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McGrath J. The clinical pathway in ADMiRE, Ireland's first public specialist service for children and adolescents with attention deficit hyperactivity disorder. Ir J Psychol Med 2024:1-8. [PMID: 38825868 DOI: 10.1017/ipm.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder occurring in approximately one in twenty young people in Ireland, and in one-third of those attending Irish Child and Adolescent Mental Health Services (CAMHS). It is important to treat ADHD, as un/poorly treated ADHD is associated with a raft of negative health and socio-economic outcomes. Effective interventions for ADHD are available, and the use of standardised, evidence-based pathways for assessment and management of ADHD optimises outcomes. Despite this, there is no national standardised clinical pathway for assessment and treatment of ADHD in Ireland. ADMiRE, the first public healthcare specialist service for children and adolescents in Ireland, has developed a strongly evidence-based, efficient, effective and safe clinical pathway for assessment and management of ADHD. This paper describes the ADMiRE Clinical Pathway and references ADMiRE resources that are available to other services.
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Affiliation(s)
- Jane McGrath
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital, Dublin, Ireland
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Johnson M, Johnels JÅ, Östlund S, Jakobsson K, Högstedt J, Larsson PJ, Gillberg C, Billstedt E. Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes. Eur Arch Psychiatry Clin Neurosci 2024; 274:879-890. [PMID: 38280948 PMCID: PMC11127865 DOI: 10.1007/s00406-023-01744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/11/2023] [Indexed: 01/29/2024]
Abstract
More knowledge is needed about long-term ADHD medication and symptom, daily functioning, comorbidity, and tolerability outcomes. This "Long-term Medication for ADHD (LMA) trial" was a prospective observational 2-year trial in children and adolescents aged 6-18 years (extension of 1-year trial). Participants met criteria for DSM-5 ADHD (inattentive or combined), with complex comorbidities; autism spectrum disorder (31%), autistic traits (24%), oppositional symptoms (59%), anxiety (32%), dyslexia/language disorder (16%), borderline intellectual functioning (17%). Medication was individually tailored and followed-up at clinical visits (1, 2, 3, 6, 12, 18, 24 months). Primary outcome: Clinical Global Impression-Severity and Improvement scales (CGI-S, CGI-I). Secondary outcomes: Investigator-rated ADHD-Rating Scale, Weiss Functional Impairment Rating Scale-Parent report (WFIRS-P; Family, School Learning and Behavior, Life Skills, Self-Concept, Social Activities, and Risky Activities domains), comorbidity symptoms and adverse events (AEs). One hundred twenty-eight participants were enrolled (1-year trial only n = 27, LMA trial n = 101). Of these 29 (23%) discontinued, mainly due to AEs (n = 7), moving (n = 7), or no longer needing medication (n = 6). Main AEs were poor appetite, low mood, anxiety, irritability, fatigue. Improvements from baseline to 2 years were large in CGI-S (effect size (ES) 2.28), ADHD-RS (ES 2.06), and moderate to large in WFIRS-P (ES total 0.73, learning 0.4, family 0.67). Overall, the trial showed robust and sustained improvements in ADHD symptom severity and daily functioning over a period of 2 years of ADHD medication in children and adolescents with ADHD and complex comorbidities. Most AEs were mild. Comorbidity symptoms were improved after 1 year, particularly oppositional symptoms, depression, and anxiety.
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Affiliation(s)
- M Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - J Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Östlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Jakobsson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Högstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Javid Larsson
- Habilitation and Health, Region Västra Götaland, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bellato A, Perrott NJ, Marzulli L, Parlatini V, Coghill D, Cortese S. Systematic Review and Meta-Analysis: Effects of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Quality of Life. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00304-6. [PMID: 38823477 DOI: 10.1016/j.jaac.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to quantify the effect of attention-deficit/hyperactivity disorder (ADHD) medication on quality of life (QoL), and to understand whether this effect differs between stimulants and non-stimulants. METHOD From the dataset of a published network meta-analysis (Cortese et al., 20181), updated on 27th February 2023 (https://med-adhd.org/), we identified randomized controlled trials (RCTs) of ADHD medications for individuals aged 6 years or more with a diagnosis of ADHD based on the DSM (from third to fifth editions) or the International Classification of Diseases (ICD; ninth or tenth revision), reporting data on QoL (measured with a validated scale). The risk of bias for each RCTs was assessed using the Cochrane Risk of Bias tool 2. Multi-level meta-analytic models were conducted with R 4.3.1. RESULTS We included 17 RCTs (5,388 participants in total; 56% randomized to active medication) in the meta-analyses. We found that amphetamines (Hedges g = 0.51, 95% CI = 0.08, 0.94), methylphenidate (0.38; 0.23, 0.54), and atomoxetine (0.30; 0.19, 0.40) were significantly more efficacious than placebo in improving QoL in people with ADHD, with moderate effect size. For atomoxetine, these effects were not moderated by the length of intervention, and did not differ between children/adolescents and adults. CONCLUSION In addition to being efficacious in reducing ADHD core symptom severity, both stimulant and non-stimulant medications are efficacious in improving QoL in people with ADHD, albeit with lower effect sizes. Future research should explore whether, and to what degree, combining pharmacological and non-pharmacological interventions is likely to further improve QoL in people with ADHD. STUDY PREREGISTRATION INFORMATION Effects of pharmacological treatment for ADHD on quality of life: a systematic review and meta-analysis; https://osf.io/;qvgps.
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Affiliation(s)
- Alessio Bellato
- University of Southampton, Southampton, United Kingdom; University of Nottingham Malaysia, Semenyih, Malaysia.
| | | | | | - Valeria Parlatini
- University of Southampton, Southampton, United Kingdom; King's College London, London, United Kingdom; Solent NHS Trust, Southampton, United Kingdom
| | - David Coghill
- University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Samuele Cortese
- University of Southampton, Southampton, United Kingdom; Università degli Studi di Bari "Aldo Moro", Bari, Italy; Solent NHS Trust, Southampton, United Kingdom; New York University Child Study Center, New York
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Dafny N, Claussen C, Frazier E, Liu Y. Differential Roles of Key Brain Regions: Ventral Tegmental Area, Locus Coeruleus, Dorsal Raphe, Nucleus Accumbens, Caudate Nucleus, and Prefrontal Cortex in Regulating Response to Methylphenidate: Insights from Neuronal and Behavioral Studies in Freely Behaving Rats. Int J Mol Sci 2024; 25:5938. [PMID: 38892125 PMCID: PMC11173053 DOI: 10.3390/ijms25115938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
A total of 3102 neurons were recorded before and following acute and chronic methylphenidate (MPD) administration. Acute MPD exposure elicits mainly increases in neuronal and behavioral activity in dose-response characteristics. The response to chronic MPD exposure, as compared to acute 0.6, 2.5, or 10.0 mg/kg MPD administration, elicits electrophysiological and behavioral sensitization in some animals and electrophysiological and behavioral tolerance in others when the neuronal recording evaluations were performed based on the animals' behavioral responses, or amount of locomotor activity, to chronic MPD exposure. The majority of neurons recorded from those expressing behavioral sensitization responded to chronic MPD with further increases in firing rate as compared to the initial MPD responses. The majority of neurons recorded from animals expressing behavioral tolerance responded to chronic MPD with decreases in their firing rate as compared to the initial MPD exposures. Each of the six brain areas studied-the ventral tegmental area, locus coeruleus, dorsal raphe, nucleus accumbens, prefrontal cortex, and caudate nucleus (VTA, LC, DR, NAc, PFC, and CN)-responds significantly (p < 0.001) differently to MPD, suggesting that each one of the above brain areas exhibits different roles in the response to MPD. Moreover, this study demonstrates that it is essential to evaluate neuronal activity responses to psychostimulants based on the animals' behavioral responses to acute and chronic effects of the drug from several brain areas simultaneously to obtain accurate information on each area's role in response to the drug.
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Affiliation(s)
- Nachum Dafny
- Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, Houston, TX 77030, USA; (C.C.); (Y.L.)
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Kirk HE, Richmond S, Gaunson T, Bennett M, Herschtal A, Bellgrove M, Cornish K. A 5-week Digital Intervention to Reduce Attention Problems in Children With ADHD: A Double-Blind Randomized Controlled Trial. J Atten Disord 2024:10870547241256269. [PMID: 38804292 DOI: 10.1177/10870547241256269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Growing evidence suggests digital interventions may provide neurocognitive benefits for children with ADHD. This study aimed to investigate the efficacy of a digital attention intervention in children with ADHD. METHOD In this double-blind randomized controlled trial 55 children with ADHD (5-9 years) were allocated to the intervention (N = 28) or control program (N = 27). Both programs were delivered via touchscreen tablets at home 5 days a week for 5 weeks. The primary outcome was change in the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) from pre- to post-intervention. RESULTS Participants who received the intervention had significantly greater improvements in the TOVA ACS from pre- to post-intervention than those in the control (p < .044). No intervention effects were observed on secondary outcomes assessing executive functioning, ADHD symptoms, or functional impairment. CONCLUSION Collectively these findings provide insufficient evidence for the implementation of digital attention interventions for children with ADHD.
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Salazar de Pablo G, Iniesta R, Bellato A, Caye A, Dobrosavljevic M, Parlatini V, Garcia-Argibay M, Li L, Cabras A, Haider Ali M, Archer L, Meehan AJ, Suleiman H, Solmi M, Fusar-Poli P, Chang Z, Faraone SV, Larsson H, Cortese S. Individualized prediction models in ADHD: a systematic review and meta-regression. Mol Psychiatry 2024:10.1038/s41380-024-02606-5. [PMID: 38783054 DOI: 10.1038/s41380-024-02606-5] [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] [Received: 09/28/2023] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
There have been increasing efforts to develop prediction models supporting personalised detection, prediction, or treatment of ADHD. We overviewed the current status of prediction science in ADHD by: (1) systematically reviewing and appraising available prediction models; (2) quantitatively assessing factors impacting the performance of published models. We did a PRISMA/CHARMS/TRIPOD-compliant systematic review (PROSPERO: CRD42023387502), searching, until 20/12/2023, studies reporting internally and/or externally validated diagnostic/prognostic/treatment-response prediction models in ADHD. Using meta-regressions, we explored the impact of factors affecting the area under the curve (AUC) of the models. We assessed the study risk of bias with the Prediction Model Risk of Bias Assessment Tool (PROBAST). From 7764 identified records, 100 prediction models were included (88% diagnostic, 5% prognostic, and 7% treatment-response). Of these, 96% and 7% were internally and externally validated, respectively. None was implemented in clinical practice. Only 8% of the models were deemed at low risk of bias; 67% were considered at high risk of bias. Clinical, neuroimaging, and cognitive predictors were used in 35%, 31%, and 27% of the studies, respectively. The performance of ADHD prediction models was increased in those models including, compared to those models not including, clinical predictors (β = 6.54, p = 0.007). Type of validation, age range, type of model, number of predictors, study quality, and other type of predictors did not alter the AUC. Several prediction models have been developed to support the diagnosis of ADHD. However, efforts to predict outcomes or treatment response have been limited, and none of the available models is ready for implementation into clinical practice. The use of clinical predictors, which may be combined with other type of predictors, seems to improve the performance of the models. A new generation of research should address these gaps by conducting high quality, replicable, and externally validated models, followed by implementation research.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Raquel Iniesta
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
- King's Institute for Artificial Intelligence, King's College London, London, UK
| | - Alessio Bellato
- School of Psychology, University of Nottingham, Nottingham, Malaysia
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Arthur Caye
- Post-Graduate Program of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Center for Research and Innovation (CISM), University of São Paulo, São Paulo, Brazil
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maja Dobrosavljevic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Miguel Garcia-Argibay
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Mian Haider Ali
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Lucinda Archer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK
| | - Alan J Meehan
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Halima Suleiman
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, Syracuse, NY, USA
| | - Marco Solmi
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South-London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, Syracuse, NY, USA
| | - Henrik Larsson
- School of Psychology, University of Southampton, Southampton, UK
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, Southampton, UK.
