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Caci H. Prevalence rate of ADHD in France: Review of the literature and results from ChiP-ARD study. L'ENCEPHALE 2023; 49:624-631. [PMID: 37612161 DOI: 10.1016/j.encep.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder whose first clinical description was published more than two centuries ago. Prevalence rates have been evaluated in many countries and meta-analyses conducted, but the data collected in France are scarce. METHODS A review of the literature was conducted by retrieving the references from four electronic databases leading to the selection of four studies in children and four in adults. Meta-analyses of prevalence rates were performed on this published data as well as unpublished results from the ChiP-ARD study (Children and Parents with ADHD and Related Disorders), separately for children and adults. RESULTS While the quality of most studies is questionable, the prevalence rates are close to those reported in international meta-analytic studies for children (3.68%), but are higher in adults (5.5%). CONCLUSIONS Well-conducted studies in both general and special populations are needed (e.g., in patients with depression, anxiety, bipolar disorder, developmental disorders including autism spectrum disorder, behavioural or substance abuse, and incarcerated). Nevertheless, healthcare stakeholders can conservatively consider that .8 million children and 1.4 million adults in the metropolitan French general population are likely to have ADHD and suffer from its multiple consequences.
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Affiliation(s)
- Hervé Caci
- Hôpitaux Pédiatrique de Nice, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France; Centre de recherche en Epidémiologie et Santé des Populations. Psychiatrie du Développement et Trajectoires (CESP), U1018 INSERM, Université Paris Saclay et Université de Versailles, Saint-Quentin-en-Yvelines, France.
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Herzig M, Bertsche A, Kiess W, Bertsche T, Neininger MP. Medicine and supplement use in infants, children, and adolescents depends on sex, age, and socioeconomic status: results of a German longitudinal population-based cohort study (LIFE Child). Eur J Pediatr 2022; 181:2991-3003. [PMID: 35614281 PMCID: PMC9132604 DOI: 10.1007/s00431-022-04504-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Children and adolescents are exposed to medicines and supplements, but only a few studies have evaluated the actual intake in routine care. Thus, we performed a pharmacoepidemiological evaluation of a longitudinal population-based pediatric cohort study (LIFE Child) conducted at the University Hospital of Leipzig between 2014 and 2019. We analyzed all visits of the participants of the LIFE Child cohort between 1 January 2014 and 31 December 2019. Participants were asked to bring their medicines and supplements to their appointments at the study center. If they had not brought the preparations with them, attempts were made to obtain the relevant information during a telephone call after the visit to the study center. Furthermore, the participants and their parents were interviewed on medicine and supplement use and on sociodemographic and socioeconomic data during their visit to the study center. Associations of medicine and supplement use with age, sex, and socioeconomic status were analyzed using multivariate binary logistic regressions to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Furthermore, the number of the respective visit was included as possible confounder in the multivariate model. We included 3602 participants who visited the study center 11,906 times. The intake of 9759 medicines and supplements was recorded. Based on the evaluation of all study visits, 49% of the children and adolescents took at least one medicine or supplement. Self-medication accounted for 28% of the medicines and supplements. The prevalence of overall intake increased from 45% in 2014 to 53% in 2019 (aOR 2.63, 95% CI 2.23, 3.09). The prevalence was the highest (77%) in children aged 0- < 3 years, owing mainly to vitamin D. The prevalence of medicine use was higher in females (40%; aOR 1.18, 95% CI 1.10, 1.28) than in males (35%), owing mainly to the intake of ibuprofen and hormonal contraceptives in adolescent females. A high socioeconomic status was a predictor of lower medicine (aOR 0.80, 95% CI 0.68, 0.95) and higher supplement (aOR 1.47, 95% CI 1.09, 1.98) use. CONCLUSION Half of all children and adolescents took at least one medicine or supplement. The intake varied depending on age and sex. Furthermore, high socioeconomic status was associated with a decreased probability of medicine intake. WHAT IS KNOWN • Half of all children and adolescents in Germany are exposed to medicines and supplements. • Data on the actual intake are scarce as most studies focus on prescribed medicines. WHAT IS NEW • The prevalence of medicine/supplement use rose from 2014 (45%) to 2019 (53%). The prevalence was age-dependent: it was the highest in children aged < 3 years, and the lowest in children aged 6-< 9 years. Females took medicines more frequently than males. • High socioeconomic status was associated with lower medicine and higher supplement use. Self-medication accounted for 28% of all preparations.
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Affiliation(s)
- Markus Herzig
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Leipzig, Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
- Neuropediatrics, University Hospital for Children and Adolescents, Rostock, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig, Germany
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Leipzig, Germany
| | - Martina P. Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Leipzig, Germany
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Ponnou S, Thomé B. ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010-2019. Front Psychiatry 2022; 13:957242. [PMID: 36299551 PMCID: PMC9590284 DOI: 10.3389/fpsyt.2022.957242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
CONTEXT ADHD is the most common mental disorder in school-aged children. In France, methylphenidate is the only drug authorized for ADHD. Here, we describe the pattern of ADHD diagnosis and methylphenidate prescription to children and adolescents from 2010 to 2019. METHODS We conducted a retrospective cohort study of all beneficiaries of the French general health insurance scheme (87% of the population, 58 million people). We extracted information for all children and adolescents aged 0-17 years who received: (1) A diagnosis of ADHD (34,153 patients). (2) At least one methylphenidate prescription (144,509 patients). We analyzed the clinical, demographic, institutional, and social parameters associated with ADHD diagnosis and methylphenidate consumption in France. RESULTS The ADHD diagnosis among children and adolescents increased by 96% between 2010 and 2019. ADHD diagnosis affects more boys than girls. About 50.6% of children hospitalized with a diagnosis of ADHD in 2017 also had another psychiatric diagnosis. The rate of children hospitalized with an ADHD diagnosis and treated with MPH varied between 56.4 and 60.1%. The median duration of MPH treatment for a 6-year-old ADHD child initiated in 2011 is 7.1 years. In 2018, 62% of ADHD children were receiving at least one psychotropic medication. Between 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription reached between 0.61 and 0.75% in 2019. Boys are predominantly medicated. The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. Diagnoses associated with methylphenidate prescription did not always correspond to the marketing authorization. Among children receiving the first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. A quarter of initiations and half of renewals were made outside governmental recommendations. Educational and psychotherapeutic follow-up decreased from 4.1% in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class were more likely to be diagnosed (55%) and prescribed methylphenidate (54%). Children from disadvantaged families had an increased risk of ADHD diagnosis (41.4% in 2019) and methylphenidate medication (25.7% in 2019).
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Affiliation(s)
- Sébastien Ponnou
- CIRNEF (EA 7454), University of Rouen Normandy, Mont-Saint-Aignan, France
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Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4:e215335. [PMID: 33843998 PMCID: PMC8042533 DOI: 10.1001/jamanetworkopen.2021.5335] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCE This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.
