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Warlick Iv H, Tocci D, Prashar S, Boldt E, Khalil A, Arora S, Matthews T, Wahid T, Fernandez R, Ram D, Leon L, Arain A, Rey J, Davis K. Role of vesicular monoamine transporter-2 for treating attention deficit hyperactivity disorder: a review. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06686-7. [PMID: 39302436 DOI: 10.1007/s00213-024-06686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
RATIONALE The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) classifies attention deficit hyperactivity disorder (ADHD) as a neurodevelopmental disorder that interferes with human functioning and development. As the clinical presentation of ADHD involves a deficiency in executive function, neurocognitive deficits involving distinctive neuropathological changes must be present for clinical diagnosis. OBJECTIVES The vesicular monoamine transporter (VMAT), specifically VMAT-2, plays a role in ADHD pathogenesis. In addition, experimental data show that the stimulants (amphetamines and methylphenidate) are first-line treatments for the condition because of their extensive interaction with VMAT-2. The interactions of peptides, bupropion, and nutritional supplements with VMAT-2 receptors have been researched, but more evidence is needed to elucidate their pharmacodynamic properties. Therefore, this literature review evaluated the current pharmacological treatment modalities, peptides, and nutritional supplements for ADHD that target the VMAT-2 system. METHODS, RESULTS, AND CONCLUSIONS We obtained relevant studies from several platforms, including the National Center for Biotechnology, Clinical Key, Access Medicine, and PubMed. From the results of these studies, we observed that stimulants interact highly with the VMAT-2 transporter, with omega-3 fatty acids, peptides, and bupropion exerting some modulatory activity on VMAT-2. These agents should be considered for the future treatment of ADHD, although clinical-level research involving human participants is necessary.
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Affiliation(s)
- Halford Warlick Iv
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA.
| | - Darcy Tocci
- Dr. Kiran C. Patel College of Allopathic Medicine, Health Profession Division, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sukriti Prashar
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Erick Boldt
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Alena Khalil
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Simran Arora
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Thomas Matthews
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Talha Wahid
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Richard Fernandez
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Dhiya Ram
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Lexie Leon
- Dr. Kiran C. Patel College of Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Fort Lauderdale, Florida, USA
| | - Arisha Arain
- Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jose Rey
- College of Pharmacy, Health Profession Division, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Kelley Davis
- Dr. Kiran C. Patel College of Allopathic Medicine, Health Profession Division, Nova Southeastern University, Fort Lauderdale, Florida, USA
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Zakariyah A, Al Qutub S, Kazim S, Alharbi R, Alharthi H, Alharbi H, Albassami M, Hanbazazh M, Mahnashi M. Exposure to Smoking as a Predictor of ADHD Subtypes Among Children Within Saudi Arabia: An Observational Study. Tob Use Insights 2024; 17:1179173X241283765. [PMID: 39258266 PMCID: PMC11384971 DOI: 10.1177/1179173x241283765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
Previous studies have found an association between maternal smoking and an increased risk of attention deficit hyperactivity disorder (ADHD) in offspring. However, the prevalence of maternal smoking, secondhand smoke (SHS) exposure during pregnancy, and ADHD in children within the Saudi Arabian context is not well-documented. OBJECTIVE To explore the prevalence of maternal smoking and SHS exposure during pregnancy among mothers of children diagnosed with ADHD and investigate exposure to smoking as a predictor of ADHD subtypes. METHODS A cross-sectional study was conducted from December 1, 2022, to February 28, 2023, using an online questionnaire. The study included 217 parents of children aged 4-17 years diagnosed with ADHD and without a family history of the disorder. Data on sociodemographic determinants, academic achievement, ADHD types, and maternal smoking habits during pregnancy were collected. RESULTS Among the mothers surveyed, 6.4% reported smoking during pregnancy, while 41% were exposed to SHS. The study found a predominance of the combined subtype of ADHD among the children. Logistic regression analysis revealed that families with monthly income <10 000 SR were 2.6 times more likely to have a child with inattentive or hyperactive ADHD (P < 0.03). Male gender was associated with a 46% reduced likelihood of these subtypes (P < 0.03). SHS smoking and active exposure to smoking during pregnancy did not show any significant effect on ADHD. CONCLUSION The study found that child gender and family income were significantly associated with the distribution of ADHD subtypes, while maternal smoking and SHS exposure during pregnancy did not show a significant association. The high prevalence of SHS exposure emphasizes the need for increased public health awareness and interventions to promote smoke-free environments during pregnancy.
