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Cools R, Froböse M, Aarts E, Hofmans L. Dopamine and the motivation of cognitive control. HANDBOOK OF CLINICAL NEUROLOGY 2019; 163:123-143. [DOI: 10.1016/b978-0-12-804281-6.00007-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Venkataraman SS, Joseph M, Dafny N. Concomitant behavioral and prefrontal cortex neuronal responses following acute and chronic methylphenidate exposure in adolescent and adult rats. Brain Res Bull 2018; 144:200-212. [PMID: 30502401 DOI: 10.1016/j.brainresbull.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
There is growing concern that the psychostimulant Methylphenidate (MPD) is being abused for cognitive enhancement and recreation by healthy adults and adolescents seeking to improve their work or academic performance. This study concomitantly recorded the behavioral and prefrontal cortex (PFC) neuronal activity in freely behaving animals exposed to acute and chronic MPD doses (0.6, 2.5, and 10.0 mg/kg MPD) in order to compare MPD effects on adult and adolescent rats. The PFC is one of the primary brain areas affected by MPD and the drug of choice for treating ADHD. Moreover, the PFC is one of the last brain areas to complete development, suggesting that the behavioral and neurophysiological response to MPD may differ in adolescents and adults. In both adult and adolescent animals, it was observed that the same repetitive (chronic) dose of either 0.6, 2.5, or 10.0 mg/kg MPD elicited behavioral sensitization in some animals and tolerance in others, experimental biomarkers indicating drug of abuse symptoms, and the majority of PFC units recorded in animals expressing behavioral sensitization or tolerance to chronic MPD exposure responded by increasing and decreasing their neuronal firing rate, respectively. Further, it was shown that high doses of 10.0 mg/kg MPD significantly modified adolescent behavioral activity but did not impact adults suggesting that adolescents may be more receptive to chronic MPD exposure. These findings raise concerns regarding the use and abuse of MPD in normal, healthy individuals and support the notion that the adolescent PFC is more susceptible than the adult PFC to neuromodulation from chronic MPD use.
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Affiliation(s)
- Sidish S Venkataraman
- University of Texas McGovern Medical School at Houston, Department of Neurobiology and Anatomy, 6431 Fannin Street, Houston TX, 77030, United States
| | - Michael Joseph
- University of Texas McGovern Medical School at Houston, Department of Neurobiology and Anatomy, 6431 Fannin Street, Houston TX, 77030, United States
| | - Nachum Dafny
- University of Texas McGovern Medical School at Houston, Department of Neurobiology and Anatomy, 6431 Fannin Street, Houston TX, 77030, United States.
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Ramstad E, Storebø OJ, Gerner T, Krogh HB, Holmskov M, Magnusson FL, Moreira-Maia CR, Skoog M, Groth C, Gillies D, Zwi M, Kirubakaran R, Gluud C, Simonsen E. Hallucinations and other psychotic symptoms in response to methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder: a Cochrane systematic review with meta-analysis and trial sequential analysis . Scand J Child Adolesc Psychiatr Psychol 2018; 6:52-71. [PMID: 33520751 PMCID: PMC7750702 DOI: 10.21307/sjcapp-2018-003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is little evidence in the literature on the association between methylphenidate treatment and psychotic symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE We examine the occurrence of psychotic symptoms during methylphenidate treatment of children and adolescents with ADHD. The data arise from our two Cochrane systematic reviews on methylphenidate, reported elsewhere. METHODS Electronic databases were searched up to January 2016 (for observational studies) and March 2017 (for randomized trials). We summarized data as risk ratios and pooled prevalences. Trial Sequential Analysis was used to control for random errors. We assessed the risk of bias and the quality of evidence according to Cochrane guidelines. RESULTS Ten randomized trials (1103 participants), 17 non-randomized studies (76,237 participants) and 12 patient reports or series (18 patients) were identified. In the randomized trials, there was no significant difference in the risk of developing psychotic symptoms [10 of 654 (pooled prevalence, 2.5%) methylphenidate versus 1 of 508 (pooled prevalence, 1.7%) placebo patients; risk ratio, 2.07; 95% confidence interval, 0.58 to 7.35]. Nine of 10 trials had a high risk of bias, and according to the Trial Sequential Analysis, the required information size was not achieved, that is, the meta-analysis was considerably underpowered. There were 873 instances of psychotic symptoms in the non-randomized studies among 55,603 participants (pooled prevalence, 1.2%; 95% confidence interval, 0.7 to 2.4). In the comparative cohort study, methylphenidate significantly increased the risk for any psychotic disorder by 36% (risk ratio, 1.36; 95% confidence interval, 1.17 to 1.57). The overall risk of bias was rated as critical for this study. CONCLUSIONS Because of sparse data and low quality of evidence, we cannot confirm or refute whether methylphenidate increases the risk of psychotic symptoms in children and adolescents with ADHD. This possible adverse event may affect 1.1% to 2.5%, and physicians, patients and caregivers should be aware of this to ensure proper treatment in case of occurrence during methylphenidate treatment.
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Affiliation(s)
- Erica Ramstad
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Ole Jakob Storebø
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Trine Gerner
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Helle B. Krogh
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | | | | | | | - Maria Skoog
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Groth
- Pediatric Department E, Herlev University Hospital, Herlev, Denmark
| | - Donna Gillies
- Western Sydney Local Health District; Mental Health, Parramatta, Australia
| | | | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy, Christian Medical College, Vellore, India
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira‐Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. Cochrane Database Syst Rev 2018; 5:CD012069. [PMID: 29744873 PMCID: PMC6494554 DOI: 10.1002/14651858.cd012069.pub2] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. The psychostimulant methylphenidate is the most frequently used medication to treat it. Several studies have investigated the benefits of methylphenidate, showing possible favourable effects on ADHD symptoms, but the true magnitude of the effect is unknown. Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events. OBJECTIVES To assess the adverse events associated with methylphenidate treatment for children and adolescents with ADHD in non-randomised studies. SEARCH METHODS In January 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 12 other databases and two trials registers. We also checked reference lists and contacted authors and pharmaceutical companies to identify additional studies. SELECTION CRITERIA We included non-randomised study designs. These comprised comparative and non-comparative cohort studies, patient-control studies, patient reports/series and cross-sectional studies of methylphenidate administered at any dosage or formulation. We also included methylphenidate groups from RCTs assessing methylphenidate versus other interventions for ADHD as well as data from follow-up periods in RCTs. Participants had to have an ADHD diagnosis (from the 3rd to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or the 9th or 10th edition of theInternational Classification of Diseases, with or without comorbid diagnoses. We required that at least 75% of participants had a normal intellectual capacity (intelligence quotient of more than 70 points) and were aged below 20 years. We excluded studies that used another ADHD drug as a co-intervention. DATA COLLECTION AND ANALYSIS Fourteen review authors selected studies independently. Two review authors assessed risk of bias independently using the ROBINS-I tool for assessing risk of bias in non-randomised studies of interventions. All review authors extracted data. We defined serious adverse events according to the International Committee of Harmonization as any lethal, life-threatening or life-changing event. We considered all other adverse events to be non-serious adverse events and conducted meta-analyses of data from comparative studies. We calculated meta-analytic estimates of prevalence from non-comparative cohorts studies and synthesised data from patient reports/series qualitatively. We investigated heterogeneity by conducting subgroup analyses, and we also conducted sensitivity analyses. MAIN RESULTS We included a total of 260 studies: 7 comparative cohort studies, 6 of which compared 968 patients who were exposed to methylphenidate to 166 controls, and 1 which assessed 1224 patients that were exposed or not exposed to methylphenidate during different time periods; 4 patient-control studies (53,192 exposed to methylphenidate and 19,906 controls); 177 