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Lamoureux L, Beverley J, Steiner H, Marinelli M. Methylphenidate with or without fluoxetine triggers reinstatement of cocaine seeking behavior in rats. Neuropsychopharmacology 2024; 49:953-960. [PMID: 38086900 DOI: 10.1038/s41386-023-01777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 04/25/2024]
Abstract
Methylphenidate (MP) is commonly prescribed to treat attention-deficit hyperactivity disorder (ADHD). MP is also taken for non-medical purposes as a recreational drug or "cognitive enhancer". Combined exposure to MP and selective serotonin reuptake inhibitors such as fluoxetine (FLX) can also occur, such as in the treatment of ADHD with depression comorbidity or when patients taking FLX use MP for non-medical purposes. It is unclear if such exposure could subsequently increase the risk for relapse in former cocaine users. We investigated if an acute challenge with MP, FLX, or the combination of MP + FLX could trigger reinstatement of cocaine seeking behavior in a model for relapse in rats. Juvenile rats self-administered cocaine (600 µg/kg/infusion, 1-2 h/day, 7-8 days) and then underwent extinction and withdrawal during late adolescence-early adulthood. Reinstatement was tested at a low dose of MP (2 mg/kg, I.P., comparable to doses used therapeutically) or a high dose of MP (5 mg/kg, comparable to doses used recreationally or as a cognitive enhancer), with or without FLX (2.5-5 mg/kg, I.P.). An acute challenge with the high dose of MP (5 mg/kg), with or without FLX, reinstated cocaine seeking behavior to levels comparable to those seen after an acute challenge with cocaine (15 mg/kg, I.P.). The low dose of MP (2 mg/kg) with or without FLX did not reinstate cocaine seeking behavior. Our results suggest that acute exposure to a high dose of MP, with or without FLX, may increase the risk for relapse in individuals who used cocaine during the juvenile period.
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Affiliation(s)
- Lorissa Lamoureux
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Joel Beverley
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Heinz Steiner
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Stanson Toshok Center for Brain Function and Repair, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Michela Marinelli
- Discipline of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
- Department of Neuroscience and the Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA.
- Department of Neurology, Department of Psychiatry and Behavioral Science, and the Mulva Clinic for the Neurosciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
- Division of Pharmacology and Toxicology, College of Pharmacy, the University of Texas at Austin, Austin, TX, USA.
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Manza P, Tomasi D, Vines L, Sotelo D, Yonga MV, Wang GJ, Volkow ND. Brain connectivity changes to fast versus slow dopamine increases. Neuropsychopharmacology 2024; 49:924-932. [PMID: 38326458 PMCID: PMC11039764 DOI: 10.1038/s41386-024-01803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
The rewarding effects of stimulant drugs such as methylphenidate (MP) depend crucially on how fast they raise dopamine in the brain. Yet how the rate of drug-induced dopamine increases impacts brain network communication remains unresolved. We manipulated route of MP administration to generate fast versus slow dopamine increases. We hypothesized that fast versus slow dopamine increases would result in a differential pattern of global brain connectivity (GBC) in association with regional levels of dopamine D1 receptors, which are critical for drug reward. Twenty healthy adults received MP intravenously (0.5 mg/kg; fast dopamine increases) and orally (60 mg; slow dopamine increases) during simultaneous [11C]raclopride PET-fMRI scans (double-blind, placebo-controlled). We tested how GBC was temporally associated with slow and fast dopamine increases on a minute-to-minute basis. Connectivity patterns were strikingly different for slow versus fast dopamine increases, and whole-brain spatial patterns were negatively correlated with one another (rho = -0.54, pspin < 0.001). GBC showed "fast>slow" associations in dorsal prefrontal cortex, insula, posterior thalamus and brainstem, caudate and precuneus; and "slow>fast" associations in ventral striatum, orbitofrontal cortex, and frontopolar cortex (pFDR < 0.05). "Fast>slow" GBC patterns showed significant spatial correspondence with D1 receptor availability (estimated via normative maps of [11C]SCH23390 binding; rho = 0.22, pspin < 0.05). Further, hippocampal GBC to fast dopamine increases was significantly negatively correlated with self-reported 'high' ratings to intravenous MP across individuals (r(19) = -0.68, pbonferroni = 0.015). Different routes of MP administration produce divergent patterns of brain connectivity. Fast dopamine increases are uniquely associated with connectivity patterns that have relevance for the subjective experience of drug reward.