- Solent NHS Trust, Southampton, UK.
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA.
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy.
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Cortese S, Coghill D, Fegert JM, Mattingly GW, Rohde LA, Wong ICK, Faraone SV. ESCAP endorses the inclusion of methylphenidate in the WHO model lists of essential medicines and in the Union list of critical medicines. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02443-5. [PMID: 38662057 DOI: 10.1007/s00787-024-02443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Building 44, Southampton, SO17 1BJ, UK.
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
- Solent NHS Trust, Southampton, UK.
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University "Aldo Moro", Bari, Italy.
| | - David Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Australia
- Murdoch Children's research Institute, Melbourne, Australia
| | - Joerg M Fegert
- Klinik für Kinder- und Jugendpsychiatrie / Psychotherapie, Universitatsklinikum Ulm, Baden-Württemberg, Germany
| | - Gregory W Mattingly
- Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Midwest Research Group, Washington University School of Medicine, St. Louis, MO, USA
| | - Luis A Rohde
- Attention Deficit/Hyperactivity Program and Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Medical Council, UniEduK, São Paulo, Brazil
- Center for Research and Innovation in Mental Health, National Institute of Developmental Psychiatry, São Paulo, Brazil
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Centre for Medicines Optimisation Research and Education University College London Hospitals NHS Foundation Trust, London, UK
- Aston School of Pharmacy, Aston University, Birmingham, UK
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
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Willig TN, Blanc JP, Assathiany R, Bilbault C, Raffier L, Werner A. Ambulatory pediatricians: how to bridge the gaps in diagnosis and care coordination for neurodevelopmental disorders in France. Front Pediatr 2024; 12:1269198. [PMID: 38725981 PMCID: PMC11079306 DOI: 10.3389/fped.2024.1269198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/10/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction and aims The organization of healthcare pathways for neurodevelopmental disorders (NDD) relies on different levels of expertise depending on the complexity of these disorders. NDDs affect between 8% and 15% of children. Historically, national recommendations and healthcare planning measures were initially devoted to autism spectrum disorders and were gradually extended to Attention deficit hyperactivity disorder (ADHD) and specific learning and development disorders. Private doctors play an increasing role in these pathways at different levels of care due to difficulties in organization, particularly in the health and social sector. The aim of this work was to evaluate the contribution of second-line private doctors in the diagnosis and care of children affected by NDD. Methods A first series of surveys in 2016 evaluated the level of commitment of primary care pediatricians; this online national survey was repeated in 2023 among 1,430 members of the French Association of Ambulatory Pediatrics (Association Française de Pédiatrie Ambulatoire: AFPA) to assess their training, current and future involvement, and activity in NDD care. Analysis was performed by the main author using Epi-Info software. Results The study identified in 2023 214 second-line private doctors (14% of all pediatricians in activity), of which 185 agreed to appear in a directory published the same year by the AFPA to facilitate referrals from other professionals. Sex ratio of responders is usual for paediatricians: 79.5%/20.5% (F/M), with a distribution among ages showing a slight increase of the age range between age 51-60 (30.5%). Our data indicate that in France in 2022, second-line private doctors made 48%-53% of NDD diagnoses, 24%-26.4% of follow-up consultations and declare to be accountable for 21% of initial prescriptions for Methylphenidate. Among these second-line doctors, 40% had completed a post-university degree on NDD, 74.3% had completed professional development training (PDT) and 85.2% had completed either or both types of training. Most doctors participating in the survey wanted to improve their level of practice, suggesting that in five years, the number of second-line private doctors will increase by 20% to 244 despite 24 planned retirements within the same period. This data probably underestimates the role of private doctors in NDD diagnosis, follow-up, and initial Methylphenidate prescriptions given the unfavourable working conditions (no financial compensation for long appointments, difficulty accessing paramedical and psychological assessments). Conclusions Our data confirms that diagnosis and care coordination in the various presentations of NDD may rely on different types of practices and specializations: medical and social professionals, mental health professionals, but also a growing body of medical doctors involved in developmental and behavioural pediatrics. This data and reflection will be helpful for organizing healthcare in France or in other countries. Main study limitation relies in the self-declaration of MD's involvement in NDD and could not evaluate the activity of employed MD's from the social and medico social sector, nor be based on the national databases for prescription. It remains however the first attempt of characterization of medical activity at the national level in France for NDD.
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Affiliation(s)
- Thiébaut-Noël Willig
- Clinique Ambroise Paré, ELSAN Group, & Eventail 31, Toulouse, France
- Occitadys, Toulouse, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Jean-Paul Blanc
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Rémy Assathiany
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Claire Bilbault
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
- Association Française des Neuropédiatres Libéraux (AFNL), Chatenay Malabry, France
- CHR Metz Thionville, Ars Laquenexy, France
| | | | - Andreas Werner
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
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Hamard J, Rousseau V, Durrieu G, Garcia P, Yrondi A, Sommet A, Revet A, Montastruc F. Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults. BMJ MENTAL HEALTH 2024; 27:e300876. [PMID: 38609318 PMCID: PMC11029235 DOI: 10.1136/bmjment-2023-300876] [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: 09/05/2023] [Accepted: 01/13/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Use of psychostimulants and relative drugs has increased worldwide in treatment of attention-deficit hyperactivity disorder (ADHD) in adolescents and adults. Recent studies suggest a potential association between use of psychostimulants and psychotic symptoms. The risk may not be the same between different psychostimulants. OBJECTIVE To assess whether amphetamine or atomoxetine use is associated with a higher risk of reporting symptoms of psychosis than methylphenidate use in adolescents and adults, particularly in patients with ADHD. METHODS Using VigiBase, the WHO's pharmacovigilance database, disproportionality of psychotic symptoms reporting was assessed among adverse drug reactions related to methylphenidate, atomoxetine and amphetamines, from January 2004 to December 2018, in patients aged 13-25 years. The association between psychotic symptoms and psychostimulants was estimated through the calculation of reporting OR (ROR). FINDINGS Among 13 863 reports with at least one drug of interest, we found 221 cases of psychosis with methylphenidate use, 115 with atomoxetine use and 169 with a prescription of an amphetamine drug. Compared with methylphenidate use, amphetamine use was associated with an increased risk of reporting psychotic symptoms (ROR 1.61 (95% CI 1.26 to 2.06)]. When we restricted the analysis to ADHD indication, we found a close estimate (ROR 1.94 (95% CI 1.43 to 2.64)). No association was found for atomoxetine. CONCLUSION Our study suggests that amphetamine use is associated with a higher reporting of psychotic symptoms, compared with methylphenidate use. CLINICAL IMPLICATIONS The prescription of psychostimulants should consider this potential adverse effect when assessing the benefit-risk balance.
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Affiliation(s)
- Jacques Hamard
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Department of Psychiatry, Centre Hospitalier Gérard Marchant, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Geneviève Durrieu
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Philippe Garcia
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Department of Medical Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
| | - Antoine Yrondi
- Department of Medical Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
- Treatment Resistant Depression Expert Center, FondaMental, Toulouse, France
- ToNIC Toulouse NeuroImaging Center, University Paul Sabatier Toulouse INSERM, Toulouse, France
| | - Agnès Sommet
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
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10
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Kim S, Munten S, Kolla NJ, Konkolÿ Thege B. Conduct problems, hyperactivity, and screen time among community youth: can mindfulness help? an exploratory study. Front Psychiatry 2024; 15:1248963. [PMID: 38654727 PMCID: PMC11035720 DOI: 10.3389/fpsyt.2024.1248963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Background The influence of mindfulness-based intervention (MBI) programs on behavioural problems among community youth is largely understudied. While technology continues to evolve and the prevalence of screen-based activities is rising, limited studies have accounted for screen time when examining the efficacy of an MBI. Accordingly, this study investigated the impact of MBI on conduct problems and hyperactivity among community youth, accounting for sociodemographic characteristics and four types of screen time. Method Linear regression models were used to investigate 1) the association between four types of screen time and behavioural problems (i.e., conduct problems and hyperactivity) and 2) the efficacy of online mindfulness programs in reducing behavioural problems among community youth. The data were collected at baseline, intervention completion and 1-month follow-up (Spring 2021 to Spring 2022) in Ontario, Canada (n=117, mean age=16.82, male=22%, non-White=21%). Results The average score for conduct problems was within the normal range, while the average score for hyperactivity was considered borderline at baseline. Accounting for other types of screen time, time spent playing video games was significantly associated with increased conduct problems (β= 1.75, p=.03), albeit rendering non-significant after correcting for multiple comparisons. The online mindfulness program was significantly associated with reduced hyperactivity, controlling for baseline mental health, age, sex and screen time. Conclusion The current findings suggest a 12-week online mindfulness program may play a positive role in reducing hyperactivity even when accounting for screen time. Our findings advocate the evidence base on the efficacy of MBI in managing hyperactivity.
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Affiliation(s)
- Soyeon Kim
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stephanie Munten
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Nathan J. Kolla
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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11
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Andersen AC, Sund AM, Thomsen PH, Lydersen S, Young S, Nøvik TS. One year follow-up of participants in a randomised controlled trial of a CBT-based group therapy programme for adolescents diagnosed with ADHD. Nord J Psychiatry 2024; 78:189-197. [PMID: 38353423 DOI: 10.1080/08039488.2024.2301774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adolescents with ADHD often struggle on many areas of their lives and have a high risk of adverse outcomes and negative life trajectories. Multimodal treatment including psychosocial interventions is recommended but evidence regarding effect of such interventions is still limited. MATERIALS AND METHODS This study was a follow-up study of adolescents participating in a randomised controlled trial (RCT) of a group intervention based on cognitive behavioural therapy (CBT). Participants were adolescents diagnosed with ADHD and still impaired by their symptoms after standard treatment including psychoeducation and medication. All participants were interviewed by telephone one year after inclusion, and outcome measures included both quantitative and qualitative measures. RESULTS There were 100 adolescents included in the study. We found no significant differences between treatment and control group on measures of ADHD-symptoms, self-efficacy, overall problems, global psychosocial functioning, or symptom severity at one-year follow-up. Still, participants in the intervention group reported on positive gains and that they learned a lot about ADHD and themselves. CONCLUSIONS The intervention delivered in this trial failed to show a treatment effect on symptom level when added to standard care. Participants did however report on positive gains and felt they learned a lot. More research is needed to explore how the programme and delivery of treatment might be improved, and which patients might benefit the most from this type of interventions.