non-comparative cohort studies (2,207,751 participants); 2 cross-sectional studies (96 participants) and 70 patient reports/series (206 participants). Participants' ages ranged from 3 years to 20 years. Risk of bias in the included comparative studies ranged from moderate to critical, with most studies showing critical risk of bias. We evaluated all non-comparative studies at critical risk of bias. The GRADE quality rating of the evidence was very low.Primary outcomesIn the comparative studies, methylphenidate increased the risk ratio (RR) of serious adverse events (RR 1.36, 95% confidence interval (CI) 1.17 to 1.57; 2 studies, 72,005 participants); any psychotic disorder (RR 1.36, 95% CI 1.17 to 1.57; 1 study, 71,771 participants); and arrhythmia (RR 1.61, 95% CI 1.48 to 1.74; 1 study, 1224 participants) compared to no intervention.In the non-comparative cohort studies, the proportion of participants on methylphenidate experiencing any serious adverse event was 1.20% (95% CI 0.70% to 2.00%; 50 studies, 162,422 participants). Withdrawal from methylphenidate due to any serious adverse events occurred in 1.20% (95% CI 0.60% to 2.30%; 7 studies, 1173 participants) and adverse events of unknown severity led to withdrawal in 7.30% of participants (95% CI 5.30% to 10.0%; 22 studies, 3708 participants).Secondary outcomesIn the comparative studies, methylphenidate, compared to no intervention, increased the RR of insomnia and sleep problems (RR 2.58, 95% CI 1.24 to 5.34; 3 studies, 425 participants) and decreased appetite (RR 15.06, 95% CI 2.12 to 106.83; 1 study, 335 participants).With non-comparative cohort studies, the proportion of participants on methylphenidate with any non-serious adverse events was 51.2% (95% CI 41.2% to 61.1%; 49 studies, 13,978 participants). These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants); and decreased appetite, 31.1% (95% CI 26.5% to 36.2%; 84 studies, 11,594 participants). Withdrawal of methylphenidate due to non-serious adverse events occurred in 6.20% (95% CI 4.80% to 7.90%; 37 studies, 7142 participants), and 16.2% were withdrawn for unknown reasons (95% CI 13.0% to 19.9%; 57 studies, 8340 participants). AUTHORS' CONCLUSIONS Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | - Helle B Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | | | | | - Trine Gerner
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreIndia632002
| | - Sasja J Håkonsen
- Aalborg UniversityDepartment of Health Science and TechnologyNiels Jernes Vej 14AalborgDenmark9220
| | | | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Transcranial direct current brain stimulation decreases impulsivity in ADHD. Brain Stimul 2018; 11:974-981. [PMID: 29885858 DOI: 10.1016/j.brs.2018.04.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/21/2018] [Accepted: 04/19/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Impulsivity is a core deficit in attention deficit hyperactivity disorder (ADHD). Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) has been shown to modulate cognitive control circuits and could enhance DLPFC activity, leading to improved impulse control in ADHD. OBJECTIVE Hypothesis: We predicted 2.0 mA anodal stimulation (tDCS) versus sham stimulation applied over the left DLPFC would improve Conners Continuous Performance Task (CPT) scores. Our secondary hypothesis predicted that stop signal task (SST) reaction time (SSRT) would decrease with tDCS (versus sham). METHODS Thirty-seven participants completed two periods of three tDCS (or sham) sessions two weeks apart in a within-subject, double-blind, counterbalanced order. Participants performed a fractal N-back training task concurrent with tDCS (or sham) stimulation. Participants completed the CPT and SST at the beginning of treatment (baseline), at the end of the treatment, and at a 3-day post-stimulation follow-up. RESULTS There was a significant stimulation condition by session interaction for CPT false positive scores (χ2 = 15.44, p < 0.001) driven by a decrease in false positive errors from baseline to end of treatment in the tDCS group (β = -0.36, 95% Confidence Interval (CI) -0.54 to -0.18, p < 0.001). This effect did not persist at follow-up (β = -0.13, p > 0.05). There was no significant stimulation condition by session interaction effect on CPT true positive errors or response time (ps > 0.05). No significant change in SSRT performance was observed (p > 0.05). CONCLUSION These findings suggest that stimulation of the left DLPFC with tDCS can improve impulsivity symptoms in ADHD, supporting the therapeutic potential for tDCS in adult ADHD patients.
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Sweitzer MM, Kollins SH, Kozink RV, Hallyburton M, English J, Addicott MA, Oliver JA, McClernon FJ. ADHD, Smoking Withdrawal, and Inhibitory Control: Results of a Neuroimaging Study with Methylphenidate Challenge. Neuropsychopharmacology 2018; 43:851-858. [PMID: 29052617 PMCID: PMC5809794 DOI: 10.1038/npp.2017.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/30/2017] [Accepted: 10/09/2017] [Indexed: 02/03/2023]
Abstract
Smoking withdrawal negatively impacts inhibitory control, and these effects are greater for smokers with preexisting attention problems, such as attention deficit/hyperactivity disorder (ADHD). The current study preliminarily evaluated changes in inhibitory control-related behavior and brain activation during smoking withdrawal among smokers with ADHD. Moreover, we investigated the role of catecholamine transmission in these changes by examining the effects of 40 mg methylphenidate (MPH) administration. Adult daily smokers with (n=17) and without (n=20) ADHD completed fMRI scanning under each of three conditions: (a) smoking as usual+placebo; (b) 24 h smoking abstinence+placebo and (c) 24 h smoking abstinence+MPH. Scan order was randomized and counterbalanced. Participants completed a modified Go/No-Go task to assess both sustained and transient inhibitory control. Voxelwise analysis of task-related BOLD signal revealed a significant group-by-abstinence interaction in occipital/parietal cortex during sustained inhibition, with greater abstinence-induced decreases in activation observed among ADHD smokers compared with non-ADHD smokers. Changes in behavioral performance during abstinence were associated with changes in activation in regions of occipital and parietal cortex and bilateral insula during sustained inhibition in both groups. MPH administration improved behavioral performance and increased sustained inhibitory control-related activation for both groups. During transient inhibition, MPH increased prefrontal activation for both groups and increased striatal activation only among ADHD smokers. These preliminary findings suggest that abstinence-induced changes in catecholamine transmission in visual attention areas (eg, occipital and superior parietal cortex) may be associated with inhibitory control deficits and contribute to smoking vulnerability among individuals with ADHD.
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Affiliation(s)
- Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road., Suite 300, Durham, NC 27710, USA, Tel: +1 919 668 0094, Fax: +1 919 681 0016, E-mail:
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rachel V Kozink
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Matt Hallyburton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Joseph English
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Merideth A Addicott
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Unraveling Individual Differences In The HIV-1 Transgenic Rat: Therapeutic Efficacy Of Methylphenidate. Sci Rep 2018; 8:136. [PMID: 29317696 PMCID: PMC5760575 DOI: 10.1038/s41598-017-18300-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023] Open
Abstract
Despite the heterogeneity of HIV-1 associated neurocognitive disorders (HAND), assignment of categorical diagnoses based on the level of impairment (e.g., Frascati criteria) obfuscates the well-acknowledged variability observed within the population of HIV-1+ individuals. The present study sought to elucidate the natural heterogeneity in adult HIV-1 transgenic (Tg) rats using three interrelated aims. First, heterogeneity of the HIV-1 transgene was examined using a pretest-posttest design to assess therapeutic efficacy of oral self-administration (OSA) of methylphenidate (MPH; 2.4 ± 0.2 mg/kg), targeting neurotransmitter alterations in HIV-1, on temporal processing. Approximately 42% of HIV-1 Tg animals displayed an improvement in temporal processing following OSA of MPH. Second, repeated OSA of MPH (22–27 days) altered dendritic spine morphology in layer II-III pyramidal neurons in the medial prefrontal cortex. HIV-1 Tg animals exhibited a population shift towards longer spines with decreased head diameter on lower order branches; a shift associated with temporal processing impairment. Third, in HIV-1 Tg animals, dendritic spine backbone length (µm) was associated with temporal processing impairment; a brain/behavior relationship not observed in control animals. Assessing the therapeutic efficacy of MPH revealed heterogeneity in the neural mechanisms underlying neurocognitive impairments, providing a key target for individualized therapeutic and diagnostic approaches for HAND.