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Affiliation(s)
- Peter Manza
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Leah Vines
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Diana Sotelo
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Michele-Vera Yonga
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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Benn A, Robinson ESJ. Development of a novel rodent rapid serial visual presentation task reveals dissociable effects of stimulant versus nonstimulant treatments on attentional processes. Cogn Affect Behav Neurosci 2024; 24:351-367. [PMID: 38253774 DOI: 10.3758/s13415-023-01152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
The rapid serial visual presentation (RSVP) task and continuous performance tasks (CPT) are used to assess attentional impairments in patients with psychiatric and neurological conditions. This study developed a novel touchscreen task for rats based on the structure of a human RSVP task and used pharmacological manipulations to investigate their effects on different performance measures. Normal animals were trained to respond to a target image and withhold responding to distractor images presented within a continuous sequence. In a second version of the task, a false-alarm image was included, so performance could be assessed relative to two types of nontarget distractors. The effects of acute administration of stimulant and nonstimulant treatments for ADHD (amphetamine and atomoxetine) were tested in both tasks. Methylphenidate, ketamine, and nicotine were tested in the first task only. Amphetamine made animals more impulsive and decreased overall accuracy but increased accuracy when the target was presented early in the image sequence. Atomoxetine improved accuracy overall with a specific reduction in false-alarm responses and a shift in the attentional curve reflecting improved accuracy for targets later in the image sequence. However, atomoxetine also slowed responding and increased omissions. Ketamine, nicotine, and methylphenidate had no specific effects at the doses tested. These results suggest that stimulant versus nonstimulant treatments have different effects on attention and impulsive behaviour in this rat version of an RSVP task. These results also suggest that RSVP-like tasks have the potential to be used to study attention in rodents.
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Affiliation(s)
- Abigail Benn
- University of Bristol, School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Emma S J Robinson
- University of Bristol, School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
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Alam N, Ikram R, Naeem S, Khan SS, Siddiqui T, Khatoon H, Kashif SS. Effect of Methylphenidate and buspirone-methylphenidate co-administration on biochemical and hematological parameters in rats: Implications for safe and confrontational use. Pak J Pharm Sci 2021; 34:2131-2139. [PMID: 35034873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Methylphenidate (MPH) is a psychostimulant, beneficial in attention deficit hyperactivity disorder (ADHD). Previously it has been shown that MPH-induced locomotor sensitization could be attenuate by buspirone co administration however the effect of chronic MPH and co-administration of MPH-buspirone on biochemical and hematological parameters are unknown. This study is designed to investigate these parameters after long term administration of MPH, Buspirone and their combination in rats. 40 male Wister rats were divided in to 4 groups, and treated with saline, MPH (2mg/kg/day), Buspirone (10mg/kg/day) and MPH-Buspirone co-administration (2mg/kg/day ±10mg/kg/day; respectively) up to six weeks. Administration of MPH significantly increase blood glucose level in saline treated control rats, however co-administration of MPH-buspirone exhibited less effect on blood glucose levels. Serum creatinine levels significantly decreased in all treated groups as compared to control but highly significant results were seen with combination treatment. Co-administration of MPH-buspirone and buspirone treated rats exhibited increased cholesterol and hemoglobin values. All treated groups showed increased values of hematocrit, MCV, MCH and MCHC compared to control group. RBCs and WBC's count were decreased in all treated groups. The platelet count rose significantly by Buspirone and MPH-buspirone administration, while MPH showed decreased platelet count. Thus, results suggested that prolong co-administration of MPH-buspirone is safe and effective for ADHD patients by preventing adverse effects not only on behavioral but also on biochemical and hematological parameter.
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Affiliation(s)
- Nausheen Alam
- Faculty of Pharmacy, Federal Urdu University of Arts Science & Technology, Karachi, Pakistan
| | - Raheela Ikram
- Faculty of Pharmacy, Salim Habib University, Karachi, Pakistan
| | - Sadaf Naeem
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Saira Saeed Khan
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Tuba Siddiqui
- Faculty of Pharmacy, Federal Urdu University of Arts Science & Technology, Karachi, Pakistan
| | - Humera Khatoon
- Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
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Melo V, Zaccariello M, Girard E, Croarkin P, Romanowicz M. Internet parent-child interaction therapy (I-PCIT) in medically ill child: A case report. Medicine (Baltimore) 2021; 100:e27547. [PMID: 34731157 PMCID: PMC8519228 DOI: 10.1097/md.0000000000027547] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/01/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION This case illustrates the feasibility, benefit, and putative enhanced ecological validity of performing internet-parent-child interaction therapy (I-PCIT) in the parent-child dyad's home for the treatment of behavior problems in medically ill children in the context of a global pandemic. PATIENT CONCERNS Parents of a 5-year-old girl initially presented with concerns regarding inattentiveness, physical and verbal fighting with her siblings, and getting kicked out of daycare for hitting another child. Patient also had difficulties sleeping at night. DIAGNOSES Patient was diagnosed with electrical status epilepticus in sleep, frontal lobe executive function deficit, and attention deficit hyperactivity disorder. INTERVENTIONS Patient received a course of I-PCIT. Equipment included a cell phone with video capabilities connected to a videotelephony software program and set-up in the child's home by the parents. The treatment course included 8, 1-hour, weekly teaching/coaching sessions (7 of which were performed using I-PCIT) plus 1 follow-up booster session 6 months later. OUTCOMES Home-based I-PCIT implementation greatly improved disruptive behaviors in a young child with electrical status epilepticus in sleep and attention deficit hyperactivity disorder. CONCLUSION A combination of I-PCIT and methylphenidate allowed her to be successful at home and in a school setting. More research is needed on PCIT adaptations, such as home-based and internet-based PCIT, for medically ill children as well as treatment protocols for combined therapies.
