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Faraone SV, Newcorn JH, Wozniak J, Joshi G, Coffey B, Uchida M, Wilens T, Surman C, Spencer TJ. In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry. J Atten Disord 2024; 28:550-582. [PMID: 38334088 PMCID: PMC10947509 DOI: 10.1177/10870547231225818] [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] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. METHOD Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. RESULTS Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. CONCLUSION The world is a better place because Joe Biederman was here.
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Affiliation(s)
| | | | - Janet Wozniak
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Gagan Joshi
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Mai Uchida
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Timothy Wilens
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Craig Surman
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas J. Spencer
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Dinu LM, Singh SN, Baker NS, Georgescu AL, Overton PG, Dommett EJ. The effects of tryptophan loading on Attention Deficit Hyperactivity in adults: A remote double blind randomised controlled trial. PLoS One 2023; 18:e0294911. [PMID: 38033150 PMCID: PMC10688902 DOI: 10.1371/journal.pone.0294911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Despite the impact and prevalence of Attention Deficit Hyperactivity Disorder (ADHD), current treatment options remain limited and there is a drive for alternative approaches, including those building on evidence of a role for tryptophan (TRP) and serotonin (5-HT). This study aimed to evaluate the effect of acute TRP loading on attention and impulsivity in adults with ADHD. TRIAL DESIGN AND METHODS We conducted a remote double blind randomised controlled trial (RCT) using TRP loading to examine the effects of a balanced amino acid load in comparison to low and high TRP loading in individuals with ADHD (medicated, N = 48, and unmedicated, N = 46) and controls (N = 50). Participants were randomised into one of three TRP treatment groups using stratified randomisation considering participant group and gender using a 1:1:1 ratio. Baseline testing of attention and impulsivity using the Test of Variables of Attention Task, Delay Discounting Task, and Iowa Gambling Task was followed by consumption of a protein drink (BAL, LOW, or HIGH TRP) before repeated testing. RESULTS AND CONCLUSIONS No effects of TRP were observed for any of the measures. In the present study, TRP loading did not impact on any measure of attention or impulsivity in those with ADHD or Controls. The findings need to be confirmed in another trial with a larger number of patients that also considers additional measures of dietary protein, plasma TRP and aggression. (Registration ID ISRCTN15119603).
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Affiliation(s)
- Larisa M. Dinu
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Samriddhi N. Singh
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Neo S. Baker
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alexandra L. Georgescu
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul G. Overton
- Department of Psychology, The University of Sheffield, Cathedral Court, Sheffield, United Kingdom
| | - Eleanor J. Dommett
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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O'Connor L, Carbone S, Gobbo A, Gamble H, Faraone SV. Pediatric attention deficit hyperactivity disorder (ADHD): 2022 updates on pharmacological management. Expert Rev Clin Pharmacol 2023; 16:799-812. [PMID: 37587841 DOI: 10.1080/17512433.2023.2249414] [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: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Pediatric attention-deficit disorder (ADHD) impacts a significant percentage of the population world-wide. Pharmacologic treatments have been shown to be safe and effective for managing symptoms. Various medication formulations exist, and new medication agents are continually approved each year. AREAS COVERED This article offers an overview of ADHD, an overview of both stimulant and non-stimulant medication options as well as an overview of stimulant misuse. It explores the medication mechanisms of action and side effect profiles, as well as offering an in-depth summary of the novel agents recently approved and soon-to-be approved for use in youth. PubMed and Medline were utilized. Search terms included children, adolescents, ADHD, and medication. FDA package inserts were reviewed for all medications. EXPERT OPINION New formulations of medications include an evening administered, extended, and delayed-release form of methylphenidate (DR/ER MPH), a methylphenidate pro-drug (serdexmethylphenidate) and an amphetamine patch. The availability of a new SNRI (selective norepinephrine reuptake inhibitor), viloxazine extended-release (VER), and the pending approval of a triple reuptake inhibitor (centanafadine) provides welcome additions to the prescriber's toolbox.
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Affiliation(s)
- Lisa O'Connor
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephanie Carbone
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anthony Gobbo
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hilary Gamble
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephen V Faraone
- Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA
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McGuire JF, Ricketts EJ, Scahill L, Wilhelm S, Woods DW, Piacentini J, Walkup JT, Peterson AL. Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults. Psychol Med 2020; 50:2046-2056. [PMID: 31451122 PMCID: PMC7190082 DOI: 10.1017/s0033291719002150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. METHOD A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. RESULTS At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. CONCLUSION Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
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Affiliation(s)
- Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily J. Ricketts
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | | | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
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State-of-the-Art Review on Physiologically Based Pharmacokinetic Modeling in Pediatric Drug Development. Clin Pharmacokinet 2020; 58:1-13. [PMID: 29777528 DOI: 10.1007/s40262-018-0677-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Physiologically based pharmacokinetic modeling and simulation is an important tool for predicting the pharmacokinetics, pharmacodynamics, and safety of drugs in pediatrics. Physiologically based pharmacokinetic modeling is applied in pediatric drug development for first-time-in-pediatric dose selection, simulation-based trial design, correlation with target organ toxicities, risk assessment by investigating possible drug-drug interactions, real-time assessment of pharmacokinetic-safety relationships, and assessment of non-systemic biodistribution targets. This review summarizes the details of a physiologically based pharmacokinetic modeling approach in pediatric drug research, emphasizing reports on pediatric physiologically based pharmacokinetic models of individual drugs. We also compare and contrast the strategies employed by various researchers in pediatric physiologically based pharmacokinetic modeling and provide a comprehensive overview of physiologically based pharmacokinetic modeling strategies and approaches in pediatrics. We discuss the impact of physiologically based pharmacokinetic models on regulatory reviews and product labels in the field of pediatric pharmacotherapy. Additionally, we examine in detail the current limitations and future directions of physiologically based pharmacokinetic modeling in pediatrics with regard to the ability to predict plasma concentrations and pharmacokinetic parameters. Despite the skepticism and concern in the pediatric community about the reliability of physiologically based pharmacokinetic models, there is substantial evidence that pediatric physiologically based pharmacokinetic models have been used successfully to predict differences in pharmacokinetics between adults and children for several drugs. It is obvious that the use of physiologically based pharmacokinetic modeling to support various stages of pediatric drug development is highly attractive and will rapidly increase, provided the robustness and reliability of these techniques are well established.
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Perugi G, Pallucchini A, Rizzato S, Pinzone V, De Rossi P. Current and emerging pharmacotherapy for the treatment of adult attention deficit hyperactivity disorder (ADHD). Expert Opin Pharmacother 2019; 20:1457-1470. [PMID: 31112441 DOI: 10.1080/14656566.2019.1618270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: ADHD is characterized by a developmentally inappropriate level of inattentiveness, impulsivity and/or hyperactivity. In adults, the disorder is frequently accompanied by Emotional Dysregulation (ED), associated to a variety of related psychiatric comorbidities, complicating its recognition and treatment management. Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of pharmacotherapy in adults with ADHD and ED, other neurodevelopmental disorders, Bipolar Disorder (BD) and Anxiety Disorders (ADs). When controlled data are unavailable, the authors have included open-label and observational studies. Expert opinion: ED in adult patients with ADHD is a very common and impairing problem that can be treated with stimulants or atomoxetine. ADHD studies in adults with other neurodevelopment disorders are scarce; stimulants seem to be the most effective and safe drugs in treating ADHD symptoms, without worsening the core features of other neurodevelopmental disorders. In patients with ADHD and comorbid BD, the treatment of BD alone may result in residual symptoms of ADHD. Patients should be treated hierarchically: BD should be treated first, while ADHD should be treated combining ADHD medications and mood stabilizers after mood stabilization. The available evidence for treating patients with ADHD and comorbid ADs in adults supports the idea of an anti-anxiety/ADHD-specific treatment association.
