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Wilens TE, Stone M, Lanni S, Berger A, Wilson RLH, Lydston M, Surman CB. Treating Executive Function in Youth With Attention Deficit Hyperactivity Disorder: A Review of Pharmacological and Non-Pharmacological Interventions. J Atten Disord 2024; 28:751-790. [PMID: 38178649 DOI: 10.1177/10870547231218925] [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: 01/06/2024]
Abstract
INTRODUCTION Executive function (EF) deficits are common in youth with ADHD and pose significant functional impairments. The extent and effect of interventions addressing EF in youth with ADHD remain unclear. METHODS We conducted a systematic literature review using PRISMA guidelines. Included studies were randomized controlled trials of interventions to treat EF in youth with ADHD. RESULTS Our search returned 136 studies representing 11,443 study participants. We identified six intervention categories: nonstimulant pharmacological (N = 3,576 participants), neurological (N = 1,935), psychological (N = 2,387), digital (N = 2,416), physiological (N = 680), and combination (N = 366). The bulk of the evidence supported pharmacological interventions as most effective in mitigating EF, followed by psychological and digital interventions. CONCLUSION A breadth of treatments exists for EF in youth with ADHD. Pharmacological, psychotherapeutic, and digital interventions had the most favorable, replicable outcomes. A lack of outcome standardization across studies limited treatment comparison. More data on the persistence of intervention effects are necessary.
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Affiliation(s)
- Timothy E Wilens
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mira Stone
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Amy Berger
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Craig B Surman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Park HN, Kong NY, Kim HC, Kim YT, Jung SW, Lee H. Effectiveness and Tolerability of Combination Pharmacotherapy With Stimulant and Non-Stimulant in Children With Attention Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2024; 35:82-89. [PMID: 38204741 PMCID: PMC10774558 DOI: 10.5765/jkacap.230048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives This study aimed to investigate the effectiveness and safety of combining psychostimulants and nonstimulants for patients under treatment for attention deficit hyperactivity disorder (ADHD). Methods The study included 96 patients aged 6-12 years who were diagnosed with ADHD, among whom 34 received combination pharmacotherapy, 32 received methylphenidate monotherapy, and 30 received atomoxetine monotherapy. Statistical analysis was conducted to compare treatment and adverse effects among groups and to analyze changes before and after combination pharmacotherapy. The difference between combination pharmacotherapy and monotherapy was investigated. Logistic regression analysis was used to identify the predictors of combination pharmacotherapy. Results No significant differences were observed between the groups in terms of age or pretreatment scores. The most common adverse effect experienced by 32% of patients in the combination pharmacotherapy group was decreased appetite. Clinical global impression- severity score decreased significantly after combination pharmacotherapy. All three groups showed significant clinical global impression- severity score improvements over time, with no significant differences among them. The predictive factors for combination pharmacotherapy included the Child Behavior Checklist total score internalizing subscale. Conclusion Combination pharmacotherapy with methylphenidate and atomoxetine is a relatively effective and safe option for patients with ADHD who do not respond to monotherapy.
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Affiliation(s)
- Hyung Nam Park
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Na Yeong Kong
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hee-Cheol Kim
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yang Tae Kim
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sung-Won Jung
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hojun Lee
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
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O'Connor L, Carbone S, Gobbo A, Gamble H, Faraone SV. Pediatric attention deficit hyperactivity disorder (ADHD): 2022 updates on pharmacological management. Expert Rev Clin Pharmacol 2023; 16:799-812. [PMID: 37587841 DOI: 10.1080/17512433.2023.2249414] [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: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Pediatric attention-deficit disorder (ADHD) impacts a significant percentage of the population world-wide. Pharmacologic treatments have been shown to be safe and effective for managing symptoms. Various medication formulations exist, and new medication agents are continually approved each year. AREAS COVERED This article offers an overview of ADHD, an overview of both stimulant and non-stimulant medication options as well as an overview of stimulant misuse. It explores the medication mechanisms of action and side effect profiles, as well as offering an in-depth summary of the novel agents recently approved and soon-to-be approved for use in youth. PubMed and Medline were utilized. Search terms included children, adolescents, ADHD, and medication. FDA package inserts were reviewed for all medications. EXPERT OPINION New formulations of medications include an evening administered, extended, and delayed-release form of methylphenidate (DR/ER MPH), a methylphenidate pro-drug (serdexmethylphenidate) and an amphetamine patch. The availability of a new SNRI (selective norepinephrine reuptake inhibitor), viloxazine extended-release (VER), and the pending approval of a triple reuptake inhibitor (centanafadine) provides welcome additions to the prescriber's toolbox.
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Affiliation(s)
- Lisa O'Connor
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephanie Carbone
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anthony Gobbo
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hilary Gamble
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephen V Faraone
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
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Hellings J. Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry 2023; 13:262-277. [PMID: 37383284 PMCID: PMC10294139 DOI: 10.5498/wjp.v13.i6.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023] Open
Abstract
Available pharmacotherapies for autism spectrum disorders (ASD) are reviewed based on clinical and research experience, highlighting some older drugs with emerging evidence. Several medications show efficacy in ASD, though controlled studies in ASD are largely lacking. Only risperidone and aripiprazole have Federal Drug Administration approval in the United States. Methylphenidate (MPH) studies showed lower efficacy and tolerability for attention deficit hyperactivity disorder (ADHD) than in the typically developing (TD) population; atomoxetine demonstrated lower efficacy but comparable tolerability to TD outcomes. Guanfacine improved hyperactivity in ASD comparably to TD. Dex-troamphetamine promises greater efficacy than MPH in ASD. ADHD medications reduce impulsive aggression in youth, and may also be key for this in adults. Controlled trials of the selective serotonin reuptake inhibitors citalopram and fluoxetine demonstrated poor tolerability and lack of efficacy for repetitive behaviors. Trials of antiseizure medications in ASD remain inconclusive, however clinical trials may be warranted in severely disabled individuals showing bizarre behaviors. No identified drugs treat ASD core symptoms; oxytocin lacked efficacy. Amitriptyline and loxapine however, show promise. Loxapine at 5-10 mg daily resembled an atypical antipsychotic in positron emission tomography studies, but may be weight-sparing. Amitriptyline at approximately 1 mg/ kg/day used cautiously, shows efficacy for sleep, anxiety, impulsivity and ADHD, repetitive behaviors, and enuresis. Both drugs have promising neurotrophic properties.
