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Bhagavan C, Glue P, Evans W, Reynolds L, Turner T, King C, Russell BR, Morunga E, Mills JL, Layton G, Menkes DB. Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial. Trials 2024; 25:336. [PMID: 38773523 DOI: 10.1186/s13063-024-08174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Symptoms of anxiety and depression are common in patients with terminal illness and multiple challenges exist with timely and effective care in this population. Several centres have reported that one dose of the serotonergic psychedelic psilocybin, combined with therapeutic support, improves these symptoms for up to 6 months in this patient group. Drawing upon related therapeutic mechanisms, 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy may have the potential to achieve similar, positive mental health outcomes in this group. Preliminary evidence also supports the tolerability of MDMA-assisted therapy for anxiety and depression in advanced-stage cancer. METHODS Up to 32 participants with advanced-stage cancer and associated depression and anxiety will be randomised in a 1:1 ratio into one of two blinded parallel treatment arms. The intervention group will receive 120 mg (+ 60 mg optional supplemental dose) MDMA-assisted therapy. The psychoactive control group will receive 20 mg oral (+ 10 mg optional supplemental dose) methylphenidate-assisted therapy. For each medication-assisted therapy session, participants will undergo two 90-min therapeutic support sessions in the week preceding, and one 90-min support session the day after the experimental session. A battery of measures (mood, anxiety, quality of life, mystical experience, spiritual wellbeing, attitudes towards death, personality traits, holistic health and wellbeing, connectedness, demoralisation, expectations, qualitative data and safety measures) will be assessed at baseline and through to the end of the protocol. Participants will be followed up until either 12 months post-randomisation or death, whichever occurs first. DISCUSSION This study will examine the effect of MDMA-assisted therapy on symptoms of anxiety and depression in advanced-stage cancer. Potential therapeutic implications include establishing the safety and effectiveness of a novel treatment that may relieve mental suffering in patients with life-threatening illness. TRIAL REGISTRATION Trial registered on Australian New Zealand Clinical Trials Registry. REGISTRATION NUMBER ACTRN12619001334190p. Date registered: 30/09/2019. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378153&showOriginal=true&isReview=true.
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Affiliation(s)
- Chiranth Bhagavan
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Paul Glue
- Department of Psychological Medicine, Division of Health Sciences, University of Otago, 464 Cumberland Street, Central Dunedin, Dunedin, 9016, New Zealand
| | - Will Evans
- Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand
| | - Lisa Reynolds
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Thivya Turner
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Chris King
- Te Whatu Ora Southern, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, New Zealand
| | - Bruce R Russell
- School of Pharmacy, University of Otago, 18 Frederick Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Eva Morunga
- Te Whatu Ora Te Toka Tumai, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Jessica Lee Mills
- University of Auckland, 6 Symonds Street, Auckland, 1010, New Zealand
| | - Geoff Layton
- Ashburn Clinic, 496 Taieri Road, Halfway Bush, Dunedin, 9010, New Zealand
| | - David B Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waikato Clinical Campus, Peter Rothwell Academic Centre, Pembroke Street, Hamilton, 3240, New Zealand
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Beaglehole B, Jarman S, Frampton C. Dispensing of attention-deficit hyperactivity disorder medications for adults in Aotearoa New Zealand. N Z Med J 2024; 137:23-30. [PMID: 38696829 DOI: 10.26635/6965.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
AIM To report dispensing trends for attention-deficit hyperactivity disorder (ADHD) in Aotearoa New Zealand, focussing on adults in order to highlight increasing demand for ADHD treatment by adults and to prompt discussion. METHOD Demographic and dispensing data for ADHD were obtained from the Pharmaceutical Collection between the years 2006 and 2022. This was stratified according to child (<18 years) and adult (≥18 years) populations. Population dispensing rates for methylphenidate and atomoxetine were calculated. Key findings are reported to reveal demographic and dispensing trends for medication treated ADHD in Aotearoa New Zealand. RESULTS More males are dispensed ADHD medication than females, although this is less evident for adults (54.8% male). Māori adults are dispensed ADHD medication at a lower rate (10.1%) than Māori children (22.9%). There was a 10-fold increase in dispensing of ADHD medication for adults compared to a three-fold increase for children over the study period. New dispensing for adults doubled between 2011 and 2022. CONCLUSION Medication treatment for adult ADHD is increasing in Aotearoa New Zealand and includes treatment for persisting childhood ADHD and new diagnoses made in adulthood. Despite increases, dispensing rates for ADHD remain lower than prevalence estimates, suggesting a significant treatment gap. Addressing the treatment gap for ADHD may reduce negative effects of ADHD, but wider social influences should also be considered.
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Affiliation(s)
- Ben Beaglehole
- Senior Lecturer, Department of Psychological Medicine, University of Otago, Christchurch
| | - Stephen Jarman
- Psychiatric Registrar, Te Whatu Ora - Waitaha Canterbury
| | - Chris Frampton
- Biostatistician, Department of Psychological Medicine, University of Otago, Christchurch
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Caliendo E, Lowder R, McLaughlin MJ, Watson WD, Baum KT, Blackwell LS, Koterba CH, Hoskinson KR, Tlustos SJ, Shah SA, Suskauer SJ, Kurowski BG. The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns. J Head Trauma Rehabil 2024; 39:E122-E131. [PMID: 38709832 PMCID: PMC11076004 DOI: 10.1097/htr.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation. SETTING Inpatient pediatric rehabilitation. PARTICIPANTS In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission. DESIGN Multicenter, retrospective medical record review. MAIN MEASURES Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day). RESULTS Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported. CONCLUSION This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.
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Affiliation(s)
- Eric Caliendo
- Department of Medicine, Emory University, Atlanta, Georgia (Dr Caliendo); David Geffen School of Medicine at UCLA, Los Angeles, California (Ms Lowder); Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri (Dr McLaughlin); University of Missouri-Kansas City School of Medicine (Dr McLaughlin); Blythedale Children's Hospital, Valhalla, New York (Dr Watson); Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York (Dr Watson); Department of Radiology, Weill Cornell Medicine, New York City, New York (Dr Shah); Department of Rehabilitation, Children's Hospital Colorado, Aurora (Dr Tlustos); Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Dr Tlustos); Department of Neuropsychology (Dr Koterba), and Center for Biobehavioral Health, Abigail Wexner Research Institute (Dr Hoskinson), Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus (Dr Koterba); Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Hoskinson); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kurowski); Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowski); Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia (Dr Blackwell); Kennedy Krieger Institute, Baltimore, Maryland (Dr Suskauer); and Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer). Dr Baum is in private practice, Paoli, Pennsylvania
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Vertessen K, Luman M, Bet P, Bergwerff CE, Bottelier M, Stoffelsen R, Swanson JM, Wisse A, Twisk J, Oosterlaan J. Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Randomized Controlled Trial Using Placebo-Controlled Titration Implemented in Clinical Practice. Paediatr Drugs 2024; 26:319-330. [PMID: 38280943 DOI: 10.1007/s40272-023-00604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVES Concerns exist regarding the rising use of methylphenidate. A double-blind, placebo-controlled methylphenidate titration (PCT) for children with attention-deficit/hyperactivity disorder (ADHD) has shown potential to improve titration (i.e., detection of placebo responders and larger ADHD symptom improvement) in experimental settings. This study aims to determine if these advantages can be transferred to clinical settings. METHOD Children (aged 5-13 years) with an ADHD diagnosis and an indication to start methylphenidate (MPH) treatment were recruited. Participants were randomized to PCT or care as usual (CAU) in a 1:1 ratio followed by a 7-week randomized controlled trial (T1) and 6-month, naturalistic, open-label follow-up (T2). Parents, teachers, and physicians rated ADHD symptoms, ADHD medication use, MPH dosing, and treatment satisfaction using questionnaires. RESULTS A total of 100 children were enrolled and randomized to PCT (n = 49) or CAU (n = 51). In the PCT group, we found 8.2% placebo responders, 16.3% non-responders, and 65.3% responders to MPH. With PCT compared with CAU, a significantly larger number of children discontinued MPH (T1: 24.5 vs 5.9%, p = 0.009; T2: 41.7 vs 10.4%, p < 0.001) and refrained from using other pharmacological treatment (T1: 20.4 vs 3.9%, p = 0.013; T2: 20.83 vs 6.25%, p = 0.002). At both timepoints, there were no significant differences between the groups in the average dose of MPH, ADHD symptoms, or treatment satisfaction. CONCLUSIONS PCT can be used to improve detection of children who do not benefit from MPH, and may therefore potentially reduce overtreatment of ADHD with MPH.
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Affiliation(s)
- Karen Vertessen
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Marjolein Luman
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - Pierre Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Catharina E Bergwerff
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Marco Bottelier
- Child Study Center Accare, UMC Groningen, Groningen, The Netherlands
| | - Reino Stoffelsen
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA
| | - Annemiek Wisse
- Youz, Center for Youth Mental Healthcare, Velsen-Noord, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Miskowiak KW, Obel ZK, Guglielmo R, Bonnin CDM, Bowie CR, Balanzá-Martínez V, Burdick KE, Carvalho AF, Dols A, Douglas K, Gallagher P, Kessing LV, Lafer B, Lewandowski KE, López-Jaramillo C, Martinez-Aran A, McIntyre RS, Porter RJ, Purdon SE, Schaffer A, Stokes PRA, Sumiyoshi T, Torres IJ, Van Rheenen TE, Yatham LN, Young AH, Vieta E, Hasler G. Efficacy and safety of established and off-label ADHD drug therapies for cognitive impairment or attention-deficit hyperactivity disorder symptoms in bipolar disorder: A systematic review by the ISBD Targeting Cognition Task Force. Bipolar Disord 2024; 26:216-239. [PMID: 38433530 DOI: 10.1111/bdi.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Abnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off-label ADHD therapies in BD. METHODS We included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials. RESULTS Seventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment-related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro-cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias. CONCLUSIONS Methylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.
