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Bayranj Z, Fotros D, Sohouli MH, Rohani P, Eslahi M, Ferdosi S, Khodadadi N, Hosseinzadeh M. The relation between MIND diet with odds of attention-deficit/hyperactivity disorder in Iranian children: a case-control study. Child Neuropsychol 2024:1-15. [PMID: 38975687 DOI: 10.1080/09297049.2024.2375493] [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: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
This study aims to investigate the association between the MIND index (Mediterranean- Dietary approaches to Stop Hypertension diet Intervention for Neurodegenerative Delay) and attention-deficit hyperactivity disorder (ADHD) in the Iranian children. It builds upon existing research that highlights the role of dietary antioxidants in alleviating psychological disorders, cognitive impairments, and memory deficits. Additionally, previous studies have separately explored the beneficial effects of the Mediterranean and DASH diets on these issues. A case-control study was undertaken in Iran, involving a sample of 360 children and adolescents aged 7-13 years. Participants were divided into two groups, namely the case group (n = 120) and the control group (n = 240), with age and sex being matched between the groups. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) was employed for the diagnosis of ADHD. The MIND diet score was computed using the food intake data acquired from the Food Frequency Questionnaire (FFQ) completed by the subjects. The mean ± SD for the age and BMI of the study population was 8.76 ± 1.64 years and 16.90 ± 3.58 kg/m2, respectively. The mean score of MIND in this study was 27.93. After adjustment for potential confounder in the final model, subjects in highest compared to the lowest quartile of MIND diet score had significantly lower odds of ADHD (OR = 0.59, 95% CI 0.37-0.83; P-trend = 0.019). This study provides valuable evidence suggesting that adherence to the MIND diet is associated with decreased odds of ADHD.
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Affiliation(s)
- Zahra Bayranj
- Department of Clinical Nutrition and Dietetics, Kashan University of Medical Sciences, Kashan, Iran
| | - Danial Fotros
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Eslahi
- Department of Clinical Nutrition and Dietetics, Kashan University of Medical Sciences, Kashan, Iran
| | - Samira Ferdosi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navideh Khodadadi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Gupta U, Baig S, Majid A, Bell SM. The neurology of space flight; How does space flight effect the human nervous system? LIFE SCIENCES IN SPACE RESEARCH 2023; 36:105-115. [PMID: 36682819 DOI: 10.1016/j.lssr.2022.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
RATIONALE AND HYPOTHESIS Advancements in technology, human adaptability, and funding have increased space exploration and in turn commercial spaceflight. Corporations such as Space X and Blue Origin are exploring methods to make space tourism possible. This could lead to an increase in the number of patients presenting with neurological diseases associated with spaceflight. Therefore, a comprehensive understanding of spaceflight stressors is required to manage neurological disease in high-risk individuals. OBJECTIVES This review aims to describe the neurological effects of spaceflight and to assess countermeasures such as pre-flight prophylaxis, training, and possible therapeutics to reduce long-term effects. METHODOLOGY A literature search was performed for experimental studies conducted in astronauts and in animal models that simulated the space environment. Many studies, however, only discussed these with scientific reasoning and did not include any experimental methods. Relevant studies were identified through searching research databases such as PubMed and Google Scholar. No inclusion or exclusion criteria were used. FINDINGS Analysis of these studies provided a holistic understanding of the acute and chronic neurological changes that occur during space flight. Astronauts are exposed to hazards that include microgravity, cosmic radiation, hypercapnia, isolation, confinement and disrupted circadian rhythms. Microgravity, the absence of a gravitational force, is linked to disturbances in the vestibular system, intracranial and intraocular pressures. Furthermore, microgravity affects near field vision as part of the spaceflight-associated neuro-ocular syndrome. Exposure to cosmic radiation can increase the risk of neurodegenerative conditions and malignancies. It is estimated that cosmic radiation has significantly higher ionising capabilities than the ionising radiation used in medicine. Space travel also has potential benefits to the nervous system, including psychological development and effects on learning and memory. Future work needs to focus on how we can compare a current astronaut to a future space tourist. Potentially the physiological and psychological stresses of space flight might lead to neurological complications in future space travellers that do not have the physiological reserve of current astronauts.
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Affiliation(s)
- Udit Gupta
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield and S10 2HQ, United Kingdom
| | - Sheharyar Baig
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield and S10 2HQ, United Kingdom; Department of Clinical Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield and S10 2HQ, United Kingdom; Department of Clinical Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom
| | - Simon M Bell
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385a Glossop Road, Sheffield and S10 2HQ, United Kingdom; Department of Clinical Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom.
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Galvez-Contreras AY, Vargas-de la Cruz I, Beltran-Navarro B, Gonzalez-Castaneda RE, Gonzalez-Perez O. Therapeutic Approaches for ADHD by Developmental Stage and Clinical Presentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12880. [PMID: 36232180 PMCID: PMC9566361 DOI: 10.3390/ijerph191912880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder with three presentations: inattentive, hyperactive/impulsive and combined. These may represent an independent disease entity. Therefore, the therapeutic approach must be focused on their neurobiological, psychological and social characteristics. To date, there is no comprehensive analysis of the efficacy of different treatments for each presentation of ADHD and each stage of development. This is as narrative overview of scientific papers that summarize the most recent findings and identify the most effective pharmacological and psychosocial treatments by ADHD presentation and age range. Evidence suggests that methylphenidate is the safest and most effective drug for the clinical management of children, adolescents and adults. Atomoxetine is effective in preschoolers and maintains similar efficacy to methylphenidate in adults, whereas guanfacine has proven to be an effective monotherapy for adults and is a worthy adjuvant for the management of cognitive symptoms. The psychosocial treatments with the best results in preschoolers are behavioral interventions that include training of primary caregivers. In adolescents, the combination of cognitive and cognitive-behavioral therapies has shown the best results, whereas cognitive-behavioral interventions are the most effective in adults. Pharmacological and psychosocial treatments must be adjusted to the ADHD presentation and its neurocognitive characteristics through the patient's development.
