MUST HAVE Books on Alzheimer's Disease - for Friends, Caregivers and Relatives of People with Alzheimer's Disease, Dementia and Memory Loss Issues

36-Hour Day: A Family Guide to Caring for Persons with Alzheimer's Disease, Related Dementing Illnesses, and Memory Loss in Later Life
By: Nancy L. Mace, Peter V. Rabins
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Reader Comment: "Very informative, very helpful suggestions, deals well with a difficult topic."

Dancing with Rose: Finding Life in the Land of Alzheimer's
By: Lauren Kessler
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Reader Comment: "The story has deeply moved me. When I first started reading the book I found it difficult to breathe."

Learning to Speak Alzheimer's: A Groundbreaking Approach for Everyone Dealing with the Disease
By: Joanne Koenig Coste, Robert N. Butler
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Reader Comment: "Really full of current knowledge on AD. Really helps the caregiver which there are millions of us. Also has a good reference list."

The Simplicity Of Dementia: A Guide For Family And Carers
By: Huub Buijssen
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Reader Comment: "This book was very informative for me and my family. We were able to understand better what our Mom is going through."

Alzheimer's Early Stages: First Steps for Family, Friends, and Caregivers
By: Daniel Kuhn, David A. Bennett, David A. Bennett (Foreword by)
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Reader Comment: "A really informative book that points you in the right direction as far as finances, estate planning etc."

A Dignified Life: The Best Friends Approach to Alzheimer's Care, A Guide for Family Caregivers
By: Virginia Bell, David Troxel
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Reader Comment:
"This book has helped us with communication, self-esteem, how to still do things together. We feel so much more supported."

Alzheimer's from the Inside Out
By: Richard Taylor
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Reader Comment: "In this collection of essays, Richard Taylor gets at the essence of dementia, and how it has redefined his relationships with family, friends and even with himself."

The Myth of Alzheimer's: What You Aren't Being Told About Today's Most Dreaded Diagnosis
By: Peter J. Whitehouse, Daniel George
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Reader Comment: "This book offers the reader clues to maintain a quality of life as we age. In addition, Dr. Whitehouse brings years of clinical experience presenting ways to reduce the burnout of the caregiver."

Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's-Type Dementia
By: Naomi Feil, Vicki de Klerk-Rubin
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Reader Comment: "This validation technique is simple to learn. It has made my work in a nursing home so much more enjoyable and rewarding."

With its introduction in 1998, helped bring erectile dysfunction out of the bedroom and into the doctor's office. Since then, the drug has become a first-line treatment for men hoping to improve erectile function. But it's no longer the only pill that treats this condition. and Tadalafil (Cialis) are two other available options.

Erectile dysfunction - also referred to as impotence - most commonly refers to the inability to achieve an adequate erection for sexual activity. More men are seeking help for this problem. And doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better ways to treat it.

With new medications - and more choices on the horizon - men who find one medication that doesn't work for them have other options. Find out how these medications work, what their potential side effects are and what makes them different.

Many similarities, some differences

Viagra, Levitra and Cialis work in much the same way. They enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood and allows a natural sequence to occur - an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation.

Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence. For instance, men with high blood pressure, heart disease, diabetes, spinal cord injuries and depression have reported favorable results.

These medications share many similarities, but they have differences as well. These drugs vary in dosage, duration of effectiveness and possible side effects. Other distinctions - for example, which drug is best for certain types of men - aren't yet known. No study has directly compared these three medications.

* A drug's full range of side effects isn't known until it has been in widespread use for many years.

Choosing the best oral medication for you may depend on several factors, including how well your body handles one drug over another and the amount of time you want the drug to remain in effect. Talk to your doctor about your options and personal preferences to help decide if one of these medications might work for you.

Not for everyone: A word of caution

Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor.

In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drug nitroglycerin. The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems.

Rare reports of blindness caused by nonarteritic anterior ischemic optic neuropathy (NAION) have also been reported in men using impotence drugs. However, because NAION and erectile dysfunction share many of the same risk factors, it's unclear whether the drugs themselves are responsible for NAION or whether the underlying causes of impotence, such as age, high blood pressure and diabetes, are responsible. If you're considering an impotence drug but have a significant vision problem, see your eye doctor before taking any of these medications.

