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De Serrano AR, Hughes KA, Rodd FH. Paternal exposure to a common pharmaceutical (Ritalin) has transgenerational effects on the behaviour of Trinidadian guppies. Sci Rep 2021; 11:3985. [PMID: 33597600 PMCID: PMC7889922 DOI: 10.1038/s41598-021-83448-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/02/2021] [Indexed: 01/04/2023] Open
Abstract
Evidence is emerging that paternal effects, the nongenetic influence of fathers on their offspring, can be transgenerational, spanning several generations. Methylphenidate hydrochloride (MPH; e.g. Ritalin) is a dopaminergic drug that is highly prescribed to adolescent males for the treatment of Attention-deficit/hyperactivity disorder. It has been suggested that MPH could cause transgenerational effects because MPH can affect the male germline in rodents and because paternal effects have been observed in individuals taking similar drugs (e.g. cocaine). Despite these concerns, the transgenerational effects of paternal MPH exposure are unknown. Therefore, we exposed male and female Trinidadian guppies (Poecilia reticulata) to a low, chronic dose of MPH and observed that MPH affected the anxiety/exploratory behaviour of males, but not females. Because of this male-specific effect, we investigated the transgenerational effects of MPH through the paternal line. We observed behavioural effects of paternal MPH exposure on offspring and great-grandoffspring that were not directly administered the drug, making this the first study to demonstrate that paternal MPH exposure can affect descendants. These effects were not due to differential mortality or fecundity between control and MPH lines. These results highlight the transgenerational potential of MPH.
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Affiliation(s)
- Alex R De Serrano
- Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks St, Toronto, ON, M5S 3B2, Canada.
| | - Kimberly A Hughes
- Department of Biological Science, Florida State University, 319 Stadium Dr, Tallahassee, FL, 32304, USA
| | - F Helen Rodd
- Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks St, Toronto, ON, M5S 3B2, Canada
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2
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Zhang H, Yang B, Peng G, Zhang L, Fang D. Effects of the DRD4 -521 C/T SNP on Local Neural Activity and Functional Connectivity in Children With ADHD. Front Psychiatry 2021; 12:785464. [PMID: 35069289 PMCID: PMC8772420 DOI: 10.3389/fpsyt.2021.785464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The present study aimed to investigate the effects of the dopamine receptor D4 (DRD4) -521 C/T single-nucleotide polymorphism on brain function among children with attention deficit hyperactivity disorder (ADHD) and to evaluate whether brain function is associated with behavioral performance among this demographic. Methods: Using regional homogeneity, fractional amplitude low-frequency fluctuation, and functional connectivity as measurement indices, we compared differences in resting-state brain function between 34 boys with ADHD in the TT homozygous group and 37 boys with ADHD in the C-allele carrier group. The Conners' Parent Rating Scale, the SNAP-IV Rating Scale, the Stroop Color Word Test, the go/no-go task, the n-back task, and the working memory index within the Wechsler Intelligence Scale for Children-Fourth Edition were selected as comparative indicators in order to test effects on behavioral performance. Results: We found that TT homozygotes had low behavioral performance as compared with C-allele carriers. The regional homogeneity for TT homozygotes decreased in the right middle occipital gyrus and increased in the right superior frontal gyrus as compared with C-allele carriers. In addition, the right middle occipital gyrus and the right superior frontal gyrus were used as the seeds of functional connectivity, and we found that the functional connectivity between the right middle occipital gyrus and the right cerebellum decreased, as did the functional connectivity between the right superior frontal gyrus and the angular gyrus. No statistically significant differences were observed in the respective brain regions when comparing the fractional amplitudes for low-frequency fluctuation between the two groups. Correlation analyses demonstrated that the fractional amplitude low-frequency fluctuation in the precentral gyrus for TT homozygotes were statistically significantly correlated with working memory. Conclusions: We found differing effects of DRD4 -521 C/T polymorphisms on brain function among boys with ADHD. These findings promote our understanding of the genetic basis for neurobiological differences observed among children with ADHD, but they must be confirmed in larger samples.
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Affiliation(s)
- Huan Zhang
- Department of Zunyi Medical University Zhuhai, Zhuhai, China
| | - Binrang Yang
- Centre for Child Care and Mental Health, Shenzhen Children's Hospital, Shenzhen, China
| | - Gang Peng
- Department of Adolescent Gynecology, Shenzhen Children's Hospital, Shenzhen, China
| | - Linlin Zhang
- Centre for Child Care and Mental Health, Shenzhen Children's Hospital, Shenzhen, China
| | - Diangang Fang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
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3
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Ramos-Galarza C, Pérez-Salas C. Moderator Role of Monitoring in the Inhibitory Control of Adolescents With ADHD. J Atten Disord 2021; 25:188-198. [PMID: 29806534 DOI: 10.1177/1087054718776478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this research was to analyze the role of monitoring in the causal relationship between inhibitory control and symptoms of combined ADHD. Method: It has been conducted a quantitative investigation of two phases. Results: In the first study, a moderation model was analyzed (N = 144 adolescents with combined ADHD), where monitoring was considered as a moderating variable in the causal relationship between the inhibitory control and the symptomatology of ADHD F(3, 140) = 28.03, p < .001; R2 = .37. In the second study, the model through an experimental study was tested (N = 52 adolescents with and without ADHD) where it was found that adolescents with ADHD improve in their inhibitory control when they receive external support to the monitoring F(1, 50) = 21.38, p < .001, η2 = .30. Conclusion: Results suggest that monitoring compensates the poor performance of inhibitory control in adolescents with ADHD, which is a contribution to the theoretical construction of ADHD and to the treatments proposed for this condition because it goes beyond the classic conception of a causality chain among the deficit of inhibitory control and ADHD symptomatology to propose a new explanation about this disorder, where neuropsychology intervention of monitoring would diminish ADHD's symptomatology impact on adolescents.
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Affiliation(s)
- Carlos Ramos-Galarza
- Facultad de Psicología, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.,Laboratorio MIST, Universidad Tecnológica Indoamérica, Quito, Ecuador
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4
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Experimentally altered male mating behaviour affects offspring exploratory behaviour via nongenetic paternal effects. Behav Brain Res 2020; 401:113062. [PMID: 33316325 DOI: 10.1016/j.bbr.2020.113062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Evidence is emerging that fathers can have nongenetic effects on the phenotypes of their offspring. Most studies have focused on the role that nongenetic modifications to sperm can have on offspring phenotype; however, fathers can also have nongenetic effects on offspring through their interactions with females, called female-mediated paternal effects. These effects can occur in situations where male phenotype, e.g. behaviour or morphology, affects female stress and/or provisioning of offspring. These effects are potentially widespread, but few studies have explicitly investigated the role of female-mediated paternal effects on offspring phenotype. Here, we asked if male mating interactions can affect offspring via female mediated paternal effects in the Trinidadian guppy, Poecilia reticulata. To do this, we manipulated mating behaviour by: (i) administering a drug known to affect the neurotransmitter dopamine, and (ii) varying the familiarity of potential mates, which affects attractiveness in this species. With these treatments, we successfully manipulated the mating behaviour of male guppies and female preference for those males. Further, we found significant effects of sire mating behaviour, sire drug treatment, and parental familiarity status on behavioural measures of offspring anxiety in response to a novel object. Because Control offspring of 'familiar' and 'unfamiliar' pairs differed in their behaviour, our results cannot be solely attributed to potential nongenetic modifications to sperm caused by the drug. These results emphasize the importance of female-mediated paternal effects, including those caused by altered male mating behaviour, in shaping offspring phenotype.
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Carias E, Hamilton J, Robison LS, Delis F, Eiden R, Quattrin T, Hadjiargyrou M, Komatsu D, Thanos PK. Chronic oral methylphenidate treatment increases microglial activation in rats. J Neural Transm (Vienna) 2018; 125:1867-1875. [PMID: 30238340 DOI: 10.1007/s00702-018-1931-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
Methylphenidate (MP) is a widely prescribed psychostimulant used to treat attention deficit hyperactivity disorder. Previously, we established a drinking paradigm to deliver MP to rats at doses that result in pharmacokinetic profiles similar to treated patients. In the present study, adolescent male rats were assigned to one of three groups: control (water), low-dose MP (LD; 4/10 mg/kg), and high dose MP (HD; 30/60 mg/kg). Following 3 months of treatment, half of the rats in each group were euthanized, and the remaining rats received only water throughout a 1-month-long abstinence phase. In vitro autoradiography using [3H] PK 11195 was performed to measure microglial activation. HD MP rats showed increased [3H] PK 11195 binding compared to control rats in several cerebral cortical areas: primary somatosensory cortex including jaw (68.6%), upper lip (80.1%), barrel field (88.9%), and trunk (78%) regions, forelimb sensorimotor area (87.3%), secondary somatosensory cortex (72.5%), motor cortices 1 (73.2%) and 2 (69.3%), insular cortex (59.9%); as well as subcortical regions including the thalamus (62.9%), globus pallidus (79.4%) and substantia nigra (22.7%). Additionally, HD MP rats showed greater binding compared to LD MP rats in the hippocampus (60.6%), thalamus (59.6%), substantia nigra (38.5%), and motor 2 cortex (55.3%). Following abstinence, HD MP rats showed no significant differences compared to water controls; however, LD MP rats showed increased binding in pre-limbic cortex (78.1%) and ventromedial caudate putamen (113.8%). These findings indicate that chronic MP results in widespread microglial activation immediately after treatment and following the cessation of treatment in some brain regions.