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Affiliation(s)
- Valeria Melo
- Mayo Clinic Alix School of Medicine, Mayo Clinic Rochester, MN
| | | | - Emma Girard
- Department of Health Sciences, UC Riverside School of Medicine Riverside, CA
| | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN
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Azstarys (serdexmethylphenidate/dexmethylphenidate) for ADHD. Med Lett Drugs Ther 2021; 63:157-9. [PMID: 34550957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Eggert E, Bluschke A, Takacs A, Kleimaker M, Münchau A, Roessner V, Mückschel M, Beste C. Perception-Action Integration Is Modulated by the Catecholaminergic System Depending on Learning Experience. Int J Neuropsychopharmacol 2021; 24:592-600. [PMID: 33730752 PMCID: PMC8299823 DOI: 10.1093/ijnp/pyab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/31/2021] [Accepted: 03/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The process underlying the integration of perception and action is a focal topic in neuroscientific research and cognitive frameworks such as the theory of event coding have been developed to explain the mechanisms of perception-action integration. The neurobiological underpinnings are poorly understood. While it has been suggested that the catecholaminergic system may play a role, there are opposing predictions regarding the effects of catecholamines on perception-action integration. METHODS Methylphenidate (MPH) is a compound commonly used to modulate the catecholaminergic system. In a double-blind, randomized crossover study design, we examined the effect of MPH (0.25 mg/kg) on perception-action integration using an established "event file coding" paradigm in a group of n = 45 healthy young adults. RESULTS The data reveal that, compared with the placebo, MPH attenuates binding effects based on the established associations between stimuli and responses, provided participants are already familiar with the task. However, without prior task experience, MPH did not modulate performance compared with the placebo. CONCLUSIONS Catecholamines and learning experience interactively modulate perception-action integration, especially when perception-action associations have to be reconfigured. The data suggest there is a gain control-based mechanism underlying the interactive effects of learning/task experience and catecholaminergic activity during perception-action integration.
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Affiliation(s)
- Elena Eggert
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | - Adam Takacs
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | | | | | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | - Moritz Mückschel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
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Sluiter MN, de Vries YA, Koning LG, Hak E, Bos JHJ, Schuiling-Veninga CCM, Batstra L, Doornenbal JM, de Jonge P. A Prescription Trend Analysis of Methylphenidate: Relation to Study Reports on Efficacy. Adm Policy Ment Health 2021; 47:291-299. [PMID: 31620909 DOI: 10.1007/s10488-019-00983-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Use of methylphenidate in children has increased substantially, despite conflicting evidence regarding efficacy. In this study, prescription data were analyzed in relation to the publication of new evidence regarding efficacy. Incidence rates and prescribed doses of methylphenidate increased, with a decline during the last few years. Duration of use is still increasing. In half of the cases, starting dosages are higher than recommended in guidelines. There was little evidence that publication of new evidence directly influenced the use of methylphenidate. Recent and critical study findings should receive more attention to contribute to the development and use of treatment guidelines for ADHD and evidence-based methylphenidate use.
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Affiliation(s)
- Maruschka N Sluiter
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands.
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands.