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Affiliation(s)
- Alma Y. Galvez-Contreras
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ivette Vargas-de la Cruz
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Beatriz Beltran-Navarro
- Unidad de Atención en Neurociencias, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Rocio E. Gonzalez-Castaneda
- Instituto de Neurociencias Traslacionales, Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Oscar Gonzalez-Perez
- Laboratorio de Neurociencias, Facultad de Psicología, Universidad de Colima, Colima 28040, Mexico
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Gaertner K, Teut M, Walach H. RETRACTED ARTICLE: Is homeopathy effective for attention deficit and hyperactivity disorder? A meta-analysis. Pediatr Res 2022:10.1038/s41390-022-02127-3. [PMID: 35701608 DOI: 10.1038/s41390-022-02127-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Katharina Gaertner
- University of Witten/Herdecke, Institute for Integrative Medicine, Herdecke, Germany
| | - Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
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Rafeiy-Torghabeh M, Ashraf-Ganjouei A, Moradi K, Bagheri S, Mohammadi MR, Akhondzadeh S. Resveratrol adjunct to methylphenidate improves symptoms of attention-deficit/hyperactivity disorder: a randomized, double-blinded, placebo-controlled clinical trial. Eur Child Adolesc Psychiatry 2021; 30:799-807. [PMID: 32449130 DOI: 10.1007/s00787-020-01562-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/15/2020] [Indexed: 12/25/2022]
Abstract
Current pharmacological approaches have failed to provide complete remission for patients with Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to evaluate the efficacy and tolerability of resveratrol (that have been shown to have antioxidative, anti-inflammatory, and anti-apoptotic effects) as an adjunct to methylphenidate in pharmacologic treatment of ADHD. This 8-week, double-blinded, placebo-controlled trial randomized 66 participants to receive either 500 mg/day resveratrol or matched placebo in addition to methylphenidate. ADHD symptoms were evaluated in the patients using the Parent and Teacher versions of ADHD-Rating Scale (ADHD-RS) at three measurement points with time intervals of 4 weeks. Furthermore, the tolerability of the treatment strategies was systematically compared. Repeated measures analysis demonstrated a significant effect for time-treatment interaction on all three subscales of the Parent ADHD-RS during the trial period (total: p = 0.015; inattention: p = 0.032; hyperactivity/impulsivity: p = 0.036). Nevertheless, the effect for time-treatment interaction was not significant for the Teacher version of ADHD-RS (total: F = 0.81, df = 1.33, p = 0.401; inattention: F = 0.57, df = 1.37, p = 0.507; hyperactivity/impulsivity: F = 0.65, df = 1.34, p = 0.466). The frequencies of complications in the treatment groups were similar. Resveratrol administration for a duration of 8 weeks improved characteristic symptoms in patients with ADHD according to their parents. Further investigations containing larger sample sizes, longer supplementation periods, and dose-response evaluations are required to replicate these findings in ADHD children more confidently.
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Affiliation(s)
- Maryam Rafeiy-Torghabeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran
| | - Kamyar Moradi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran
| | - Sayna Bagheri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran
| | - Mohammad-Reza Mohammadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Street, 13337, Tehran, Iran.
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See LC, Li HM, Chao KY, Chung CC, Li PR, Lin SR. Knowledge of attention-deficit hyperactivity disorder among the general public, parents, and primary school teachers. Medicine (Baltimore) 2021; 100:e25245. [PMID: 33761719 PMCID: PMC9282068 DOI: 10.1097/md.0000000000025245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/01/2021] [Indexed: 01/05/2023] Open
Abstract
We compared the knowledge of attention-deficit hyperactivity disorder (ADHD) among the general public, parents of children with ADHD, and primary school teachers and identified factors associated with ADHD knowledge in each group, separately.Secondary data analysis was made on the pre-lecture data from those (122 from the general public, 64 parents of children with ADHD, and 515 primary school teachers) attending education lectures by the Department of Public Health, New Taipei City Government, Taiwan, 2014.ADHD onset age was least known in these 3 groups. Knowledge of ADHD was significantly better among teachers (test score, 75.3%) than among parents (65.5%) and the general public (59.2%). Among the general public, the test score significantly decreased with age and was worst in those who did not know their friends or relatives with ADHD. Among parents, service workers, and retired/unemployed knew significantly less about ADHD than housewife did. Among teachers, men knew significantly less than women; those who taught children with ADHD knew significantly more than those who did not.Primary school teachers knew more about ADHD than parents and the general public. Factors associated with ADHD knowledge varied among the 3 groups.
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Affiliation(s)
- Lai-Chu See
- Department of Public Health, College of Medicine
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou
| | - Hsin-Mei Li
- Department of Public Health, College of Medicine
| | - Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou
| | | | - Pei-Ru Li
- Department of Public Health, College of Medicine
| | - Sheue-Rong Lin
- Department of Public Health, New Taipei City Government, New Taipei City, Taiwan
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7
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Fu D, Wu DD, Guo HL, Hu YH, Xia Y, Ji X, Fang WR, Li YM, Xu J, Chen F, Liu QQ. The Mechanism, Clinical Efficacy, Safety, and Dosage Regimen of Atomoxetine for ADHD Therapy in Children: A Narrative Review. Front Psychiatry 2021; 12:780921. [PMID: 35222104 PMCID: PMC8863678 DOI: 10.3389/fpsyt.2021.780921] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Atomoxetine, a selective norepinephrine (NE) reuptake inhibitor, was approved for attention deficit/hyperactivity disorder (ADHD) treatment in children, adolescents and adults. We searched the database PubMed/MEDLINE (2000 to October 1, 2021). Only publications in English were considered. Atomoxetine inhibits the presynaptic norepinephrine transporter (NET), preventing the reuptake of NE throughout the brain along with inhibiting the reuptake of dopamine in specific brain regions such as the prefrontal cortex (PFC). The novel mechanism of atomoxetine also includes several new brain imaging studies and animal model studies. It is mainly metabolized by the highly polymorphic drug metabolizing enzyme cytochrome P450 2D6 (CYP2D6). Atomoxetine is effective and generally well tolerated. ADHD is often accompanied by multiple comorbidities. A series of studies have been published suggesting that atomoxetine is effective in the treatment of ADHD symptoms for children with various types of comorbidity. In some cases, it is possible that atomoxetine may have a positive influence on the symptoms of comorbidities. Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses, and has a negligible risk of abuse or misuse. The latest guideline updated that clinical dose selection of atomoxetine was recommended based on both CYP2D6 genotype and the peak concentration. To have a more comprehensive understanding of atomoxetine, this review sets the focus on the mechanism, clinical efficacy and dosage regimen in detail, and also touches on those studies regarding adverse reactions of atomoxetine.
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Affiliation(s)
- Di Fu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China.,School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Dan-Dan Wu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Xia
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Ji
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Rong Fang
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yun-Man Li
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qi Liu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
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Bosch A, Bierens M, de Wit AG, Ly V, van der Velde J, de Boer H, van Beek G, Appelman D, Visser S, Bos L, van der Meer J, Kamphuis N, Draaisma JMT, Donders R, van de Loo-Neus GHH, Hoekstra PJ, Bottelier M, Arias-Vasquez A, Klip H, Buitelaar JK, van den Berg SW, Rommelse NN. A two arm randomized controlled trial comparing the short and long term effects of an elimination diet and a healthy diet in children with ADHD (TRACE study). Rationale, study design and methods. BMC Psychiatry 2020; 20:262. [PMID: 32460725 PMCID: PMC7251686 DOI: 10.1186/s12888-020-02576-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Food may trigger Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Therefore, an elimination diet (ED) might be an effective treatment for children with ADHD. However, earlier studies were criticized for the nature of the control group, potential confounders explaining the observed effects, unsatisfactory blinding, potential risks of nutritional deficiencies and unknown long term and cost-effectiveness. To address these issues, this paper describes the rationale, study design and methods of an ongoing two arm randomized controlled trial (RCT) comparing the short (5 week) and long term (1 year) effects of an elimination diet and a healthy diet compared with care as usual (CAU) in children with ADHD. METHODS A total of N = 162 children (5-12 years) with ADHD will be randomized to either an ED or a healthy diet. A comparator arm including N = 60 children being solely treated with CAU (e.g. medication) is used to compare the effects found in both dietary groups. The two armed RCT is performed in two youth psychiatry centers in the Netherlands, with randomization within each participating center. The primary outcome measure is response to treatment defined as a ≥ 30% reduction on an ADHD DSM-5 rating scale (SWAN) and/or on an emotion dysregulation rating scale (SDQ: dysregulation profile). This is assessed after 5 weeks of dietary treatment, after which participants continue the diet or not. Secondary outcome measures include the Disruptive Behavior Diagnostic Observational Schedule (DB-DOS), parent and teacher ratings of comorbid symptoms, cognitive assessment (e.g. executive functions), school functioning, physical measurements (e.g. weight), motor activity, sleep pattern, food consumption, nutritional quality of the diet, adherence, parental wellbeing, use of health care resources and cost-effectiveness. Assessments take place at the start of the study (T0), after five weeks (T1), four months (T2), eight months (T3) and 12 months of treatment (T4). T0, T1 and T4 assessments take place at one of the psychiatric centers. T2 and T3 assessments consist of filling out online questionnaires by the parents only. DISCUSSION This RCT will likely contribute significantly to clinical practice for ADHD by offering insight into the feasibility, nutritional quality, (cost-)effectiveness and long term effects of dietary treatments for ADHD. TRIAL REGISTRATION www.trialregister.nl, NTR5434. Registered at October 11th, 2015.
