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Häge A, Man KKC, Inglis SK, Buitelaar J, Carucci S, Danckaerts M, Dittmann RW, Falissard B, Garas P, Hollis C, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Zuddas A, Wong ICK, Coghill D, Banaschewski T. Methylphenidate and Sleep Difficulties in Children and Adolescents With ADHD: Results From the 2-Year Naturalistic Pharmacovigilance ADDUCE Study. J Atten Disord 2024; 28:699-707. [PMID: 38389266 DOI: 10.1177/10870547241232337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Short-term RCTs have demonstrated that MPH-treatment significantly reduces ADHD-symptoms, but is also associated with adverse events, including sleep problems. However, data on long-term effects of MPH on sleep remain limited. METHODS We performed a 2-year naturalistic prospective pharmacovigilance multicentre study. Participants were recruited into three groups: ADHD patients intending to start MPH-treatment (MPH-group), those not intending to use ADHD-medication (no-MPH-group), and a non-ADHD control-group. Sleep problems were assessed with the Children's-Sleep-Habits-Questionnaire (CSHQ). RESULTS 1,410 participants were enrolled. Baseline mean CSHQ-total-sleep-scores could be considered clinically significant for the MPH-group and the no-MPH-group, but not for controls. The only group to show a significant increase in any aspect of sleep from baseline to 24-months was the control-group. Comparing the MPH- to the no-MPH-group no differences in total-sleep-score changes were found. CONCLUSION Our findings support that sleep-problems are common in ADHD, but don't suggest significant negative long-term effects of MPH on sleep.
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Affiliation(s)
| | - Kenneth K C Man
- University College London, UK
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, Hong Kong
| | | | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Sara Carucci
- University of Cagliari and "A.Cao" Paediatric Hospital, Italy
| | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital and Bethesda Children's Hospital, Budapest, Hungary
| | | | | | | | - Ian C K Wong
- The University of Hong Kong, Hong Kong
- Aston University, Birmingham, UK
| | - David Coghill
- University of Dundee, Scotland
- University of Melbourne, Australia
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Carucci S, Zuddas A, Lampis A, Man KKC, Balia C, Buitelaar J, Danckaerts M, Dittmann RW, Donno F, Falissard B, Gagliano A, Garas P, Häge A, Hollis C, Inglis SK, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Wong ICK, Banaschewski T, Coghill D. The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project. J Atten Disord 2024; 28:722-739. [PMID: 38366816 DOI: 10.1177/10870547241226726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. METHOD Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. RESULTS The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. CONCLUSION Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.
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Affiliation(s)
- Sara Carucci
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | | | | | - Kenneth K C Man
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
| | - Carla Balia
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | | | | | - Ian C K Wong
- University College London, UK
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
- Aston University, Birmingham, UK
| | | | - David Coghill
- University of Dundee, UK
- University of Melbourne, VIC, Australia
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Gyori D, Farkas BF, Komaromy D, Horvath LO, Kollarovics N, Garas P, Balazs J. The Association between Nonsuicidal Self-Injury and Perfectionism in Adolescence: The Role of Mental Disorders. Eur J Investig Health Psychol Educ 2023; 13:2299-2327. [PMID: 37998053 PMCID: PMC10670610 DOI: 10.3390/ejihpe13110163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023] Open
Abstract
Previous evidence has drawn attention to the fact that maladaptive perfectionism is a risk factor for engagement in nonsuicidal self-injury (NSSI). Until now, few studies have examined this topic, especially among community adolescents. The aim of this study was to explore the relationship between perfectionism dimensions and NSSI functions to examine the potential mediating effect of mental disorders. Altogether, 146 Hungarian community adolescents (ages 13-18 years) were involved. All participants completed the Hungarian adaptation of the Inventory of Statements about Self-Injury (ISAS), the Frost Multidimensional Perfectionism Scale (FMPS), and the Mini International Neuropsychiatric Interview Kid. To analyse the interrelationships among NSSI, perfectionism, and mental disorders, we conducted regression and network analysis. Of the 146 adolescents, 90 (61.64%, girls: 71.11%) engaged in NSSI. The Concern over Mistakes and Doubts about Action scales of the FMPS significantly and positively predicted both NSSI intrapersonal and interpersonal motivation, with comparable effect sizes, and this association was fully mediated by anxiety disorders. There was a significant direct negative relationship between the FMPS Organisation dimension and both main NSSI functions. This study draws attention to an increasing trend and the extremely high NSSI prevalence rate among community adolescents. Adolescents with perfectionistic concerns are at heightened risk for anxiety disorders, which can increase their vulnerability to NSSI engagement.