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Affiliation(s)
- Jessica Hellings
- Department of Psychiatry, University of Missouri-Kansas City, Lee's Summit, MO 64063, United States
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5
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Lin CC, Chung CH, Chien WC, Tzeng NS. Pharmacotherapy May Attenuate the Risk of Child Abuse in Attention-Deficit/Hyperactivity Disorder from the Real-World Evidence. J Child Adolesc Psychopharmacol 2023; 33:59-68. [PMID: 36944094 DOI: 10.1089/cap.2023.0003] [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] [Indexed: 03/23/2023]
Abstract
Objective: Psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), may serve as a risk factor for child abuse. Methods: This study aimed to evaluate the association between children and adolescents with ADHD diagnosis and the risk of child abuse. The effectiveness of a pharmacological intervention on reducing the risk of child abuse was also assessed. A nationwide, population-based, retrospective with a matched-cohort study design was used. Data were from the National Health Insurance Research Database of Taiwan over a 15-year period (2000-2015). Results: Increased risk of child abuse in the ADHD group was noticed and the adjusted hazard ratio (HR) was 1.797 (95% confidence interval [CI] = 1.245-2.388, p < 0.001). The Kaplan-Meier analysis showed a significantly higher cumulative incidence in the ADHD group over the 15-year period (Log-rank test p < 0.001). ADHD patients with other psychiatric comorbidities had a higher risk of child abuse. Pharmacological treatment of either methylphenidate or atomoxetine was associated with a reduced risk of child abuse. The total adjusted HR was 1.466 (95% CI = 1.077-1.883, p < 0.001) in medicine group compared with the controls. Conclusions: ADHD was associated with a subsequent risk of child abuse in Taiwan. Pharmacological treatment could reduce the risk of child abuse in ADHD patients.
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Affiliation(s)
- Cian-Cian Lin
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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Silveira PP, Meaney MJ. Examining the biological mechanisms of human mental disorders resulting from gene-environment interdependence using novel functional genomic approaches. Neurobiol Dis 2023; 178:106008. [PMID: 36690304 DOI: 10.1016/j.nbd.2023.106008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
We explore how functional genomics approaches that integrate datasets from human and non-human model systems can improve our understanding of the effect of gene-environment interplay on the risk for mental disorders. We start by briefly defining the G-E paradigm and its challenges and then discuss the different levels of regulation of gene expression and the corresponding data existing in humans (genome wide genotyping, transcriptomics, DNA methylation, chromatin modifications, chromosome conformational changes, non-coding RNAs, proteomics and metabolomics), discussing novel approaches to the application of these data in the study of the origins of mental health. Finally, we discuss the multilevel integration of diverse types of data. Advance in the use of functional genomics in the context of a G-E perspective improves the detection of vulnerabilities, informing the development of preventive and therapeutic interventions.
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Affiliation(s)
- Patrícia Pelufo Silveira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
| | - Michael J Meaney
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore; Brain - Body Initiative, Agency for Science, Technology and Research (ASTAR), Singapore.
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Xu Y, Chung H, Shu M, Liu Y, Zhang Y, Qiu H. Dose titration of osmotic release oral system methylphenidate in children and adolescents with attention-deficit hyperactivity disorder: a retrospective cohort study. BMC Pediatr 2023; 23:38. [PMID: 36683085 PMCID: PMC9869580 DOI: 10.1186/s12887-023-03850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Osmotic release oral system methylphenidate (OROS-MPH) is one of the most commonly used medication for attention-deficit hyperactivity disorder (ADHD), however, real-world knowledge on OROS-MPH dose titration has been limited. This study aims to summarize and visualise the OROS-MPH titration patterns in children and adolescents with ADHD in the United States (US) and Japan. METHODS This retrospective cohort study used the US IBM® MarketScan® Commercial Claims and Encounters database from 2000 to 2019 and the Japan Medical Data Centre database from 2008 to 2019. New OROS-MPH users with ADHD were identified and split into child (6 to < 13 years) and adolescent (13 to < 18 years) groups according to age at OROS-MPH initiation/reinitiation. Patient characteristics and OROS-MPH treatment patterns were described. OROS-MPH dose titration pathways were visualised by Sankey diagrams. RESULTS We included 98,973 children and 62,002 adolescents in the US cohort, and 4595 children and 1508 adolescents in the Japanese cohort. In Japanese cohort, 91.9% of children and 77.9% of adolescents initiated OROS-MPH at the lowest dose (18 mg/day), whereas US patients had a broader distribution of initial doses (e.g., 18-54 mg/day). The US patients had higher daily dose of OROS-MPH than Japanese patients. Overall, a minority (< 40%) of the OROS-MPH users underwent dose titration, and different titration patterns were observed between the US and Japanese patients. CONCLUSIONS Different treatment and titration patterns of OROS-MPH were observed in the two countries. Additional real-world studies about clinical reasoning underlying dose selection are needed to support clinical decision-making.