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Affiliation(s)
- Ann Christin Andersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Per Hove Thomsen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Torunn Stene Nøvik
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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12
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Cortese S, Besag FMC, Clark B, Hollis C, Kilgariff J, Moreno C, Nicholls D, Wilkinson P, Woodbury-Smith M, Sharma A. Common pitfalls, and how to avoid them, in child and adolescent psychopharmacology: Part I. J Psychopharmacol 2024; 38:311-317. [PMID: 38494948 PMCID: PMC11010544 DOI: 10.1177/02698811241239582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of attention-deficit/hyperactivity disorder, anxiety, bipolar disorder, depression, obsessive-compulsive disorder and related disorders, and tic disorder. Pitfalls in the treatment of other disorders are addressed in a separate paper (part II).
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Frank MC Besag
- UCL School of Pharmacy, London, UK
- East London Foundation NHS Trust, Bedfordshire, UK
| | - Bruce Clark
- National Specialist Clinic for Young People with OCD, BDD and Related Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Hollis
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
- National Institute of Mental Health (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health & Technology Theme, Institute of Mental Health, Nottingham, UK
| | - Joe Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
- NIHR ARC Northwest London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Aditya Sharma
- Academic Psychiatry, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Specialist Adolescent Mood Disorders Service (SAMS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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13
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Abbas K, Barnhardt EW, Nash PL, Streng M, Coury DL. A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder. Expert Rev Neurother 2024; 24:421-432. [PMID: 38391788 DOI: 10.1080/14737175.2024.2321921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Amphetamine preparations are one of the two categories of stimulant medications approved for the treatment of attention deficit hyperactivity disorder (ADHD). Optimal treatment of ADHD aims to reduce core symptoms for as much of the waking hours as possible, leading to longer-acting delivery formats. In addition, the pediatric population commonly has difficulty swallowing pills and manufacturers have developed a variety of options to facilitate this concern. These include chewable tablets, capsules that may be sprinkled on soft food, liquids and transdermal patches. AREAS COVERED This article reviews the once-daily extended-release preparations currently available for amphetamine compounds, their pharmacodynamics, and common adverse effects. EXPERT OPINION There is an extensive evidence base supporting use of amphetamine preparations in the treatment of ADHD. Rapid onset of action and a favorable side effect profile make these widely used. The availability of once-daily extended-release chewable tablets, capsules that can be opened and sprinkled, and liquid formulations provides clinicians with multiple options to meet the specific needs of patients with difficulty swallowing whole pills.
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Affiliation(s)
- Kendall Abbas
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth W Barnhardt
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Patricia L Nash
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maria Streng
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel L Coury
- Division of Developmental-Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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Stein MA, Sibley MH, Newcorn JH. Editorial: Attention-Deficit/Hyperactivity Disorder, Stimulant Medication, and Criminality: Commentary and Caution. J Am Acad Child Adolesc Psychiatry 2024; 63:401-403. [PMID: 37657497 DOI: 10.1016/j.jaac.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
Pioneering longitudinal studies of boys with hyperactivity by Satterfield et al.1 indicated that one of the most deleterious outcomes associated with attention-deficit/hyperactivity disorder (ADHD) is later antisocial behaviors. This risk grows when ADHD is accompanied by severe behavior problems.2 Though most children with ADHD will not go on to engage in criminal behavior, dimensional measures of externalizing behavior problems as well as categorical diagnoses of oppositional defiant disorder and conduct disorder have strong associations with ADHD. Moreover, cross-sectional studies of incarcerated adults indicate that 20% to 30% meet diagnostic criteria for ADHD.3 These associations between childhood ADHD, oppositional defiant disorder, and conduct disorder and later criminal behavior beg the question of whether treatment of ADHD can reduce the severity of, or in some cases prevent, criminal behavior.
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Affiliation(s)
- Mark A Stein
- Seattle Children's and University of Washington, Seattle, Washington.
| | - Margaret H Sibley
- Seattle Children's and University of Washington, Seattle, Washington
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15
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Ruchkin V, Wallonius M, Odekvist E, Kim S, Isaksson J. Memory training with the method of loci for children and adolescents with ADHD-A feasibility study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:137-145. [PMID: 36344263 DOI: 10.1080/21622965.2022.2141120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate if training with the memory technique Method of Loci (MoL) is feasible for children and adolescents with ADHD. Twelve children (aged 9-17 years) with ADHD participated. Training with MoL was done using a mobile application, memorizing a sequence of 20-80 pictures, intended to be carried out five times per week for 4 weeks. Feasibility was assessed with pre- and post-intervention ratings, and with interviews after the training. Qualitative data were analyzed with content analysis. Those who trained with MoL performed better on memory test and reported fewer ADHD symptoms after completing the training, as compared to their baseline levels. All of these children would recommend the training to peers but the duration of training varied considerably. The participants and their parents reported that the MoL training was easy and fun to use, although lack of motivation, distractions in every-day life, and lack of routines created challenges. We conclude that training with MoL was considered feasible by most of the participants. Future research should try to make the intervention more acceptable by motivating the participants and limiting potential distractions and involving larger study groups and controls to study the efficacy of the training.
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Affiliation(s)
- Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marwin Wallonius
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Odekvist
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sharmeen Kim
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Eiland LS, Gildon BL. Diagnosis and Treatment of ADHD in the Pediatric Population. J Pediatr Pharmacol Ther 2024; 29:107-118. [PMID: 38596418 PMCID: PMC11001204 DOI: 10.5863/1551-6776-29.2.107] [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: 04/20/2023] [Accepted: 07/19/2023] [Indexed: 04/11/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood with approximately 6 million children (age 3 to 17 years) ever diagnosed based on data from 2016-2019. ADHD is characterized by a constant pattern of inattention and/or hyperactivity-impulsivity symptoms that interferes with development or functioning. Specific criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition Text Revision assist with the diagnosis with multiple guidelines available providing non-pharmacologic and pharmacologic recommendations for the treatment of ADHD in the pediatric population. While all guidelines similarly recommend behavioral and/or stimulant therapy as first-line therapy based on age, not all stimulant products are equal. Their differing pharmacokinetic profiles and formulations are essential to understand in order to optimize efficacy and safety for patients. Additionally, new stimulant products and non-stimulant medications continue to be approved for use of ADHD in the pediatric population and it is important to know their differences in formulation, efficacy, and safety to other products currently available. Lastly, due to drug shortages, it is important to understand product similarities and differences to select alternative therapy for patients.
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Affiliation(s)
- Lea S. Eiland
- Department of Pharmacy Practice (LSE), Auburn University Harrison College of Pharmacy
| | - Brooke L. Gildon
- Department of Pharmacy Practice (BLG), Southwestern Oklahoma State University College of Pharmacy
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17
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Guo HL, Wu DD, Fu D, Li Y, Wang J, Zhang YY, Wang WJ, Huang J, Fang WR, Xu J, Hu YH, Liu QQ, Chen F. Individualized atomoxetine response and tolerability in children with ADHD receiving different dosage regimens: the need for CYP2D6 genotyping and therapeutic drug monitoring to dance together. Transl Psychiatry 2024; 14:151. [PMID: 38504095 PMCID: PMC10951231 DOI: 10.1038/s41398-024-02859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
Integrating CYP2D6 genotyping and therapeutic drug monitoring (TDM) is crucial for guiding individualized atomoxetine therapy in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this retrospective study was (1) to investigate the link between the efficacy and tolerability of atomoxetine in children with ADHD and plasma atomoxetine concentrations based on their CYP2D6 genotypes; (2) to offer TDM reference range recommendations for atomoxetine based on the CYP2D6 genotypes of children receiving different dosage regimens. This retrospective study covered children and adolescents with ADHD between the ages of 6 and <18, who visited the psychological and behavioral clinic of Children's Hospital of Nanjing Medical University from June 1, 2021, to January 31, 2023. The demographic information and laboratory examination data, including CYP2D6 genotype tests and routine TDM of atomoxetine were obtained from the hospital information system. We used univariate analysis, Mann-Whitney U nonparametric test, Kruskal-Wallis test, and the receiver operating characteristic (ROC) curve to investigate outcomes of interest. 515 plasma atomoxetine concentrations of 385 children (325 boys and 60 girls) with ADHD between 6 and 16 years of age were included for statistical analysis in this study. Based on genotyping results, >60% of enrolled children belonged to the CYP2D6 extensive metabolizer (EM), while <40% fell into the intermediate metabolizer (IM). CYP2D6 IMs exhibited higher dose-corrected plasma atomoxetine concentrations by 1.4-2.2 folds than those CYP2D6 EMs. Moreover, CYP2D6 IMs exhibited a higher response rate compare to EMs (93.55% vs 85.71%, P = 0.0132), with higher peak plasma atomoxetine concentrations by 1.67 times than those of EMs. Further ROC analysis revealed that individuals under once daily in the morning (q.m.) dosing regimen exhibited a more effective response to atomoxetine when their levels were ≥ 268 ng/mL (AUC = 0.710, P < 0.001). In addition, CYP2D6 IMs receiving q.m. dosing of atomoxetine were more likely to experience adverse reactions in the central nervous system and gastrointestinal system when plasma atomoxetine concentrations reach 465 and 509 ng/mL, respectively. The findings in this study provided promising treatment strategy for Chinese children with ADHD based on their CYP2D6 genotypes and plasma atomoxetine concentration monitoring. A peak plasma atomoxetine concentration higher than 268 ng/mL might be requisite for q.m. dosing. Assuredly, to validate and reinforce these initial findings, it is necessary to collect further data in controlled studies with a larger sample size.
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Affiliation(s)
- Hong-Li Guo
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dan-Dan Wu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Di Fu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Visiting graduate student from China Pharmaceutical University, Nanjing, China
| | - Yue Li
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan-Yuan Zhang
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Jun Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Visiting graduate student from China Pharmaceutical University, Nanjing, China
| | - Jian Huang
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Rong Fang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Qian-Qi Liu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Feng Chen
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
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18
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Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA 2024; 331:850-860. [PMID: 38470385 PMCID: PMC10936112 DOI: 10.1001/jama.2024.0851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024]
Abstract
Importance Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk. Objective To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD. Design, Setting, and Participants In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first. Exposures ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis. Main Outcomes and Measures We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings). Results Of 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 individuals (95% CI, -17.3 to -0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 individuals; 95% CI, -14.2 to -0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 individuals; 95% CI, -6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05). Conclusions and Relevance Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.