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Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Soeiro T, Frauger É, Pradel V, Micallef J. Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France. Fundam Clin Pharmacol 2020; 35:751-761. [PMID: 33025606 DOI: 10.1111/fcp.12612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Doctor shopping enables subjects to receive more than the prescribed dose out of any medical management, which suggests a search for high doses and makes doctor shopping a relevant proxy for misuse and potential abuse. Therefore, this study aimed to identify and characterize profiles of subjects with doctor-shopping behavior for methylphenidate in the entire French population. This study is a cross-sectional study of doctor-shopping behavior for methylphenidate in France, in 2016, using the Système national des données de santé, and accounting for overlapping prescriptions. Subjects who obtained >840 mg by doctor shopping were defined as subjects with heavy doctor-shopping behavior, and subjects who obtained >0 mg and ≤840 mg by doctor shopping were defined as subjects with light doctor-shopping behavior. A total of 63 739 subjects were included, and received 339.6 kg of methylphenidate. Among them, 216 (0.3%) subjects had heavy doctor-shopping behavior, and 313 (0.5%) subjects had light doctor-shopping behavior. Compared with subjects with light doctor-shopping behavior, subjects with heavy doctor-shopping behavior were older (64% of 30- to 49-year-old subjects vs. 77% of ≤17-year-old subjects; P < 0.001), received more concomitant dispensings of antipsychotics (37% vs. 26%; P = 0.008) and opioid maintenance treatments (50% vs. 6%; P < 0.001), and had more prescribers (4 [IQR = 2-5] vs. 2 [IQR = 2-3]; P < 0.001). In the French context where prescription and dispensing of methylphenidate are highly regulated and methylphenidate is much less used than in other countries, these results are a warning signal to avoid trivializing methylphenidate in adults.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Élisabeth Frauger
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
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Revet A, Montastruc F, Raynaud JP, Baricault B, Montastruc JL, Lapeyre-Mestre M. Trends and Patterns of Antidepressant Use in French Children and Adolescents From 2009 to 2016: A Population-Based Study in the French Health Insurance Database. J Clin Psychopharmacol 2018; 38:327-335. [PMID: 29851707 DOI: 10.1097/jcp.0000000000000891] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND Over the last decade, the use of antidepressants (ATDs) in children and adolescents has markedly increased in several occidental countries, but recent data in French children are missing. This study aimed to assess trends of ATD use in French children (6-11 years) and adolescents (12-17 years) and to characterize changes in ATD prescribing patterns from 2009 to 2016. METHODS Using data from the French Health Insurance Database, annual prevalence and incidence of ATD use and changes in ATD prescribing patterns were analyzed. RESULTS Overall ATD prevalence of use rose slightly from 0.51% in 2009 to 0.53% in 2016 (+3.9%), with a decrease in children (0.18%-0.11%; -38.9%) and an increase in adolescents (0.86%-0.98%; +14.0%) and an overall female preponderance (56.7% in 2009; 58.7% in 2016). Serotonin reuptake inhibitor prevalence of use increased from 0.24% to 0.34%, whereas tricyclic ATD use decreased (from 0.20% to 0.16%). Similar trends were obtained with overall incidence of use, from 0.39% in 2009 to 0.36% in 2016 (-7.7%). Sertraline was the most frequently prescribed in adolescents (2009: 22.2% of all ATD prescriptions; 2016: 32.9%), whereas amitriptyline was the most prescribed in children (2009: 42.7% and 2016: 41.2%). Off-label use decreased in adolescents (from 48.4% to 34.8%) but increased in children (from 10.0% to 26.5%). IMPLICATIONS/CONCLUSIONS Antidepressant level of use in French children and adolescents was stable in recent years and lower than that observed in other European countries and the United States.
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Criado-Álvarez J, González González J, Romo Barrientos C, Mohedano Moriano A, Montero Rubio J, Pérez Veiga J. Variability and trends in the consumption of drugs for treating attention-deficit/hyperactivity disorder in Castile-La Mancha, Spain (1992–2015). NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Patterns and profiles of methylphenidate use both in children and adults. Br J Clin Pharmacol 2018; 84:1215-1227. [PMID: 29512177 DOI: 10.1111/bcp.13544] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3-year period. METHODS Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18-24, 25-49 and ≥50 years of age for adults and <6, 6-11 and 12-17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow-up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs. RESULTS We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long-term use of MPH with few comedications. The group of 25-49-year-old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50 year-old group was more often coprescribed antidepressants and antiparkinsonian drugs. CONCLUSIONS Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25-49-year-old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.
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Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Magalie Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
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Ehrhardt C, Boucherie Q, Pauly V, Braunstein D, Ronflé E, Thirion X, Frauger E, Micallef J. Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period. Therapie 2017; 72:635-641. [DOI: 10.1016/j.therap.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/11/2023]
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Öner Ö, Yilmaz EŞ, Karadağ H, Vural M, Vural EH, Akbulat A, Gürsöz H, Türkçapar H, Kerman S. ADHD Medication Trends in Turkey: 2009-2013. J Atten Disord 2017; 21:1192-1197. [PMID: 24554298 DOI: 10.1177/1087054714523129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the change of ADHD medication prescriptions in Turkey between 2009 and 2013. METHOD Consumption data of ADHD medications, immediate release (IR) methylphenidate (MPH; Ritalin), OROS MPH (Concerta), and atomoxetine (Strattera) were obtained from IMS Health database for the November 2008 to October 2013 period. Defined daily dose (DDD) of each drug was calculated according to WHO definitions and time-series analysis was conducted. RESULTS There was a significant seasonal effect for prescription of all drugs. Annual use of ADHD medications increased 2.18 times for all ADHD medications combined. DDDs per 1,000 population per day for all ADHD medications were 0.28 in 2009, 0.41 in 2010, 0.52 in 2011, and 0.59 in 2012. OROS MPH represented almost 75% of all ADHD medication utilization. CONCLUSION As reported from several other countries, ADHD medication use increased in Turkey. Results suggested that over- and underdiagnosis might be seen at the same time.
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Affiliation(s)
- Özgür Öner
- 1 Ankara University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| | - Esra Şafak Yilmaz
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
| | - Hasan Karadağ
- 3 Yildirim Bayazit Hospital, Department of Psychiatry, Ankara, Turkey
| | - Mert Vural
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
| | - Elif Hilal Vural
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
| | - Akif Akbulat
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
| | - Hakkı Gürsöz
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
| | - Hakan Türkçapar
- 4 Hasan Kalyoncu University, Department of Psychology,İstanbul, Turkey
| | - Saim Kerman
- 2 Ministry of Health, Turkish Drug and Medical Instruments Institution, Ankara, Turkey
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Criado-Álvarez JJ, González González J, Romo Barrientos C, Mohedano Moriano A, Montero Rubio JC, Pérez Veiga JP. Variability and trends in the consumption of drugs for treating attention-deficit/hyperactivity disorder in Castile-La Mancha, Spain (1992-2015). Neurologia 2016; 33:S0213-4853(16)30171-2. [PMID: 27645774 DOI: 10.1016/j.nrl.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year. MATERIAL AND METHODS The prevalence of ADHD was estimated by calculating the defined daily dose per 1,000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models. RESULTS The minimum prevalence of ADHD in the population of Castile-La Mancha aged 5 to 19 was estimated at 13.22 cases per 1,000 population per day; prevalence varied across provinces (p<.05). Overall consumption has increased from 1992 to 2015, with an annual percentages of change of 10.3% and several joinpoints (2000, 2009, and 2012). methylphenidate represents 89.6% of total drug consumption, followed by lisdexamfetamine at 8%. CONCLUSIONS Analysing drug consumption enables us to estimate the distribution of ADHD patients in Castile-La Mancha. Our data show an increase in the consumption of these drugs as well as differences in drug consumption between provinces, which reflect differences in ADHD management in clinical practice.