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Affiliation(s)
- Emily Carias
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - Lisa S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave., Albany, NY, USA
| | - Foteini Delis
- Department of Pharmacology, Medical School, University of Ioannina, 45110, Ioannina, Greece
| | - Rina Eiden
- Department of Psychology, University at Buffalo, 1021 Main St., Buffalo, NY, USA
| | - Teresa Quattrin
- Women and Children's Hospital of Buffalo, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Hadjiargyrou
- Department of Life Sciences, New York Institute of Technology, Northern Blvd., Old Westbury, NY, USA
| | - David Komatsu
- Department of Orthopedics, Stony Brook University, 100 Nicolls Rd., Stony Brook, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1021 Main St., Buffalo, NY, USA.
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6
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Pagerols M, Richarte V, Sánchez-Mora C, Rovira P, Soler Artigas M, Garcia-Martínez I, Calvo-Sánchez E, Corrales M, da Silva BS, Mota NR, Victor MM, Rohde LA, Grevet EH, Bau CHD, Cormand B, Casas M, Ramos-Quiroga JA, Ribasés M. Integrative genomic analysis of methylphenidate response in attention-deficit/hyperactivity disorder. Sci Rep 2018; 8:1881. [PMID: 29382897 PMCID: PMC5789875 DOI: 10.1038/s41598-018-20194-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
Methylphenidate (MPH) is the most frequently used pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD). However, a considerable interindividual variability exists in clinical outcome. Thus, we performed a genome-wide association study of MPH efficacy in 173 ADHD paediatric patients. Although no variant reached genome-wide significance, the set of genes containing single-nucleotide polymorphisms (SNPs) nominally associated with MPH response (P < 0.05) was significantly enriched for candidates previously studied in ADHD or treatment outcome. We prioritised the nominally significant SNPs by functional annotation and expression quantitative trait loci (eQTL) analysis in human brain, and we identified 33 SNPs tagging cis-eQTL in 32 different loci (referred to as eSNPs and eGenes, respectively). Pathway enrichment analyses revealed an over-representation of genes involved in nervous system development and function among the eGenes. Categories related to neurological diseases, psychological disorders and behaviour were also significantly enriched. We subsequently meta-analysed the association with clinical outcome for the 33 eSNPs across the discovery sample and an independent cohort of 189 ADHD adult patients (target sample) and we detected 15 suggestive signals. Following this comprehensive strategy, our results provide a better understanding of the molecular mechanisms implicated in MPH treatment effects and suggest promising candidates that may encourage future studies.
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Affiliation(s)
- Mireia Pagerols
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vanesa Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Sánchez-Mora
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Paula Rovira
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María Soler Artigas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Iris Garcia-Martínez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eva Calvo-Sánchez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Montse Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bruna Santos da Silva
- Department of Genetics, Institute of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nina Roth Mota
- Department of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.,ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo Moraes Victor
- ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eugenio Horacio Grevet
- ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton Henrique Dotto Bau
- Department of Genetics, Institute of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,ADHD Outpatient Program, Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain.,Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Spain
| | - Miguel Casas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.
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Barterian JA, Arnold LE, Brown NV, Farmer CA, Williams C, Findling RL, Kolko DJ, Bukstein OG, Molina BSG, Townsend L, Aman MG. Clinical Implications From the Treatment of Severe Childhood Aggression (TOSCA) Study: A Re-Analysis and Integration of Findings. J Am Acad Child Adolesc Psychiatry 2017; 56:1026-1033. [PMID: 29173736 PMCID: PMC5847292 DOI: 10.1016/j.jaac.2017.09.426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Treatment of Severe Childhood Aggression (TOSCA) project examined augmentation of stimulant treatment and parent training (PT) with risperidone for severe physical aggression. This article summarizes the clinical implications; reanalyzes the data to examine the utility of 4 criteria for deciding to augment; and presents a treatment algorithm. METHOD The newly analyzed 4 criteria for augmenting after 3 weeks of stimulant and PT treatment consisted of not meeting a Clinical Global Impressions-Improvement (CGI-I) score of 1 and a normal score (≤15) on the Nisonger Child Behavior Rating Form Disruptive-Total (D-Total); a CGI-I score of 1 or 2 plus 25% improvement in D-Total score; a D-Total score no higher than 15; and a CGI-Severity score of 3 (mild) or better. Effect sizes were calculated. Prior TOSCA publications were reviewed for clinically relevant findings. RESULTS All 4 criteria resulted in medium or better effect sizes (d = 0.59-0.72) when comparing risperidone with placebo. Providing risperidone to children who did not reach a CGI-I score of 1 plus a D-Total score no higher than 15 resulted in the greatest benefit. In addition, a review of clinically relevant data suggests that stimulant plus PT shows further improvement after 3 weeks even without augmentation. CONCLUSION For those children who did not attain a CGI-I score of 1 and a D-total score no higher than 15, adding risperidone maximized the number of children benefitting from treatment and the average amount of benefit. Unless clinical circumstances dictate otherwise, practitioners should delay an antipsychotic drug for at least 1 month after the optimal stimulant dose is achieved and PT has commenced. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov; NCT00796302.
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Affiliation(s)
| | | | | | | | - Craig Williams
- The Ohio State University-Wexner Medical Center, Columbus
| | | | | | - Oscar G Bukstein
- University of Pittsburgh and currently is with the Boston Children's Hospital and Harvard Medical School, Boston
| | | | | | - Michael G Aman
- The Ohio State University-Wexner Medical Center, Columbus
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Gomez-Sanchez CI, Carballo JJ, Riveiro-Alvarez R, Soto-Insuga V, Rodrigo M, Mahillo-Fernandez I, Abad-Santos F, Dal-Ré R, Ayuso C. Pharmacogenetics of methylphenidate in childhood attention-deficit/hyperactivity disorder: long-term effects. Sci Rep 2017; 7:10391. [PMID: 28871191 PMCID: PMC5583388 DOI: 10.1038/s41598-017-10912-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in which a significant proportion of patients do not respond to treatment. The objective of this study was to examine the role of genetic risk variants in the response to treatment with methylphenidate (MPH). The effectiveness of MPH was evaluated based on variations in the CGI-S and CGAS scales over a 12-month treatment period using linear mixed effects models. A total of 208 ADHD patients and 34 polymorphisms were included in the analysis. For both scales, the response was associated with time, extended-release MPH/both formulations, and previous MPH treatment. For the CGI-S scale, response was associated with SLC6A3 rs2550948, DRD4 promoter duplication, SNAP25 rs3746544, and ADGRL3 rs1868790. Interactions between the response over time and SLC6A3 and DRD2 were found in the CGI-S and CGAS scales, respectively. The proportion of the variance explained by the models was 18% for the CGI-S and 22% for the CGAS. In this long-term study, the effects of SLC6A3, DRD4, SNAP25, and ADGRL3 on response to treatment reflect those observed in previous studies. In addition, 2 previously unreported interactions with response to treatment over a 12-month period were found (SLC6A3 and DRD2).
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Affiliation(s)
- Clara I Gomez-Sanchez
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain
| | - Juan J Carballo
- Department of Psychiatry, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Rosa Riveiro-Alvarez
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain
| | - Victor Soto-Insuga
- Department of Pediatrics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Maria Rodrigo
- Department of Pediatrics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Ignacio Mahillo-Fernandez
- Epidemiology Unit, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, IIS- La Princesa University Hospital (IIS-IP). C/ de Diego Leon, 62, Madrid, 28006, Spain
| | - Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM + CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid. Ciudad Universitaria de Cantoblanco, Madrid, 28049, Spain
| | - Carmen Ayuso
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain.
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain.
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9
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Short- and Long-Term Effects of Methylphenidate on Cost-Benefit Decision Making in Adult Rats. NEUROPHYSIOLOGY+ 2017. [DOI: 10.1007/s11062-017-9629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Ogrim G, Aasen IE, Brunner JF. Single-dose effects on the P3no-go ERP component predict clinical response to stimulants in pediatric ADHD. Clin Neurophysiol 2016; 127:3277-87. [PMID: 27567447 DOI: 10.1016/j.clinph.2016.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/20/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Approximately 30% of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with stimulants are considered non-responders (non-REs). Reliable predictors of response are missing. We examined changes in Event-Related Potentials (ERPs) induced by a single dose of stimulant medication in order to predict later clinical response. METHODS ERPs were registered twice during performance of a visual cued go/no-go task in 87 ADHD patients (27 girls) aged 8-18years; the second recording on a single dose of stimulant medication, followed by a systematic medication trial lasting 4weeks. Based on the four-week trial, participants were categorized as responders (REs, N=62) or non-REs (N=25). Changes among REs and non-REs in ERP components (cueP3, CNV, P3go, N2no-go, P3no-go) and behavioral-test variables were then compared. RESULTS REs and non-REs differed significantly in medication-induced changes in P3no-go, cue-P3, CNV, omission errors, reaction time, and reaction-time variability. The largest effect size was found for P3no-go amplitude (p<.001; d=1.76). Changes in P3no-go and omission errors correctly classified 90% of the REs and 76% of the non-REs, when controlling for the age of the participants. CONCLUSION Clinical response to stimulants can be predicted by assessing single-dose changes in the P3no-go ERP component amplitude. SIGNIFICANCE Changes in P3no-go may be a clinically useful marker of response to stimulants.
