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Ramji AV, Dommett EJ, Runswick OR. "I Found Comfort in Exercising": Exploring Experiences With Exercise for Adults With Attention-Deficit/Hyperactivity Disorder. Adapt Phys Activ Q 2024:1-18. [PMID: 38942419 DOI: 10.1123/apaq.2023-0175] [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: 11/20/2023] [Revised: 04/28/2024] [Accepted: 05/09/2024] [Indexed: 06/30/2024] Open
Abstract
Little is known about how adults with attention-deficit/hyperactivity disorder (ADHD) experience exercise, resulting in a lack of recommendations for supporting this population. We aimed to explore how adults with ADHD experience exercise as a management tool before and after diagnosis and how and why individuals experience issues related to exercise dependence. Fifteen active adults with a diagnosis of ADHD participated in semistructured interviews. Three overarching themes were identified: (a) exercise as a necessity for ADHD, reflecting the need to exercise before a formal ADHD diagnosis, and use of exercise as a management tool postdiagnosis; (b) goals and achievements to live by, reflecting how exercise patterns revolved around a need to make progress toward targets; and (c) activity or exercise: a roller coaster journey, covering the ups and downs of exercise journeys. This article highlights the importance of exercise for adults to manage ADHD and how this can be encouraged and supported.
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Affiliation(s)
- Anusha V Ramji
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eleanor J Dommett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Oliver R Runswick
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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2
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Ryst E, Childress A. An updated safety review of the current drugs for managing ADHD in children. Expert Opin Drug Saf 2023; 22:1025-1040. [PMID: 37843488 DOI: 10.1080/14740338.2023.2271392] [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: 02/27/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers. AREAS COVERED This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described. EXPERT OPINION Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.
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Affiliation(s)
- Erika Ryst
- College of Education and Human Development, University of Nevada, Reno, USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA
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Ritchie BN, Peterson KA. Mindful Awareness Practices for Adults with Attention-Deficit/Hyperactivity Disorder: A Virtual Program Implementation and Evaluation during the COVID-19 Pandemic. Issues Ment Health Nurs 2023; 44:134-137. [PMID: 35658731 DOI: 10.1080/01612840.2022.2081391] [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: 10/18/2022]
Affiliation(s)
- Britt N Ritchie
- University of Colorado College of Nursing Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kerry A Peterson
- University of Colorado College of Nursing Anschutz Medical Campus, Aurora, Colorado, USA
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Meraya AM. Patterns of Medication Prescription among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in the United States. CHILDREN 2022; 9:children9020171. [PMID: 35204892 PMCID: PMC8870051 DOI: 10.3390/children9020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/23/2022]
Abstract
The objectives of this study are to: (1) quantify the difference in the annual number of prescription medications (total and unique) between children and adolescents with ADHD and those without ADHD; and (2) identify the most prescribed medication classes and unique medications among children and adolescents with ADHD. A retrospective cross-sectional study design was employed using data from the 2015 and 2017 Medical Expenditure Panel Survey. The study sample comprised children and adolescents (5–17 years). In the 5–12-year age group, those with ADHD were 2.4%, 17%, and 15% significantly more likely to have one, 2–4, and ≥5 prescription medications, respectively. Similarly, those in the 13–17-year age group were more likely to have one prescription medication (3%), 2–4 prescription medications (15%), and ≥5 prescription medications (12%) than those without ADHD. The most prescribed medications among children and adolescents with ADHD were methylphenidate and amphetamine-dextroamphetamine. ADHD was associated with both higher annual total and unique prescription medications. Additionally, concurrent use of prescription medications was more prevalent among children and adolescents with ADHD. High-quality randomized clinical trials on the safety and efficacy of combinations of multiple psychotherapeutics and stimulants’ agents are required to guide the evidence-based practices.