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Affiliation(s)
- Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa , Pisa , Italy
| | - Alessandro Pallucchini
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa , Pisa , Italy
| | - Salvatore Rizzato
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome , Rome , Italy
| | - Vito Pinzone
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome , Rome , Italy
| | - Pietro De Rossi
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital , Rome , Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome , Rome , Italy.,Department of Psychiatry, ASL Roma 5 , Rome , Italy
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Biederman J, Lindsten A, Sluth LB, Petersen ML, Ettrup A, Eriksen HLF, Fava M. Vortioxetine for attention deficit hyperactivity disorder in adults: A randomized, double-blind, placebo-controlled, proof-of-concept study. J Psychopharmacol 2019; 33:511-521. [PMID: 30843450 DOI: 10.1177/0269881119832538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stimulants remain the mainstay of treatment for attention-deficit hyperactivity disorder (ADHD) but are often associated with insufficient response or poor tolerability, leading to many patients not wishing to be treated with controlled substances. AIMS This randomized, placebo-controlled, proof-of-concept study (NCT02327013) evaluated the efficacy of a multimodal antidepressant, vortioxetine, in the treatment of ADHD, using a two-stage sequential parallel comparison design. METHODS Patients aged 18-55 years with a diagnosis of ADHD (DSM-5) and a total score ⩾24 on the Adult ADHD Investigator Symptom Rating Scale (AISRS) were randomized in study stage I with a 1:1:3 ratio to six weeks of treatment with vortioxetine 10 or 20 mg/day, or placebo ( n = 227). In study stage II, placebo non-responders (AISRS total score reduction <30% from stage I baseline) were re-randomized with a 1:1:1 ratio to six weeks of vortioxetine 10 or 20 mg/day, or placebo ( n = 59). RESULTS Across the two study stages combined, ADHD symptoms improved by approximately eight AISRS points in all treatment groups, showing no difference from placebo for either dose of vortioxetine, the study thus failing to meet its primary endpoint. However, both doses of vortioxetine separated from placebo in improving overall patient functioning, as measured by the Sheehan Disability Scale. CONCLUSION Studies are warranted to further investigate this suggested benefit of a multimodal antidepressant for patient functioning in ADHD while addressing issues of non-adherence and placebo response. The study confirmed vortioxetine 10 mg and 20 mg as generally well-tolerated.
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Affiliation(s)
| | | | | | | | | | | | - Maurizio Fava
- 1 Massachusetts General Hospital, Boston, MA, USA
- 3 Harvard Medical School, Boston, MA, USA
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Bhattacharjee M, Perumal E. Potential plant-derived catecholaminergic activity enhancers for neuropharmacological approaches: A review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 55:148-164. [PMID: 30668425 DOI: 10.1016/j.phymed.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 07/16/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Catecholamines (CAs) have been reported to be involved in numerous functions including central nervous system. CA release from the intra neuronal storage vesicles aid in the therapy of various neurological and neuropsychiatric disorders where the catecholaminergic neurotransmission is compromised. Bioavailability of CA at the synapse can be increased through stimulated neurotransmitter release, monoamine oxidase and CA reuptake inhibition. Plant based galenicals are reported to have similar CA enhancement activities and have been used for the management of neurological disorders. AIM To review evidence-based literature with plant extracts, bioactive compounds, and composite extracts that modulate central catecholaminergic system, thereby enhancing CA activity for beneficial neurological effect. METHODS Electronic databases such as PubMed, Scopus, and ScienceDirect were used to search scientific contributions until January 2018, using relevant keywords. Literature focusing plant-derived CA enhancing compounds, extracts and/or composite extracts were identified and summarized. In all cases, dose, route of administration, the model system and type of extract were accounted. RESULTS A total of 49 plant extracts, 31 compounds and 16 herbal formulations have shown CA activity enhancement. Stimulated CA release from the storage vesicles, monoamine oxidase and CA reuptake inhibition were the major mechanisms involved in the increase of CA bioavailability by these phytoconstituents. CONCLUSION This review provides an overview on the phytoconstituents with CA enhancement property that have been used for neuropsychiatric disorders. Such herbal remedies will provide an avenue for cost effective and easily available medication which have holistic approach towards disease management. There is also scope for alternate medicines or prototype drug development utilizing these phytomedicines for treating neurodegenerative diseases. However, hurdles are to be met for analyzing the mode and mechanism of action associated with these phytomedicines and their proper scientific documentation.
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Affiliation(s)
- Monojit Bhattacharjee
- Defence Research and Development Organisation - Bharathiar University Center for Life Sciences (DRDO-BU CLS), Bharathiar University Campus, Coimbatore, Tamil Nadu 641046, India
| | - Ekambaram Perumal
- Defence Research and Development Organisation - Bharathiar University Center for Life Sciences (DRDO-BU CLS), Bharathiar University Campus, Coimbatore, Tamil Nadu 641046, India; Molecular Toxicology Laboratory, Department of Biotechnology, Bharathiar University, Coimbatore, Tamil Nadu 641046, India.
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Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Mol Psychiatry 2019; 24:390-408. [PMID: 29955166 DOI: 10.1038/s41380-018-0116-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.
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Chierrito de Oliveira D, Guerrero de Sousa P, Borges Dos Reis C, Tonin FS, Maria Steimbach L, Virtuoso S, Fernandez-Llimos F, Pontarolo R, Cristina Conegero Sanches A. Safety of Treatments for ADHD in Adults: Pairwise and Network Meta-Analyses. J Atten Disord 2019; 23:111-120. [PMID: 28366111 DOI: 10.1177/1087054717696773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to analyze evidence comparing the profile of drugs used to treat ADHD in adult patients. METHOD Systematic searches were conducted in electronic databases. Randomized, double-blind, parallel controlled trials that evaluated the safety of drugs in ADHD were included. The statistical analyses were conducted by pairwise meta-analyses and mixed treatment comparison (MTC). RESULTS Ten ( n = 3006) trials were included in the analyses. We observed statistical differences for the following outcomes: decreased appetite between atomoxetine and placebo (odds ratio [OR] = 0.15, 95% credibility interval [CrI] = [0.05, 0.38]) and extended-release mixed amphetamine salts and placebo (OR = 0.06, 95% CrI = [0.00, 0.51]); insomnia between atomoxetine and placebo (OR = 0.48, 95% CrI = [0.27, 0.88]) and extended-release mixed amphetamine salts and placebo (OR = 0.23, 95% CrI = [0.06, 0.76]); sleepiness between atomoxetine and methylphenidate OROS (OR = 0.24, 95% CrI = [0.06, 0.97]); and decreased libido between atomoxetine and placebo (OR = 0.28, 95% CrI = [0.08, 0.90]). CONCLUSION It was possible to generate evidence about the safety profile of different ADHD drugs.
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Affiliation(s)
| | | | | | | | | | - Suzane Virtuoso
- 1 Universidade Estadual do Oeste do Paraná, Cascavel, Brazil
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Zwi M, York A. Attention-deficit hyperactivity disorder in adults: validity unknown1. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.10.4.248] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed childhood psychiatric disorder. Debate over its diagnostic validity, aetiology, presentation and treatment has extended from the clinical to the public domain. As children with ADHD diagnoses reach adulthood there is increasing interest in ‘adult ADHD’. Cohorts followed up show poorer outcomes as adults than do controls. Self-referred adults, sometimes relatives of children with ADHD, are also of interest regarding adult ADHD. Innovative work is being done examining issues of aetiology, treatment, outcomes and comorbidity in these groups, but heterogeneity among those diagnosed with ADHD and changes in classification systems and diagnostic criteria over time complicate comparison of research findings. The diagnostic validity of adult ADHD remains uncertain and needs further study.