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Affiliation(s)
- Youran Xu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Beijing, China
| | - Hsingwen Chung
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Titusville, NJ USA
| | - Meng Shu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Yanfang Liu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Singapore, Singapore
| | - Yongjing Zhang
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Hong Qiu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Titusville, NJ USA
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8
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Bahn GH, Seo K. Combined Medication with Stimulants and Non-stimulants for Attention-deficit/hyperactivity Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:705-711. [PMID: 34690125 PMCID: PMC8553528 DOI: 10.9758/cpn.2021.19.4.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 11/18/2022]
Abstract
Objective To study the efficiency and indication of combined medication with a stimulant and non-stimulant for attention-deficiency/hyperactivity disorder (ADHD), herein, the authors examined children and adult patients with ADHD. Methods Subjects included patients diagnosed with ADHD who paid two or more visits to the outpatient clinic of the Kyung Hee University hospital from January 2009 to December 2019. The authors examined the age, sex, drugs, treatment adherence, and reason for combined medication. The subjects were classified into four groups treatment with a non-stimulant (atomoxetine) only (Group ATX), treatment with a stimulant (methylphenidate immediate-release, extended-release, or osmotic-release oral system) only (Group MPH), exposed to both but separately used (Group SEP), and exposed to both with combined use (Group COM). The patient was considered adherent to treatment (1) on visiting the hospital ten or more times or consecutively for six months, and (2) medication possession ratio ≥ 0.8. Results Of 929 patients, 229 (24.7%) were female. Group ATX comprised 146 (15.7%) patients, Group MPH comprised 627 (67.5%) patients, Group SEP comprised 106 (11.4%) patients, and Group COM comprised 50 (5.4%) patients. Longer-term adherence was seen with combined medication and in females than with monopharmacy and in males. The main indication for combination was dose-limiting untoward effects. Conclusion These results suggest that combined medication would facilitate treatment adherence for ADHD. Further research is essential for the replication of these results in a large sample and the investigation of the indications for administering combined medication in children and adults with ADHD.
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Affiliation(s)
- Geon Ho Bahn
- Deparment of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyunghoon Seo
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
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Bushnell GA, Crystal S, Olfson M. Trends in Antipsychotic Medication Use in Young Privately Insured Children. J Am Acad Child Adolesc Psychiatry 2021; 60:877-886. [PMID: 33091567 PMCID: PMC8055725 DOI: 10.1016/j.jaac.2020.09.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate trends of annual antipsychotic medication use by privately insured young children (aged 2-7 years) in the United States, and to describe the clinical and treatment characteristics of these children. METHOD The study population included young children from a nationwide commercial claims database (2007-2017). We estimated annual antipsychotic use by age and sex, defined as the number of children dispensed an antipsychotic per year divided by the number enrolled. We described clinical diagnoses and mental health service use in those with prescription antipsychotic use in 2009 and 2017. RESULTS Annual antipsychotic use in young children was 0.27% in 2007, peaked at 0.29% in 2009, and statistically significantly declined to 0.17% by 2017 (linear trend: -0.017% per year, 95% CI: -0.018 to -0.016). Antipsychotic use was higher in boys than in girls. A greater proportion of antipsychotic users received a mental disorder diagnosis in 2017 (89%) than in 2009 (86%, p < .01). The most common clinical diagnoses in antipsychotic users, under a hierarchical classification, were pervasive developmental disorder (2009 = 27%, 2017 = 38%, p < .01), conduct or disruptive behavior disorder (2009 = 15%, 2017 = 21%, p < .01), and attention-deficit/hyperactivity disorder (2009 = 24%, 2017 = 18%, p < .01). Among 2017 antipsychotic users, 32% had 4+ psychotherapy claims, 43% had a psychiatrist visit, and the majority used another psychotropic medication, most commonly a stimulant (boys = 57%, girls = 50%). CONCLUSION In privately insured young children, antipsychotic use declined from 2009 to 2017, with shifts toward indications with some supporting evidence. Nevertheless, a majority of use remains off label and for conditions lacking effectiveness and safety data. Improving antipsychotic prescribing in young children remains a challenge.
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Affiliation(s)
- Greta A Bushnell
- Rutgers School of Public Health, Piscataway, and the Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, New Jersey.
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research at Rutgers University in New Brunswick, New Jersey
| | - Mark Olfson
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Mailman School of Public Health, and the New York State Psychiatric Institute in New York
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Findling RL, Candler SA, Nasser AF, Schwabe S, Yu C, Garcia-Olivares J, O'Neal W, Newcorn JH. Viloxazine in the Management of CNS Disorders: A Historical Overview and Current Status. CNS Drugs 2021; 35:643-653. [PMID: 34003459 PMCID: PMC8219567 DOI: 10.1007/s40263-021-00825-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Viloxazine has a long history of clinical use in Europe as an antidepressant, and has recently been repurposed into an extended-release form for the treatment of attention-deficit/hyperactivity disorder in the USA. An immediate-release formulation was approved for the treatment of depression in the UK in 1974, and was subsequently marketed there and in several European countries for 30 years with no major safety concerns. In contrast to first-generation antidepressants (e.g., tricyclic antidepressants, monoamine oxidase inhibitors), viloxazine was associated with a relatively low risk for cardiotoxicity. Gastrointestinal symptoms were the most commonly reported side effects. The therapeutic effects of viloxazine are thought to be primarily the result of its action as a norepinephrine reuptake inhibitor, although in vitro and preclinical in vivo animal data suggest that viloxazine may also impact the serotoninergic system. This review summarizes the evolving knowledge of viloxazine based on information from previously published preclinical and clinical investigations, and acquired unpublished historical study reports from both open-label and blinded controlled clinical trials. We review the chemical properties, mechanism of action, safety, and tolerability across these studies, and discuss the contemporary rationale for the development of this agent as an extended-release oral formulation for the treatment of attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Robert L Findling
- VCU Department of Psychiatry, 501 North 2nd Street, Richmond, VA, 23298-0308, USA.