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Affiliation(s)
- Abdulkarim M. Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45124, Saudi Arabia;
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan 45124, Saudi Arabia
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Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition associated with impaired function and increased risk of poor outcomes in children, young people and adults with the condition. Currently approved pharmacological treatments for ADHD include a range of stimulant (methylphenidate, amphetamine) and nonstimulant (atomoxetine, guanfacine, clonidine) medications. All have been shown to be effective in treating the symptoms of ADHD and improving other functional outcomes including quality of life, academic performance, rates of accidents and injuries, and do not appear to be associated with significant adverse outcomes or side effects. In this chapter, we review medications for ADHD by summarising the mechanisms of action of each of the two main classes of compounds (stimulants and nonstimulants), the formulations of the most commonly prescribed medications within each class, their efficacy in treating ADHD symptoms and other outcomes, and other factors that influence treatment decisions including side effects and tolerability, comorbidities and medical history. We conclude with a summary of the treatment decisions made by clinicians and suggest some next steps for research. Further research is needed to understand the mechanisms of action of these medications and how exactly they improve symptoms, and to examine their effects on commonly occurring comorbidities.
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Affiliation(s)
- Madeleine J Groom
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | - Samuele Cortese
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder. Transl Psychiatry 2021; 11:349. [PMID: 34091591 PMCID: PMC8179928 DOI: 10.1038/s41398-021-01473-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurological and neurodevelopmental childhood-onset disorder characterized by a persistent pattern of inattentiveness, impulsiveness, restlessness, and hyperactivity. These symptoms may continue in 55-66% of cases from childhood into adulthood. Even though the precise etiology of ADHD is not fully understood, it is considered as a multifactorial and heterogeneous disorder with several contributing factors such as heritability, auxiliary to neurodevelopmental issues, severe brain injuries, neuroinflammation, consanguineous marriages, premature birth, and exposure to environmental toxins. Neuroimaging and neurodevelopmental assessments may help to explore the possible role of genetic variations on ADHD neuropsychobiology. Multiple genetic studies have observed a strong genetic association with various aspects of neuropsychobiological functions, including neural abnormalities and delayed neurodevelopment in ADHD. The advancement in neuroimaging and molecular genomics offers the opportunity to analyze the impact of genetic variations alongside its dysregulated pathways on structural and functional derived brain imaging phenotypes in various neurological and psychiatric disorders, including ADHD. Recently, neuroimaging genomic studies observed a significant association of brain imaging phenotypes with genetic susceptibility in ADHD. Integrating the neuroimaging-derived phenotypes with genomics deciphers various neurobiological pathways that can be leveraged for the development of novel clinical biomarkers, new treatment modalities as well as therapeutic interventions for ADHD patients. In this review, we discuss the neurobiology of ADHD with particular emphasis on structural and functional changes in the ADHD brain and their interactions with complex genomic variations utilizing imaging genetics methodologies. We also highlight the genetic variants supposedly allied with the development of ADHD and how these, in turn, may affect the brain circuit function and related behaviors. In addition to reviewing imaging genetic studies, we also examine the need for complementary approaches at various levels of biological complexity and emphasize the importance of combining and integrating results to explore biological pathways involved in ADHD disorder. These approaches include animal models, computational biology, bioinformatics analyses, and multimodal imaging genetics studies.
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Camp A, Pastrano A, Gomez V, Stephenson K, Delatte W, Perez B, Syas H, Guiseppi-Elie A. Understanding ADHD: Toward an Innovative Therapeutic Intervention. Bioengineering (Basel) 2021; 8:56. [PMID: 34062853 PMCID: PMC8147268 DOI: 10.3390/bioengineering8050056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a pervasive condition affecting persons across all age groups, although it is primarily diagnosed in children. This neurological condition affects behavior, learning, and social adjustment and requires specific symptomatic criteria to be fulfilled for diagnosis. ADHD may be treated with a combination of psychological or psychiatric therapeutic interventions, but it often goes unattended. People with ADHD face societal bias challenges that impact how they manage the disorder and how they view themselves. This paper summarizes the present state of understanding of this disorder, with particular attention to early diagnosis and innovative therapeutic intervention. Contemporary understanding of the mind-brain duality allows for innovative therapeutic interventions based on neurological stimulation. This paper introduces the concept of neurostimulation as a therapeutic intervention for ADHD and poses the question of the relationship between patient adherence to self-administered therapy and the aesthetic design features of the neurostimulation device. By fabricating devices that go beyond safety and efficacy to embrace the aesthetic preferences of the patient, it is proposed that there will be improvements in patient adherence to a device intended to address ADHD.