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Affiliation(s)
- J J Criado-Álvarez
- Departamento de Ciencias Médicas, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España; Centro de Salud de La Pueblanueva, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM).
| | - J González González
- Departamento de Ciencias Médicas, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España; Centro de Salud de Santa Olalla, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM)
| | - C Romo Barrientos
- Servicio de Salud Mental, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM)
| | - A Mohedano Moriano
- Departamento de Ciencias Médicas, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España
| | - J C Montero Rubio
- Servicio de Laboratorio, Instituto de Ciencias de la Salud de Castilla-La Mancha, Consejería de Sanidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España
| | - J P Pérez Veiga
- Servicio de Control Farmacéutico, Área de Farmacia, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, España
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Beau-Lejdstrom R, Douglas I, Evans SJW, Smeeth L. Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence. BMJ Open 2016; 6:e010508. [PMID: 27297009 PMCID: PMC4932306 DOI: 10.1136/bmjopen-2015-010508] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013. METHODS All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated. RESULTS The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years. CONCLUSIONS There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries.
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Affiliation(s)
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, UK
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Antipsychotic prescribing in youths: a French community-based study from 2006 to 2013. Eur Child Adolesc Psychiatry 2015; 24:1181-91. [PMID: 25564132 DOI: 10.1007/s00787-014-0668-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/17/2014] [Indexed: 01/15/2023]
Abstract
The objectives were to explore in a community-based sample of persons aged 0-25 years: (1) trends in antipsychotic prescribing, (2) characteristics of the zone of residence associated with antipsychotic prescribing rates, and (3) the pattern of antipsychotic prescribing. The study was performed using reimbursement data from the French Insurance Healthcare system. Prescribing trends were investigated over the period 2006-2013. An ecological design was used to assess the impact of the socio-economical and health resource characteristics of the zone of residence (n = 96 administrative subdivisions of French territory) on antipsychotic prescribing rates. The pattern of antipsychotic prescribing was explored in a cohort of youths newly treated with antipsychotics. Over the period 2006-2013, antipsychotic dispensing rates were stable in persons aged 0-25 years (4.8 per 1,000 in 2006 and 4.9 per 1,000 in 2013). First-generation antipsychotic dispensing rates decreased from 3.1 to 2.6 per 1,000 (OR = 0.96, 95% CI 0.94-0.98), while second-generation antipsychotic dispensing rates increased from 2.7 to 3.4 per 1,000 (OR = 1.03, 95% CI 1.01-1.05). Antipsychotic prescribing rates were impacted by health resource characteristics of the zone of residence in children aged 10 years and under and by socio-economical characteristics in those aged 16-20 years. In all the age groups, antipsychotics were principally started by hospital practitioners (47%) and general practitioners (34%). The rates of psychostimulants concomitantly prescribed with antipsychotics were lower than 5%. In conclusion, rates of youths exposed to second-generation antipsychotics are still rising. The impact of environmental characteristics on antipsychotics prescribing and appropriateness of these prescriptions in youths should be further investigated.
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Steinhausen HC. Recent international trends in psychotropic medication prescriptions for children and adolescents. Eur Child Adolesc Psychiatry 2015; 24:635-40. [PMID: 25378107 DOI: 10.1007/s00787-014-0631-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022]
Abstract
Prescriptions of psychotropic medications have become an important intervention for many children and adolescents with mental disorders, and the rise of these prescriptions is debated intensively both among experts and the public. This review reports some recent international findings on point prevalence rates, cross-country comparisons, and time trends in psychotropic medication prescriptions for children and adolescents. Besides the total prescription rates, figures for antidepressants, antipsychotics, stimulants, and anxiolytics prescriptions are provided. The overall prescription rates of psychotropics in general and the major medication subgroups prescribed to children and adolescents vary substantially between countries with the US consumption being markedly higher than the use in European countries. However, even among the latter there are marked variations in findings. Studies reporting on time trends clearly indicate that there was a marked increase in the use of psychotropics for children and adolescents in the recent past. However, only a single study adjusted prevalence rates for the increasing number of children and adolescents assessed and treated in institutions providing mental health care. Considering the increasing numbers of children and adolescents seen in psychiatric services, the increase of psychotropic medications is less strong though still pronounced enough to stimulate further reflections on the use of these interventions.
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Affiliation(s)
- Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark,
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Conrad P, Bergey MR. The impending globalization of ADHD: notes on the expansion and growth of a medicalized disorder. Soc Sci Med 2014; 122:31-43. [PMID: 25441315 DOI: 10.1016/j.socscimed.2014.10.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally. After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups. Finally, we discuss what this globalization of a diagnosis reflects about the potential global medicalization of other conditions.
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Affiliation(s)
- Peter Conrad
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
| | - Meredith R Bergey
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
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Trenque T, Herlem E, Abou Taam M, Drame M. Methylphenidate off-label use and safety. SPRINGERPLUS 2014; 3:286. [PMID: 25279275 PMCID: PMC4162523 DOI: 10.1186/2193-1801-3-286] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/25/2014] [Indexed: 12/17/2022]
Abstract
Introduction Methylphenidate is a piperidine derivative structurally and pharmacologically similar to amphetamine. Methylphenidate is indicated for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 years of age and over when remedial measures alone prove insufficient. In adults, its indication, except in narcolepsy, is not defined. Methylphenidate received regulatory approval almost sixty years ago with a first registration in Switzerland in October 1954. Objective To evaluate the off-label use of methylphenidate and its characteristics from a database of spontaneous reports. Methods This study analysed data from the French Pharmacovigilance Database of adverse drug reactions spontaneously reported by health professionals from 1985 to December 2011. Off-label use was evaluated according to age. Results In the French Pharmacovigilance database, 181 cases of adverse drug reactions were reported with methylphenidate. Neuropsychiatric effects were the most frequent adverse event reported (41%) followed by cardiovascular and cutaneous side effects (14%). 143 reports concerned children (113 boys, 30 girls, mean age 10.6 ± 3.3 years) of which 46 (30%) were off-label uses. There were 38 adults (20 men, 18 women), of which 32 (88%) off-label use. In adults, methylphenidate was prescribed for depression, and this practice was associated with serious adverse events of drug dependence, overdose and suicide attempt. Overall, off-label use was detected in 43% (78/181) of all cases reported. Conclusion More than 40% of the patients with drug reactions received methylphenidate for off-label indications. Additional long-term exposures and independent clinical studies are necessary to establish the long-term profile safety of methylphenidate.