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Determination of monoamine neurotransmitters in zebrafish (Danio rerio) by gas chromatography coupled to mass spectrometry with a two-step derivatization. Anal Bioanal Chem 2017; 409:2931-2939. [PMID: 28204887 DOI: 10.1007/s00216-017-0239-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/18/2017] [Accepted: 02/02/2017] [Indexed: 12/24/2022]
Abstract
A sensitive analytical method for the determination of monoamine neurotransmitters (MNTs) in zebrafish larvae was developed using gas chromatography coupled to mass spectrometry. Six MNTs were selected as target compounds for neurotoxicity testing. MNTs underwent a two-step derivatization with hexamethyldisilazane (HDMS) for O-silylation followed by N-methyl-bis-heptafluorobutyramide (MBHFBA) for N-perfluoroacylation. Derivatization conditions were optimized by an experimental design approach. Method validation showed linear calibration curves (r 2 > 0.9976) in the range of 1-100 ng for all the compounds. The recovery rates were between 92 and 119%. The method was repeatable and reproducible with relative standard deviations (RSD) in the range of 2.5-9.3% for intra-day and 4.8-12% for inter-day variation. The limits of detection and the limits of quantitation were 0.4-0.8 and 1.2-2.7 ng/mL, respectively. The method was successfully applied to detect and quantify trace levels of MNTs in 5-day-old zebrafish larvae that were exposed to low concentrations of neurotoxic chemicals such as pesticides and methylmercury. Although visual malformations were not detected, the MNT levels varied significantly during early zebrafish development. These results show that exposure to neurotoxic chemicals can alter neurotransmitter levels and thereby may influence early brain development. Graphical abstract ᅟ.
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Torres Nupan MM, Velez Van Meerbeke A, López Cabra CA, Herrera Gomez PM. Cognitive and Behavioral Disorders in Children with Neurofibromatosis Type 1. Front Pediatr 2017; 5:227. [PMID: 29164079 PMCID: PMC5670111 DOI: 10.3389/fped.2017.00227] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/05/2017] [Indexed: 11/13/2022] Open
Abstract
AIM The last systematic review of research on the behavior of children with neurofibromatosis type 1 (NF1) was in 2012. Since then, several important findings have been published. Therefore, the study aim was to synthesize recent relevant work related to this issue. METHOD We conducted a systematic review of the literature. Relevant articles were identified using the electronic databases PubMed, PsycINFO, and Scopus and a manual search of references lists. Thirty of 156 articles identified met the inclusion criteria. A quality evaluation of the articles was performed and the information was synthesized using a narrative approach. RESULTS Compared with controls, children and adolescents with NF1 present significant alterations in language, reading, visuospatial skills, motor function, executive function, attention, behavior, emotion, and social skills. The prevalence of attention-deficit/hyperactivity disorder (ADHD) is important and can affect cognition and executive function variables. A high prevalence of autistic traits and autistic spectrum disorder were reported. The benefits of using statins to treat cognitive deficits are unclear. However, children with NF1 and ADHD seem to benefit from methylphenidate treatment. The presence of hyperintensities in brain magnetic resonance imaging data seem to be related to poor cognitive performance. Analysis of these lesions could help to predict cognitive alterations in children with NF1. INTERPRETATION There has been important progress to evaluate cognitive characteristics of children with NF1 and to determine the physiological mechanisms of the concomitant disorders. However, discrepancies in relation to intelligence, learning disabilities, attention deficits, and treatment remain. Further investigations on this topic are recommended.
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Affiliation(s)
- Martha Milade Torres Nupan
- Neurosciences Research Group, Medicine and Health Sciences School, Universidad del Rosario, Bogota, Colombia
| | - Alberto Velez Van Meerbeke
- Neurosciences Research Group, Medicine and Health Sciences School, Universidad del Rosario, Bogota, Colombia
| | | | - Paula Marcela Herrera Gomez
- Neurosciences Research Group, Medicine and Health Sciences School, Universidad del Rosario, Bogota, Colombia
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Park JH, Lee YS, Sohn JH, Han DH. Effectiveness of atomoxetine and methylphenidate for problematic online gaming in adolescents with attention deficit hyperactivity disorder. Hum Psychopharmacol 2016; 31:427-432. [PMID: 27859666 DOI: 10.1002/hup.2559] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/22/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is a high prevalence of problematic online gaming in adolescents with attention deficit hyperactivity disorder (ADHD). In the current study, we compared the effectiveness of atomoxetine (ATM) and methylphenidate (MPH) on problematic online gaming in adolescents with ADHD. METHODS We recruited 86 adolescents diagnosed with ADHD together with Internet gaming disorder. These participants were divided into two treatment groups: 44 participants were treated with MPH for 12 weeks, and 42 participants were treated with ATM for 12 weeks. RESULTS During the 3-month study period, the MPH group showed greater improvement in Korean ADHD rating scale scores than the ATM group. The ATM group showed greater improvement in Child Depression Inventory scores than the MPH group. However, Young Internet Addiction Scale and Behavioral Inhibition & Activation Scales score changes did not differ significantly between the MPH and ATM groups. In both groups, changes in Young Internet Addiction Scale scores were positively correlated with the changes in Behavioral Inhibition & Activation Scales scores. CONCLUSIONS Both MPH and ATM reduced the severity of Internet gaming disorder symptoms, and this reduction was correlated with impulsivity reduction, which also resulted from both ADHD medications. These findings suggest impulsivity plays a critical role in the development of problematic online gaming.
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Affiliation(s)
- Jeong Ha Park
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
| | - Ji Hyun Sohn
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Korea
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Teixeira MZ, Podgaec S, Baracat EC. Protocol of randomized controlled trial of potentized estrogen in homeopathic treatment of chronic pelvic pain associated with endometriosis. HOMEOPATHY 2016; 105:240-249. [PMID: 27473545 DOI: 10.1016/j.homp.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endometriosis is a chronic inflammatory disease that causes difficult-to-treat pelvic pain. Thus being, many patients seek help in complementary and alternative medicine, including homeopathy. The effectiveness of homeopathic treatment for endometriosis is controversial due to the lack of evidences in the literature. The aim of the present randomized controlled trial is to assess the efficacy of potentized estrogen compared to placebo in the treatment of chronic pelvic pain associated with endometriosis. METHODS/DESIGN The present is a randomized, double-blind, placebo-controlled trial of a homeopathic medicine individualized according to program 'New Homeopathic Medicines: use of modern drugs according to the principle of similitude' (http://newhomeopathicmedicines.com). Women with endometriosis, chronic pelvic pain and a set of signs and symptoms similar to the adverse events caused by estrogen were recruited at the Endometriosis Unit of Division of Clinical Gynecology, Clinical Hospital, School of Medicine, University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HCFMUSP). The participants were selected based on the analysis of their medical records and the application of self-report structured questionnaires. A total of 50 women meeting the eligibility criteria will be randomly allocated to receive potentized estrogen or placebo. The primary clinical outcome measure will be severity of chronic pelvic pain. Statistical analysis will be performed on the intention-to-treat and per-protocol approaches comparing the effect of the homeopathic medicine versus placebo after 24 weeks of intervention. DISCUSSION The present study was approved by the research ethics committee of HCFMUSP and the results are expected in 2016. TRIAL REGISTRATION ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT02427386.
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Affiliation(s)
- Marcus Zulian Teixeira
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Sérgio Podgaec
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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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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63
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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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64
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Epstein T, Patsopoulos NA, Weiser M. WITHDRAWN: Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2016:CD005041. [PMID: 27228176 DOI: 10.1002/14651858.cd005041.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Tamir Epstein
- Department of Psychiatry, The Chaim Sheba Medical Center, Affiliated to the Tel-Aviv University, Sackler School of Medicine, Tel Hashomer, Israel, 52621
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65
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Hegvik TA, Jacobsen KK, Fredriksen M, Zayats T, Haavik J. A candidate gene investigation of methylphenidate response in adult attention-deficit/hyperactivity disorder patients: results from a naturalistic study. J Neural Transm (Vienna) 2016; 123:859-65. [PMID: 27091191 PMCID: PMC4969350 DOI: 10.1007/s00702-016-1540-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/20/2016] [Indexed: 12/28/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood onset neuropsychiatric disorder with a complex and heterogeneous symptomatology. Persistence of ADHD symptoms into adulthood is common. Methylphenidate (MPH) is a widely prescribed stimulant compound that may be effective against ADHD symptoms in children and adults. However, MPH does not exert satisfactory effect in all patients. Several genetic variants have been proposed to predict either treatment response or adverse effects of stimulants. We conducted a literature search to identify previously reported variants associated with MPH response and additional variants that were biologically plausible candidates for MPH response. The response to MPH was assessed by the treating clinicians in 564 adult ADHD patients and 20 genetic variants were successfully genotyped. Logistic regression was used to test for association between these polymorphisms and treatment response. Nominal associations (p < 0.05) were meta-analysed with published data from previous comparable studies. In our analyses, rs1800544 in the ADRA2A gene was associated with MPH response at a nominal significance level (OR 0.560, 95 % CI 0.329–0.953, p = 0.033). However, this finding was not affirmed in the meta-analysis. No genetic variants revealed significant associations after correction for multiple testing (p < 0.00125). Our results suggest that none of the studied variants are strong predictors of MPH response in adult ADHD as judged by clinician ratings, potentially except for rs1800544. Consequently, pharmacogenetic testing in routine clinical care is not supported by our analyses. Further studies on the pharmacogenetics of adult ADHD are warranted.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, 5009, Bergen, Norway. .,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, 5009, Bergen, Norway.