| | | | | | | | - Chungping Yu
- Supernus Pharmaceuticals, Inc., Rockville, MD, USA
| | | | | | - Jeffrey H Newcorn
- Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Park D, Mabunga DFN, Adil KJ, Ryu O, Valencia S, Kim R, Kim HJ, Cheong JH, Kwon KJ, Kim HY, Han SH, Jeon SJ, Shin CY. Synergistic efficacy and diminished adverse effect profile of composite treatment of several ADHD medications. Neuropharmacology 2021; 187:108494. [PMID: 33587920 DOI: 10.1016/j.neuropharm.2021.108494] [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: 05/07/2020] [Revised: 01/05/2021] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) is widely studied, problems regarding the adverse effect risks and non-responder problems still need to be addressed. Combination pharmacotherapy using standard dose regimens of existing medication is currently being practiced mainly to augment the therapeutic efficacy of each drug. The idea of combining different pharmacotherapies with different molecular targets to alleviate the symptoms of ADHD and its comorbidities requires scientific evidence, necessitating the investigation of their therapeutic efficacy and the mechanisms underlying the professed synergistic effects. Here, we injected male ICR mice with MK-801 to induce ADHD behavioral condition. We then modeled a "combined drug" using sub-optimal doses of methylphenidate, atomoxetine, and fluoxetine and investigated the combined treatment effects in MK-801-treated mice. No sub-optimal dose monotherapy alleviated ADHD behavioral condition in MK-801-treated mice. However, treatment with the combined drug attenuated the impaired behavior of MK-801-treated animals. Growth impediment, sleep disturbances, or risk of substance abuse were not observed in mice treated subchronically with the combined drugs. Finally, we observed that the combined ADHD drug rescued alterations in p-AKT and p-ERK1/2 levels in the prefrontal cortex and hippocampus, respectively, of MK-801-treated mice. Our results provide experimental evidence of a possible new pharmacotherapy option in ameliorating the ADHD behavioral condition without the expected adverse effects. The detailed mechanism of action underlying the synergistic therapeutic efficacy and reduced adverse reaction by combinatorial drug treatment should be investigated further in future studies.
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Affiliation(s)
- Donghyun Park
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Darine Froy N Mabunga
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Keremkleroo Jym Adil
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Onjeon Ryu
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Schley Valencia
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Ryeongeun Kim
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Hee Jin Kim
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul, 01795, Republic of Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul, 01795, Republic of Korea
| | - Kyung Ja Kwon
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University Medical Center, Center for Geriatric Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, 05029, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University Medical Center, Center for Geriatric Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, 05029, Republic of Korea
| | - Se Jin Jeon
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea; TriNeuro Inc., 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.
| | - Chan Young Shin
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029, Republic of Korea; TriNeuro Inc., 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.
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Ishizuya A, Enomoto M, Tachimori H, Takahashi H, Sugihara G, Kitamura S, Mishima K. Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder. Sci Rep 2021; 11:1707. [PMID: 33462331 PMCID: PMC7814069 DOI: 10.1038/s41598-021-81416-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Poor adherence is a major concern in the treatment of attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to evaluate factors linked to early interruption of and low adherence to treatment with osmotic-release oral system methylphenidate hydrochloride (OROS-MPH) in pediatric patients with ADHD. A total of 1353 young people (age 6–17 years) with a diagnosis of ADHD who newly started OROS-MPH were extracted from the pharmacoepidemiological data of 3 million people in Japan. The cohort was retrospectively surveyed every month for 12 months. Ten possible risk factors were extracted from the data and analyzed by multivariable logistic regression. Sensitivity analysis was conducted to ensure the robustness of the analysis. The results revealed that treatment adherence was generally poor, with a tendency for discontinuation in the early stage. Multivariable logistic regression results showed that adherence is reduced by female sex, lower starting dose, and concomitant atomoxetine or hypnotics. These findings may help clinicians to predict the risk of poor adherence in the early stage of treatment and improve not only patients’ symptoms, but also their quality of life.
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Affiliation(s)
- Asami Ishizuya
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.,Department of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita-city, Akita, 010-8543, Japan.,Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan
| | - Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita-city, Akita, 010-8543, Japan. .,Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan. .,International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Japan.
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13
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Miguel PM, Pereira LO, Barth B, de Mendonça Filho EJ, Pokhvisneva I, Nguyen TTT, Garg E, Razzolini BR, Koh DXP, Gallant H, Sassi RB, Hall GBC, O'Donnell KJ, Meaney MJ, Silveira PP. Prefrontal Cortex Dopamine Transporter Gene Network Moderates the Effect of Perinatal Hypoxic-Ischemic Conditions on Cognitive Flexibility and Brain Gray Matter Density in Children. Biol Psychiatry 2019; 86:621-630. [PMID: 31142432 DOI: 10.1016/j.biopsych.2019.03.983] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Genetic polymorphisms of the dopamine transporter gene (DAT1) and perinatal complications associated with poor oxygenation are risk factors for attentional problems in childhood and may show interactive effects. METHODS We created a novel expression-based polygenic risk score (ePRS) reflecting variations in the function of the DAT1 gene network (ePRS-DAT1) in the prefrontal cortex and explored the effects of its interaction with perinatal hypoxic-ischemic-associated conditions on cognitive flexibility and brain gray matter density in healthy children from two birth cohorts-MAVAN from Canada (n = 139 boys and girls) and GUSTO from Singapore (n = 312 boys and girls). RESULTS A history of exposure to several perinatal hypoxic-ischemic-associated conditions was associated with impaired cognitive flexibility only in the high-ePRS group, suggesting that variation in the prefrontal cortex expression of genes involved in dopamine reuptake is associated with differences in this behavior. Interestingly, this result was observed in both ethnically distinct birth cohorts. Additionally, parallel independent component analysis (MAVAN cohort, n = 40 children) demonstrated relationships between single nucleotide polymorphism-based ePRS and gray matter density in areas involved in executive (cortical regions) and integrative (bilateral thalamus and putamen) functions, and these relationships differ in children from high and low exposure to hypoxic-ischemic-associated conditions. CONCLUSIONS These findings reveal that the impact of conditions associated with hypoxia-ischemia on brain development and executive functions is moderated by genotypes associated with dopamine signaling in the prefrontal cortex. We discuss the potential impact of innovative genomic and environmental measures for the identification of children at high risk for impaired executive functions.
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Affiliation(s)
- Patrícia Maidana Miguel
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lenir Orlandi Pereira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Barbara Barth
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Euclides José de Mendonça Filho
- Programa de Pós-Graduação em Psicologia, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Irina Pokhvisneva
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Thao T T Nguyen
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Elika Garg
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Bruna Regis Razzolini
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Dawn Xin Ping Koh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Heather Gallant
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Roberto Britto Sassi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Kieran John O'Donnell
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Patrícia Pelufo Silveira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montréal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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14
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Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2019; 144:e20192528. [PMID: 31570648 PMCID: PMC7067282 DOI: 10.1542/peds.2019-2528] [Citation(s) in RCA: 566] [Impact Index Per Article: 113.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.