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Affiliation(s)
- Geir Ogrim
- Neuropsychiatric Unit, Østfold Hospital Trust, Aasebraatveien 27, 1605 Fredrikstad, Norway; Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Ida Emilia Aasen
- Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, 8656 Mosjøen, Norway.
| | - Jan Ferenc Brunner
- Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, 8656 Mosjøen, Norway; Department of Neuroscience, NTNU, 7491 Trondheim, Norway.
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11
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Wolff N, Rubia K, Knopf H, Hölling H, Martini J, Ehrlich S, Roessner V. Reduced pain perception in children and adolescents with ADHD is normalized by methylphenidate. Child Adolesc Psychiatry Ment Health 2016; 10:24. [PMID: 27453723 PMCID: PMC4957360 DOI: 10.1186/s13034-016-0112-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The present study examined pain perception in children and adolescents with ADHD and the interaction between pain perception and the administration of methylphenidate (MPH) in order to generate hypotheses for further research that will help to clarify the association between ADHD diagnosis, MPH treatment and pain perception. METHODS We included 260 children and adolescents of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) and analyzed parent's assessments of children's pain distribution and pain perception, as well as the influence of MPH administration on pain perception in affected children and adolescents. RESULTS Pain perception was associated with ADHD and MPH administration, indicating that children and adolescents suffering from ADHD without MPH treatment were reported to have lower pain perception compared to both, healthy controls (HC) and ADHD patients medicated with MPH. CONCLUSION We suggest that reduced pain perception in children and adolescents with ADHD not medicated with MPH may lead to higher risk tolerance by misjudgments of dangerous situations, expanding the importance of MPH administration in affected children and adolescents.
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Affiliation(s)
- Nicole Wolff
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Martini
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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12
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Yang YH, Hwang JW, Kim BN, Kang H, Lee JS, Lee DS, Cho SC. A Study about Effects of Osmotic-Controlled Release Oral Delivery System Methylphenidate on Regional Cerebral Blood Flow in Korean Children with Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2016. [DOI: 10.5765/jkacap.2016.27.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Young-Hui Yang
- Department of Child Psychiatry, Seoul National Hospital, Seoul, Korea
| | - Jun-Won Hwang
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Boong-Nyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hyejin Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sung Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo-Churl Cho
- Mental Health Center, Korean Armed Forces Capital Hospital, Seongnam, Korea
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13
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Liu YS, Dai X, Wu W, Yuan FF, Gu X, Chen JG, Zhu LQ, Wu J. The Association of SNAP25 Gene Polymorphisms in Attention Deficit/Hyperactivity Disorder: a Systematic Review and Meta-Analysis. Mol Neurobiol 2016; 54:2189-2200. [PMID: 26941099 DOI: 10.1007/s12035-016-9810-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most highly heritable psychiatric disorders in childhood. The risk gene mutation accounts for about 60 to 90 % cases. Synaptosomal-associated protein of 25 kDa (SNAP-25) is a presynaptic plasma membrane protein which is expressed highly and specifically in the neuronal cells. A number of evidences have suggested the role of SNAP-25 in the etiology of ADHD. Notably, the animal model of coloboma mouse mutant bears a ∼2-cM deletion encompassing genes including SNAP25 and displays spontaneous hyperkinetic behavior. Previous investigators have reported association between SNPs in SNAP25 and ADHD, and controversial results were observed. In this study, we analyzed the possible association between six polymorphisms (rs3746544, rs363006, rs1051312, rs8636, rs362549, and rs362998) of SNAP25 and ADHD in a pooled sample of ten family-based studies and four case-control studies by using meta-analysis. The combined analysis results were significant only for rs3746544 (P = 0.010) with mild association (odds ratio (OR) = 1.14). And, the meta-analysis data for rs8636, rs362549, and rs362998 are the first time to be reported; however, no positive association was detected. In conclusion, we report some evidence supporting the association of SNAP25 to ADHD. Future research should emphasize genome-wide association studies in more specific subgroups and larger independent samples.
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Affiliation(s)
- Yun-Sheng Liu
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xuan Dai
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wei Wu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Fang-Fen Yuan
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xue Gu
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jian-Guo Chen
- Key Lab of Neurological Disorder of Education Ministry, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.,Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Ling-Qiang Zhu
- Key Lab of Neurological Disorder of Education Ministry, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China. .,Department of Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Jing Wu
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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14
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Pagerols M, Richarte V, Sánchez-Mora C, Garcia-Martínez I, Corrales M, Corominas M, Cormand B, Casas M, Ribasés M, Ramos-Quiroga JA. Pharmacogenetics of methylphenidate response and tolerability in attention-deficit/hyperactivity disorder. THE PHARMACOGENOMICS JOURNAL 2016; 17:98-104. [DOI: 10.1038/tpj.2015.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 01/06/2023]
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15
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Connor DF. Pharmacological Management of Pediatric Patients with Comorbid Attention-Deficit Hyperactivity Disorder Oppositional Defiant Disorder. Paediatr Drugs 2015; 17:361-71. [PMID: 26233632 DOI: 10.1007/s40272-015-0143-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common developmental neurobiological condition of childhood characterized by age-inappropriate degrees of hyperactivity/impulsivity and inattention to tasks requiring sustained vigilance. Oppositional defiant disorder (ODD) is an externalizing behavior disorder characterized by difficulties with emotional and behavioral regulation that frequently brings the child into conflict with authority figures. In the clinical setting, ODD is the most common ADHD comorbidity. The combination portends more severe symptom severity, daily impairment, and a more at-risk prognosis than either disorder alone. We briefly review the literature on the characteristics and treatment of the ADHD and ODD child. A clinical approach to evaluation and treatment of ADHD and ODD is then presented. This approach emphasizes the importance of child and parent psychoeducation about the two disorders alone and in combination, the importance of behavioral management therapy approaches, the possible need for school and academic supports, and the decision to use evidence-based stimulant or non-stimulant ADHD medications depending on symptom severity combined with child and parental wishes and choice.
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Affiliation(s)
- Daniel F Connor
- Department of Psychiatry/MC1410, University of Connecticut Medical School, 263 Farmington Avenue, Farmington, CT, 06030-1410, USA.
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16
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Tarazi FI, Sahli ZT, Pleskow J, Mousa SA. Asperger’s syndrome: diagnosis, comorbidity and therapy. Expert Rev Neurother 2015; 15:281-93. [DOI: 10.1586/14737175.2015.1009898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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17
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Doyle CA, McDougle CJ. Pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders across the lifespan. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23226952 PMCID: PMC3513681 DOI: 10.31887/dcns.2012.14.3/cdoyle] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review outlines pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders (ASDs) in children, adolescents, and adults. Symptom domains include repetitive and stereotyped behaviors, irritability and aggression, hyperactivity and inattention, and social impairment. Medications covered include serotonin reuptake inhibitors (SRIs), mirtazapine, antipsychotics, psychostimulants, atomoxetine, α-2 agonists, D-cycloserine, and memantine. Overall, SRIs are less efficacious and more poorly tolerated in children with ASDs than in adults. Antipsychotics are the most efficacious drugs for the treatment of irritability in ASDs, and may be useful in the treatment of other symptoms. Psychostimulants demonstrate some benefit for the treatment of hyperactivity and inattention in individuals with ASDs, but are less efficacious and associated with more adverse effects compared with individuals with ADHD. D-cycloserine and memantine appear helpful in the treatment of social impairment, although further research is needed.
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Affiliation(s)
- Carolyn A Doyle
- Department of Psychiatry, Harvard Medical School; Lurie Center for Autism, Massachusetts General Hospital, Boston, MA, USA
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18
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Strand MT, Hawk LW, Bubnik M, Shiels K, Pelham WE, Waxmonsky JG. Improving working memory in children with attention-deficit/hyperactivity disorder: the separate and combined effects of incentives and stimulant medication. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1193-207. [PMID: 22477205 DOI: 10.1007/s10802-012-9627-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Working memory (WM) is considered a core deficit in Attention-Deficit/ Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was assessed using a visuo-spatial n-back task. Study 1 compared children (ages 9-12 years) with ADHD-Combined type (n = 24) to a group of typically developing (TD) children (n = 32). Study 1 replicated WM deficits among children with ADHD. Incentives improved WM, particularly among children with ADHD. The provision of incentives reduced the ADHD-control group difference by approximately half but did not normalize WM. Study 2 examined the separate and combined effects of incentives and stimulant medication among 17 children with ADHD-Combined type. Both incentives and a moderate dose of long-acting methylphenidate (MPH; ~0.3 mg/kg t.i.d. equivalent) robustly improved WM relative to the no-incentive, placebo condition. The combination of incentives and medication improved WM significantly more than either incentives or MPH alone. These studies indicate that contingencies markedly improve WM among children with ADHD-Combined type, with effect sizes comparable to a moderate dose of stimulant medication. More broadly, this work calls attention to the role of motivation in studying cognitive deficits in ADHD and in testing multifactorial models of ADHD.