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Affiliation(s)
- Annick Bosch
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands.
| | - Margreet Bierens
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Ardine G de Wit
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Verena Ly
- Leiden University, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Jessica van der Velde
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Heleen de Boer
- Accare, Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Gerry van Beek
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Danielle Appelman
- Triversum - GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, the Netherlands
| | | | - Lisa Bos
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jolanda van der Meer
- De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Niki Kamphuis
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's hospital, Nijmegen, the Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gigi H H van de Loo-Neus
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Bottelier
- Triversum - GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, the Netherlands
| | - Alejandro Arias-Vasquez
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia W van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525, GC, Nijmegen, the Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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Liang ZW, Ong SH, Xie YH, Lim CG, Fung D. The Effects of a Traditional Chinese Medication on Children with Attention-Deficit/Hyperactivity Disorder. J Altern Complement Med 2020; 26:473-481. [PMID: 32407137 DOI: 10.1089/acm.2020.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: This feasibility study examined the effects of a particular Traditional Chinese Medicine (TCM) herbal formula on attention-deficit/hyperactivity disorder (ADHD) and related problem behaviors. Design: A total of 79 participants aging 6-12 years consumed a granulated TCM herbal formula twice daily over a period of 3 months and underwent assessments at months 0, 3, and 6. Changes in ADHD symptoms and related behaviors were measured using the ADHD rating scale-IV (ADHD-RS-IV), child behavior checklist (CBCL), children's global sssessment scale (CGAS), as well as the clinical global impressions-severity (CGI-S) and improvement (CGI-I) scales. Results: Repeated measures mixed model analyses revealed significant differences in scores across time on all ADHD-RS-IV and CBCL subscales as well as on the CGAS, CGI-S, and CGI-I scales. Pairwise comparisons between months 0 and 3 as well as months 0 and 6 indicated significant improvements in scores. Scores also did not differ significantly between months 3 and 6. The results may suggest that this particular TCM formula possesses potential therapeutic qualities in the treatment of ADHD. Furthermore, changes in ADHD symptoms generally appear to be stable 3 months after discontinuation. However, these findings could also be attributed to placebo effects as well as reporting biases. Conclusion: This particular TCM formula may prove to be a useful adjunctive treatment for children with ADHD, and randomized controlled trials need to be conducted to evaluate its efficacy.
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Affiliation(s)
- Zhijian Wilfred Liang
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore.,CareHub, Alexandra Hospital, Singapore
| | - Say How Ong
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Yu Huan Xie
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore.,Rogers Behavioral Health, Walnut Creek, CA, USA
| | - Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Daniel Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
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10
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Lappin JM, Sara GE. Psychostimulant use and the brain. Addiction 2019; 114:2065-2077. [PMID: 31321819 DOI: 10.1111/add.14708] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/01/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022]
Abstract
Psychostimulant users are typically young adults. We have conducted a narrative review of neuropsychiatric harms associated with the psychostimulants methamphetamine/amphetamine, cocaine and 3,4-methylenedioxymethamphetamine (MDMA), focusing on epidemiological factors, common clinical presentations, underlying causal mechanisms and treatment options. The major neuropsychiatric harms of psychostimulant use are stroke, neurocognitive impairment, Parkinson's disease, seizures and psychotic illness. These arise through a combination of acute monoamine release, longer-term neurotransmitter effects and indirect effects. These effects are moderated by factors in the individual and in the pattern of substance use. Neuropsychiatric harms associated with psychostimulant use can thus lead to severe long-term impairment.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Grant E Sara
- InforMH, NSW Ministry of Health, North Ryde, NSW, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Lappin JM, Darke S, Farrell M. Methamphetamine use and future risk for Parkinson's disease: Evidence and clinical implications. Drug Alcohol Depend 2018; 187:134-140. [PMID: 29665491 DOI: 10.1016/j.drugalcdep.2018.02.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Methamphetamine use has been posited to be a risk factor for the development of Parkinson's disease (PD) and parkinsonism. The clinical implications of a potential association between methamphetamine use and PD are considered. METHODS A review of methamphetamine and PD and parkinsonism was conducted, including evidence from animal models, clinical and population studies. RESULTS There is biological plausibility to a link between methamphetamine use and PD. Though clinical and epidemiological evidence in this area is scant, a number of studies suggest that methamphetamine is associated with a moderately increased risk of PD and parkinsonism, and may also lead to premature onset of PD. The long lag time between exposure to methamphetamine and onset of PD, the potential for recovery from neurotoxic effects, and tobacco smoking each may attenuate the association. Individual and drug use characteristics that may modulate a user's risk remain poorly understood. CONCLUSIONS The use of methamphetamine may be an initiating event in the development of PD and parkinsonism, in addition to other risk factors that a given individual may hold. Clinicians should be vigilant to signs of prodromal and emerging PD among methamphetamine users. In individuals with premature onset illness, information on current or prior exposure to methamphetamine should be sought.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Meyers KJ, Upadhyaya HP, Goodloe R, Kryzhanovskaya LA, Liles-Burden MA, Kellier-Steele NA, Mancini M. Evaluation of dystonia in children and adolescents treated with atomoxetine within the Truven MarketScan database: a retrospective cohort study. Expert Opin Drug Saf 2018; 17:467-473. [DOI: 10.1080/14740338.2018.1462333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Abstract
OBJECTIVES Amphetamine improves vigilance as assessed by continuous performance tests (CPT) in children and adults with attention deficit hyperactivity disorder (ADHD). Less is known, however, regarding amphetamine effects on vigilance in healthy adults. Thus, it remains unclear whether amphetamine produces general enhancement of vigilance or if these effects are constrained to the remediation of deficits in patients with ADHD. METHODS We tested 69 healthy adults (35 female) on a standardized CPT (Conner's CPT-2) after receiving 10- or 20-mg d-amphetamine or placebo. To evaluate potential effects on learning, impulsivity, and perseveration, participants were additionally tested on the Iowa Gambling Task (IGT) and Wisconsin Card Sorting Task (WCST). RESULTS Participants receiving placebo exhibited the classic vigilance decrement, demonstrated by a significant reduction in attention (D') across the task. This vigilance decrement was not observed, however, after either dose of amphetamine. Consistent with enhanced vigilance, the 20-mg dose also reduced reaction time variability across the task and the ADHD confidence index. The effects of amphetamine appeared to be selective to vigilance since no effects were observed on the IGT, WCST, or response inhibition/perseveration measures from the CPT. CONCLUSIONS The present data support the premise that amphetamine improves vigilance irrespective of disease state. Given that amphetamine is a norepinephrine/dopamine transporter inhibitor and releaser, these effects are informative regarding the neurobiological substrates of attentional control. (JINS, 2018, 24, 283-293).