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Affiliation(s)
- Mark L. Wolraich
- Section of Developmental and Behavioral Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma
| | - Joseph F. Hagan
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont
- Hagan, Rinehart, and Connolly Pediatricians, PLLC, Burlington, Vermont
| | - Carla Allan
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Dale Davison
- Children and Adults with Attention-Deficit/Hyperactivity Disorder, Lanham, Maryland
- Dale Davison, LLC, Skokie, Illinois
| | - Marian Earls
- Community Care of North Carolina, Raleigh, North Carolina
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio
- Center for Intervention Research in Schools, Ohio University, Athens, Ohio
| | | | - Tanya Froehlich
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Frost
- Swope Health Services, Kansas City, Kansas
- American Academy of Family Physicians, Leawood, Kansas
| | - Joseph R. Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christoph Ulrich Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee
| | | | | | - Karen L. Pierce
- American Academy of Child and Adolescent Psychiatry, Washington, District of Columbia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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15
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Feldman ME, Charach A, Bélanger SA. Le TDAH chez les enfants et les adolescents, partie 2 : le traitement. Paediatr Child Health 2018; 23:473-484. [PMCID: PMC6199638 DOI: 10.1093/pch/pxy114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Le trouble de déficit de l’attention/hyperactivité (TDAH) est un trouble neurodéveloppemental chronique. La Société canadienne de pédiatrie a préparé trois documents de principes après avoir effectué des analyses bibliographiques systématiques. Leurs objectifs s’établissent comme suit : 1) Résumer les données probantes cliniques à jour sur le TDAH. 2) Établir une norme pour les soins du TDAH. 3) Aider les cliniciens canadiens à prendre des décisions éclairées et fondées sur des données probantes pour rehausser la qualité des soins aux enfants et aux adolescents qui présentent cette affection. La partie 2, axée sur le traitement, porte sur les données probantes et le contexte entourant diverses approches cliniques, la combinaison des interventions comportementales et pharmacologiques pour assurer un traitement plus efficace, le rôle de la formation des parents et des enseignants (ou des autres personnes qui s’occupent de l’enfant), le recours aux stimulants et aux non-stimulants, leurs effets et leurs risques, leur posologie et les protocoles de surveillance. Les recommandations thérapeutiques reposent sur les lignes directrices à jour, les données probantes tirées de publications scientifiques et le consensus d’experts.
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Affiliation(s)
- Mark E Feldman
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Alice Charach
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Stacey A Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
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16
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Feldman ME, Charach A, Bélanger SA. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health 2018; 23:462-472. [PMID: 30681665 DOI: 10.1093/pch/pxy113] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 2, which focuses on treatment, include: evidence and context for a range of clinical approaches, combining behavioural and pharmacological interventions to address impairment more effectively, the role of parent and teacher (or other caregiver) training, the use of stimulant and nonstimulant medications, with effects and risks, and dosing and monitoring protocols. Treatment recommendations are based on current guidelines, evidence from the literature, and expert consensus.
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Affiliation(s)
- Mark E Feldman
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Stacey A Bélanger
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
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17
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Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders. Semin Pediatr Neurol 2018; 25:123-135. [PMID: 29735110 DOI: 10.1016/j.spen.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves. For more uncommon movement disorders, such as juvenile-onset Huntington disease, treatment of psychiatric comorbidities is not well-characterized, and best-practice recommendations are not available. For the least common movement disorders, such as childhood neurodegeneration with brain iron accumulation, psychiatric features may be nonspecific so that underlying diagnosis may be apparent only after recognition of other symptoms. However, psychiatric medication, psychotherapy, and psychosocial support for these disorders may prove helpful to many children and adolescents.
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18
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Churchill SS, Leo MC, Brennan EM, Sellmaier C, Kendall J, Houck GM. Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD. Matern Child Health J 2018; 22:1172-1182. [PMID: 29476416 DOI: 10.1007/s10995-018-2502-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.
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Affiliation(s)
- Shervin S Churchill
- Family and Child Nursing, University of Washington, Seattle, WA, 98195-7266, USA. .,School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, 98011, USA.
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Eileen M Brennan
- School of Social Work, Portland State University, Portland, OR, USA
| | - Claudia Sellmaier
- Social Work and Criminal Justice, University of Washington-Tacoma, Tacoma, WA, 98402, USA
| | - Judy Kendall
- Cascadia Behavioral Health Care, Portland, OR, USA
| | - Gail M Houck
- Family and Child Nursing, University of Washington, Seattle, WA, 98195-7266, USA
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19
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Markowitz JS, Patrick KS. The Clinical Pharmacokinetics of Amphetamines Utilized in the Treatment of Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2017; 27:678-689. [PMID: 28910145 DOI: 10.1089/cap.2017.0071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Amphetamine (AMP), an indirectly acting psychostimulant approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults, is among the most long-standing therapeutic agents in all of clinical psychopharmacology. This review focuses on AMP absorption, metabolism, and elimination brought to bear on comparative pharmacokinetics in its various formulations. A comprehensive search of the published literature was conducted using MEDLINE (PubMed) and Google Scholar databases through April 2017 to retrieve all pertinent in vitro and human studies for review and synthesis. Additionally, Food and Drug Administration (FDA) databases were accessed for otherwise unavailable data when possible. Initially available as racemic (dl)-AMP, this drug was later supplanted by enantiopure (d)-AMPH or enantioenriched (75:25 dl)-AMP formulations; although racemic AMP returned as an approved drug to treat ADHD in 2014. Presently, there are several immediate-release (IR) formulations available, including d-AMP, dl-AMP, and mixed amphetamine salts, which are neither racemic nor the pure d-enantiomer (i.e., a 3:1 mixture of d-AMP and l-AMP). Furthermore, new modified-release AMP formulations, including an oral suspension and an orally disintegrating tablet, are now available. A lysine-bonded prodrug form of d-AMP also serves as a treatment option. Oral AMP is rapidly absorbed, with high absolute bioavailability, followed by extensive metabolism involving multiple enzymes. Some metabolic pathways exhibit stereoselective biotransformations favoring the l-isomer substrate. Drug exposure exhibits dose-proportional pharmacokinetics. Body weight is a fundamental determinant of differences in observed AMP plasma concentrations. IR formulations typically provide a Tmax from 2 to 3 hours. In replicated studies, children exhibit a shorter plasma T1/2 (∼7 hours) relative to adults (∼10 to 12 hours). There are few documented pharmacokinetic drug interactions of clinical significance beyond influences of drug-induced alteration of urinary pH. The array of AMP formulations addressed in this review offer flexibility in dosing, drug onset, and offset to assist in individualized pharmacotherapy of ADHD.