Have realistic expectations

Don't expect these medications to fix your impotence immediately, as that's not always the case. Dosages may need adjusting. Or you may need to alter when you take the medication. For example, Viagra is best absorbed on an empty stomach, so taking the pill right after a meal can reduce its affects. If these medications don't work for you, other treatments - such as injectable agents, medication placed in the urethra (MUSE), vacuum devices or penile implants - are available.

The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you. Before taking any medication, make sure to discuss with your doctor its potential benefits and side effects.

More on Surgical Methods of Treating Erectile Dysfunction

next: Penile Prostheses for Erectile Dysfunction

ADD/ADHD: A Developmental Process of Self-Discovery and Self-Acceptance

As a professional psychologist and counsellor who is no stranger to the worries induced by ADD, I would like to present a mixture of personal and professional reflections. As the title of this brief article suggests, self-discovery and self-acceptance is a dual process that is life-long. Those who face symptoms of ADD/ADHD are particularly challenged. Unfocussed attention, lack of completion, overactivity and nervousness, impulsivity and "accident-proneness" have a wide range of negative effects on our relationships as well as on the development of a secure and integrated identity. Low self-esteem, poor self-confidence and loneliness ("not fitting in") are but a few of the reactions we develop. We spend a great deal of energy apologising and compensating for our "dysfunctional" behaviours, and hiding our "disorderly" lives. In the process, we risk losing respect for who we are, and may take on different public facades which prevent others from knowing our true selves. This set of occurrences provides a perfect breeding ground for loneliness, depression, and anxious feelings . The first step out of this situation is awareness.

I remember well, a few years ago, when I discovered a book on ADD. I was relieved and inspired. At last, I could understand some of my own behaviours, and I knew that others could, too. My first steps were to EDUCATE myself further, and to reveal my discovery to family and friends once I felt more confident in my knowledge. I met with various reactions ranging from support and acceptance to denial of the existence of this "currently fashionable" disorder. I am better able to identify true sources of support for what I now know and believe, and to surround myself with those who understand and can help. The ADD/ADHD Support Group is a major resource in this respect. Putting a name on my ADD experiences and contact with like-minded people may be only the first step, but it is a giant step. It can be hugely satisfying and continues to bring joy and pleasure with each new conversation and discovery.

There is now a great deal of information about the causes and management of ADD/ADHD in children and adults. You will discover a variety of approaches, including time and behaviour structuring, counselling and psychotherapy, relaxation and stress management, cognitive-behavioural techniques, and medication. Most important, begin to imagine that your symptoms are flexible, and that your energy can be channelled through the power of your thoughts, expectations, and surroundings. You have choices about all of these things which can improve the quality of your life.

Finally, here are some TIPS to remember as you pursue your journey:

Take your journey seriously and find at least one person you love who can do the same.

-Also, find the humour and learn to laugh at yourself, respectfully and compassionately.

-Read the literature, some of which is available through the Support Group.

-Talk about your experiences of ADD/ADHD with those who can support you.

-Seek professionals (counsellors, psychologists, psychotherapists, GP s, psychiatrists) who are open-minded, compassionate, and willing to listen to your concerns, and who can provide you with treatment and management strategies.

-Know that discoveries about ADD/ADHD are being made all the time, and that there is no consensus about the causes and treatment. This actually allows a great deal of flexibility in the development of treatment programs.

-There are a variety of interventions that do work. A predominant one is medication, which may be a stimulant, an anti-depressant, or and anti-anxiety drug. Usually, a collection of strategies work best, such as medication and counselling.

-Your strategies are personal and ought to be tailored to your own needs. If one set of strategies do not seem to work, make small shifts and check the results.

-With appropriate professional support, you can experiment with different management strategies safely and successfully.

-Ask others for their honest assessment of any changes you might be making in yourself. We often are the last to see the positive changes, and need others to affirm the changes.

-Let go of some of your efforts to control too much. People with ADD tend to think that they should always be in control. This is an impossible expectation, and you will make mistakes.

-Remember, sometimes life is just plain unmanageable. Don't always blame your self.