| | - Kaya Kvarme Jacobsen
- Department of Biomedicine, University of Bergen, 5009, Bergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, 5009, Bergen, Norway.,Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021, Bergen, Norway
| | - Mats Fredriksen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, 3101, Tønsberg, Norway.,University of Oslo, 0318, Oslo, Norway
| | - Tetyana Zayats
- Department of Biomedicine, University of Bergen, 5009, Bergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, 5009, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, 5009, Bergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, 5009, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, 5021, Bergen, Norway
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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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67
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Tufi S, Leonards P, Lamoree M, de Boer J, Legler J, Legradi J. Changes in Neurotransmitter Profiles during Early Zebrafish (Danio rerio) Development and after Pesticide Exposure. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:3222-30. [PMID: 26866575 DOI: 10.1021/acs.est.5b05665] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
During early development, neurotransmitters are important stimulants for the development of the central nervous system. Although the development of different neuronal cell types during early zebrafish (Danio rerio) development is well-studied, little is known of the levels of neurotransmitters, their precursors and metabolites during development, and how these levels are affected by exposure to environmental contaminants. A method based on hydrophilic interaction liquid chromatography coupled to tandem mass spectrometry has been applied for the first time to zebrafish embryos and larvae to study five neurotransmitter systems in parallel, including the dopaminergic-andrenergic, glutaminergic-GABAnergic, serotoninergic, histaminergic, and cholinergic systems. Our method enables the quantification of neurotransmitters and their precursors and metabolites in whole zebrafish from the period of zygote to free-swimming larvae 6 days postfertilization (dpf). We observed a developmental stage-dependent pattern with clear differences between the first 2 days of development and the following days. Whereas the neurotransmitter levels steadily increased, the precursors showed a peak at 3 dpf. After exposure to several pesticides, significant differences in concentrations of neurotransmitters and precursors were observed. Our study revealed new insights about neurotransmitter systems during early zebrafish development and showed the usefulness of our approach for environmental neurotoxicity studies.
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Affiliation(s)
- Sara Tufi
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Pim Leonards
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Marja Lamoree
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Jacob de Boer
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Juliette Legler
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Jessica Legradi
- Institute for Environmental Studies, VU University Amsterdam , De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
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68
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Storebø OJ, Pedersen N, Ramstad E, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Nilausen TD, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of harmful effects in non-randomised studies. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ole Jakob Storebø
- Region Zealand; Child and Adolescent Psychiatric Department; Birkevaenget 3 Roskilde Denmark 4300
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
- University of Southern Denmark; Department of Psychology, Faculty of Health Science; Campusvej 55 Odense Denmark 5230
| | - Nadia Pedersen
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
| | - Erica Ramstad
- Region Zealand; Child and Adolescent Psychiatric Department; Birkevaenget 3 Roskilde Denmark 4300
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
| | - Helle B. Krogh
- Region Zealand; Child and Adolescent Psychiatric Department; Birkevaenget 3 Roskilde Denmark 4300
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
| | - Carlos R Moreira-Maia
- Federal University of Rio Grande do Sul; Department of Psychiatry; Rua Ramiro Barcelos, 2350-2201A Porto Alegre RS Brazil 90035-003
| | | | - Mathilde Holmskov
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
| | | | - Maria Skoog
- Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Department 7812, Rigshospitalet Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Susanne Rosendal
- Psychiatric Centre North Zealand; The Capital Region of Denmark Denmark
| | - Camilla Groth
- Herlev University Hospital; Pediatric Department; Capital Region Herlev Denmark
| | - Donna Gillies
- Western Sydney Local Health District - Mental Health; Cumberland Hospital Locked Bag 7118 Parramatta NSW Australia 2124
| | | | - Dorothy Gauci
- Department of Health; Directorate for Health Information and Research; 95 G'Mangia Hill G'Mangia Malta PTA 1313
| | - Morris Zwi
- Whittington Health; Islington Child and Adolescent Mental Health Service; 580 Holloway Road London London UK N7 6LB
| | - Richard Kirubakaran
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| | - Bente Forsbøl
- Region Sjaelland; Child and Adolescent Psychiatric Clinic; Birkevaenget 3 Holbaek Denmark DK 4300
| | - Sasja J Håkonsen
- Aalborg University; Department of Health Science and Technology; Niels Jernes Vej 14 Aalborg Denmark 9220
| | - Lise Aagaard
- University of Southern Denmark; Faculty of Health Sciences, Department of Public Health; J.B. Winsløws Vej 19. 2. Odense Denmark 5000
| | - Erik Simonsen
- Region Zealand Psychiatry; Psychiatric Research Unit; Slagelse Denmark
| | - Christian Gluud
- Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Department 7812, Rigshospitalet Blegdamsvej 9 Copenhagen Denmark DK-2100
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
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Cognitive enhancers versus addictive psychostimulants: The good and bad side of dopamine on prefrontal cortical circuits. Pharmacol Res 2016; 109:108-18. [PMID: 26826399 DOI: 10.1016/j.phrs.2016.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/19/2022]
Abstract
In this review we describe how highly addictive psychostimulants such as cocaine and methamphetamine actions might underlie hypoexcitabilty in frontal cortical areas observed in clinical and preclinical models of psychostimulant abuse. We discuss new mechanisms that describe how increments on synaptic dopamine release are linked to reduce calcium influx in both pre and postsynaptic compartments on medial PFC networks, therefore modulating synaptic integration and information. Sustained DA neuromodulation by addictive psychostimulants can "lock" frontal cortical networks in deficient states. On the other hand, other psychostimulants such as modafinil and methylphenidate are considered pharmacological neuroenhancement agents that are popular among healthy people seeking neuroenhancement. More clinical and preclinical research is needed to further clarify mechanisms of actions and physiological effects of cognitive enhancers which show an opposite pattern compared to chronic effect of addictive psychostimulants: they appear to increase cortical excitability. In conclusion, studies summarized here suggest that there is frontal cortex hypoactivity and deficient inhibitory control in drug-addicted individuals. Thus, additional research on physiological effects of cognitive enhancers like modafinil and methylphenidate seems necessary in order to expand current knowledge on mechanisms behind their therapeutic role in the treatment of addiction and other neuropsychiatric disorders.
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Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Bayram Ö, Hergüner S. OROS-Methylphenidate-Induced Raynaud's Phenomenon: A Dose-Related Side Effect. J Child Adolesc Psychopharmacol 2015. [PMID: 26222712 DOI: 10.1089/cap.2015.0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Özlem Bayram
- Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Meram, Konya, Turkey
| | - Sabri Hergüner
- Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Meram, Konya, Turkey
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Kim KH, Jung HB, Choi DK, Park GH, Cho ST. Does Methylphenidate Affect Cystometric Parameters in Spontaneously Hypertensive Rats? Int Neurourol J 2015; 19:67-73. [PMID: 26126435 PMCID: PMC4490317 DOI: 10.5213/inj.2015.19.2.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 05/31/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Methylphenidate (MPH) is one of the most commonly prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract function. This study investigated changes in cystometric parameters after intragastric administration of MPH in conscious spontaneously hypertensive rats (SHRs), an animal model of ADHD. METHODS Fourteen- to 16-week-old male SHRs (n=10), weighing between 280 and 315 g, were used. Three micturition cycles were recorded before administering MPH. One hour after each intragastric MPH injection, three cycles of cystometrogram were obtained in the awake condition. Various cystometric parameters were evaluated, including basal pressure (BP), maximal pressure (MP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), micturition interval (MI), and residual volume (RV). The data were analyzed using paired Student t-tests. RESULTS Five SHRs were each administered a dose of 3-mg/kg MPH, and the other five received a dose of 6-mg/kg MPH. BP and MP increased significantly in the rats that received the 3-mg/kg MPH injection, but not in those that received the 6-mg/kg injection. BC, MV, and MI significantly increased in the rats that received the 6-mg/kg MPH injection, but not in those that received the 3-mg/kg injection. There were no significant changes in TP after either injection. CONCLUSIONS Significant increases in BC, MV, and MI after the 6-mg/kg MPH injection suggest that the peripheral and the central nervous systems may play important roles in bladder function in those receiving MPH for ADHD.