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Affiliation(s)
- John S Markowitz
- 1 Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida , Gainesville, Florida.,2 Center for Pharmacogenomics, University of Florida , Gainesville, Florida
| | - Kennerly S Patrick
- 3 Deparment of Drug Discovery and Biomedical Sciences, Medical University of South Carolina , Charleston, South Carolina
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20
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Özbaran B, Köse S, Ocakoğlu FT, Kayış H, Satar A, Tekin U. Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1358684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Burcu Özbaran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sezen Köse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Fevzi Tuna Ocakoğlu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hakan Kayış
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ayşegül Satar
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Uğur Tekin
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
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21
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Fan LY, Chou TL, Gau SSF. Neural correlates of atomoxetine improving inhibitory control and visual processing in Drug-naïve adults with attention-deficit/hyperactivity disorder. Hum Brain Mapp 2017; 38:4850-4864. [PMID: 28657141 DOI: 10.1002/hbm.23683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 11/09/2022] Open
Abstract
Atomoxetine improves inhibitory control and visual processing in healthy volunteers and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about the neural correlates of these two functions after chronic treatment with atomoxetine. This study aimed to use the counting Stroop task with functional magnetic resonance imaging (fMRI) and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to investigate the changes related to inhibitory control and visual processing in adults with ADHD. This study is an 8-week, placebo-controlled, double-blind, randomized clinical trial of atomoxetine in 24 drug-naïve adults with ADHD. We investigated the changes of treatment with atomoxetine compared to placebo-treated counterparts using the counting Stroop fMRI and two CANTAB tests: rapid visual information processing (RVP) for inhibitory control and delayed matching to sample (DMS) for visual processing. Atomoxetine decreased activations in the right inferior frontal gyrus and anterior cingulate cortex, which were correlated with the improvement in inhibitory control assessed by the RVP. Also, atomoxetine increased activation in the left precuneus, which was correlated with the improvement in the mean latency of correct responses assessed by the DMS. Moreover, anterior cingulate activation in the pre-treatment was able to predict the improvements of clinical symptoms. Treatment with atomoxetine may improve inhibitory control to suppress interference and may enhance the visual processing to process numbers. In addition, the anterior cingulate cortex might play an important role as a biological marker for the treatment effectiveness of atomoxetine. Hum Brain Mapp 38:4850-4864, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Li-Ying Fan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.,Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Tai-Li Chou
- Department of Psychology, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.,Department of Psychology, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
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22
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Rolle des Kinderarztes bei Lernstörungen und Schulproblemen. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Baker M, Bellonci C, Huefner JC, Hilt RJ, Carlson GA. Polypharmacy and the Pursuit of Appropriate Prescribing for Children and Adolescents. ACTA ACUST UNITED AC 2017. [DOI: 10.1521/capn.2017.22.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Megan Baker
- Stanford Child and Adolescent Psychiatry, Fellow
| | - Christopher Bellonci
- Vice President of Policy and Practice/Chief Medical Officer at Judge Baker Children's Center,
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24
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Ozbaran B, Kose S, Yuzuguldu O, Atar B, Aydin C. Combined methylphenidate and atomoxetine pharmacotherapy in attention deficit hyperactivity disorder. World J Biol Psychiatry 2016. [PMID: 26223958 DOI: 10.3109/15622975.2015.1051109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes stimulant and non-stimulant medications. Our purpose in this study is to investigate efficacy, safety and tolerability of combined methylphenidate and atomoxetine pharmacotherapy. METHODS We included 12 patients of the 824 patients with ADHD using methylphenidate and atomoxetine combined therapy between the years 2010 and 2014. Kiddie-SADS, Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale, Child Behavior Checklist, Clinic Global Impression Scale Severity and Impression (CGIS-S-I) scales were used. RESULTS Patients were between the ages of 7 and 17 years. Before combined pharmacotherapy the CGIS-S score mean was 5.08. Mean CGIS-S score after the combined pharmacotherapy was 3.08 (P = 0.03; -2,980). The most common side effects were irritability (n = 5, 41.6%), appetite reduction (n = 3, 25%), palpitations (n = 2, 16.7%), headache (n = 1, 8.3%). CONCLUSIONS Nine of these 12 patients showed significant improvement in their symptoms, combined therapy enhanced the effectiveness of monotherapy.