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Affiliation(s)
- Dora Gyori
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
| | - Bernadett Frida Farkas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Daniel Komaromy
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lili Olga Horvath
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Pedagogical Services, 1141 Budapest, Hungary
| | - Nora Kollarovics
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Peter Garas
- Mental Health Sciences Doctoral School, Semmelweis University Doctoral School, 1083 Budapest, Hungary; (B.F.F.); (N.K.); (P.G.)
| | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary; (D.K.); (L.O.H.)
- Department of Psychology, Oslo New University College, 0456 Oslo, Norway
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Man KKC, Häge A, Banaschewski T, Inglis SK, Buitelaar J, Carucci S, Danckaerts M, Dittmann RW, Falissard B, Garas P, Hollis C, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Zuddas A, Wong ICK, Coghill D. Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. Lancet Psychiatry 2023; 10:323-333. [PMID: 36958362 DOI: 10.1016/s2215-0366(23)00042-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Methylphenidate is the most frequently prescribed medication for the treatment of ADHD in children and adolescents in many countries. Although many randomised controlled trials support short-term efficacy, tolerability, and safety, data on long-term safety and tolerability are scarce. The aim of this study was to investigate the safety of methylphenidate over a 2-year period in relation to growth and development, psychiatric health, neurological health, and cardiovascular function in children and adolescents. METHODS We conducted a naturalistic, longitudinal, controlled study as part of the ADDUCE research programme in 27 European child and adolescent mental health centres in the UK, Germany, Switzerland, Italy, and Hungary. Participants aged 6-17 years were recruited into three cohorts: medication-naive ADHD patients who intended to start methylphenidate treatment (methylphenidate group), medication-naive ADHD patients who did not intend to start any ADHD medication (no-methylphenidate group), and a control group without ADHD. Children with ADHD diagnosed by a qualified clinician according to the DSM-IV criteria and, in the control group, children who scored less than 1·5 on average on the Swanson, Nolan, and Pelham IV rating scale for ADHD items, and whose hyperactivity score on the parent-rated Strengths and Difficulties Questionnaire was within the normal range (<6) were eligible for inclusion. Participants were excluded if they had previously taken any ADHD medications but remained eligible if they had previously taken or were currently taking other psychotropic drugs. The primary outcome was height velocity (height velocity SD score; estimated from at least two consecutive height measurements, and normalised with reference to the mean and SD of a population of the same age and sex). FINDINGS Between Feb 01, 2012, and Jan 31, 2016, 1410 participants were enrolled (756 in methylphenidate group, 391 in no-methylphenidate group, and 263 in control group). 1070 (76·3%) participants were male, 332 (23·7%) were female, and for eight gender was unknown. The average age for the cohort was 9·28 years (SD 2·78; IQR 7-11). 1312 (93·0%) of 1410 participants were White. The methylphenidate and no-methylphenidate groups differed in ADHD symptom severity and other characteristics. After controlling for the effects of these variables using propensity scores, there was little evidence of an effect on growth (24 months height velocity SD score difference -0·07 (95% CI -0·18 to 0·04; p=0·20) or increased risk of psychiatric or neurological adverse events in the methylphenidate group compared with the no-methylphenidate group. Pulse rate and systolic and diastolic blood pressure were higher in the methylphenidate group compared with the no-methylphenidate group after 24 months of treatment. No serious adverse events were reported during the study. INTERPRETATION Our results suggest that long-term treatment with methylphenidate for 2 years is safe. There was no evidence to support the hypothesis that methylphenidate treatment leads to reductions in growth. Methylphenidate-related pulse and blood pressure changes, although relatively small, require regular monitoring. FUNDING EU Seventh Framework Programme.