You may have ADD/ADHD symptoms, but you are much more than this. You do not have to let these symptoms run your life. Some you can reduce; some you can eliminate; some you can channel more positively; and some you can learn better ways to live with. The resources have arrived!

- Dr. Scott E. Borrelli,

Many thanks to Dr. Borrelli for providing this item.

Sometimes, when children act out, we parents lash out at them instead of comprehending or responding to their pain.

Dear Kristen,

Today was your last day of nursery school. I've attempted for days to prepare you for this milestone. To my surprise, when I picked you up, you seemed completely indifferent. You cheerfully said goodbye to all your friends and teachers. You danced around the room while I gathered up your keepsakes. You skipped to the car without so much as a backward glance. "Wow, that was easy," I said to myself, breathing a sigh of relief. Off we go to run errands.

We are driving along, and you insist that I stop for a slushy. I say no. You start to whine and plead and will not stop. I ignore your protests. You then embarrass me more than usual in the supermarket. I am growing increasingly more frustrated with you. Back in the car, you yell at me, you talk back, and you whine some more. Even when you're being a brat - you're never this bratty. And then you get worse. Finally, my patience has reached its limit. I stop the car in front of the post office, yank you out, and get ready to pounce! You are in BIG trouble now KID!!!

Suddenly it hits me. My temperature immediately starts to cool, and I look down into your anxious little face. "Krissie," I ask, forcing my voice to sound calm. "Are you sad or hurt about anything, honey?" Your whole body begins to tremble and you croak, "I don't want to go to kindergarten! My friends at nursery school -need - me - Mommy!" You begin to sob, making heart-wrenching, hiccupping sounds. I sit down on the sidewalk and gently guide you down with me to nest in my arms. And I sit on the side of the road on a busy Lewiston street, cradling my little bird. We're oblivious to the traffic. We've more important things to tend to right now- you, your grief, and I, my child.

You're sleeping now, snuggled up to your teddy bear, serenaded by lullabies, a sippy cup of apple juice beside the bed. We had another close call, you and I.

Strange how we expect adults to be mature, to express their feelings appropriately, to not take it out on others when they've had a bad day. But grownups still fail to meet our expectations every now and then, no matter how old or how wise. And yet, we so readily lash out at our children's undesirable behavior without taking the time to peer beneath the surface, failing from time to time to respond to the pain of a child...

Love, Mom...

next:Mommy Do You Love Me?

No one had ever heard music anything like it before. It soared, it flew, it triumphed against all natural laws, all while struggling against itself in a way that suggested no possible resolution. On one hand, he remained true to the classicism of Mozart and Haydn, on the other the sheer power and passion of his work broke the mold forever.

Say hello to Ludwig van Beethoven, the most influential composer of all time.

We know him best, of course, by his Choral Symphony, but the Beethoven aficionados have their own favorites: The Seventh Symphony, the Emperor Concerto, the Waldstein Sonata, the later string quartets ... There's no right or wrong choice, here. Sometimes, it can be a Beethoven moment as opposed to a whole piece: the coda in the Egmont Overture, the stormy intro to his Eroica Symphony, the trombones barking out their lofty challenge in the last movement of the Fifth Symphony.

His life could fill up a segment on Oprah: an abusive father who tried to exploit him as a child prodigy, an infatuation for women who were totally out of reach, a tragic deafness that defies imagination, the comical frequency in which he shifted residences in Vienna, his disillusionment with Napoleon, his unkempt appearance and lack of personal hygiene, a man with a vision of universal brotherhood increasingly withdrawing into himself.

It's almost tempting to stop right there, as if his tormented life were reason enough to explain his exalted music, but the written record demands a closer look. Beethoven wrote a lot of letters and so did his friends, and in the book, Manic Depression and Creativity (Prometheus Books, 1999), authors D Jablow Hershman and Dr Julian Lieb argue quite convincingly that the great composer was manic depressive:

"I joyfully hasten to meet death," Beethoven wrote as his deafness made itself apparent, "... for will it not deliver me from endless suffering?"

This was no isolated event. An 1801 letter to a friend refers to a two-year-long depression. The next year he is begging Providence for "but one more day of pure joy." In 1813, he may have attempted suicide, disappearing and being found three days later. In 1816, he wrote: "During the last six weeks my health has been so shaky, so that I often think of death, but without fear ..."