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Affiliation(s)
- Thierry Trenque
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France ; Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, F-51095 Reims, France
| | - Emmanuelle Herlem
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France
| | - Malak Abou Taam
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France
| | - Moustapha Drame
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, F-51095 Reims, France ; Department of Research and Innovations, Reims University Hospitals, Avenue du General Koenig, 51092 Reims, France
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Abstract
BACKGROUND Medication in attention deficit/hyperactivity disorder (ADHD) is so controversial that in some countries many children go untreated, while in others the prevalence of medication has become very high, and possibly even higher than the rate of ADHD. AIMS This lecture addresses the reasons for overuse and the obstacles to adequate use. METHODS Clinical and scientific literature is reviewed, with emphasis on published meta-analyses and national guidelines. RESULTS AND CONCLUSIONS The lecture suggests that overuse is associated with economic forces affecting prescribers, while underuse may come about in some European countries because we have overestimated the hazards of drugs, overestimated the value of non-pharmaceutical interventions or underestimated the severity of disorder.
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Affiliation(s)
- Eric Taylor
- Eric Taylor, FRCP, FRCPsych (Hon), FMedSci, Emeritus Professor of Child and Adolescent Psychiatry, King's College London Institute of Psychiatry , London , UK
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Steinhausen HC, Bisgaard C. Nationwide time trends in dispensed prescriptions of psychotropic medication for children and adolescents in Denmark. Acta Psychiatr Scand 2014; 129:221-31. [PMID: 23738593 DOI: 10.1111/acps.12155] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The analysis of time trends in dispensed prescriptions of psychotropic medications for children and adolescents in Denmark. METHOD The entire data set of the Danish prescription register covering stimulants, antidepressants, antipsychotics, and anxiolytics used in children and adolescents over a 15-year time span from 1996 to 2010 was analyzed. Both non-adjusted age-standardized prevalence rates and adjusted age-standardized prevalence rates considering the increase in patient numbers over time were calculated, and time trends were assessed based on 105908 patient-years. RESULTS For stimulants, antidepressants, and antipsychotics, the non-adjusted prevalence rates increased significantly. These trends were strongest for the stimulants. However, all adjusted prevalence rates were much lower with the anxiolytics even declining significantly. The prevalence rates of stimulants and antipsychotics were significantly higher among males than females, whereas females received significantly more antidepressants. The increase in prescription rates for both antidepressants and antipsychotics was mainly due to increased use among the 14- to 17-year-olds. Stratification by diagnoses revealed significantly increasing prevalence rates of dispensed antidepressants and antipsychotics in six major diagnostic indications. CONCLUSION Although increasing, the unadjusted Danish prevalence rates of dispensed prescriptions of psychotropics for children and adolescents are still lower than in many other Western countries.
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Affiliation(s)
- H-C Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
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Les psychotropes en pédopsychiatrie : comment les utiliser ? Quels référentiels ? Eur Psychiatry 2013. [DOI: 10.1016/j.eurpsy.2013.09.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Les besoins spécifiques de la population pédiatrique en termes d’indication et de surveillance des psychotropes sont étayés par des données issues de la recherche préclinique et clinique. Cependant, la recherche en psychopharmacologie pédiatrique est un domaine de développement récent ayant bénéficié de mesures incitatives législatives tant en Europe qu’aux États-Unis concernant l’usage des médicaments chez l’enfant et l’adolescent. Les modalités de prescription des psychotropes en pédiatrie, longtemps extrapolées à partir des données obtenues chez l’adulte, commencent donc à être basées sur des essais menés en population pédiatrique. Cette communication se propose de faire un état des lieux des pratiques de prescription des médicaments psychotropes chez l’enfant et l’adolescent, du cadre réglementaire (en évoquant notamment les prescriptions hors autorisation de mise sur le marché) et des spécificités pédiatriques des indications et de la surveillance des principales classes de psychotropes. Elle permettra une comparaison des données pharmacoépidémiologiques françaises avec celles d’autres pays européens en termes de prévalence globale de prescription et de profil de prescription des différentes classes de psychotropes. Elle illustrera également, à l’aide d’exemples concrets issus de projets de recherche collaboratifs, les enjeux d’avenir en psychopharmacologie pédiatrique afin que nos pratiques de prescription soient étayées par des données scientifiques prenant en compte les aspects développementaux. Ces enjeux ne sont pas uniquement scientifiques mais concernent plus largement la politique de santé, les représentations sociales et la communication avec les usagers et le grand public autour de la prescription de psychotropes en population pédiatrique.
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Zetterqvist J, Asherson P, Halldner L, Långström N, Larsson H. Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006-2009. Acta Psychiatr Scand 2013; 128:70-7. [PMID: 22943458 DOI: 10.1111/acps.12004] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the prevalence and discontinuation of dispensed medications for attention deficit/hyperactivity disorder (ADHD) drugs from 2006 to 2009. METHOD A total population cohort of all individuals aged 6-45 years, alive and registered as residents in Sweden during any calendar year from 2006 to 2009 (N = 5 149 791) included 41 700 patients dispensed with an ADHD drug (methylphenidate, atomoxetine, amphetamine, or dexamphetamine). The dispensing prevalence was calculated for each year, stratified on sex and age. A longitudinal analysis was also performed to compare the rates of treatment discontinuation across the strata. RESULTS The dispensing prevalence increased from 2.93 per 1000 in 2006 to 6.98 in 2009 (PR = 2.38, 95% CI = 2.34-2.43). The prevalence ratio (PR) was 3.40 for adults, 22-45 years old; 2.41 for adolescents, 15-21 years old; and 1.90 for children aged 6-14. The increase was also greater in women than in men (PR = 2.92 vs. 2.19). Patients aged 15-21 were the most likely to discontinue treatment; after 3 years and 11 months, 27% of those patients were still under treatment. CONCLUSION From 2006 to 2009, the number of prescriptions dispensed for ADHD drugs increased substantially. The rate of treatment discontinuation in the age interval 15-21 is higher than expected considering the persistence rates of the disorder.
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Affiliation(s)
- J Zetterqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Affiliation(s)
- Eric Taylor
- Institute of Psychiatry, King's College London, London; UK
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22
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Kraut AA, Langner I, Lindemann C, Banaschewski T, Petermann U, Petermann F, Mikolajczyk RT, Garbe E. Comorbidities in ADHD children treated with methylphenidate: a database study. BMC Psychiatry 2013; 13:11. [PMID: 23294623 PMCID: PMC3544568 DOI: 10.1186/1471-244x-13-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 01/04/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Methylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication. METHODS We used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression. RESULTS In 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls. CONCLUSIONS Besides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.