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Affiliation(s)
- Burcu Ozbaran
- a Ege University Medical School, Child and Adolescent Psychiatry Department , Bornova, İzmir , Turkey
| | - Sezen Kose
- a Ege University Medical School, Child and Adolescent Psychiatry Department , Bornova, İzmir , Turkey
| | - Onur Yuzuguldu
- a Ege University Medical School, Child and Adolescent Psychiatry Department , Bornova, İzmir , Turkey
| | - Burcu Atar
- a Ege University Medical School, Child and Adolescent Psychiatry Department , Bornova, İzmir , Turkey
| | - Cahide Aydin
- a Ege University Medical School, Child and Adolescent Psychiatry Department , Bornova, İzmir , Turkey
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25
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Liu X, Kubilis P, Bussing R, Winterstein AG. Development of a refill pattern method to measure polypharmacy in administrative claims databases. Pharmacoepidemiol Drug Saf 2016; 25:1407-1413. [PMID: 27528378 DOI: 10.1002/pds.4082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/02/2016] [Accepted: 07/26/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The purposes of the study were to develop a refill pattern method to identify polypharmacy in pharmacy billing records and to compare the method with traditional days' supply overlap algorithms. METHODS This method is characterized by the assessment of prescription refill pattern. Concomitant therapy is assumed when two drugs are dispensed repeatedly during the active days' supply of each other. We tested the refill pattern method in a simplified scenario in which two drugs (methylphenidate/dexmethylphenidate and atomoxetine) for attention deficit/hyperactivity disorder (ADHD) were considered. Children who had at least one prescription of methylphenidate/dexmethylphenidate or atomoxetine in 2008 were included for the calculation of 2-year prevalence of ADHD treatment polypharmacy. Results were compared with traditional method that requires a minimum overlap of 30, 60 or 90 days of filled prescriptions. We compared polypharmacy prevalence estimated by the two methods and explored reasons for disagreement. RESULTS Among 131 385 children who had at least one prescription of methylphenidate/dexmethylphenidate or atomoxetine, the refill pattern method identified 4021 patients who had ADHD treatment polypharmacy (2-year prevalence = 3.1%). This prevalence estimate fell between those from a 30- to 60-day overlap method. The Cohen's kappa regarding determination of polypharmacy was 0.83, 0.92 and 0.80 considering 90-, 60- and 30-day overlap method, respectively. CONCLUSIONS The refill pattern method can be used as another way to measure polypharmacy in administrative claims databases and can be adapted to a wide variety of research questions, diseases and study populations. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Paul Kubilis
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, College of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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26
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Wang LJ, Yang KC, Lee SY, Yang CJ, Huang TS, Lee TL, Yuan SS, Shyu YC. Initiation and Persistence of Pharmacotherapy for Youths with Attention Deficit Hyperactivity Disorder in Taiwan. PLoS One 2016; 11:e0161061. [PMID: 27518196 PMCID: PMC4982593 DOI: 10.1371/journal.pone.0161061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pharmacotherapy is an effective therapeutic option for attention deficit hyperactivity disorder (ADHD). Understanding the patterns of medication treatment is crucial for clinical practice. This study employed nationwide population-based data to elucidate the initiation and persistence of pharmacotherapy (immediate-release methylphenidate [IR-MPH], osmotic controlled-release formulations of methylphenidate [OROS-MPH] and atomoxetine [ATX]) for youths with ADHD in Taiwan. METHODS Patients first receiving an ADHD diagnosis at age 18 or younger between January 2000 and December 2009 (n = 112,140; mean age at ADHD diagnosis: 7.7 years) were selected from Taiwan's National Health Insurance database. All patients were monitored through December 31, 2011, with an average follow-up time of 5.8 years. The initiation of ADHD drug therapy was defined as the first patient prescription, and discontinuation was defined as the cessation of ADHD medication for 180 days or longer. RESULTS Within the first year after ADHD diagnosis, 47.3%, 14.4%, and 0.8% of the patients were prescribed IR-MPH, OROS-MPH, and ATX, respectively. Regarding the patients prescribed IR-MPH, OROS-MPH, and ATX, 17.8%, 12.6%, and 18.8%, respectively, received the prescription only once and never returned for a drug refill, and 51.0%, 38.9%, and 58.8%, respectively, discontinued drug therapy within 1 year after the first prescription. Male sex and neuropsychiatric comorbidities were associated with higher probabilities of being prescribed one of the medications. An older age at first prescription and a higher daily dose of prescription were significant predictors of early discontinuation of ADHD medication. CONCLUSIONS The current findings suggest that IR-MPH is the most frequently prescribed drug for ADHD treatment in Taiwan. Patients treated with OROS-MPH possessed the highest persistence rate, whereas those treated with ATX had the lowest persistence rate. The results provide insight into the delivery of pediatric mental health services and have crucial implications for ADHD medication treatment in real clinical settings.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kang-Chung Yang
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ju Yang
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ting-Shuo Huang
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Liang Lee
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
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Clemow DB, Mason OW, Sarkis EH, Ruff DD, Berman BD, Donnelly CL, Robb AS, Holland DS, Schuh KJ, Barnes JM, Araujo AB. Atomoxetine monotherapy compared with combination therapy for the treatment of ADHD: a retrospective chart review study. Expert Rev Neurother 2015; 15:1353-66. [DOI: 10.1586/14737175.2015.1102060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, Rohde LA, Sonuga-Barke EJS, Tannock R, Franke B. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. [PMID: 27189265 DOI: 10.1038/nrdp.2015.20] [Citation(s) in RCA: 800] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York 13210, USA
- K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, 5020 Bergen, Norway
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joseph Biederman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil
| | - Edmund J S Sonuga-Barke
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rosemary Tannock
- Neuroscience and Mental Health Research Program, Research Institute of The Hospital for Sick Children, Toronto, Canada
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Departments of Human Genetics and Psychiatry, Nijmegen, The Netherlands
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Zlebnik NE, Carroll ME. Effects of the combination of wheel running and atomoxetine on cue- and cocaine-primed reinstatement in rats selected for high or low impulsivity. Psychopharmacology (Berl) 2015; 232:1049-59. [PMID: 25258161 PMCID: PMC4339407 DOI: 10.1007/s00213-014-3744-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/07/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Aerobic exercise and the attention-deficit/hyperactivity disorder medication, atomoxetine (ATO), are two monotherapies that have been shown to suppress reinstatement of cocaine-seeking in an animal model of relapse. The present study investigated the effects of combining wheel running and ATO versus each treatment alone on cocaine-seeking precipitated by cocaine and cocaine-paired cues in rats with differing susceptibility to drug abuse (i.e., high vs. low impulsive). METHODS Rats were screened for high (HiI) or low impulsivity (LoI) based on their performance on a delay-discounting task and then trained to self-administer cocaine (0.4 mg/kg/inf) for 10 days. Following 14 days of extinction, both groups were tested for reinstatement of cocaine-seeking precipitated by cocaine or cocaine-paired cues in the presence of concurrent running wheel access (W), pretreatment with ATO, or both (W+ATO). RESULTS HiI rats acquired cocaine self-administration more quickly than LoI rats. While both individual treatments and W+ATO significantly attenuated cue-induced cocaine seeking in HiI and LoI rats, only W+ATO was effective in reducing cocaine-induced reinstatement compared with vehicle treatment. There were dose-dependent and phenotype-specific effects of ATO with HiI rats responsive to the low but not high ATO dose. Floor effects of ATO and W on cue-induced reinstatement prevented the assessment of combined treatment effects. CONCLUSIONS These findings demonstrated greater attenuation of cue- versus cocaine-induced reinstatement by ATO and W alone and recapitulate impulsivity phenotype differences in both acquisition of cocaine self-administration and receptivity to treatment.