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Affiliation(s)
- Allyson Camp
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Amanda Pastrano
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Valeria Gomez
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Kathleen Stephenson
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - William Delatte
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Brianna Perez
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Hunter Syas
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Anthony Guiseppi-Elie
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
- Department of Electrical and Computer Engineering, College of Engineering, Anderson University, Anderson, SC 29621, USA
- ABTECH Scientific, Inc., Biotechnology Research Park, 800 East Leigh Street, Richmond, VA 23219, USA
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Carolan D. ADHD stimulant medication misuse and considerations for current prescribing practice: a literature review. Ir J Med Sci 2021; 191:313-320. [PMID: 33559870 DOI: 10.1007/s11845-020-02502-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stimulant medications have been prescribed to effectively treat childhood Attention Deficit Hyperactivity Disorder (ADHD) since the 1960's, with improved outcomes observed in the three core symptom domains. Over the course of these decades researchers and clinicians have debated the issue of negative outcomes with regard to later development of substance use disorders (SUD) for these children. AIMS To chronicle the development of medical and scientific opinion on the subject of SUD outcomes in ADHD and to appraise most recently published research in this sphere. METHODS A systematic search of the literature was conducted over 4 databases. Removal of duplicates, application of exclusion criteria and inclusion of publications identified through manual and citation-based search yielded 9 papers. RESULTS Prescriptions for stimulant medications are increasing worldwide and in tandem the prevalence of stimulant misuse. Much research focuses on non-medical stimulant misuse as a study aid; however, they are also used as recreational drugs with action on dopaminergic neurotransmitter pathways implicated in addiction disorders. Considering the risks and benefits of stimulant prescribing on later SUD development research in recent decades has produced inconsistent results. Current research supports the hypothesis of improved SUD outcomes for young people treated early and intensely, with poorer outcomes for those with less robust treatment histories. CONCLUSIONS Consideration of the impact that variable treatment trajectories may have on the risk of later SUD development is recommended, with further research potentially leading to the development of different management pathways based on an individual's multivariate treatment profile.
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Affiliation(s)
- Deirdre Carolan
- Department of Psychiatry, Health Service Executive South, Cork, Ireland.
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9
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Wang C, Li K, Seo DC, Gaylord S. Use of complementary and alternative medicine in children with ADHD: Results from the 2012 and 2017 National Health Interview Survey. Complement Ther Med 2020; 49:102352. [DOI: 10.1016/j.ctim.2020.102352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
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Picarzo JPL, Malfaz FC, Marcos DC, Hernández RC, Soria TF, García BM, Sombrero HR, Rotés AS, Sarquella-Brugada G. Recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease as regards the use of drugs in attention deficit hyperactivity disorder in children and adolescents with a known heart disease, as well as in the general paediatric population: position statement by the Spanish Paediatric Association. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pérez-Lescure Picarzo J, Centeno Malfaz F, Collell Hernández R, Crespo Marcos D, Fernández Soria T, Manso García B, Rojo Sombrero H, Sabaté Rotés A, Sarquella-Brugada G. [Recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease as regards the use of drugs in attention deficit hyperactivity disorder in children and adolescents with a known heart disease, as well as in the general paediatric population: Position statement by the Spanish Paediatric Association]. An Pediatr (Barc) 2020; 92:109.e1-109.e7. [PMID: 31676246 DOI: 10.1016/j.anpedi.