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Affiliation(s)
- Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Jan Buitelaar
- Radboudumc, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Sara Carucci
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry Unit, A Cao Paediatric Hospital, Cagliari, Italy
| | - Marina Danckaerts
- Department of Neurosciences, Developmental Psychiatry, KU Leuven, Leuven, Belgium; Department of Child and Adolescent Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations, CESP, INSERM U1018, Université Paris-Saclay, Paris, France
| | - Peter Garas
- Mental Health Sciences, Schools of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Chris Hollis
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK; NIHR MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Mental Health, and Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen and Research Centre Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth Liddle
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | | | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary
| | | | - Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari and A Cao Paediatric Hospital, G Brotzu Hospital Trust, Cagliari, Italy
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Faculty of Medicine, University of Dundee, Dundee, UK.
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Szentivanyi D, Horváth L, Buist K, Farkas B, Dallos G, Garas P, Győri D, Balazs J. Coronavirus Pandemic - #STAYHOME: How Are You Holding Up? Questions And Tips For 11-18 Year Olds To Make It Better. Eur Psychiatry 2022. [PMCID: PMC9566581 DOI: 10.1192/j.eurpsy.2022.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Adolescents have to cope with several challenges and restrictions due to the COVID-19 pandemic, with many of those incongruent with the typical developmental tasks of adolescent age. Some adolescent might be particularly vulnerable in this situation. Objectives This study aimed: 1) to collect data on the mental health and quality of life of adolescents during/after the pandemic; 2. to improve adolescents’ mental health by providing an online prevention program that addresses their actual needs; 3. to accelerate the development of culturally adapted prevention programs by involving an international team, and 4. to contribute to adequate preparation for any similar situation in the future. Methods Participants aged 11-18 years and their parents/caregivers were recruited online. Data has been collected regularly in a follow-up study by Inventar zur Erfassung der Lebensqualitat and Strengths and Difficulties Questionnaire. The baseline data collection was in March 2020 at first restrictions of the COVID pandemic in Europe Results In the baseline data 428 adolescents (29.7% boys;70.3% girls) were included. Adolescents reported significantly lower quality of life during the pandemic (F (1,557) = 29.11; p <0.001; R2 = 0.048). There was no significant difference in quality of life according to whether the adolescents live in a household with their siblings ( F (2, 356) = 0.785 p = 0.457; η2 = 0.004), and whether the adolescents have symptoms of hyperactivity (ß = 0.105; p = 0.295). Conclusions Prevention based on the results of this study is expected to contribute to maintaining adolescents’ mental health during and after the COVID pandemic. Disclosure No significant relationships.
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Garas P, Balazs J. Long-term suicide risk of children and adolescents with attention deficit and hyperactivity disorder – a systematic review. Eur Psychiatry 2022. [PMCID: PMC9564383 DOI: 10.1192/j.eurpsy.2022.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Several studies showed the high suicide risk of patients with attention deficit and hyperactivity disorder (ADHD), however most of these studies had cross-sectional design.
Objectives
The aim of the current study was to review systematically those studies which investigated the suicide risk among ADHD patients with longitudinal design.
Methods
The systematic search was made on OVID Medline, PsychInfo, PubMed, Scopus, and Web of Science. The search terms were (ADHD OR attention deficit hyperactivity disorder) AND (suicide OR suicidal OR suicidality) AND (follow-up OR longitudinal study OR prospective study). Inclusion criteria were: written in English; participants under 18 years at the baseline; longitudinal, prospective studies; ADHD population at the baseline and at the follow-up; suicide behavior as primary outcome. Exclusion criteria were: the study did not contain empirical data, and reviews/meta-analyses and studies which aimed to investigate the drug treatment efficacy of ADHD.