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Affiliation(s)
- Khae Hawn Kim
- Department of Urology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ha Bum Jung
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Don Kyoung Choi
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Geun Ho Park
- Department of Pharmacology, Inha University College of Medicine, Incheon, Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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73
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Levy E, Traicu A, Iyer S, Malla A, Joober R. Psychotic disorders comorbid with attention-deficit hyperactivity disorder: an important knowledge gap. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:S48-52. [PMID: 25886680 PMCID: PMC4418622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/01/2014] [Indexed: 03/07/2023]
Abstract
Psychotic disorders (PDs) and attention-deficit hyperactivity disorder (ADHD) are frequently comorbid. Clinicians are often reticent to treat ADHD in patients with psychosis, fearing that psychostimulants will worsen psychotic symptoms. Advances in neurobiology have challenged the simplistic dichotomy where PD is considered a disorder of high dopamine (DA), treated by DA antagonists, and ADHD a disorder of low DA, treated by DA agonists. In our paper, we review the literature on comorbid ADHD and psychosis. Treating ADHD with psychostimulants may be considered in patients with PD who have been stabilized with antipsychotics (APs). Not treating ADHD may have consequences because ADHD may predispose patients to drug abuse, which further increases the risk of PD. Nevertheless, more systematic studies are needed as there remains some uncertainty on the combined use of APs and psychostimulants in comorbid PD and ADHD.
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Affiliation(s)
- Emmanuelle Levy
- Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Alexandru Traicu
- Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Srividya Iyer
- Associate Professor, Douglas Mental Health University Institute, Montreal, Quebec
| | - Ashok Malla
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Ridha Joober
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
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Schapperer E, Daumann H, Lamouche S, Thyroff-Friesinger U, Viel F, Weitschies W. Bioequivalence of Sandoz methylphenidate osmotic-controlled release tablet with Concerta® (Janssen-Cilag). Pharmacol Res Perspect 2015; 3:e00072. [PMID: 25692005 PMCID: PMC4317218 DOI: 10.1002/prp2.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 11/06/2022] Open
Abstract
The aim was to assess the bioequivalence of Sandoz methylphenidate osmotic-controlled release (OCR) tablets (Sandoz [Methylphenidate[ MPH OCR) with Concerta®, a methylphenidate formulation indicated for the treatment of attention deficit/hyperactivity disorder (ADHD). Four open-label, randomized, single-dose, two-way crossover bioequivalence studies were conducted in healthy subjects: three fasting studies with 54-, 36- and 18-mg doses of methylphenidate, and one fed study with the 54-mg dose. The d- and l-threo-methylphenidate plasma levels were quantified using liquid chromatographic methods with tandem mass spectrometry (LC MS/MS). Bioequivalence of the formulations was accepted if the 90% geometric confidence intervals of the ratio of least-squares means of Sandoz MPH OCR to Concerta® of ln-transformed area under the curve (AUC0–t) and Cmax were within the acceptance range of 80–125%. All studies met the bioequivalence criteria, and 90% geometric confidence intervals for AUC0–t and Cmax were within the predefined range. All plasma concentration time curves for Sandoz MPH OCR under fasting conditions showed a biphasic profile comparable with Concerta®, confirmed by bioequivalence of the partial metrics AUC0–2h, AUC2-24 h, Cmax(0–2 h) and Cmax(2–24 h). Both products were well tolerated and no relevant differences in the safety profiles were observed. It was concluded that Sandoz MPH OCR is bioequivalent to Concerta® in terms of rate and extent of absorption when administered as a single dose of one extended-release tablet of 54, 36, or 18 mg under fasting conditions and at a dose of 54 mg under fed conditions.
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Affiliation(s)
| | - Heike Daumann
- Sandoz Development Center Holzkirchen Holzkirchen, Germany
| | | | | | | | - Werner Weitschies
- Center of Drug Absorption and Transport, Institute of Pharmacy, University of Greifswald Greifswald, Germany
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75
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Katzman MA, Sternat T. A review of OROS methylphenidate (Concerta(®)) in the treatment of attention-deficit/hyperactivity disorder. CNS Drugs 2014; 28:1005-33. [PMID: 25120227 DOI: 10.1007/s40263-014-0175-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioural disorder with onset during childhood. It affects a child's development, both at home and at school, and impacts on social, emotional and cognitive functioning, in both the home and the school environment. Untreated ADHD is very often associated with poor academic achievement, low occupational status, increased risk of substance abuse and delinquency. Current practice guidelines recommend a multimodal approach in the treatment of ADHD, which includes educational, behavioural and mental health interventions, and pharmacological management. Stimulant medications, including methylphenidate (MPH) and amphetamine products, are recommended as first-line pharmacotherapy in the treatment of ADHD. The choice of stimulant is influenced by several factors; the most influential factor is the duration of action. Long-acting medication provides benefits long after school and work. It also increases the likelihood of once-daily dosing, thereby eliminating the need for mid-day dosing, making the treatment more private, avoiding stigma and improving adherence to medication. MPH is the most widely used psychotropic medication in child psychiatry. It was first developed for use in children as an oral, immediate-release formulation and more recently as various extended-release formulations. These latter formulations include the 12 h preparation Concerta(®) (osmotic-release oral system [OROS] MPH), which utilizes an osmotic pump system, designed to overcome the difficulties of multiple daily dosing. Since it received approval from the US Food and Drug Administration in August 2000, OROS MPH has been quickly and widely accepted as one of the preferred treatments for ADHD because of its once-daily dosing. This paper reviews the data in support of long-acting OROS MPH in children, adolescents and adults, both in ADHD and in association with its comorbidities.
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Affiliation(s)
- Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, 32 Park Road, Toronto, ON, M4W 2N4, Canada,
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76
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Epstein T, Patsopoulos NA, Weiser M. Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2014:CD005041. [PMID: 25230710 DOI: 10.1002/14651858.cd005041.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Symptoms of attention deficit hyperactivity disorder (ADHD), diagnosed mainly in children, often persist into adulthood. Adults in this group have a high rate of other psychiatric problems and functional difficulties in a number of key areas such as academic achievement, interpersonal relationships, and employment. Although the usefulness of immediate-release methylphenidate in children has been extensively studied, studies in adults, which are few, demonstrate varying results. OBJECTIVES To evaluate the efficacy and tolerability of immediate-release methylphenidate versus placebo in the treatment of adults with ADHD. SEARCH METHODS We searched the following databases in November 2013: CENTRAL, Ovid MEDLINE, EMBASE, PsycINFO, Database of Abstracts of Reviews of Effects (DARE), and two trials registers. Biosis was searched in December 2013. We inspected references of all relevant papers to identify more studies and contacted authors of recently published trials. SELECTION CRITERIA We included all randomized trials comparing immediate-release methylphenidate versus placebo in participants aged 18 years or older with ADHD. We excluded trials conducted on subpopulations of adults with ADHD such as adults with both ADHD and substance dependence. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed trial risk of bias. We contacted authors of trials to ask for additional and missing data. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardized mean differences (SMDs) with 95% CIs. MAIN RESULTS Results from the 11 randomized controlled trials (474 participants, counting participants from cross-over studies as a single arm, and counting both arms from parallel studies) included in the review demonstrated improvement in core clinical ADHD symptoms of hyperactivity, impulsivity, and inattentiveness, and overall improvement. We were able to pool results from 10 studies, which included 466 participants.Most included studies were judged to have unclear risk of bias for most categories. However, as all studies were randomized, double-blind, and placebo-controlled and, in general, did not contain factors that significantly decreased the quality of the body of evidence, the quality of evidence was assessed as "high" for most outcomes according to the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. For one outcome-inattentiveness-most information came from studies at unclear risk of bias, and so the quality of evidence for this outcome was judged as "moderate."Results are given as SMD for each of the core clinical symptoms of ADHD. In all cases, participant numbers were calculated by counting participants in a single arm from cross-over studies and in both arms from parallel studies. The SMD for the outcome of hyperactivity was -0.60 (95% CI -1.11 to -0.09, 6 studies, number of participants (n) = 245, high-quality evidence) in favor of immediate-release methylphenidate; the SMD for impulsivity was -0.62 (95% CI -1.08 to -0.17, 5 studies, n = 207, high-quality evidence) in favor of immediate-release methylphenidate; and the SMD for inattentiveness was -0.66 (95% CI -1.02 to -0.30, 7 studies, n = 391, moderate-quality evidence) in favor of immediate-release methylphenidate. Moderate to extreme statistical heterogeneity was detected for all outcomes. Subgroup analysis comparing high versus low doses did not indicate that higher doses of immediate-release methylphenidate were associated with greater efficacy.For overall change, the SMD was -0.72 (95% CI -1.12 to -0.32, 9 studies, n = 455, high-quality evidence) in favor of immediate-release methylphenidate.The effects of immediate-release methylphenidate on anxiety and depression as parameters of general changes in mental state were equivocal. Some trials reported reduction in depression and anxiety, others detailed no change, and still others described an increase in depressive and anxious symptoms.The most common adverse effect was loss of appetite, in some cases with weight loss. Although no study reported either of these effects as problematic or severe, the included studies were of short duration; thus clinical significance could not be properly assessed. Five studies reported changes in systolic or diastolic blood pressure, and three reported increases in heart rate. None of these results were judged to present cause for concern. No study reported clinically significant adverse effects-cardiovascular or other. Three studies did not mention adverse effects. We were unable to determine whether adverse effects were not discussed by study authors because none occurred, or because no data on adverse effects were collected. AUTHORS' CONCLUSIONS Data from randomized controlled trials suggest that immediate-release methylphenidate is efficacious for treating adults with ADHD with symptoms of hyperactivity, impulsivity, and inattentiveness, and for improving their overall clinical condition. Trial data suggest that adverse effects from immediate-release methylphenidate for adults with ADHD are not of serious clinical significance, although this conclusion may be limited, certainly in the case of weight loss, by the short duration of published studies.
