."

The End of Overeating: Taking Control of the Insatiable American Appetite
By: David Kessler MD
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Reader Comment: "The book is a fascinating read, full of documentation and testimonials on the growing obesity problem and our apparent inability to control our food intake as a culture."

The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys
By: Harrison G. Pope, Katharine A. Phillips, Roberto Olivardia
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Reader Comment: "The chapter notes contain at least 50 research papers that they have published in various scientific journals. Some of their findings are pretty stunning."

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Serious depression and conduct disorder raise a teen's risk of suicide. Substance abuse problems also increase suicidal thinking and behavior in teens.

In addition to depression, there are other emotional conditions that can put teens at greater risk for suicide - for example, girls and guys with conduct disorder are at higher risk. This may be partly because teens with conduct disorder have problems with aggression and may be more likely than other teens to act in aggressive or impulsive ways to hurt themselves when they are depressed or under great stress. The fact that many teens with conduct disorder also have depression may partly explain this, too. Having both serious depression and conduct disorder increases a teen's risk of suicide. Substance abuse problems also put teens at risk for suicidal thinking and behavior. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression, especially in teens prone to depression because of their biology, family history, or other life stressors.

Besides depressive effects, alcohol and drugs alter a person's judgment. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when a teen is under the influence of alcohol or drugs. Teens with substance abuse problems often have serious depression or intense life stresses, too, further increasing their risk.

Life Stress and Suicidal Behavior

Let's face it - being a teen is not easy for anyone. There are many new social, academic, and personal pressures. And for teens who have additional problems to deal with, life can feel even more difficult. Some teens have been physically or sexually abused, have witnessed one parent abusing another at home, or live with lots of arguing and conflict at home. Others witness violence in their neighborhoods. Many teens have parents who divorce, and others may have a parent with a drug or alcohol addiction.

Some teens are struggling with concerns about sexuality and relationships, wondering if their feelings and attractions are normal, if they will be loved and accepted, or if their changing bodies are developing normally. Others struggle with body image and eating problems, finding it impossible to reach a perfect ideal, and therefore having trouble feeling good about themselves. Some teens have learning problems or attention problems that make it hard for them to succeed in school. They may feel disappointed in themselves or feel they are a disappointment to others.

All these things can affect mood and cause some people to feel depressed or to turn to alcohol or drugs for a false sense of soothing. Without the necessary coping skills or support, these social stresses can increase the risk of serious depression and, therefore, of suicidal ideas and behavior. Teens who have had a recent loss or crisis or who had a family member who committed suicide may be especially vulnerable to suicidal thinking and behavior themselves.

Guns and Suicide Risk

Finally, having access to guns is extremely risky for any teen who has any of the other risk factors. Depression, anger, impulsivity, life stress, substance abuse, feelings of alienation or loneliness - all these factors can place a teen at major risk for suicidal thoughts and behavior. Availability of guns along with one or more of these risk factors is a deadly equation. Many teen lives could be saved by making sure those who are at risk don't have access to guns.

Different Types of Suicidal Behaviors

Teen girls attempt suicide far more often (about nine times more often) than teen guys, but guys are about four times more likely to succeed when they try to kill themselves. This is because teen guys tend to use more deadly methods, like guns or hanging. Girls who try to hurt or kill themselves tend to use overdoses of medications or cutting. More than 60% of teen suicide deaths happen with a gun. But suicide deaths can and do occur with pills and other harmful substances and methods.

Sometimes a depressed person plans a suicide in advance. Many times, though, suicide attempts are not planned in advance, but happen impulsively, in a moment of feeling desperately upset. Sometimes a situation like a breakup, a big fight with a parent, an unintended pregnancy, being harmed by abuse or rape, being outed by someone else, or being victimized in any way can cause a teen to feel desperately upset. In situations such as these, teens may fear humiliation, rejection, social isolation, or some terrible consequence they think they can't handle. If a terrible situation feels too overwhelming, a teen may feel that there is no way out of the bad feeling or the consequences of the situation. Suicide attempts can occur under conditions like this because, in desperation, some teens - at least for the moment - see no other way out and they impulsively act against themselves.

Sometimes teens who feel or act suicidal mean to die and sometimes they don't. Sometimes a suicide attempt is a way to express the deep emotional pain they're feeling in hopes that someone will get the message they are trying to communicate.

Even though a teen who makes a suicide attempt may not actually want or intend to die, it is impossible to know whether an overdose or other harmful action they may take will actually result in death or cause a serious and lasting illness that was never intended. Using a suicide attempt to get someone's attention or love or to punish someone for hurt they've caused is never a good idea. People usually don't really get the message, and it often backfires on the teen. It's better to learn other ways to get what you need and deserve from people. There are always people who will value, respect, and love you - sure, sometimes it takes time to find them - but it is important to value, respect, and love yourself, too.

Unfortunately, teens who attempt suicide as an answer to problems tend to try it more than once. Though some depressed teens may first attempt suicide around age 13 or 14, suicide attempts are highest during middle adolescence. Then by about age 17 or 18, the rate of teen suicide attempts lowers dramatically. This may be because, with maturity, teens have learned to tolerate sad or upset moods, have learned how to get support they need and deserve, and have developed better coping skills to deal with disappointment or other difficulties.

next: Depressed Veterans and Suicide
~ depression library articles
~ all articles on depression

Detailed information on mood stabilizers and atypical antipsychotics for treatment of bipolar disorder in children and adolescents.

Children and adolescents with bipolar disorder are treated with medications, although none of these medications, with the sole exception of lithium (in patients as young as 12 years old), have received Food and Drug Administration (FDA) approval for this application. Despite the paucity of data, pediatric treatment guidelines have evolved based on empirically derived plans. The Child Psychiatric Workgroup on Bipolar Disorder established guidelines based on the most up-to-date evidence (Kowatch, 2005). In general, these guidelines involve algorithm-based use of mood stabilizers and atypical antipsychotic agents alone or in various combinations.