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Affiliation(s)
- Angela A Kraut
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Christina Lindemann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, J 5, Mannheim, 68159, Germany
| | - Ulrike Petermann
- Centre for Psychology and Rehabilitation, University of Bremen, Grazer Strasse 2 & 6, Bremen, 28359, Germany
| | - Franz Petermann
- Centre for Psychology and Rehabilitation, University of Bremen, Grazer Strasse 2 & 6, Bremen, 28359, Germany
| | - Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany,Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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Steer C, Froelich J, Soutullo CA, Johnson M, Shaw M. Lisdexamfetamine dimesylate: a new therapeutic option for attention-deficit hyperactivity disorder. CNS Drugs 2012; 26:691-705. [PMID: 22762726 DOI: 10.2165/11634340-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is associated with substantial functional, clinical and economic burdens. It is among the most common psychiatric disorders in children and adolescents, and often persists into adulthood. Both medication and psychosocial interventions are recommended for the treatment of ADHD. However, ADHD treatment practices vary considerably, depending on medication availability, reimbursement and the evolution of clinical practice in each country. In Europe, stimulants and atomoxetine are widely available medications for the treatment of ADHD, whereas in the US approved treatment options also include extended-release formulations of clonidine and guanfacine. Lisdexamfetamine dimesylate (lisdexamfetamine) is a long-acting, prodrug formulation of dexamfetamine. It is currently licensed in the US, Canada and Brazil, and is undergoing phase III studies in Europe. We performed a PubMed/MEDLINE search looking for recent (2005-2012) scientific papers regarding the pharmacokinetics, pharmacodynamics, efficacy and safety of lisdexamfetamine. The lisdexamfetamine molecule is therapeutically inactive and is enzymatically hydrolysed, primarily in the blood, to the active dexamfetamine. This conversion is unaffected by gastrointestinal pH and variations in normal transit times. Lisdexamfetamine was developed with the goal of providing an extended duration of effect that is consistent throughout the day. Clinical trials have demonstrated robust clinical efficacy of lisdexamfetamine in the treatment of children, adolescents and adults with ADHD with dose-dependent improvements in the core symptoms of ADHD. Studies have further shown that the duration of action of lisdexamfetamine continues for 13 hours post-dosing in children and for 14 hours in adults. The tolerability profile of lisdexamfetamine is consistent with those of other stimulant medications, with decreased appetite, insomnia, abdominal pain and irritability among the more frequent treatment-emergent adverse events, most of which are mild to moderate in intensity and transient in nature. There are currently no parallel-group, head-to-head trial data comparing the efficacy and safety of lisdexamfetamine with other medications for ADHD. However, the available data, including a large effect size and consistent plasma concentrations throughout the day, suggest that lisdexamfetamine is a useful treatment option for patients with ADHD.
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Prescription drug dispensing profiles for one million children: a population-based analysis. Eur J Clin Pharmacol 2012; 69:581-8. [DOI: 10.1007/s00228-012-1343-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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Zoëga H, Rothman KJ, Huybrechts KF, Ólafsson Ö, Baldursson G, Almarsdóttir AB, Jónsdóttir S, Halldórsson M, Hernández-Diaz S, Valdimarsdóttir UA. A population-based study of stimulant drug treatment of ADHD and academic progress in children. Pediatrics 2012; 130:e53-62. [PMID: 22732167 DOI: 10.1542/peds.2011-3493] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We evaluated the hypothesis that later start of stimulant treatment of attention-deficit/hyperactivity disorder adversely affects academic progress in mathematics and language arts among 9- to 12-year-old children. METHODS We linked nationwide data from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. The study population comprised 11,872 children born in 1994-1996 who took standardized tests in both fourth and seventh grade. We estimated the probability of academic decline (drop of ≥ 5.0 percentile points) according to drug exposure and timing of treatment start between examinations. To limit confounding by indication, we concentrated on children who started treatment either early or later, but at some point between fourth-grade and seventh-grade standardized tests. RESULTS In contrast with nonmedicated children, children starting stimulant treatment between their fourth- and seventh-grade tests were more likely to decline in test performance. The crude probability of academic decline was 72.9% in mathematics and 42.9% in language arts for children with a treatment start 25 to 36 months after the fourth-grade test. Compared with those starting treatment earlier (≤ 12 months after tests), the multivariable adjusted risk ratio (RR) for decline was 1.7 (95% confidence interval [CI]: 1.2-2.4) in mathematics and 1.1 (95% CI: 0.7-1.8) in language arts. The adjusted RR of mathematics decline with later treatment was higher among girls (RR, 2.7; 95% CI: 1.2-6.0) than boys (RR, 1.4; 95% CI: 0.9-2.0). CONCLUSIONS Later start of stimulant drug treatment of attention-deficit/hyperactivity disorder is associated with academic decline in mathematics.
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Affiliation(s)
- Helga Zoëga
- Center of Public Health Sciences, Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Galéra C, Bouvard MP, Lagarde E, Michel G, Touchette E, Fombonne E, Melchior M. Childhood attention problems and socioeconomic status in adulthood: 18-year follow-up. Br J Psychiatry 2012; 201:20-5. [PMID: 22626635 PMCID: PMC3907305 DOI: 10.1192/bjp.bp.111.102491] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) has been associated with socioeconomic difficulties later in life. Little research in this area has been based on longitudinal and community studies. AIMS To examine the relationship between childhood attention problems and socioeconomic status 18 years later. METHOD Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems and socioeconomic status between ages 22 and 35 years, adjusting for potential childhood and family confounders. RESULTS Individuals with high levels of childhood attention problems were three times more likely to experience subsequent socioeconomic disadvantage than those with low levels of attention problems (odds ratio 3.44, 95% CI 1.72-6.92). This association remained statistically significant even after adjusting for childhood externalising problems, low family income, parental divorce and parental alcohol problems. CONCLUSIONS This longitudinal community-based study shows an association between childhood attention problems and socioeconomic disadvantage in adulthood. Taking into account ADHD and associated difficulties could help reduce the long-term socioeconomic burden of the disorder.
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Affiliation(s)
| | - Manuel-Pierre Bouvard
- Service de Pédopsychiatrie
Hôpital Charles PerrensUniversité Victor Segalen - Bordeaux II121 rue de la Béchade 33076 Bordeaux, FR
| | - Emmanuel Lagarde
- Epidémiologie et Biostatistique
INSERM : U897Université Victor Segalen - Bordeaux IIInstitut de Santé Publique, d'Épidémiologie et de Développement (ISPED)146, rue Léo-Saignat 33076 Bordeaux, FR
| | - Grégory Michel
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France, FR
| | - Evelyne Touchette
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France, FR,Department of Child Psychiatry
McGill UniversityMontreal Children's Hospital2300 rue Tupper, Montreal, H3H 1P3, CA
| | - Eric Fombonne
- Research Unit on Children's Psychosocial Maladjustment
Department of PsychologyLaval University2325 rue de l'Université, Québec G1V 0A6, CA
| | - Maria Melchior
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France, FR,* Correspondence should be addressed to: Maria Melchior
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Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry 2012; 200:393-8. [PMID: 22442100 DOI: 10.1192/bjp.bp.111.104257] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increasing rates of prescriptions for antidepressants, antipsychotics and stimulants have been reported from various countries. AIMS To examine trends in prescriptions and the costs of all classes of psychiatric medication in England. METHOD Data from the Prescription Cost Analysis 1998-2010 was examined, using linear regression analysis to examine trends. RESULTS Prescriptions of drugs used for mental disorders increased by 6.8% (95% CI 6.3-7.4) per year on average, in line with other drugs, but made up an increasing proportion of all prescription drug costs (P = 0.001). There were rising trends in prescriptions of all classes of psychiatric drugs, except anxiolytics and hypnotics (which did not change). Antidepressant prescriptions increased by 10% (95% CI 9.0-11) per year on average, and antipsychotics by 5.1% (95% CI 4.3-5.9). Antipsychotics overtook antidepressants as the most costly class of psychiatric medication, with costs rising 22% (95% CI 17-27) per year. CONCLUSIONS Rising prescriptions may be partly explained by longer-term treatment and increasing population. Nevertheless, it appears that psychiatric drugs make an increasing contribution to total prescription drug costs, with antipsychotics becoming the most costly. Low-dose prescribing of some antipsychotics is consistent with other evidence that their use may not be restricted to those with severe mental illness.