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Affiliation(s)
- Tamir Epstein
- Department of Psychiatry, The Chaim Sheba Medical Center, Affiliated to the Tel-Aviv University,, Sackler School of Medicine,, Tel Hashomer, Israel, 52621
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The effect of methylphenidate on neurofibromatosis type 1: a randomised, double-blind, placebo-controlled, crossover trial. Orphanet J Rare Dis 2014; 9:142. [PMID: 25205361 PMCID: PMC4172829 DOI: 10.1186/s13023-014-0142-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with an estimated prevalence of about 1/3000, independent of ethnicity, race, or gender. Attention Deficit Hyperactivity like Disorder (ADHD)-like characteristics are often reported in patients with NF1. We hypothesised that learning disabilities in NF1 children were related to ADHD symptoms. Treatment with methylphenidate (MPD) has improved learning disabilities in ADHD by acting on neurotransmitters. Our objective was to evaluate its efficacy on ADHD-like symptoms in neurofibromatosis type 1 children (7–12 years). Methods This was a randomised, double blind, placebo controlled, and crossover trial comparing 0.5 to 0.8 mg/kg/d of MPD as it is indicated for ADHD to placebo in NF1 children with ADHD-like symptoms. Children aged 7 to 12 years were eligible when their IQ was between 80 and 120. The total follow-up was 9 weeks including 4 weeks for each period and 1 week wash out. Fifty subjects (25 for each period) were required for testing the primary study hypothesis. The main outcome was an improvement in scores on the simplified Conners’ Parent Rating Scale. Results Thirty-nine patients were included between April 2004 and December 2010. Twenty participants received MPD and 19 placebo during the first period. They all completed the trial. MPD decreased the simplified Conners by 3.9 points (±1.1, p = 0. 0003). Conclusions This is the first randomised controlled trial showing the short-term benefit of MPD on simplified Conners scores in NF1 children. Trial registration ClinicalTrials.gov NCT00169611.
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Adisetiyo V, Jensen JH, Tabesh A, Deardorff RL, Fieremans E, Di Martino A, Gray KM, Castellanos FX, Helpern JA. Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment? Radiology 2014; 272:524-32. [PMID: 24937545 DOI: 10.1148/radiol.14140047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To comprehensively assess brain iron levels in typically developing control subjects and patients with attention deficit hyperactivity disorder (ADHD) when psychostimulant medication history is accounted for. MATERIALS AND METHODS This prospective study was approved by the institutional review board, and informed consent was obtained. Brain iron was indexed noninvasively by using magnetic resonance (MR) imaging relaxation rates (R2, R2*, R2') and magnetic field correlation (MFC) in the globus pallidus, putamen, caudate nucleus, and thalamus for 22 patients with ADHD (12 medication-naïve patients and 10 with a history of psychostimulant treatment) and 27 control subjects (age range, 8-18 years). Serum iron measures were also collected. Subgroup differences were analyzed with data-appropriate omnibus tests followed by post hoc pairwise comparisons; false discovery rate correction was conducted to control for multiple comparisons. RESULTS Medication-naïve ADHD patients had significantly lower striatal and thalamic MFC indexes of brain iron than did control subjects (putamen, P = .012; caudate nucleus, P = .008; thalamus, P = .012) and psychostimulant-medicated ADHD patients (putamen, P = .006; caudate nucleus, P = .010; thalamus, P = .021). Conversely, the MFC indexes in medicated patients were comparable to those in control subjects. No significant differences were detected with R2, R2*, R2', or serum measures. CONCLUSION Lower MFC indexes of striatal and thalamic brain iron in medication-naïve ADHD patients and lack of differences in psychostimulant-medicated patients suggest that MFC indexes of brain iron may represent a noninvasive diagnostic biomarker that responds to psychostimulant treatment.
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Affiliation(s)
- Vitria Adisetiyo
- From the Center for Biomedical Imaging (V.A., J.H.J., A.T., R.L.D., J.A.H.), Department of Radiology and Radiological Science (V.A., J.H.J., A.T., R.L.D., J.A.H.), Department of Psychiatry and Behavioral Sciences (K.M.G.), and Department of Neurosciences (J.A.H.), Medical University of South Carolina, 68 President St, Bioengineering Building, 2nd Floor, Charleston, SC 29425; Center for Biomedical Imaging, Department of Radiology (E.F., F.X.C.), Child Study Center, Department of Child and Adolescent Psychiatry (A.D.M., F.X.C.), and Department of Physiology and Neuroscience (F.X.C.), New York University School of Medicine, New York, NY; and Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY (F.X.C.)
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Mueller S, Costa A, Keeser D, Pogarell O, Berman A, Coates U, Reiser MF, Riedel M, Möller HJ, Ettinger U, Meindl T. The effects of methylphenidate on whole brain intrinsic functional connectivity. Hum Brain Mapp 2014; 35:5379-88. [PMID: 24862742 DOI: 10.1002/hbm.22557] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 04/25/2014] [Accepted: 05/07/2014] [Indexed: 12/29/2022] Open
Abstract
Methylphenidate (MPH) is an indirect dopaminergic and noradrenergic agonist that is used to treat attention deficit hyperactivity disorder and that has shown therapeutic potential in neuropsychiatric diseases such as depression, dementia, and Parkinson's disease. While effects of MPH on task-induced brain activation have been investigated, little is known about how MPH influences the resting brain. To investigate the effects of 40 mg of oral MPH on intrinsic functional connectivity, we used resting state fMRI in 54 healthy male subjects in a double-blind, randomized, placebo-controlled study. Functional connectivity analysis employing ICA revealed seven resting state networks (RSN) of interest. Connectivity strength between the dorsal attention network and the thalamus was increased after MPH intake. Other RSN located in association cortex areas, such as the left and right frontoparietal networks and the executive control network, showed MPH-induced connectivity increase to sensory-motor and visual cortex regions and connectivity decrease to cortical and subcortical components of cortico-striato-thalamo-cortical circuits (CST). RSN located in sensory-motor cortex areas showed the opposite pattern with MPH-induced connectivity increase to CST components and connectivity decrease to sensory-motor and visual cortex regions. Our results provide evidence that MPH does not only alter intrinsic connectivity between brain areas involved in sustained attention, but that it also induces significant changes in the cortico-cortical and cortico-subcortical connectivity of many other cognitive and sensory-motor RSN.