Use of mood-stabilizing agents in children and adolescents has some unique considerations. Specifically, adolescents and children generally metabolize more rapidly than adults because of more efficient hepatic functions. Also, adolescents and children have faster renal clearance rates than adults. For example, lithium carbonate has an elimination half-life of 30-36 hours in an elderly patient, 24 hours in an adult, 18 hours in an adolescent, and less than 18 hours in children. Steady states also are achieved earlier in children than in adolescents and earlier in adolescents than in adults. Thus, plasma levels may be drawn and assessed earlier in children and adolescents than in adults.

Some consequences of the efficient metabolizing and clearance systems of young individuals are as follows: (1) peak drug levels may show higher plasma concentrations than anticipated in adults, and (2) trough levels may show lower plasma concentrations than anticipated in adults. Thus, children may require higher doses of medications to attain therapeutic response (measured in mg/kg/d) than adults. Special precautions must be taken when dosing psychiatric medications in the treatment of adolescents and children to achieve therapeutic effect while staying safely below toxic levels.

Although the mood stabilizers have not been established as primary treatment of bipolar disorders in adolescents or children by controlled studies, they are used clinically in this context. Mood stabilizers include lithium carbonate, valproic acid or sodium divalproex, and carbamazepine. These medications still are considered first-line agents in managing bipolar disorders in pediatric patients because case reports and limited studies have suggested that efficacy and safety are sufficiently present to benefit the patient with symptom relief and control.

Lithium carbonate is effective in approximately 60-70% of adolescents and children with bipolar disorder and remains the first line of therapy in many settings. Approximately 15% of children receiving lithium medication have enuresis, primarily nocturnal enuresis. In those who do not respond to lithium, sodium divalproex is generally the next agent of choice. As with adult patients with bipolar disorder, carbamazepine often is considered a third choice, after sodium divalproex and lithium carbonate have been tried at optimal doses for a sufficient length of time. This medication often is tried after an acute or crisis state has been stabilized and adverse effects of either sodium divalproex or lithium carbonate are intolerable.

Lamotrigine has been approved for bipolar maintenance therapy in adults, but data in pediatric patients are lacking. Other antiepileptic medications (eg, gabapentin, oxcarbazepine, topiramate) have had mixed results in adults with bipolar disorder in case reports and studies. However, limited data are available regarding the potential usefulness of these medications in pediatric patients with bipolar disorder, though a benefit may theoretically be possible.

Emerging evidence indicates that atypical antipsychotic agents may be used in pediatric patients with bipolar disorder who presents with or without psychosis. Given the antimanic properties demonstrated in adult and limited adolescent studies, olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) may be considered first-line alternatives to lithium, valproate, or carbamazepine. Pediatric studies with ziprasidone (Geodon) and aripiprazole (Abilify) are limited at this point; this limitation indicates that these agents should be considered second-line alternatives if first-line mood stabilizers or atypical antipsychotic agents are ineffective or if they result in intolerable adverse effects. Clozapine (Clozaril) may be considered only in treatment-refractory cases given its need for frequent hematologic monitoring due to the risk for agranulocytosis.

An important consideration with atypical antipsychotics is the potential for weight gain and metabolic syndrome. The patient's weight should be measured, and a fasting lipid profile and serum glucose level should be evaluated before these agents are started, and these values should be monitored periodically during treatment. Patients and families should be advised of the need to appropriately manage diet and exercise. Limited data indicate that ziprasidone and aripiprazole may have a low potential for these adverse effects and that they may be considered in patients at high risk because of a family or personal history of metabolic abnormalities. Atypical antipsychotics also pose a potential risk for extrapyramidal symptoms and tardive dyskinesia.

Common adverse effects and special concerns for mood stabilizers are listed in Table 1.

Table 1. Mood Stabilizers: Common Adverse Effects and Special Concerns

Mood Stabilizer	Common Adverse Effects	Doses	Special Concerns
Lithium Carbonate (Eskalith CR, Lighobid)	Gastrointestinal distress, lethargy or sedation, tremor, enuresis, weight gain, alopecia, cognitive blunting	10-30 mg/kg/d Dose must be adjusted by monitoring serum level and patient response Titrate up on bid schedule	Hypothyroidism, diabetes insipidus, toxic in dehydration, polyuria, polydipsia, renal disease
Sodium divalproex/valproic acid (Depakote, Depakene)	Sedation, platelet dysfunction, liver disease, alopecia, weight gain	15-60 mg/kg/d Dose must be adjusted by monitoring serum levels Titrate up on bid/tid schedule	Elevated liver enzymes or liver disease, drug-drug interactions, bone marrow suppression
Carbamazepine (Tegretol)	Suppressed WBC, dizziness, drowsiness, rashes, liver toxicity (rarely)	10-20 mg/kg/d Dose must be adjusted by monitoring serum blood levels Titrate up on bid schedule	Drug-drug interactions, bone marrow suppression
Risperidone (Risperdal)	Weight gain, sedation, orthostasis	0.25 mg bid or 0.5 mg at bedtime initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d	Galactorrhea, extrapyramidal symptoms
Quetiapine (Seroquel)	Sedation, orthostasis, weight gain	50 mg bid initially; titrate as tolerated to target dosage of 400-600 mg/d	Decrease dosage with hepatic impairment, may cause neuroleptic malignant syndrome (NMS) or hyperglycemia
Olanzapine (Zyprexa)	Weight gain, dyslipidemia, sedation, or orthostasis	2.5-5 mg at bedtime initially; titrate as tolerated to target dosage of 10-20 mg/d	Metabolic syndrome, extrapyramidal symptoms

While mood stabilizers are first-line agents for patients with bipolar disorder, adjunctive medications often are used to control psychosis, agitation, or irritability and to improve sleep. Commonly, antipsychotics and benzodiazepines are used to reduce these symptoms.

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Benzodiazepines and Antidepressants for Treating Bipolar Symptoms

Benzodiazepines, such as clonazepam and lorazepam, generally are avoided, but they may be temporarily useful in restoring sleep or in modulating irritability or agitation not caused by psychosis. Because of the slow-on and slow-off action of clonazepam (Klonopin), the risk of abuse is lower with this drug than with fast-acting benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax). In the outpatient setting, clonazepam may be preferred because of the efficacy and the lowered risks of abuse by the patient or others. Clonazepam can be dosed in the range of 0.01-0.04 mg/kg/d, and it is often administered once per day at bedtime or twice per day. Lorazepam is dosed to 0.04-0.09 mg/kg/d and administered 3 times per day because of its short half-life.