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Affiliation(s)
- Stephen Ilyas
- General Adult Psychiatry, Tower Hamlets Centre for Mental Health, East London NHS Foundation Trust, London
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Abstract
AIMS To examine the literature pertaining to the diversion and misuse of pharmaceutical stimulants. METHODS Relevant literature was identified through comprehensive MEDLINE, EMBASE and PubMed searches. RESULTS The evidence to date suggests that the prevalence of diversion and misuse of pharmaceutical stimulants varies across adolescent and young adult student populations, but is higher than that among the general population, with the highest prevalence found among adults with attention deficit-hyperactive disorder (ADHD) and users of other illicit drugs. Concerns that these practices have become more prevalent as a result of increased prescribing are not supported by large-scale population surveys. Information on trends in misuse in countries where there have been recent increases in prescription and consumption rates, however, is limited. Little is known about the frequency and chronicity of misuse, or the extent of associated harms, particularly among those populations, i.e. adolescents, young adult student populations, those with ADHD and illicit drug users, where abuse may be more likely to occur. CONCLUSIONS Continued monitoring of the diversion and misuse of pharmaceutical stimulants is of major clinical importance. Despite recognition of the abuse liability of these medications, there is a paucity of data on the prevalence, patterns and harms of diversion and misuse among populations where problematic use and abuse may be most likely to occur (e.g. adolescents, young adults, illicit drug users). Comprehensive investigations of diversion and misuse among these populations should be a major research priority, as should the assessment of abuse and dependence criteria among those identified as regular users.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.
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Brault MC, Lacourse É. Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994-2007. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:93-101. [PMID: 22340149 DOI: 10.1177/070674371205700206] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe trends in the prevalence of prescribed attention-deficit hyperactivity disorder (ADHD) medication by Canadian preschoolers and school-age children and to compare these with trends in the prevalence of the ADHD diagnosis between 1994 and 2007. METHODS Subjects participated in the National Longitudinal Survey on Children and Youth, a Canadian prospective survey collecting data biennially. Three cross-sectional samples of nonreferred children, aged 3 to 9 years and representative of Canadian children for 1994-1995 (n = 12 595), 2000-2001 (n = 13 904), and 2006-2007 (n = 14 655), were selected for the analyses. Information on prescribed medications and ADHD diagnosis was reported by each child's parents. Prevalence was estimated at each cycle, taking the child's age and sex into account. RESULTS The estimated prevalence of prescribed medications and ADHD diagnosis in Canada was generally low (less than 3%), but higher for boys (less than 4%) and school-age children (less than 5%). Preschoolers' prevalence of both prescribed medications and ADHD diagnosis stayed stable between 1994 and 2007 (1% or less), while that of school-age children increased nearly 2-fold. Boys' prevalence was higher than that of girls, but girls show the steepest increase over time, up to 2.1-fold. The association between prescribed medications and ADHD diagnosis has strengthened during the 2000s: a greater number of medications were used for children with ADHD (from 43% in 2000 to 59% in 2007) while off-label use of prescribed medications decreased among school-age children. CONCLUSIONS The upward trend in the prevalence of prescribed ADHD medications and ADHD diagnosis currently observed in contemporary societies is also occurring in Canada, except with preschoolers.
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Treceño C, Martín Arias LH, Sáinz M, Salado I, García Ortega P, Velasco V, Jimeno N, Escudero A, Velasco A, Carvajal A. Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y León (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate. Pharmacoepidemiol Drug Saf 2012; 21:435-41. [PMID: 22253017 DOI: 10.1002/pds.2348] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is the most diagnosed behavioural disorder in children and adolescents; prevalence has been estimated around 5%. Studies have shown an increase in the use of ADHD medications during the last years. The aim of the present study was to learn the pattern and the evolution of ADHD medication consumption in Castilla y León (Spain). METHOD Consumption data for the period 1992-2009 were obtained from databases containing information upon consumption and cost of medications dispensed by pharmacies at the expense of the Spanish National Health System. The data were expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DDD/1000 inhabitants/day). A model to forecast consumption was built. RESULTS Attention deficit hyperactivity disorder medication consumption increased in Castilla y León from 0.1 DDD/1000 inhabitants/day in 1992 to 1.5 DDD/1000 inhabitants/day in 2009; expected consumption will reach 2.5 DDD/1000 inhabitants/day by 2013. The drugs accounting for this increase were mainly made up of methylphenidate preparations (1.4 DDD/1000 inhabitants/day in 2009). From 1992 to 1999, there was a slight reduction in methylphenidate use; following amphetamine withdrawal, the consumption of stimulants began to increase, and figures showed a sharp rise after marketing of extended-release formulations in 2003. CONCLUSIONS There has been an enormous increase in ADHD medication consumption in Castilla y León in the last few years; increase rocketed when extended-release methylphenidate was marketed. A rapid increase in the consumption is a warning on possible overdiagnosis and inappropriate prescription.
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Affiliation(s)
- Carlos Treceño
- Instituto de Farmacoepidemiología, Universidad de Valladolid, Valladolid, Spain
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Le trouble déficitaire de l’attention, avec ou sans hyperactivité (TDA/H) : une approche pluridisciplinaire longitudinale croisée de 36 enfants. Encephale 2011; 37:180-90. [DOI: 10.1016/j.encep.2011.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022]
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Frauger E, Nordmann S, Orleans V, Pradel V, Pauly V, Thirion X, Micallef J. Which psychoactive prescription drugs are illegally obtained and through which ways of acquisition? About OPPIDUM survey. Fundam Clin Pharmacol 2011; 26:549-56. [DOI: 10.1111/j.1472-8206.2011.00950.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frauger E, Pauly V, Natali F, Pradel V, Reggio P, Coudert H, Thirion X, Micallef J. Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behaviour determined from a reimbursement database: main trends from 2005 to 2008. CNS Drugs 2011; 25:415-24. [PMID: 21476612 DOI: 10.2165/11587640-000000000-00000] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Methylphenidate is a psychostimulant drug indicated for the treatment of attention-deficit hyperactivity disorder (ADHD). Its abuse and diversion have been previously described in specific populations, such as students; however, few studies investigating abuse and diversion among the overall population are available. OBJECTIVES The aim of this study was to describe patterns of methylphenidate use and to explore the magnitude of its abuse and diversion in two French administrative areas using data from a reimbursement database. A proxy of 'deviant behaviour' was used for the abuse and diversion of methylphenidate, defined using the following parameters: total number of defined daily doses (DDDs) of methylphenidate dispensed; number of different pharmacies seen for dispensing of methylphenidate; number of prescribers consulted for a prescription of methylphenidate; and number of dispensings of methylphenidate. Data from the reimbursement database were analysed by clustering methods. These data were assessed from 2005 to 2008. METHOD The French General Health Insurance System (GHIS) database was used to obtain data on methylphenidate use in two French administrative areas. Individuals affiliated to the GHIS who had a prescription for methylphenidate reimbursed between 1 January and 31 March of 4 selected years (2005, 2006, 2007 and 2008) were included. After the first dispensing of methylphenidate for these individuals, all their dispensings (including methylphenidate and other psychoactive drugs) were monitored over a 9-month period. Following a descriptive analysis, a clustering method was used to identify different subgroups of subjects according to the methylphenidate consumer profile characteristics. RESULTS With regard to the number of patients who had a dispensing for methylphenidate during the first quarter of the year, an 84% increase was observed between 2005 (n = 640) and 2008 (n = 1175). The clustering method identified two subgroups. One of them was characterized by a higher number of dispensings, different prescribers and pharmacies and a greater total dispensed quantity, suggesting a deviant behaviour and, thus, possible abuse and diversion of methylphenidate. These subjects were older (aged 35.4 ± 11.3 years) and were more frequently patients receiving benzodiazepines, antidepressants, antipsychotics and maintenance opioid treatment. The proportion of subjects with a deviant behaviour increased from 0.5% in 2005 to 2% in 2007 and then decreased to 1.2% in 2008. CONCLUSION This method was able to assess the magnitude of methylphenidate abuse liability and to follow its evolution. The decrease in methylphenidate abuse and diversion seen between 2007 and 2008 can be explained by the enactment in April 2008 of specific regulations for prescription drugs (such as methylphenidate) that are deemed by the French government to have the potential for misuse; these regulations require the establishment of a 'contract of care' between the GHIS, prescriber and patient.