Ironically, his manic depression may have enabled him to survive deafness and loneliness. According to the book's authors:

"[Manic depressives] can be happy without cause, or even in the face of misfortune It may be that Beethoven survived as a creator because he was brave or because his love of music kept him going. What he did have were his manic days of 'pure joy' that he prayed for, and manias triggered by the process of working, along with the confidence and optimism mania brings."

His mania seemed to stoke his creativity, as he crashed and banged on his pianoforte, taking the instrument to its limits, scribbling on walls and shutters if paper wasn't available, dousing his head with water that ran through to the rooms below.

A friend describes one Beethoven session:

"He ... tore open the pianoforte ... and began to improvise marvelously ... The hours went by, but Beethoven improvised on. Supper, which he had purported to eat with us, was served, but - he would not permit himself to be disturbed."

His mania also had its flip side, as he destroyed relationships with raging quarrels and psychotic delusions. On one occasion, he flung a gravy-laden platter of food at a waiter's head. His friends called him "half crazy," and when enraged, "he became like a wild animal."

Ultimately, Beethoven medicated himself with the only available drug besides opium - alcohol. He literally drank himself to death. And as deafness closed in around him, he withdrew from the world, into himself. He wrote his Eighth Symphony in 1812. Then his creative output dried up. In 1824, he would premier his Choral Symphony. It was as if a piece of this magnitude required a tortuous 12-year gestation. He would also compose his transcendent string quartets. But soon his liver would give out on him, and in early 1827 he died at the age of 56, leaving behind sketches of a tenth symphony the world would never hear.

The authors of Manic Depression and Creativity note a rough correlation between Beethoven's manic phases and his creative bursts. Apparently, winter depressions stopped him in his tracks while summers brought on periods of intense activity. As a friend noted: "He composes, or was unable to compose, according to the moods of happiness, vexation or sorrow."

But as to whether manic depression actually constituted the creative spark in Beethoven, the authors defer to none other than Beethoven's teacher and fellow composer, Franz Joseph Haydn:

"You will accomplish more than has ever been accomplished," wrote Haydn at the beginning of Beethoven's career, "have thoughts that no other has had. You will never sacrifice a beautiful idea to a tyrannical rule, and in that you will be right. But you will sacrifice your rules to your moods, for you seem to me to be a man of many heads and hearts. One will always find something irregular in your compositions, things of beauty, but rather dark and strange."

Oh, that there could be five more like him.

Update: Oct 24, 2000

Scientists analyzing eight strands of Beethoven's hair found "unusually high" levels of lead. According to William Walsh, chief researcher of the project: "We are quite certain that lead was responsible for his lifelong illnesses and that lead impacted his personality."

Buy Manic Depression and Creativity from Amazon.com by clicking on the following link: Manic Depression and Creativity

Buy the Van Karajan's classic cycle, Beethoven: Nine Symphonies, from Amazon.com.

next: Bipolar Disorder and Alcohol Abuse
~ bipolar disorder library
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Quest for Freedom!

~ An insight into OCD ~ Obsessive Compulsive Disorder

Dear Diary,

Well firstly, I apologise for my entry being a little late! I seem to have quite a few projects running at the moment. Two of them being with Healthyplace.com. My site's been added to their OCD Community section! Just about all of it's been put up, so hopefully OCD awareness is being promoted a bit further. Plus, I shall be trained to become a Support Host for the OCD Community on Wednesday. I'm really excited about it, and see it as another way to turn what was an OCD negative into a positive.

Yesterday, our weather decided to become more spring-like and reached the dizzy heights of 16 degrees; shame it didn't last - it rained today!

My OCD is doing ok. I realise that I'll never be rid of it though. The last 3 weeks have been good, but today was the end of Phil and my 3 week break and I've been quite stressed about it all day, which, of course, makes my OCD symptoms worse! I hate feeling like this - all tense and nervous, out of control. I feel the need to repeat actions more when feeling like this, arghhh!

My driving has taken a bit of a backseat at the moment, as I need insurance and because I haven't driven for so long, it's very expensive! Sigh, oh well.