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Affiliation(s)
- Kamilla W Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen | Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zacharias K Obel
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen | Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Riccardo Guglielmo
- Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Caterina Del Mar Bonnin
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | | | | | - Katherine E Burdick
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andre F Carvalho
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Victoria, Australia
| | - Annemieke Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Peter Gallagher
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Beny Lafer
- Bipolar Disorder Research Program, Institute of Psychiatry, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Kathryn E Lewandowski
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts, USA
| | - Carlos López-Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Universidad de Antioquia, Medellín, Colombia
| | - Anabel Martinez-Aran
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, University of Toronto, Toronto, Canada
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Scot E Purdon
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul R A Stokes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Gregor Hasler
- Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
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van der Veen R, Königs M, Bakker S, van Iperen A, Peerdeman S, Bet PM, Oosterlaan J. Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta-Analysis and Meta-Regression. Clin Pharmacol Ther 2024; 115:971-987. [PMID: 38294196 DOI: 10.1002/cpt.3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Cognitive impairments, common sequelae of acquired brain injury (ABI), significantly affect rehabilitation and quality of life. Currently, there is no solid evidence-base for pharmacotherapy to improve cognitive functioning after ABI, nevertheless off-label use is widely applied in clinical practice. This meta-analysis and meta-regression aims to quantitatively aggregate the available evidence for the effects of pharmacological agents used in the treatment of cognitive impairments following ABI. We conducted a comprehensive search of Embase, Medline Ovid, and Cochrane Controlled Trials Register databases for randomized controlled and crossover trials. Meta-analytic effects were calculated for each pharmaceutical agent and targeted neuromodulator system. Cognitive outcome measures were aggregated across cognitive domains. Of 8,216 articles, 41 studies (4,434 patients) were included. The noradrenergic agent methylphenidate showed a small, significant positive effect on cognitive functioning in patients with traumatic brain injury (TBI; k = 14, d = 0.34, 95% confidence interval: 0.12-0.56, P = 0.003). Specifically, methylphenidate was found to improve cognitive functions related to executive memory, baseline speed, inhibitory control, and variability in responding. The cholinergic drug donepezil demonstrated a large effect size, albeit based on a limited number of studies (k = 3, d = 1.68, P = 0.03). No significant effects were observed for other agents. Additionally, meta-regression analysis did not identify significant sources of heterogeneity in treatment response. Our meta-analysis supports the use of methylphenidate for enhancing cognitive functioning in patients with TBI. Although donepezil shows potential, it warrants further research. These results could guide clinical decision making, inform practice guidelines, and direct future pharmacotherapeutic research in ABI.
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Affiliation(s)
- Ruud van der Veen
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Marsh Königs
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Simon Bakker
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands
| | - Andries van Iperen
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Saskia Peerdeman
- Department of Neurosurgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Beaudin SA, Howard S, Santiago N, Strupp BJ, Smith DR. Methylphenidate alleviates cognitive dysfunction caused by early manganese exposure: Role of catecholaminergic receptors. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110949. [PMID: 38266866 DOI: 10.1016/j.pnpbp.2024.110949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Environmental manganese (Mn) exposure is associated with impaired attention and psychomotor functioning, as well as impulsivity/hyperactivity in children and adolescents. We have shown previously that developmental Mn exposure can cause these same dysfunctions in a rat model. Methylphenidate (MPH) lessens impairments in attention, impulse control, and psychomotor function in children, but it is unknown whether MPH ameliorates these dysfunctions when induced by developmental Mn exposure. Here, we sought to (1) determine whether oral MPH treatment ameliorates the lasting attention and sensorimotor impairments caused by developmental Mn exposure, and (2) elucidate the mechanism(s) of Mn neurotoxicity and MPH effectiveness. Rats were given 50 mg Mn/kg/d orally over PND 1-21 and assessed as adults in a series of attention, impulse control and sensorimotor tasks during oral MPH treatment (0, 0.5, 1.5, or 3.0 mg/kg/d). Subsequently, selective catecholaminergic receptor antagonists were administered to gain insight into the mechanism(s) of action of Mn and MPH. Developmental Mn exposure caused persistent attention and sensorimotor impairments. MPH treatment at 0.5 mg/kg/d completely ameliorated the Mn attentional dysfunction, whereas the sensorimotor deficits were ameliorated by the 3.0 mg/kg/d MPH dose. Notably, the MPH benefit on attention was only apparent after prolonged treatment, while MPH efficacy for the sensorimotor deficits emerged early in treatment. Selectively antagonizing D1, D2, or α2A receptors had no effect on the Mn-induced attentional dysfunction or MPH efficacy in this domain. However, antagonism of D2R attenuated the Mn sensorimotor deficits, whereas the efficacy of MPH to ameliorate those deficits was diminished by D1R antagonism. These findings demonstrate that MPH is effective in alleviating the lasting attentional and sensorimotor dysfunction caused by developmental Mn exposure, and they clarify the mechanisms underlying developmental Mn neurotoxicity and MPH efficacy. Given that the cause of attention and psychomotor deficits in children is often unknown, these findings have implications for the treatment of environmentally induced attentional and psychomotor dysfunction in children more broadly.
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Affiliation(s)
- Stephane A Beaudin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Shanna Howard
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Nicholas Santiago
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Barbara J Strupp
- Division of Nutritional Sciences, and Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Donald R Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA.
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Miladinia M, Jahangiri M, White SJ, Karimpourian H, Inno A, Chan SWC, Ganji R, Maniati M, Zarea K, Ghalamkari M, Farahat A, Fagerström C. 5-EPIFAT trial protocol: a multi-center, randomized, placebo-controlled trial of the efficacy of pharmacotherapy for fatigue using methylphenidate, bupropion, ginseng, and amantadine in advanced cancer patients on active treatment. Trials 2024; 25:230. [PMID: 38570861 PMCID: PMC10988831 DOI: 10.1186/s13063-024-08078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacological treatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is still unclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-to-head trial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadine vs. placebo in patients with advanced cancer. METHODS The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will use a parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidate vs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255 adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0-10 scale. The study period includes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcome is the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illness therapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, which will be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learning algorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. DISCUSSION The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatment approach, design of future trials, as well as the development of CRF management guidelines. TRIAL REGISTRATION IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.
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Affiliation(s)
- Mojtaba Miladinia
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mina Jahangiri
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Hossein Karimpourian
- Department of Medical Oncology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alessandro Inno
- Medical Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella (VR), Italy
| | | | - Reza Ganji
- Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmood Maniati
- School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
| | - Marziyeh Ghalamkari
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Farahat
- Department of Hematology and Oncology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Kalmar, Sweden
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9
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Li YT, Huang YL, Chen JJJ, Hyland BI, Wickens JR. Phasic dopamine signals are reduced in the spontaneously hypertensive rat and increased by methylphenidate. Eur J Neurosci 2024; 59:1567-1584. [PMID: 38314648 DOI: 10.1111/ejn.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
The spontaneously hypertensive rat (SHR) is a selectively bred animal strain that is frequently used to model attention-deficit hyperactivity disorder (ADHD) because of certain genetically determined behavioural characteristics. To test the hypothesis that the characteristically altered response to positive reinforcement in SHRs may be due to altered phasic dopamine response to reward, we measured phasic dopamine signals in the SHRs and Sprague Dawley (SD) rats using in vivo fast-scan cyclic voltammetry. The effects of the dopamine reuptake inhibitor, methylphenidate, on these signals were also studied. Phasic dopamine signals during the pairing of a sensory cue with electrical stimulation of midbrain dopamine neurons were significantly smaller in the SHRs than in the SD rats. Over repeated pairings, the dopamine response to the sensory cue increased, whereas the response to the electrical stimulation of dopamine neurons decreased, similarly in both strains. However, the final amplitude of the response to the sensory cue after pairing was significantly smaller in SHRs than in the SD rats. Methylphenidate increased responses to sensory cues to a significantly greater extent in the SHRs than in the SD rats, due largely to differences in the low dose effect. At a higher dose, methylphenidate increased responses to sensory cues and electrical stimulation similarly in SHRs and SD rats. The smaller dopamine responses may explain the reduced salience of reward-predicting cues previously reported in the SHR, whereas the action of methylphenidate on the cue response suggests a potential mechanism for the therapeutic effects of low-dose methylphenidate in ADHD.
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Affiliation(s)
- Yu-Ting Li
- Neurobiology Research Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu, Taiwan
| | - Yi-Ling Huang
- Neurobiology Research Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
| | - Jia-Jin Jason Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Brian Ian Hyland
- Department of Physiology, Brain Health Research Centre, University of Otago, Dunedin, New Zealand
| | - Jeffery R Wickens
- Neurobiology Research Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
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10
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Madaan V, Bhaskar S, Donnelly GAE, Cox DJ. A Randomized, Phase 3, Double-Blind, Crossover Comparison of Multilayer, Extended-Release Methylphenidate (PRC-063), and Lisdexamfetamine in the Driving Performance of Young Adults With ADHD. J Atten Disord 2024; 28:947-956. [PMID: 38404033 PMCID: PMC10981171 DOI: 10.1177/10870547241226634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To compare PRC-063 (multilayer-release methylphenidate) and lisdexamfetamine dimesylate (LDX) on the driving performance of young adults with attention deficit hyperactivity disorder (ADHD) in a randomized, double-blind, crossover study. METHOD Following up to 21 days of each treatment in each treatment course (PRC-063/LDX or LDX/PRC-063), subjects completed a 15-hour driving simulator laboratory assessment. The primary outcome measure was the Tactical Driving Quotient (TDQ) and the Clinical Global Impressions-Improvement (CGI-I) scale was a secondary outcome measure. RESULTS Forty-four subjects completed the study. PRC-063 and LDX had equivalent effects on driving performance through a 15-hour time period (least square mean difference -0.3 [standard error 1.08], 95% confidence interval [-2.4, 1.8], p = .793). Consistent improvement in CGI-I was observed. The incidence of treatment-emergent adverse events was similar for each treatment sequence. CONCLUSIONS PRC-063 and LDX had comparable effects on driving performance, from 1 through 15 hours, the last time point measured.
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Affiliation(s)
- Vishal Madaan
- American Psychiatric Association, Washington, DC, USA
| | - Sailaja Bhaskar
- Imbrium Therapeutics L.P., A Subsidiary of Purdue Pharma L.P., Stamford, CT, USA
| | | | - Daniel J. Cox
- University of Virginia Health System, Charlottesville, USA
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11
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Abbas K, Barnhardt EW, Nash PL, Streng M, Coury DL. A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder. Expert Rev Neurother 2024; 24:421-432. [PMID: 38391788 DOI: 10.1080/14737175.2024.2321921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Amphetamine preparations are one of the two categories of stimulant medications approved for the treatment of attention deficit hyperactivity disorder (ADHD). Optimal treatment of ADHD aims to reduce core symptoms for as much of the waking hours as possible, leading to longer-acting delivery formats. In addition, the pediatric population commonly has difficulty swallowing pills and manufacturers have developed a variety of options to facilitate this concern. These include chewable tablets, capsules that may be sprinkled on soft food, liquids and transdermal patches. AREAS COVERED This article reviews the once-daily extended-release preparations currently available for amphetamine compounds, their pharmacodynamics, and common adverse effects. EXPERT OPINION There is an extensive evidence base supporting use of amphetamine preparations in the treatment of ADHD. Rapid onset of action and a favorable side effect profile make these widely used. The availability of once-daily extended-release chewable tablets, capsules that can be opened and sprinkled, and liquid formulations provides clinicians with multiple options to meet the specific needs of patients with difficulty swallowing whole pills.