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Affiliation(s)
- Elisabeth Frauger
- Centre dEvaluation et dInformation sur la Pharmacodpendance-Addictovigilance, CEIP-A, Pharmacologie Clinique, CHU Timone, Marseille, France
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Hollingworth SA, Nissen LM, Stathis SS, Siskind DJ, Varghese JMN, Scott JG. Australian national trends in stimulant dispensing: 2002-2009. Aust N Z J Psychiatry 2011; 45:332-6. [PMID: 21184644 DOI: 10.3109/00048674.2010.543413] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Internationally there has been an increase in the prescriptions of stimulant medication. The aim of this study was to examine longitudinal national trends of stimulant dispensing in Australia between 2002 and 2009. METHOD Government databases were retrospectively reviewed for all dispensed stimulant prescriptions between 2002 and 2009. Prescriptions were converted to defined daily dose (DDD)/1000 population/day using census data. Utilization of dexamphetamine and methylphenidate were analysed by source (subsidized or non-subsidized), prescriber (general practitioner, psychiatrist or other specialists), gender and age of patient. RESULTS Between 2002 and 2009, dispensing of stimulants in Australia increased 87% from 2.93 to 5.47 DDD/1000 population/day. Dexamphetamine remained the most commonly dispensed stimulant, with rates of dispensing falling 13% from 2.02 to 1.75 DDD/1000 population/day. Dispensed prescriptions of methylphenidate increased 300% from 0.45 in 2002 to 1.81 DDD/1000 population/day in 2009, attributable to the availability of long-acting preparations. Dispensing of stimulants to males was four-fold greater than to females. There was substantial dispensing of dexamphetamine to those older than 25 years. CONCLUSIONS Stimulant dispensing in Australia increased between 2002 and 2009 as a result of increased dispensing of long-acting preparations of methylphenidate. Further research is required to determine if the increase in stimulant dispensing in Australia is clinically appropriate.
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Affiliation(s)
- Samantha A Hollingworth
- Queensland Centre for Mental Health Research, The Park, Centre for Mental Health, Wacol, Queensland, Australia
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Schubert I, Köster I, Lehmkuhl G. The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: a study of data from a random sample of insurees of the AOK Health Insurance Company in the German State of Hesse, 2000-2007. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:615-21. [PMID: 20948775 DOI: 10.3238/arztebl.2010.0615] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 11/26/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study is to assess changes in the prevalence of attention-deficit/hyperactivity disorder (ADHD) and methylphenidate prescriptions over the period 2000 to 2007 on the basis of data from a German statutory health insurance carrier. METHODS In a cross-sectional study, we analyzed data from a random sample of insurees of the AOK health insurance company in the German state of Hesse for the years 2000 to 2007. Per calender year, 50,000 to 63,000 children and adolescents were retrospectively observed with respect to the documentation of ADHD diagnosis (ICD-10 diagnosis F90) and the prescribing of methylphenidate (ATC: N06BA04). RESULTS In 2007, the overall prevalence of ADHD in all age groups (0-18 years) was 2.21% (95% CI: 2.09-2.34). This figure was 45% greater than the corresponding figure for the year 2000. The prevalence increased by a larger amount among girls aged 6 to 18 years than among boys in the same age group (+69% vs. +53%). In 2007, 1.06% (95% CI: 0.98-1.16) of the children/adolescents received at least one prescription for methylphenidate; this was a 96% increase over the prescription rate for 2000. A comparison of the two years 2000 and 2007 reveals a clear prevalence shift towards the older age groups, as well as an 82% increase in the average number of daily doses per recipient. Outpatient departments of child and adolescent psychiatry initiated more treatments in 2007 than in 2000. CONCLUSION The 1% prevalence of methylphenidate use among children and adolescents that was found in this study is the same as that reported in other European countries, such as Switzerland, the Netherlands, and Norway. A drawback of our study is its limitation to a single insurance carrier in a single region. Nonetheless, data of this type are useful for monitoring. The findings suggest further issues worth studying, e.g., off-label use or the indications for treatment in older age groups.
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Affiliation(s)
- Ingrid Schubert
- PMV forschungsgruppe, angegliedert an die Klinik für Kinder- und Jugendpsychiatrie der Universität zu Köln, Köln, Germany.
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Disruptive symptoms in childhood and adolescence and early initiation of tobacco and cannabis use: the Gazel Youth study. Eur Psychiatry 2010; 25:402-8. [PMID: 20813507 DOI: 10.1016/j.eurpsy.2010.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/05/2010] [Accepted: 06/13/2010] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To examine the link between symptoms of hyperactivity-inattention and conduct disorder in childhood, and the initiation of tobacco and cannabis use, controlling for other behavioral symptoms, temperament and environmental risk factors. METHOD The sample (N=1107 participants, aged 4 to 18 years at baseline) was recruited from the population-based longitudinal Gazel Youth study with a follow-up assessment 8 years later. Psychopathology, temperament, environmental variables, and initiation of tobacco and cannabis use were self-reported. Event time analyses were performed to assess the effects of childhood disruptive symptoms on age at first use of tobacco and cannabis. RESULTS Proportional hazard models revealed that participants with high levels of childhood symptoms of both hyperactivity-inattention and conduct disorder were at highest risk of early tobacco initiation (in males: hazard ratio [HR]=2.05; confidence interval [CI]: 1.24-3.38; in females: HR=2.01; CI: 1.31-3.09), and, in males, of early cannabis initiation (HR=1.95; CI: 1.04-3.64). Temperament, through activity in both males and females and negative emotionality in females, was also associated to early substance use initiation. CONCLUSIONS Children who simultaneously have high levels of symptoms of hyperactivity-inattention and conduct disorder are at increased risk for early substance initiation. These associations may guide childhood health professionals to consider the liability for early substance initiation in high-risk groups.