Results
18 papers were included in the systematic review. 10 articles were published in the last 5 years. 9 studies enrolled children aged under 12 at baseline. The follow-up periods varied between 2 and 17 years. 17 studies found a significant positive association between ADHD diagnosis at baseline and the future suicidal behavior and/or attempts at the follow-up. The affective comorbidity showed an association with the future suicide risk.
Conclusions
These results highlight the importance of screening suicidality in patient with ADHD and consider it during treatment. Further studies are needed to clarify the role of the treatment and comorbidities of ADHD in the increased suicide risk.
Disclosure
No significant relationships.
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Szentiványi D, Horvath LO, Kjeldsen A, L Buist K, Farkas BF, Ferenczi-Dallos G, Garas P, Gyori D, Gyorfi A, Gyorfi D, Ravens-Sieberer U, Balazs J. Coronavirus Pandemic - #STAYHOME: How Are You Holding Up? Questions And Tips For 11-18-Year-Olds To Make It Better. Neuropsychopharmacol Hung 2021; 23:208-214. [PMID: 33835042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Adolescents have to cope with several challenges and restrictions due to the COVID-19 pandemic, with many of those incongruent with the typical developmental tasks of adolescent age. Some adolescents might be particularly vulnerable in this situation, including those who are deprived of psychological, social or health care services and/or are exposed to abuse or neglect in their home environment. The aims of the current international multicentre follow-up study are to: 1. collect data on the mental health and quality of life of adolescents during and after the pandemic; 2. improve their mental health by providing an online prevention program that addresses their actual needs; 3. accelerate the development of culturally adapted prevention programs by involving an international team, and 4. to contribute to adequate preparation for any potentially occurring, similar situationin the future. METHODS Participants aged 11-18 years and their parents/caregivers from diff erent parts of Europe and non-European countries are recruited online. Data are collected regularly in a follow-up study by means of structured self-administered online questionnaires on adolescents' mental health, quality of life and current attitudes and needs. The baseline data collection was in March 2020 at first restrictions of the COVID pandemic in Europe. It is followed up several times (at the beginning weekly, later monthly, bi-monthly, three-monthly) to study changes in mental health, quality of life and attitudes of children and adolescents during the coronavirus disease pandemic. Data were collected by means of structured questionnaires (see below). The time frame of the study is set to one year from study start, March 2021. The last data collection was done in December 2020. The prevention program is developed and provided based on continuously analysed incoming data. CONCLUSIONS Prevention based on the results of the study is expected to contribute to maintaining adolescents' mental health, improve their quality of life, increase their and their environment's cooperation with the necessary restrictions during the pandemic, and to make reintegration easier once the restrictions are over. Furthermore, the study has the potential to inform on the wellbeing of children and adolescents in extreme situations in general, thus contribute to future preventive measures and policymaking. Implications and Contribution: The proposed international online follow-up study is expected to provide scientifi c evidence for 1. possible changes in the mental health and quality of life of adolescents during and after a pandemic situation, 2. the eff ectiveness of a culturally adapted prevention program developed to address challenges associated with these changes.
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Affiliation(s)
- Dora Szentiványi
- Eötvös Loránd Tudományegyetem, Pszichológiai Intézet, Budapest, Hungary.
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8
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Carucci S, Balia C, Gagliano A, Lampis A, Buitelaar JK, Danckaerts M, Dittmann RW, Garas P, Hollis C, Inglis S, Konrad K, Kovshoff H, Liddle EB, McCarthy S, Nagy P, Panei P, Romaniello R, Usala T, Wong ICK, Banaschewski T, Sonuga-Barke E, Coghill D, Zuddas A. Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 120:509-525. [PMID: 33080250 DOI: 10.1016/j.neubiorev.2020.09.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. OBJECTIVES To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. RESULTS Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naïve condition as clinical moderators were found. Data on timing of puberty are currently limited. CONCLUSIONS Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.