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Affiliation(s)
- Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nanbo Zhu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health–School of Psychology, Faculty of Environmental and Life Sciences, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- New York University Child Study Center, Hassenfeld Children’s Hospital at NYU Langone, New York
- Solent NHS Trust, Southampton, United Kingdom
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari Aldo Moro, Bari, Italy
| | - Henrik Larsson
- School of medical sciences, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Levin FR, Hernandez M, Mariani JJ. Treating Attention-Deficit/Hyperactivity Disorder Matters. JAMA 2024; 331:831-833. [PMID: 38470393 DOI: 10.1001/jama.2024.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Mariely Hernandez
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - John J Mariani
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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20
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Zhang Y, Yin L, You C, Liu C, Dong P, Xu X, Zhang K. Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting. Drugs R D 2024; 24:29-39. [PMID: 37982991 PMCID: PMC11035522 DOI: 10.1007/s40268-023-00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Methylphenidate (MPH) and atomoxetine (ATX) are the most common medications used to treat attention-deficit hyperactivity disorder (ADHD) in China; however, despite this, there is still a paucity of studies comparing their efficacy and safety, particularly for different characteristics. To address the lack of research, a real-world prospective cohort study was conducted to examine these properties of MPH and ATX, and to analyze correlations associated with age, sex, and different ADHD presentation. METHODS Children with ADHD meeting the eligibility criteria were recruited from January 2016 to July 2021. Study participants were treated with either MPH or ATX prescribed in the real-world setting, and were followed up for 26 weeks. Clinical efficacy response and adverse events (AEs) were recorded and measured. Subgroup analysis was performed to examine the efficacy response and AEs associated with age, sex, and different ADHD presentation. RESULTS A total of 1050 children were recruited and 29 children were lost to follow-up. Of the 1021 children remaining, 533 were treated with MPH and 488 were treated with ATX. No significant differences were found in intelligence quotient, age, sex, or ADHD presentation between the MPH- and ATX-treated groups (p > 0.05). The response rates were 84.6% in the MPH-treated group and 63.3% in the ATX-treated group. Subgroup analysis of response rate demonstrated that the treatment effect of MPH over ATX was consistent across subgroups except in the girls (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.97-4.7) and the hyperactive/impulsive presentation group (OR 2.88, 95% CI 0.77-12.76). A total of 47.8% of children experienced AEs during MPH treatment, significantly lower than the rate of 56.8% during ATX treatment (p < 0.05). The incidence of AEs in the MPH-treated group was higher in young children (<8 years: 56.8%; 8-10 years: 47.2%) and lower in children over 10 years of age (29.0%). CONCLUSIONS Overall, MPH was more effective and better tolerated than ATX. The incidence of AEs in children treated with MPH varied with age, and was higher in young children and lower in children over 10 years of age.
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Affiliation(s)
- Ying Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Yin
- Department of Pediatrics, Taixing People's Hospital, Taizhou, China
| | - Cun You
- Department of Pediatrics, Fudan University Minhang Hospital, Shanghai, China
| | - Chunxue Liu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Dong
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Kaifeng Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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21
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Kawabe K, Horiuchi F, Matsumoto Y, Inoue S, Okazawa M, Hosokawa R, Nakachi K, Soga J, Ueno S. Practical clinical guidelines and pharmacological treatment for attention-deficit hyperactivity disorder in Asia. Neuropsychopharmacol Rep 2024; 44:29-33. [PMID: 38059346 PMCID: PMC10932761 DOI: 10.1002/npr2.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 12/08/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is characterized by persistent symptoms of inattention, hyperactivity, and impulsivity. Both, stimulant and nonstimulant medications have been approved for the treatment of this disorder. Several Western guidelines recommend the use of prescribed Food and Drug Administration (FDA)-approved medications for ADHD along with parental training in behavior management and behavioral classroom intervention. In 2022, new Japanese guidelines for ADHD were issued, which recommended school environment management and psychosocial treatment as the first-line treatment, with pharmacological treatment added as the second-line treatment. Although Japanese guidelines, including pharmacological treatments, have been established, the guidelines and utilization of ADHD medications across Asian regions are unclear. Therefore, to appropriately evaluate the strategy of pharmacological treatments for ADHD, we investigated Asian regional guidelines for ADHD medication in children. We also reviewed the guidelines in Malaysia, Singapore, India, and the Republic of Korea and found that these guidelines differ from Western guidelines.
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Affiliation(s)
- Kentaro Kawabe
- Department of Child PsychiatryEhime University Graduate School of MedicineToon CityJapan
| | - Fumie Horiuchi
- Department of Child PsychiatryEhime University Graduate School of MedicineToon CityJapan
| | - Yu Matsumoto
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Saori Inoue
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Maya Okazawa
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Rie Hosokawa
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Kiwamu Nakachi
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Junya Soga
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
| | - Shu‐Ichi Ueno
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToon CityJapan
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22
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Vasiliadis HM, Lunghi C, Rahme E, Rochette L, Gignac M, Massamba V, Diallo FB, Fansi A, Cortese S, Lesage A. ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study. Transl Psychiatry 2024; 14:128. [PMID: 38418443 PMCID: PMC10901868 DOI: 10.1038/s41398-024-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Department of Community Health Science, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A5, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, 48 - 40126, Bologna, Italy
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Fatoumata Binta Diallo
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Alvine Fansi
- Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal /Montreal West Island Integrated University Health and Social Services Centre, Montreal, QC, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Building 44, Room 4059, University Rd, Southampton, SO171PS, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, HighPoint Venue, Bursledon Rd, Southampton, SO19 8BR, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, One Park, New York City, NY, 10016, USA
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari "Aldo Moro", Bari, Italy
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montreal, QC, H1N 3M5, Canada
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23
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Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
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24
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McCabe SE, Schulenberg JE, Wilens TE, Schepis TS, Werner KS, McCabe VV, Veliz PT. Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood. Psychiatr Serv 2024:appips20230418. [PMID: 38321920 DOI: 10.1176/appi.ps.20230418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants). METHODS National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM. RESULTS Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood. CONCLUSIONS Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - John E Schulenberg
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Timothy E Wilens
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Kennedy S Werner
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Philip T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
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25
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Cortese S, Fava C. Long-Term Cardiovascular Effects of Medications for Attention-Deficit/Hyperactivity Disorder-Balancing Benefits and Risks of Treatment. JAMA Psychiatry 2024; 81:123-124. [PMID: 37991770 DOI: 10.1001/jamapsychiatry.2023.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City
| | - Cristiano Fava
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Verona, Italy
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
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26
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Cao C, Deakin C, Gill S. Attitudes of South Australian psychiatrists towards attention deficit hyperactivity disorder in adults. Australas Psychiatry 2024; 32:11-17. [PMID: 37943992 DOI: 10.1177/10398562231211132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE A lack of access to psychiatric services for adult ADHD is a recognised issue in South Australia and nationally. This study aims to explore the practices of local psychiatrists and their attitudes towards adult ADHD, with a view to determining any barriers influencing accessibility to treatment. METHODS We developed an online survey to examine the aims of the study. Free text boxes were included to obtain qualitative data. Quantitative data were tallied and presented as percentages. Qualitative data (free text responses) were analysed thematically. RESULTS 73 out of 322 psychiatrists responded (22.7%). The greatest barrier to seeing adult ADHD was the fear of being inundated with cases (68.5%), followed by lack of experience managing ADHD (32.9%), and potential drug-seeking behaviour of patients (31.5%). Two overarching qualitative themes were identified: practical barriers and attitudinal barriers. CONCLUSION ADHD service provision is complex and relates to many systemic factors such as public versus private, funding, and service organisation. More psychiatrists need to become involved in treating ADHD so that the work is more widely spread. Increased training in ADHD is also needed to increase confidence in managing the condition.
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Affiliation(s)
- Claudia Cao
- Child and Adolescent Mental Health Service, Women's and Children's Health Network, North Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Callum Deakin
- Child and Adolescent Mental Health Service, Women's and Children's Health Network, North Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Shane Gill
- South Australian Psychiatry Branch Training Committee, Glenside Health Service, Glenside, SA, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
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27
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Zhang L, Li L, Andell P, Garcia-Argibay M, Quinn PD, D’Onofrio BM, Brikell I, Kuja-Halkola R, Lichtenstein P, Johnell K, Larsson H, Chang Z. Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry 2024; 81:178-187. [PMID: 37991787 PMCID: PMC10851097 DOI: 10.1001/jamapsychiatry.2023.4294] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/29/2023] [Indexed: 11/23/2023]
Abstract
Importance Use of attention-deficit/hyperactivity disorder (ADHD) medications has increased substantially over the past decades. However, the potential risk of cardiovascular disease (CVD) associated with long-term ADHD medication use remains unclear. Objective To assess the association between long-term use of ADHD medication and the risk of CVD. Design, Setting, and Participants This case-control study included individuals in Sweden aged 6 to 64 years who received an incident diagnosis of ADHD or ADHD medication dispensation between January 1, 2007, and December 31, 2020. Data on ADHD and CVD diagnoses and ADHD medication dispensation were obtained from the Swedish National Inpatient Register and the Swedish Prescribed Drug Register, respectively. Cases included individuals with ADHD and an incident CVD diagnosis (ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease). Incidence density sampling was used to match cases with up to 5 controls without CVD based on age, sex, and calendar time. Cases and controls had the same duration of follow-up. Exposure Cumulative duration of ADHD medication use up to 14 years. Main Outcomes and Measures The primary outcome was incident CVD. The association between CVD and cumulative duration of ADHD medication use was measured using adjusted odds ratios (AORs) with 95% CIs. Results Of 278 027 individuals with ADHD aged 6 to 64 years, 10 388 with CVD were identified (median [IQR] age, 34.6 [20.0-45.7] years; 6154 males [59.2%]) and matched with 51 672 control participants without CVD (median [IQR] age, 34.6 [19.8-45.6] years; 30 601 males [59.2%]). Median (IQR) follow-up time in both groups was 4.1 (1.9-6.8) years. Longer cumulative duration of ADHD medication use was associated with an increased risk of CVD compared with nonuse (0 to ≤1 year: AOR, 0.99 [95% CI, 0.93-1.06]; 1 to ≤2 years: AOR, 1.09 [95% CI, 1.01-1.18]; 2 to ≤3 years: AOR, 1.15 [95% CI, 1.05-1.25]; 3 to ≤5 years: AOR, 1.27 [95% CI, 1.17-1.39]; and >5 years: AOR, 1.23 [95% CI, 1.12-1.36]). Longer cumulative ADHD medication use was associated with an increased risk of hypertension (eg, 3 to ≤5 years: AOR, 1.72 [95% CI, 1.51-1.97] and >5 years: AOR, 1.80 [95% CI, 1.55-2.08]) and arterial disease (eg, 3 to ≤5 years: AOR, 1.65 [95% CI, 1.11-2.45] and >5 years: AOR, 1.49 [95% CI, 0.96-2.32]). Across the 14-year follow-up, each 1-year increase of ADHD medication use was associated with a 4% increased risk of CVD (AOR, 1.04 [95% CI, 1.03-1.05]), with a larger increase in risk in the first 3 years of cumulative use (AOR, 1.08 [95% CI, 1.04-1.11]) and stable risk over the remaining follow-up. Similar patterns were observed in children and youth (aged <25 years) and adults (aged ≥25 years). Conclusions and Relevance This case-control study found that long-term exposure to ADHD medications was associated with an increased risk of CVDs, especially hypertension and arterial disease. These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use. Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment.