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Affiliation(s)
- Michael T Strand
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
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19
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De Sousa A, Kalra G. Drug therapy of attention deficit hyperactivity disorder: current trends. Mens Sana Monogr 2012; 10:45-69. [PMID: 22654382 PMCID: PMC3353606 DOI: 10.4103/0973-1229.87261] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 11/04/2022] Open
Abstract
Attention deficit hyperactivity disorder is a developmental disorder with an age onset prior to 7 years. Children with ADHD have significantly lower ability to focus and sustain attention and also score higher on impulsivity and hyperactivity. Stimulants, such as methylphenidate, have remained the mainstay of ADHD treatment for decades with evidence supporting their use. However, recent years have seen emergence of newer drugs and drug delivery systems, like osmotic release oral systems and transdermal patches, to mention a few. The use of nonstimulant drugs like atomoxetine and various other drugs, such as α-agonists, and a few antidepressants, being used in an off-label manner, have added to the pharmacotherapy of ADHD. This review discusses current trends in drug therapy of ADHD and highlights the promise pharmacogenomics may hold in the future.
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Affiliation(s)
- Avinash De Sousa
- Consultant Psychiatrist & Founder Trustee, Desousa Foundation, Carmel, 18, St. Francis Avenue, Off SV Road, Santacruz West, Mumbai-400 054, Maharashthra, India
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20
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Pardey MC, Kumar NN, Goodchild AK, Clemens KJ, Homewood J, Cornish JL. Long-term effects of chronic oral Ritalin administration on cognitive and neural development in adolescent wistar kyoto rats. Brain Sci 2012; 2:375-404. [PMID: 24961199 PMCID: PMC4061802 DOI: 10.3390/brainsci2030375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022] Open
Abstract
The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) often results in chronic treatment with psychostimulants such as methylphenidate (MPH, Ritalin®). With increases in misdiagnosis of ADHD, children may be inappropriately exposed to chronic psychostimulant treatment during development. The aim of this study was to assess the effect of chronic Ritalin treatment on cognitive and neural development in misdiagnosed “normal” (Wistar Kyoto, WKY) rats and in Spontaneously Hypertensive Rats (SHR), a model of ADHD. Adolescent male animals were treated for four weeks with oral Ritalin® (2 × 2 mg/kg/day) or distilled water (dH2O). The effect of chronic treatment on delayed reinforcement tasks (DRT) and tyrosine hydroxylase immunoreactivity (TH-ir) in the prefrontal cortex was assessed. Two weeks following chronic treatment, WKY rats previously exposed to MPH chose the delayed reinforcer significantly less than the dH2O treated controls in both the DRT and extinction task. MPH treatment did not significantly alter cognitive performance in the SHR. TH-ir in the infralimbic cortex was significantly altered by age and behavioural experience in WKY and SHR, however this effect was not evident in WKY rats treated with MPH. These results suggest that chronic treatment with MPH throughout adolescence in “normal” WKY rats increased impulsive choice and altered catecholamine development when compared to vehicle controls.
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Affiliation(s)
- Margery C Pardey
- Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - Natasha N Kumar
- The Australian School of Advanced Medicine, Macquarie University, Sydney 2109, Australia.
| | - Ann K Goodchild
- The Australian School of Advanced Medicine, Macquarie University, Sydney 2109, Australia.
| | - Kelly J Clemens
- Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - Judi Homewood
- Department of Psychology, Macquarie University, Sydney 2109, Australia.
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21
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Doyle CA, McDougle CJ. Pharmacotherapy to control behavioral symptoms in children with autism. Expert Opin Pharmacother 2012; 13:1615-29. [DOI: 10.1517/14656566.2012.674110] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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When does it end? Attention-deficit/hyperactivity disorder in the middle aged and older populations. Clin Neuropharmacol 2011; 34:148-54. [PMID: 21738027 DOI: 10.1097/wnf.0b013e3182206dc1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is estimated to affect 4% to 6% of the adult population. In recent years, more and more middle-aged and older adults (>55 years) turn to the ADHD unit at Geha Mental Health Center suspecting ADHD. Yet, a literature search resulted in very few relevant studies. METHODS AND RESULTS This study, approved by the Geha Mental Health Center ethics committee, presents 11 patients, 55 years or older, diagnosed and treated by the unit. The patients underwent complete clinical evaluation for ADHD according to Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. The data-collection phase included demographic and clinical data; Test of Variables of Attention scores used as indicators of methylphenidate (MPH) response; Clinical Global Impression scores of both severity and improvement were used. Because the sample is very small, allowing only limited statistical analyses, nonparametric statistics were used. Eleven patients, aged 61.64 ± 3.87 years (male-female ratio, 9:2), were assessed. The follow-up was conducted for more than 2 months. Fifty-five percent had ADHD, predominantly inattentive, and 45% had ADHD combined type. All patients indicated suffering (Clinical Global Impression-Severity score range: mild = 27.3%, moderate = 45.4%, severe = 27.3%). Fifty-four percent showed at least 1 psychiatric comorbidity. Test of Variables of Attention scores showed significant improvement in 90% (8/9 patients) with MPH dosages similar to those used in younger adults. All patients attended the follow-up visits. Ninety-one percent (10/11) continued with the medication. Clinical Global Impression-Improvement scores showed significant improvement in 73%. No adverse effects were reported. CONCLUSIONS This pilot study described 11 adults 55 years or older, diagnosed with ADHD for the first time. Attention-deficit/hyperactivity disorder characteristics seemed to persevere; middle aged or older ADHD patients had similar clinical-demographic characteristics and a similar response to MPH as younger adults. No significant adverse effects were noted.
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Goldsmith M, Singh M, Chang K. Antidepressants and psychostimulants in pediatric populations: is there an association with mania? Paediatr Drugs 2011; 13:225-43. [PMID: 21692547 PMCID: PMC3394932 DOI: 10.2165/11591660-000000000-00000] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article reviews the literature that examines whether exposure to psychostimulants or antidepressants precipitates or exacerbates manic symptoms, or decreases the age at onset of mania in pediatric populations. A PubMed search using relevant key words identified studies targeting five distinct clinical groups: (i) youth without a diagnosis of bipolar disorder (BD) at the time of exposure to psychostimulants; (ii) youth with a diagnosis of BD at the time of exposure to psychostimulants; (iii) youth without a diagnosis of BD at the time of exposure to antidepressants; (iv) youth with a diagnosis of BD at the time of exposure to antidepressants; and (v) youth who develop BD after exposure to these medications. In patients with attention-deficit hyperactivity disorder (ADHD), the risk for mania was found to be relatively low with the use of psychostimulants. For patients with BD and ADHD, effective mood stabilization is important prior to adding a stimulant. For children with depression and/or anxiety, the risk of antidepressant-induced mania (AIM) was generally low (<2%), but the risk of general 'activation' secondary to a selective serotonin reuptake inhibitor (SSRI) may be greater (2-10%). However, rates of AIM in specialty clinics appear to be much higher. SSRIs may be particularly problematic in specific populations, such as those with some symptoms of mania or a family history of BD, but the precise risk is unknown. There is no clear evidence that stimulants or SSRIs accelerate the natural course of BD development in overall samples, but in individual cases prescribers should proceed cautiously when using these agents in youth already at risk for developing BD, such as those with ADHD and mood dysregulation, a history of prior AIM, a history of psychosis, or a family history of BD.