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Lotte G Koning
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Eelko Hak
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child Care, University of Groningen, Groningen, The Netherlands
| | - Jeannette M Doornenbal
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
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Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is characterized by symptoms of inattention or impulsivity or both, and hyperactivity, which affect children, adolescents, and adults. In some countries, methylphenidate is the first option to treat adults with moderate or severe ADHD. However, evidence on the efficacy and adverse events of immediate-release (IR) methylphenidate in the treatment of ADHD in adults is limited and controversial. OBJECTIVES To evaluate the efficacy and harms (adverse events) of IR methylphenidate for treating ADHD in adults. SEARCH METHODS In January 2020, we searched CENTRAL, MEDLINE, Embase, eight additional databases and three trial registers. We also searched internal reports on the European Medicines Agency and the US Food and Drug Administration websites. We checked citations of included trials to identify additional trials not captured by the electronic searches. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing IR methylphenidate, at any dose, with placebo or other pharmacological interventions (including extended-release formulations of methylphenidate) for ADHD in adults. Primary outcomes comprised changes in the symptoms of ADHD (efficacy) and harms. Secondary outcomes included changes in the clinical impression of severity and improvement, level of functioning, depression, anxiety and quality of life. Outcomes could have been rated by investigators or participants. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently on the characteristics of the trials, participants, interventions; outcomes and financial conflict of interests. We resolved disagreements by discussion or consulting a third review author. We obtained additional, unpublished information from the authors of one included trial that had reported efficacy data in a graph. We calculated mean differences (MDs) or standardized MDs (SMDs) with 95% confidence intervals (CIs) for continuous data reported on the same or different scales, respectively. We summarized dichotomous variables as risk ratios (RRs) with 95% CI. MAIN RESULTS We included 10 trials published between 2001 and 2016 involving 497 adults with ADHD. Three trials were conducted in Europe and one in Argentina; the remaining trials did not report their location. The RCTs compared IR methylphenidate with placebo, an osmotic-release oral system (OROS) of methylphenidate (an extended-release formulation), an extended-release formulation of bupropion, lithium, and Pycnogenol® (maritime pine bark extract). Participants comprised outpatients, inpatients in addiction treatment, and adults willing to attend an intensive outpatient program for cocaine dependence. The duration of the follow-up ranged from 6 to 18 weeks. IR methylphenidate versus placebo We found very low-certainty evidence that, compared with placebo, IR methylphenidate may reduce symptoms of ADHD when measured with investigator-rated scales (MD -20.70, 95% CI -23.97 to -17.43; 1 trial, 146 participants; end scores; Adult ADHD Investigator Symptom Report Scale (AISRS), scored from 0 to 54), but the evidence is uncertain. The effect of IR methylphenidate on ADHD symptoms when measured with participant-rated scales was moderate, but the certainty of the evidence is very low (SMD -0.59, 95% CI -1.25 to 0.06; I2 = 69%; 2 trials, 138 participants; end scores). There is very low-certainty evidence that, compared with placebo, IR methylphenidate may reduce the clinical impression of the severity of ADHD symptoms (MD -0.57, 95% CI -0.85 to -0.28; 2 trials, 139 participants; I2 = 0%; change and end scores; Clinical Global Impression (CGI)-Severity scale (scored from 1 (very much improved) to 7 (very much worse))). There is low-certainty evidence that, compared with placebo, IR methylphenidate may slightly impact the clinical impression of an improvement in symptoms of ADHD (MD -0.94, 95% CI -1.37 to -0.51; 1 trial, 49 participants; end scores; CGI-Improvement scale (scored from 1 (very much improved) to 7 (very much worse))). There is no clear evidence of an effect on anxiety (MD -0.20, 95% CI -4.84 to 4.44; 1 trial, 19 participants; change scores; Hamilton Anxiety Scale (HAM-A; scored from 0 to 56); very low-certainty evidence) or depression (MD 2.80, 95% CI -0.09 to 5.69; 1 trial, 19 participants; change scores; Hamilton Depression Scale (HAM-D; scored from 0 to 52); very low-certainty evidence) in analyses comparing IR methylphenidate with placebo. IR methylphenidate versus lithium Compared with lithium, it is uncertain whether IR methylphenidate increases or decreases symptoms of ADHD (MD 0.60, 95% CI -3.11 to 4.31; 1 trial, 46 participants; end scores; Conners' Adult ADHD Rating Scale (scored from 0 to 198); very low-certainty evidence); anxiety (MD -0.80, 95% CI -4.49 to 2.89; 1 trial, 46 participants; end scores; HAM-A; very low-certainty evidence); or depression (MD -1.20, 95% CI -3.81 to 1.41, 1 trial, 46 participants; end scores; HAM-D scale; very low-certainty evidence). None of the included trials assessed participant-rated changes in symptoms of ADHD, or clinical impression of severity or improvement in participants treated with IR methylphenidate compared with lithium. Adverse events were poorly assessed and reported. We rated all trials at high risk of bias due to selective outcome reporting of harms and masking of outcome assessors (failure to blind outcome assessor to measure adverse events). Overall, four trials with 203 participants who received IR methylphenidate and 141 participants who received placebo described the occurrence of harms. The use of IR methylphenidate in these trials increased the risk of gastrointestinal complications (RR 1.96, 95% CI 1.13 to 2.95) and loss of appetite (RR 1.77, 95% CI 1.06 to 2.96). Cardiovascular adverse events were reported inconsistently, preventing a comprehensive analysis. One trial comparing IR methylphenidate to lithium reported five and nine adverse events, respectively. We considered four trials to have notable concerns of vested interests influencing the evidence, and authors from two trials omitted information related to the sources of funding and conflicts of interest. AUTHORS' CONCLUSIONS We found no certain evidence that IR methylphenidate compared with placebo or lithium can reduce symptoms of ADHD in adults (low- and very low-certainty evidence). Adults treated with IR methylphenidate are at increased risk of gastrointestinal and metabolic-related harms compared with placebo. Clinicians should consider whether it is appropriate to prescribe IR methylphenidate, given its limited efficacy and increased risk of harms. Future RCTs should explore the long-term efficacy and risks of IR methylphenidate, and the influence of conflicts of interest on reported effects.