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Affiliation(s)
- Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Andell
- Unit of Cardiology, Heart and Vascular Division, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Miguel Garcia-Argibay
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Brikell I, Yao H, Li L, Astrup A, Gao L, Gillies MB, Xie T, Zhang-James Y, Dalsgaard S, Engeland A, Faraone SV, Haavik J, Hartman C, Ip P, Jakobsdóttir Smári U, Larsson H, Man KK, de Oliveira Costa J, Pearson SA, Hostrup Nielsen NP, Snieder H, Wimberley T, Wong IC, Zhang L, Zoega H, Klungsøyr K, Chang Z. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry 2024; 11:16-26. [PMID: 38035876 DOI: 10.1016/s2215-0366(23)00332-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice. METHODS We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4-11 years], adolescents [age 12-17 years], young adults [age 18-24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available. FINDINGS 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8-21 years) were included in the study. Across countries, treatment discontinuation 1-5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60-70) of children, 47% (43-51) of adolescents, 39% (36-42) of young adults, and 48% (44-52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50-60% of children and 30-40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex. INTERPRETATION Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use. FUNDING European Union Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- Isabell Brikell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Honghui Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aske Astrup
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Malcolm B Gillies
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tian Xie
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark; Institute of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stephen V Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina Hartman
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Unnur Jakobsdóttir Smári
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kenneth Kc Man
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Juliana de Oliveira Costa
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Nina Pil Hostrup Nielsen
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Theresa Wimberley
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ian Ck Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Qu S, Zhou X, Wang Z, Wei Y, Zhou H, Zhang X, Zhu Q, Wang Y, Yang Q, Jiang L, Ma Y, Gao Y, Kong L, Zhang L. The effects of methylphenidate and atomoxetine on Drosophila brain at single-cell resolution and potential drug repurposing for ADHD treatment. Mol Psychiatry 2024; 29:165-185. [PMID: 37957291 PMCID: PMC11078728 DOI: 10.1038/s41380-023-02314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The stimulant methylphenidate (MPH) and the non-stimulant atomoxetine (ATX) are frequently used for the treatment of attention-deficit/hyperactivity disorder (ADHD); however, the function of these drugs in different types of brain cells and their effects on related genes remain largely unknown. To address these questions, we built a pipeline for the simultaneous examination of the activity behavior and transcriptional responses of Drosophila melanogaster at single-cell resolution following drug treatment. We selected the Drosophila with significantly increased locomotor activities (hyperactivity-like behavior) following the administration of each drug in comparison with the control (same food as the drug-treated groups with 5% sucrose, yeast, and blue food dye solution) using EasyFlyTracker. Subsequently, single cell RNA sequencing (scRNASEQ) was used to capture the transcriptome of 82,917 cells, unsupervised clustering analysis of which yielded 28 primary cell clusters representing the major cell types in adult Drosophila brain. Indeed, both neuronal and glial cells responded to MPH and ATX. Further analysis of differentially expressed genes (DEGs) revealed distinct transcriptional changes associated with these two drugs, such as two well-studied dopamine receptor genes (Dop2R and DopEcR) were responsive to MPH but not to ATX at their optimal doses, in addition to genes involved in dopamine metabolism pathways such as Syt1, Sytalpha, Syt7, and Ih in different cell types. More importantly, MPH also suppressed the expression of genes encoding other neurotransmitter receptors and synaptic signaling molecules in many cell types, especially those for Glu and GABA, while the responsive effects of ATX were much weaker. In addition to monoaminergic neuronal transmitters, other neurotransmitters have also shown a similar pattern with respect to a stronger effect associated with MPH than with ATX. Moreover, we identified four distinct glial cell subtypes responsive to the two drugs and detected a greater number of differentially expressed genes associated with ensheathing and astrocyte-like glia. Furthermore, our study provides a rich resource of candidate target genes, supported by drug set enrichment analysis (P = 2.10E-4; hypergeometric test), for the further exploration of drug repurposing. The whole list of candidates can be found at ADHDrug ( http://adhdrug.cibr.ac.cn/ ). In conclusion, we propose a fast and cost-efficient pipeline to explore the underlying molecular mechanisms of ADHD drug treatment in Drosophila brain at single-cell resolution, which may further facilitate drug repurposing applications.
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Affiliation(s)
- Susu Qu
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- Chinese Institute for Brain Research, Beijing, China.
| | - Xiangyu Zhou
- Chinese Institute for Brain Research, Beijing, China
| | - Zhicheng Wang
- Chinese Institute for Brain Research, Beijing, China
| | - Yi Wei
- Chinese Institute for Brain Research, Beijing, China
| | - Han Zhou
- Chinese Institute for Brain Research, Beijing, China
| | | | - Qingjie Zhu
- Chinese Institute for Brain Research, Beijing, China
| | - Yanmin Wang
- Chinese Institute for Brain Research, Beijing, China
| | - Quanjun Yang
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Likun Jiang
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Yuan Ma
- Chinese Institute for Brain Research, Beijing, China
| | - Yuan Gao
- Chinese Institute for Brain Research, Beijing, China
| | - Lei Kong
- Center for Bioinformatics, State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences, Peking University, Beijing, China
| | - Li Zhang
- Chinese Institute for Brain Research, Beijing, China.
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Petti T, Gupta M, Fradkin Y, Gupta N. Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians. BJPsych Open 2023; 10:e11. [PMID: 38088185 PMCID: PMC10755553 DOI: 10.1192/bjo.2023.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 12/31/2023] Open
Abstract
AIMS To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. BACKGROUND Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. METHOD This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. RESULTS Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. CONCLUSIONS Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.
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Affiliation(s)
- Theodore Petti
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Yuli Fradkin
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Raible H, D'Souza MS. Extended-Release Viloxazine for the Treatment of Attention-Deficit Hyperactivity Disorder in School-Age Children and Adolescents. Ann Pharmacother 2023; 57:1436-1448. [PMID: 37021356 DOI: 10.1177/10600280231163252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE To describe the efficacy and safety of extended-release viloxazine (viloxazine ER; Qelbree) for the treatment of attention-deficit hyperactivity disorder (ADHD) in school-age children and adolescents (6-17 years). DATA SOURCES A literature search was conducted with PubMed using the following terms: viloxazine and ADHD (August 1, 2017 to February 1, 2023). STUDY SELECTION AND DATA EXTRACTION All relevant English-language articles examining the efficacy and safety of viloxazine ER were considered for inclusion. DATA SYNTHESIS Phase III studies reported significant improvement in ADHD symptoms after viloxazine ER treatment in both school-age children (100 mg/d, P = 0.0004 and 200 mg/d, P < 0.0001; NCT03247530) and adolescents (200 mg/d, P = 0.0232; 400 mg/d, P = 0.0091; NCT03247517) compared with placebo. Common adverse effects associated with viloxazine ER included somnolence, fatigue, irritability, decreased appetite, and headache. Together, the studies demonstrated the efficacy and safety of viloxazine ER in patients with ADHD. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS Viloxazine ER is a serotonin-norepinephrine modulator, which is administered once daily orally. It is classified as a nonstimulant medication, which can be used in patients with ADHD who do not respond to or cannot tolerate stimulant medications. Even though atomoxetine and viloxazine ER have not been directly compared, clinical studies have suggested that viloxazine ER has a faster onset of action (~1-2 weeks) compared with atomoxetine (~4 weeks). Like atomoxetine, viloxazine ER carries a boxed warning for suicidal ideation and/or behavior. CONCLUSION Viloxazine ER is a useful addition to other nonstimulant medications available to treat patients with ADHD.
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Affiliation(s)
- Haley Raible
- The Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
| | - Manoranjan S D'Souza
- The Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
- Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
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Ahlberg R, Garcia-Argibay M, Rietz ED, Butwicka A, Cortese S, D'Onofrio BM, Ludvigsson JF, Larsson H. Associations Between Attention-Deficit/Hyperactivity Disorder (ADHD), ADHD Medication, and Shorter Height: A Quasi-Experimental and Family-Based Study. J Am Acad Child Adolesc Psychiatry 2023; 62:1316-1325. [PMID: 37084883 DOI: 10.1016/j.jaac.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The association between attention-deficit/hyperactivity disorder (ADHD) and shorter height is unclear. This study examined the risk of shorter height in individuals with ADHD, and the influence of prenatal factors, ADHD medication, psychiatric comorbidity, socioeconomic factors, and familial liability. METHOD We drew on Swedish National Registers for 2 different study designs. First, height data for 14,268 individuals with ADHD and 71,339 controls were stratified into 2 groups: (1) before stimulant treatment was introduced in Sweden, and (2) after stimulant treatment was introduced in Sweden. Second, we used a family-based design including 833,172 relatives without ADHD with different levels of relatedness to the individuals with ADHD and matched controls. RESULTS ADHD was associated with shorter height both before (below-average height: OR = 1.31, 95% CI = 1.22-1.41) and after (below-average height: OR = 1.21, 95% CI = 1.13-1.31) stimulants for ADHD were introduced in Sweden, and was of similar magnitude in both cohorts. The association between ADHD and shorter height attenuated after adjustment for prenatal factors, psychiatric disorders, and socioeconomic status. Relatives of individuals with ADHD had an increased risk of shorter height (below-average height in full siblings: OR = 1.14, 95% CI = 1.09-1.19; maternal half siblings: OR = 1.10, 95% CI = 1.01-1.20; paternal half siblings: OR = 1.15, 95% CI = 1.07-1.24, first full cousins: OR = 1.10, 95% CI = 1.08-1.12). CONCLUSION Our findings suggest that ADHD is associated with shorter height. On a population level, this association was present both before and after ADHD medications were available in Sweden. The association between ADHD and height was partly explained by prenatal factors, psychiatric comorbidity, low socioeconomic status, and a shared familial liability for ADHD.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Örebro, Sweden; Karolinska Institutet, Stockholm, Sweden
| | | | - Agnieszka Butwicka
- Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life sciences, University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Brian M D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, Indiana
| | - Jonas F Ludvigsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Karolinska Institutet, Stockholm, Sweden; Örebro University Hospital, Örebro University, Örebro, Sweden
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Gosling CJ, Caparos S, Pinabiaux C, Schwarzer G, Rücker G, Agha SS, Alrouh H, Ambler A, Anderson P, Andiarena A, Arnold LE, Arseneault L, Asherson P, Babinski L, Barbati V, Barkley R, Barros AJD, Barros F, Bates JE, Bell LJ, Berenguer C, van Bergen E, Biederman J, Birmaher B, B⊘e T, Boomsma DI, Brandt VC, Bressan RA, Brocki K, Broughton TR, Bufferd SJ, Bussing R, Cao M, Cartigny A, Casas AM, Caspi A, Castellanos FX, Caye A, Cederkvist L, Collishaw S, Copeland WE, Cote SM, Coventry WL, Debes NMM, Denyer H, Dodge KA, Dogru H, Efron D, Eller J, Abd Elmaksoud M, Ercan ES, Faraone SV, Fenesy M, Fernández MF, Fernández-Somoano A, Findling R, Fombonne E, Fossum IN, Freire C, Friedman NP, Fristad MA, Galera C, Garcia-Argibay M, Garvan CS, González-Safont L, Groenman AP, Guxens M, Halperin JM, Hamadeh RR, Hartman CA, Hill SY, Hinshaw SP, Hipwell A, Hokkanen L, Holz N, Íñiguez C, Jahrami HA, Jansen PW, Jónsdóttir LK, Julvez J, Kaiser A, Keenan K, Klein DN, Klein RG, Kuntsi J, Langfus J, Langley K, Lansford JE, Larsen SA, Larsson H, Law E, Lee SS, Lertxundi N, Li X, Li Y, Lichtenstein P, Liu J, Lundervold AJ, Lundström S, Marks DJ, Martin J, Masi G, Matijasevich A, Melchior M, Moffitt TE, Monninger M, Morrison CL, Mulraney M, Muratori P, Nguyen PT, Nicholson JM, Øie MG, O'Neill S, O'Connor C, Orri M, Pan PM, Pascoe L, Pettit GS, Price J, Rebagliato M, Riaño-Galán I, Rohde LA, Roisman GI, Rosa M, Rosenbaum JF, Salum GA, Sammallahti S, Santos IS, Schiavone NS, Schmid L, Sciberras E, Shaw P, Silk TJ, Simpson JA, Skogli EW, Stepp S, Strandberg-Larsen K, Sudre G, Sunyer J, Tandon M, Thapar A, Thomson P, Thorell LB, Tinchant H, Torrent M, Tovo-Rodrigues L, Tripp G, Ukoumunne O, Van Goozen SHM, Vos M, Wallez S, Wang Y, Westermaier FG, Whalen DJ, Yoncheva Y, Youngstrom EA, Sayal K, Solmi M, Delorme R, Cortese S. Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis. Lancet Psychiatry 2023; 10:922-933. [PMID: 37898142 DOI: 10.1016/s2215-0366(23)00272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. METHODS For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to "cohort" and "ADHD" with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. FINDINGS Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. INTERPRETATION The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. FUNDING None.