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Affiliation(s)
- Abeer Zakariyah
- Department of Medical Genetics, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Sulafa Al Qutub
- Department of Family and Community Medicine, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Sereen Kazim
- Department of Family and Community Medicine, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Reman Alharbi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Hams Alharthi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Hadeel Alharbi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Maram Albassami
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mehenaz Hanbazazh
- Department of Pathology, College of Medicine,University of Jeddah, Jeddah, Saudi Arabia
| | - Morooj Mahnashi
- Department of Pediatric, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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Rowan L, Gary A, Geist R. Improving access and outcomes for children with ADHD. Nurse Pract 2024; 49:17-27. [PMID: 39186121 DOI: 10.1097/01.npr.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT Attention-deficit hyperactivity disorder (ADHD) is a mental health condition characterized by inattentiveness, hyperactivity, and impulsivity as well as difficulties with social interaction, learning, and sometimes sleep. A variety of symptoms is possible, and three ADHD presentations have been defined. Owing to healthcare workforce shortages, particularly in mental health care, it is critical for family NPs and other primary care providers to possess accurate understanding of the disorder and its symptomatology, evaluation, diagnosis, and management in children and adolescents. In today's landscape, newer extended-release and long-acting stimulants support better medication administration and adherence, as well as maintain more consistent levels in the body throughout the day, for pediatric patients. This article aims to keep family NPs up to date in the latest in ADHD diagnosis and management to reduce patient barriers to care; it also provides NPs with critical information to convey to pediatric patients, their families, and their teachers during this back-to-school season.
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Chepke C, Brunner E, Cutler AJ. Serotonergic Drugs for the Treatment of Attention-Deficit/Hyperactivity Disorder: A Review of Past Development, Pitfalls and Failures, and a Look to the Future. PSYCHOPHARMACOLOGY BULLETIN 2024; 54:45-80. [PMID: 39263202 PMCID: PMC11385260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Serotonin has been implicated in the neurobiology of attention-deficit/hyperactivity disorder (ADHD) due to its association with impulsivity, attention, and emotional regulation. Many compounds with serotonergic properties have been evaluated in ADHD, but few have been approved by regulatory authorities. Utilizing a search of public databases, we identified interventions studied in ADHD. Prescribing information and peer-reviewed and gray literature helped us to determine which compounds had an underlying mechanism of action associated with changing serotonin levels. Of the 24 compounds that met the search criteria, 16 had either failed clinical studies in an ADHD population or had been discontinued from future development. The available evidence was assessed to identify the developmental history of drugs with serotonergic activity and the outlook for new ADHD drug candidates targeting serotonin. Several treatment candidates floundered due to an inability to balance effectiveness with safety, underscoring the potential importance of potency, and selectivity. Ongoing drug development includes compounds with multimodal mechanisms of action targeting neurotransmission across serotonin, norepinephrine, and dopamine pathways; it appears likely that treatment which balances competing and complementary monoamine effects may provide improved outcomes for patients. It is hoped that continuing research into ADHD treatment will produce new therapeutic options targeting the serotonergic system, which can positively impact a wide range of symptoms, including mood, anxiety, and sleep as well as attention and hyperactivity.