Three weeks ago, I went to stay with my mum for a couple of weeks. As you may remember from previous entries, my mums feels very contaminated to me. Well, I did really well and braved it even, by going in mums car! We went to visit my Dad. He's in a nursing home. It's so nice to be able to go and see them both, for a few years I wasn't able to.

Last week, I went on my own into the nearest town by bus. It was a bit scarey, but I did okay. It's hard to believe what I am achieving now when I consider all those years of inactivity. I realise I have come a long way.

I hope if you have OCD and are reading this, you can grab even a little bit of encouragement for yourself, that you, too, can achieve more control over the illness.

I'll say bye bye until next month. Take care and keep smiling!

~Sani~ xx

next: My Obsessively Clean Diary: May 2001
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Psychology essays by Richard Grossman, Ph.D. on voicelessness, giving your children voice, good and bad relationships, and how psychotherapy works.

Understanding Voicelessness

• The Four Questions
• Six Questions About 'Voice' and 'Voicelessness'
• Voicelessness: Narcissism
• Voicelessness: Holiday Blues
• Depression and the Subtext of Family Life
• Adult Children of Narcissistic Parents: Is Love Enough?
• Little Voices
• Voicelessness: Depression
• Bill Clinton: A Case of Attention Deficit Disorder?
• Voicelessness: A Personal Account

Parenting

• Giving Your Child "Voice" Fundamental to a child's self-esteem and emotional well being is their sense of "voice." How do you ensure your child receives this lifelong gift?
• The Dance If you want to inoculate your child against depression and help build their self-esteem, you must learn how to dance.
• Do Parents Matter? The debate has been contentious and highly publicized. One critical issue has not been addressed.
• Voice Lessons: Littleton, Colorado (Guest column reprinted from the Brookline Tab, May 13, 1999 and excerpted in Massachusetts Psychologist, June, 1999) What can be learned about parenting from the Columbine High School tragedy?
• What is a Wookah? What does a child with "voice" sound like?
• Voicelessness: The Depressed Teenager Alienation and despair have reached epidemic proportions in high schools. How can you help your child?
• Voicelessness
• The Four Questions Who am I? Do I have any value? Why doesn't anyone see or hear me? Why should I live?
• Six Questions About "Voice" and "Voicelessness" What is "voice?" Why is it important?
• Voicelessness: Narcissism Narcissism is a misnomer. At their core narcissists don't love themselves -- in fact their self barely exists, and what part does exist is deemed worthless. All energy is devoted to inflating the self...

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• Voicelessness: Holiday Blues If you become depressed at holiday time, you are not alone.
• Depression and the Subtext of Family Life In the psychology of children and adults, hidden messages rule.
• Adult Children of Narcissistic Parents: Is Love Enough? Important lessons about love and "voice" can be learned from the adult children of narcissistic parents...
• Little Voices Deprived of voice in childhood, some people shrink or twist themselves like a pretzel to fit others' worlds.
• Voicelessness: Depression Many chronically depressed people experienced childhood voicelessness. How does voicelessness affect adult depression?
• Bill Clinton: A Case of Attention Deficit Disorder? Unfortunately, Hillary did not get it quite right when she explained Bill's sexual escapades...
• Voicelessness: A Personal Account What happens when a dying parent values one small part of us and neglects the rest? (Invited talk: Contemporary Spiritual Experience, Brookline, MA, Sept, 2002).

Relationships

• Why Can't Some People Maintain Intimate Relationships? Many people retreat from close emotional contact, frustrating spouses and partners.Here's a look at the problem from the perspective of childhood "voicelessness."
• Why Do Some People Choose One Bad Relationship After Another? Psychoanalysts, citing Freud's "pleasure principle", have suggested masochism as the answer. Why else would people suffer the same pain and humiliation over and over again? Here's another explanation based upon the need to exist in other's eyes.
• Relationships: Hidden Messages Hidden messages from childhood secretly affect adult relationships. Here's an example.
• Couples Counseling: Is Better Communication Enough? We've read it in all the popular magazines: better communication leads to a happier marriage. But is better communication enough?