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Buckley S, Dodd P, Burke A, Guerin S, McEvoy J, Hillery J. Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.7.251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodAnecdotal evidence suggests that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in adults and people of all ages with learning disability. This study examines the clinical practice of Irish consultant psychiatrists when assessing and treating symptoms of ADHD in children and adults with and without a learning disability. A postal questionnaire was sent to 302 consultant psychiatrists working in Ireland.ResultsNinety-seven consultants (32%) responded, 62 working in general adult psychiatry, 23 in child and adolescent psychiatry and 12 in learning disability. Overall, respondents were more confident about making a diagnosis of ADHD in people without a learning disability. Those working with children were significantly more confident in diagnosing and treating ADHD than those working with adults, irrespective of whether the patient had a learning disability.Clinical ImplicationsThere is general agreement that symptoms of ADHD exist in children and adults both with and without a learning disability. It is likely that ADHD may be undertreated in patients with learning disability, especially in the adult population.
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Samant TS, Lukacova V, Schmidt S. Development and Qualification of Physiologically Based Pharmacokinetic Models for Drugs With Atypical Distribution Behavior: A Desipramine Case Study. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 6:315-321. [PMID: 28398693 PMCID: PMC5697013 DOI: 10.1002/psp4.12180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 12/16/2016] [Accepted: 01/18/2017] [Indexed: 12/04/2022]
Abstract
Desipramine is a secondary tricyclic amine, which is primarily metabolized by cytochrome 2D6. It shows a high volume of distribution (Vss) (10–50 L/kg) due to its high lipophilicity, unspecific phospholipid binding, and lysosomal trapping. The objective of this study was to develop and qualify a physiologically based pharmacokinetic (PBPK) model for desipramine, which accounts for the high Vss of the drug following intravenous and oral administration of doses up to 100 mg. The model also accounts for the extended time to reach maximum concentration after oral dosing due to enterocyte trapping. Once developed and qualified in adults, we characterized the dynamic changes in metabolism and pharmacokinetics of desipramine after birth by scaling the system‐specific parameters of the model from adults to pediatrics. The developed modeling strategy provides a prototypical workflow that can also be applied to other drugs with similar properties and a high volume of distribution.
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Affiliation(s)
- T S Samant
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Lake Nona (Orlando), Florida, USA
| | - V Lukacova
- Simulations Plus, Inc., Lancaster, California, USA
| | - S Schmidt
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Lake Nona (Orlando), Florida, USA
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Kim HW, Kim E, Kim JH, Park J, Bahn GH, Lee YJ, Jhung K, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III) - Pharmacological Treatment -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eunjoo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea
| | - Jangho Park
- Department of Psychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungun Jhung
- Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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15
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Sherwood DA, Rey JA. Pharmacological Agents for the Treatment of Adult Attention Deficit Hyperactivity Disorder: A Review of the Literature. J Pharm Pract 2016. [DOI: 10.1177/0897190007300727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adult attention deficit hyperactivity disorder (ADHD) has been an emerging area of psychiatry of particular interest over the past few years. Whether this attention is due to new medications prompting the issue (ie, FocalinTM, StratteraTM) or emerging awareness that an estimated 4.4% of adults suffer with this diagnosis, therapy is of a limited selection. Untreated symptoms can lead to several life problems, including work and school difficulties, personal relationship issues, low self-esteem, and an increased chance of tobacco use, alcohol abuse, or other substance abuse. This article is to serve as a general overview of the available information regarding adult ADHD and the pharmacologic therapies available to treat the disorder.
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Affiliation(s)
- Devon A. Sherwood
- Psychiatric Pharmacy Practice, Department of Pharmaceutical and Administrative Sciences, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, FL 33328,
| | - Jose A. Rey
- Department of Pharmaceutical and Administrative Sciences, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Fla
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Buoli M, Serati M, Cahn W. Alternative pharmacological strategies for adult ADHD treatment: a systematic review. Expert Rev Neurother 2016; 16:131-44. [DOI: 10.1586/14737175.2016.1135735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVES Until recently, it was believed that attention deficit and hyperactivity disorder (ADHD) are outgrown by the end of adolescence and the beginning of adulthood. The purpose of this review is to describe the characteristics of the disease in adults, depict comorbidities that accompany it, and expand the scope over methods of diagnosis and treatment of these ages. METHODS A search was conducted in the PubMed/MEDLINE database for relevant key words 'ADHD', 'attention deficit', 'hyperactivity' and 'adult'. Secondary search parameters were 'comorbid', 'prevalence', 'epidemiology', 'therapy' and 'drug therapy'. Search was limited to 'English' and 'Humans'. RESULTS Over the years, the persistent nature of the disorder has been clarified, elucidating prevalence rate, gender differences and subtype shifts among adult ADHD population. Nevertheless, even today, there is only limited awareness of the existence of the disorder across one's lifespan, its consequences and the appropriate treatment. CONCLUSIONS Our results emphasise the growing awareness of adult psychosocial impairments due to ADHD symptoms and comorbidities, as well as the need for further collaboration among practitioners and mental health-care professionals to better identify the condition and allow for effective treatment.
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Affiliation(s)
- Gil Zalsman
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Molecular Imaging and Neuropathology Division, Psychiatry Department , Columbia University , New York , NY , USA
| | - Tal Shilton
- a Child and Adolescent Division , Geha Mental Health Center , Petah Tikva , Israel
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Babcock T, Ornstein CS. Comorbidity and its Impact in Adult Patients with Attention-Deficit/Hyperactivity Disorder: A Primary Care Perspective. Postgrad Med 2015; 121:73-82. [DOI: 10.3810/pgm.2009.05.2005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Goodman DW, Thase ME. Recognizing ADHD in Adults with Comorbid Mood Disorders: Implications for Identification and Management. Postgrad Med 2015; 121:20-30. [DOI: 10.3810/pgm.2009.09.2049] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
AbstractAdult ADHD is becoming a rather ‘firm’ diagnosis in adult psychiatry practice. Nevertheless it is a diagnosis that is often missed which leads to unnecessary distress to patients. This paper sets out the treatment possibilities.
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Reese HE, Scahill L, Peterson AL, Crowe K, Woods DW, Piacentini J, Walkup JT, Wilhelm S. The premonitory urge to tic: measurement, characteristics, and correlates in older adolescents and adults. Behav Ther 2014; 45:177-86. [PMID: 24491193 PMCID: PMC4445415 DOI: 10.1016/j.beth.2013.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
In addition to motor and/or vocal tics, many individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) report frequent, uncomfortable sensory phenomena that immediately precede the tics. To date, examination of these premonitory sensations or urges has been limited by inconsistent assessment tools. In this paper, we examine the psychometric properties of a nine-item self-report measure, the Premonitory Urge to Tic Scale (PUTS) and examine the characteristics and correlates of the premonitory urge to tic in a clinical sample of 122 older adolescents and adults with TS or CTD. The PUTS demonstrated adequate internal consistency, temporal stability, and concurrent validity. Premonitory urges were endorsed by the majority of individuals. Most individuals reported some relief from the urges after completing a tic and being able to stop their tics even if only temporarily. Degree of premonitory urges was not significantly correlated with age, and we did not observe any gender differences. Degree of premonitory urges was significantly correlated with estimated IQ and tic severity, but not severity of comorbid obsessive-compulsive disorder or attention-deficit hyperactivity disorder. Also, it was not related to concomitant medication status. These findings represent another step forward in our understanding of the premonitory sensations associated with TS and CTD.