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Affiliation(s)
| | | | - Su Golder
- Department of Health Sciences, University of York, York, UK
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Jalloh K, Roeder N, Hamilton J, Delis F, Hadjiargyrou M, Komatsu D, Thanos PK. Chronic oral methylphenidate treatment in adolescent rats promotes dose-dependent effects on NMDA receptor binding. Life Sci 2021; 264:118708. [PMID: 33186568 DOI: 10.1016/j.lfs.2020.118708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
AIM Examine the effects of chronic oral Methylphenidate (MP) treatment on the N-Methyl-D-aspartic acid (NMDA) glutamate receptor binding in the rat brain using a previously established drinking paradigm that has been shown to deliver MP with similar pharmacokinetic profile as observed clinically. MAIN METHODS Briefly, rats were divided into three treatment groups of water, low dose MP (LD; 4/10 mg/kg), or high dose MP (HD; 30/60 mg/kg). Following a 3-month treatment period, some rats were sacrificed while others went through an additional 1-month abstinence period before they were sacrificed. In vitro autoradiography (ARG) was carried out using [3H] MK801 to examine NMDA receptor binding in the brain. KEY FINDINGS The dose-dependent effects of MP following 13 weeks of treatment on [3H] MK-801 binding were seen across the brain in the following regions: prelimbic, insular, secondary motor, primary motor, retrosplenial, rhinal, piriform, auditory, visual, dorsolateral striatum, nucleus accumbens core, hippocampus, amygdala, and thalamic regions. No differences were observed in [3H] MK-801 binding levels in animals that underwent the same treatment followed by a 4 week abstinence. SIGNIFICANCE These results demonstrate that chronic MP treatment altered NMDA receptor expression throughout the brain, which in turn may impact an individual's drug-seeking behavior, fear memory formation and overall activity. However, these effects of chronic MP were eliminated following cessation of treatment.
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Affiliation(s)
- Khadija Jalloh
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nicole Roeder
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Foteini Delis
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, NY, USA
| | - David Komatsu
- Department of Orthopedics, Stony Brook University, Stony Brook, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Psychology, University at Buffalo, Buffalo, NY, USA.
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Childress AC, Uchida CL, Po MD, DeSousa NJ, Incledon B. A Post Hoc Comparison of Prior ADHD Medication Dose and Optimized Delayed-release and Extended-release Methylphenidate Dose in a Pivotal Phase III Trial. Clin Ther 2020; 42:2332-2340. [PMID: 33168234 DOI: 10.1016/j.clinthera.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE HLD200 is the first evening-dosed, delayed-release and extended-release methylphenidate (DR/ER-MPH) designed to delay initial release of MPH and provide treatment effects throughout the day and into the evening for individuals with attention-deficit/hyperactivity disorder (ADHD). Because DR/ER-MPH is uniquely absorbed in the colon, it cannot be substituted for other ADHD medications on a milligram-per-milligram basis. To provide clinicians with a target dose range for DR/ER-MPH when transitioning patients from a prior ADHD medication, dose conversion ratios (DCRs) between prior medication doses and optimized doses of DR/ER-MPH were determined post hoc from a pivotal Phase III study of children (aged 6-12 years) with ADHD. METHODS DR/ER-MPH doses were optimized over a 6-week open-label period. DCRs were calculated between optimized doses of DR/ER-MPH at week 6 and prior stable doses of ADHD medication. FINDINGS Mean DCRs ranged from 1.8 to 4.3 for optimized DR/ER-MPH dose versus previous stable dose for individuals taking an extended-release stimulant monotherapy. DCRs for those taking an immediate-release stimulant monotherapy ranged from 4.7 to 6.0. IMPLICATIONS In a Phase III trial of children with ADHD, optimized doses of DR/ER-MPH were higher than doses of prior ADHD medications, but the adverse event profile was consistent with that of other MPHs. Higher DCRs compared with those predicted by bioavailability differences are consistent with a predicted dose-dependent duration of effect for DR/ER-MPH: with increasing doses, absorption is extended but with an attenuated increase in Cmax compared with MPH formulations absorbed in the upper bowel. These data may help guide clinicians to optimize DR/ER-MPH doses. ClinicalTrials.gov identifier: NCT02493777.