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Growth and Puberty in a 2-Year Open-Label Study of Lisdexamfetamine Dimesylate in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. CNS Drugs 2018; 32:455-467. [PMID: 29790103 PMCID: PMC5976689 DOI: 10.1007/s40263-018-0514-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Stimulant medications for the treatment of attention-deficit/hyperactivity disorder have a history of safe and effective use; however, concerns exist that they may adversely affect growth trajectories in children and adolescents. OBJECTIVE The objective of this study was to evaluate the longer-term effects of lisdexamfetamine dimesylate on weight, height, body mass index and pubertal development in children and adolescents with attention-deficit/hyperactivity disorder. METHODS Children and adolescents aged 6-17 years with attention-deficit/hyperactivity disorder took open-label lisdexamfetamine dimesylate (30, 50 or 70 mg/day) in this open-label 2-year safety and efficacy study. Safety evaluations included treatment-emergent adverse events, measurement of weight, height and body mass index, and self-reported pubertal status using Tanner staging. RESULTS The safety analysis population comprised all enrolled participants (N = 314) and 191 (60.8%) completed the study. Weight decrease was reported as a treatment-emergent adverse event in 63 participants (20.1%) and two participants (0.6%) discontinued the study as a result of treatment-emergent adverse events of weight decrease. Growth retardation of moderate intensity was reported as a treatment-emergent adverse event for two participants. From baseline to the last on-treatment assessment, there were increases in mean weight of 2.1 kg (standard deviation 5.83) and height of 6.1 cm (standard deviation 4.90), and a body mass index decrease of 0.5 kg/m2 (standard deviation 1.72). Mean weight, height and body mass index z-scores decreased over the first 36 weeks of the study and then stabilised. Changes from baseline to the last on-treatment assessment in mean z-scores for weight, height and body mass index were significantly less than zero (- 0.51, - 0.24 and - 0.59, respectively; nominal p < 0.0001). The proportion of participants with a z-score of < - 1 ranged from 5.1% (baseline) to 22.1% (week 84) for weight, 8.2% (baseline) to 12.6% (week 96) for height, and 8.3% (baseline) to 28.8% (week 96) for body mass index. Thirteen participants (4.1%) shifted to a weight below the fifth percentile at the last on-treatment assessment from a higher weight category at baseline. At the last on-treatment assessment, most participants remained at their baseline Tanner stage or had shifted higher. CONCLUSIONS Findings from this comprehensive examination of growth outcomes associated with lisdexamfetamine dimesylate treatment over 2 years were consistent with previous studies of stimulant medications. Whilst mean weight and height increased over the course of the study, there was a small but transient reduction in mean weight, height and body mass index z-scores. A small increase in the proportion of participants in the lowest weight and body mass index categories highlights the importance of the regular monitoring of weight and height. There was no evidence of delayed onset of puberty. CLINICALTRIALS. GOV IDENTIFIER NCT01328756.
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Berro LF, Andersen ML, Howell LL. Assessment of tolerance to the effects of methamphetamine on daytime and nighttime activity evaluated with actigraphy in rhesus monkeys. Psychopharmacology (Berl) 2017; 234:2277-2287. [PMID: 28589263 PMCID: PMC5522354 DOI: 10.1007/s00213-017-4654-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/19/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE Methamphetamine is one of the most largely consumed illicit drugs, and its use is associated with abuse liability and several adverse health effects, such as sleep impairment. Importantly, sleep quality can influence addiction treatment outcomes. Evidence suggests that tolerance can develop to the sleep-disrupting effects of stimulant drugs. OBJECTIVE The aim of the present study was to investigate the development of tolerance to the actigraphy-based sleep-disrupting and stimulant effects of methamphetamine self-administration in rhesus monkeys. METHODS Methamphetamine (0.03 mg/kg/inf, i.v.) self-administration was carried out following three different protocols: 14 consecutive days of self-administration, 5 days/week for 3 weeks, with a 2-day interval between 5-day blocks of self-administration, and 3 days/week for 3 weeks, with a 4-day interval between 3-day blocks of self-administration. Daytime activity and activity-based sleep measures were evaluated with Actiwatch monitors a week before (baseline parameters) and throughout each protocol. RESULTS Methamphetamine self-administration markedly disrupted sleep-like measures and increased daytime activity. Tolerance developed to those effects with repeated methamphetamine intake exceeding five consecutive days. Inclusion of washout periods (2 or 4 days) between blocks of methamphetamine self-administration attenuated the development of tolerance, with longer breaks from methamphetamine intake being more effective in maintaining the sleep-disrupting and stimulant effects of methamphetamine. CONCLUSIONS Tolerance can develop to the stimulant and sleep-disrupting effects of methamphetamine self-administration. Interruption of drug intake extends the effects of methamphetamine on sleep-like measures and daytime activity.
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Affiliation(s)
- Laís F. Berro
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Road N.E., Atlanta, GA, USA, 30329,Department of Psychobiology, Universidade Federal de São Paulo, R. Napoleão de Barros, 925, 04021002 São Paulo, SP, Brazil
| | - Monica L. Andersen
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Road N.E., Atlanta, GA, USA, 30329,Department of Psychobiology, Universidade Federal de São Paulo, R. Napoleão de Barros, 925, 04021002 São Paulo, SP, Brazil
| | - Leonard L. Howell
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Road N.E., Atlanta, GA, USA, 30329,Department of Psychiatry and Behavioral Science, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road N.E., Atlanta, GA, USA, 30329,Correspondence: Leonard L. Howell, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road N.E., Atlanta, GA, USA, 30329, Phone: (+1)404-727-7786, Fax: (+1)404-727-1266,
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Den Heijer AE, Groen Y, Tucha L, Fuermaier ABM, Koerts J, Lange KW, Thome J, Tucha O. Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. J Neural Transm (Vienna) 2017; 124:3-26. [PMID: 27400928 PMCID: PMC5281644 DOI: 10.1007/s00702-016-1593-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/01/2016] [Indexed: 12/05/2022]
Abstract
As attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed developmental disorders in childhood, effective yet safe treatment options are highly important. Recent research introduced physical exercise as a potential treatment option, particularly for children with ADHD. The aim of this review was to systematically analyze potential acute and chronic effects of cardio and non-cardio exercise on a broad range of functions in children with ADHD and to explore this in adults as well. Literature on physical exercise in patients with ADHD was systematically reviewed based on categorizations for exercise type (cardio versus non-cardio), effect type (acute versus chronic), and outcome measure (cognitive, behavioral/socio-emotional, and physical/(neuro)physiological). Furthermore, the methodological quality of the reviewed papers was addressed. Cardio exercise seems acutely beneficial regarding various executive functions (e.g., impulsivity), response time and several physical measures. Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. The acute and chronic effects of non-cardio exercise remain more questionable but seem predominantly positive too. Research provides evidence that physical exercise represents a promising alternative or additional treatment option for patients with ADHD. Acute and chronic beneficial effects of especially cardio exercise were reported with regard to several cognitive, behavioral, and socio-emotional functions. Although physical exercise may therefore represent an effective treatment option that could be combined with other treatment approaches of ADHD, more well-controlled studies on this topic, in both children and adults, are needed.