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Affiliation(s)
- Kendall Abbas
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth W Barnhardt
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Patricia L Nash
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maria Streng
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel L Coury
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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12
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Spencer RC, Martin AJ, Devilbiss DM, Berridge CW. Cognition-enhancing and cognition-impairing doses of psychostimulants exert opposing actions on frontostriatal neural coding of delay in working memory. Neuropsychopharmacology 2024; 49:837-844. [PMID: 37741905 PMCID: PMC10948860 DOI: 10.1038/s41386-023-01738-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
The prefrontal cortex (PFC) and extended frontostriatal circuitry play a critical role in executive cognitive processes that guide goal-directed behavior. Dysregulation of frontostriatal-dependent cognition is implicated in a variety of cognitive/behavioral disorders, including addiction and attention deficit hyperactivity disorder (ADHD). Psychostimulants exert dose-dependent and opposing actions on frontostriatal cognitive function. Specifically, low and clinically-relevant doses improve, while higher doses associated with abuse and addiction impair, frontostriatal-dependent cognitive function. Frontostriatal cognition is supported by the coordinated activity of neurons across this circuit. To date, the neural coding mechanisms that support the diverse cognitive actions of psychostimulants are unclear. This represents a significant deficit in our understanding of the neurobiology of frontostriatal cognition and limits the development of novel treatments for frontostriatal cognitive impairment. The current studies examined the effects of cognition-enhancing and cognition-impairing doses of methylphenidate (MPH) on the spiking activity of dorsomedial PFC (dmPFC) and dorsomedial striatal (dmSTR) neurons in 17 male rats engaged in a working memory task. Across this frontostriatal circuit, we observed opposing actions of low- and high-dose MPH on the population-based representation of delay: low-dose strengthened, while high-dose weakened, representation of this event. MPH elicited a more complex pattern of actions on reward-related signaling, that were highly dose-, region- and neuron-dependent. These observations provide novel insight into the neurophysiological mechanisms that support the cognitive actions of psychostimulants.
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Affiliation(s)
- Robert C Spencer
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, 53706, USA.
| | - Andrea J Martin
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - David M Devilbiss
- Department of Cell Biology and Neuroscience, Rowan University, 2 Medical Center Drive, SC220, Stratford, NJ, 08084, USA
| | - Craig W Berridge
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, 53706, USA
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13
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Kappel RK, Bisgaard TH, Poulsen G, Jess T. Risk of Anxiety, Depression, and Attention-Deficit/Hyperactivity Disorder in Pediatric Patients With Inflammatory Bowel Disease: A Population-Based Cohort Study. Clin Transl Gastroenterol 2024; 15:e00657. [PMID: 37934192 DOI: 10.14309/ctg.0000000000000657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is associated with depression and anxiety in adults, but data are scarce on risk of psychiatric diseases in children with IBD. We aimed to estimate the risk of anxiety, depression, or attention-deficit/hyperactivity disorder (ADHD) in patients with pediatric-onset IBD. METHODS We performed a nationwide, register-based cohort study including all patients with pediatric-onset IBD diagnosed in Denmark during 1998-2018, resulting in 3,559 patients matched 1:5 on age, sex, municipality of residence, and time period, resulting in 17,795 reference individuals. We used Cox regression to calculate hazard ratios for each outcome after a diagnosis with IBD. RESULTS Patients with pediatric-onset IBD had an increased risk of depression (hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.26-1.80) and of using antidepressants (HR, 1.54; 95% CI, 1.39-1.71) and, surprisingly, a reduced risk of using methylphenidate (HR, 0.75; 95% CI, 0.58-0.98). Patients with both IBD subtypes (Crohn's disease and ulcerative colitis) had an increased risk of using antidepressants and developing depression, which was particularly high in patients with Crohn's disease (HR, 1.73; 95% CI, 1.35-2.22). Patients with ulcerative colitis had reduced risk of using methylphenidate (HR, 0.63; 95% CI, 0.43-0.93) and a reduced-although not statistically significant-risk of being diagnosed with ADHD compared with the background population. DISCUSSION Patients with pediatric-onset IBD have a 50% increased risk of developing depression, which is important for healthcare providers to be aware of and manage. Remarkably, we found a reduced risk of receiving methylphenidate and being diagnosed with ADHD, which merits further investigation.
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Affiliation(s)
- Rebecca Kristine Kappel
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Tania Hviid Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Gry Poulsen
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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14
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Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen T, Madsen MG, Hove Thomsen P, Bergink V, Srinivas C, Cohen JM, Brikell I, Liu X. Attention-Deficit Hyperactivity Disorder (ADHD) Medication Use Trajectories Among Women in the Perinatal Period. CNS Drugs 2024; 38:303-314. [PMID: 38489019 PMCID: PMC10980654 DOI: 10.1007/s40263-024-01076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND An increasing number of women of reproductive age are treated with attention-deficit hyperactivity disorder (ADHD) medication; however, patterns of ADHD medication use for women in the perinatal period have not been well described. OBJECTIVE This study aimed to describe ADHD medication use patterns from 1 year before pregnancy to 1 year after delivery, and to describe sociodemographic characteristics and clinical features by medication trajectories. METHODS The population-based cohort study included pregnancies in Denmark between 1997 and 2020, from the Medical Birth Register, by women who filled at least one prescription for ADHD medication from 12 months before pregnancy until 12 months after delivery. We applied group-based trajectory modeling to classify women into subgroups based on the identification of heterogeneous ADHD medication treatment patterns, and described the characteristics associated with these groups. RESULTS Overall, we included 4717 pregnancies leading to liveborn singletons by 4052 mothers with a mean (standard deviation) age of 27.5 (5.6) years. We identified four treatment trajectories across pregnancy and the postpartum period: continuers (23.3%), discontinuers (41.8%), interrupters who ceased filling prescriptions during pregnancy but resumed postpartum (17.2%), and postpartum initiators (17.7%). Continuers were older at the time of conception, gave birth in more recent years, were more likely to smoke during pregnancy, and used other psychotropic medications during pregnancy. A large proportion of continuers used methylphenidate (89.1%) compared with the other groups (75.9-84.1%) and had switched ADHD medication type during the whole period (16.4% vs. 7.4-14.8%). CONCLUSION We found that approximately 60% of women discontinued or interrupted their ADHD medication around pregnancy, and those who continued differed in sociodemographic and clinical factors that may reflect more severe ADHD.
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Affiliation(s)
- Kathrine Bang Madsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark.
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Mette Bliddal
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Borg Skoglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Trine Munk-Olsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Galle Madsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
| | - Per Hove Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center at the Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Chaitra Srinivas
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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15
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Hung Y, Green A, Kelberman C, Gaillard S, Capella J, Rudberg N, Gabrieli JDE, Biederman J, Uchida M. Neural and Cognitive Predictors of Stimulant Treatment Efficacy in Medication-Naïve ADHD Adults: A Pilot Diffusion Tensor Imaging Study. J Atten Disord 2024; 28:936-944. [PMID: 38321936 PMCID: PMC10964228 DOI: 10.1177/10870547231222261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Stimulant medications are the main treatment for Attention Deficit Hyperactivity Disorder (ADHD), but overall treatment efficacy in adults has less than a 60% response rate. This study aimed to identify neural and cognitive markers predictive of longitudinal improvement in response to stimulant treatment in drug-naïve adults with ADHD. METHOD We used diffusion tensor imaging (DTI) and executive function measures with 36 drug-naïve adult ADHD patients in a prospective study design. RESULTS Structural connectivity (measured by fractional anisotropy, FA) in striatal regions correlated with ADHD clinical symptom improvement following stimulant treatment (amphetamine or methylphenidate) in better medication responders. A significant positive correlation was also found between working memory performance and stimulant-related symptom improvement. Higher pre-treatment working memory scores correlated with greater response. CONCLUSION These findings provide evidence of pre-treatment neural and behavioral markers predictive of longitudinal treatment response to stimulant medications in adults with ADHD.
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Affiliation(s)
- Yuwen Hung
- Massachusetts Institute of Technology, Cambridge, USA
| | | | | | | | - James Capella
- Massachusetts Institute of Technology, Cambridge, USA
| | | | | | - Joseph Biederman
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Mai Uchida
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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16
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Zhang Y, Yin L, You C, Liu C, Dong P, Xu X, Zhang K. Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting. Drugs R D 2024; 24:29-39. [PMID: 37982991 PMCID: PMC11035522 DOI: 10.1007/s40268-023-00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Methylphenidate (MPH) and atomoxetine (ATX) are the most common medications used to treat attention-deficit hyperactivity disorder (ADHD) in China; however, despite this, there is still a paucity of studies comparing their efficacy and safety, particularly for different characteristics. To address the lack of research, a real-world prospective cohort study was conducted to examine these properties of MPH and ATX, and to analyze correlations associated with age, sex, and different ADHD presentation. METHODS Children with ADHD meeting the eligibility criteria were recruited from January 2016 to July 2021. Study participants were treated with either MPH or ATX prescribed in the real-world setting, and were followed up for 26 weeks. Clinical efficacy response and adverse events (AEs) were recorded and measured. Subgroup analysis was performed to examine the efficacy response and AEs associated with age, sex, and different ADHD presentation. RESULTS A total of 1050 children were recruited and 29 children were lost to follow-up. Of the 1021 children remaining, 533 were treated with MPH and 488 were treated with ATX. No significant differences were found in intelligence quotient, age, sex, or ADHD presentation between the MPH- and ATX-treated groups (p > 0.05). The response rates were 84.6% in the MPH-treated group and 63.3% in the ATX-treated group. Subgroup analysis of response rate demonstrated that the treatment effect of MPH over ATX was consistent across subgroups except in the girls (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.97-4.7) and the hyperactive/impulsive presentation group (OR 2.88, 95% CI 0.77-12.76). A total of 47.8% of children experienced AEs during MPH treatment, significantly lower than the rate of 56.8% during ATX treatment (p < 0.05). The incidence of AEs in the MPH-treated group was higher in young children (<8 years: 56.8%; 8-10 years: 47.2%) and lower in children over 10 years of age (29.0%). CONCLUSIONS Overall, MPH was more effective and better tolerated than ATX. The incidence of AEs in children treated with MPH varied with age, and was higher in young children and lower in children over 10 years of age.