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Affiliation(s)
- Sara Carucci
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy.
| | - Carla Balia
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Antonella Gagliano
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Angelico Lampis
- Paediatric Endocrinology Unit, A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Garas
- Semmelweis University Mental Health Sciences School of PhD Studies, Budapest, Hungary
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sarah Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Pietro Panei
- Grant Office and Technology Transfer, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Romaniello
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Tatiana Usala
- Child and Adolescent Neuropsychiatry Unit, Azienda per la Tutela della Salute, ATS Sardegna, ASSL Oristano, Italy
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tobias Banaschewski
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
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9
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Garas P, Balazs J. Long-Term Suicide Risk of Children and Adolescents With Attention Deficit and Hyperactivity Disorder-A Systematic Review. Front Psychiatry 2020; 11:557909. [PMID: 33408650 PMCID: PMC7779592 DOI: 10.3389/fpsyt.2020.557909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Attention deficit and hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood. Recently, several studies showed the high suicide risk of patients with ADHD; however, most of these studies had a cross-sectional design. Aims: The aim of the current research is to complete a systematic review of published studies which investigate the suicide risk of ADHD patients with longitudinal design. Methods: The systematic search was made on OVID Medline, PsychInfo, PubMed, Scopus, and Web of Science. The search terms were (ADHD OR attention deficit hyperactivity disorder) AND (suicide OR suicidal OR suicidality) AND (follow-up OR longitudinal study OR prospective study). The inclusion criteria were as follows: written in English; the participants were under 18 years at baseline; longitudinal, prospective studies; ADHD population at baseline and at follow-up; and suicide behavior as a primary outcome. The exclusion criteria were as follows: the study did not contain empirical data and reviews/meta-analyses and studies which aimed to investigate the drug treatment efficacy of ADHD. Results: After the screening process, 18 papers were included in the systematic review. Ten articles were altogether published in the last 5 years. The range of follow-up periods varied between 2 and 17 years. Several different assessment tools were used to investigate the symptoms and/or the diagnosis of ADHD and the suicidal risk. Nine studies enrolled children aged under 12 at baseline, and three studies used birth cohort data, where there was no strict age-based inclusion criteria. A total of 17 studies found a positive association between ADHD diagnosis at baseline and the presence of suicidal behavior and/or attempts at the follow-up visits. Limitations: The main limitation of this review is the methodological heterogeneity of the selected studies. A further limitation is the relatively low number of studies that examined a population with balanced gender ratios. Additionally, only one study published data about the treatment of ADHD. Finally, though we carefully chose the keywords, we still may be missing some relevant papers on this topic. Conclusions: In spite of the methodological diversity of the included studies, the results of the current systematic review highlight the importance of screening suicidality in the long term in patients with ADHD. Therefore, further studies that compare the suicidal risk of treated and untreated groups of ADHD patients in the long term are needed.
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Affiliation(s)
- Peter Garas
- Mental Health Sciences School of Ph.D., Semmelweis University, Budapest, Hungary
| | - Judit Balazs
- Mental Health Sciences School of Ph.D., Semmelweis University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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10
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Krinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, Dittmann RW, Falissard B, Garas P, Inglis SK, Kovshoff H, Kochhar P, McCarthy S, Nagy P, Neubert A, Roberts S, Sayal K, Sonuga-Barke E, Wong ICK, Xia J, Zuddas A, Hollis C, Konrad K, Liddle EB. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neurosci Biobehav Rev 2019; 107:945-968. [PMID: 31545988 DOI: 10.1016/j.neubiorev.2019.09.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a "traffic light" system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as "Unclear". Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.
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Affiliation(s)
- Helga Krinzinger
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany
| | - Charlotte L Hall
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Madeleine J Groom
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Tobias Banaschewski
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Sara Carucci
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - Peter Garas
- Semmelweis University, Károly Rácz School of PhD Studies, Mental Health Sciences Phd School, Budapest, Hungary
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Puja Kochhar
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Xia
- The Nottingham Ningbo GRADE Center, Nottingham China Health Institute, The University of Nottingham Ningbo, China
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; National Institute of Health Research (NIHR) MindTech MedTech Cooperative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kerstin Konrad
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany; JARA-BRAIN Institute II, Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK.