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Affiliation(s)
- Sophia Mueller
- Institute of Clinical Radiology, Ludwig-Maximilians University Munich, 81377, Munich, Germany
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Genro JP, Kieling C, Rohde LA, Hutz MH. Attention-deficit/hyperactivity disorder and the dopaminergic hypotheses. Expert Rev Neurother 2014; 10:587-601. [DOI: 10.1586/ern.10.17] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Yamashita M, Sakakibara Y, Hall FS, Numachi Y, Yoshida S, Kobayashi H, Uchiumi O, Uhl GR, Kasahara Y, Sora I. Impaired cliff avoidance reaction in dopamine transporter knockout mice. Psychopharmacology (Berl) 2013; 227:741-9. [PMID: 23397052 DOI: 10.1007/s00213-013-3009-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/23/2013] [Indexed: 12/29/2022]
Abstract
RATIONALE Impulsivity is a key feature of disorders that include attention-deficit/hyperactivity disorder (ADHD). The cliff avoidance reaction (CAR) assesses maladaptive impulsive rodent behavior. Dopamine transporter knockout (DAT-KO) mice display features of ADHD and are candidates in which to test other impulsive phenotypes. OBJECTIVES Impulsivity of DAT-KO mice was assessed in the CAR paradigm. For comparison, attentional deficits were also assessed in prepulse inhibition (PPI) in which DAT-KO mice have been shown to exhibit impaired sensorimotor gating. RESULTS DAT-KO mice exhibited a profound CAR impairment compared to wild-type (WT) mice. As expected, DAT-KO mice showed PPI deficits compared to WT mice. Furthermore, the DAT-KO mice with the most impaired CAR exhibited the most severe PPI deficits. Treatment with methylphenidate or nisoxetine ameliorated CAR impairments in DAT-KO mice. CONCLUSION These results suggest that DAT-KO mice exhibit impulsive CAR behavior that correlates with their PPI deficits. Blockade of monoamine transporters, especially the norepinephrine transporter (NET) in the prefrontal cortex (PFC), may contribute to pharmacological improvement of impulsivity in these mice.
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Affiliation(s)
- Motoyasu Yamashita
- Department of Biological Psychiatry, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Somkuwar SS, Darna M, Kantak KM, Dwoskin LP. Adolescence methylphenidate treatment in a rodent model of attention deficit/hyperactivity disorder: dopamine transporter function and cellular distribution in adulthood. Biochem Pharmacol 2013; 86:309-16. [PMID: 23623751 DOI: 10.1016/j.bcp.2013.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is attributed to dysfunction of the prefrontal cortex. Methylphenidate, an inhibitor of dopamine and norepinephrine transporters (DAT and NET, respectively), is a standard treatment for ADHD. The Spontaneously Hypertensive Rat (SHR) is a well-established animal model of ADHD. Our previous results showed that methylphenidate treatment in adolescent SHR enhanced cocaine self-administration during adulthood, and alterations in DAT function in prefrontal cortex play a role in this response. Importantly, prefrontal cortex subregions, orbitofrontal cortex (OFC) and medial prefrontal cortex (mPFC), have been shown to have distinct roles in ADHD and cocaine self-administration. In the current study, SHR, Wistar-Kyoto (WKY) and Wistar (WIS) rats received a therapeutically relevant dose of methylphenidate (1.5mg/kg, p.o.) or vehicle during adolescence and then OFC and mPFC DAT function and cellular expression were assessed during adulthood. In both OFC and mPFC, no strain differences in Vmax or Km for dopamine uptake into synaptosomes were found between vehicle-treated SHR, WKY and WIS. Methylphenidate increased DAT Vmax in SHR mPFC and decreased DAT Vmax in WKY OFC. Also, methylphenidate decreased DAT Km in WIS OFC. Further, methylphenidate did not alter DAT cellular localization, indicating that methylphenidate treatment during adolescence regulated DAT function in SHR mPFC in a trafficking-independent manner. Thus, the increase in mPFC DAT function was an SHR-specific long term consequence of methylphenidate treatment during adolescence, which may be responsible for the treatment-induced alterations in behavior including the observed increases in cocaine self-administration.
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Affiliation(s)
- Sucharita S Somkuwar
- Department of Pharmaceutical Sciences, 789 South Limestone, University of Kentucky, Lexington, KY 40536, USA
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Kubas HA, Backenson EM, Wilcox G, Piercy JC, Hale JB. The effects of methylphenidate on cognitive function in children with attention-deficit/hyperactivity disorder. Postgrad Med 2013; 124:33-48. [PMID: 23095424 DOI: 10.3810/pgm.2012.09.2592] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Focusing on behavioral criteria for attention-deficit/hyperactivity disorder (ADHD) diagnosis leads to considerable neuropsychological profile heterogeneity among diagnosed children, as well as variable response to methylphenidate (MPH) treatment. Documenting "cold" executive working memory (EWM) or "hot" self-regulation (SR) neuropsychological impairments could aid in the differential diagnosis of ADHD subtypes and may help to determine the optimal MPH treatment dose. In this study, children with ADHD inattentive type (n = 19), combined type (n = 33), and hyperactive-impulse type (n = 4) underwent randomized controlled MPH trials; neuropsychological, behavioral, and observational data were collected to evaluate the children's responses. Those with moderate or significant baseline EWM/SR impairment showed robust MPH response, whereas response for those with lower baseline impairment was equivocal. Implications for medication use and titration, academic achievement, and long-term treatment efficacy are examined.
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Storebø OJ, Rosendal S, Skoog M, Groth C, Bille T, Buch Rasmussen K, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009885] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kohn MR, Tsang TW, Clarke SD. Efficacy and Safety of Atomoxetine in the Treatment of Children and Adolescents with Attention Deficit Hyperactivity Disorder. CLINICAL MEDICINE. PEDIATRICS 2012; 6:95-162. [PMID: 23641171 PMCID: PMC3620814 DOI: 10.4137/cmped.s7868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several non-stimulant medications have been used in the treatment of attention deficit hyperactivity disorder (ADHD). Atomoxetine, was introduced in 2002. The safety and efficacy of atomoxetine in the treatment of ADHD for children, adolescents, and adults has been evaluated in over 4000 patients in randomized controlled studies and double blinded studies as well as in recent large longitudinal studies. This paper provides an updated summary of the literature on atomoxetine, particularly in relation to findings on the short- and long-term safety of atomoxetine in children and adolescents arising from recent large longitudinal cohort studies. Information is presented about the efficacy, safety, and tolerability of this medication.
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Affiliation(s)
- Michael R. Kohn
- Centre for Research into Adolescents’ Health (CRASH), The Sydney Children's Hospital Network and Westmead Hospital, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
| | - Tracey W. Tsang
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
| | - Simon D. Clarke
- Centre for Research into Adolescents’ Health (CRASH), The Sydney Children's Hospital Network and Westmead Hospital, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School—Westmead, Westmead, NSW, Australia
- Department of Psychiatry and Medicine, University of Sydney Medical School—Westmead, NSW, Australia
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86
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Demurie E, Roeyers H, Baeyens D, Sonuga-Barke E. Common alterations in sensitivity to type but not amount of reward in ADHD and autism spectrum disorders. J Child Psychol Psychiatry 2011; 52:1164-73. [PMID: 21223259 DOI: 10.1111/j.1469-7610.2010.02374.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with attention deficit/hyperactivity disorder (ADHD) display abnormalities in reward processing. Most reward studies have focused on the effects of material or monetary rewards. Studies with autism spectrum disorder (ASD) have focused on social rewards. In this study we compared the effects of amount and type of reward in children with ADHD and those with ASD. METHODS Two adapted versions of the Monetary Incentive Delay Task were used to study the effects of monetary and social reward anticipation on performance in 40 typically developing (TD) children and adolescents (8-16y), 35 children and adolescents with ADHD and 31 children and adolescents with ASD. RESULTS Monetary and social reward improved accuracy and response time (RT) in all groups. The higher the anticipated reward, the more accurate and faster were responses. Independent of these effects, there was a differential effect of reward type. Both clinical groups, but not TD, responded faster for monetary than social rewards. CONCLUSIONS The results, while not supporting hyposensitivity to changes in reward amount in ADHD and ASD, do suggest that both groups are generally less motivated in settings where social as opposed to monetary rewards can be earned.
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Affiliation(s)
- Ellen Demurie
- Ghent University, Belgium Lessius University College, Belgium University of Southampton, UK.