When a patient with bipolar disorder is having a depressive episode, the use of an antidepressant may be considered after a mood stabilizer or atypical antipsychotic agent has been started and after a therapeutic response or level is achieved. Caution must be exercised in starting an antidepressant in a person with bipolar disorder because it may precipitate mania. An antidepressant with a potentially lowered risk of inducing mania is bupropion (Wellbutrin).

Selective serotonin reuptake inhibitors (SSRIs) may also be used. However, because of the risk of mania, doses should be low and titration should be slow. The only SSRI currently FDA approved for the management of unipolar depression in adolescents is fluoxetine (Prozac). However, this agent should be used carefully in patients with bipolar disorder because of its long half-life and because of its potential to exacerbate manic symptoms when not coadministered with an antimanic or mood-stabilizing agent.

All medications used in pediatric bipolar disorder pose a risk of adverse effects or interactions with other medications. These risks should be clearly discussed with patients and families and weighed against the potential benefits. Medication should be started only after informed consent is obtained.

Drug Category: Mood stabilizers -- Indicated for control of manic episodes occurring in bipolar disorder. Mood stabilizers include lithium carbonate, valproic acid or sodium divalproex, and carbamazepine. These medications are considered first-line agents in managing bipolar disorder in pediatric patients.

Drug Name	Lithium (Lithotabs, Lithobid, Lithane, Eskalith) -- Used to manage and prevent acute manic episodes. Influences reuptake of serotonin and/or norepinephrine at cell membrane.
Adult Dose	300-600 PO tid/qid in divided doses Maintenance: 2.4 g/d or 450-900 mg bid of SR dosage form
Pediatric Dose	10-30 mg/kg/d PO divided bid/tid; titrate upward gradually from lower range while monitoring serum levels and patient response
Contraindications	Documented hypersensitivity; severe cardiovascular or renal disease
Interactions	Thiazide diuretics, haloperidol, phenothiazines, neuromuscular blockers, carbamazepine, fluoxetine, and ACE inhibitors may decrease elimination and increase toxicity
Pregnancy	D - Unsafe in pregnancy
Precautions	Toxicity is closely related to serum levels and can occur at therapeutic doses; caution in hypothyroidism, cardiovascular or renal compromise, and diabetes insipidus; decreased intake of sodium may cause increased lithium levels

 

Drug Name	Valproic acid (Depakote, Depakene, Depacon) -- Although mechanism of action is not established, activity may be related to increased brain levels of GABA or enhanced GABA action. Valproate also may potentiate postsynaptic GABA responses, affect potassium channel, or have a direct membrane-stabilizing effect. Has proven effectiveness in treating and preventing mania. Classified as a mood stabilizer and can be used alone or in combination with lithium. Useful in treating patients with rapid-cycling bipolar disorders and has been used to treat aggressive or behavioral disorders. A combination of valproic acid and valproate (ie, divalproex [Depakote]) has been effective in treating persons in manic phase, with a success rate of 49%.
Adult Dose	10-20 mg/kg/d PO divided bid; may gradually titrate upward by 5-10 mg/kg/d at weekly intervals; not to exceed 30-60 mg/kg/d
Pediatric Dose	Administer as in adults
Contraindications	Documented hypersensitivity; hepatic disease or dysfunction
Interactions	Coadministration with cimetidine, salicylates, felbamate, and erythromycin may increase toxicity; rifampin may significantly reduce valproate levels; in pediatric patients, protein binding and metabolism of valproate decrease when taken concomitantly with salicylates; coadministration with carbamazepine may result in variable changes of carbamazepine concentrations; may increase diazepam and ethosuximide toxicity (monitor closely); may increase phenobarbital and phenytoin levels while either one may decrease valproate levels; may displace warfarin from protein-binding sites (monitor coagulation tests); may increase zidovudine levels in patients with HIV
Pregnancy	D - Unsafe in pregnancy
Precautions	Thrombocytopenia and abnormal coagulation parameters have occurred; risk of thrombocytopenia increases significantly at total trough valproate plasma concentrations >110 mcg/mL in females and >135 mcg/mL in males; before initiating therapy, at periodic intervals, and prior to surgery, determine platelet counts and bleeding time; reduce dose or discontinue therapy if hemorrhage, bruising, or a hemostasis or coagulation disorder occurs; hyperammonemia may occur, resulting in hepatotoxicity; monitor patients closely for appearance of malaise, weakness, facial edema, anorexia, jaundice, and vomiting; may cause drowsiness

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Drug Name	Carbamazepine (Tegretol) -- Effective in patients who have not responded to lithium therapy. Also can act to inhibit seizures induced through the kindling effect, which is thought to occur by way of repeated limbic stimulation. Has been effective in treating patients who have rapid-cycling bipolar disorder or those who have not been responsive to lithium therapy.
Adult Dose	200 mg PO bid (100 mg PO qid if susp) May increase at weekly intervals by no more than 200 mg/d tid/qid (bid with ER) until best response obtained; not to exceed 1600 mg/d
Pediatric Dose	10-20 mg/kg/d PO divided bid (qid with susp)
Contraindications	Documented hypersensitivity; history of bone marrow depression; administration of MAOIs within last 14 d
Interactions	Serum levels may increase significantly within 30 d of danazol coadministration (avoid whenever possible); do not administer concurrently with MAOIs; cimetidine may increase toxicity, especially if taken in first 4 wk of therapy; carbamazepine may decrease primidone and phenobarbital levels (their coadministration may increase carbamazepine levels)
Pregnancy	D - Unsafe in pregnancy
Precautions	Caution with increased intraocular pressure; obtain CBCs and serum-iron baseline prior to treatment, during first 2 mo, and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness

 