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11
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McCarthy S, Neubert A, Man KKC, Banaschewski T, Buitelaar J, Carucci S, Coghill D, Danckaerts M, Falissard B, Garas P, Häge A, Hollis C, Inglis S, Kovshoff H, Liddle E, Mechler K, Nagy P, Rosenthal E, Schlack R, Sonuga-Barke E, Zuddas A, Wong ICK. Effects of long-term methylphenidate use on growth and blood pressure: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). BMC Psychiatry 2018; 18:327. [PMID: 30305167 PMCID: PMC6180569 DOI: 10.1186/s12888-018-1884-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Concerns have been raised over the safety of methylphenidate (MPH), with regard to adverse effects on growth and blood pressure. Our study investigates whether, and to what extent, methylphenidate use in boys with ADHD is associated with having low body mass index (BMI), having low height, and increased systolic and diastolic blood pressure. METHODS Data used for this study stem from the German KiGGS dataset. Three different groups of boys aged 6-15 years were included in the analysis: ADHD patients who used MPH for less than 12 months; ADHD patients who used MPH for 12 months or more; and ADHD patients without current MPH treatment. Each of these three groups was compared to a non-ADHD control group regarding low weight (BMI ≤ 3rd percentile), low height (≤3rd percentile) and raised systolic and diastolic blood pressure. For growth outcomes, boys were categorized according to age (< 11 years/≥11 years, to account for pubertal maturation). Multivariable logistic regression was conducted to test for associations. RESULTS 4244 boys were included in the study; MPH < 12 months: n = 65 (n = 36 < 11 years), MPH ≥ 12 months: n = 53 (n = 22 < 11 years), ADHD controls: n = 320 (n = 132 < 11 years), non-ADHD controls: n = 3806 (n = 2003 < 11 years). Pre-pubertal boys with MPH use less than 12 months and pubertal/postpubertal boys with MPH use of 12 months or greater were significantly more likely to have a BMI ≤ 3rd percentile compared to non-ADHD controls. Boys from the ADHD control group were significantly less likely to have a raised systolic blood pressure compared to non-ADHD controls. Beyond that, no significant between group differences were observed for any other growth and BP parameter. CONCLUSION The analyses of the KiGGS dataset showed that MPH use in boys with ADHD is associated with low BMI. However, this effect was only observed in certain groups. Furthermore, our analysis was unable to confirm that MPH use is also associated with low height (≤3rd percentile) and changes in blood pressure.
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Affiliation(s)
| | - Antje Neubert
- 0000 0000 9935 6525grid.411668.cDepartment of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Kenneth K. C. Man
- 0000000121901201grid.83440.3bCentre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK ,0000000121742757grid.194645.bDepartment of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong ,000000040459992Xgrid.5645.2Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tobias Banaschewski
- 0000 0001 2190 4373grid.7700.0Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- 0000 0004 0444 9382grid.10417.33Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Sara Carucci
- 0000 0004 1755 3242grid.7763.5Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & “A. Cao” Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - David Coghill
- 0000 0001 2179 088Xgrid.1008.9Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Melbourne, Australia ,0000 0004 0397 2876grid.8241.fDivision of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU Belgium ,Department of Neurosciences, University Psychiatric Center, Leuven, KU Belgium
| | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - Peter Garas
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Alexander Häge
- 0000 0001 2190 4373grid.7700.0Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Chris Hollis
- 0000 0004 1936 8868grid.4563.4Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Inglis
- 0000 0004 0397 2876grid.8241.fTayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Hanna Kovshoff
- 0000 0004 1936 9297grid.5491.9Department of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth Liddle
- 0000 0004 1936 8868grid.4563.4Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK ,Institute of Mental Health, Nottingham, UK
| | - Konstantin Mechler
- 0000 0001 2190 4373grid.7700.0Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Eric Rosenthal
- grid.425213.3Department of Paediatric Cardiology, Evelina Children’s Hospital, St Thomas’ Hospital, London, UK
| | - Robert Schlack
- 0000 0001 0940 3744grid.13652.33Unit of Mental Health Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Edmund Sonuga-Barke
- 0000 0001 2322 6764grid.13097.3cDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK ,0000 0001 2069 7798grid.5342.0Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Alessandro Zuddas
- 0000 0004 1755 3242grid.7763.5Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & “A. Cao” Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Ian C. K. Wong
- 0000000121901201grid.83440.3bCentre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK ,0000000121742757grid.194645.bCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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12