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Affiliation(s)
- Anne E Den Heijer
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Yvonne Groen
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Klaus W Lange
- Department of Experimental Psychology, University of Regensburg, Universitätssraße 31, 93053, Regensburg, Germany
| | - Johannes Thome
- Department of Psychiatry and Psychotherapy, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
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Maia CRM, Cortese S, Caye A, Deakin TK, Polanczyk GV, Polanczyk CA, Rohde LAP. Long-Term Efficacy of Methylphenidate Immediate-Release for the Treatment of Childhood ADHD. J Atten Disord 2017; 21:3-13. [PMID: 25501355 DOI: 10.1177/1087054714559643] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the long-term effects of methylphenidate imediate-release (MPH-IR), and to confirm the efficacy established in previous meta-analyses of short-term studies. METHOD Published and unpublished studies in which participants were treated with MPH-IR for 12 weeks or more were searched. Pooled effect sizes from these studies were computed with the DerSimonian and Laird random-effect model. Meta-regression analysis was conducted to estimate covariates associated with treatment effects. RESULTS Seven studies were included. Pooled parents ratings for inattention and hyperactivity/impulsivity resulted in standardized mean difference (SMD) = 0.96 (95% confidence interval [CI] = [0.60, 1.32]) and SMD = 1.12 (95% CI = [0.85, 1.39]), respectively; pooled teachers ratings showed SMD = 0.98 (95% CI = [0.09, 1.86]) for inattention and SMD = 1.25 (95% CI = [0.7, 1.81]) for hyperactivity/impulsivity. No evidence of association of any covariates with treatment effect was detected in the meta-regression. CONCLUSION MPH-IR is efficacious for childhood ADHD for periods longer than 12 weeks.
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Affiliation(s)
| | - Samuele Cortese
- 2 Cambridge University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Arthur Caye
- 1 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Busardò FP, Kyriakou C, Cipolloni L, Zaami S, Frati P. From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate. Curr Neuropharmacol 2016; 14:17-27. [PMID: 26813119 PMCID: PMC4787280 DOI: 10.2174/1570159x13666150407225902] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/17/2015] [Accepted: 04/03/2015] [Indexed: 12/20/2022] Open
Abstract
Methylphenidate (MPD) is a central nervous system (CNS) stimulant, which belongs to the phenethylamine group and is mainly used in the treatment of attention deficit hyperactive disorder (ADHD). However, a growing number of young individuals misuse or abuse MPD to sustain attention, enhance intellectual capacity and increase memory. Recently, the use of MPD as a cognitive enhancement substance has received much attention and raised concerns in the literature and academic circles worldwide. The prescribing frequency of the drug has increased sharply as consequence of the more accurate diagnosis of the ADHD and the popularity of the drug itself due to its beneficial short-term effect. However, careful monitoring is required, because of possible abuse. In this review different aspects concerning the use of MPD have been approached. Data showing its abuse among college students are given, when the drug is prescribed short term beneficial effects and side effects are provided; moreover studies on animal-models suggesting long lasting negative effects on healthy brains are discussed. Finally, emphasis is given to the available formulations and pharmacology.
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Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Medico-legal and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336 (00185) Rome, IT.
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Sleep Problems in Children with Attention Deficit/Hyperactivity Disorder: Current Status of Knowledge and Appropriate Management. Curr Psychiatry Rep 2016; 18:76. [PMID: 27357497 DOI: 10.1007/s11920-016-0711-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) affects approximately 5 % of children and adolescents, and sleep problems are common in these patients. There is growing evidence informing the significant importance of sleep problems in youth with ADHD. The sleep problems in children with ADHD include specific sleep disorders and sleep disturbances due to comorbid psychiatric disorders or ADHD medications. The specific sleep disorders of ADHD children include behaviorally based insomnia, sleep-disordered breathing, and restless legs syndrome/periodic limb movement disorder. Current practices on the management of sleep problems for ADHD children are based mostly on expert consensus, whereas more evidence-based literature can be found only recently. Assessment of the sleep conditions in ADHD children before initiation of pharmacotherapy is the currently recommended guideline, and good sleep hygiene can be considered as the first-line treatment option. In addition to modifying the dose regimens, formulation, or alternative stimulants when sleep problems are encountered in ADHD children, atomoxetine, once daily guanfacine extended release, and melatonin are potential choices for ADHD children with more severe sleep problems. In this review, we aimed to provide the most updated information, preferably based on meta-analyses, systemic review, and randomized controlled trials published in the latest 3 years, in order to be clinically useful for practitioners and clinicians.
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Wang LJ, Chen CK, Huang YS. Gender Differences in the Behavioral Symptoms and Neuropsychological Performance of Patients with Attention-Deficit/Hyperactivity Disorder Treated with Methylphenidate: A Two-Year Follow-up Study. J Child Adolesc Psychopharmacol 2015; 25:501-8. [PMID: 26262904 DOI: 10.1089/cap.2014.0175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study investigated the gender differences in behavioral symptoms, as rated by various informants, and in neuropsychological performance, among patients with attention-deficit/hyperactivity disorder (ADHD) treated with methylphenidate during 24 months in a clinical setting. METHODS Study participants comprised 128 boys (mean age: 13.2±2.4 years) and 26 girls (mean age: 12.8±1.0 years) with ADHD. All patients were prescribed short-acting oral methylphenidate, taken two or three times daily; each dose ranged between 0.3 and 1.0 mg/kg. At the baseline and 6, 12, 18, and 24 months later, behavioral symptoms were evaluated using the parent and teacher forms of the Swanson, Nolan, and Pelham Version IV (SNAP-IV) scale for ADHD and the ADHD Rating Scale (completed by a child psychiatrist). In addition, neuropsychological function was assessed using the Test of Variables of Attention (TOVA) at each interval. RESULTS Although both the boys and girls exhibited a significant decrease in the ADHD symptoms observed by parents and clinicians, the girls improved more than the boys did. Based on the teacher reports, neither the boys nor the girls exhibited significant decreases in ADHD symptoms. The symptoms rated by teachers were more severe in the boys than in the girls throughout the first 12 months; however, the gender difference lessened after 12 months. Based on the TOVA assessment, a composite score (containing response time, response time variability, and ADHD score obtained using the TOVA) did not indicate differences between genders. However, another composite score (containing omission errors, commission errors, and response sensitivity) suggested significant improvement only in the boys. CONCLUSIONS The results suggested that according to a longitudinal follow-up, behavioral and neuropsychological changes among patients with ADHD might differ between genders. Gathering multidimensional information from patients with ADHD is essential in determining how gender modifies the functional outcome of ADHD.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Chih-Ken Chen
- 2 Department of Psychiatry, Chang Gung Memorial Hospital at Keelung , Keelung, Taiwan .,3 Chang Gung University School of Medicine , Taoyuan, Taiwan
| | - Yu-Shu Huang
- 3 Chang Gung University School of Medicine , Taoyuan, Taiwan .,4 Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital at Linko , Taoyuan, Taiwan
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[Attention deficit hyperactivity disorder]. Med Clin (Barc) 2015; 144:370-5. [PMID: 24787685 DOI: 10.1016/j.medcli.2014.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/16/2014] [Accepted: 02/27/2014] [Indexed: 11/22/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and can persist into the adulthood. ADHD has important social, academic and occupational consequences. ADHD diagnosis is based on the fulfillment of several clinical criteria, which can vary depending on the diagnostic system used. The clinical presentation can show great between-patient variability and it has been related to a dysfunction in the fronto-striatal and meso-limbic circuits. Recent investigations support a model in which multiple genetic and environmental factors interact to create a neurobiological susceptibility to develop the disorder. However, no clear causal association has yet been identified. Although multimodal treatment including both pharmacological and psychosocial interventions is usually recommended, no convincing evidence exists to support this recommendation. Pharmacological treatment has fundamentally shown to improve ADHD symptoms in the short term, while efficacy data for psychosocial interventions are scarce and inconsistent. Yet, drug treatment is increasingly popular and the last 2 decades have witnessed a sharp increase in the prescription of anti-ADHD medications coinciding with the marketing of new drugs to treat ADHD.