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Affiliation(s)
- Ying Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Yin
- Department of Pediatrics, Taixing People's Hospital, Taizhou, China
| | - Cun You
- Department of Pediatrics, Fudan University Minhang Hospital, Shanghai, China
| | - Chunxue Liu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Dong
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Kaifeng Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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17
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Wiggs KK, Breaux R, Langberg JM, Peugh JL, Becker SP. Examining daily stimulant medication use and sleep in adolescents with ADHD. Eur Child Adolesc Psychiatry 2024; 33:821-832. [PMID: 37043095 DOI: 10.1007/s00787-023-02204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/31/2023] [Indexed: 04/13/2023]
Abstract
Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12-14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.
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Affiliation(s)
- Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA.
| | - Rosanna Breaux
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Joshua M Langberg
- Department of Clinical Psychology, Rutgers University, Piscataway, NJ, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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18
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McCarthy DM, Spencer TJ, Bhide PG. Preclinical Models of Attention Deficit Hyperactivity Disorder: Neurobiology, Drug Discovery, and Beyond. J Atten Disord 2024; 28:880-894. [PMID: 38084074 DOI: 10.1177/10870547231215286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE We offer an overview of ADHD research using mouse models of nicotine exposure. METHOD Nicotine exposure of C57BL/6 or Swiss Webster mice occurred during prenatal period only or during the prenatal and the pre-weaning periods. Behavioral, neuroanatomical and neurotransmitter assays were used to investigate neurobiological mechanisms of ADHD and discover candidate ADHD medications. RESULTS Our studies show that norbinaltorphimine, a selective kappa opioid receptor antagonist is a candidate novel non-stimulant ADHD treatment and that a combination of methylphenidate and naltrexone has abuse deterrent potential with therapeutic benefits for ADHD. Other studies showed transgenerational transmission of ADHD-associated behavioral traits and demonstrated that interactions between untreated ADHD and repeated mild traumatic brain injury produced behavioral traits not associated with either condition alone. CONCLUSION Preclinical models contribute to novel insights into ADHD neurobiology and are valuable tools for drug discovery and translation to benefit humans with ADHD.
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Affiliation(s)
| | - Thomas J Spencer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pradeep G Bhide
- Florida State University College of Medicine, Tallahassee, FL, USA
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Surman CBH, Walsh DM, Bond JB. Comparing Pharmacotherapies for ADHD in Adults: Evidence From Outcome-Focused Analysis of Food and Drug Administration Drug Label Registration Trials. J Atten Disord 2024; 28:800-809. [PMID: 38229445 DOI: 10.1177/10870547231218041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE We appraised whether FDA registration trials for ADHD pharmacotherapy in adults provides comparable information to inform treatment expectations. METHOD Comparison of ADHD outcome measure patterns in ADHD pharmacotherapy FDA drug label source studies. RESULTS Among stimulants, from fixed-dose titration data, amphetamine agents had numerically higher placebo-corrected symptom improvement and symptom effect sizes than methylphenidate agents. Symptom effect sizes were lower in the flexible dosing registration studies of atomoxetine and viloxazine. Varying responder definitions were analyzable, based on ≥30% symptom improvement and/or CGI-I improvement of "much" or "very much improved." Number of exposures needed to create these responses were lower for stimulants than for viloxazine. CONCLUSION Heterogeneity in the design and analysis of FDA drug label source trials restricts implications for clinical practice. Research conducted using replicated designs, direct comparison of available treatments, and outcome analyses that generalize to clinical care could better inform clinical decision making.
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Affiliation(s)
- Craig B H Surman
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Joseph B Bond
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham Integrated Care, Somerville, MA, USA
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20
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Moharram M, Kiang T. Pharmacokinetics of Long-Acting Methylphenidate: Formulation Differences, Bioequivalence, Interchangeability. Eur J Drug Metab Pharmacokinet 2024; 49:149-170. [PMID: 38127227 DOI: 10.1007/s13318-023-00873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE: Attention deficit hyperactivity disorder is one of the most common neuropsychiatric conditions in children, and methylphenidate (MPH) is one of the first-line therapies. MPH is available in a variety of extended-release (ER) formulations worldwide, and most formulations are not considered bioequivalent due to differences in pharmacokinetics. It is hypothesized that the current bioequivalence guidelines from the different regulatory bodies may generate inconsistent findings or recommendations when assessing the bioequivalence of ER MPH formulations. This manuscript aims to conduct a comprehensive and narrative critical literature review to analyze pharmacokinetic data pertaining to ER formulations of MPH in order to assess bioequivalence, differences in regulatory guidelines, and additional pharmacokinetic-pharmacodynamic parameters that may help define interchangeability. METHODS A literature search was conducted in EMBASE, Medline, and Cochrane Library with no time limits. Study characteristics, non-compartmental pharmacokinetic parameters, and bioequivalence data were extracted for analysis. RESULTS Thirty-three studies were identified with primary pharmacokinetic data after the administration of ER MPH, of which 10 were direct comparative studies (i.e., at least 2 formulations tested within a single setting) and 23 were indirect comparisons (i.e., different experimental settings). Two formulations were consistently reported as bioequivalent across the regulatory bodies using criteria from their guidance documents, although inconsistencies have been observed. However, when additional kinetic criteria (discussed in this manuscript) were imposed, only one study met the more stringent definition of bioequivalence. Various clinical factors also had inconsistent effects on the pharmacokinetics and interchangeability of the different formulations, which were associated with a lack of standardization for assessing covariates across the regulatory agencies. CONCLUSION Additional pharmacokinetic parameters and consistency in guidelines across the regulatory bodies may improve bioequivalence assessments. Based on our findings, more research is also required to understand whether bioequivalence is an appropriate measure for determining MPH interchangeability. This critical review is suitable for formulation scientists, clinical pharmacologists, and clinicians.
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Affiliation(s)
- Mostafa Moharram
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-142D (Office), 3081 (Lab) Katz Group Centre for Research, 11315, 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
| | - Tony Kiang
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-142D (Office), 3081 (Lab) Katz Group Centre for Research, 11315, 87 Ave NW, Edmonton, AB, T6G 2H5, Canada.
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Schermann H, Schiffmann N, Ankory R, Shlaifer A, Yavnai N, Yoffe V, Natapov L. Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder. Spec Care Dentist 2024; 44:556-562. [PMID: 37288998 DOI: 10.1111/scd.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the effect and dose-response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. PARTICIPANTS AND METHODS This retrospective study comprises a cohort of military recruits aged 18-25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. RESULTS Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose-response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) CONCLUSIONS: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).
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Affiliation(s)
- Haggai Schermann
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Nathan Schiffmann
- Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Ran Ankory
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Amir Shlaifer
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Nirit Yavnai
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Victoria Yoffe
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Lena Natapov
- Division of Dental Health, State of Israel Ministry of Health, Jerusalem, Israel
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Van Vyve L, Dierckx B, Lim CG, Danckaerts M, Koch BCP, Häge A, Banaschewski T. Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines. Eur J Pediatr 2024; 183:1047-1056. [PMID: 38095716 DOI: 10.1007/s00431-023-05370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries. Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications. What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications.
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Affiliation(s)
| | - B Dierckx
- Erasmus MC, Rotterdam, The Netherlands
| | - C G Lim
- Institute of Mental Health, Singapore, Singapore
| | | | | | - A Häge
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
| | - T Banaschewski
- Zentralinstitut für Seelische Gesundheit, Mannheim, Germany
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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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24
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Lillis S. Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap. J Prim Health Care 2024; 16:27-32. [PMID: 38546775 DOI: 10.1071/hc23126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting about 7% of those aged up to 12 years, 5% of teenagers and 3% of adults. It is associated with poor academic performance, substance abuse, criminality, poor social functioning and other negative outcomes. Psychotherapeutic treatment is moderately successful, whereas pharmacotherapy with stimulant medication is more efficacious and is recommended in many international guidelines. Anecdotal evidence suggests underuse of these medications in Aotearoa, New Zealand. Aim To estimate how many patients with ADHD are prescribed psychostimulants in Aotearoa, New Zealand. Methods National prescribing data for dexamphetamine and methylphenidate in 2022 were obtained and matched against estimated prevalence of ADHD by age. Results There is a significant treatment gap for which inability to access first-line medication is likely to be the predominant explanation. Discussion The data suggest failure of our health system to provide reasonable health care for a significant number of people with ADHD, and results in inequity in outcomes. New approaches are needed that will increase access to first-line medication, yet maintain appropriateness of diagnosis and limit risk of medication diversion.
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Affiliation(s)
- Steven Lillis
- Student Health, University of Waikato, Knighton Road, Hamilton, New Zealand
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25
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Nardi J, Freddo N, Biazus IC, Oliveira AP, Soares SM, Fortuna M, Varela ACC, Siqueira L, Pompermaier A, Tamagno WA, do Prado L, Berton N, Barcellos LJG, Rossato-Grando LG. Methylphenidate exposure in juvenile period elicits locomotion changes and anxiolytic-like behavior in adulthood: Evidence using zebrafish as a translational model. Behav Brain Res 2024; 457:114709. [PMID: 37827251 DOI: 10.1016/j.bbr.2023.114709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
Methylphenidate (MPH) is a central nervous system stimulant that is mainly used for Attention-Deficit/Hyperactivity Disorder (ADHD). It is well known that there is a high rate of ADHD misdiagnosis, leading to a great number of neurotypical children chronically exposed to MPH in early periods of life. This increase raises concern about possible long-lasting effects of this exposure. We aimed to evaluate whether exposure to MPH during childhood might impact adult behavioral pattern. For this purpose, we used zebrafish as a translational model considering its robustness as experimental model and fast life cycle. Fish were exposed during juvenile period (from 30 to 60 post-natal day) at MPH therapeutic concentration (2 mg L-1), and behavioral tests were performed at fish adulthood (120 post-natal day). MPH provoked slight anxiolytic-like effects and hyperlocomotion, and no differences on sociability and cortisol levels were observed. Moreover, sex did not affect any of the parameters evaluated. These results demonstrate that early chronic exposure to MPH leads to neurobehavioral adaptations that persist into adulthood in zebrafish regardless of sex, suggesting that the misuse of MPH during childhood and adolescence can alter neurobehavioral plasticity and these alterations might persist until adulthood.