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Approved drugs for attention deficit hyperactivity disorder (ADHD) in Spain are methylphenidate, lisdexamphetamine, atomoxetine and guanfacine. Due to adverse cardiovascular effects, mainly increased blood pressure and heart rate, its use in patients with known or undiagnosed heart disease may be controversial. OBJECTIVE To obtain a consensus document from the Spanish Society of Paediatric Cardiology and Congenital Heart Diseases (SECPCC) and experts from other Agencies and Societies as a guide for the paediatric cardiologist and physicians who treat children and adolescents with ADHD. METHODOLOGY An analysis was performed on the bibliography and Clinical Practice Guidelines, technical data sheets approved by the Spanish Agency of Medicines and Health Devices, and the Spanish Ministry of Health Guidelines. A Working Group was formed, with a Coordinator, as well as members of the Clinical Cardiology Working Group and Arrhythmia Group of the SECPCC. This Group produced a preliminary document that was reviewed by a group of external experts and a group of internal experts of the SECPCC with a consensus being reached on the final document. RESULTS The recommendations of the SECPCC and the group of experts are presented on cardiovascular evaluation prior to treatment in children and adolescents with no known cardiovascular disease and with known cardiovascular disease. The recommendations of the SECPCC and the group of experts are also presented on the use of medications for ADHD in children and adolescents with cardiological symptoms with no evidence of heart disease, congenital heart disease, cardiomyopathy, Marfan syndrome and other aortic diseases, hypertension, and arrhythmias.
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Affiliation(s)
- Javier Pérez-Lescure Picarzo
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Junta Directiva, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España.
| | - Fernando Centeno Malfaz
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Río Hortega, Valladolid, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Rosa Collell Hernández
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitari Sant Joan de Reus, Tarragona, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - David Crespo Marcos
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Teresa Fernández Soria
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Begoña Manso García
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Henar Rojo Sombrero
- Servicio de Pediatría, Cardiología Infantil, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Anna Sabaté Rotés
- Cardiología Infantil, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Cardiología Clínica, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
| | - Georgia Sarquella-Brugada
- Unidad de Arritmias, Cardiopatías Familiares y Muerte Súbita, Hospital Sant Joan de Déu, Barcelona, España; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España; Recerca Cardiovascular, Institut de Recerca, Fundació Sant Joan de Déu, Barcelona, España; Guard-Heart, European Reference Center, Barcelona, España; Junta Directiva, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España; Grupo de Arritmias, Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas, Madrid, España
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Abstract
PURPOSE OF REVIEW To present current data on the coexistence of attention deficit hyperactivity disorder (ADHD) and the metabolic syndrome and type 2 diabetes mellitus in adults and children and to discuss possible mechanisms. RECENT FINDINGS Emerging data suggest that risk factors for obesity and insulin resistance such as diabetes during pregnancy and intrauterine growth failure may also have a role in the development of ADHD. Furthermore, ADHD and obesity share lifestyle factors, such as abnormal eating patterns, binge eating, and a sedentary lifestyle. ADHD is a risk factor for components of the metabolic syndrome, particularly obesity and type 2 diabetes mellitus, and also hypertension, both in adults and youth. Associations of ADHD with obesity, diabetes, and hypertension have been ascertained, and various mechanisms have been proposed. Research is needed to decipher the shared genetic, pharmacological, and lifestyle risk factors. Individuals with ADHD should be treated as a high-risk group for cardiometabolic complications.
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Affiliation(s)
- Zohar Landau
- Pediatric Division, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Maccabi Juvenile Diabetes Center, Raanana, Israel
| | - Orit Pinhas-Hamiel
- Maccabi Juvenile Diabetes Center, Raanana, Israel.