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Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies. ACTA ACUST UNITED AC 2015; 7:237-47. [DOI: 10.1007/s12402-015-0170-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 12/22/2022]
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Wang LJ, Chen CK, Huang YS. Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. J Child Adolesc Psychopharmacol 2015; 25:246-53. [PMID: 25574708 DOI: 10.1089/cap.2014.0015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder (ADHD) during 24 months of treatment with methylphenidate in a clinical setting. METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years (ages ranged from 8 to 18 years; 151 boys and 30 girls) who were prescribed oral short-acting methylphenidate two or three times daily, with each dose ranging between 0.3 and 1.0 mg/kg. At baseline and 6, 12, 18, and 24 months from baseline, neurocognitive function was assessed using the Test of Variables of Attention (TOVA) on the day the patient was off medication, and behavioral symptoms were evaluated using the Swanson, Nolan, and Pelham Version IV Scale for ADHD (SNAP-IV) parent form, the SNAP-IV teacher form, and the ADHD-Rating Scale (completed by a child psychiatrist). RESULTS Of the 181 ADHD patients at the initial visit, 103 (56.9%) completed the study. During the 24-month methylphenidate treatment, only the commission errors in TOVA significantly improved; however, the omission errors, response time, response time variability, response sensitivity, and ADHD score did not. The behavioral symptoms of ADHD, observed by various informants, all declined substantially, and were significantly correlated with each other during the long-term follow-up. The severity of teacher ratings was lower than that of parent and psychiatrist ratings. However, the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance. CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients, except inhibition ability, might be long lasting in realistic settings. In addition, obtaining behavior profile assessments from multiple informants, especially from teachers, is vital for establishing a complete understanding of ADHD patients.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
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Heilskov Rytter MJ, Andersen LBB, Houmann T, Bilenberg N, Hvolby A, Mølgaard C, Michaelsen KF, Lauritzen L. Diet in the treatment of ADHD in children - a systematic review of the literature. Nord J Psychiatry 2015; 69:1-18. [PMID: 24934907 DOI: 10.3109/08039488.2014.921933] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric conditions in childhood. Dietary changes have been suggested as a way of reducing ADHD symptoms. AIMS To provide an overview of the evidence available on dietary interventions in children with ADHD, a systematic review was carried out of all dietary intervention studies in children with ADHD. METHODS Relevant databases were searched in October 2011, with an update search in March 2013. The studies included describe diet interventions in children with ADHD or equivalent diagnoses measuring possible changes in core ADHD symptoms: inattention, hyperactivity and impulsivity. RESULTS A total of 52 studies were identified, some investigating whether ADHD symptoms can improve by avoiding certain food elements (20 studies), and some whether certain food elements may reduce ADHD symptoms (32 studies). CONCLUSION Elimination diets and fish oil supplementation seem to be the most promising dietary interventions for a reduction in ADHD symptoms in children. However, the studies on both treatments have shortcomings, and more thorough investigations will be necessary to decide whether they are recommendable as part of ADHD treatment.
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Affiliation(s)
- Maren Johanne Heilskov Rytter
- Maren Johanne Heilskov Rytter, M.D., Ph.D. student, Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen , Frederiksberg , Denmark
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Dalsgaard S, Kvist AP, Leckman JF, Nielsen HS, Simonsen M. Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study. J Child Adolesc Psychopharmacol 2014; 24:302-10. [PMID: 24956171 PMCID: PMC4137345 DOI: 10.1089/cap.2014.0020] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether stimulant users are at higher risk of a later cardiovascular event than are non-users, examining this association in both a national cohort and a population-based sample of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). We also aim to examine a possible dose-response relationship in such an association. METHODS We conducted a longitudinal, prospective cohort study of all children born in Denmark between 1990 and 1999. Within this cohort, children with ADHD were identified. Data from national health registers on psychiatric and somatic diagnoses, stimulant prescriptions, cardiovascular risk factors, pre- and perinatal and sociodemographic covariates in all children and their parents were merged, using the unique personal identification number. Hazard ratios (HR) for cardiovascular events were estimated using Cox regression, adjusted for other known risk factors. RESULTS In the total population (n=714,258 contributing a total of 6,767,982 person-years) use of stimulants increased the risk of a cardiovascular event; adjusted HR=1.83 (1.10-3.04). In children with ADHD (n=8300) stimulant treatment also increased the risk of a cardiovascular event (adjusted HR=2.20 [2.15-2.24]), with a complex time-dependent dose-response relationship. CONCLUSIONS This is the first nationwide cohort study of the cardiovascular safety of stimulants in children and adolescents, and it represents, to our knowledge, the longest prospective follow-up study. Cardiovascular events were rare but twice as likely in stimulant users as in non-users, both in the total national population and in children with ADHD. We found a complex, time- and dose-dependent interrelationship between cardiovascular adverse events and stimulant treatment in children and adolescents. Our results suggest a safety signal with an increased risk of cardiovascular disease associated with stimulant treatment in children and adolescents, even after adjusting for a number of potential confounders.