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Tan X, Xu Y, Wang S, Li J, Hu C, Chen Z, Cheng Q, Wang Z. Efficacy and Safety of SPN-812 (Extended-Release Viloxazine) in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1627. [PMID: 38137075 PMCID: PMC10742293 DOI: 10.3390/brainsci13121627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND SPN-812 has been approved for attention-deficit/hyperactivity disorder (ADHD) treatment in children and adolescents. OBJECTIVE We aimed to analyze the efficacy and safety of different doses of SPN-812 for ADHD pediatric patients of different ages, verify its clinical efficacy, and evaluate its safety. METHODS Up until 30 August 2023, randomized controlled trials (RCTs) were searched in EMBASE, MEDLINE, the Cochrane Library, and clinicaltrials.gov to evaluate different doses of SPN-812 and a placebo. RESULTS We pooled 1619 patients from five RCTs with a duration of 6-8 weeks. Patients (6-17 years old) in SPN-812 (100, 200, and 400 mg/d) groups were superior to the control group in all efficacy outcomes with lower attention-deficit/hyperactivity disorder rating scale-5 (ADHD-RS-5), Conners 3-parent short form composite T score (Conners 3-PS), Weiss functional impairment rating scale-parent (WFIRS-P), and increased clinical global impression-improvement (CGI-I) score (both p < 0.05). At the same time, only SPN-812 300 mg/d did not show a significantly high risk of the adverse events (AEs) such as somnolence and decreased appetite (p = 0.09). There was no significant difference between placebo and SPN-812 groups (100, 200, and 400 mg/d) in serious adverse events (SAEs) such as syncope. The subgroup analyses showed that, both in children and adolescents subgroups, SPN-812 showed better efficacy than the placebo. The two age subgroups showed a significantly higher risk of AEs and an insignificant risk of SAEs than the placebo. CONCLUSION At present, SPN-812 (100, 200, and 400 mg/d) is superior to the corresponding control in efficacy measures. However, the safety problem cannot be ignored.
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Affiliation(s)
- Xin Tan
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China;
| | - Yuejuan Xu
- Department of Respiratory Medicine, Children’s Hospital of Wujiang District, Children’s Hospital of Soochow University, Suzhou 215025, China; (Y.X.); (C.H.)
| | - Shixin Wang
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (S.W.); (J.L.); (Z.C.)
| | - Jiaxuan Li
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (S.W.); (J.L.); (Z.C.)
| | - Chunxia Hu
- Department of Respiratory Medicine, Children’s Hospital of Wujiang District, Children’s Hospital of Soochow University, Suzhou 215025, China; (Y.X.); (C.H.)
| | - Zhouqing Chen
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (S.W.); (J.L.); (Z.C.)
| | - Qingzhang Cheng
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China;
| | - Zhong Wang
- Department of Neurosurgery& Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (S.W.); (J.L.); (Z.C.)
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Reyes-Vasquez C, Jones Z, Tang B, Dafny N. Dopamine, Norepinephrine and Serotonin Participate Differently in Methylphenidate Action in Concomitant Behavioral and Ventral Tegmental Area, Locus Coeruleus and Dorsal Raphe Neuronal Study in Young Rats. Int J Mol Sci 2023; 24:16628. [PMID: 38068951 PMCID: PMC10705956 DOI: 10.3390/ijms242316628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Methylphenidate (MPD), known as Ritalin, is a psychostimulant used to treat children, adults, and the elderly. MPD exerts its effects through increasing concentrations of dopamine (DA), norepinephrine (NE), and serotonin (5-HT) in the synaptic cleft. Concomitant behavioral and neuronal recording from the ventral tegmental area (VTA), locus coeruleus (LC), and from the dorsal raphe (DR) nucleus, which are the sources of DA, NE, and 5-HT to the mesocorticolimbic circuit, were investigated following acute and repetitive (chronic) saline, 0.6, 2.5, or 10.0 mg/kg MPD. Animals received daily saline or MPD administration on experimental days 1 to 6 (ED1-6), followed by a 3-day washout period and MPD rechallenge on ED10. Each chronic MPD dose elicits behavioral sensitization in some animals while inducing behavioral tolerance in others. The uniqueness of this study is in the evaluation of neuronal activity based on the behavioral response to chronic MPD. Neuronal excitation was observed mainly in brain areas of animals exhibiting behavioral sensitization, while neuronal attenuation following chronic MPD was observed in animals expressing behavioral tolerance. Different ratios of excitatory/inhibitory neuronal responses were obtained from the VTA, LC, or DR following chronic MPD. Thus, each brain area responds differently to each MPD dose used, suggesting that DA, NE, and 5-HT in the VTA, LC, and DR exert different effects.
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Affiliation(s)
- Cruz Reyes-Vasquez
- Physiology Department, Medical School, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Zachary Jones
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX 77030, USA
| | - Bin Tang
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX 77030, USA
| | - Nachum Dafny
- Department of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin Street, Houston, TX 77030, USA
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Novo JP, Muga M, Lourenço T, Sanches ES, Leitão RA, Silva AP. Dichotomous effect of methylphenidate on microglia and astrocytes: Insights from in vitro and animal studies. Toxicol Lett 2023; 389:1-10. [PMID: 37844808 DOI: 10.1016/j.toxlet.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Methylphenidate (MPH) has been used for decades to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Moreover, several studies have shown that it is subject to misuse, particularly among college students and adolescents, for cognitive enhancement or as a recreational drug. This phenomenon causes concern, and it is critical to clarify better how MPH impacts brain cells. In fact, data has suggested that MPH could result in neuroinflammation and neurodegeneration across several brain regions; however, little is known about the effect of MPH on glial cells. To address this, we used microglia N9 cell line and primary cultures of cortical astrocytes that were exposed to MPH (0.01 - 2 mM), as well as Wistar Kyoto rats (WKY) chronically administered with MPH (1.5 mg/kg/day). Several parameters were analyzed, and we concluded that MPH has no significant direct effect on microglial cells, apart from cell migration impairment. On the contrary, MPH promotes astrogliosis, oxidative/nitrosative stress, and increases proinflammatory cytokine TNF levels by astrocytes, which was concordant with the results obtained in the hippocampus of WKY rats. Overall, the present results suggest that brain cells respond differently to MPH, with a more prominent direct effect on astrocytes when compared to microglia.
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Affiliation(s)
- João P Novo
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Portugal
| | - Mariana Muga
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Teresa Lourenço
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Eliane S Sanches
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Portugal
| | - Ricardo A Leitão
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Ana Paula Silva
- Univ Coimbra, Faculty of Medicine, Institute of Pharmacology and Experimental Therapeutics, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Univ Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
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Ince N, Sari SA. Atomoxetine-Associated Maculopapular Rash: A Case Report. J Clin Psychopharmacol 2023; 43:539-541. [PMID: 37930210 DOI: 10.1097/jcp.0000000000001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
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Safiri S, Mousavi SE, Nejadghaderi SA, Noori M, Sullman MJM, Amiri S, Kolahi AA. The Burden of Attention-Deficit Hyperactivity Disorder (ADHD) in the Middle East and North Africa Region, 1990 to 2019. J Atten Disord 2023; 27:1433-1447. [PMID: 37491897 DOI: 10.1177/10870547231187161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To report the burden of ADHD in the Middle East and North Africa (MENA) region from 1990 to 2019. METHODS Publicly available data on the burden of ADHD were retrieved from the Global Burden of Disease study 2019. The counts and age-standardized rates (per 100,000) were presented. RESULTS In 2019, ADHD had an age-standardized point prevalence of 1245.1 and a years lived with disability (YLD) rate of 15.1 per 100,000 in MENA, which were 7.2% (-11 to -3.3) and 7.2% (-11.2 to -2.7) lower, respectively, than in 1990. The highest YLD rate of ADHD was found in the 10 to 14 age group and there were no remarkable differences between males and females. No clear association was found between the YLD rate and the socio-demographic index. CONCLUSION The burden of ADHD in the MENA region decreased over the period 1990 to 2019, and regularly updating the epidemiological information is suggested.
