SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Psychiatric Association), several treatment approaches received strong endorsement for BN. Cognitive behavioral therapy (CBT) is
recommended as an effective treatment for bulimic patients and considered the ‘treatment choice’ for BN and binge eating disorder (BED),
it is also supported by strong evidence-based literature.
With regard to the efficacy of CBT specifically in BN, in various studies CBT was associated with more improvements in bulimic and
depressive symptoms of patients than symtoms of control patients in waiting-list and any other psychotherapy cases. In terms of general
psychiatric symptoms, studies have not shown any difference between CBT and any other psychotherapy.
Other psychotherapy choices have included interpersonal psychotherapy (IPT), dialectical behavior therapy, supportive and psychodynamic
psychotherapy, and certain self-help approaches. Thus, in clinical practice there have been a number of evidence-supported treatments
for BN patients.
IPT is a psychological treatment for BN that has demonstrated long-term outcomes that are comparable to those for CBT. Currently,
all controlled studies of IPT for BN have been comparison studies with CBT. Although there have been only few controlled trials of
psychodynamic treatment of eating disorders, these reports yielded important findings in this field. Standard dialectical behavior therapy
(DBT) has been adapted to address a variety of problematic behaviors associated with emotion dysregulation in bulimia nervosa and
also DBT may be used in BN patients with comorbid borderline personality disorder. Beside these, the knowledge in the field of self-help
treatments continues to develope.
Key words: Bulimia nervosa, psychotherapy
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S94-5
[PS-21]
Symposium Title: Treatment approaches to comorbidities of ADHD
Treatment approaches to psychiatric comorbidities of ADHD in children
Tümer Türkbay
GATA, Department of Child and Adolescent Psychiatry, Ankara, Turkey
E-mail: tumerturkbay@yahoo.com;tturkbay@gata.edu.tr
Attention-deficit hyperactivity disorder (ADHD) is highly comorbid with other psychiatric disorders. Each of the comorbid disorders
modifies the overall clinical presentation and treatment response. Sometimes there can be more complex situations. For example,
depressed children demonstrate diminished concentration and irritability and it may be difficult to differentiate from the cardinal
symptoms of ADHD. Children with ADHD and comorbid disorders have poorer prognoses than those with ADHD alone.
Both stimulant medications and atomoxetine markedly reduce symptoms of comorbid oppositional defiant disorder, which often requires
adjunctive parent training and behavior management. Severely explosive anger may require the use of atypical antipsychotics. In conduct
disorder, stimulant medications and atomoxetine also reduce aggressive behavior and antisocial acts. Atypical psychotics or mood
stabilizers may be used for highly aggressive-explosive cases.
The majority of children with comorbid ADHD/depression can be managed with a psycho stimulant. However, initial treatment with
antidepressant drugs should be saved for treating children with more severe depression. Stimulants can exacerbate symptoms of anxiety
disorders. Atomoxetine, SSRIs and behavioral therapies reduce anxiety symptoms.
If tic disorders are mild or episodic, they usually require no treatment. Most ADHD/tic disorder patients will not demonstrate an
exacerbation of their tics with stimulants. Nevertheless, if tics worsen with stimulant use, an antipsychotic or alpha agonist should be
added to the psychostimulant.
Key words: Attention deficit hyperactivity disorder, comorbidity, management
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S95
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