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87
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Salatino-Oliveira A, Genro JP, Zeni C, Polanczyk GV, Chazan R, Guimarães AP, Callegari-Jacques SM, Rohde LA, Hutz MH. Catechol-O-methyltransferase valine158methionine polymorphism moderates methylphenidate effects on oppositional symptoms in boys with attention-deficit/hyperactivity disorder. Biol Psychiatry 2011; 70:216-21. [PMID: 21550019 DOI: 10.1016/j.biopsych.2011.03.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 03/10/2011] [Accepted: 03/12/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND The catechol-O-methyltransferase enzyme plays a key role in the function of prefrontal cortex, accounting for most of the degradation of dopamine. Previous studies have documented the improvement of oppositional symptoms in attention-deficit/hyperactivity disorder (ADHD) patients with methylphenidate (MPH) treatment. However, the effect of the COMT gene in the response to MPH on oppositional symptoms has not been investigated. METHODS A total of 251 children with ADHD fulfilled inclusion criteria to participate in the study. Dosages of short-acting MPH were augmented until no further clinical improvement was detected or until there were significant adverse events (MPH dose always > .3 mg/kg/day). The outcome measure was the parent-rated oppositional subscale of the Swanson, Nolan and Pelham Scale-Version IV (SNAP-IV). The scale was applied by child psychiatrists blinded to genotype at baseline and in the first and third months. The COMT valine158methionine polymorphism was genotyped by polymerase chain reaction based methods. RESULTS We detected significant improvement in SNAP-IV oppositional scores from baseline to the first and three months of treatment [n = 112; F(2,231) = 5.35, p = .005]. A significant effect of the presence of methionine allele in oppositional defiant disorder scores during treatment [F(1,148) = 5.02, p = .027] and a significant interaction between the methionine allele and treatment over time for the SNAP-IV oppositional scores during this period of treatment [F(2,229) = 6.40, p = .002] were both observed. CONCLUSIONS These results suggest an effect of the COMT genotype on the trajectory of oppositional defiant disorder symptoms improvement with MPH treatment in boys with ADHD.
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88
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Restless legs syndrome as a possible predictor for psychiatric disorders in parents of children with ADHD. Eur Arch Psychiatry Clin Neurosci 2011; 261:285-91. [PMID: 20820796 DOI: 10.1007/s00406-010-0140-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common disorder with estimated prevalence of 5% in children and 3.4% in adults. Psychiatric disorders are a frequent concomitant feature. Restless legs syndrome (RLS) may mimic the symptoms of ADHD. The aim of the study is to evaluate whether the presence of RLS predicts occurrence of psychiatric disorders in parents of children with ADHD. Thirty-seven parents of 26 children with ADHD were examined for RLS and for lifetime prevalence rates of psychiatric disorders and personality disorders based on the Structured Clinical Interview for DSM-IV Diagnoses (SCID). Prevalence rates in parents were 29.7% for RLS, 67.6% for Axis I and 40.5% for Axis II disorders. Mothers revealed higher rates for depression, anxiety disorders and ADHD than fathers, whereas personality disorders occurred at higher rates in fathers. The presence of RLS predicted a diagnosis of ADHD (odds ratio (OR) 21.9), agoraphobia (OR = 20.4) and any anxiety disorder (OR = 8.5). Although limited by the small sample size, we found evidence for increased rates of cluster B personality disorders (OR = 59.3) in parents with RLS. All parents of the latter group (100%) reported a positive family history of psychiatric disorders which was not the case in parents without RLS (69.2%) excluding the index children with ADHD. RLS seems to indicate increased vulnerability for psychiatric disorders, i.e., ADHD and anxiety disorders, in a subgroup of parents from ADHD children. Synaptic dysfunction affecting dopaminergic transmission among other transmitter systems may be a common final pathway related to the phenotypic spectrum of ADHD.
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89
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Motofei IG. A dual physiological character for cerebral mechanisms of sexuality and cognition: common somatic peripheral afferents. BJU Int 2011; 108:1634-9. [DOI: 10.1111/j.1464-410x.2011.10116.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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90
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Hale JB, Reddy LA, Semrud-Clikeman M, Hain LA, Whitaker J, Morley J, Lawrence K, Smith A, Jones N. Executive impairment determines ADHD medication response: implications for academic achievement. JOURNAL OF LEARNING DISABILITIES 2011; 44:196-212. [PMID: 21383110 DOI: 10.1177/0022219410391191] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.
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Affiliation(s)
- James B Hale
- Professor, Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
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91
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Abstract
Tonic and phasic dopamine release is implicated in learning, motivation, and motor functions. However, the relationship between spike patterns in dopaminergic neurons, the extracellular concentration of dopamine, and activation of dopamine receptors remains unresolved. In the present study, we develop a computational model of dopamine signaling that give insight into the relationship between the dynamics of release and occupancy of D(1) and D(2) receptors. The model is derived from first principles using experimental data. It has no free parameters and offers unbiased estimation of the boundaries of dopaminergic volume transmission. Bursts primarily increase occupancy of D(1) receptors, whereas pauses translate into low occupancy of D(1) and D(2) receptors. Phasic firing patterns, composed of bursts and pauses, reduce the average D(2) receptor occupancy and increase average D(1) receptor occupancy compared with equivalent tonic firing. Receptor occupancy is crucially dependent on synchrony and the balance between tonic and phasic firing modes. Our results provide quantitative insight in the dynamics of volume transmission and complement experimental data obtained with electrophysiology, positron emission tomography, microdialysis, amperometry, and voltammetry.
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92
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Serotonin-dopamine antagonism ameliorates impairments of spontaneous alternation and locomotor hyperactivity induced by repeated electroconvulsive seizures in rats. Epilepsy Res 2010; 90:221-7. [PMID: 20605414 DOI: 10.1016/j.eplepsyres.2010.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/30/2010] [Accepted: 05/03/2010] [Indexed: 11/23/2022]
Abstract
We have shown that seven consecutive administrations of electroconvulsive shock (ECS) produce impairment of spontaneous alternation behavior in a Y-maze test and a locomotor hyperactivity in an open-field test even 24h after the last administration in rats. To clarify the mechanisms of the behavioral impairments, we investigated the effect of drugs acting on dopaminergic and serotonergic nervous systems. The dopamine-2 (D(2)) receptor antagonists haloperidol and sulpiride abolished locomotor hyperactivity, but did not show effects on the impairment of spontaneous alternation behavior. The serotonin-2 (5-HT(2)) receptor antagonist ketanserin suppressed the impairment of spontaneous alternation behavior without affecting locomotor hyperactivity. The 5-HT(2) and D(2) receptor antagonist risperidone significantly ameliorated both behavioral impairments. These results suggest that 5-HT(2) receptors and D(2) receptors are associated with repeated ECS-induced impairment of spontaneous alternation behavior and locomotor hyperactivity, respectively.
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93
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Loutfi KS, Carvalho AM. Possíveis interfaces entre TDAH e epilepsia. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000200011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Identificar na literatura elementos para explicar uma possível associação entre o transtorno de déficit de atenção e hiperatividade (TDAH) e a epilepsia e orientar quanto ao manejo clínico dos pacientes que compartilham esses transtornos. MÉTODOS: Realizou-se revisão da literatura dos últimos 10 anos nas bases de dados MedLine e Lilacs com a combinação dos descritores "attention deficit hyperactivity disorder", "ADHD" e "epilepsy". RESULTADOS: Sintomas de TDAH são frequentes em síndromes epilépticas idiopáticas. Vários fatores podem contribuir para a coexistência desses transtornos: 1) possibilidade de uma mesma propensão genética; 2) participação dos neurotransmissores noradrenalina e dopamina no TDAH e na modulação da excitabilidade neuronal; 3) anormalidades estruturais do cérebro evidenciadas em epilépticos portadores de TDAH; 4) influência dos efeitos crônicos das crises e das descargas epileptiformes interictais sob a atenção; 5) efeitos adversos das drogas antiepilépticas sob a cognição. CONCLUSÕES: As evidências atuais apontam que crises epilépticas e TDAH podem apresentar bases neurobiológicas comuns. Estudos que avaliam disfunções nas vias de sinalização das catecolaminas cerebrais e o papel das descargas epileptiformes interictais na geração dos sintomas são fundamentais na investigação desses mecanismos. Drogas psicoestimulantes são seguras e eficazes para o tratamento do TDAH na maioria dos portadores de epilepsia.
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