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Affiliation(s)
- Søren Dalsgaard
- National Centre for Register-based Research, School of Business and Social Sciences, Department of Economics and Business, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus and Copenhagen, Denmark.,Department of Child and Adolescent Psychiatry, Hospital of Telemark, Kragerø, Norway.,Department of Child and Adolescent Mental Health Odense, Research Unit, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Denmark
| | | | - James F. Leckman
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | | | - Marianne Simonsen
- Department of Economics and Business, Aarhus University, Aarhus, Denmark
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Wang LJ, Wu CC, Lee SY, Tsai YF. Salivary neurosteroid levels and behavioural profiles of children with attention-deficit/hyperactivity disorder during six months of methylphenidate treatment. J Child Adolesc Psychopharmacol 2014; 24:336-40. [PMID: 24956271 DOI: 10.1089/cap.2013.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This prospective study aimed to investigate the relationships between salivary levels of neurosteroids, including dehydroepiandrosterone (DHEA), cortisol, and DHEA/cortisol ratios, and behavioral symptoms in patients with attention-deficit/hyperactivity disorder (ADHD) during treatment with methylphenidate (MPH). METHODS Fifty-eight ADHD patients (48 boys and 10 girls) were included in the study initially. Forty patients (mean age: 7.77±1.64 years; 32 boys and 8 girls) who completed the study received treatment with oral MPH with a dose range of 5-15 mg/day (mean dose: 12.47±7.74 mg/day.) for 6 months at the discretion of the psychiatrist. DHEA and cortisol levels were determined from saliva samples collected at 0800 h at baseline and 6 months from baseline. ADHD symptoms were evaluated with the Child Behavior Checklist (CBCL). RESULTS Salivary DHEA levels (mean difference=9.05 pg/mL, p=0.027) and DHEA/cortisol ratios (mean difference=32.42, p=0.007) in ADHD patients were significantly increased, but the cortisol levels did not change significantly. During a 6 month follow-up, all behavioral problems assessed using the CBCL improved significantly. Changes in salivary DHEA levels were positively correlated with changes in salivary cortisol levels (r=0.44, p=0.004); however, changes in salivary levels of DHEA, cortisol, and the DHEA/cortisol ratio were not significantly correlated with change in any subscales of the CBCL. Mean doses of MPH were not significantly correlated with changes in neurosteroid levels and behavioral symptoms. CONCLUSIONS These findings provide evidence that MPH administration might affect DHEA levels and DHEA/cortisol ratios. Whether levels of neurosteroids are directly associated with brain function or behavioral problems in ADHD patients warrants further investigation.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
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Bourgeois FT, Kim JM, Mandl KD. Premarket safety and efficacy studies for ADHD medications in children. PLoS One 2014; 9:e102249. [PMID: 25007171 PMCID: PMC4090185 DOI: 10.1371/journal.pone.0102249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/16/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a chronic condition and pharmacotherapy is the mainstay of treatment, with a variety of ADHD medications available to patients. However, it is unclear to what extent the long-term safety and efficacy of ADHD drugs have been evaluated prior to their market authorization. We aimed to quantify the number of participants studied and their length of exposure in ADHD drug trials prior to marketing. METHODS We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug's clinical efficacy and safety. For each ADHD medication, we measured the total number of participants studied and the length of participant exposure and identified any FDA requests for post-marketing trials. RESULTS A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75 (IQR 0, 419). Eleven drugs (55%) were approved after <100 participants were studied and 14 (70%) after <300 participants. The median trial length prior to approval was 4 weeks (IQR 2, 9), with 5 (38%) drugs approved after participants were studied <4 weeks and 10 (77%) after <6 months. Six drugs were approved with requests for specific additional post-marketing trials, of which 2 were performed. CONCLUSIONS Clinical trials conducted for the approval of many ADHD drugs have not been designed to assess rare adverse events or long-term safety and efficacy. While post-marketing studies can fill in some of the gaps, better assurance is needed that the proper trials are conducted either before or after a new medication is approved.
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Affiliation(s)
- Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Jeong Min Kim
- Faculty of Arts and Sciences, Wellesley College, Wellesley, Massachusetts, United States of America
| | - Kenneth D. Mandl
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School Center for Biomedical Informatics, Boston, Massachusetts, United States of America
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Raghibi M, Fouladi S, Bakhshani NM. Parent Training and Behavior Therapy on Behaviors of Children With Attention Deficit-Hyperactivity Disorder. HEALTH SCOPE 2014. [DOI: 10.17795/jhealthscope-15418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sasaki T, Hashimoto K, Tachibana M, Kurata T, Okawada K, Ishikawa M, Kimura H, Komatsu H, Ishikawa M, Hasegawa T, Shiina A, Hashimoto T, Kanahara N, Shiraishi T, Iyo M. Tipepidine in children with attention deficit/hyperactivity disorder: a 4-week, open-label, preliminary study. Neuropsychiatr Dis Treat 2014; 10:147-51. [PMID: 24493927 PMCID: PMC3908907 DOI: 10.2147/ndt.s58480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tipepidine (3-[di-2-thienylmethylene]-1-methylpiperidine) has been used solely as a nonnarcotic antitussive in Japan since 1959. The safety of tipepidine in children and adults has already been established. It is reported that tipepidine inhibits G-protein-coupled inwardly rectifying potassium (GIRK)-channel currents. The inhibition of GIRK channels by tipepidine is expected to modulate the level of monoamines in the brain. We put forward the hypothesis that tipepidine can improve attention deficit/hyperactivity disorder (ADHD) symptoms by modulating monoaminergic neurotransmission through the inhibition of GIRK channels. The purpose of this open-label trial was to confirm whether treatment with tipepidine can improve symptoms in pediatric patients with ADHD. SUBJECTS AND METHODS This was a 4-week, open-label, proof-of-efficacy pilot study for pediatric subjects with ADHD. Ten pediatric ADHD subjects (70% male; mean age, 9.9 years; combined [inattentive and hyperactive/impulsive] subtype, n=7; inattentive subtype, n=3; hyperimpulsive subtype, n=0) received tipepidine hibenzate taken orally at 30 mg/day for 4 weeks. All subjects were assessed using the ADHD Rating Scale IV (ADHD-RS), Japanese version, and the Das-Naglieri Cognitive Assessment System (DN-CAS), Japanese version. RESULTS A comparison of baseline scores and 4-week end-point scores showed that all the ADHD-RS scores (total scores, hyperimpulsive subscores, and inattentive subscores) improved significantly (P<0.001). Furthermore, a comparison of baseline DN-CAS total scores and 4-week end-point scores showed a mild trend of improvement (P=0.093). Tipepidine was well tolerated, with no patients discontinuing medication because of side effects. CONCLUSION Our pilot study suggests that tipepidine therapy may prove to be an effective alternative treatment for pediatric patients with ADHD. Nonetheless, more detailed randomized, double-blind trials are needed to confirm tipepidine's efficacy.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan ; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masumi Tachibana
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Tsutomu Kurata
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Keiko Okawada
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Maki Ishikawa
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Komatsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masatomo Ishikawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akihiro Shiina
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhisa Kanahara
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Tetsuya Shiraishi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaomi Iyo
- Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan ; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan ; Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
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Dolina S, Margalit D, Malitsky S, Rabinkov A. Attention-deficit hyperactivity disorder (ADHD) as a pyridoxine-dependent condition: Urinary diagnostic biomarkers. Med Hypotheses 2014; 82:111-6. [DOI: 10.1016/j.mehy.2013.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 11/02/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
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Levine M, Froberg B, Ruha AM, Burns-Ewald M, Yen M, Claudius IA, Arthur AO, Tormoehlen L, Thomas SH. Assessing the toxicity and associated costs among pediatric patients admitted with unintentional poisonings of attention-deficit/hyperactivity disorder drugs in the United States. Clin Toxicol (Phila) 2013; 51:147-50. [PMID: 23473458 DOI: 10.3109/15563650.2013.772623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is widespread, with a national (United States) prevalence of nearly 10%. The 2011 changes in the diagnostic criteria will likely further increase the prevalence of this disorder. Little is known about the incidence of toxicity from unintentional poisonings of ADHD medications. This study attempted to determine the incidence of these ingestions and the corresponding financial impact in the United States. METHODS Four geographically different centers were chosen. Subjects with unintentional poisonings due to ADHD medications were included if the admission dates were between 2000 and 2002 (cohort A) or between 2009 and 2010 (cohort B). Using data from the participating hospitals and the number of monitored beds in each corresponding county, data were extrapolated on a national (United States) level. RESULTS Sixty-three subjects were admitted at four hospitals (18, cohort A and 45, cohort B). The crude incidence rate ratio increased in the later time frame as compared to that in the earlier time frame (incidence rate ratio, 3.13; 95% CI, 1.80-5.68; p < 0.0001). The median (IQR) charges per patient, adjusted for inflation, were $4780 ($3,895-$8,287) and $5912 ($3,432-$9,433) for cohorts A and B, respectively (p = 0.57). If the subjects in the participating counties were only admitted to the participating hospitals, the annual charges, extrapolated throughout the United States for the two periods, would be $2,419,016 and $8,129,538, respectively. If the subjects were evenly distributed across all pediatric monitored beds in a given county, the annual charges extrapolated throughout the United States for the two periods would be $5,694,232 and $24,126,640, respectively. CONCLUSION The incidence of unintentional poisonings from ADHD drugs is increasing and is associated with a significant cost.