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Affiliation(s)
- Hannah E. Reese
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
| | - Lawrence Scahill
- Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Alan L. Peterson
- Division of Behavioral Medicine, Department of Psychiatry, University of Texas Health Science Center at San Antonio, 77550 IH-10 West, Suite 1325, San Antonio, TX 78229, USA
| | - Katherine Crowe
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
| | - Douglas W. Woods
- University of Wisconsin-Milwaukee, Department of Psychology, 224 Garland Hall, 2441 E. Hartford Ave., Milwaukee, WI 53211, USA
| | - John Piacentini
- University of California at Los Angeles Psychiatry & Biobehavioral Sciences, BOX 951759, 760 Westwood Plaza, 67-455 Semel Institute, Los Angeles, CA 90095-1759, USA
| | | | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
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Abstract
A number of medication and psychologic treatment options for adults with attention deficit hyperactivity disorder have become available during the past 5 years, while others are under investigation. This review describes the safety and effectiveness of the stimulants (i.e., methylphenidate and dexedrine), and particularly the newer long-acting stimulants (i.e., Concerta) and Adderall XR) in the treatment of this population. Some nonstimulant/nonantidepressants, particularly atomoxetine, have also been shown to improve attention deficit hyperactivity disorder symptoms. Combination treatment of stimulants and antidepressants require more study with regard to safety and efficacy. Psychosocial interventions (e.g., cognitive behavioral therapy, mindfulness training and cognitive remediation) can also benefit adults with attention deficit hyperactivity disorder. Cognitive behavioral therapy combined with medication is more effective than either intervention alone, especially for addressing the emotional and functional aspects of peoples lives and thus improving occupational, interpersonal and emotional outcomes.
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Affiliation(s)
- Brian Greenfield
- Montreal Childrens Hospital, Emergency Follow-Up Team, 2300 Tupper Ave, Montreal, Quebec, H3H 1P3, Canada.
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Maneeton N, Maneeton B, Intaprasert S, Woottiluk P. A systematic review of randomized controlled trials of bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat 2014; 10:1439-49. [PMID: 25120365 PMCID: PMC4128852 DOI: 10.2147/ndt.s62714] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some trials have suggested that bupropion, as well as methylphenidate, is beneficial in the treatment of attention-deficit/hyperactivity disorder (ADHD). OBJECTIVES The purpose of this systematic review was to summarize the efficacy, acceptability, and tolerability of bupropion in comparison with methylphenidate for ADHD treatment. Included studies were randomized controlled trials (RCTs) that compared bupropion and methylphenidate. Clinical studies conducted between January 1991 and January 2014 were reviewed. DATA SOURCES MEDLINE(®), EMBASE™, CINAHL, PsycINFO(®), and the Cochrane Controlled Trials Register were searched in January 2014. Additionally, clinical trials were identified from the databases of ClinicalTrials.gov and the EU Clinical Trials Register. STUDY ELIGIBLE CRITERIA PARTICIPANTS AND INTERVENTIONS All RCTs of bupropion and methylphenidate reporting final outcomes relevant to 1) ADHD severity, 2) response or remission rates, 3) overall discontinuation rate, or 4) discontinuation rate due to adverse events. Language restriction was not applied. STUDY APPRAISAL AND SYNTHESIS METHODS The relevant clinical trials were examined and the data of interest were extracted. Additionally, the risks of bias were also inspected. The efficacy outcomes were the mean changed scores of ADHD rating scales, the overall response rate, and the overall remission rates. The overall discontinuation rate and the discontinuation rate due to adverse events were determined. Relative risks and weighted mean differences or standardized mean differences with 95% confidence intervals were estimated using a random effect model. RESULTS A total of 146 subjects in four RCTs comparing bupropion with methylphenidate in the treatment of ADHD were included. The pooled mean changed scores of the Iowa-Conner's Abbreviated Parent and Teacher Questionnaires and the ADHD Rating Scale-IV for parents and teachers of children and adolescents with ADHD in the bupropion- and methylphenidate-treated groups were not significantly different. Additionally, the pooled mean changed score in adult ADHD between the two groups, measured by the ADHD Rating Scale-IV and the Adult ADHD Rating Scale, was also not significantly different. The pooled rates of response, overall discontinuation, and discontinuation due to adverse events between the two groups were not significantly different. CONCLUSION Based on limited data from this systematic review, bupropion was as effective as methylphenidate for ADHD patients. Additionally, tolerability and acceptability were also comparable. However, these findings should be considered as very preliminary results. To confirm this evidence, further studies in this area should be conducted.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suthi Intaprasert
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Umehara M, Ago Y, Fujita K, Hiramatsu N, Takuma K, Matsuda T. Effects of serotonin-norepinephrine reuptake inhibitors on locomotion and prefrontal monoamine release in spontaneously hypertensive rats. Eur J Pharmacol 2013; 702:250-7. [PMID: 23376565 DOI: 10.1016/j.ejphar.2013.01.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/10/2013] [Accepted: 01/16/2013] [Indexed: 01/05/2023]
Abstract
Catecholamine neurotransmission in the prefrontal cortex plays a key role in the therapeutic actions of drugs for attention-deficit/hyperactivity disorder (ADHD). Recent clinical studies show that several serotonin-norepinephrine reuptake inhibitors have potential for treating ADHD. In this study, we examined the effects of acute treatment with serotonin-norepinephrine reuptake inhibitors on locomotion and the extracellular levels of monoamines in the prefrontal cortex in spontaneously hypertensive rats (SHR), an animal model of ADHD. Adolescent male SHR exhibited greater horizontal locomotion in an open-field test than male WKY control rats. Psychostimulant methylphenidate (0.3 and 1 mg/kg), the selective norepinephrine reuptake inhibitor atomoxetine (1 and 3 mg/kg), and serotonin-norepinephrine reuptake inhibitors duloxetine (10 mg/kg), venlafaxine (10 and 30 mg/kg) and milnacipran (30 mg/kg) reduced the horizontal activity in SHR, but did not affect in WKY rats. The selective norepinephrine reuptake inhibitor reboxetine (10 mg/kg) and the tricyclic antidepressant desipramine (10 and 30 mg/kg) also reduced the horizontal activity in SHR, whereas the selective serotonin reuptake inhibitor citalopram (30 mg/kg) did not. Microdialysis studies showed that atomoxetine, methylphenidate, duloxetine, venlafaxine, milnacipran, and reboxetine increased the extracellular levels of norepinephrine and dopamine in the prefrontal cortex in SHR. Citalopram did not affect norepinephrine and dopamine levels in the prefrontal cortex, although it increased the serotonin levels. Neither duloxetine nor venlafaxine increased the dopamine levels in the striatum. These findings suggest that serotonin-norepinephrine reuptake inhibitors, similar to methylphenidate and atomoxetine, have potential for ameliorating motor abnormality in the SHR model.
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Affiliation(s)
- Masato Umehara
- Laboratory of Medicinal Pharmacology, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamada-oka, Suita, Osaka 565-0871, Japan
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A Retrospective Study of Amitriptyline in Youth with Autism Spectrum Disorders. J Autism Dev Disord 2012; 43:1017-27. [DOI: 10.1007/s10803-012-1647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The prefrontal cortex (PFC) utilizes working memory to guide behavior and to release the organism from dependence on environmental cues and is commonly disrupted in neuropsychiatric disorders, normal aging, or exposure to uncontrollable stress. This review posits that the PFC is very sensitive to changes in the neuromodulatory inputs it receives from norepinephrine (NE) and dopamine (DA) systems and that this sensitivity can lead to marked changes in the working-memory functions of the PFC. While NE and DA have important beneficial influences on processing in this area, very high levels of catecholamine release, for example, during exposure to uncontrollable stress, disrupt the cognitive functions of the PFC. This fresh understanding of the neurochemical influences on PFC function has led to new treatments for cognitive disorders such as Attention Deficit Hyperactivity Disorder (ADHD), and may help to elucidate the prevalence of PFC dysfunction in other mental disorders.