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Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA.
| | | | | | - Norberto J DeSousa
- Ironshore Pharmaceuticals & Development, Inc, Camana Bay, Grand Cayman, Cayman Islands
| | - Bev Incledon
- Ironshore Pharmaceuticals & Development, Inc, Camana Bay, Grand Cayman, Cayman Islands
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Asth L, Tiago PRF, Costa LRF, Holanda VAD, Pacifico S, Zaveri NT, Calo' G, Ruzza C, Gavioli EC. Effects of non-peptide nociceptin/orphanin FQ receptor ligands on methylphenidate-induced hyperactivity in mice: Implications for bipolar disorders. Neuropeptides 2020; 82:102059. [PMID: 32600667 DOI: 10.1016/j.npep.2020.102059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/11/2023]
Abstract
Bipolar disorder is a psychiatric pathology characterized by biphasic mood episodes of mania or hypomania and depression. The pharmacotherapy of bipolar disorder has significant adverse effects impairing treatment adherence and patient quality of life. The N/OFQ-NOP receptor system has been widely implicated with mood disorders. Clinical and preclinical findings suggest antidepressants actions for NOP antagonists. More recently, the administration of NOP agonists has shown to promote depressant states. The present study aimed to investigate the effects of non-peptide NOP ligands in methylphenidate-induced manic-like behavior in mice. The NOP agonist Ro 65-6570 (0.01-1 mg/kg, ip), at the higher dose, did not affect spontaneous locomotion per se, but prevented the methylphenidate (10 mg/kg, sc)-induced hyperlocomotion. The NOP partial agonist AT-090 (0.001-0.03 mg/kg, ip) and the NOP antagonist SB-612111 (1-10 mg/kg, ip) did not significantly affect the psychostimulant-induced hyperactivity. Experiments performed with mice lacking the NOP receptor (NOP(-/-)) demonstrated that the treatment with methylphenidate induced similar hyperlocomotion in NOP(-/-) and NOP(+/+) mice. In conclusion, these findings suggest a potential role for NOP agonists in the prevention of manic states, especially by counteracting the hyperactivity symptom of bipolar patients. However, more studies are necessary in order to evaluate these compounds in other features of bipolar disorder.
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Affiliation(s)
- Laila Asth
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Pamella R F Tiago
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Layse R F Costa
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Victor A D Holanda
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Salvatore Pacifico
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Nurulain T Zaveri
- Astraea Therapeutics, LLC., 320 Logue Avenue, Mountain View, CA 94043, United States
| | - Girolamo Calo'
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, 44121 Ferrara, Italy
| | - Chiara Ruzza
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, 44121 Ferrara, Italy; Technopole of Ferrara, LTTA Laboratory for Advanced Therapies, Ferrara, Italy
| | - Elaine C Gavioli
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil.
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Masi G, Fantozzi P, Muratori P, Bertolucci G, Tacchi A, Villafranca A, Pfanner C, Cortese S. Emotional dysregulation and callous unemotional traits as possible predictors of short-term response to methylphenidate monotherapy in drug-naïve youth with ADHD. Compr Psychiatry 2020; 100:152178. [PMID: 32386957 DOI: 10.1016/j.comppsych.2020.152178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) and callous unemotional (CU) traits can be associated with ADHD in youth, influencing its natural history and outcome, but their effect on medication efficacy is unexplored. We examined whether two measures of baseline ED and CU traits, the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) and the Antisocial Process Screening Device (APSD), respectively, were predictors of change of ADHD-Rating Scale (ADHD-RS) after a 4-week methylphenidate (MPH) monotherapy. METHODS 43 patients (37 males, 8-16 years, mean 9.9 ± 2.7 years) were included. Hierarchical linear regression models were used to explore whether CBCL-DP and APSD might predict ADHD-RS score, controlling for baseline severity. RESULTS Baseline CBCL-DP predicted higher post-treatment ADHD-RS scores in total and hyperactivity-impulsivity, but not in inattention subscale. Baseline APSD was not significantly related to ADHD-RS scores at the follow-up. LIMITATIONS Small sample size, lack of gender diversity, non-blind design and short period of observation. CONCLUSION ED, assessed with that CBCL-DP, might be a negative predictor of change of hyperactive-impulsive symptoms after MPH treatment and should be systematically assessed at baseline.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Pamela Fantozzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Giulia Bertolucci