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Affiliation(s)
- Jessica Nardi
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Natália Freddo
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Inara Carbonera Biazus
- Curso de Farmácia, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Ana Paula Oliveira
- Curso de Farmácia, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Suelen Mendonça Soares
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Avenida Roraima, Bairro Camobi, Santa Maria, Rio Grande do Sul, Brazil
| | - Milena Fortuna
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Avenida Roraima, Bairro Camobi, Santa Maria, Rio Grande do Sul, Brazil
| | - Amanda Carolina Cole Varela
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Avenida Roraima, Bairro Camobi, Santa Maria, Rio Grande do Sul, Brazil
| | - Lisiane Siqueira
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Aline Pompermaier
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Wagner Antonio Tamagno
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Avenida Roraima, Bairro Camobi, Santa Maria, Rio Grande do Sul, Brazil
| | - Luciane do Prado
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Nicole Berton
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil
| | - Leonardo José Gil Barcellos
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Avenida Roraima, Bairro Camobi, Santa Maria, Rio Grande do Sul, Brazil
| | - Luciana Grazziotin Rossato-Grando
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil; Curso de Farmácia, Universidade de Passo Fundo, BR 285, São José, Passo Fundo, Rio Grande do Sul, Brazil.
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Cortese S, Coghill D, Mattingly GW, Rohde LA, Wong ICK, Faraone SV. WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents - Authors' reply. Lancet Psychiatry 2024; 11:93-95. [PMID: 38245024 DOI: 10.1016/s2215-0366(23)00437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
| | - David Coghill
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Gregory W Mattingly
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Midwest Research Group, Washington University School of Medicine, St Louis, MO, USA
| | - Luis A Rohde
- Attention Deficit/Hyperactivity Program and Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Medical Council, UniEduK, São Paulo, Brazil; Center for Research and Innovation in Mental Health, National Institute of Developmental Psychiatry, São Paulo, Brazil
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Aston School of Pharmacy, Aston University, Birmingham, UK
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
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Luo X, Dang C, Guo J, Li D, Wang E, Zhu Y, Liu L, Wang Y, Song Y, Sun L. Overactivated contextual visual perception and response to a single dose of methylphenidate in children with ADHD. Eur Arch Psychiatry Clin Neurosci 2024; 274:35-44. [PMID: 36725736 DOI: 10.1007/s00406-023-01559-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023]
Abstract
The pathogenesis of overactivated visual perception in attention-deficit hyperactivity disorder (ADHD) remains unclear, which is interpreted as a cognitive compensation. The existing studies have proposed that perceptual abnormalities in neurodevelopmental disorders are associated with dysfunction of the contextual knowledge system, which influences the development and formation of perception. We hypothesized that alterations in contextual states may also be responsible for inducing perceptual abnormalities in ADHD. Therefore, the present study evaluated the characteristics of pre-stimulus alpha and its response to a single dose of methylphenidate (MPH). A total of 135 Chinese children participated in the first study, including 70 children with ADHD (age = 10.61 ± 1.93 years, female = 17) and 65 age- and sex-matched control children (age = 10.73 ± 1.93 years, female = 20). The second clinical trial included 19 Chinese children with ADHD (age = 11.85 ± 1.72 years, female = 4), with an identical visual spatial search task. Pre-stimulus alpha oscillations and P1 activity were significantly greater in children with ADHD than in the controls. Overactivated pre-stimulus alpha positively predicted P1. Both pre-stimulus alpha and P1 overactivation have beneficial effects on cognitive performance in children with ADHD. No intervening effect of a single dose of MPH on the compensatory activation of pre-stimulus alpha and P1 were observed. Our findings extended the perceptual activation to the contextual knowledge system, suggesting that compensatory perception in children with ADHD is more likely to be a top-down regulated cognitive operational process.
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Affiliation(s)
- Xiangsheng Luo
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China
| | - Chen Dang
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China
| | - Jialiang Guo
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Dongwei Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Encong Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yu Zhu
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China
| | - Lu Liu
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China
| | - Yufeng Wang
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China
| | - Yan Song
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China.
| | - Li Sun
- Peking University Sixth Hospital & Peking University Institute of Mental Health, Beijing, China.
- NHC Key Laboratory of Mental Health (Peking University) & National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, China.
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Ponnou S, Timimi S, Briffault X, Batstra L, Gøtzsche PC, Gonon F. WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents. Lancet Psychiatry 2024; 11:92-93. [PMID: 38245022 DOI: 10.1016/s2215-0366(23)00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Sébastien Ponnou
- Educational Sciences, University of Paris 8 (CIRCEFT-CLEF, EA 4384), 93200 Saint-Denis, France.
| | | | - Xavier Briffault
- Centre for Research in Medicine, Sciences, Health, Mental Health, and Society (CERMES3), National Centre for Scientific Research,Université Paris Cité, Paris, France
| | - Laura Batstra
- Faculty of the Behavioural and Social Sciences, Department of Child and Family Welfare, University of Groningen, Netherlands
| | | | - François Gonon
- Institute of Neurodegenerative Diseases, National Centre for Scientific Research, University of Bordeaux, Bordeaux, France
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Sweere DJJ, Hendriksen JGM, Jeroen Vermeulen R, Klinkenberg S. Efficacy of methylphenidate treatment in childhood myotonic dystrophy type 1 and comorbid attention deficit hyperactivity disorder: A case report using eye tracking assessment. Brain Dev 2024; 46:118-121. [PMID: 38007339 DOI: 10.1016/j.braindev.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Despite the increased prevalence of comorbid attention deficit hyperactivity disorder (ADHD) in children with myotonic dystrophy type 1, the effects of methylphenidate treatment on associated cognitive deficits in this population is not yet investigated. CASE We describe a case study of an eleven-year-old male patient with myotonic dystrophy type 1 and comorbid ADHD that was treated with methylphenidate in a twice daily regime (0.60 mg/kg/day). Positive effects on learning and cognition were reported by the parents and teachers. No negative side effects were reported. Sequential neuropsychological assessments before and 45 minutes after methylphenidate intake were conducted to quantify the cognitive effects of methylphenidate treatment. Significant improvements in regulation of attention were behaviorally observed and were quantified using eye tracking technology. CONCLUSION We conclude that methylphenidate may be an effective treatment for ADHD-related cognitive deficits and learning difficulties in children with myotonic dystrophy type 1 which merits further research.
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Affiliation(s)
- Dirk J J Sweere
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Jos G M Hendriksen
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - R Jeroen Vermeulen
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University Medical Centre, Department of Neurology, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University Medical Centre, Department of Neurology, Maastricht, the Netherlands
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Storebø OJ, Ribeiro JP, Lunde C, Gluud C. WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents. Lancet Psychiatry 2024; 11:93. [PMID: 38245023 DOI: 10.1016/s2215-0366(23)00395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Ole Jakob Storebø
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Johanne Pereira Ribeiro
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Christian Gluud
- Department of Regional Health Research, The Faculty of Health Science, University of Southern Denmark, Odense, Denmark; The Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Farhat LC, Flores JM, Avila-Quintero VJ, Polanczyk GV, Cipriani A, Furukawa TA, Bloch MH, Cortese S. Treatment Outcomes With Licensed and Unlicensed Stimulant Doses for Adults With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:157-166. [PMID: 37878348 PMCID: PMC10600727 DOI: 10.1001/jamapsychiatry.2023.3985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/18/2023] [Indexed: 10/26/2023]
Abstract
Importance Stimulants (methylphenidate and amphetamines) are often prescribed at unlicensed doses for adults with attention-deficit/hyperactivity disorder (ADHD). Whether dose escalation beyond US Food and Drug Administration recommendations is associated with positive risk benefits is unclear. Objective To investigate the impact, based on averages, of stimulant doses on treatment outcomes in adults with ADHD and to determine, based on averages, whether unlicensed doses are associated with positive risk benefits compared with licensed doses. Data Sources Twelve databases, including published (PubMed, Cochrane Library, Embase, Web of Sciences) and unpublished (ClinicalTrials.gov) literature, up to February 22, 2023, without language restrictions. Study Selection Two researchers independently screened records to identify double-blinded randomized clinical trials of stimulants against placebo in adults (18 years and older) with ADHD. Data Extraction and Synthesis Aggregate data were extracted and synthesized in random-effects dose-response meta-analyses and network meta-analyses. Main Outcome Measures Change in ADHD symptoms and discontinuations due to adverse events. Results A total of 47 randomized clinical trials (7714 participants; mean age, 35 (SD, 11) years; 4204 male [56%]) were included. For methylphenidate, dose-response curves indicated additional reductions of symptoms with increments in doses, but the gains were progressively smaller and accompanied by continued additional risk of adverse events dropouts. Network meta-analyses showed that unlicensed doses were associated with greater reductions of symptoms compared with licensed doses (standardized mean difference [SMD], -0.23; 95% CI, -0.44 to -0.02; very low certainty of evidence), but the additional gain was small and accompanied by increased risk of adverse event dropouts (odds ratio, 2.02; 95% CI, 1.19-3.43; moderate certainty of evidence). For amphetamines, the dose-response curve approached a plateau and increments in doses did not indicate additional reductions of symptoms, but there were continued increments in the risk of adverse event dropouts. Network meta-analysis did not identify differences between unlicensed and licensed doses for reductions of symptoms (SMD, -0.08; 95% CI, -0.24 to 0.08; very low certainty of evidence). Conclusions and Relevance Based on group averages, unlicensed doses of stimulants may not have positive risk benefits compared with licensed doses for adults with ADHD. In general, practitioners should consider unlicensed doses cautiously. Practitioners may trial unlicensed doses if needed and tolerated but should be aware that there may not be large gains in the response to the medication with those further increments in dose. However, the findings are averages and will not generalize to every patient.