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Affiliation(s)
- A F Arnsten
- Section of Neurobiology, Yale Medical School, New Haven, CT 06520-8001, USA
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Ramos-Quiroga JA, Bosch R, Richarte V, Valero S, Gómez-Barros N, Nogueira M, Palomar G, Corrales M, Sáez-Francàs N, Corominas M, Real A, Vidal R, Chalita PJ, Casas M. Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.rpsmen.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramos-Quiroga JA, Bosch R, Richarte V, Valero S, Gómez-Barros N, Nogueira M, Palomar G, Corrales M, Sáez-Francàs N, Corominas M, Real A, Vidal R, Chalita PJ, Casas M. Validez de criterio y concurrente de la versión española de la Conners Adult ADHD Diagnostic Interview for DSM-IV. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:229-35. [DOI: 10.1016/j.rpsm.2012.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/25/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
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Winstanley CA. The utility of rat models of impulsivity in developing pharmacotherapies for impulse control disorders. Br J Pharmacol 2012; 164:1301-21. [PMID: 21410459 DOI: 10.1111/j.1476-5381.2011.01323.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
High levels of impulsive behaviours are a clinically significant symptom in a range of psychiatric disorders, such as attention deficit hyperactivity disorder, bipolar disorder, personality disorders, pathological gambling and substance abuse. Although often measured using questionnaire assessments, levels of different types of impulsivity can also be determined using behavioural tests. Rodent analogues of these paradigms have been developed, and similar neural circuitry has been implicated in their performance in both humans and rats. In the current review, the methodology underlying the measurement of different aspects of impulsive action and choice are considered from the viewpoint of drug development, with a focus on the continuous performance task (CPT), stop-signal task (SST), go/no-go and delay-discounting paradigms. Current issues impeding translation between animal and human studies are identified, and comparisons drawn between the acute effects of dopaminergic, noradrenergic and serotonergic compounds across species. Although the field could benefit from a more systematic determination of different pharmacological agents across paradigms, there are signs of strong concordance between the animal and human data. However, the type of impulsivity measured appears to play a significant role, with the SST and delay discounting providing more consistent effects for dopaminergic drugs, while the CPT and SST show better predictive validity so far for serotonergic and noradrenergic compounds. Based on the available data, it would appear that these impulsivity models could be used more widely to identify potential pharmacotherapies for impulse control disorders. Novel targets within the glutamatergic and serotonergic system are also suggested.
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Wilens TE, Morrison NR, Prince J. An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Rev Neurother 2012; 11:1443-65. [PMID: 21955201 DOI: 10.1586/ern.11.137] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adults with attention-deficit/hyperactivity disorder (ADHD) are more frequently presenting for diagnosis and treatment. Medication is considered to be appropriate among available treatments for ADHD; however, the evidence supporting the use of pharmacotherapeutics for adults with ADHD remains less established. In this article, the effectiveness and dosing parameters of the various agents investigated for adult ADHD are reviewed. In adults with ADHD, short-term improvements in symptomatology have been documented through the use of stimulants and antidepressants. Studies suggest that methylphenidate and amphetamine maintained an immediate onset of action, whereas the ADHD response to the nonstimulants appeared to be delayed. At a group level, there appears to be some, albeit not entirely consistent, dose-dependent responses to amphetamine and methylphenidate. Generally speaking, variability in diagnostic criteria, dosing parameters and response rates between the various studies was considerable, and most studies were of a relatively short duration. The aggregate literature shows that the stimulants and catecholaminergic nonstimulants investigated had a clinically significant beneficial effect on treating ADHD in adults.
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Affiliation(s)
- Timothy E Wilens
- Clinical Research Program in Pediatric Psychopharmacology, Child Psychiatry Service, Massachusetts General Hospital, Boston, MA, USA.
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Amiri S, Farhang S, Ghoreishizadeh MA, Malek A, Mohammadzadeh S. Double-blind controlled trial of venlafaxine for treatment of adults with attention deficit/hyperactivity disorder. Hum Psychopharmacol 2012; 27:76-81. [PMID: 22252909 DOI: 10.1002/hup.1274] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/12/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders beginning in childhood that may continue to adulthood. The purpose of this study was to evaluate the possible therapeutic effect of venlafaxine in adults with ADHD. METHODS In a double-blind setting, drug-naïve adults with a diagnosis of ADHD based on DSM-IV-TR criteria were randomly selected to receive either venlafaxine (up to 225 mg/day) or a placebo for 6 weeks. The Conners Adult ADHD Rating Scale self-report screening version was administered before and during the treatment at 2-week intervals to measure the therapeutic effects. RESULTS The mean age (SD) of patients was 30.5 (8.1) years. Eleven out of 20 patients receiving venlafaxine and 13 out of 21 patients receiving the placebo were male. The two groups were not significantly different in terms of age, educational level, weight, or blood pressure. Significant decrease was observed in both subscales (inattentive, hyperactive/impulsive), total ADHD symptoms score, and ADHD index in both the venlafaxine and the placebo groups. Seventy-five percent of treatment group versus 20% of placebo group met treatment response criteria when defined as a 25% drop in total ADHD score (p = 0.001). No serious adverse effects were reported during the trial. CONCLUSIONS In this double-blind trial, the symptoms of adult ADHD decreased after a 6-week trial of either venlafaxine or a placebo with no significant difference. However, a significant treatment response defined as a 25% drop in ADHD index (measured by a self-report scale) was achieved by venlafaxine. The interpretation of these results is limited by the short duration of follow-up in this study.
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Affiliation(s)
- Shahrokh Amiri
- Department of Psychiatry, Tabriz University of Medical Sciences, Tabriz, Iran.