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Affiliation(s)
- Michelle Goldsmith
- Stanford Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Department of Psychiatry, 401 Quarry Road, Stanford, CA 94305, USA
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Blankenship K, Erickson CA, Stigler KA, Posey DJ, McDougle CJ. Guanfacine extended release in two patients with pervasive developmental disorders. J Child Adolesc Psychopharmacol 2011; 21:287-90. [PMID: 21663433 PMCID: PMC3111864 DOI: 10.1089/cap.2010.0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kelly Blankenship
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Craig A. Erickson
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Kimberly A. Stigler
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - David J. Posey
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. McDougle
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
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Spencer TJ, Mick E, Surman CBH, Hammerness P, Doyle R, Aleardi M, Kotarski M, Williams CG, Biederman J. A randomized, single-blind, substitution study of OROS methylphenidate (Concerta) in ADHD adults receiving immediate release methylphenidate. J Atten Disord 2011; 15:286-94. [PMID: 20495161 DOI: 10.1177/1087054710367880] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The main aim of this study was to examine the efficacy, tolerability, and compliance of an extended-release formulation of methylphenidate (OROS-MPH) in adults with ADHD receiving immediate-release methylphenidate (IR-MPH). METHOD Participants were outpatient adults with ADHD who were stable on IR-MPH-administered TID. Participants were randomized (4:1) to equipotent doses of OROS-MPH or to continue IR-MPH and were assessed weekly for 6 weeks with the Adult ADHD Investigator System Symptom Report Scale (AISRS). RESULTS Randomization of 53 IR-MPH responders to IR- or OROS-MPH had no effect on AISRS score at endpoint (11.2 ± 6.9 vs. 10.7 ± 5.1, p = .8). Participants stabilized on IR-MPH and switched to OROS-MPH remained satisfied over 71% of the time. However, the IR-MPH group missed more doses (7.3 ± 6.8 vs. 3.3 ± 4.2, p = .02) than the OROS-MPH group. CONCLUSION Findings showed that adults with ADHD can be successfully switched from an effective regimen of IR-MPH TID to once-daily OROS-MPH. Results also demonstrated better compliance with OROS-MPH than with IR-MPH treatment.
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Affiliation(s)
- Thomas J Spencer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Adrenergic α2A receptor gene is not associated with methylphenidate response in adults with ADHD. Eur Arch Psychiatry Clin Neurosci 2011; 261:205-11. [PMID: 21103886 DOI: 10.1007/s00406-010-0172-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/09/2010] [Indexed: 01/20/2023]
Abstract
Adrenergic α2A receptor gene (ADRA2A) is one of the most promising candidate genes for ADHD pharmacogenetics. Thus far, three studies have investigated the association between the ADRA2A -1291 C>G polymorphism and the therapeutic response to methylphenidate (MPH) in children with ADHD, all of them with positive results. The aim of this study is to investigate, for the first time, the association between three ADRA2A polymorphisms (-1291 C>G, -262 G>A, and 1780 C>T) and the response to MPH in adults with ADHD. The sample comprises 165 Brazilians of European descent evaluated in the adult ADHD outpatient clinic of the Hospital de Clínicas de Porto Alegre. The diagnostic procedures followed the DSM-IV criteria. Drug response was assessed by both categorical and dimensional approaches, through the scales Swanson, Nolan, and Pelham Rating scale version IV and the Clinical Global Impression-Severity Scale, applied at the beginning and after the 30th day of treatment. We found no evidence of association between the three ADRA2A polymorphisms and the therapeutic response to MPH treatment. Our findings do not support a significant role for the ADRA2A gene in ADHD pharmacogenetics, at least among adult patients.
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Binding of [123I]iodobenzamide to the rat D2 receptor after challenge with various doses of methylphenidate: an in vivo imaging study with dedicated small animal SPECT. Eur J Nucl Med Mol Imaging 2010; 38:694-701. [PMID: 21110190 DOI: 10.1007/s00259-010-1668-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 11/01/2010] [Indexed: 02/05/2023]
Abstract
PURPOSE The effect of various doses of methylphenidate on the binding of [(123)I]iodobenzamide ([(123)I]IBZM) to the rat D(2) receptor was assessed using small animal SPECT. METHODS D(2) receptor binding was measured at baseline and after pretreatment with various doses of methylphenidate. For baseline and methylphenidate challenge, striatal equilibrium ratios (V(3)″) were computed as an estimation of the binding potential. RESULTS After methylphenidate, striatal V(3)″ was 1.61 ± 0.61 (mean ± SD; 0.3 mg/kg), 0.91 ± 0.44 (3 mg/kg), 1.01 ± 0.44 (10 mg/kg), 0.91 ± 0.34 (30 mg/kg) and 0.99 ± 0.51 (60 mg/kg). Baseline values amounted to 1.73 ± 0.48, 1.32 ± 0.35, 1.50 ± 0.27, 1.82 ± 0.55 and 1.66 ± 0.41, respectively. Differences between baseline and methylphenidate were significant for the doses 3, 10, 30 and 60 mg/kg, whereas no significant difference was obtained for 0.3 mg/kg methylphenidate. Between-group differences of percentage reduction of D(2) receptor binding were only significant for the groups pretreated with 0.3 and 30 mg/kg methylphenidate, respectively. CONCLUSION Methylphenidate between 0.3 and 60 mg/kg decreased D(2) receptor binding with a maximum reduction after 30 mg/kg. As no between-group differences were evident between the groups pretreated with 3, 10, 30 and 60 mg/kg, it may be inferred that doses ≥ 3 mg/kg were sufficient to induce maximum dopamine concentration in the synaptic cleft. Further investigations are needed in order to clarify whether the variation between subjects can be accounted for by different synaptic mechanisms at the presynaptic binding site.
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Engert V, Pruessner JC. Dopaminergic and noradrenergic contributions to functionality in ADHD: the role of methylphenidate. Curr Neuropharmacol 2010; 6:322-8. [PMID: 19587853 PMCID: PMC2701285 DOI: 10.2174/157015908787386069] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/18/2008] [Accepted: 08/04/2008] [Indexed: 12/23/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a childhood psychiatric condition characterized by severe impulsiveness, inattention and overactivity. Methylphenidate (MPH), a psychostimulant affecting both the dopaminergic and the noradrenergic systems, is one of the most frequently prescribed treatments for ADHD. Despite the widespread use of MPH and its proven effectiveness, its precise neurochemical mechanisms of action are under debate. For the most part, MPH’s influence on subcortical dopamine neurotransmission is thought to play a crucial role in its behavioral and cognitive effects. In their hypothesis of biphasic MPH action, Seeman and Madras [42, 43] suggest that therapeutic doses of MPH elevate tonic dopamine while inhibiting phasic transmitter release in subcortical structures, leading to reduced postsynaptic receptor stimulation and psychomotor activation in response to salient stimuli. Volkow and colleagues [56] suggest that by amplifying a weak striatal dopamine signal, MPH increases the perception of a stimulus or task as salient. The enhanced interest for the task is thought to increase attention and improve performance. Recent animal studies have however shown that when administered at doses producing clinically relevant drug plasma levels and enhancing cognitive function, MPH preferentially activates dopamine and noradrenaline efflux within the prefrontal cortex relative to the subcortical structures [5]. Overall, we suggest that the delineated theories of MPH therapeutic action should not be discussed as exclusive. Studies are outlined that allow integrating the different findings and models.
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Affiliation(s)
- Veronika Engert
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada H4H 1R3.
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Newcorn JH, Stein MA, Cooper KM. Dose-response characteristics in adolescents with attention-deficit/hyperactivity disorder treated with OROS methylphenidate in a 4-week, open-label, dose-titration study. J Child Adolesc Psychopharmacol 2010; 20:187-96. [PMID: 20578931 DOI: 10.1089/cap.2009.0102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate dose-response characteristics in adolescents with attention-deficit/hyperactivity disorder (ADHD) treated with once-daily OROS methylphenidate (OROS MPH) during the 4-week, open-label, escalating dose-titration phase of a larger multisite, placebo-controlled trial. Patient factors such as age, height, weight, and baseline symptom severity were evaluated as predictors of selected dose, as was the degree of incremental response with each successive dose escalation. METHODS Adolescents 13-18 years of age with ADHD underwent a 4-week, open-label, escalating dose-titration trial to determine the minimal effective dose (18, 36, 54, or 72 mg once daily) of OROS to be used in a multiphase, placebo-controlled study (NCT00249353). Both final absolute dose and mean weight-adjusted dose were used to assess predictors of response, using a one-way analysis of variance and regression analyses. RESULTS The majority of subjects who did not respond at lower doses achieved response at each escalating dose level. Approximately two-thirds of subjects required a dose of 54 mg or greater to achieve improvement criteria. Minimal effective dose correlated modestly with baseline symptom severity. Age, height, and weight did not correlate with absolute dose and accounted for only a small percentage of variance in weight-based dose. Weight was not a major factor in predicting effective dose; however, using weight-adjusted rather than absolute dose proved slightly superior for modeling of adverse effects. CONCLUSIONS Adolescents required, on average, a higher absolute dose but a lower weight-adjusted dose (mg/kg) of OROS) than was previously reported in children. There were few predictors of optimal dose of OROS other than baseline symptom severity. The increased percentage of adolescent responders at each dose level using this clinically driven approach to titration differs from recent findings from randomized forced dose titration studies in adults with ADHD.
