1. At 4, he hardly sits still. Methylphenidate is given when he goes to preschool only. Recently he got 2 weeks’ break, and he didn’t take any medicine. Upon restarting the drug, hyperactivity seems to be worsening, a phenomenon of paradoxical hyperactivity.

2. The aunt noticed some form of physical aggression toward animals. He threw away two rabbits to the ground till both died on the spot. His emotion was labile and unstable.

3. The aunt wants mum to confirm with the doctor does Methylphenidate cause aggression. The truth is Methylphenidate-induced agitation, hostility and depression are known side-effects. But at the same time, Mum confirmed that the acts have had just occurring even before he was started with medication. The best part is: he is manageable now!

4. Methylphenidate is a great drug. Managing it is difficult. In a small group discussion among few of us, very recently, we shared some interesting views on Ritalin. A friend said: ‘The contradiction is, a fat guy needs smaller doses but a thin chap needs higher doses’. Of course, those are not necessarily true, but the point is you can’t predict the response.

5. Perhaps this is what I would now call personalized medicine phenomena. Either it is due to slow and fast metabolizers in regard to cytochrome activities or differential tenancy of genetic makeup which involved in drug metabolism and excretion.

6. We reminded ourselves to explain and caution patients and their parents before starting the medication. This is to emphasize that Methylphenidate when use with caution is safe and beneficial especially to patients with hyperactivity.

7. The objective of our meeting? Group in the making: MyCAPS – Malaysia Association of Child and Adolescent Psychiatry. Bravos.