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Man KKC, Coghill D, Chan EW, Lau WCY, Hollis C, Liddle E, Banaschewski T, McCarthy S, Neubert A, Sayal K, Ip P, Schuemie MJ, Sturkenboom MCJM, Sonuga-Barke E, Buitelaar J, Carucci S, Zuddas A, Kovshoff H, Garas P, Nagy P, Inglis SK, Konrad K, Häge A, Rosenthal E, Wong ICK. Association of Risk of Suicide Attempts With Methylphenidate Treatment. JAMA Psychiatry 2017; 74:1048-1055. [PMID: 28746699 PMCID: PMC5710471 DOI: 10.1001/jamapsychiatry.2017.2183] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear. OBJECTIVE To investigate the association between methylphenidate and the risk of suicide attempts. DESIGN, SETTING, AND PARTICIPANTS A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients. MAIN OUTCOMES AND MEASURES Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods. RESULTS Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35). CONCLUSIONS AND RELEVANCE The incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.
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Affiliation(s)
- Kenneth K. C. Man
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands,The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium
| | - David Coghill
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland,Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wallis C. Y. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chris Hollis
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Elizabeth Liddle
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Tobias Banaschewski
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Suzanne McCarthy
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,School of Pharmacy, University College Cork, Cork, Ireland
| | - Antje Neubert
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Kapil Sayal
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Edmund Sonuga-Barke
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Psychology, University of Southampton, Southampton, England
| | - Jan Buitelaar
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, and Karakter Child and Adolescent Psychiatry, Nijmegen, the Netherlands
| | - Sara Carucci
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Biomedical Sciences, Section Of Neuroscience and Clinical Pharmacology, University of Cagliari, and Child and Adolescent Neuropsychiatry Unit, G. Brotzu Hospital Trust, Cagliari, Italy
| | - Alessandro Zuddas
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Biomedical Sciences, Section Of Neuroscience and Clinical Pharmacology, University of Cagliari, and Child and Adolescent Neuropsychiatry Unit, G. Brotzu Hospital Trust, Cagliari, Italy
| | - Hanna Kovshoff
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Psychology, University of Southampton, Southampton, England
| | - Peter Garas
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Peter Nagy
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Sarah K. Inglis
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland,Tayside Clinical Trials Unit, University of Dundee, Dundee, Scotland
| | - Kerstin Konrad
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Alexander Häge
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eric Rosenthal
- The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Evelina London Children’s Hospital, London, England
| | - Ian C. K. Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong,The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium,Research Department of Practice and Policy, University College London School of Pharmacy, London, England
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13
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Inglis SK, Carucci S, Garas P, Häge A, Banaschewski T, Buitelaar JK, Dittmann RW, Falissard B, Hollis C, Kovshoff H, Liddle E, McCarthy S, Nagy P, Neubert A, Rosenthal E, Sonuga-Barke E, Wong I, Zuddas A, Coghill DC. Prospective observational study protocol to investigate long-term adverse effects of methylphenidate in children and adolescents with ADHD: the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. BMJ Open 2016; 6:e010433. [PMID: 27118284 PMCID: PMC4853973 DOI: 10.1136/bmjopen-2015-010433] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/29/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Methylphenidate is the most frequently used medication for the treatment of attention-deficit/hyperactivity disorder (ADHD) in Europe. Following concerns about its safety, the European Commission called for research into the long-term effects of methylphenidate on children and adolescents with ADHD. The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) research programme was designed to address this call. At the heart of this programme is a 2-year longitudinal naturalistic pharmacovigilance study being conducted in 27 European sites. METHODS AND ANALYSIS 3 cohorts of children and adolescents (aged 6-17) living in the UK, Germany, Italy and Hungary are being recruited:Group 1 (Medicated ADHD): 800 ADHD medication-naive children and adolescents with a clinical diagnosis of ADHD about to start methylphenidate treatment for the first time.Group 2 (Unmedicated ADHD): 400 children and adolescents with a clinical diagnosis of ADHD who have never been treated with ADHD medication and have no intention of beginning medication.Group 3 (Non-ADHD): 400 children and adolescents without ADHD who are siblings of individuals in either group 1 or 2.All participants will be assessed 5 times during their 2-year follow-up period for growth and development, psychiatric, neurological and cardiovascular health. The primary outcome measure will be the height velocity SD score. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the East of Scotland Research Ethics Service. Following this approval, patient information leaflets and consent forms were translated as necessary and submissions made by lead sites in each of the other 3 countries to their own ethics committees. Following ethical approval in each country, local ethical permissions at each site were sought and obtained as needed. The study's website (http://www.adhd-adduce.org/page/view/2/Home) provides information for researchers, participants and the general public. TRIAL REGISTRATION NUMBER NCT01470261.