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McCloskey M, Palmer AA, de Wit H. Are attention lapses related to d-amphetamine liking? Psychopharmacology (Berl) 2010; 208:201-9. [PMID: 19936714 PMCID: PMC4004179 DOI: 10.1007/s00213-009-1719-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
Abstract
RATIONALE A rich literature suggests that both impulsiveness and drug-induced euphoria are risk factors for drug abuse. However, few studies have examined whether sensitivity to the euphoric effects of stimulants is related to attention lapses, a behavioral measure of inattention sometimes associated with impulsivity. OBJECTIVE The aim of the study was to examine ratings of d-amphetamine drug liking among individuals with high, moderate, and low attention lapses. METHODS Ninety-nine healthy volunteers were divided into three equal-sized groups based on their performance on a measure of lapses of attention. The groups, who exhibited low, medium, and high attention lapses (i.e., long reaction times) on a simple reaction time task, were compared on their subjective responses (i.e., ratings of liking and wanting more drug) after acute doses of d-amphetamine (0, 5, 10, and 20 mg). RESULTS Subjects who exhibited high lapses liked 20 mg d-amphetamine less than subjects who exhibited low lapses. These subjects also tended to report smaller increases in "wanting more drug" after d-amphetamine. CONCLUSION The findings suggest that participants who exhibit impaired attention may be less sensitive to stimulant-induced euphoria.
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Affiliation(s)
- Michael McCloskey
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA.
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Sheridan MA, Hinshaw S, D’Esposito M. Stimulant medication and prefrontal functional connectivity during working memory in ADHD: a preliminary report. J Atten Disord 2010; 14:69-78. [PMID: 20576647 PMCID: PMC2935299 DOI: 10.1177/1087054709347444] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent theoretical and empirical work suggests that while unmedicated, children with ADHD have a deficit in subcortical processing that leads to greater and more varied prefrontal cortical (PFC) activation, compared to (a) age-matched control participants and (b) their own brain activity while on stimulant medication. This pattern has been described elsewhere as inefficient. METHOD Functional magnetic resonance imaging (fMRI) and functional connectivity analyses were used during a working memory task for five female adolescents with ADHD, aged 11 to 17 years, both on and off their usual dose of stimulant medication. RESULTS On medication, adolescents with ADHD demonstrated less PFC activation and less functional connectivity between frontal and subcortical regions compared to off medication. CONCLUSIONS Because of the small sample size, results are presented as preliminary findings which await replication in a larger sample. However, these findings lend support to the idea that remediation of inefficiencies in PFC function for individuals with ADHD by stimulant medication may be related, in part, to frontal-subcortical connectivity.
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Affiliation(s)
- Margaret A. Sheridan
- Robert Wood Johnson Foundation Health & Society Scholar at the Harvard School of Public Health in Harvard University,Developmental Medicine Center, Children’s Hospital Boston
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley
| | - Mark D’Esposito
- Corresponding Author: Helen Wills Neuroscience Institute; 132 Barker Hall, #3190; Berkeley, CA 94720-3190. Tel.:510-642-2593; fax: 510-642-3192,
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Janknegt R, Faber A, Rodrigues Pereira R, Kalverdijk LJ. InforMatrix for attention deficit hyperactivity disorder. Expert Opin Pharmacother 2009; 10:755-72. [PMID: 19351226 DOI: 10.1517/14656560902765769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this review is to facilitate discussion on drug selection for the treatment of ADHD by using only clinically relevant selection criteria and providing an up-to-date overview. The InforMatrix method was used to select drugs to treat attention deficit hyperactivity disorder (ADHD). The following selection criteria were applied: clinical efficacy, safety, tolerability, ease of use, applicability, and cost. The drugs approved for ADHD in the Netherlands were included in the analysis, namely: atomoxetine, immediate-release methylphenidate, and various formulations of slow-release methylphenidate (Concerta, Equasym and Medikinet). Most studies are of limited quality, duration, and size. In one study, Concerta was more effective than atomoxetine. Although no relevant differences were seen in other comparative studies, the clinical experience with atomoxetine is still limited and unexpected toxicity cannot be excluded; few studies have been published with Equasym and Medikinet. No major differences were seen in general tolerability between the drugs. The ease of use of immediate-release methylphenidate is less than for the other drugs. The acquisition cost of immediate-release methylphenidate is considerably lower than that of the slow-release formulations. Atomoxetine is the most expensive drug. The InforMatrix program is available in an interactive format. It enables the user to judge both the importance of the selection criteria and the properties of each therapeutic option per criterion on the basis of his or her own personal expertise and/or the present document.
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Affiliation(s)
- Robert Janknegt
- Hospital Pharmacist, Clinical Pharmacologist Maasland Ziekenhuis, Postbus, Sittard, The Netherlands.
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Hong Q, Zhang M, Pan XQ, Guo M, Li F, Tong ML, Chen RH, Guo XR, Chi X. Prefrontal cortex Homer expression in an animal model of attention-deficit/hyperactivity disorder. J Neurol Sci 2009; 287:205-11. [PMID: 19709672 DOI: 10.1016/j.jns.2009.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 07/16/2009] [Accepted: 07/24/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a pervasive neurobehavioral disorder affecting approximately 5% of children and adolescents and 3% of adults, and the prefrontal cortex (PFC) may play the most critical role in the expression of ADHD. Converging previous studies indicate a potential role of Homer--a scaffolding protein family localized at the postsynaptic density (PSD) of glutamatergic excitatory synapses--in behavioral pathologies associated with neuropsychiatric disorders. Accordingly, we speculate that these Homer isoforms might contribute to the etiology and development of ADHD. METHOD We investigated the differential mRNA and protein expressions of several Homer isoforms in the PFC of the spontaneous hypertensive rat/Wistar-Kyoto rats (SHR/WKY), the most frequently used animal model of ADHD, using RT-PCR and western blotting. Furthermore, we examined the effects of methylphenidate (MPH) exposure on the behaviors and the expression of different Homer isoforms in the PFC of SHR, using Làt maze, RT-PCR and western blotting, respectively. RESULTS Homer 1a and Homer 2a/b, but not Homer 1b/c, were expressed at a significantly lower levels in the PFC of SHR compared with WKY. MPH exposure decreased the locomotor activity and non-selective attention of SHR, and it up regulated the expression of Homer 1a and Homer 2a/b, but not Homer 1b/c, in the PFC of SHR. CONCLUSION It is plausible that Homer 1a and Homer 2a/b may be involved in the etiology and pathogenesis of ADHD. Future work will focus on elucidating the specific mechanisms of Homer 1a and Homer 2a/b in ADHD.
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Affiliation(s)
- Qin Hong
- Department of Pediatrics, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing 210004, China
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Chou WJ, Chou MC, Tzang RF, Hsu YC, Gau SSF, Chen SJ, Wu YY, Huang YF, Liang HY, Cheng H. Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes. Psychiatry Clin Neurosci 2009; 63:167-75. [PMID: 19335386 DOI: 10.1111/j.1440-1819.2009.01937.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine factors for switching to osmotic release oral system methylphenidate (OROS-MPH) among poor adherents to immediate-release methylphenidate (IR-MPH); and to compare the efficacy of OROS-MPH on the three attention-deficit/hyperactivity disorder (ADHD) subtypes in a multi-site prospective observational study in Taiwan. METHODS The sample included 240 children with ADHD, aged 6-16 years, who were poor adherents to IR-MPH, 137 of whom were switched to OROS-MPH. The child psychiatrists diagnosed the Diagnostic Statistical Manual of Mental Disorders (4th edition) ADHD subtypes and assessed the medical history, adherence, side-effects, global ADHD severity, and family/school effectiveness. Parents reported their child's behavioral symptoms. RESULTS The determinants for an OROS-MPH switch were higher dosage, shorter treatment and thrice-daily administration of IR-MPH, and more severe inattention symptoms. Hyperactivity and oppositional symptoms were greater in the ADHD combined and hyperactive-impulsive subtypes than the inattentive subtype. Switching to OROS-MPH significantly improved behavioral symptoms and family/school measures, and this was most evident in the ADHD-combined group, followed by the ADHD-inattentive group. Inattention influenced not only academic performance, but also overall classroom behaviors and the parent-child relationship, with the latter two also influenced by oppositional symptoms. CONCLUSIONS This study suggests better efficacy for the OROS-MPH among poor adherents to IR-MPH; however, its effectiveness varied across the three ADHD subtypes (ClinicalTrials.gov number NCT00460720).
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Affiliation(s)
- Wen-Jiun Chou
- Department of Child Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Leddy JJ, Waxmonsky JG, Salis RJ, Paluch RA, Gnagy EM, Mahaney P, Erbe R, Pelham WE, Epstein LH. Dopamine-related genotypes and the dose-response effect of methylphenidate on eating in attention-deficit/hyperactivity disorder youths. J Child Adolesc Psychopharmacol 2009; 19:127-36. [PMID: 19364291 DOI: 10.1089/cap.2008.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are individual differences in the effects of methylphenidate (MPH), a dopamine (DA) transport inhibitor, on appetite in children with attention-deficit/hyperactivity disorder (ADHD). One potential moderating factor is variation in brain DA activity, which is influenced by dopamine-related genes: the DA transporter (DAT) (SLC6A3), the DA D2 receptor (DRD2), and the DA D4 receptor (DRD4) genes. The purpose of this study was to explore the relationship between dopamine-related gene polymorphisms and food consumption in ADHD children receiving varying doses of MPH. METHODS In a randomized, within-subject, double-blind design, 58 ADHD children (ages 6-12 years) received placebo, 0.15, 0.3, or 0.6 mg/kg of MPH three times daily over 9 weeks. Observations of percent lunch consumed as a function of dopamine-related genotypes and MPH dose were analyzed using mixed effects regression models. RESULTS A significant dose-response reduction in eating was observed across all genotypes (p < 0.001). There was an interaction of DAT SLC6A3 and DRD2 genotypes and dose, because 9/9 DAT children showed a stronger effect of dose when compared with the 9/10 and 10/10 children (p < 0.001) and DRD2 A2/A2 children showed a stronger effect of dose when compared with A1/A1 and A1/A2 children combined (p = 0.007). There was no significant interaction of dose by DRD4 genotype. CONCLUSIONS Lunch consumption decreased as a function of MPH dose. DA-related genotypes associated with greater brain DA signaling moderated the influence of drug on consumption. These results provide information relevant to predicting which children are likely to experience the greatest appetite suppression when taking MPH.