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Affiliation(s)
- Craig Chepke
- Chepke, MD, DFAPA, Excel Psychiatric Associates, Huntersville, NC; Atrium Health, Charlotte, NC
| | - Elizabeth Brunner
- Brunner, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ
| | - Andrew J Cutler
- Cutler, MD, SUNY Upstate Medical University, Lakewood Ranch, FL
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Zhao L, Agazzi H, Du Y, Meng H, Maku R, Li K, Aspinall P, Garvan CW, Fang S. A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial. J Med Internet Res 2024; 26:e55569. [PMID: 38728075 PMCID: PMC11127175 DOI: 10.2196/55569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. OBJECTIVE The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. METHODS This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. RESULTS Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. CONCLUSIONS This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.
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Affiliation(s)
- Licong Zhao
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Heather Agazzi
- Department of Pediatrics & Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of South Florida, Tampa, FL, United States
| | - Yasong Du
- Department of Child & Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China
| | - Hongdao Meng
- College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, United States
| | - Renya Maku
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Ke Li
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | | | - Cynthia Wilson Garvan
- Department of Anesthesiology, College of Medicine, University of Florida, Tampa, FL, United States
| | - Shuanfeng Fang
- Department of Child Healthcare, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Maletic V, Mattingly GW, Earnest J. Viloxazine extended-release capsules as an emerging treatment for attention-deficit/hyperactivity disorder in children and adolescents. Expert Rev Neurother 2024; 24:443-455. [PMID: 38502148 DOI: 10.1080/14737175.2024.2327533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and/or hyperactivity and impulsivity. Viloxazine extended-release (ER) capsules (Qelbree®) is a US Food and Drug Administration-approved nonstimulant treatment option for children, adolescents, and adults with ADHD. AREAS COVERED This review manuscript summarizes the neurobiology of ADHD and currently available treatment options before discussing viloxazine pharmacology, efficacy, safety, and tolerability data from phase II and III trials in children and adolescents (6-17 years old). Viloxazine clinical efficacy has also been further demonstrated by post hoc analyses of pediatric clinical trial results. EXPERT OPINION Current stimulant and nonstimulant treatments for ADHD may be suboptimal given low response rates and that tolerability issues are frequently experienced. Preclinical and clinical evidence has implicated both the role of catecholamine and serotonin signaling in the pathophysiology of ADHD and the pharmacologic effect of viloxazine on these critical neurotransmitter systems. With a relatively rapid onset of action, sustained symptom improvement, and clinical benefit in ADHD-associated impairments (functional and social), viloxazine ER represents a novel and emerging ADHD treatment option.
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Affiliation(s)
- Vladimir Maletic
- Department of Psychiatry and Behavioral Science, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Gregory W Mattingly
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Jami Earnest
- Medical Affairs, Supernus Pharmaceuticals, Inc, Rockville, MD, USA
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Aloni R, Kalron A, Goodman A, Ben-Ari A, Yoeli-Shalom T, Menascu S. Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis. J Atten Disord 2024; 28:1105-1113. [PMID: 38385203 DOI: 10.1177/10870547241232710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological autoimmune disease; pediatric-onset multiple sclerosis (POMS) represents 5% to 10% of total MS population. Children with POMS may experience attention difficulties due to the disease's impact on the central nervous system. However, little is known regarding Attention Deficit Hyperactivity Disorder (ADHD) in POMS, and its relation to cognitive performance. METHODS A retrospective case review was conducted using medical records of 66 children and adolescent patients diagnosed with POMS between 2012 and 2021 in a MS center of a tertiary medical center. All patients had undergone routine clinical neurological examinations and had been assessed for a diagnosis of ADHD by a department pediatric neurologist. In addition, sociodemographic data, disease-related variables, and cognitive performance were collected. RESULTS Of the 66 patients, 31 (47%) had a diagnosis of ADHD; 29 (44%) had cognitive impairment. Moreover, we identified four different profiles of POMS: those with only ADHD (17, 26%); only cognitive impairment (15, 23%), ADHD and cognitive impairment (14, 21%), and only POMS (20, 30%). A significant difference in disease duration was found among the four profiles [F(3,65) = 8.17, p < .001, η² = 0.29], indicating that patients with ADHD and cognitive impairment were characterized by longer disease duration. CONCLUSIONS ADHD may be prominently involved in POMS, even during the early stages of the disease and early diagnosis is crucial in order to provide appropriate interventions and support.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Physical Therapy, School of Health Professions, Tel-Aviv Faculty of Medicine, Tel-Aviv University, Israel