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Maneeton N, Maneeton B, Srisurapanont M, Martin SD. Bupropion for adults with attention-deficit hyperactivity disorder: meta-analysis of randomized, placebo-controlled trials. Psychiatry Clin Neurosci 2011; 65:611-7. [PMID: 22176279 DOI: 10.1111/j.1440-1819.2011.02264.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to systematically review the efficacy, acceptability and tolerability of bupropion in comparison to placebo. Only randomized-controlled trials were included in the meta-analysis. METHODS MEDLINE, EMBASE, CINHL, PsycINFO and Cochrane Controlled Trials Register were searched in October 2010. Study populations comprised adults with any subtype of attention-deficit hyperactivity disorder, attention-deficit disorder, hyperkinetic disorder, minimal brain dysfunction, minimal cerebral dysfunction or minor cerebral dysfunction. Efficacy outcomes were pooled mean changed scores of the ADHD rating scale (ADHD-RS) and the overall response rates. The overall discontinuation rate was considered as the measure of acceptability. RESULTS A total of 349 participants (n for bupropion treatment = 175) in five published randomized, controlled trials were included. Bupropion sustained- or extended-release was the experimental treatment in all studies. The pooled mean changed score of the ADHD-RS of the bupropion-treated group was greater than that of the placebo-treated group with a weighted mean difference (95%CI) of 5.08 (3.13-7.03). The overall response rate of the bupropion-treated group was significantly greater than that of placebo-treated groups with a relative risk (95%CI) of 1.67 (1.23-2.26). However, the pooled overall discontinuation rate and the pooled discontinuation rate due to adverse events were not significantly different between groups with a relative risk (95%CI) of 1.11 (0.71-1.72) and 0.87 (0.08-9.79), respectively. CONCLUSION The evidence suggests that bupropion is superior to placebo and effective for the treatment of ADHD in adults. However, its acceptability and tolerability were not significantly higher than those of placebo.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Linderkamp F, Lauth G. Zur Wirksamkeit pharmakologischer und psychotherapeutischer Therapien bei Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter: Eine empirische Metaanalyse. VERHALTENSTHERAPIE 2011. [DOI: 10.1159/000332429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Santosh PJ, Sattar S, Canagaratnam M. Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults. CNS Drugs 2011; 25:737-63. [PMID: 21870887 DOI: 10.2165/11593070-000000000-00000] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This review examines the evidence regarding the efficacy and tolerability of long- and short-acting stimulant medications, as well as the non-stimulant medications atomoxetine and bupropion in the treatment of adult attention-deficit hyperactivity disorder (ADHD). Effect sizes in adults appear to be of almost the same magnitude as in school-age children when robust doses are used. There are adequate data demonstrating short-term efficacy and safety of medication in ADHD during adulthood but long-term studies are lacking, particularly in view of concerns regarding cardiovascular adverse events. There is some evidence that stimulant medication can improve driving performance in adults with ADHD. The extent to which medication may improve academic, occupational and social functioning in adults with ADHD is unclear, and future research should investigate these outcomes. Medication treatment of adults with ADHD in sports is controversial. Both stimulant and non-stimulant medications seem to be well tolerated. Monitoring of pulse and blood pressure is recommended with these drugs because of their cardiovascular effects. There have been extremely rare case reports of sudden death in adults and children treated with stimulants and atomoxetine, but it is difficult to clearly establish causality. In view of reports of treatment-related suicide-related behaviour with atomoxetine, it is recommended that adults should be observed for agitation, irritability, suicidal thinking, self-harming or unusual behaviour, particularly in the first months of treatment, or after a change of dose. ADHD in adults continues to remain an under-recognized disorder in many parts of the world and there is a lack of specialist clinics for assessment and treatment of adult ADHD. Studies to date have failed to show efficacy of medications in the treatment of ADHD in the substance misuse population. There is little evidence so far to suggest an increased misuse of stimulants or diversion amongst substance misusers; however, data are insufficient to draw firm conclusions. Further work is necessary to evaluate effective treatments in subgroups such as the substance misuse population, those with multiple co-morbidities and different ADHD subtypes.
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Affiliation(s)
- Paramala J Santosh
- Centre for Interventional Paediatric Psychopharmacology, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
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The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry 2011; 69:e145-57. [PMID: 21550021 DOI: 10.1016/j.biopsych.2011.02.036] [Citation(s) in RCA: 395] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 01/16/2011] [Accepted: 02/15/2011] [Indexed: 12/14/2022]
Abstract
Through neuromodulatory influences over fronto-striato-cerebellar circuits, dopamine and noradrenaline play important roles in high-level executive functions often reported to be impaired in attention-deficit/hyperactivity disorder (ADHD). Medications used in the treatment of ADHD (including methylphenidate, dextroamphetamine and atomoxetine) act to increase brain catecholamine levels. However, the precise prefrontal cortical and subcortical mechanisms by which these agents exert their therapeutic effects remain to be fully specified. Herein, we review and discuss the present state of knowledge regarding the roles of dopamine (DA) and noradrenaline in the regulation of corticostriatal circuits, with a focus on the molecular neuroimaging literature (both in ADHD patients and in healthy subjects). Recent positron emission tomography evidence has highlighted the utility of quantifying DA markers, at baseline or following drug administration, in striatal subregions governed by differential cortical connectivity. This approach opens the possibility of characterizing the neurobiological underpinnings of ADHD (and associated cognitive dysfunction) and its treatment by targeting specific neural circuits. It is anticipated that the application of refined and novel positron emission tomography methodology will help to disentangle the overlapping and dissociable contributions of DA and noradrenaline in the prefrontal cortex, thereby aiding our understanding of ADHD and facilitating new treatments.
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A neurochemical yin and yang: does serotonin activate and norepinephrine deactivate the prefrontal cortex? Psychopharmacology (Berl) 2011; 213:171-82. [PMID: 20386882 DOI: 10.1007/s00213-010-1856-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/27/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The prefrontal cortex (PFC) receives serotonergic input from the dorsal raphe nucleus of the brainstem, as well as noradrenergic input from another brainstem nucleus, the locus coeruleus. A large number of studies have shown that these two neurotransmitter systems, and drugs that affect them, modulate the functional properties of the PFC in both humans and animal models. RESULTS Here I examine the hypothesis that serotonin (5-HT) plays a general role in activating the PFC, whereas norepinephrine (NE) plays a general role in deactivating this brain region. In this manner, the two neurotransmitter systems may have opposing effects on PFC-influenced behavior. To assess this hypothesis, three primary lines of evidence are examined comprising the effects of 5-HT and NE on impulsivity, cognitive flexibility, and working memory. DISCUSSION While all of the existing data do not unequivocally support the activation/deactivation hypothesis, there is a large body of support for it.
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Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing MB, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10:67. [PMID: 20815868 PMCID: PMC2942810 DOI: 10.1186/1471-244x-10-67] [Citation(s) in RCA: 499] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 09/03/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.
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Affiliation(s)
- Sandra JJ Kooij
- PsyQ, psycho medische programma's, Department Adult ADHD, Carel Reinierszkade 197, Den Haag, The Netherlands
| | - Susanne Bejerot
- Department of Clinical Neuroscience, Karolinksa Institutet, Section Psychiatry, St. Goran, Stockholm, Sweden
| | - Andrew Blackwell
- University Department of Psychiatry, Addenbrookes Hospital, Cambridge, UK
| | - Herve Caci
- Pediatric Department, Hôpitaux Pédiatriques CHU-Lenval, 06200 Nice, France
| | - Miquel Casas-Brugué
- Servicio de Psiquiatria, Hospital Universitari Vall d' Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Pieter J Carpentier
- Reinier van Arkel Groep, Postbus 70058, 5201 DZ 's-Hertogenbosch, The Netherlands
| | - Dan Edvinsson
- Department of Neuroscience/Psychiatri Ulleråker, MK 75, S-750 17 Uppsala, Sweden
| | - John Fayyad
- Institute of Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon
| | - Karin Foeken
- Centre des Consultations, Institut A Tzanck, Mougins, France
| | - Michael Fitzgerald
- Department of Psychiatry, Trinity College Dublin (TCD), Dublin 2, Ireland
| | - Veronique Gaillac
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Sainte Anne Hospital Paris, France
| | - Ylva Ginsberg
- Affektiva mottagningen, M 59, Psykiatri Sydväst, 141 86 Stockholm, Sweden
| | - Chantal Henry
- Département de Psychiatrie Adulte, Unité Lescure, CH Charles Perrens, Bordeaux, France
| | - Johanna Krause
- Private clinic for psychiatry and psychotherapy, 11a Schillerstrasse, Ottobrunn, Germany
| | - Michael B Lensing
- Department of Child Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Iris Manor
- Geha Mental Health Center, Petach-Tiqva, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Helmut Niederhofer
- Department of Child Psychiatry, Regional Hospital of Bolzano, Via Guncina, Bolzano, Italy
| | - Carlos Nunes-Filipe
- Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal
| | - Martin D Ohlmeier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Pierre Oswald
- Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefano Pallanti
- Department of Neurosciences, Florence University, Florence, Italy
| | - Artemios Pehlivanidis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Josep A Ramos-Quiroga
- Programa Integral del Déficit de Atención en el Adulto (P.I.D.A.A), Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Rastam
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Lund University, Sweden
| | | | - Steven Stes
- ADHD Program, University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Kings College London, London, UK
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Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA 2010; 304:875-80. [PMID: 20736471 PMCID: PMC3641654 DOI: 10.1001/jama.2010.1192] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. OBJECTIVE To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. DESIGN, SETTING, AND PATIENTS Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. INTERVENTIONS Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). MAIN OUTCOME MEASURES The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. RESULTS Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. CONCLUSION Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00118911.