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Affiliation(s)
- John J Leddy
- State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
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Ghaffari M. The abuse potential of medications for attention-deficit/hyperactivity disorder: Recent advances in our understanding. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s12618-009-0005-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE To evaluate stimulant dosing patterns in the community treatment of children with attention-deficit/hyperactivity disorder (ADHD). METHOD Claims data from U.S. managed care organizations (2000-2004) were analyzed for patients ages 6 to 12 years treated for ADHD with osmotically released oral system (OROS) methylphenidate (MPH; n = 3,815), immediate-release (IR) MPH (n = 1,960), mixed amphetamine salts extended-release (MAS XR; n = 1,847), or IR MAS (n = 1,937), and who filled prescriptions covering at least 72 of the first 90 days of treatment. RESULTS The mean initial and maximum dosages were 23.8 and 33.4 mg/day for OROS MPH, 14.8 and 21.8 mg/day for IR MPH, 12.7 and 17.4 mg/day for MAS XR, and 11.2 and 16.5 mg/day for IR MAS. Dose titration occurred in 51.8% (MAS XR) to 61.6% (IR MPH) of patients. Lower initial dose and three or more visits for the treatment of ADHD during the first 90 days of treatment were associated with dose titration. Maximum dose was significantly related to higher initial dose and titration for all four stimulants. For children treated with OROS MPH or IR MAS, treatment by a psychiatrist was significantly related to higher maximum dose. CONCLUSIONS Among children with ADHD who continue stimulants through the first 3 months of treatment, dosing in the community treatment of ADHD tends to be lower than doses used in clinical trials. When titration does occur, it is linked to lower initial dosing, clinical monitoring, higher final stimulant doses, and treatment by a psychiatrist.
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Objective versus subjective assessment of methylphenidate response. Child Psychiatry Hum Dev 2008; 39:273-82. [PMID: 18058019 DOI: 10.1007/s10578-007-0087-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
Subjective improvement-assessment in attention deficit/hyperactivity disorder (ADHD), following a single dose of methylphenidate (MPH) was compared to performance on the Test-of-Variables-of-Attention (TOVA). Self-perception was assessed with the clinical-global-impression-of-change (CGI-C). Participants included 165 ADHD subjects (M:F ratio 67%:33%) aged 5-18 (11.09 +/- 3.43) years. TOVA was administered before and after MPH challenge (0.3 mg/kg). Self-perception CGI-C scores were compared to the TOVA scores. An inverse correlation was found only between CGI-C and the TOVA-Commission-scores (r = -0.326, p < 0.001). We thus conclude that subjective reports are too unreliable to be used in order to assess MPH benefit in ADHD pediatric populations.
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Affiliation(s)
- Craig A Erickson
- Department of Psychiatry, Indiana University School of Medicine, and the Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis 46202-4800, USA
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Findling RL, Greenhill LL, McNamara NK, Demeter CA, Kotler LA, O'Riordan MA, Myers C, Reed MD. Venlafaxine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007; 17:433-45. [PMID: 17822339 DOI: 10.1089/cap.2007.0119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objectives of this pilot study were to explore the changes in symptom severity, tolerability, and the pharmacodynamics of venlafaxine treatment in youths with attention-deficit/hyperactivity disorder (ADHD). METHODS This was a 2-week, open-label, outpatient trial of venlafaxine in children and adolescents, ages 5-17 years, with ADHD. Three dosing strata, 0.5, 1.0, and 2.0 mg/kg per day, were examined. ADHD symptom severity and improvement assessments included the ADHD Rating Scale (ARS-IV) and the Clinical Global Impressions Scale (CGI). During this study, venlafaxine, O-desmethylvenlafaxine (ODV), norepinephrine, and serotonin concentrations were obtained. RESULTS Thirty-eight participants (33 males) were treated in this trial. Overall, parent-completed and teacher-completed ARS-IV total scores showed a statistically significant positive change at the end of the study when compared to baseline (p < 0.05). Significant increases in plasma venlafaxine concentrations were observed at day 15 when compared to day 8 (p = 0.04). In addition, plasma norepinephrine and serotonin concentrations were found to be significantly decreased from baseline at end of study (p < 0.05). Four patients ended participation in the study prematurely: lost to follow up (n = 2), withdrawal of consent (n = 1), and worsening of ADHD symptoms after 8 days of treatment (n = 1). There were no discontinuations due to other adverse events. CONCLUSIONS Venlafaxine appeared to offer some benefit and appears to be relatively safe for the short-term treatment of ADHD in this open-label trial. The pharmacodynamics of venlafaxine in youths are consistent with serotonergic and neuradrenergic modulation.
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Affiliation(s)
- Robert L Findling
- Department of Psychiatry, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5080, USA.
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Gau SSF, Huang YS, Soong WT, Chou MC, Chou WJ, Shang CY, Tseng WL, Allen AJ, Lee P. A randomized, double-blind, placebo-controlled clinical trial on once-daily atomoxetine in Taiwanese children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007; 17:447-60. [PMID: 17822340 DOI: 10.1089/cap.2006.0091] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of the once-daily atomoxetine compared with placebo in pediatric patients with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. METHOD The study sample included 106 patients aged 6-16 years who met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria of ADHD randomly assigned to atomoxetine once daily (n = 72) and placebo once daily (n = 34) in a double-blind, 6-week treatment study. The primary efficacy measure was the total score of the ADHD Rating Scale-IV Parents Version: Investigator Administered and Scored. The secondary efficacy measures included the Clinical Global Impressions--ADHD--Severity and Chinese Conner's Parent and Teacher Rating Scale--Revised: Short Form. Data were analyzed on an intent-to-treat basis and a last-observation-carried-forward approach. RESULTS The two treatment groups did not differ in demographics and baseline measures. Compared to the placebo group, the atomoxetine group showed significantly greater reductions in ADHD-related symptoms according to the ratings of investigators, parents, and teachers. The treatment effect size of the primary efficacy measure was 0.70 at the end of study. Adverse events reported significantly more frequently with atomoxetine were decreased appetite (36.1%) and nausea (16.6%). No drug-related serious adverse event was observed. CONCLUSIONS Once-daily atomoxetine is an effective, well-tolerable, and safe treatment for children and adolescents with ADHD in Taiwan.
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Affiliation(s)
- Susan S F Gau
- Department of Psychiatry, College of Medicine, National Taiwan Universiy, Taipei, Taiwan
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Hermens DF, Rowe DL, Gordon E, Williams LM. Integrative neuroscience approach to predict ADHD stimulant response. Expert Rev Neurother 2006; 6:753-63. [PMID: 16734523 DOI: 10.1586/14737175.6.5.753] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite high rates of prescription, little is known about the long-term consequences of stimulant medication therapy for attention-deficit hyperactivity disorder (ADHD) sufferers. Historically, the clinical use of stimulants for ADHD has been based on trial and error before optimal therapy is reached. Concurrently, scientific research on the mechanism of action of stimulants has influenced neurobiological models of ADHD, but has not always informed their prescription. Whilst the two main stimulant types (methylphenidate and dexamphetamine) have numerous similarities, they also differ (slightly) in mechanism and possibly individual response. A further issue relates to differences in cost and availability compounded by the expectation for stimulants to be effective in ameliorating a broad spectrum of ADHD-related symptoms. Thus, there is an increasing need for treating clinicians to prescribe not only the most effective drug, but also the most appropriate dose with the associated release mechanism and schedule for each ADHD patient presented. In this regard, the field is witnessing an emergence of the personalized medicine approach to ADHD, in which treatment decisions are tailored to each individual. This shift requires a new approach to research into treatment response prediction. Given the heterogeneity of ADHD, a profile of information may be required to capture the most sensitive predictors of treatment response in individuals. These profiles will also benefit from the integration of data from clinical rating scales with more direct measures of cognition and brain function. In conclusion, there is a need to establish a more robust normative framework as the baseline for treatment, as well as diagnostic decisions, and as discussed, the growth of integrated neuroscience databases will be important in this regard.
