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Adhd drug deaths the advisory panel acted after a study found an increased risk of heart attacks and strokes in adults taking adhd drugs and pantoprazole. Patients with heart failure at high risk of death are least likely to receive treatment with angiotensin-converting enzymes, angiotensin II receptor blockers and beta-blockers, say Canadian researchers. They analysed data from 1, 418 hospital patients in Ontario, Canada, aged 79 years or younger, with a left ventricular ejection fraction of 40 per cent or less.They found that as predicted risk of death increased, discharge prescriptions for these drugs decreased. This pattern was maintained for up to one year after discharge. The researchers suggest several possible explanations for their findings, including an under appreciation of the benefits of therapy and the need for multiple medicines. They also suggested doctors may be distracted from, for example, glimepiride.
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Medication should be thought of as an adjunct to the treatment of pathological gambling. Most gamblers can be treated successfully without it. Even when one does prescribe medication, it is still necessary to help the patient identify and express feelings, confront difficult situations, develop social skills, and deal with relationship problems. In fact, medication is given in the context of a relationship. It is in the therapeutic relationship that we observe and try to solve problems in compliance. Less than 40% of patients with physical illnesses follow the doctor's instructions for dose and frequency of their medications Buckalew & Buckalew, 1995; review by O'Brien & McLellan, 1996 ; . Onethird of the general population does not get prescriptions filled, and over 40% will use someone else's medication Buckalew & Buckalew, 1995 ; . Full compliance occurs only 25% of the time. Compliance is an even more serious problem with pathological gamblers because they are often ambivalent about giving up gambling or altering lifelong patterns of coping, no matter how ineffective these strategies may have been. What these gamblers often express is the feeling that something is being taken away from them. Problems with trust exist for both therapist and patient. Given such issues, what then is to be gained by attempting to medicate pathological gamblers? First of all, there are a number of studies that point toward the importance of biological factors in gambling addiction. Kruedelbach and Rugle 1994 ; found gamblers to be more impulsive than cocaine addicts or alcoholics, and also found that, at least for a subgroup of pathological gamblers, high impulsivity preceded the history of gambling problems. Studies of biological markers have suggested deficits in the serotonergic Moreno, Saiz-Ruiz & Lopez-Ibor, 1991; Carrasco, Saiz -Ruiz, Hollander, Cesar & Lopez-Ibor, 1994; Blanco, Orensanz-Munoz, BlancoJerez & Saiz -Ruiz, 1996; DeCaria, Begaz & Hollander, 1998a ; , dopaminergic Bergh, Eklund, Sodersten, Nordin, 1997 ; , and noradrenergic DeCaria et al., 1998a ; systems. A genetic predisposition is suggested by family histories of problem gambling Gambino, Fitzgerald, Shaffer, Renner & Courtnage, 1993; Winters, Stinchfield & Fulkerson, 1993; Winters, Bengston, Dorr & Stinchfield, 1998 ; , twin studies Eisen et al., 1998; Slutske et al., 2000 ; , and genetic research Comings et al., 1996; Ibanez, Perez de Castro, Fernandez-Piqueras & Saiz -Ruiz, 2000; Comings et al., 2001 ; . EEG Goldstein, Manowitz, Nora, Swartzburg & Carlton, 1985 ; and neuroimaging studies utilizing PET scans and MRIs Goyer, Semple, Rugle & McCormick, 1999; Potenza, 2001 ; show significant differences between pathological gamblers and normal controls. Potenza found that the gambling urges of the problem gambler activate the same regions of the brain e.g. the anterior cingulate ; as the cocaine cravings of people with chemical dependencies and trental.
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