- Pediatric Endocrine and Diabetes Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Pozzi M, Carnovale C, Peeters GGAM, Gentili M, Antoniazzi S, Radice S, Clementi E, Nobile M. Adverse drug events related to mood and emotion in paediatric patients treated for ADHD: A meta-analysis. J Affect Disord 2018; 238:161-178. [PMID: 29883938 DOI: 10.1016/j.jad.2018.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/09/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND ADHD is frequently comorbid with anxiety and mood disorders, which may increase the severity of inattention and hyperactivity symptoms. Emotional symptoms (anxiety, irritability, mood lability) also affect patients without comorbidity or emerge as adverse drug events. The influence of ADHD drugs on emotional symptoms demands investigation to improve therapies. METHODS Systematic review of trials reporting adverse events in patients pharmacologically treated for ADHD. Meta-analysis of the occurrence of irritability, anxiety, apathy, reduced talk, sadness, crying, emotional lability, biting nails, staring, perseveration, euphoria. Meta-regression analysis. RESULTS Forty-five trials were meta-analysed. The most frequently reported outcomes were irritability, anxiety, sadness, and apathy. Methylphenidates, especially immediate-release formulations, were most studied; amphetamines were half as studied and were predominantly mixed amphetamine salts. Reports on atomoxetine were scant. Meta-analysis showed that methylphenidates reduced the risk of irritability, anxiety, euphoria, whereas they worsened the risk of apathy and reduced talk; amphetamines worsened the risk of emotional lability. Factors influencing risks were study year and design, patients' sex and age, drug dose and release formulation. LIMITATIONS Possible discrepancy between adverse events as indicated in clinical trials and as summarised herein. Confounding due to the aggregation of drugs into groups; uninvestigated sources of bias; incomplete lists of adverse events; lack of observations on self-injury. CONCLUSIONS Methylphenidates appeared safer than amphetamines, although younger patients and females may incur higher risks, especially with high-dose, immediate-release methylphenidates. Only atomoxetine holds a black-box warning, but amphetamines and methylphenidates also did not show a safe profile regarding mood and emotional symptoms.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Gabriëlla G A M Peeters
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Stefania Antoniazzi
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy; Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy.
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
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14
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Ramalho R, Pereira AC, Vicente F, Pereira P. Docosahexaenoic acid supplementation for children with attention deficit hyperactivity disorder: A comprehensive review of the evidence. Clin Nutr ESPEN 2018; 25:1-7. [PMID: 29779801 DOI: 10.1016/j.clnesp.2018.03.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is considered the most common behavioural disorder in school-age children. ADHD is a complex and multifactorial disorder characterised by a variety of symptoms, including concentration problems, excessive motor activity and impulsivity which interferes with execution of simple school tasks. Diagnosis has been essentially subjective, since no specific laboratory tests are available. However, ADHD remains overdiagnosed, probably due to social pressures for children to be successful in school from an early age, which leads parents to seek medical support. Although therapeutic approaches for ADHD have been essentially pharmacologic, in recent years several studies were performed to investigate the role of nutrition, especially omega 3 polyunsaturated fatty acid (omega 3-PUFA), in the development and treatment of this disorder. In this review, the authors gathered the most relevant evidence regarding omega 3-PUFA, mainly docosahexaenoic acid, as coadjutant or as a single therapy, in the management of ADHD symptoms. The authors also reviewed this disorder's current medical and therapeutic features.
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Affiliation(s)
- Renata Ramalho
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal.
| | - Ana Colaço Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Filipa Vicente
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Paula Pereira
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
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15
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Faraone SV. The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev 2018; 87:255-270. [PMID: 29428394 DOI: 10.1016/j.neubiorev.2018.02.001] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 12/20/2022]
Abstract
Psychostimulants, including amphetamines and methylphenidate, are first-line pharmacotherapies for individuals with attention-deficit/hyperactivity disorder (ADHD). This review aims to educate physicians regarding differences in pharmacology and mechanisms of action between amphetamine and methylphenidate, thus enhancing physician understanding of psychostimulants and their use in managing individuals with ADHD who may have comorbid psychiatric conditions. A systematic literature review of PubMed was conducted in April 2017, focusing on cellular- and brain system-level effects of amphetamine and methylphenidate. The primary pharmacologic effect of both amphetamine and methylphenidate is to increase central dopamine and norepinephrine activity, which impacts executive and attentional function. Amphetamine actions include dopamine and norepinephrine transporter inhibition, vesicular monoamine transporter 2 (VMAT-2) inhibition, and monoamine oxidase activity inhibition. Methylphenidate actions include dopamine and norepinephrine transporter inhibition, agonist activity at the serotonin type 1A receptor, and redistribution of the VMAT-2. There is also evidence for interactions with glutamate and opioid systems. Clinical implications of these actions in individuals with ADHD with comorbid depression, anxiety, substance use disorder, and sleep disturbances are discussed.