Drug Name	Risperidone (Risperdal) -- Binds dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor. Indicated for short-term (3-wk) treatment of acute mania associated with bipolar disorder. May use alone or combined with lithium or valproate.
Adult Dose	2-3 mg PO qd up to 3 wk; may increase by 1 mg/d at 24-h intervals, not to exceed 6 mg/d
Pediatric Dose	Data limited; 0.25 mg PO bid or 0.5 mg qhs initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d
Contraindications	Documented hypersensitivity
Interactions	Coadministration with carbamazepine may decrease effects; may inhibit effects of levodopa; clozapine may increase levels; PO solution not compatible with cola or tea
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	May cause extrapyramidal reactions, hypotension, tachycardia, and arrhythmias; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; do not split or chew PO disintegrating tablets

 

Drug Name	Quetiapine (Seroquel) -- May act by antagonizing dopamine and serotonin effects. Newer antipsychotic used for long-term management. Improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia.
Adult Dose	Initial: 25 mg PO bid/tid; increase by 25-50 mg bid/tid on day 2 or 3 to achieve range 300-400 mg divided bid/tid by day 4; adjust as needed at intervals of >2 d with adjustments of 25-50 mg bid Maintenance: 150-750 mg/d PO; not to exceed 800 mg/d
Pediatric Dose	Data limited; 50 mg PO bid initially; titrate as tolerated to target dosage of 400-600 mg/d
Contraindications	Documented hypersensitivity
Interactions	May antagonize levodopa and dopamine agonists; phenytoin, thioridazine, and other liver enzyme inducers may reduce levels; cytochrome P450 (CYP) 3A inhibitors (eg, ketoconazole, fluconazole, erythromycin) increase serum concentration
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	May induce orthostatic hypotension associated with dizziness, tachycardia, and syncope; has been associated with NMS and tardive dyskinesia; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; caution in hepatic impairment (decrease dose)

 

Drug Name	Olanzapine (Zyprexa) -- Mechanism of action for acute manic episodes associated with bipolar I disorder unknown. Available as tab, PO disintegrating tab (Zyprexa, Zydis), and IM dosage forms.
Adult Dose	10-15 mg PO qd; adjust by 5 mg/d at intervals >24 h; not to exceed 20 mg/d Agitation associated with bipolar mania: 10 mg IM once; may repeat after 2 h; not to exceed 30 mg/24 h Geriatric or debilitated individuals: 2.5-5 mg IM/dose
Pediatric Dose	Data limited; 2.5-5 mg PO qhs initially; titrate as tolerated to target dosage of 10-20 mg/d
Contraindications	Documented hypersensitivity
Interactions	Fluvoxamine may increase effects; antihypertensives may increase risk of hypotension and orthostatic hypotension; levodopa, pergolide, bromocriptine, charcoal, carbamazepine, omeprazole, rifampin, and cigarette smoking may decrease effects
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Caution in narrow-angle glaucoma, cardiovascular disease, cerebrovascular disease, prostatic hypertrophy, seizure disorders, hypovolemia, and dehydration; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; administration of >1 IM injection associated with substantial orthostatic hypotension (33%), maintain patient in recumbent position and monitor blood pressure before repeating IM doses

Sources:

• Kowatch RA, Bucci JP. Mood stabilizers and anticonvulsants. Pediatr Clin North Am. Oct 1998;45(5):1173-86, ix-x.
• Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Mar 2005;44(3):213-35.
• Medication information listed in tables is from package inserts for each medication.

next: Childhood Bipolar and Special Education Needs
~ bipolar disorder library
~ all bipolar disorder articles

"Many men feel shy or awkward about seeking outside help, and therefore do not get the professional treatment they need when they suffer of eating disorders. But there are numerous medical and emotional side effects of eating disorders, and only experienced professionals have the tools to help. If you have an eating disorder, unless you are the kind of guy who builds his own house, performs dental procedures on himself, and is his own lawyer, you need to get professional guidance!" It is important to understand that even if the individual does not meet all the diagnostic criteria they may indeed still be in severe pain and should seek treatment before things become worse as they often do.

Statistically speaking, those who seek early treatment for their eating disorder will progress through recovery more quickly than those who waited years before seeking help. When the behaviors and critical thinking have been ingrained over a significant period of time, it will take longer for the individual to disengage from their disorder. In these cases, longer orTreatment Options for Eating Disorders Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimi more intensive treatment is needed.

"For most men and women who suffer, their eating disorder represents an impaired sense of self. Without effective treatment, they are unable to establish a healthy inner dialogue. What makes eating disorders difficult to overcome without professional help is the insidious way they progressively damage an already-impaired self. They ultimately become the person's identity, rather than merely an illness the person experiences. In addition, habit patterns, altered physiology, and probably neurochemical changes further lock in the disorder."

Therapy

Therapy for eating disorders provides safe and validating connections with people who know how to care for that hurt self and who understand the complexity of the illness. For men, the therapist needs to understand not only what it is like to be a person with an eating disorder, but also what it is like to be a man with an eating disorder. Although it seems obvious, the therapist needs to have genuine respect for the patient and appreciate the degree of shame that he might have simply from being a man who has what has traditionally been viewed as a "woman's problem."

Medical Management

Medical management by a physician is highly recommended. It is important to go to someone who can be understanding and compassionate allowing the man to be able to feel free enough to be honest about the eating disorder. A complete physical is recommended including appropriate blood work studies.

Nutritional Counseling

The dietitian has an important role in the man's recovery process from an eating disorder. To treat the anoretic, the dietitian has to loosen the hold on restrictive eating in a very reassuring manner. Sensitivity to the man's fears of becoming "fat" are imperative. For the bulimic or binge-eater, the dietitian must help the man normalize food consumption. It is important to keep in mind that no single meal plan works for everyone, so the dietitian must establish one that is individualized for the particular individual. Often the dietitian helps enable the person to incorporate new challenges to assist him in overcoming fears of portions, increased variety and specific foods. The focus mRole Relationships ust be removed from calories and fat grams substituting a healthy more balanced approach to meals.