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annalisa Tacchi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Arianna Villafranca
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Chiara Pfanner
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Samuele Cortese
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Environmental and Life Sciences and Faculty of Medicine, University of Southampton, Southampton, UK
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Núñez-Garces M, Sánchez-Gayango A, Romero-Pérez C. Reversible Alopecia Secondary to OROS Methylphenidate. Rev Colomb Psiquiatr (Engl Ed) 2020; 49:208-210. [PMID: 32888666 DOI: 10.1016/j.rcp.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/31/2018] [Accepted: 09/08/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder has a prevalence of 1-4% of the Spanish school population. Its treatment consists of giving amphetamine derivatives and, recently, non-stimulant drugs, without finding any differences in efficacy in the studies performed. CLINICAL CASE A 7-year-old girl was referred from neurology due to learning delay and behaviour disorders. Diagnosed as likely ADHD, treatment was started with immediate release methylphenidate, and later with an osmotic release oral system (OROS) methylphenidate. When alopecia areata appeared, this treatment was withdrawn. After the re-introduction of modified release methylphenidate 30:70, symptom control was achieved without the appearance of alopecia. DISCUSSION There is a published history of two cases of alopecia areata with OROS methylphenidate that resolved after increasing the dose of the drug without clearly knowing the reason for this event. There is no consensus on the priority use of the immediate release formula or the OROS methylphenidate.
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Affiliation(s)
- Marta Núñez-Garces
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Sur de Sevilla, Hospital Universitario Nuestra Señora de Valme, Sevilla, España.
| | - Agustín Sánchez-Gayango
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Sur de Sevilla, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
| | - Cristina Romero-Pérez
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Sur de Sevilla, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
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15
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Fernández-López L, Molina-Carballo A, Cubero-Millán I, Checa-Ros A, Machado-Casas I, Blanca-Jover E, Jerez-Calero A, Madrid-Fernández Y, Uberos J, Muñoz-Hoyos A. Indole Tryptophan Metabolism and Cytokine S100B in Children with Attention-Deficit/Hyperactivity Disorder: Daily Fluctuations, Responses to Methylphenidate, and Interrelationship with Depressive Symptomatology. J Child Adolesc Psychopharmacol 2020; 30:177-188. [PMID: 32048862 DOI: 10.1089/cap.2019.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/12/2022]
Abstract
Background: Indole tryptophan metabolites (ITMs), mainly produced at the gastrointestinal level, participate in bidirectional gut-brain communication and have been implicated in neuropsychiatric pathologies, including attention-deficit/hyperactivity disorder (ADHD). Method: A total of 179 children, 5-14 years of age, including a healthy control group (CG, n = 49), and 107 patients with ADHD participated in the study. The ADHD group was further subdivided into predominantly attention deficit (PAD) and predominantly hyperactive impulsive (PHI) subgroups. Blood samples were drawn at 20:00 and 09:00 hours, and urine was collected between blood draws, at baseline and after 4.63 ± 2.3 months of methylphenidate treatment in the ADHD group. Levels and daily fluctuations of ITM were measured by tandem mass spectrometer, and S100B (as a glial inflammatory marker) by enzyme-linked immunosorbent assay. Factorial analysis of variance (Stata 12.0) was performed with groups/subgroups, time (baseline/after treatment), hour of day (morning/evening), and presence of depressive symptoms (DS; no/yes) as factors. Results: Tryptamine and indoleacetic acid (IAA) showed no differences between the CG and ADHD groups. Tryptamine exhibited higher evening values (p < 0.0001) in both groups. No changes were associated with methylphenidate or DS. At baseline, in comparison with the rest of study sample, PHI with DS+ group showed among them much greater morning than evening IAA (p < 0.0001), with treatment causing a 50% decrease (p = 0.002). Concerning indolepropionic acid (IPA) MPH was associated with a morning IPA decrease and restored the daily profile observed in the CG. S100B protein showed greater morning than evening concentrations (p = 0.001) in both groups. Conclusion: Variations in ITM may reflect changes associated with the presence of DS, including improvement, among ADHD patients.