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Affiliation(s)
- Steven A Safren
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Martinson J, Tang HYJ. Correlating family nurse practitioners' perspectives of adult ADD/ADHD with employed pharmacotherapy: a pilot study. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2010; 22:424-430. [PMID: 20670268 DOI: 10.1111/j.1745-7599.2010.00527.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE This study explores how family nurse practitioners (FNPs) in the state of Washington view adulthood attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) and how these views affect the pharmacotherapy FNPs employ. DATA SOURCES A confidential survey containing 30 questions was mailed to self-selected FNPs who practice in the state of Washington (N= 126). Descriptive and Kendall's rank correlations coefficient statistical methods were used for data analysis. CONCLUSIONS The majority of respondents do not hold negative views toward adults with ADD/ADHD and are aware that their personal views may affect how they treat the disorder. Most of the respondents agreed that given the likelihood of co-morbidity of adult ADD/ADHD, it can be a challenge to diagnose the disorder. The predominant prescribed medications for adult ADD/ADHD are consistent with current pediatric guidelines, with the exception of buproprion, which was identified by 40% of the respondents as either their primary or secondary drug of choice for treating adult ADD/ADHD. IMPLICATIONS FOR PRACTICE Research effort needs to focus on the efficacy of buproprion for treating ADD/ADHD in adults. Moreover, exploration of the effectiveness of current pediatric guidelines to treat ADD/ADHD in adults must be assessed.
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Quintero J, López-Muñoz F, Alamo C, Loro M, García-Campos N. Reboxetine for ADHD in children non-responders or with poor tolerance to methylphenidate: a prospective long-term open-label study. ACTA ACUST UNITED AC 2010; 2:107-13. [DOI: 10.1007/s12402-010-0027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
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Turic D, Swanson J, Sonuga-Barke E. DRD4 and DAT1 in ADHD: Functional neurobiology to pharmacogenetics. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2010; 3:61-78. [PMID: 23226043 PMCID: PMC3513209 DOI: 10.2147/pgpm.s6800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 12/26/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a common and potentially very impairing neuropsychiatric disorder of childhood. Statistical genetic studies of twins have shown ADHD to be highly heritable, with the combination of genes and gene by environment interactions accounting for around 80% of phenotypic variance. The initial molecular genetic studies where candidates were selected because of the efficacy of dopaminergic compounds in the treatment of ADHD were remarkably successful and provided strong evidence for the role of DRD4 and DAT1 variants in the pathogenesis of ADHD. However, the recent application of non-candidate gene strategies (eg, genome-wide association scans) has failed to identify additional genes with substantial genetic main effects, and the effects for DRD4 and DAT1 have not been replicated. This is the usual pattern observed for most other physical and mental disorders evaluated with current state-of-the-art methods. In this paper we discuss future strategies for genetic studies in ADHD, highlighting both the pitfalls and possible solutions relating to candidate gene studies, genome-wide studies, defining the phenotype, and statistical approaches.
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Affiliation(s)
- Darko Turic
- Institute for Disorders of Impulse and Attention, School of Psychology, University of Southampton, UK
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Surman C, Hammerness P, Petty C, Doyle R, Chu N, Gebhard N, Williams C, Biederman J. Atomoxetine in the treatment of adults with subthreshold and/or late onset attention-deficit hyperactivity disorder-not otherwise specified (ADHD-NOS): a prospective open-label 6-week study. CNS Neurosci Ther 2010; 16:6-12. [PMID: 20070786 DOI: 10.1111/j.1755-5949.2009.00124.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to evaluate the efficacy and tolerability of atomoxetine hydrochloride (ATX) in the treatment of adults with atypical manifestations of attention-deficit hyperactivity disorder (ADHD) (not otherwise specified [NOS]). We hypothesized that treatment with ATX will be safe and efficacious for the treatment of adults with ADHD-NOS. This was a 6-week, open-label, prospective treatment study of ATX monotherapy in 45 adult patients with ADHD-NOS assessed using standardized instruments for diagnosis and a robust oral daily dose of up to 1.2 mg/kg/day or 120 mg/day. Symptom severity was assessed with the adult ADHD Investigator Symptom Report Scale (AISRS) and Clinical Global Impression Scale. Treatment with ATX at an average daily dose of 78.7 +/- 27.8 mg was associated with a statistically and clinically significant reduction in ADHD symptoms relative to baseline as assessed through the (AISRS) (-12.1 +/- 8.4; P < 0.001). Using a categorical definition of response (CGI-I much or very much improved), a majority (N = 29; 64%) of subjects were rated as improved at study endpoint. Treatment with ATX was relatively well tolerated. These open-label results suggest that ATX may be safe and effective in the treatment of adults meeting criteria for ADHD-NOS and support the need for further controlled clinical trials of ATX in this population.
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Affiliation(s)
- Craig Surman
- Massachusetts General Hospital, Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, and Harvard Medical School, Boston, MA, USA.
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Verster JC, Bekker EM, Kooij JJS, Buitelaar JK, Verbaten MN, Volkerts ER, Olivier B. Methylphenidate significantly improves declarative memory functioning of adults with ADHD. Psychopharmacology (Berl) 2010; 212:277-81. [PMID: 20645078 PMCID: PMC2937141 DOI: 10.1007/s00213-010-1952-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 07/05/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Declarative memory deficits are common in untreated adults with attention-deficit hyperactivity disorder (ADHD), but limited evidence exists to support improvement after treatment with methylphenidate. The objective of this study was to examine the effects of methylphenidate on memory functioning of adults with ADHD. METHODS Eighteen adults with ADHD who were clinical responders to methylphenidate participated in this randomized crossover trial. After 3 days of no treatment, patients received in random order either their usual methylphenidate dose (mean: 14.7 mg; range: 10-30 mg) or placebo, separated by a 6-7-day washout period. Patients performed an immediate word recall test 1 h after treatment administration. Three hours after intake, patients performed the second part of the memory test (delayed word recall and a recognition test). RESULTS Delayed recognition and immediate recall was similar on treatment and on placebo. Delayed word recall was significantly better in the methylphenidate than in the placebo condition (F (1, 17) = 7.0, p < 0.017). A significant correlation was found between prestudy CES-D depression scores and difference scores on delayed recall (r = 0.602, p < 0.008). CONCLUSION Methylphenidate improves declarative memory functioning in patients with ADHD. New studies should further examine whether subclinical depressive symptoms mediate the effect of methylphenidate on declarative memory.