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Affiliation(s)
- M Levine
- Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA.
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Is the treatment with psychostimulants in children and adolescents with attention deficit hyperactivity disorder harmful for the dopaminergic system? ACTA ACUST UNITED AC 2013; 5:71-81. [PMID: 23605387 DOI: 10.1007/s12402-013-0105-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 03/09/2013] [Indexed: 12/13/2022]
Abstract
A major concern regarding psychostimulant medication (amphetamine and methylphenidate) in the treatment of children and adolescents with attention deficit/hyperactivity disorder (ADHD) are the potential adverse effects to the developing brain, particularly in regard to dopaminergic brain function. The present review focuses on the pharmacology of these psychostimulants, their mode of action in the human brain and their potential neurotoxic effects to the developing brain in animals, particularly concerning DA brain function. The potential clinical significance of these findings for the treatment of ADHD in children and adolescents is discussed. Studies on sensitization to psychostimulants' rewarding effects, which is a process expected to increase the risk of substance abuse in humans, are not included. The available findings in non-human primates support the notion that the administration of amphetamine and methylphenidate with procedures simulating clinical treatment conditions does not lead to long-term adverse effects in regard to development, neurobiology or behaviour as related to the central dopaminergic system.
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Ramos Olazagasti MA, Klein RG, Mannuzza S, Belsky ER, Hutchison JA, Lashua-Shriftman EC, Castellanos FX. Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood? J Am Acad Child Adolesc Psychiatry 2013; 52:153-162.e4. [PMID: 23357442 PMCID: PMC3662801 DOI: 10.1016/j.jaac.2012.11.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/14/2012] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test whether children with attention-deficit/hyperactivity disorder (ADHD), free of conduct disorder (CD) in childhood (mean = 8 years), have elevated risk-taking, accidents, and medical illnesses in adulthood (mean = 41 years); whether development of CD influences risk-taking during adulthood; and whether exposure to psychostimulants in childhood predicts cardiovascular disease. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood; and that development of CD/antisocial personality (APD) would account for the link between ADHD and risk-taking. We report causes of death. METHOD Prospective 33-year follow-up of 135 boys of white ethnicity with ADHD in childhood and without CD (probands), and 136 matched male comparison subjects without ADHD (comparison subjects; mean = 41 years), blindly interviewed by clinicians. RESULTS In adulthood, probands had relatively more risky driving, sexually transmitted disease, head injury, and emergency department admissions (p< .05-.01). Groups did not differ on other medical outcomes. Lifetime risk-taking was associated with negative health outcomes (p = .01-.001). Development of CD/APD accounted for the relationship between ADHD and risk-taking. Probands without CD/APD did not differ from comparison subjects in lifetime risky behaviors. Psychostimulant treatment did not predict cardiac illness (p = .55). Probands had more deaths not related to specific medical conditions (p = .01). CONCLUSIONS Overall, among children with ADHD, it is those who develop CD/APD who have elevated risky behaviors as adults. Over their lifetime, those who did not develop CD/APD did not differ from comparison subjects in risk-taking behaviors. Findings also provide support for long-term safety of early psychostimulant treatment.
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Huang YS, Wang LJ, Chen CK. Long-term neurocognitive effects of methylphenidate in patients with attention deficit hyperactivity disorder, even at drug-free status. BMC Psychiatry 2012; 12:194. [PMID: 23140464 PMCID: PMC3514239 DOI: 10.1186/1471-244x-12-194] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/10/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Methylphenidate (MPH), a psycho-stimulant, is the most widely administered drug for the pharmacological management of patients with attention deficit hyperactivity disorder (ADHD). This study attempts to determine whether sustainable improvements occur in neurocognitive function among ADHD patients following 12-month treatment with MPH, at drug-free status. Whether age groups, gender or ADHD subtypes differ in neurocognitive performance during MPH treatment is also examined. METHODS Study participants consisted of 103 ADHD patients (mean age: 9.1 ± 1.9 years old) who were drug naïve or drug free for at least 6 months. The patients were prescribed oral short-acting MPH at each dose range of 0.3-1.0 mg/kg daily. During 12 months of the study, the patients underwent the test of variables of attention (TOVA) at the baseline, month 6 and month12. Patients were instructed to not intake MPH for one week before the second and the third TOVA. RESULTS Seventy five patients completed the study. Results of this study indicated that although commission errors and response sensitivity (d') significantly improved during MPH treatment for 12 months, omission errors, response time, response time variability and ADHD score did not. While younger ADHD patients (<9 y/o) performed better in response time, response time variability, d' and ADHD score than older ones (≥9 y/o), the latter more significantly improved in response time than the former during 12 months of treatment. Additionally, boys improved more than girls in omission error and d'. Moreover, although ADHD subtypes significantly differed in ADHD score during the treatment, MPH treatment and ADHD subtypes did not interact with each other for all TOVA indices. CONCLUSIONS ADHD patients significantly improved in impulsivity and perceptual sensitivity, determined as TOVA, during MPH treatment for 12 months. Age and gender, yet not ADHD subtypes, appear to influence the MPH treatment effects in some indices of TOVA. A future study containing a comparison group is suggested to confirm whether the neurocognitive improvements are attributed to long-term effects of MPH or natural maturation of patients.
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Affiliation(s)
- Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan,Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Chang Gung University School of Medicine, Taoyuan, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Chang Gung University School of Medicine, Taoyuan, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, No.200 Lane 208, Ji-Jin 1st Road, Anle District, Keelung City, 204, Taiwan, R.O.C
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Hebebrand J, Blanz B, Herpertz-Dahlmann B, Lehmkuhl G. [Increase in incidence of drug treatments, ethical principles and conflict of interest in cooperation with the pharmaceutical industry]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:133-8. [PMID: 22774235 DOI: 10.1024/1422-4917/a000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review. ACTA ACUST UNITED AC 2012; 4:167-77. [DOI: 10.1007/s12402-012-0087-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/14/2012] [Indexed: 01/02/2023]
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Buchhorn R, Conzelmann A, Willaschek C, Störk D, Taurines R, Renner TJ. Heart rate variability and methylphenidate in children with ADHD. ACTA ACUST UNITED AC 2012; 4:85-91. [DOI: 10.1007/s12402-012-0072-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/02/2012] [Indexed: 11/29/2022]
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Journal Watch. Pharmaceut Med 2011. [DOI: 10.1007/bf03256876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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