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Affiliation(s)
- Natalie E Zlebnik
- Graduate Program in Neuroscience, University of Minnesota Medical School, Jackson Hall, 321 Church St. SE, Minneapolis, MN, 55455, USA,
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30
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Gorman DA, Gardner DM, Murphy AL, Feldman M, Bélanger SA, Steele MM, Boylan K, Cochrane-Brink K, Goldade R, Soper PR, Ustina J, Pringsheim T. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:62-76. [PMID: 25886657 PMCID: PMC4344948 DOI: 10.1177/070674371506000204] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop evidence-based guidelines on pharmacotherapy for severe disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD). The guidelines assume that psychosocial interventions have been pursued but did not achieve sufficient improvement. METHOD A multidisciplinary consensus group used the Grading of Recommendations Assessment, Development and Evaluation approach for rating evidence quality and for grading recommendations. We conducted a systematic review of medications studied in placebo-controlled trials for treating disruptive and aggressive behaviour in children and adolescents with ADHD, ODD, or CD. We followed consensus procedures to make 1 of 4 recommendations for each medication: strong, in favour (↑↑); conditional, in favour (↑?); conditional, against (↓?); and strong, against (↓↓). RESULTS For children and adolescents with disruptive or aggressive behaviour associated with ADHD, psychostimulants received a strong recommendation in favour of use, while atomoxetine and alpha-2 agonists received a conditional recommendation in favour of use. If these patients do poorly with ADHD medications, the medication with the most evidence is risperidone. Risperidone also has the most evidence for treating disruptive or aggressive behaviour in the absence of ADHD. However, given risperidone's major adverse effects, it received only a conditional recommendation in favour of use. We recommended against using quetiapine, haloperidol, lithium, or carbamazepine because of the poor quality of evidence and their major adverse effects. CONCLUSION When severe disruptive or aggressive behaviour occurs with ADHD, medications for ADHD should be used first. Other medications have major adverse effects and, with the exception of risperidone, very limited evidence to support their use.
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Affiliation(s)
- Daniel A Gorman
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, The Hospital for Sick Children, Toronto, Ontario
| | - David M Gardner
- Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
| | - Andrea L Murphy
- Associate Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
| | - Mark Feldman
- Associate Professor, Department of Paediatrics, University of Toronto, Toronto, Ontario; Paediatrician, The Hospital for Sick Children and St Joseph's Health Centre, Toronto, Ontario
| | - Stacey A Bélanger
- Clinical Assistant Professor, Department of Paediatrics, Université de Montréal, Montreal, Quebec; Paediatrician (Diplôme d'études spécialisées Paediatric Neurology), Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec
| | - Margaret M Steele
- Professor, Departments of Psychiatry, Family Medicine, and Paediatrics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario
| | - Khrista Boylan
- Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Kate Cochrane-Brink
- Lecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, Youthdale Treatment Centres, Toronto, Ontario
| | - Roxanne Goldade
- Clinical Assistant Professor, Department of Paediatrics, University of Calgary, Calgary, Alberta
| | - Paul R Soper
- Child and Adolescent Psychiatrist, Glenrose Attention-Deficit Hyperactivity Disorder Clinic, Edmonton, Alberta
| | - Judy Ustina
- Clinical Lecturer, Department of Psychiatry, University of Alberta, Edmonton, Alberta
| | - Tamara Pringsheim
- Assistant Professor, Department of Clinical Neurosciences, Psychiatry, Community Health Sciences, and Paediatrics, University of Calgary, Calgary, Alberta; Neurologist, Director, Calgary Tourette and Paediatric Movement Disorders Clinic, Calgary, Alberta
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31
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Mergy MA, Gowrishankar R, Davis GL, Jessen TN, Wright J, Stanwood GD, Hahn MK, Blakely RD. Genetic targeting of the amphetamine and methylphenidate-sensitive dopamine transporter: on the path to an animal model of attention-deficit hyperactivity disorder. Neurochem Int 2014; 73:56-70. [PMID: 24332984 PMCID: PMC4177817 DOI: 10.1016/j.neuint.2013.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 11/20/2013] [Accepted: 11/23/2013] [Indexed: 12/20/2022]
Abstract
Alterations in dopamine (DA) signaling underlie the most widely held theories of molecular and circuit level perturbations that lead to risk for attention-deficit hyperactivity disorder (ADHD). The DA transporter (DAT), a presynaptic reuptake protein whose activity provides critical support for DA signaling by limiting DA action at pre- and postsynaptic receptors, has been consistently associated with ADHD through pharmacological, behavioral, brain imaging and genetic studies. Currently, the animal models of ADHD exhibit significant limitations, stemming in large part from their lack of construct validity. To remedy this situation, we have pursued the creation of a mouse model derived from a functional nonsynonymous variant in the DAT gene (SLC6A3) of ADHD probands. We trace our path from the identification of these variants to in vitro biochemical and physiological studies to the production of the DAT Val559 mouse model. We discuss our initial findings with these animals and their promise in the context of existing rodent models of ADHD.
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Affiliation(s)
- Marc A Mergy
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Raajaram Gowrishankar
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gwynne L Davis
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tammy N Jessen
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jane Wright
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gregg D Stanwood
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Maureen K Hahn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Randy D Blakely
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA.
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32
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Froehlich TE, Delgado SV, Anixt JS. Expanding medication options for pediatric ADHD. CURRENT PSYCHIATRY 2013; 12:20-29. [PMID: 25598746 PMCID: PMC4296564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Tanya E Froehlich
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center / University of Cincinnati, Cincinnati, OH
| | - Sergio V Delgado
- Medical Director Outpatient Services, Division of Child Psychiatry, Cincinnati Children's Hospital Medical Center / University of Cincinnati, Cincinnati, OH
| | - Julia S Anixt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center / University of Cincinnati, Cincinnati, OH
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