Psychotherapy

• Psychotherapy and Humanism Life experience has taught me that humanism plays a critical role in the healing process.
• Psychotherapy: Truth or Revisionist History? Can a therapist uncover the truth about a client's past? Here's a case example based upon a mother's diary.
• A Person Appears in My Office What happens next? How does therapy begin?
• Psychotherapy in the Internet Age To "e" or not to "e", that is the question...
• So, You're Thinking About Becoming a Therapist? Learning about subtext is critical. Here's an exercise based upon Robert Frost's poem, "Stopping by the Woods on a Snowy Evening."
• Therapy on the High Seas: A Search for Self What happens when an adult child of a narcissistic family faces progressive heart failure? Consider this account of a man's struggle for physical and emotional survival.
• Dreams, Imagined Dreams--Failed Therapy Therapists can not only heal, they can hurt.
• Depression: Why See a Therapist if You Can Just Take a Pill? Sometimes medication is the easiest and most inexpensive answer for depression. But there are good reasons to consider therapy, even if you are on anti-depressants.
• Vulnerability: the roots of compassion Response to the 9-11 terrorist attack. September 27, 2001

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: The Four Questions

I believe that forgiveness holds the key to our happiness. I would stop short of saying that if we don't seek forgiveness we may never be happy again. And, that could be true. We may have occasional spurts of happiness and we may notice that there is something else that needs to be done to insure a more consistent pattern of happiness. Unhappiness is a choice. We may be always and only thinking about forgiving ourselves and others, which keeps us from forgiving and the happiness we deserve. Doing is the key.             

I am saying that our future happiness will be free to express itself more openly and spontaneously when we can forgive ourselves and forgive others. . . with no concern about whether they or we deserve it. We may notice that we carry forgiveness as a burden. That's a sign that points in the right direction. If we can notice that, we will be in wonder of what might happen if we could shed this tiresome burden of non-forgiveness.

When we give in to our curiosity, we will find ourselves on a path of forgiveness that can lead to more happiness than we can possibly imagine.

Forgiveness opens doors. Windows to. The window to open is the one to the world in which you are free to do and be what you are here to do and be. Without the tiresome burden of worry, you unleash unlimited possibilities. Without the worry of non-forgiveness you can get on with what's next.

Additional resource:

Read, "Forgiveness. . . What's it for?" - Forgiveness is often misunderstood. We often think of forgiveness as something that someone who has done us wrong must ask of US. This article suggests that you focus on offering forgiveness TO the person who has wronged you as a healthy way of releasing the anger, resentment, etc.  

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next: Never Intentionally Say Hurtful Words to Your Partner

Summary of storage and usage guidelines for ADHD stimulant medications - Ritalin, Equasym and Concerta.

We have all been aware recently of the articles in the media concerning medication in the treatment of ADHD.

We must all take the responsibility to ensure that if we use ADHD stimulant medication, we learn more about it and how to store and administer this medication correctly and within proper safety guidelines.

It is only when we do this can we respond to these articles to change the media image for ADD/ADHD and stimulant medication, to start to gain more acceptance and services for all those with the condition.

• Methylphenidate is the generic name of this medication. However, the more common names are the brand names Ritalin, Equasym and Concerta.
• Medication should only be used/taken by the person it has been prescribed for.
• Methylphenidate is a stimulant medication - it is classified as a Class B, Schedule II medication. This means that it is called a "Controlled Drug" or "C.D.
• This fact means that it needs to be treated with respect. We need to be aware of this and keep it in mind when we take responsibility for it on behalf of our children if they are prescribed it or if prescribed for ourselves.

Storage of stimulants  needs to be considered

• As a Class B medication Methylphenidate is prescribed on a named person basis - by this it means that the prescription is handwritten.
• Being a "Controlled Drug" ("C.D.") this means that in a Pharmacy Methylphenidate is kept under strict conditions and always should be kept under lock and key, along with many other medications with the classification of "Controlled Drug" status.
• At home or school keep the stimulant medication under lock and key so that no one has the opportunity to take any tablets which they have not been prescribed or should not have access to.

Care needs to be taken from the start.

• Confidentially should be observed by all parties. When handing over or collecting the prescription, you should feel confident in the pharmacist and staff, that they will maintain your confidentiality when they dispense the medication.
• You should also ensure that you also keep the confidentiality of the prescription - there is no need to discuss the content in front of other customers. Be aware there are people out there who will know what the medication is that you are referring to and these people will also probably know ways of abusing this and many of the other medications, "Controlled Drugs".
• Make sure that the person for whom the medication has been prescribed actually takes the tablet at the time it is administered. Don't let them take it away to take later.
• If you wish someone to give medication to a child at school, make sure you have advised them correctly about the medication. If one person does not feel they wish to take the responsibility for this, speak to someone who is.