Treatment for Men

Although the vast majority of issues related to eating disorders are common to men and women, there are issues unique to men, such as the shame they feel for suffering with what was formally known as a "woman's" illness, hormone changes, gender roles, and male body image. Ideally treatment for men should include segregated programs allowing them to work on gender-specific issues. They can express their masculine emotions with others who can relate. Additionally they can be monitored for hormonal needs and focus on male body image.

There are a variety of treatment options available but not all are segregated:

• Outpatient treatment suffices for most people entering treatment and in less severe cases
• Day hospital programs offer a flexible, though structured, treatment setting during the daytime.
• Inpatient hospital programs are geared to stabilize medically-compromised patients.
• Residential treatment at treatment centers for eating disorders is specifically designed for patients with severe cases, or who have been unsuccessful with the other levels of treatment. (At this time only Rogers Memorial Hospital, in Oconomowoc, Wisconsin offers a residential program specifically designed for men)
• There are relatively few programs available specifically for men. Some partial programs exist.
• St. Anthony's Medical Center in St. Louis provides specialized out-patient groups for men's eating disorders.
• It is important to understand what you may face with respect to insurance companies

How Can Loved Ones Help

"Regardless of the nature of your relationship, or his problems, you are vital to his healing process, and will ultimately benefit from his feeling better about himself. Keep in mind how difficult it must be living with the "stigma" of having a "woman's disease". Men have been suffering in the silence of a "macho" culture of denial, shame, and secrecy."

Men are typically silent about what bothers them, or they may not even be able to articulate their feelings or thoughts. However, when obsessions are serious, they are signs of deep emotional pain--people who focus on their looks often do so to avoid or compensate for internal issues.

"Given the complexity of men's problems, it stands to reason that the recovery process takes time and effort. Once he gets past denial, you can help him sort out his situation and make a plan. Let him do the talking. Ask questions, be a good listener, interject observations once in a while, but mainly listen."

next: Eating Disorders in Men and Boys
~ eating disorders library
~ all articles on eating disorders

Even with ADHD, a person can get a driver's license in the UK. Getting car insurance when you have ADHD may be another question altogether.

People with ADHD can get accommodations for the theory part (written part) of a driving test. You can ask for extra time or for someone to read the questions.

However you must contact the local Driving Theory Test Centre well in advance for details on how to apply.

ADD-ADHD and Driving

People with ADD/ADHD are not precluded from driving solely because of their diagnosis. It may take someone with ADHD a lot longer to learn all the implications of driving, but it should not affect how long it takes to learn the rules and facts in The Highway Code, nor the correct physical handling of the controls of a vehicle. What may be a problem is the ability to judge what other road users, pedestrians, animals, etc. might do and how this should affect their own driving; understanding that not all drivers and other road users obey all of the rules all of the time; that it is not their place to judge and sentence other, less able, road users (road rage'). Learning to ride a bike as a child and passing the Cycling Proficiency Test would be a very good foundation for anyone with AS as this will help them become more aware of the possible actions of other drivers and pedestrians.

First Things First

Will a provisional licence be granted?

Before any application for a provisional licence is made, it would be advisable to discuss the plan to learn to drive with a GP. The doctor will have access to the DVLA guidelines for people with disabilities wishing to learn to drive. If in any doubt, contact: The Medical Adviser, D M U, Longview Road, SWANSEA, SA99 1 TU, who would also be able to offer guidance.

If a parent is contacting the Medical Adviser on behalf of their son or daughter, his advice will be useful when reporting back to them. This is a delicate area: If the Medical Advisor has indicated a provisional licence may not be granted. The disappointment / resentment will need careful handling.

Should Driving Be An Option?

The UK Forum of Mobility Centres has 11 places around the country where people with disabilities, including ADHD, are taught to drive. A list of the centres can be obtained from the Disabled Drivers' Association on 01508 489449. The Centres also offer a preliminary off-road assessment after which they will give their opinion as to the candidate's likelihood of learning to drive successfully and over what length of time. Such an assessment would be a good option to consider before sending off for a provisional licence, and before signing up for what might be a long and probably expensive period of learning to drive. Even if the DVLA feel that a provisional licence is likely to he granted, it does not follow that learning to drive is going to be an easy or enjoyable activity. So a "trial run" might he a very good first step. It would also help the prospective driver discover if he is going to be happy and comfortable, not only being a driver in charge of a vehicle, but also spending time learning from a driving instructor. The driving test is an assessment of a candidate's ability to control a motor vehicle during a very short drive, and his knowledge of the Highway Code. It is not an accurate gauge as to how good a driver that person will be under exceptional or emergency situations.

Applying for a Provisional Driver's License

When applying for a Provisional Licence, the applicant must declare his ADHD in the relevant section of the form. If he wants to supply current medical reports to support his application, this would be helpful: otherwise the reports will be requested from his doctor.

Once a provisional licence has been granted, there will be no indication on it that the holder has ADHD.

In order to get a full licence, the learner driver must pass both sections of the driving test, meeting the standards set by the national driving test centres. If he is told that he has passed, and he is therefore able to apply for a full licence, then it must be supposed that he has fully met the necessary test standards. If a full licence is granted, there will be no indication on it that the driver has ADHD.

Getting Insurance When You Have ADHD

When applying for motor insurance, the application form will ask if the applicant has any disability, and if the DVLA is aware of it. Again, it is essential to declare all relevant information, as failure to do so is likely to make the insurance invalid.

Some insurance companies will not quote for people who have disabilities such as ADHD. Some will load the premiums they require for any disability. All companies load their premiums for 'young drivers' (those under 25), whom they consider to have little or no road-use experience.

Many young people with ADHD under 25, therefore, who have a 'disability', may discover to their dismay that once having successfully learnt to drive, passed their driving test and received their full driving licence, affordable insurance is extremely difficult, if not impossible, to find.

READING Knowledge is power: for a good understanding of your own strong and weak points read up as much as you can about any condition you may have.