| | - Assaf Goodman
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Talya Yoeli-Shalom
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Tel-Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Bannett Y, Gunturkun F, Pillai M, Herrmann JE, Luo I, Huffman LC, Feldman HM. Leveraging a Large Language Model to Assess Quality-of-Care: Monitoring ADHD Medication Side Effects. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.23.24306225. [PMID: 38712037 PMCID: PMC11071552 DOI: 10.1101/2024.04.23.24306225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Objective To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD). Methods Retrospective population-based cohort study of electronic health records. Cohort included children aged 6-11 years with ADHD diagnosis and ≥2 ADHD medication encounters (stimulants or non-stimulants prescribed) between 2015-2022 in a community-based primary healthcare network (n=1247). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n=15,593 notes). Model performance was assessed using holdout and deployment test sets, compared to manual chart review. Results The LLaMA model achieved excellent performance in classifying notes that contain side effects inquiry (sensitivity= 87.2%, specificity=86.3/90.3%, area under curve (AUC)=0.93/0.92 on holdout/deployment test sets). Analyses revealed no model bias in relation to patient age, sex, or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; patient characteristics were similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower in telephone encounters than in-clinic/telehealth encounters (51.9% vs. 73.0%, p<0.01). Side effects inquiry was documented in 61% of encounters following stimulant prescriptions and 48% of encounters following non-stimulant prescriptions (p<0.01). Conclusions Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality-of-care and uncovered opportunities to improve psychopharmacological medication management in primary care.
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Affiliation(s)
- Yair Bannett
- Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Malvika Pillai
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Biomedical Informatics Research Center, Stanford University School of Medicine, Stanford, California, USA
| | | | - Ingrid Luo
- Stanford Quantitative Sciences Unit, Stanford, CA, USA
| | - Lynne C. Huffman
- Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Heidi M. Feldman
- Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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García-Hermoso A, Ezzatvar Y, Izquierdo M, López-Gil JF. Can an active lifestyle reduce the risk of obesity in adulthood among adolescents with Attention-Deficit/Hyperactivity Disorder symptoms? An ambispective cohort study. Psychiatry Res 2024; 334:115770. [PMID: 38350293 DOI: 10.1016/j.psychres.2024.115770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
Various studies have associated Attention-Deficit/Hyperactivity Disorder (ADHD) with obesity, but the role of physical activity in this connection is uncertain. This study examined whether adopting an active lifestyle can mitigate the link between adolescent ADHD and the risk of adult obesity. Longitudinal data from the Add Health Study (Waves I, III, and V) were used. Participants self-reported ADHD symptoms (hyperactivity/impulsivity, inattention, combined) during Wave III and self-assessed their recent moderate-to-vigorous physical activity. An "active lifestyle" required meeting activity criteria in both adolescence (Wave I) and adulthood (Wave III-V). Of 2609 participants, 1.42 % exhibited combined ADHD symptoms. A non-linear relationship was observed between inattentive/hyperactive scores and body mass index (BMI) and waist circumference (WC). Individuals with ≥ 6 hyperactivity/impulsivity symptoms had higher BMI (1.29 kg/m²) and WC (1.27 cm) at adulthood. Logistic regressions indicate that, compared to individuals without ADHD maintaining an active lifestyle, both inactive participants with and without ADHD show an elevated risk of obesity (odds ratio [OR]=1.56 to 2.63) and abdominal obesity in adulthood (OR = 1.51 to 2.50). Mediation analysis models further confirm these findings, suggesting that physical activity may explain this association. Though exact mechanisms warrant further exploration, adopting an active lifestyle offers promise for reducing obesity risk among individuals with ADHD symptoms.
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Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Spain.
| | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), IdiSNA, Universidad Pública de Navarra (UPNA), Pamplona, Spain
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