If  ADHD medication is administered at school

• The school should also take extra precautions with regard to the administration of Methylphenidate:
• There should be written confirmation from the child's consultant that the particular child has been diagnosed by that consultant with ADD/ADHD and has been prescribed the medication, this should include the dosage and timings for taking the medication, also any other treatments which are being considered or being given.
• Any changes to dose or timing should also be confirmed by the consultant and kept on file. This covers the school on administration issues.
• If a parent wishes the school to alter dosage or timing then they should be able to give the confirmation from the child's consultant that this is being done under their guidance.
• It is important that the school and the doctor work together to help the child and it would be good if the school could go through things with the doctor and also help with the various behaviour rating scales as this helps to optimise the medications effective dose for the child to reach the maximum benefit for the child. This helps the school and the doctor and also the child and their family. Co-operation with Education - Health and the Child and Family is a big step to the success to the treatment programme.
• Staff need to be fully aware of that Methylphenidate is a Class B, Schedule II medication and is a "Controlled Drug".
• They need to be confident and prepared to take on the responsibility for administering the medication to the child and also to consider the safe storage of it.
• Keeping Methylphenidate in the teachers unlocked desk drawer is not acceptable. Methylphenidate should be kept in a central location in a locked cupboard or drawer and should be signed for when given to the child.
• Remember that Methylphenidate as a "Controlled Drug" should not be carried by a child - This includes those at High School - Even at the age of 14, 15, 16 years + it is not appropriate for the child to carry Methylphenidate with them.
• Implications of a child carrying Methylphenidate, especially if they do not have any proof that it is prescribed for them is the same as it would be for carrying any other "Controlled Substance" - The police could arrest them for being in possession of a "Controlled Substance" - depending on the amount carried. This could be considered as intent to supply.
• At the end of the day, the safe storage and administration of Methylphenidate lays with the adult - the Parent or the teacher or other appointed named adult.

In the Government Guidance document Drugs: Guidance for Schools, date of issue: February 2004, it talks about illegal drugs but it also states:

"Schools should be aware that Methylphenidate Hydrochloride (Ritalin) is a class B drug that may be prescribed as part of the treatment for those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). As with all prescribed medication it may only be taken by those for whom it has been prescribed. Inappropriate use of Ritalin, including sharing or selling to others, should be dealt with in line with the school's drug policy."

A final point on the subject of the safety issues surrounding Methylphenidate is Concerta has now become available in the UK - This is a one-a-day form of Methylphenidate and therefore takes away the need to take medication at school / during the day. It also uses a different delivery system for administering the tablet itself which makes it almost impossible to abuse. There are other forms of slow release methylphenidate which are available.

Stress is not the same for everybody. Stress is different for each of us. What is stressful for one person may or may not be stressful for another; each of us responds to stress in an entirely different way.

Keep in mind, stress is not always bad for you. A little stress can help to motivate and actually increase our performance on certain tasks. The key issue is how to manage it and prevent it from becoming overwhelming. Managed stress makes us productive and happy; mismanaged stress hurts and even kills us.

Plan your life so that stress does not overwhelm you. Effective planning involves setting priorities and working on simple problems first, solving them, and then going on to more complex difficulties. When stress is mismanaged, it's difficult to prioritize. All your problems seem to be equal and stress seems to be everywhere.

No universally effective stress reduction techniques exist. We are all different, our lives are different, our situations are different, and our reactions are different. Only a comprehensive program tailored to the individual works.

Absence of symptoms does not mean the absence of stress. In fact, camouflaging symptoms with medication may deprive you of the signals you need for reducing the strain on your physiological and psychological systems.

Don't ignore minor symptoms of stress such as headaches or stomach acid. Minor symptoms of stress are the early warnings that your life is getting out of hand and that you need to do a better job of managing stress.

If you need to talk with someone about stress management in your life, contact our Virtual Clinic for more information.

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