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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, NY, United States; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway.
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16
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Fairman KA, Davis LE, Peckham AM, Sclar DA. Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs Real World Outcomes 2018; 5:69-79. [PMID: 29305714 PMCID: PMC5825392 DOI: 10.1007/s40801-017-0129-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Among US adults, utilization of pharmacotherapy for attention-deficit hyperactivity disorder (ADHD) has increased more than ninefold since 1995–1996. Potential contraindications to ADHD pharmacotherapy include serious cardiovascular disease (CVD) and, for stimulants, addictions and bipolar disorder (BPD). Objective To assess the prevalence of potential contraindications among adults treated with ADHD pharmacotherapy. Methods A retrospective cohort analysis was performed using the Truven Health MarketScan® database. Subjects filled ≥ 1 prescription for atomoxetine or ≥ 1 stimulant in 2014–2015, were aged 18–64 years, commercially insured throughout observation, and diagnosed with ADHD on two or more medical claims. Diagnoses and medical procedures were measured in the 12 months prior to pharmacotherapy initiation. Metrics included serious CVD (cardiomegaly, cardiomyopathy, cerebrovascular occlusion, congestive heart failure, myocardial infarction, pacemaker, or valvular disorder) and any CVD (serious CVD, other atherosclerotic CVD, arrhythmia, congenital heart anomaly, or hypertensive heart disease). Rates of substance addiction or abuse were measured in a range to address nonspecific diagnostic coding. Results Only 2.0% of treated adults (n = 91,588) had one or more diagnosis indicating serious CVD. CVD prevalence increased monotonically with age. Of patients aged 55–64 years (n = 5,237), 7.2% had serious CVD; 15.9% had any CVD; and 1.9% had been hospitalized with one or more CVD. Of patients treated with stimulants (n = 87,167), 11.3–18.5% were diagnosed with addiction/abuse and 4.1% with BPD. Conclusions CVD prevalence is generally low among adults using ADHD medication but increases with age. Although difficult to estimate precisely, the rate of addiction/abuse among stimulant-treated patients appears unexpectedly high. Further research should assess cardiovascular events and other potential harms associated with contraindicated use in high-risk adults. Electronic supplementary material The online version of this article (10.1007/s40801-017-0129-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen A Fairman
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA.
| | - Lindsay E Davis
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
| | - Alyssa M Peckham
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
| | - David A Sclar
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
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17
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Marraccini ME, Weyandt LL, Gudmundsdottir BG, Oster DR, McCallum A. Attention-Deficit Hyperactivity Disorder: Clinical Considerations for Women. J Midwifery Womens Health 2017; 62:684-695. [PMID: 29160614 DOI: 10.1111/jmwh.12671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by hyperactivity, impulsivity, and/or inattention. Women with ADHD represent a particularly vulnerable group, given their increased risk for psychosocial and parenting difficulties. Women's health care clinicians should expect to encounter women with diagnosed and undiagnosed ADHD that may or may not be treated. Pharmacologic intervention, namely, prescription stimulants, is an important consideration for pregnant and breastfeeding women with ADHD, especially because the US Food and Drug Administration has determined that there is not enough information to confirm either harm or lack of harm to the developing fetus following exposure to these drugs. Due to the increase in use of prescription stimulants without a prescription, clinicians are also likely to encounter women misusing stimulants for a variety of reasons. This article provides an overview of ADHD diagnosis, outlines effective treatment options, and offers insight into the importance for clinicians to consider prescription stimulant misuse. Guidance concerning treatment of ADHD during pregnancy and lactation is reviewed.
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