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Affiliation(s)
- Luis C. Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - José M. Flores
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, California
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | | | - Guilherme V. Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - Michael H. Bloch
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Sharafi H, Bakouni H, McAnulty C, Drouin S, Coronado-Montoya S, Bahremand A, Bach P, Ezard N, Le Foll B, Schütz CG, Siefried KJ, Tardelli VS, Ziegler D, Jutras-Aswad D. Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials. Addiction 2024; 119:211-224. [PMID: 37880829 DOI: 10.1111/add.16347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS There is currently no standard of care for pharmacological treatment of amphetamine-type stimulant (ATS) use disorder (ATSUD). This systematic review with meta-analysis (PROSPERO CRD42022354492) aimed to pool results from randomized placebo-controlled trials (RCTs) to evaluate efficacy and safety of prescription psychostimulants (PPs) for ATSUD. METHODS Major indexing sources and trial registries were searched to include records published before 29 August 2022. Eligible studies were RCTs evaluating efficacy and safety of PPs for ATSUD. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Risk ratio (RR) and risk difference were calculated for random-effect meta-analysis of dichotomous variables. Mean difference and standardized mean difference (SMD) were calculated for random-effect meta-analysis of continuous variables. RESULTS Ten RCTs (n = 561 participants) were included in the meta-analysis. Trials studied methylphenidate (n = 7), with daily doses of 54-180 mg, and dextroamphetamine (n = 3), with daily doses of 60-110 mg, for 2-24 weeks. PPs significantly decreased end-point craving [SMD -0.29; 95% confidence interval (CI) = -0.55, -0.03], while such a decrease did not reach statistical significance for ATS use, as evaluated by urine analysis (UA) (RR = 0.93; 95% CI = 0.85-1.01). No effect was observed for self-reported ATS use, retention in treatment, dropout following adverse events, early-stage craving, withdrawal and depressive symptoms. In a sensitivity analysis, treatment was associated with a significant reduction in UA positive for ATS (RR = 0.89; 95% CI = 0.79-0.99) after removing studies with a high risk of bias. In subgroup analyses, methylphenidate and high doses of PPs were negatively associated with ATS use by UA, while higher doses of PPs and treatment duration (≥ 20 weeks) were positively associated with longer retention. CONCLUSIONS Among individuals with amphetamine-type stimulant use disorder, treatment with prescription psychostimulants may decrease ATS use and craving. While effect size is limited, it may increase with a higher dosage of medications.
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Affiliation(s)
- Heidar Sharafi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sarah Drouin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Stephanie Coronado-Montoya
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Arash Bahremand
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Paxton Bach
- Department of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, St Paul's Hospital, Vancouver, Canada
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Vitor S Tardelli
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela Ziegler
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
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Houmann TB, Kaalund-Brok K, Clemmensen L, Petersen MA, Plessen KJ, Bilenberg N, Verhulst F, Jeppesen P. Early treatment response as predictor of long-term outcome in a clinical cohort of children with ADHD. Eur Child Adolesc Psychiatry 2024; 33:357-367. [PMID: 36795232 PMCID: PMC10869385 DOI: 10.1007/s00787-023-02158-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
This study investigates early onset of treatment response as predictor of symptomatic and functional outcome 3 years after initiation of methylphenidate (MPH) administration in a naturalistic, clinical cohort of children and adolescents with ADHD. Children were followed across an initial 12-week MPH treatment trial and after 3 years, with ratings of symptoms and impairment. Associations between a clinically significant MPH treatment response in week 3 (defined as ≥ 20% reduction in clinician-rated symptoms) and in week 12 (defined as ≥ 40% reduction), and 3-year outcome were tested in multivariate linear regression models, adjusting for sex, age, comorbidity, IQ, maternal education, parental psychiatric disorder, and baseline symptoms and function. We did not have information on treatment adherence or the nature of treatments beyond 12 weeks. 148 children, mean age 12.4 years (range 10-16 years), 77% males, participated in the follow-up. We found a significant decrease in symptom score from baseline [M = 41.9 (SD = 13.2)] to 3-year follow-up [M = 27.5 (SD = 12.7), p < 0.001, and in impairment score from baseline (M = 41.6 (SD = 19.4)] to 3-year follow-up [M = 35.6 (SD = 20.2), p = 0.005]. Treatment responses in week 3 and week 12 were significant predictors of the long-term outcome of symptoms, but not of impairment at 3-year follow-up, when adjusting for other well-known predictors. Early treatment response predicts long-term outcome over and above other well-known predictors. Clinicians should follow-up patients carefully, during the first months of treatment, and detect non-responders, since there might be a window of opportunity to alter the outcome, by changing the treatment strategy.Clinical trial registration: ClinicalTrials.gov, registration number NCT04366609, April 28, 2020 retrospectively registered.
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Affiliation(s)
- Tine Bodil Houmann
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristine Kaalund-Brok
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Clemmensen
- Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, 2900, Hellerup, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Smedegade 16, 4000, Roskilde, Denmark
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Salloum-Asfar S, Zawia N, Abdulla SA. Retracing our steps: A review on autism research in children, its limitation and impending pharmacological interventions. Pharmacol Ther 2024; 253:108564. [PMID: 38008401 DOI: 10.1016/j.pharmthera.2023.108564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by three core impairments: impaired communication, impaired reciprocal social interaction, and restricted, repetitive, and stereotypical behavior patterns. Spectrum refers to the heterogeneity of presentation, severity of symptoms, and medical comorbidities associated with ASD. Among the most common underlying medical conditions are attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, epilepsy, digestive disorders, metabolic disorders, and immune disorders. At present, in the absence of an objective and accurate diagnosis of ASD, such as a blood test, pharmacological management remains a challenge. There are no approved medications to treat the core symptoms of the disorder and behavioral interventions are typically used as first line treatment. Additionally, psychotropic drugs with different mechanisms of action have been approved to reduce associated symptoms and comorbidities, including aripiprazole, risperidone, and haloperidol for irritability and aggression, methylphenidate, atomoxetine, clonidine, and guanfacine for ADHD, and melatonin for sleep disturbances. The purpose of this review is to emphasize that it is imperative to develop objective, personalized diagnostic kits in order to tailor and individualize treatment strategies, as well as to describe the current pharmacological management options available in clinical practice and new prospects that may be helpful in managing ASD's core symptoms.
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Affiliation(s)
- Salam Salloum-Asfar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
| | - Nasser Zawia
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Sara A Abdulla
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
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Konofal E, Lecendreux M, Bizot JC, Lormier AT, Figadère B. NLS-3 (Levophacetoperane or ( R,R) Phacetoperane): A Reverse Ester of Methylphenidate: A Literature Review. Curr Med Chem 2024; 31:1069-1081. [PMID: 36683369 DOI: 10.2174/0929867330666230120161837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND NLS-3 or (R, R) enantiomer of phacetoperane (levophacetoperane) is the reverse ester of methylphenidate, a well-documented psychostimulant marketed for the treatment of attention-deficit/hyperactivity disorder (ADHD) since the end of 1950s. Launched in Canada and Europe by Specia Rhône-Poulenc and Rhodia, marketed as Lidepran® (8228 R.P.), for the treatment of obesity and depression, phacetoperane became an increasingly popular psychiatric medication from 1959 to 1967. Previous data supported that the stimulant effect of phacetoperane differed from those of other medications acting on the catecholamine system (e.g., methylphenidate, amphetamine), with an advantage of benefit/risk balance. METHOD The goal of this study is to characterize the binding profile of NLS-3 using in vitro and in vivo assays and hypothesize potential therapeutic uses considering all available data. RESULTS A complete binding profile assay confirmed the potential benefit of phacetoperane with a higher benefit/risk compared to other stimulants. NLS-3 synthesis resulted from phenylketone, which is also used for the synthesis of methylphenidate. It differs from that used by Rhône-Poulenc SA laboratories, allowing the possibility of individualizing several enantiomers not synthesized previously. The present review also confirmed extensive clinical use of the compound in almost one thousand children and adolescents in large dose ranges with fewer side effects versus comparative treatments. Furthermore, levophacetoperane was found to be generally well-tolerated by the subjects. CONCLUSION NLS-3 could be a safer and more potent alternative to stimulants for patients with ADHD.
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Affiliation(s)
- Eric Konofal
- Centre Pédiatrique des Pathologies du Sommeil, APHP Hôpital Robert Debré, 48 Boulevard Sérurier, Paris, 75019, France
| | - Michel Lecendreux
- Centre Pédiatrique des Pathologies du Sommeil, APHP Hôpital Robert Debré, 48 Boulevard Sérurier, Paris, 75019, France
| | | | - Anh-Tuan Lormier
- Department of ChemistryCAYLAB, 2 Chemin de la Romaniquette, Le Cascaveau, Istres, 13800, France
| | - Bruno Figadère
- BioCIS, Faculté de Pharmacie, Université Paris-Saclay, CNRS, 17 rue des Sciences, Orsay, 91400, France
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Sun F, Fang Y, Chan CKM, Poon ETC, Chung LMY, Or PPL, Chen Y, Cooper SB. Structured physical exercise interventions and children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis. Child Care Health Dev 2024; 50:e13150. [PMID: 37433667 DOI: 10.1111/cch.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The efficacy of structured physical exercise (SPE) has been examined in empirical studies to treat attention deficit hyperactivity disorder (ADHD). This review aimed (i) to systematically review and quantify the effects of SPE on ADHD symptomology and executive function (primary outcomes) and on physical health, physical fitness and mental health issues (secondary outcomes) in children/adolescents with ADHD; (ii) to evaluate the study quality and explore moderation of the effects of SPE; and (iii) to summarize the design of SPE interventions. METHODS An extensive literature search in the databases of PubMed, Web of Science and EBSCOhost was conducted to identify eligible intervention studies for meta-analysis. A descriptive account of the features of the studies is provided, including assessment of risk/quality (ROB-2/ROBINS-I). Standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated with random effects models to compare post-intervention effects. RESULTS A total of 18 studies were included in the review. The majority of the studies examined the effects of SPE lasting for 3-12 weeks. Assessment of bias/quality indicated half of the included studies as high quality. The meta-analysis (pooled n = 627) revealed that SPE had a positive effect on primary and secondary outcomes, that is, inattention (SMD = -1.79), executive function (SMD = 2.19), physical fitness (SMD = 1.39) and mental health issues (SMD = -0.89). Subgroup analysis showed that long-term practice of SPE, featured/tailored SPE, non-Chinese participants, taking methylphenidate and study with low quality had larger effects. CONCLUSIONS There is emerging evidence that SPE is a promising option to enhance symptom management and physical/mental health in children/adolescents with ADHD.