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Affiliation(s)
- S K Inglis
- Division of Neuroscience, School of Medicine, University of Dundee & Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - S Carucci
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
| | - P Garas
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - A Häge
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - T Banaschewski
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - J K Buitelaar
- Cognition and Behavior, Department of Cognitive Neuroscience, Radboud University Medical Centre, Donders Institute for Brain, Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - R W Dittmann
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - B Falissard
- Univercity Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - C Hollis
- Faculty of Medicine & Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - H Kovshoff
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - E Liddle
- Faculty of Medicine & Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - S McCarthy
- School of Pharmacy, University College Cork, Cork, Ireland
| | - P Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - A Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | - E Rosenthal
- Evelina Children's Hospital, St Thomas' Hospital, London, UK
| | - E Sonuga-Barke
- UK and Department of Experimental Clinical & Health Psychology, University of Southampton, Ghent University, Belgium
| | - I Wong
- UCL School of Pharmacy, 29-39 Brunswick Square, London, UK
| | - A Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
| | - D C Coghill
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
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Ismail N, Garas P, Blaustein JD. Long-term effects of pubertal stressors on female sexual receptivity and estrogen receptor-α expression in CD-1 female mice. Horm Behav 2011; 59:565-71. [PMID: 21376052 PMCID: PMC3085923 DOI: 10.1016/j.yhbeh.2011.02.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/16/2011] [Accepted: 02/19/2011] [Indexed: 11/20/2022]
Abstract
Exposure to stress during puberty can lead to long-term behavioral alterations. Female mice, of the inbred C57BL/6 strain, have been shown to display lower levels of sexual receptivity in adulthood when exposed to shipping stress or to an immune challenge during puberty. The present study investigated whether this effect can be extended to CD1 outbred mice and examined a possible mechanism through which exposure to stressors could suppress sexual receptivity. The results revealed that CD1 mice injected with lipopolysaccharide (LPS) or exposed to shipping stress at 6 weeks old display lower levels of sexual receptivity in response to estradiol and progesterone in adulthood than control mice. Moreover, mice exposed to shipping stress at 8 weeks old also displayed reduced sexual receptivity, but those injected with LPS at that time showed slightly reduced effects, suggesting that the sensitive pubertal period extends to 8 weeks of age in this strain of mice. The examination of estrogen receptor-α (ER-α) expression revealed that mice exposed to shipping stress during the sensitive period (6 weeks) display lower levels of ER-α expression in the medial preoptic area and the ventromedial nucleus and the arcuate nucleus of the hypothalamus than mice shipped at a younger age. These findings support the prediction that exposure to shipping stress or LPS during puberty decreases behavioral responsiveness to estradiol and progesterone in adulthood in an outbred strain of mice through enduring suppression of ER-α expression in some brain areas involved in the regulation of female sexual behavior.
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Affiliation(s)
- Nafissa Ismail
- Center for Neuroendocrine Studies, University of Massachusetts, Amherst, MA 01003, USA.
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