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Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Shahrokh Amiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Riccioni A, Radua J, Ashaye FO, Solmi M, Cortese S. Systematic Review and Meta-analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02149-4. [PMID: 37890665 DOI: 10.1016/j.jaac.2023.09.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates. METHOD We drew on, adapted, and updated the search of a network meta-analysis by Cortese et al. (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses. RESULTS We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered. CONCLUSION More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
| | - Joaquim Radua
- DIBAPS, Barcelona, Catalunya, Spain, Karolinska Institute Stockholm, Sweden and King's College London, United Kingdom
| | - Florence O Ashaye
- University of Southampton School of Medicine, South Hampton, United Kingdom
| | - Marco Solmi
- University of Ottawa and the Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program Ontario, Canada; Charité Universitätsmedizin, Berlin, Germany; Centre for Innovation in Mental Health, University of Southampton, United Kingdom
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK, Solent National Health System Trust (NHS), Southampton, United Kingdom, Hassenfeld Children's Hospital at NYU Langone; the New York University Child Study Center, New York City, New York; and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
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Levine SZ, Rotstein A, Kodesh A, Sandin S, Lee BK, Weinstein G, Schnaider Beeri M, Reichenberg A. Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia. JAMA Netw Open 2023; 6:e2338088. [PMID: 37847497 PMCID: PMC10582792 DOI: 10.1001/jamanetworkopen.2023.38088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/02/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Evidence that adult attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk of dementia is scarce and inconsistent, and potential sources of bias are untested. Objective To examine the association between adult ADHD and the risk of dementia. Design, Setting, and Participants This prospective national cohort study consisted of 109 218 members of a nonprofit Israeli health maintenance organization born between 1933 and 1952 who entered the cohort on January 1, 2003, without an ADHD or dementia diagnosis and were followed up to February 28, 2020. Participants were aged 51 to 70 years in 2003. Statistical analysis was conducted from December 2022 to August 2023. Exposure Adult ADHD was a time-varying covariate, classified as present from the age of the first diagnosis (using the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision); otherwise, absent. Main Outcome and Measures Cox regression models were fitted to quantify the association between adult ADHD and the risk of incident dementia with hazard ratios (HRs) and their 95% CIs unadjusted and in the primary analysis, using inverse probability weights, adjusted for 18 sources of potential confounding. In 14 complementary analyses, subgroup and sensitivity analyses were implemented. Results At the beginning of the follow-up, the sample of 109 218 participants had a mean (SD) age of 57.7 (5.5) years, 56 474 participants (51.7%) were female, and 52 744 (48.3%) were male. During follow-up, 730 participants (0.7%) received a diagnosis of adult ADHD, and 7726 (7.1%) received a diagnosis of dementia. Dementia occurred among 96 of 730 participants (13.2%) with adult ADHD and 7630 of 108 488 participants (7.0%) without adult ADHD. In the primary analysis, compared with the absence of adult ADHD, the presence of adult ADHD was statistically significantly (P < .001) associated with an increased dementia risk (unadjusted HR, 3.62 [95% CI, 2.92-4.49; P < .001]; adjusted HR, 2.77 [95% CI, 2.11-3.63; P < .001]). Twelve of the 14 complementary analyses did not attenuate the conclusions based on the results of the primary analysis. There was, however, no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication, and evidence of reverse causation was mild. Conclusions and Relevance In this cohort study of individuals born between 1933 and 1952 and followed up in old age, adult ADHD was associated with an increased risk of dementia. Policy makers, caregivers, patients, and clinicians may wish to monitor reliably for ADHD in old age.
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Affiliation(s)
| | - Anat Rotstein
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Arad Kodesh
- Mental Health, Meuhedet Health Services, Tel Aviv, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Michal Schnaider Beeri
- The Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center, Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Pagnier M. Predicting the Response of Children and Adolescents With ADHD to Methylphenidate: A Systematic Review. J Atten Disord 2023; 27:1377-1392. [PMID: 37243373 DOI: 10.1177/10870547231177234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To report the characteristics associated with response to methylphenidate (MPH) in children and adolescents with ADHD. METHODS Studies reporting potentials predictors of response to MPH were searched in Medline and Embase from January 1998 to March 2022. Narrative synthesis was performed. RESULTS Fifty-seven reports of 46 studies totaling 6,656 ADHD patients were included. No association appears between response to MPH and age, gender, MPH dosage, ADHD subtype, comorbidities nor socioeconomic status when considering a specific patient. No conclusion could be drawn about body weight, ADHD severity, intelligence quotient, and parental symptoms of depression or ADHD. CONCLUSIONS None of these potential predictors have proven their usefulness to predict response to MPH on an individual basis in clinical practice. In research, potential predictors should be measured, their association with response to MPH assessed, in order to control for confounding variables when modeling response to MPH.
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Affiliation(s)
- Maryse Pagnier
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Necker-Enfants-Malades, Paris, France
- Association Française de Pédiatrie Ambulatoire, Orléans, France
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Bryant A, Schlesinger H, Sideri A, Holmes J, Buitelaar J, Meiser-Stedman R. A meta-analytic review of the impact of ADHD medications on anxiety and depression in children and adolescents. Eur Child Adolesc Psychiatry 2023; 32:1885-1898. [PMID: 35616714 PMCID: PMC10533622 DOI: 10.1007/s00787-022-02004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
Abstract
Anxiety and depression are listed as common side effects for medications licensed for treating ADHD in children and adolescents. This meta-analytic review of randomised controlled trials aimed to explore the effect of medications on symptoms of anxiety and depression in children and adolescents with ADHD. A meta-analytic review of ADHD drug trials in children and adolescents was conducted. Random effects meta-analyses were conducted on anxiety and depression outcomes measured by validated psychological scales or side effect rating scales. Only 11% of eligible trials in this review reported anxiety and/or depression as an outcome or side effect, limiting the conclusions of the meta-analyses. Relative to placebo control, no significant effect of medication was found for symptoms of anxiety or depression in randomised controlled trials of ADHD medication in children and adolescents. This review highlights the systemic lack of mental health outcome reporting in child and adolescent ADHD drug trials. The importance of widespread implementation of standardised measurement of mental health outcomes in future trials is discussed.
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Affiliation(s)
- Annie Bryant
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Hope Schlesinger
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Athina Sideri
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, UK
| | - Joni Holmes
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Jan Buitelaar
- Radboud University, Houtlaan 4, 6525 XZ, Nijmegen, Netherlands
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK.
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Widding-Havneraas T, Elwert F, Markussen S, Zachrisson HD, Lyhmann I, Chaulagain A, Bjelland I, Halmøy A, Rypdal K, Mykletun A. Effect of ADHD medication on risk of injuries: a preference-based instrumental variable analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02294-6. [PMID: 37742289 DOI: 10.1007/s00787-023-02294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
ADHD is associated with an increased risk of injury. Causal evidence for effects of pharmacological treatment on injuries is scarce. We estimated effects of ADHD medication on injuries using variation in provider preference as an instrumental variable (IV). Using Norwegian registry data, we followed 8051 patients who were diagnosed with ADHD aged 5 to 18 between 2009 and 2011 and recorded their ADHD medication and injuries treated in emergency rooms and emergency wards up to 4 years after diagnosis. Persons with ADHD had an increased risk of injuries compared to the general population (RR 1.35; 95% CI: 1.30-1.39), with higher risk in females (RR 1.47; 95% CI: 1.38-1.56) than males (RR 1.23; 95% CI: 1.18-1.28). The between-clinics variation in provider preference for ADHD medication was large and had a considerable impact on patients' treatment status. There was no causal evidence for protective effects of pharmacological treatment on injuries overall for young individuals with ADHD characterized by milder or atypical symptoms. However, there was an apparent effect of pharmacological treatment over time on the risk of injuries treated at emergency wards in this patient group.
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Affiliation(s)
- Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Felix Elwert
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Knut Rypdal
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Ugarte G, Piña R, Contreras D, Godoy F, Rubio D, Rozas C, Zeise M, Vidal R, Escobar J, Morales B. Attention Deficit-Hyperactivity Disorder (ADHD): From Abnormal Behavior to Impairment in Synaptic Plasticity. BIOLOGY 2023; 12:1241. [PMID: 37759640 PMCID: PMC10525904 DOI: 10.3390/biology12091241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
Attention deficit-hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high incidence in children and adolescents characterized by motor hyperactivity, impulsivity, and inattention. Magnetic resonance imaging (MRI) has revealed that neuroanatomical abnormalities such as the volume reduction in the neocortex and hippocampus are shared by several neuropsychiatric diseases such as schizophrenia, autism spectrum disorder and ADHD. Furthermore, the abnormal development and postnatal pruning of dendritic spines of neocortical neurons in schizophrenia, autism spectrum disorder and intellectual disability are well documented. Dendritic spines are dynamic structures exhibiting Hebbian and homeostatic plasticity that triggers intracellular cascades involving glutamate receptors, calcium influx and remodeling of the F-actin network. The long-term potentiation (LTP)-induced insertion of postsynaptic glutamate receptors is associated with the enlargement of spine heads and long-term depression (LTD) with spine shrinkage. Using a murine model of ADHD, a delay in dendritic spines' maturation in CA1 hippocampal neurons correlated with impaired working memory and hippocampal LTP has recently reported. The aim of this review is to summarize recent evidence that has emerged from studies focused on the neuroanatomical and genetic features found in ADHD patients as well as reports from animal models describing the molecular structure and remodeling of dendritic spines.
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Affiliation(s)
- Gonzalo Ugarte
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
| | - Ricardo Piña
- Department of Biology, Faculty of Sciences, Metropolitan University of Education Sciences, Santiago 7760197, Chile;
- Department of Human Sciences, Faculty of Human Science, Bernardo O’Higgins University, Santiago 8370854, Chile
| | - Darwin Contreras
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
| | - Felipe Godoy
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
| | - David Rubio
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
| | - Carlos Rozas
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
| | - Marc Zeise
- School of Psychology, Faculty of Humanities, University of Santiago of Chile, Santiago 9170022, Chile;
| | - Rodrigo Vidal
- Laboratory of Genomics, Molecular Ecology and Evolutionary Studies, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile;
| | - Jorge Escobar
- Institute of Chemistry, Pontifical Catholic University of Valparaíso, Valparaíso 2340000, Chile
| | - Bernardo Morales
- Laboratory of Neuroscience, Department of Biology, Faculty of Chemistry and Biology, University of Santiago of Chile, Santiago 9170022, Chile; (G.U.); (D.C.); (F.G.); (D.R.); (C.R.)
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Willig TN, Dajon M, Assathiany R, Brun L, Fourneret P, Massé M, Monge A, Piollet A, Thiollier MC, Cortese S, Purper Ouakil D. Healthcare pathways and practitioners' knowledge about ADHD in children. L'ENCEPHALE 2023:S0013-7006(23)00144-6. [PMID: 37718197 DOI: 10.1016/j.encep.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/18/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD. METHODS A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder. RESULTS Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD. CONCLUSIONS This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.
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Affiliation(s)
- Thiébaut-Noël Willig
- Occitadys, 24, impasse de la Flambère, 31300 Toulouse, France; Consultation de pédiatrie, clinique Ambroise Paré, ELSAN, and Eventail31, Toulouse, France; Association française de pédiatrie ambulatoire (AFPA), zone de la Fouquetière, 155, rue Edouard-Branly, 44150 Ancenis Saint-Géron, France.
| | - Marie Dajon
- PhD in Psychology, Research engineer, GIS BECO, University of Toulouse, France
| | - Rémy Assathiany
- Association française de pédiatrie ambulatoire (AFPA), zone de la Fouquetière, 155, rue Edouard-Branly, 44150 Ancenis Saint-Géron, France
| | - Louise Brun
- General medicine resident of the University of Montpellier, France
| | - Pierre Fourneret
- Child psychiatrist, professor at the University of Lyon. Deputy Head of the Child and Adolescent Developmental Psychopathology Department, Marc Jeannerod Institute of Cognitive Sciences UMR 5229 CNRS, 59 Bd Pinel, 69677 Bron, France
| | - Magali Massé
- Head of "Réseau Dys42", and of "SESSAD Dys", "APF France handicap", Saint Étienne, France
| | - Anne Monge
- Head of "CMPP" and "PCO-OVE", Givors, France
| | - Anne Piollet
- Association française de pédiatrie ambulatoire (AFPA), zone de la Fouquetière, 155, rue Edouard-Branly, 44150 Ancenis Saint-Géron, France; PCO PICOPAP 63", Chamalières, CHEM and AFPA
| | - Marie Claire Thiollier
- Head and co-founder of the health network DYS/10, and the Dispositif TSA, coordinator of the PCO, Lyon, France
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Diane Purper Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), INSERM U 1018, CESP University Paris Saclay, Team Psychiatry, Development and Trajectories, 80, avenue Augustin-Fliche, 34000 Montpellier, France
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Sugaya LS, Farhat LC, Califano P, Polanczyk GV. Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12146. [PMID: 37720577 PMCID: PMC10501696 DOI: 10.1002/jcv2.12146] [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: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
Background Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD. Methods We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597). Results Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; p < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; p = 0.45) but the confidence of estimate was very low. Conclusions Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.