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Affiliation(s)
- Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Carmen Ka Man Chan
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Eric Tsz Chun Poon
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Louisa Ming Yan Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Peggy Pui Lai Or
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Simon B Cooper
- Department of Sport Sciences, Sport, Health and Performance Enhancement (SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
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Salvati A, Sesso G, Lenzi F, Masi G, Berloffa S. Efficacy of Methylphenidate for Internet Gaming Disorder and Internet Addiction in Patients with Attention-Deficit/Hyperactivity Disorder. Curr Pharm Des 2024; 30:477-483. [PMID: 38299404 DOI: 10.2174/0113816128281014240124074845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Internet Gaming Disorder (IGD) and Internet Addiction (IA) are related clinical conditions often comorbid with Attention-Deficit/Hyperactivity Disorder (ADHD). OBJECTIVE We evaluated the efficacy of MPH for IGD/IA symptoms in ADHD patients. METHODS We enrolled 38 drug-naive patients diagnosed with ADHD (Attention-Deficit/Hyperactivity Disorder) and IGD/IA. At baseline, all patients underwent a clinical assessment for IGD/IA symptoms and then received the most appropriate therapy according to their clinical profile. Twenty-one patients received MPH (methylphenidate) treatment, and 17 patients did not. Patients were re-evaluated after three months of treatment. RESULTS Findings revealed significant reductions in IGD/IA symptoms over time, while no significant effect of MPH on symptom reduction was found. Clinical predictors of symptom reduction were identified, including IQ (Intelligence Quotient) and comorbid anxiety. CONCLUSION This longitudinal prospective study contributes to the understanding of IGD/IA treatment in ADHD patients and highlights the importance of considering individual clinical characteristics when predicting treatment response. However, MPH may not directly impact IGD/IA symptom reduction.
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Affiliation(s)
- Andrea Salvati
- Child and Adolescent Psychiatry, Neuroscience Department, IRCCS Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Gianluca Sesso
- IRCCS Stella Maris Foundation Hospital, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno, 331A, Calambrone, Pisa 56025, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Francesca Lenzi
- IRCCS Stella Maris Foundation Hospital, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno, 331A, Calambrone, Pisa 56025, Italy
| | - Gabriele Masi
- IRCCS Stella Maris Foundation Hospital, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno, 331A, Calambrone, Pisa 56025, Italy
| | - Stefano Berloffa
- IRCCS Stella Maris Foundation Hospital, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno, 331A, Calambrone, Pisa 56025, Italy
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Verity SJ, Halliday G, Hill RM, Ryles J, Bailey S. Methylphenidate improves cognitive function and health-related quality of life in survivors of childhood brain tumours. Neuropsychol Rehabil 2024; 34:133-153. [PMID: 36580420 DOI: 10.1080/09602011.2022.2157446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The growing population of survivors of childhood brain tumors present the challenge of long-term quality of survival. The domains most affected by tumor and treatment are those implicated in development of typical intellectual functions: attention, working memory, and processing speed, with consequent effects upon function and quality of life. In this paper we present service evaluation data on the 12-month effect upon processing speed, visual and auditory attentional domains in 29 patients receiving methylphenidate aged 5-16 years (Mean=10.6). METHODS Patients received immediate-release methylphenidate and were converted to modified-release as appropriate. Mean optimal dose of immediate-release methylphenidate was 0.34 mg/kg per dose (range 0.2-0.67). RESULTS Patients showed a significant positive impact of methylphenidate on attention in all tests of selective visual attention from the Test of Everyday Attention for Children 2. A significant improvement was also shown on response time. Significant change was not found on psychometric measures of sustained auditory or visual attention, or selective auditory attention. Ratings of Health-Related Quality of Life showed a positive benefit of methylphenidate at 12 months. Side effects were minimal and not statistically significant. CONCLUSIONS Survivors of childhood brain tumor with attentional and processing speed deficit show clinical benefit from methylphenidate.
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Affiliation(s)
- Sarah J Verity
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Gail Halliday
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rebecca M Hill
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Jade Ryles
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon Bailey
- Department of Paediatric Neuro Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Vertessen K, Luman M, Oosterlaan J. ADHD medication adherence: the importance of adequate prescribing. Lancet Psychiatry 2024; 11:2-3. [PMID: 38035875 DOI: 10.1016/s2215-0366(23)00393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Karen Vertessen
- University Psychiatric Center, Catholic University of Leuven, 3000 Leuven, Belgium; Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Marjolein Luman
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Levvel Specialists in Youth and Family Care, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pediatrics, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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Rothe J, Kattlun FA, Kaufmann J, Uhlmann A, Wanderer S, Bluschke A, Beste C, Roessner V. Effects of methylphenidate and physiotherapeutic treatment on graphomotor movements in children with ADHD. Eur Child Adolesc Psychiatry 2024; 33:127-137. [PMID: 36688969 PMCID: PMC10806214 DOI: 10.1007/s00787-023-02144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Abstract
In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements.
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Affiliation(s)
- Josefine Rothe
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Fabian A Kattlun
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jeanne Kaufmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anne Uhlmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sina Wanderer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Annet Bluschke
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christian Beste
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Dul M, Walczewski K. Patient with Asperger's Syndrome, with episodes of fantasizing and rocking of body, treated with aripiprazole - a case report. Psychiatr Pol 2023; 57:1135-1142. [PMID: 38564518 DOI: 10.12740/pp/152316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In this article, we present the case of an adult patient, whose main problem is episodes of fantasizing and rocking lasting up to 12 hours a day and completely preventing school development. The nature of the disorder in the patient is related to the sinking into fantasies, and not typical obsessions as in OCD. The patient was previously treated with drugs from the SSRI group, neuroleptics (without aripiprazole) and methylphenidate. Only methylphenidate showed some improvement; however, it made the patient feel ‟stiff in thinking". The patient was hospitalized because of a suicide attempt, which, as it later turned out, was self-harm with no intention of killing himself. During hospitalization, a differential diagnosis was performed and the diagnosis of Asperger's syndrome was made, which was accompanied by immersion in the world of one's fantasies and stereotypical behavior. The patient was administered aripiprazole at a dose of 15 mg/d and after three weeks, a significant improvement in health was achieved, including a reduction in the duration of episodes from several hours to several dozen seconds. The drug is well tolerated by the patient. The patient was discharged from the hospital and continues his school education. In the article, we present single case reports in which similar spectacular results were achieved in similar cases. We also describe a possible physiological explanation for this response to this drug.
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Affiliation(s)
- Maciej Dul
- Szpital Kliniczny im. dr Józefa Babińskiego w Krakowie
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Panušková K, Voděrová L, Vaculín Š. Methylphenidate attenuates signs of evoked neuropathic pain in animal model. Physiol Res 2023; 72:S551-S558. [PMID: 38165759 PMCID: PMC10861255 DOI: 10.33549/physiolres.935215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/07/2023] [Indexed: 02/01/2024] Open
Abstract
Methylphenidate is a psychostimulant that increases dopamine and noradrenaline levels. Recent studies have shown that methylphenidate potentiates the effect of morphine and together suppress acute and chronic pain. In clinical practice, methylphenidate has been used as a treatment for ADHD and changes of pain threshold have been noted in these patients. The aim of this study was to determine the effect of methylphenidate in an animal model of peripheral neuropathic pain. Neuropathic pain was modeled by the chronic constriction of the sciatic nerve (CCI) in Wistar rats. We evaluated the effect of methylphenidate (1 mg/kg, s.c.) on evoked pain (reflex tests - plantar test, vonFrey test and operant test - thermal place preference) and on spontaneous pain (conditioned place preference). CCI induced thermal, mechanical and cold hyperalgesia/allodynia. Methyphenidate suppressed mechanical and cold hyperalgesia/allodynia, while had no effect on thermal one. Therefore, methylphenidate seems to be a new potential pharmacotherapy for the treatment of neuropathic pain.
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Affiliation(s)
- K Panušková
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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López-Pinar C, Rosen H, Selaskowski B, Staerk C, Jans T, Retz W, Retz-Junginger P, Roesler M, Sobanski E, Huss M, Matthies S, Tebartz van Elst L, Berger M, Jacob C, Kis B, Colla M, Alm B, Abdel-Hamid M, Martínez-Sanchís S, Carbonell-Vayá E, Lux S, Philipsen A. Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial. Psychother Psychosom 2023; 93:46-64. [PMID: 38142690 DOI: 10.1159/000532043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/06/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.
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Affiliation(s)
- Carlos López-Pinar
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
- Department of Psychology, European University of Valencia, Valencia, Spain
| | - Helena Rosen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Esther Sobanski
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Michael Huss
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Jacob
- Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Bernhard Kis
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Barbara Alm
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Sonia Martínez-Sanchís
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
| | - Enrique Carbonell-Vayá
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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44
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Vertessen K. [A scientifically grounded pharmacological treatment of ADHD]. Ned Tijdschr Geneeskd 2023; 168:D5660. [PMID: 38175554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Methylphenidate is the first-choice pharmaceutical treatment for children and adolescents with attention deficit/hyperactivity disorder (ADHD). Concerns have been raised regarding unnecessary or suboptimal prescription of this medicine. Based on the results of three recently conducted Dutch studies - the Medication Optimization for ADHD study (MOVA), the Methylphenidate Discontinuation Study in Children (MASK), and the Discontinuation Trials Study - we advocate for an evidence-based approach to the treatment of children and adolescents with methylphenidate. The studies highlight that careful assessment of the effects of methylphenidate using placebo-controlled titration and systematically evaluating long-term treatment through placebo-controlled discontinuation trials can be beneficial in reducing unnecessary prescriptions of methylphenidate.
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45
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Michalak A, Chrzanowski J, Kuśmierczyk-Kozieł H, Klejman E, Błaziak K, Mianowska B, Szadkowska A, Chobot AP, Jarosz-Chobot P, Myśliwiec M, Makowska I, Kalenik A, Zamarlik M, Wolańczyk T, Fendler W, Butwicka A. Lisdexamphetamine versus methylphenidate for paediatric patients with attention-deficit hyperactivity disorder and type 1 diabetes (LAMAinDiab): protocol for a multicentre, randomised cross-over clinical trial in an outpatient telemedicine-supported setting. BMJ Open 2023; 13:e078112. [PMID: 38086595 PMCID: PMC10728970 DOI: 10.1136/bmjopen-2023-078112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) affects 5%-10% of paediatric population and is reportedly more common in children with type 1 diabetes (T1D), exacerbating its clinical course. Proper treatment of ADHD in such patients may thus provide neurological and metabolic benefits. To test this, we designed a non-commercial second phase clinical trial comparing the impact of different pharmacological interventions for ADHD in children with T1D. METHODS AND ANALYSIS This is a multicentre, randomised, open-label, cross-over clinical trial in children and adolescents with ADHD and T1D. The trial will be conducted in four reference paediatric diabetes centres in Poland. Over 36 months, eligible patients with both T1D and ADHD (aged 8-16.5 years, T1D duration >1 year) will be offered participation. Patients' guardians will undergo online once-weekly training sessions behaviour management for 10 weeks. Afterward, children will be randomised to methylphenidate (long-release capsule, doses 18-36-54 mg) versus lisdexamphetamine (LDX, 30-50-70 mg). Pharmacotherapy will continue for 6 months before switching to alternative medication. Throughout the trial, the participants will be evaluated every 3 months by their diabetologist and online psychological assessments. The primary endpoint (ADHD symptom severity, Conners 3.0 questionnaire) will be assessed by a blinded investigator. Secondary endpoints will include HbA1c, continuous glucose monitoring indices and quality-of-life (PedsQL). ETHICS AND DISSEMINATION The trial is approved by Bioethical Committee at Medical University of Lodz and Polish regulatory agency (RNN/142/22/KE, UR/DBL/D/263/2022). The results will be communicated to the research and clinical community, and Polish agencies responsible for healthcare policy. Patient organisations focused on paediatric T1D will be notified by a consortium member. We hope to use the trial's results to promote collaboration between mental health professionals and diabetes teams, evaluate the economic feasibility of using LDX in patients with both diseases and the long run improve ADHD treatment in children with T1D. TRIAL REGISTRATION NUMBERS EU Clinical Trials Register (EU-CTR, 2022-001906-24) and NCT05957055.