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Helping young people battle an eating disorder is one of the toughest challenges ChildLine's counsellors face, according to a study of calls to the charity about the issue. Now a new report, I'm in Control - Calls to ChildLine about eating disorders, offers fresh insights into these life-threatening problems - revealing that friends are often the first to be told about a young person's eating disorder, and that family members have a vital part to play if a young sufferer is to recover from an eatin disorder. The report (based on analysis of calls to ChildLine between April 2001 and March 2002) also found that an eating disorder is almost always part of an 'intertwined knot of problems' - including family breakdown, bullying, bereavement, and in some cases child abuse - which must be unravelled one by one before the process of recovery can begin. (For extensive information on child abuse, visit HealthyPlace Abuse Community.)

Each year ChildLine helps around 1,000 children and young people suffering from eating disorders and last year almost 300 additional children spoke to the charity to seek advice about how to help a friend with an eating disorder. The report, sponsored by Next and written by award-winning journalist Brigid McConville, examines the gruelling and compelling testimony of young sufferers and demonstrates that there is rarely a single cause for an eating disorder.

ChildLine's Chief Executive, Carole Easton, says: 'This report makes a significant contribution to the debate on this difficult subject because it gives a voice to the young people whose lives are being destroyed by these debilitating conditions. We hope that it will form a springboard to greater understanding and offer fresh hope for young sufferers, as well as their friends and families. The pictures painted by this report are of intelligent, successful, high-achieving and determined young people who may seem unlikely to be vulnerable to destructive behaviours like anorexia and bulimia.

However, a closer look often reveals a "knot of problems" out of which an eating disorder develops. Eating disorders may develop from a need for young people to feel a sense of control, to communicate feelings, and to block out painful emotions. All too often young people get a sense of self-worth from controlling their intake of food and this is what makes it so challenging for others to help break the iron grip of an eating disorder.

'Children and young people in their thousands turn to ChildLine's experienced counsellors every day of the year to talk about every problem imaginable - including those as harrowing as abuse, and attempted suicide. Yet our counsellors say that, of all the problems they help young people with, eating disorders are among the most challenging. This report shows that ChildLine's counsellors can help to cut through the confusion of denial and distortion facing loved ones when they try to help. When children call ChildLine and talk to a counsellor about an eating disorder they have already taken the first step along the difficult road to recovery - - acknowledging that there is a problem. ChildLine is empowering for young people as they are in charge of the process and can call or write when they choose. The relationship can take on a special resonance as their counsellor can't see them and therefore can't "judge" them on their appearance.'

The report reveals that:

• Friends are enormously influential and have an important part to play in coping with an eating disorder. A significantly higher number of callers said they had told a friend (31%) rather than their mother (16%) or their GP (9%) about their illness. Friends are crucial in supporting each other, and are often extremely distressed by what their friend is going through - many call ChildLine to speak to a counsellor about the effect of an eating disorder on a friend.
• For family and friends, helping a young person with an eating disorder can be incredibly difficult - - yet young sufferers tell ChildLine that the support of people around them is indispensable. More than any other issue, family tensions are mentioned in conversations with young people about eating problems. A quarter of those who call ChildLine to talk primarily about an eating disorder also discuss family difficulties, including conflict between parents, resentment about siblings and an atmosphere of unhappiness and tension at home. However, in many cases it is unclear whether these difficulties were a precursor to the eating disorders or had arisen as a result. The report also shows that parents are extremely supportive and a crucial source of help to their children.
• Adolescence and the accompanying emergence of an adult sexual identity is often the time when a young person is most vulnerable to the onset of an eating disorder. Of callers who mentioned their age, three-quarters (74%) in ChildLine's sample were between the ages of 13 and 16. It is clear from the calls that children as young as 11 have a vocabulary that includes the words anorexia and bulimia. Children in the younger age group frequently talk about the physical symptoms of their eating disorder, while older callers are often the veterans of hospitals and clinics and have a deeper understanding of what they're going through.
• Young people tell ChildLine about a wide range of factors that they believe triggered their problem. These usually include a situation or event that threatens their self-identity or security or lowers their self-esteem. The circumstances most often mentioned by callers include family problems, bullying, school pressures, loss of a friend or family member, illness and abuse.
• Calls to ChildLine demonstrate a range of reasons for the progression of an eating disorder, once it has been triggered off. Among these is an increasingly distorted perception of body image and a sense that they are helpless to stem the progress of the eating disorder as it is 'out of control'. Pervasive social and media pressures to be thin influence the determination of many to control their body shape, as does the continued sensation that feeling thin equates with feeling good.
• A small minority of calls in the sample were from boys - only 50 of the 1,067 total. The experiences boys have in developing eating disorders appear similar to those of girls but there are significant differences in the way boys and girls talk about their eating problems and some of the triggers setting them off. These appear to be centred on the roles and behaviours considered acceptable to boys in society. The report discloses that boys are twice as likely to say that bullying is part of their problem and are far more likely to confide in their doctor or their mother about an eating problem - - perhaps due to fear of being bullied by their peers. Calls to ChildLine also portray boys as feeling an additional sense of shame about having what is seen as a 'girl's problem'.
• Boys talk about their eating disorders in a more factual, straightforward way, unlike girls who tend to start by saying they're worried about their weight, and then to gradually unravel their 'bundle of problems'. Boys focus on the health or medical reasons for being thin, rather than the aesthetic explanations girls give. Girls often tell ChildLine that they feel judged, and judge themselves, on how they look and they generally express more self-hatred than boys, which is mirrored in the way they speak about their bodies. In contrast to boys, the report's author found that some girls also appear to be in a kind of 'anorexic club' where they all diet and starve themselves to be thin.

Carole Easton says: 'Eating disorders are a minefield for everyone affected by them. One of the saddest revelations in ChildLine's report is the sense among some sufferers that their eating disorder is a coping mechanism that stops them from ""doing something worse" - and ""as an alternative to suicide, is a familiar friend that keeps them alive" The cycle of denial and deceit, and frequently withdrawn and angry behaviour of a young person with an eating disorder, can almost seem designed to drive away those who care about them, leaving parents and friends utterly bewildered and at a loss as to how to move forward.

'But our report also brings home the fact that friends and family must not give up - - their love and support is essential in building up a young person's self esteem and bringing them back to health. Although there is no single solution to the tortuous situation an eating disorder can provoke, families and friends are the best allies a young person has, and the most effective remedy is when everyone - - friends, family, school, professionals, and ChildLine counsellors - works together to ensure there is always someone to turn to.'