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Martin-Latry K, Cougnard A. Terminologie utilisée concernant les bases de remboursement de l’assurance maladie en pharmaco-épidémiologie : une harmonisation nécessaire. Therapie 2010; 65:379-85. [DOI: 10.2515/therapie/2010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
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Martin-Latry K, Bégaud B. Pharmacoepidemiological research using French reimbursement databases: yes we can! Pharmacoepidemiol Drug Saf 2010; 19:256-65. [PMID: 20128015 DOI: 10.1002/pds.1912] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe the reimbursement databases available in France for pharmacoepidemiological research and their use. METHODS France has a publicly funded health system that systematically covers the population. Within this system, three main insurance schemes provide health services to citizens in France and each have their own reimbursement database. Together these three databases cover almost 97% of the French population (respectively for 54.5, 3.6, and 3.3 million individuals, and a total of 61.4 million individuals). Data in these concern patients, prescribers, all the medical acts reimbursed, prescription and undertaking of laboratory tests (but without results), private hospital data, partial public hospital data and vital status. Their use is regulated but access is free and the data are anonymous. PubMed and Scopus were searched for relevant studies published from January 1988 to June 2009. RESULTS 110 published studies were included. The topics and the study characteristics were extremely wide-ranging. The studies assessed patterns of drug use, have tested interventions, supported or improved prescribing practices, tested compliance with the French governmental Health guidelines, assessed physicians' prescribing practices and performed economic and cost-effectiveness assessments. The number of articles published increased greatly between 2002 and 2003. CONCLUSIONS The French reimbursement databases were greatly used over the last 20 years. They can provide data on exposure to drugs and can be used to study patterns of drug utilization although their limitations must be considered.
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Affiliation(s)
- Karin Martin-Latry
- Département de Pharmacologie, Université Victor Segalen Bordeaux 2, 33076 Bordeaux, France.
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Tomás Vila M, Izquierdo Quevedo F, Cerdán Vera M, Fernández A, Artés Figueres M, Revert Gomas M. Alucinaciones visuales producidas por metilfenidato. An Pediatr (Barc) 2010; 72:229-30. [DOI: 10.1016/j.anpedi.2009.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 10/15/2009] [Accepted: 10/16/2009] [Indexed: 11/29/2022] Open
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Romano E, Thornhill S, Lacourse E. An 8-year follow-up study of profiles and predictors of methylphenidate use in a nationwide sample of boys. J Pediatr 2009; 155:721-7. [PMID: 19643442 DOI: 10.1016/j.jpeds.2009.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 04/16/2009] [Accepted: 05/18/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify methylphenidate profiles over several years in a national sample of boys and examine behavioral and sociodemographic predictors of use. STUDY DESIGN Five cycles of a Canadian survey were used, resulting in 1447 boys followed from 2 to 3 years to 10 to 11 years. Mother reports of boys' methylphenidate use from 4 to 5 years to 10 to 11 years were used to identify profiles over time. Mother-reported sociodemographic and child behavior data at 2 to 3 years were then used to predict methylphenidate profiles. RESULTS Three methylphenidate profiles were identified: no use (87.2%); slow-rising, intermittent (11.2%); and fast-rising, stable (1.6%). Sociodemographic variables were not significant predictors. Boys with greater hyperactivity-impulsivity, greater inattention, and less disruptive behavior were more likely to belong to the fast-rising, stable methylphenidate profile. Although 13% of boys were using methylphenidate over time, there were 2 heterogeneous profiles. In the first profile, there were very few initial users followed by a steady increase in the number of boys using methylphenidate over time. Among these boys, however, use was inconsistent over time. In the second profile, there was a sharp onset of methylphenidate use on school entry, followed by consistent use thereafter. CONCLUSIONS These findings have implications for the treatment effectiveness of attention deficit-hyperactivity disorder symptoms. It is important to continue examining the role of disruptive behavior because its co-occurrence with attention deficit-hyperactivity disorder symptoms and methylphenidate use is complex.
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Affiliation(s)
- Elisa Romano
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
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Camargos Jr. W, Nicolato R. Características das prescrições no transtorno de déficit de atenção/hiperatividade. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000300009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: O trabalho busca conhecer, no atual momento, a realidade das prescrições para o transtorno de déficit de atenção/hiperatividade. MÉTODO: Revisão não sistemática dos descritores "transtorno de falta de atenção/ hiperatividade" e "prescrição de medicamentos" e seus similares em inglês. Foram utilizados os seguintes limitadores: publicações de 10 anos até novembro de 2008, idiomas inglês, francês, espanhol e português, nas bases de dados do Medline, SciELO, Lilacs, áreas especializadas e Cochrane. Não foram utilizados os artigos referentes ao uso ilícito e aspectos clínicos em geral. RESULTADOS: Foram tratados 8 itens: sistema de prescrições, características socioculturais, os sistemas de saúde que influenciam as prescrições, tempo de uso das medicações, aumento das prescrições, aspectos em comum, dosagens e prescrição em idades abaixo de 5 anos. CONCLUSÕES: Alguns aspectos são preocupantes, como a baixa adesão aos tratamentos medicamentosos, doses médias de metilfenidato relativamente baixas e aumento das prescrições de psicoestimulantes para crianças de até 3 anos. Características sociais e o sistema de saúde utilizado pelo afetado também geram grandes variações na prática clínica. Uma questão interessante é a evidência de que o sistema brasileiro de prescrições não é o mais restritivo.
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Affiliation(s)
| | - Rodrigo Nicolato
- Instituto de Previdência dos Servidores do Estado de Minas Gerais
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A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatry Ment Health 2008; 2:26. [PMID: 18817536 PMCID: PMC2569908 DOI: 10.1186/1753-2000-2-26] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to compare cross-national prevalence of psychotropic medication use in youth. METHODS A population-based analysis of psychotropic medication use based on administrative claims data for the year 2000 was undertaken for insured enrollees from 3 countries in relation to age group (0-4, 5-9, 10-14, and 15-19), gender, drug subclass pattern and concomitant use. The data include insured youth aged 0-19 in the year 2000 from the Netherlands (n = 110,944), Germany (n = 356,520) and the United States (n = 127,157). RESULTS The annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5-2.2 times greater. The atypical antipsychotic subclass represented only 5% of antipsychotic use in Germany, but 48% in the Netherlands and 66% in the US. The less commonly used drugs e.g. alpha agonists, lithium and antiparkinsonian agents generally followed the ranking of US>Dutch>German youth with very rare (less than 0.05%) use in Dutch and German youth. Though rarely used, anxiolytics were twice as common in Dutch as in US and German youth. Prescription hypnotics were half as common as anxiolytics in Dutch and US youth and were very uncommon in German youth. Concomitant drug use applied to 19.2% of US youth which was more than double the Dutch use and three times that of German youth. CONCLUSION Prominent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe. Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.
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