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Affiliation(s)
- Arkadiusz Michalak
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
- Clinical Trials' Unit, Medical University of Lodz, Lodz, Poland
| | - Jędrzej Chrzanowski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Hanna Kuśmierczyk-Kozieł
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Ewa Klejman
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | | | - Beata Mianowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Agata P Chobot
- Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | | | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Iwona Makowska
- Child and Adolescent Psychiatric Department, Medical University of Lodz, Lodz, Poland
- Child and Adolescent Psychiatry Unit, Medical University of Lodz, Lodz, Poland
| | - Anna Kalenik
- Department of Child Psychiatry, Medical University of Warsaw, Warszawa, Poland
| | - Monika Zamarlik
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University, Krakow, Poland
- Polish Federation for Support for Children and Adolescents with Diabetes, Warszawa, Poland
| | - Tomasz Wolańczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warszawa, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
- Clinical Trials' Unit, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Butwicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Division of Mental Health Services, R&D Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Jacobs D. Experiences of children and adolescents with attention-deficit/hyperactivity disorder taking methylphenidate. Dev Med Child Neurol 2023; 65:1587-1595. [PMID: 37154566 DOI: 10.1111/dmcn.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
To improve clinical counselling for adolescents about the use of stimulant medication, it is crucial to understand the experiences of young people diagnosed with attention-deficit/hyperactivity disorder (ADHD) who are taking such treatment. For this narrative review, five databases were searched for studies investigating the personal experiences of control issues in adolescents diagnosed with ADHD taking methylphenidate. We extracted the data using NVivo 12 and interpretatively synthesized them according to the procedures of thematic analysis. Interviewed youngsters spontaneously put forward self-experiences about self-esteem and sense of control, although these issues were rarely explicitly addressed in the research question. The overarching theme in these studies was 'improving the self'. Two subthemes emerged: (1) medication sometimes delivered on its promise to improve the self, but regularly it did not; and (2) youngsters felt pressurized to conform to behavioural norms and comply with the medication use that adults had decided on. To genuinely involve youngsters diagnosed with ADHD for whom stimulant medication is prescribed in the shared decision-making process, we recommend to specifically involve them in a dialogue on the medication's potential effects on their self-experiences. This will allow them to feel at least partly in control of their body and life, and less pressurized to conform to others' norms.
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Affiliation(s)
- Delphine Jacobs
- Psychiatrie Infanto-Juvénile, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
- UCLouvain, Institut de Recherche Santé et Société, Bruxelles, Belgium
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Miyazaki K, Uchiyama M. An adolescent boy with kleptomania and attention-deficit hyperactivity disorder treated with methylphenidate and guanfacine: A case report. Neuropsychopharmacol Rep 2023; 43:650-653. [PMID: 37921065 PMCID: PMC10739163 DOI: 10.1002/npr2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
We present the case of a patient, a boy of 16 years of age at initial presentation, with kleptomania, an impulse disorder characterized by an impulse to steal unneeded items, and attention-deficit hyperactivity disorder (ADHD). The patient's parents reported that he would frequently impulsively steal items and money that he did not need. Cognitive and physical assessments revealed no abnormalities, and the patient had no history of substance abuse. The patient was diagnosed with kleptomania and ADHD. The patient was started on Osmotic Release Oral System Methylphenidate (OROS-MPH), a medication commonly used to treat ADHD, and experienced improvement in ADHD symptoms and stealing behavior. At 19 years of age, it was discovered that the patient's behavioral symptoms were uncontrolled during times of the day when the blood concentration of MPH was likely to have waned. After starting an additional dose of guanfacine at night, his symptoms during these times of day improved. While existing research is not definitive, there may be a connection between ADHD and kleptomania. Further, there are some reports that treatment of ADHD with MPH also reduced stealing behavior, aligning with our present findings. We discuss the potential mechanisms behind these improvements and further present the first evidence of the efficacy of guanfacine in the treatment of kleptomania.
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Affiliation(s)
- Kensuke Miyazaki
- Department of NeuropsychiatryHirosaki‐Aiseikai HospitalHirosaki‐shi, AomoriJapan
| | - Michiko Uchiyama
- Department of Hospital PharmacyHirosaki‐Aiseikai HospitalHirosaki‐shi, AomoriJapan
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48
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López-Pinar C, Selaskowski B, Braun N, Fornés-Ferrer V, Euscher R, Matthies S, Jans T, van Elst LT, Jacob C, Huss M, Sobanski E, Retz W, Roesler M, Retz-Junginger P, Alm B, Kis B, Abdel-Hamid M, Colla M, Berger M, Lux S, Philipsen A. Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial. Psychiatry Res 2023; 330:115610. [PMID: 37992514 DOI: 10.1016/j.psychres.2023.115610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).
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Affiliation(s)
- Carlos López-Pinar
- Department of Psychobiology and Basic Psychology, University of Valencia, Valencia, Spain; Department of Psychology, European University of Valencia, Valencia, Spain.
| | | | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Rebekka Euscher
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Thomas Jans
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Christian Jacob
- Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany; Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Nijenhuis M, Soree B, Jama WOM, de Boer-Veger NJ, Buunk AM, Guchelaar HJ, Houwink EJF, Rongen GA, van Schaik RHN, Swen JJ, Touw D, van der Weide J, van Westrhenen R, Deneer VHM, Risselada A. Dutch pharmacogenetics working group (DPWG) guideline for the gene-drug interaction of CYP2D6 and COMT with atomoxetine and methylphenidate. Eur J Hum Genet 2023; 31:1364-1370. [PMID: 36509836 PMCID: PMC10689464 DOI: 10.1038/s41431-022-01262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Pharmacogenetics (PGx) studies the effect of heritable genetic variation on drug response. Clinical adoption of PGx has remained limited, despite progress in the field. To promote implementation, the Dutch Pharmacogenetics Working Group (DPWG) develops evidence-based guidelines on how to optimize pharmacotherapy based on PGx test results. This guideline describes optimization of atomoxetine therapy based on genetic variation in the CYP2D6 gene. The CYP2D6 enzyme is involved in conversion of atomoxetine into the metabolite 4-hydroxyatomoxetine. With decreasing CYP2D6 enzyme activity, the exposure to atomoxetine and the risk of atomoxetine induced side effects increases. So, for patients with genetically absent CYP2D6 enzyme activity (CYP2D6 poor metabolisers), the DPWG recommends to start with the normal initial dose, bearing in mind that increasing this dose probably will not be required. In case of side effects and/or a late response, the DPWG recommends to reduce the dose and check for sustained effectiveness for both poor metabolisers and patients with genetically reduced CYP2D6 enzyme activity (CYP2D6 intermediate metabolisers). Extra vigilance for ineffectiveness is required in patients with genetically increased CYP2D6 enzyme activity (CYP2D6 ultra-rapid metabolisers). No interaction was found between the CYP2D6 and COMT genes and methylphenidate. In addition, no interaction was found between CYP2D6 and clonidine, confirming the suitability of clonidine as a possible alternative for atomoxetine in variant CYP2D6 metabolisers. The DPWG classifies CYP2D6 genotyping as being "potentially beneficial" for atomoxetine. CYP2D6 testing prior to treatment can be considered on an individual patient basis.
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Affiliation(s)
- Marga Nijenhuis
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.
| | - Bianca Soree
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | - Wafa O M Jama
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands
- Department of Family Medicine, Mayo Clinic, Rochester, MIN, USA
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daan Touw
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jan van der Weide
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute/PsyQ, Amsterdam, The Netherlands
- Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vera H M Deneer
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Arne Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
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50
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Brynte C, Konstenius M, Khemiri L, Bäcker A, Guterstam J, Levin FR, Jayaram-Lindström N, Franck J. The Effect of Methylphenidate on Cognition in Patients with Comorbid Attention Deficit/Hyperactivity Disorder and Amphetamine Use Disorder: An Exploratory Single-Blinded within-Subject Study. Eur Addict Res 2023; 30:1-13. [PMID: 38029734 DOI: 10.1159/000535016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) with co-occurring substance use disorder (SUD) is associated with poor treatment outcomes. Two randomized controlled trials, utilizing robust doses of stimulants, demonstrated a significant effect on treatment outcomes in patients with ADHD/SUD. This study aimed to investigate differences in executive functioning and explore the dose-dependent effect of OROS-methylphenidate (MPH) in patients with comorbid ADHD and amphetamine use disorder (ADHD+AMPH) and patients with ADHD only. METHODS Three groups (ADHD+AMPH, ADHD only, and healthy controls) were assessed repeatedly with a neuropsychological test battery. An exploratory within-subject single-blinded design was employed where the ADHD only group received a maximum dose of 72 mg OROS-MPH, the ADHD+AMPH group a maximum dose of 180 mg, whereas the healthy subjects did not receive any study medication. Both ADHD groups received the same dose titration up to 72 mg OROS-MPH. RESULTS The ADHD+AMPH group demonstrated a significantly poorer motor inhibition and spatial working memory and reported more severe ADHD symptoms compared to the ADHD only group. 180 mg OROS-MPH was associated with a significant improvement in executive functioning in the dual diagnosis group. However, the exploratory study design and recruitment issues do not allow for any conclusion to be drawn regarding the effect of 180 mg OROS-MPH. CONCLUSION Patients with ADHD+AMPH present with more severe neurocognitive deficits compared to ADHD only. The effect of 180 mg OROS-MPH on cognition in patients with ADHD+AMPH was inconclusive. Future studies should consider recruitment issues and high drop-out rates in this study population.
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Affiliation(s)
- Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Maija Konstenius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Amanda Bäcker
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Joar Guterstam
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York, USA
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johan Franck
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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