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Affiliation(s)
- Joris C. Verster
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands
| | - Evelijne M. Bekker
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands ,Department of Cognitive Neuroscience, Radboud University Nijmegen, Medical Center, Nijmegen, the Netherlands
| | | | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Radboud University Nijmegen, Medical Center, Nijmegen, the Netherlands
| | - Marinus N. Verbaten
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands
| | - Edmund R. Volkerts
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands
| | - Berend Olivier
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands
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Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): a meta-analysis. Int J Neuropsychopharmacol 2009; 12:1137-47. [PMID: 19580697 DOI: 10.1017/s1461145709990198] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective was to conduct a meta-analysis of therapeutic efficacy of pharmacological treatment of adult ADHD based on data from controlled clinical trials. We used the search engines PubMed and Medline to identify relevant clinical trials. Short-term studies with double-blind parallel-group design were selected for the analysis. Altogether, we identified 11 trials that met the criteria, and investigated a total of 1991 subjects, 694 and 1297 of whom were treated with placebo or active medication, respectively. In order to pool efficacy data from studies with different characteristics, including different number of participants, different trial duration and measures of efficacy, the statistical effect sizes for each study had to be calculated. Our findings showed that the pooled effect size across all treatments was in the medium-to-high range (Cohen's d=0.65, p<0.0001 vs. placebo), and the effect size for stimulants (Cohen's d=0.67, p<0.0001 vs. placebo) was somewhat higher than for non-stimulant medications (Cohen's d=0.59, p<0.0001 vs. placebo). The current database of controlled trials for adult ADHD is relatively small, and does not include data for many of the potentially important agents. In addition, effect-size estimates for different classes of medications (i.e. stimulant and non-stimulant medications) were based on separate studies; head-to-head comparisons of various agents are severely lacking. Nonetheless, results of this meta-analysis across all ADHD medications in adult subjects demonstrated statistically significant and clinically robust improvement in symptom severity compared to placebo treatment.
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Tcheremissine OV, Lieving LM. Once-daily medications for the pharmacological management of ADHD in adults. Ther Clin Risk Manag 2009; 5:367-79. [PMID: 19536322 PMCID: PMC2697545 DOI: 10.2147/tcrm.s4206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric disorder in children and adolescents. Symptoms of ADHD often persist beyond childhood and present significant challenges to adults. Pharmacotherapy is a first-line treatment option for ADHD across all age groups. The current review's goals are (a) to critically examine the current state of knowledge regarding once-daily formulations of pharmacotherapies for treatment of adults with ADHD and (b) to provide clinicians with evidence-based information regarding the safety, efficacy and tolerability of once-daily medications for adult ADHD. The reviewed body of evidence strongly supports the use of pharmacotherapy as a first-line therapeutic option for the treatment of adults with ADHD. The once-daily pharmacological agents are effective therapeutic options for the treatment of adults with ADHD. In the US, based on the available evidence, once-daily medications are currently underutilized in adults with ADHD compared to pediatric population.
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Affiliation(s)
- Oleg V Tcheremissine
- Department of Psychiatry, Behavioral Health Center – Carolinas Medical Center, Charlotte, NC, USA
| | - Lori M Lieving
- Carolinas College of Health Sciences, Charlotte, NC, USA
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Verbeeck W, Tuinier S, Bekkering GE. Antidepressants in the treatment of adult attention-deficit hyperactivity disorder: a systematic review. Adv Ther 2009; 26:170-84. [PMID: 19238340 DOI: 10.1007/s12325-009-0008-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Stimulant medications are the most effective drugs in the treatment of attention-deficit hyperactivity disorder (ADHD) in children and in adults. However, some patients do not respond to this treatment and other patients suffer from adverse effects. Very often there are also comorbid disorders that warrant treatment or there is somatic comorbidity that precludes the prescription of stimulants. As a result, alternative treatments for the treatment of ADHD have been explored, such as antidepressant agents. In this systematic review the evidence base for the effect of antidepressants for ADHD in adult patients is determined. METHODS Electronic and hand searches were conducted in order to identify clinical trials studying antidepressants for the treatment of ADHD in adult patients. The trials were screened for methodological characteristics and treatment-effect sizes. The odds ratio was calculated for randomized controlled trials with bupropion. A descriptive review of all the randomized controlled studies and an overview of the nonrandomized studies was developed. RESULTS Only eight randomized controlled trials were retrieved with four different compounds. Five studies concerned bupropion and the meta-analysis indicates a beneficial effect for bupropion compared with placebo as measured with the Clinical Global Improvement Scale (odds ratio 2.42 [95% CI 1.09 to 5.36]). Several studies suffer from clinical and methodological shortcomings, such as exclusion of patients with comorbid disorders, short treatment duration, or a lack of information with respect to the randomization procedure. CONCLUSION Although there is a need for alternative interventions for the treatment of ADHD, such as with antidepressant agents, the evidence base is not large. Only treatment with bupropion seems to have a medium-range effect size, but this is less than that of stimulant medications.
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Affiliation(s)
- Wim Verbeeck
- Vincent van Gogh Institute for Psychiatry, Postbus 5, 5800, AA Venray, the Netherlands.
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Jacob CP, Philipsen A, Ebert D, Deckert J. [Multimodal treatment of adult attention-deficit hyperactivity disorder]. DER NERVENARZT 2008; 79:801-8. [PMID: 18542905 DOI: 10.1007/s00115-008-2510-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The indication for treatment of adult attention-deficit hyperactivity disorder (adult ADHD) is derived not from the diagnosis itself but results from the severity of symptoms, comorbidities, psychosocial consequences, and a lack of defined resources for ADHD. The basis of therapy is psychoeducation that includes teaching about symptoms, models of the disorder, and options for treatment. The combination of pharmacotherapy and psychotherapy is recommended. Methylphenidate is considered the first-line therapy, because of its strong effect and modest side effects, but is not authorized in Germany ("off-label use"). Atomoxetine, which is authorized for continuing treatment into adulthood, is indicated if methylphenidate is insufficient or has unacceptable side effects and in case of comorbid substance use. Various psychotherapeutic interventions using available ADHD-typical resources have demonstrated positive effects. Psychosocial support and self-help groups complete the treatment concept. Persistence of the treatment indication has to be reevaluated at regular intervals. Disorder-specific multimodal therapy of adult ADHD conforms to the complex, primarily neurobiologic etiology and the psychosocial consequences.
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Affiliation(s)
- C P Jacob
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie der Universität Würzburg, Füchsleinstrasse 15, 97080 Würzburg.
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Castaneda R, Levy R, Hazzi C, Ross S, Roman W, Hamid H. Treating adult attention deficit hyperactivity disorder in hospitalized psychiatric patients. Gen Hosp Psychiatry 2008; 30:572-7. [PMID: 19061685 DOI: 10.1016/j.genhosppsych.2008.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 08/12/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We intend to review the importance of appropriately recognizing and managing attention deficit/attention deficit hyperactivity disorder (ADD/ADHD) in the acute psychiatric hospital setting. METHODS We demonstrate the management of three patients with associated ADD/ADHD diagnosis in the hospital setting. This case series is followed by a review of the literature on the treatment of ADD/ADHD with particular focus on inpatient treatment. RESULTS Given that the core symptoms of ADD/ADHD are inattention, hyperactivity, poor concentration, impulsivity, poor organization and emotional instability, it follows that a comprehensive inpatient treatment plan should address these issues in order to obtain sustained, focused participation on the part of the patient. Suppression of ADD/ADHD symptoms with stimulants greatly enhanced our patients' ability to more productively and actively participate in the treatment of the acute psychiatric problems which led to their admission. CONCLUSIONS Currently, no published data exist on prevalence of ADD/ADHD in psychiatric hospitals, rates of treatment and outcome of treatment with regard to recovery and quality of aftercare. Nonetheless, the benefits of treating ADD/ADHD among psychiatric inpatients may be seen in case examples and are also apparent in the data concerning treatment of ADD/ADHD in the dually diagnosed.
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Affiliation(s)
- Ricardo Castaneda
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr 2008; 13:977-84. [PMID: 19037178 DOI: 10.1017/s1092852900014036] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery.
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