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Affiliation(s)
- Luisa S. Sugaya
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Luis C. Farhat
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Pietro Califano
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
| | - Guilherme V. Polanczyk
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
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Vázquez-González D, Corona JC. Pioglitazone enhances brain mitochondrial biogenesis and phase II detoxification capacity in neonatal rats with 6-OHDA-induced unilateral striatal lesions. Front Neurosci 2023; 17:1186520. [PMID: 37575308 PMCID: PMC10416244 DOI: 10.3389/fnins.2023.1186520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
The psychostimulant methylphenidate (MPH) is the first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), but has numerous adverse side effects. The PPARγ receptor agonist pioglitazone (PIO) is known to improve mitochondrial bioenergetics and antioxidant capacity, both of which may be deficient in ADHD, suggesting utility as an adjunct therapy. Here, we assessed the effects of PIO on ADHD-like symptoms, mitochondrial biogenesis and antioxidant pathways in multiple brain regions of neonate rats with unilateral striatal lesions induced by 6-hydroxydopamine (6-OHDA) as an experimental ADHD model. Unilateral striatal injection of 6-OHDA reduced ipsilateral dopaminergic innervation by 33% and increased locomotor activity. This locomotor hyperactivity was not altered by PIO treatment for 14 days. However, PIO increased the expression of proteins contributing to mitochondrial biogenesis in the striatum, hippocampus, cerebellum and prefrontal cortex of 6-OHDA-lesioned rats. In addition, PIO treatment enhanced the expression of the phase II transcription factor Nrf2 in the striatum, prefrontal cortex and cerebellum. In contrast, no change in the antioxidant enzyme catalase was observed in any of the brain regions analyzed. Thus, PIO may improve mitochondrial biogenesis and phase 2 detoxification in the ADHD brain. Further studies are required to determine if different dose regimens can exert more comprehensive therapeutic effects against ADHD neuropathology and behavior.
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Affiliation(s)
| | - Juan Carlos Corona
- Laboratory of Neurosciences, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Sun TH, Yeom JW, Choi KY, Kim JL, Lee HJ, Kim HJ, Cho CH. Potential effectiveness of digital therapeutics specialized in executive functions as adjunctive treatment for clinical symptoms of attention-deficit/hyperactivity disorder: a feasibility study. Front Psychiatry 2023; 14:1169030. [PMID: 37547212 PMCID: PMC10397734 DOI: 10.3389/fpsyt.2023.1169030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction The role of digital therapeutics (DTx) in the effective management of attention deficit/hyperactivity disorder (ADHD) is beginning to gain clinical attention. Therefore, it is essential to verify their potential efficacy. Method We aimed to investigate the improvement in the clinical symptoms of ADHD by using DTx AimDT01 (NUROW) (AIMMED Co., Ltd., Seoul, Korea) specialized in executive functions. NUROW, which consists of Go/No-go Task- and N-Back/Updating-based training modules and a personalized adaptive algorithm system that adjusts the difficulty level according to the user's performance, was implemented on 30 Korean children with ADHD aged 6 to 12 years. The children were instructed to use the DTx for 15 min daily for 4 weeks. The Comprehensive attention test (CAT) and Childhood Behavior Checklist (CBCL) were used to assess the children at baseline and endpoint. In contrast, the ADHD-Rating Scale (ARS) and PsyToolkit were used weekly and followed up at 1 month, for any sustained effect. Repeated measures ANOVA was used to identify differences between the participants during visits, while t-tests and Wilcoxon signed-rank tests were used to identify changes before and after the DTx. Results We included 27 participants with ADHD in this analysis. The ARS inattention (F = 4.080, p = 0.010), hyperactivity (F = 5.998. p < 0.001), and sum (F = 5.902, p < 0.001) significantly improved. After applying NUROW, internalized (t = -3.557, p = 0.001, 95% CI = -3.682--0.985), other (Z = -3.434, p = 0.001, effect size = -0.661), and sum scores (t = -3.081, p = 0.005, 95% CI = -10.126--2.022) were significantly changed in the CBCL. The overall effect was confirmed in the ARS sustained effect analysis even after 1 month of discontinuing the DTx intervention. Discussion According to caregivers, the findings indicate that DTx holds potential effect as an adjunctive treatment in children with ADHD, especially in subjective clinical symptoms. Future studies will require detailed development and application targeting specific clinical domains using DTx with sufficient sample sizes.Clinical trial registration: KCT0007579.
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Affiliation(s)
- Tai Hui Sun
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yeon Choi
- Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeong-Lan Kim
- Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kim
- Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
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Gutiérrez-Casares JR, Quintero J, Segú-Vergés C, Rodríguez Monterde P, Pozo-Rubio T, Coma M, Montoto C. In silico clinical trial evaluating lisdexamfetamine's and methylphenidate's mechanism of action computational models in an attention-deficit/hyperactivity disorder virtual patients' population. Front Psychiatry 2023; 14:939650. [PMID: 37333910 PMCID: PMC10273406 DOI: 10.3389/fpsyt.2023.939650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 04/21/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) is an impairing psychiatric condition with the stimulants, lisdexamfetamine (LDX), and methylphenidate (MPH), as the first lines pharmacological treatment. Methods Herein, we applied a novel in silico method to evaluate virtual LDX (vLDX) and vMPH as treatments for ADHD applying quantitative systems pharmacology (QSP) models. The objectives were to evaluate the model's output, considering the model characteristics and the information used to build them, to compare both virtual drugs' efficacy mechanisms, and to assess how demographic (age, body mass index, and sex) and clinical characteristics may affect vLDX's and vMPH's relative efficacies. Results and Discussion We molecularly characterized the drugs and pathologies based on a bibliographic search, and generated virtual populations of adults and children-adolescents totaling 2,600 individuals. For each virtual patient and virtual drug, we created physiologically based pharmacokinetic and QSP models applying the systems biology-based Therapeutic Performance Mapping System technology. The resulting models' predicted protein activity indicated that both virtual drugs modulated ADHD through similar mechanisms, albeit with some differences. vMPH induced several general synaptic, neurotransmitter, and nerve impulse-related processes, whereas vLDX seemed to modulate neural processes more specific to ADHD, such as GABAergic inhibitory synapses and regulation of the reward system. While both drugs' models were linked to an effect over neuroinflammation and altered neural viability, vLDX had a significant impact on neurotransmitter imbalance and vMPH on circadian system deregulation. Among demographic characteristics, age and body mass index affected the efficacy of both virtual treatments, although the effect was more marked for vLDX. Regarding comorbidities, only depression negatively impacted both virtual drugs' efficacy mechanisms and, while that of vLDX were more affected by the co-treatment of tic disorders, the efficacy mechanisms of vMPH were disturbed by wide-spectrum psychiatric drugs. Our in silico results suggested that both drugs could have similar efficacy mechanisms as ADHD treatment in adult and pediatric populations and allowed raising hypotheses for their differential impact in specific patient groups, although these results require prospective validation for clinical translatability.
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Affiliation(s)
- José Ramón Gutiérrez-Casares
- Unidad Ambulatoria de Psiquiatría y Salud Mental de la Infancia, Niñez y Adolescencia, Hospital Perpetuo Socorro, Badajoz, Spain
| | - Javier Quintero
- Servicio de Psiquiatría, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
| | - Cristina Segú-Vergés
- Anaxomics Biotech, Barcelona, Spain
- Structural Bioinformatics Group, Research Programme on Biomedical Informatics, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | - Carmen Montoto
- Medical Department, Takeda Farmacéutica España, Madrid, Spain
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50
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Radonjić NV, Bellato A, Khoury NM, Cortese S, Faraone SV. Nonstimulant Medications for Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: Systematic Review and Meta-analysis. CNS Drugs 2023; 37:381-397. [PMID: 37166701 DOI: 10.1007/s40263-023-01005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND For some adults with Attention-Deficit/Hyperactivity Disorder (ADHD), nonstimulants need to be considered either as a monotherapy or as an adjunct to stimulants. OBJECTIVES The objectives of this systematic review and meta-analysis were to assess the efficacy, acceptability, and tolerability of nonstimulants in adults with ADHD. METHODS Data sources, searches, and study selection were based on a previously published network meta-analysis of randomized clinical trials (RCTs) by Cortese at al. (Lancet Psychiatry 5(9):727-738, 2018), which we updated in March 2022. Specifically, we searched PubMed, BIOSIS Previews, CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, PsycINFO, OpenGrey, Web of Science Core Collection, ProQuest Dissertations and Theses (UK and Ireland), ProQuest Dissertations and Theses (abstracts and international), and the WHO International Trials Registry Platform, including ClinicalTrials.gov for double-blind RCTs with a placebo arm, lasting at least one week, including adults with a diagnosis of ADHD based on DSM-III, DSM-III-R, DSM-IV(TR), DSM-5 or ICD-9- or 10, and reporting data on efficacy, tolerability (drop-out due to side effects) and acceptability (drop-out due to any cause) of guanfacine, clonidine, or atomoxetine. Additionally, we searched for RCTs of viloxazine extended release (ER), approved for ADHD in 2021. Random-effects meta-analyses were conducted, and the risk of bias for individual RCTs was assessed using the Cochrane Risk of Bias tool. RESULTS We included 18 studies in the meta-analyses (4308 participants) plus one additional study in the narrative synthesis (374 participants). The meta-analysis showed that atomoxetine (15 RCTs) (Hedge's g = - 0.48, 95% CI [- 0.64; - 0.33]), guanfacine (two RCTs) (Hedge's g = - 0.66, 95% CI [- 0.94; - 0.38]) and viloxazine ER (one RCT) were significantly more efficacious than placebo. Atomoxetine was less well tolerated than placebo, while tolerability of guanfacine and viloxazine ER could not be meta-analysed, since only one study, for each medication, reported on it. CONCLUSIONS All investigated nonstimulants were more efficacious in the treatment of ADHD in adults, than placebo, while the placebo had better acceptability and tolerability. PROTOCOL https://osf.io/5vnmt/?view_only=2bf87ed12ba94645babedceeee4c0120 .
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Affiliation(s)
- Nevena V Radonjić
- Department of Psychiatry and Behavioral Sciences, Upstate Medical University, Syracuse, NY, USA
| | - Alessio Bellato
- School of Psychology, University of Nottingham Malaysia, Jalan Broga, Semeniyih, Malaysia
| | - Nayla M Khoury
- Department of Psychiatry and Behavioral Sciences, Upstate Medical University, Syracuse, NY, USA
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen V Faraone
- Departments of Psychiatry and Behavioral Science and Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA.
- Departments of Psychiatry and Behavioral Science and Neuroscience and Physiology, Institute for Human Performance, SUNY Upstate Medical University, Room 3707, 505 Irving Ave., Syracuse, NY, 13210, USA.
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