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Affiliation(s)
- Daniel F Hermens
- The Brain Dynamics Centre, Westmead Millennium Institute and Western Clinical School, University of Sydney, Westmead Hospital, NSW, Australia
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Ben-Pazi H, Shalev RS, Gross-Tsur V, Bergman H. Age and medication effects on rhythmic responses in ADHD: Possible oscillatory mechanisms? Neuropsychologia 2006; 44:412-6. [PMID: 16083921 DOI: 10.1016/j.neuropsychologia.2005.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 05/01/2005] [Accepted: 05/27/2005] [Indexed: 11/29/2022]
Abstract
Voluntary motor responses in children with attention-deficit hyperactivity disorder (ADHD) may reflect underlying neuronal oscillatory mechanisms. The aims of this study were: (1) to corroborate the presence of rhythmic motor abnormalities on tapping test in children with attention-deficit hyperactivity disorder, shown in previous studies; (2) to delineate the characteristics of ADHD children demonstrating these rhythmic abnormalities; (3) to assess the impact of methylphenidate (Ritalin) on this abnormal motor phenomenon. The study was designed in a double blind manner. Sixty-four ADHD children aged 6-12 years and 60 matched controls underwent a finger tapping test (1-5 Hz). We measured the abnormal rhythmic tapping with and without methylphenidate treatment in a double blind design. Conventional statistical analysis was used to assess the correlation of the presence of motor abnormality with various clinical characteristics (such as degree of hyperactivity/impulsivity). Fifty-six percent of children with ADHD compared to 8% of controls demonstrated abnormal rhythmic responses at a mean frequency of 3.1+/-0.9 Hz. These erroneous voluntary movements were more common in children with a greater degree of hyperactivity, in younger children but not significantly altered by methylphenidate treatment. Surprisingly, abnormal rhythmic responses showed less variability than found for responses for which the tapping was adequately paced, suggesting different motor control processes for normal and abnormal paced tapping. We speculate that rhythmic tapping responses reflect abnormal oscillatory mechanisms involved in ADHD, exacerbated in younger children with ADHD and in those in whom the hyperactivity/impulsivity is more pronounced.
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Affiliation(s)
- Hilla Ben-Pazi
- Neuropediatric Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, Israel.
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47
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Feron FJM, Hendriksen JGM, van Kroonenburgh MJPG, Blom-Coenjaerts C, Kessels AGH, Jolles J, Weber WEJ, Vles JSH. Dopamine transporter in attention-deficit hyperactivity disorder normalizes after cessation of methylphenidate. Pediatr Neurol 2005; 33:179-83. [PMID: 16139732 DOI: 10.1016/j.pediatrneurol.2005.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 02/17/2005] [Accepted: 04/18/2005] [Indexed: 11/23/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder of childhood, which is frequently treated with methylphenidate. The short-term response to treatment with methylphenidate is a substantial decrease in dopamine transporter density, with improvement in neuropsychological tests. In this study, single-photon emission computed tomography was used to investigate possible long-term alterations in the cerebral dopamine system after cessation of treatment with methylphenidate in five children with ADHD. Three months after initiation of treatment with methylphenidate, a reduction of the dopamine transporter in the striatal system was observed. Methylphenidate was administered for a period of 9 to 20 months. Follow-up with single-photon emission computed tomography after withdrawal of methylphenidate medication disclosed an increase of dopamine transporter activity comparable with pretreatment values. The observed upregulation of dopamine transporter activity might support the assumption that methylphenidate does not lead to permanent damage of the nigrostriatal dopaminergic pathways.
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Affiliation(s)
- Frans J M Feron
- Youth Health Care Division of the Regional Public Health Institute Maastricht, Maastricht, The Netherlands
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48
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Müller U, Suckling J, Zelaya F, Honey G, Faessel H, Williams SCR, Routledge C, Brown J, Robbins TW, Bullmore ET. Plasma level-dependent effects of methylphenidate on task-related functional magnetic resonance imaging signal changes. Psychopharmacology (Berl) 2005; 180:624-33. [PMID: 15830222 DOI: 10.1007/s00213-005-2264-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 03/05/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE Methylphenidate (MPH) is a dopamine and noradrenaline enhancing drug used to treat attentional deficits. Understanding of its cognition-enhancing effects and the neurobiological mechanisms involved, especially in elderly people, is currently incomplete. OBJECTIVES The aim of this study was to investigate the relationship between MPH plasma levels and brain activation during visuospatial attention and movement preparation. METHODS Twelve healthy elderly volunteers were scanned twice using functional magnetic resonance imaging (fMRI) after oral administration of MPH 20 mg or placebo in a within-subject design. The cognitive paradigm was a four-choice reaction time task presented at two levels of difficulty (with and without spatial cue). Plasma MPH levels were measured at six time points between 30 and 205 min after dosing. FMRI data were analysed using a linear model to estimate physiological response to the task and nonparametric permutation tests for inference. RESULTS Lateral premotor and medial posterior parietal cortical activation was increased by MPH, on average, over both levels of task difficulty. There was considerable intersubject variability in the pharmacokinetics of MPH. Greater area under the plasma concentration-time curve was positively correlated with strength of activation in motor and premotor cortex, temporoparietal cortex and caudate nucleus during the difficult version of the task. CONCLUSION This is the first pharmacokinetic/pharmacodynamic study to find an association between plasma levels of MPH and its modulatory effects on brain activation measured using fMRI. The results suggest that catecholaminergic mechanisms may be important in brain adaptivity to task difficulty and in task-specific recruitment of spatial attention systems.
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Affiliation(s)
- Ulrich Müller
- MRC Behavioural and Clinical Neuroscience Centre, University of Cambridge, Cambridge, UK.
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49
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Fleming SM, Delville Y, Schallert T. An intermittent, controlled-rate, slow progressive degeneration model of Parkinson's disease: antiparkinson effects of Sinemet and protective effects of methylphenidate. Behav Brain Res 2005; 156:201-13. [PMID: 15582106 DOI: 10.1016/j.bbr.2004.05.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 05/18/2004] [Accepted: 05/20/2004] [Indexed: 12/21/2022]
Abstract
The causes of nigrostriatal neuron degeneration in Parkinson's disease (PD) are not known, but it has been suggested that exogenous or endogenous factors or neurotoxins may play a role. The degree of vulnerability to neurotoxins or other potential mediators of nigral dopamine cell death is thought to be important in understanding Parkinson's disease. In most animal models, the rate of terminal degeneration and corresponding functional impairment is too rapid to investigate effectively either cell vulnerability or the potential benefits of some neuroprotective treatments. In the present study, a new model of Parkinson's disease is described that might help in addressing the issue of nigral cell vulnerability and to evaluate interventions with clinical potential. 6-Hydroxydopamine (6-OHDA) was infused in escalating, intrastriatal doses over several weeks. Control animals received multiple infusions of vehicle at the same volume. Behavioral testing was carried out between each infusion, including forelimb-use and somatosensory function. A symptomatic threshold was established for each animal, indicating the amount of neurotoxin required to induce a stable deficit. Oral administration of L-DOPA (Sinemet) ameliorated limb-use asymmetries acutely. An immunocytochemical assay for tyrosine hydroxylase, a dopamine cell marker, revealed a partial loss of immunoreactive cells in the substantia nigra. Animals that were co-administered methylphenidate (MPH), a dopamine transport inhibitor, along with the 6-OHDA were spared from the behavioral and neurochemical effects of 6-OHDA, despite receiving more than twice as much neurotoxin as controls. These data suggest that establishing a symptomatic threshold preclinically may help researchers evaluate potential treatments and model individual and group resistance to nigrostriatal insults.
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Affiliation(s)
- Sheila M Fleming
- Department of Psychology, Institute for Neuroscience, University of Texas, Austin, TX 78712, USA.
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Bussing R, Zima BT, Mason D, Hou W, Garvan CW, Forness S. Use and persistence of pharmacotherapy for elementary school students with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005; 15:78-87. [PMID: 15741789 DOI: 10.1089/cap.2005.15.78] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to describe rates of attention-deficit/hyperactivity disorder (ADHD) medication treatment and relevant school services use during a 2-year period, and to examine independent predictors of these interventions. METHOD Parent and child interviews (n = 266) and follow-up 12-month telephone surveys (n = 220) were conducted among a high-risk sample, selected from a districtwide, stratified, random sample of elementary-school students screened for ADHD risk. Medication treatment status and school services use were assessed from multiple sources, and their predictors were identified by logistic regression modeling, adjusting for sociodemographic and parental characteristics, as well as clinical-need variables. RESULTS Approximately one third (35%) of the children received ADHD medications during a 2-year period, and of those treated at Time 2, approximately one third (36%) were no longer on medications at Time 3. Boys were more than twice as likely to receive ADHD medication as girls. Approximately one quarter (28%) of the children accessed school services and continued their use over 2 years. African-American youths were more likely to receive school services than were Caucasian children. CONCLUSIONS In this elementary school-district high-risk sample, care for ADHD was remarkable for underuse and attrition of medication treatment, as well as poor linkage to relevant school services. Interventions to improve ADHD care should include supports to access and sustain medication treatment, as well as link with school services, especially for girls.
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Affiliation(s)
- Regina Bussing
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA.
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