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Case Studies:

All identifying details have been changed

Becky, 14, called ChildLine because she wanted to know more about the symptoms of anorexia and bulimia. 'I've lost a lot of weight recently', she said. 'I only eat one meal a day and often I throw it up.' Becky told her counsellor that she enjoyed swimming at school but often felt faint when she did it. 'I've no energy so I've stopped doing exercise', she said. 'I haven't told my mum - we argue a lot.' Becky said she often felt fat - even though really she knew she wasn't.

Rhiannon, 13, was very upset when she called ChildLine. 'I got a swimsuit for my birthday but when I tried it on I realised I'm too fat to wear it', she said. 'I know I'm fat because my friends at school tease me about it.' Rhiannon paused and then she said, 'I've started making myself sick. It's been a few months now.' She said she had done this in the past and had lost weight - but she had ended up in hospital. 'I liked being thin - but I didn't have any energy so I couldn't play out with my friends.' Rhiannon said that her mum always tried to make sure she ate regularly.

When Ian, 13, called ChildLine he said he had recently started a special diet to help him lose weight. Ian told ChildLine that he had been 'really overweight' so his GP had given him a course of medicine to suppress his appetite. 'They worked and I lost weight which made me happy', he said. Now that he had finished the course Ian told the counsellor that he felt 'very alone' without the back-up of the drugs. 'Now I'm scared that if I start eating again I'll put the weight back on.' Since stopping taking the tablets he had only been 'snacking now and then'.

'My boyfriend is really annoying me', said 16-year-old Emma when she called ChildLine. 'He keeps asking me what I've had to eat - I always read the information on food to check I am eating well'. Emma told ChildLine that she was feeling pressured about her eating habits by several people in her life. 'My friends at school like pointing out who in the group has put weight on and where on their body. And sometimes my dad says to me watch what you eat or you'll end up as big as your auntie.'

When Natalie, 15, called ChildLine she said, 'I want to talk about food. I can't stand the thought of it inside me - so I throw it up.' Natalie said she was very unhappy about her weight but couldn't talk to her family. 'I'm being picked on at school 'cause I'm fat. If my folks find out I may as well just run away - I think they're embarrassed to know me anyhow'. She said that she had always had a problem with her weight. 'I'm so big it's unreal', Natalie said. 'I feel like food is destroying me - making me feel bigger - but then I feel so hungry'.

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Professional Guidelines Recommend The Use of Proven Psychological Methods Along With or Without Medication In The Treatment of Attention Deficit Disorder:

The prescribing information provided by CIBA ( the manufacturers of Ritalin) states "Ritalin is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to severe distractibility, short attention span, hyperactivity, emotional ability, and impulsivity."

The same literature also states, "Drug treatment is not indicated for all children with this syndrome..... Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment...."(1)-Physicians' Desk Reference 1998

Dr. William Barbaresi notes that "Comprehensive treatment, including both medication and nonmedical intervention, should be coordinated by the primary-care provider."(2)-Mayo Clinical Proceedings 1996

Similarly Dr. Michael Taylor concludes, "The most successful management of children with attention deficit disorder involves a coordinated team approach, with parents, school officials, mental health specialists and the physician using a combination of behavior management techniques at home and at school, educational placement and medication therapy."(3)-American Family Physician 1997

Research and Clinical Practice Has Shown Well Constructed Behavior Modification Programs To Be Very Useful In The Management of ADD/ADHD:

Behavior modification programs emphasizing positive reinforcement of appropriate behavior have been useful in reducing maladaptive behavior at home and at school. Research has shown that behavior modification can improve impulse control and adaptive behavior in children of various ages (4)-Perceptual Motor Skills 1995, and (5)-Abnormal Child Psychology 1992.

The use of positive reinforcement related to daily reports from school has been found to be useful in improving task completion and reducing disruptive behavior in the classroom (6)-Behavior Modification 1995.

Some parents have been found to prefer behavioral to medical treatment (7)-Strategic Interventions for Hyperactive Children 1985.

Families are often able to succeed with their behavior modification efforts through the use of written materials only (8)-Journal of Pediatric Health Care 1993.

Teaching children with attention deficit disorder how to relax can be effective in reducing hyperactivity and disruptive behavior while increasing attention span and task completion:

Relaxation training conducted by parents in the home has been found not only to be effective in improving behavior and other symptoms but also improves over all relaxation when measured by biofeedback equipment (9, 10)-Journal of Behavior Therapy & Experimental Psychiatry1985 & 1989.

A review of a number of studies related to relaxation training with children concluded, "Findings suggest that relaxation training is at least as effective as other treatment approaches for a variety of learning, behavioral, and physiological disorders . . ."
(11)-Journal of Abnormal Child Psychology 1985.

Cognitive Behavioral Therapy Can Help ADD Children Improve Problem Solving and Coping Skills:

Cognitive Behavioral Therapy (CBT) consists of teaching children to change their thought patterns from ones that lead to maladaptive behavior to ones that produce adaptive behavior and positive feelings. This technique can be used to help children to improve their self-esteem. It can also be used to help them improve coping skills, problem solving skills and social skills.

In one study CBT was found to be helpful in helping hyperactive boys develop anger control. The findings indicated that "Methylphenidate (Ritalin) reduced the intensity of the hyperactive boys' behavior but did not significantly increase either global or specific measures of self-control. Cognitive-behavioral treatment, when compared to control training, was more successful in enhancing both general self-control and the use of specific coping strategies." (12) Journal of Abnormal Child Psychology 1984. (It should be noted that CBT has not proven to be successful in all studies. The problem may be related to the fact that each study uses different strategies and measures of success).

Cognitive Rehabilitation Exercises (Brain Training) Can Improve Attention & Concentration Well As Other Intellectual and Self-Control Functions:

Victims of strokes or head injury may have significant impairments in attention and concentration. Cognitive Rehabilitation exercises are often used to help these people to improve their ability to concentrate and pay attention. This approach has been applied to children with attention deficit disorder with some success. The repeated use of simple (attentional training) exercises can help children to train their brains to concentrate and pay attention for longer periods of time. (13)-Behavior Modification 1996

Focus is a multi-media psychoeducational program that combines all of the above methods in a package that can be easily and effectively implemented at home by parents:

The training manual provides a behavior modification program using the daily report card to improve performance at school.

A token economy program is provided to improve behavior at home and foster a positive parent/child relationship.

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The manual also provides a series of Cognitive Rehabilitation exercises that are fun and easy to implement to improve attention and concentration while also helping to reduce hyperactivity and improve impulse control.

The manual along with audio tapes help not only teach how to improve their ability to relax but also how to apply this skill to home, school, social and sport activities.

A temperature biofeedback card is supplied as an additional aide for relaxation training.

Audio tapes provide Cognitive Behavioral Therapy to help improve motivation, self-control and self-esteem.

The program is organized in a way to provide materials appropriate for two different age levels (6-11 and 10-14).

The program also provides additional parent education material related to attention deficit disorder as well as a set of forms for recording progress.

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References

(1) Physicians' Desk Reference. 52nd ed. Montavle (NJ): Medical Economics Data Production Company, 1998

(2) Barbaresi, W Primary-care Approach to the Diagnosis and Management of Attention-Deficit Hyperactivity Disorder. Mayo Clin Proc 1996: 71; 463-471

(3) Taylor, M Evaluation and Management of Attention-Deficit Hyperactivity Disorder. American Family Physician 1997: 55 (3); 887-894

(4) Cociarella A, Wood R, Low KG Brief Behavioral Treatment for Attention-Deficit Hyperactivity Disorder. Percept Mot Skills 1995: 81 (1); 225-226

(5) Carlson CL, Pelham WE Jr, Milich R, Dixon J Single and Combined Effects of Methylphenidate and Behavior Therapy on the Classroom Performance of Children with Attention-Deficit Hyperactivity Disorder. J Abnorm Child Psychol 1992: 20 (2); 213-232

(6) Kelly ML, McCain AP Promoting Academic Performance in Inattentive Children: The Relative Efficacy of School-Home Notes With and Without Response Cost. Behavior Modif 1995: 19; 76-85

(7) Thurston, LP Comparison of the Effects of Parent Training and of Ritalin in Treating Hyperactive Children In: Strategic Interventions for Hyperactive Children , Gittlemen M, ed New York: ME Sharpe, 1985 pp 178-185

(8) Long N, Rickert VI, Aschraft EW Bibliotherapy as an Adjunct to Stimulant Medication in the Treatment of Attention-Deficit Hyperactivity Disorder. J Pediatric Health Care 1993: 7; 82-88

(9) Donney VK, Poppen R Teaching Parents to Conduct Behavioral Relaxation Training With Their Hyperactive Children J Behav Ther Exp Psychiatry 1989: 20 (4); 319-325

(10) Raymer R, Poppen R Behavioral Relaxation Training With Hyperactive Children J Behav Ther Exp Psychiatry 1985: 16 (4); 309-316

(11) Richter NC The Efficacy of Relaxation Training With Children J Abnorm Child Psychol 1984: 12 (2); 319-344

(12) Hinswaw SP, Henker B, Whalen CK Self-control in Hyperactive Boys in Anger-Inducing Situations: Effects of Cognitive-Behavioral Training and Methylphenidate. J Abnorm Child Psychol 1984: (12); 55-77

(13) Rapport MD Methylphenidate and Attentional Training. Comparative Effects on Behavior and Neurocognitive Effects on Behavior and Neuorcognitive Performance in Twin Girls With Attention-Deficit/Hyperactivity Disorder Behav Modif 1996: 20 (4) 428-430

(14) Myers, R Focus: A Comprehensive Psychoeducational Program For Children 6 to 14 Years of Age To Improve Attention, Concentration, Academic Achievement, Self- Control and Self-Esteem Villa Park (CA): Child Development Institute 1998

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A comprehensive overview of personality disorders; what they are, types and causes, and treatment of personality disorders.

Definition of Personality Disorders

Up to 30 percent of people who require mental health services have at least one personality disorder--characterized by abnormal and maladaptive inner experience and behavior.

Personality disorders are patterns of perceiving, reacting, and relating to other people and events that are relatively inflexible and that impair a person's ability to function socially.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) specifies that these dysfunctional patterns must be regarded as nonconforming or deviant by the person's culture, and cause significant emotional pain and/or difficulties in relationships and occupational performance. In addition, the patient usually sees the disorder as being consistent with his or her self-image and may blame others for his or her social, educational, or work-related problems.

Personality Traits of Someone with a Personality Disorder

Everyone has characteristic patterns of perceiving and relating to other people and events (personality traits). That is, people tend to cope with stresses in an individual but consistent way. For example, some people respond to a troubling situation by seeking someone else's help; others prefer to deal with problems on their own. Some people minimize problems; others exaggerate them. Regardless of their usual style, however, mentally healthy people are likely to try an alternative approach if their first response is ineffective.

In contrast, people with a personality disorder are rigid and tend to respond inappropriately to problems, to the point that relationships with family members, friends, and coworkers are affected. These maladaptive responses usually begin in adolescence or early adulthood and do not change over time. Personality disorders vary in severity. They are usually mild and rarely severe.

Most people with a personality disorder are distressed about their life and have problems with relationships at work or in social situations. Many people also have mood, anxiety, substance abuse, or eating disorders.

People with a personality disorder are unaware that their thought or behavior patterns are inappropriate; thus, they tend not to seek help on their own. Instead, they may be referred by their friends, family members, or a social agency because their behavior is causing difficulty for others. When they seek help on their own, usually because of the life stresses created by their personality disorder, or troubling symptoms (for example, anxiety, depression, or substance abuse), they tend to believe their problems are caused by other people or by circumstances beyond their control.

Until fairly recently, many psychiatrists and psychologists felt that treatment did not help people with a personality disorder. However, specific types of psychotherapy (talk therapy), sometimes with drugs, have now been shown to help many people. Choosing an experienced, understanding therapist is essential.