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Affiliation(s)
- Luisa Fernández-López
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Antonio Molina-Carballo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Isabel Cubero-Millán
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Ana Checa-Ros
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Irene Machado-Casas
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Enrique Blanca-Jover
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Antonio Jerez-Calero
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | | | - José Uberos
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
| | - Antonio Muñoz-Hoyos
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
- Servicio de Neuropediatría y Neurodesarrollo, Servicio Andaluz de Salud, Unidad de Gestión Clínica de Pediatría, Hospital Clínico San Cecilio, Granada, Spain
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Kalinowski L, Connor C, Somanesan R, Carias E, Richer K, Smith L, Martin C, Mackintosh M, Popoola D, Hadjiargyrou M, Komatsu DE, Thanos PK. Brief and extended abstinence from chronic oral methylphenidate treatment produces reversible behavioral and physiological effects. Dev Psychobiol 2020; 62:170-180. [PMID: 31456229 PMCID: PMC7028498 DOI: 10.1002/dev.21902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 01/01/2023]
Abstract
Methylphenidate (MP) is a commonly prescribed psychostimulant to individuals with Attention Deficit Hyperactivity Disorder, and is often used illicitly among healthy individuals with intermittent breaks to coincide with breaks from school. This study examined how intermittent abstinence periods impact the physiological and behavioral effects of chronic oral MP self-administration in rats, and whether these effects persist following prolonged abstinence from the drug. Rats were treated orally with water, low-dose (LD), or high-dose (HD) MP, beginning at PND 28. This daily access continued for three consecutive weeks followed by a 1-week abstinence; after three repeats of this cycle, there was a 5-week abstinence period. Throughout the study, we examined body weight, food intake, locomotor activity, and anxiety- and depressive-like behaviors. During the treatment phase, HD MP decreased body weight, food intake, and depressive- and anxiety-like behaviors, while it increased locomotor activity. During intermittent abstinence, the effects of MP on locomotor activity were eliminated. During prolonged abstinence, most of the effects of HD MP were ameliorated to control levels, with the exception of weight loss and anxiolytic effects. These findings suggest that intermittent exposure to chronic MP causes physiological and behavioral effects that are mostly reversible following prolonged abstinence.
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Affiliation(s)
- Leanna Kalinowski
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
| | - Carly Connor
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Rathini Somanesan
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Emily Carias
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Kaleigh Richer
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
| | - Lauren Smith
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Connor Martin
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Macauley Mackintosh
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Daniel Popoola
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Hadjiargyrou
- New York Institute of Technology, Department of Life Sciences, Old Westbury, NY, USA
| | - David E. Komatsu
- Stony Brook University, Department of Orthopedics, Stony Brook, NY, USA
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo, Department of Psychology, Buffalo, NY, USA
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17
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Noorazar SG, Malek A, Aghaei SM, Yasamineh N, Kalejahi P. The efficacy of zinc augmentation in children with attention deficit hyperactivity disorder under treatment with methylphenidate: A randomized controlled trial. Asian J Psychiatr 2020; 48:101868. [PMID: 31841818 DOI: 10.1016/j.ajp.2019.101868] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/12/2019] [Accepted: 11/03/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Regarding to the role of the zinc in the metabolism of the central nervous system and the correlation of zinc supplementation in the treatment of any Attention deficit hyperactivity disorder (ADHD) symptoms, this study was conducted to evaluate the complementary effects of this nutrient. METHOD This was a double-blind randomized clinical trial study and 60 children with ADHD who were treated with methylphenidate were chosen by random allocation and were divided in the two groups: 30 for the case and 30 for the control group. The treatment in case group was augmented with zinc. Duration of study was six weeks. RESULT Forty eight (80%) of participants were boy and 12 (20%) were girl. The mean age of patients was 9.6 ± 1.70 years. There was no significant difference between the two groups after the intervention in terms of total score, hyperactivity and impulsivity subscales during variance analysis, but there was a significant difference between the mean of inattention score. CONCLUSION Augmentation with zinc can enhance the improvement of inattention.
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Affiliation(s)
- Seyyed Gholamreza Noorazar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ayyoub Malek
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | - Neda Yasamineh
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Parinaz Kalejahi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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18
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Drugs for ADHD. Med Lett Drugs Ther 2020; 62:9-15. [PMID: 31999670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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19
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Cook JL, Swart JC, Froböse MI, Diaconescu AO, Geurts DEM, den Ouden HEM, Cools R. Catecholaminergic modulation of meta-learning. eLife 2019; 8:e51439. [PMID: 31850844 PMCID: PMC6974360 DOI: 10.7554/elife.51439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023] Open
Abstract
The remarkable expedience of human learning is thought to be underpinned by meta-learning, whereby slow accumulative learning processes are rapidly adjusted to the current learning environment. To date, the neurobiological implementation of meta-learning remains unclear. A burgeoning literature argues for an important role for the catecholamines dopamine and noradrenaline in meta-learning. Here, we tested the hypothesis that enhancing catecholamine function modulates the ability to optimise a meta-learning parameter (learning rate) as a function of environmental volatility. 102 participants completed a task which required learning in stable phases, where the probability of reinforcement was constant, and volatile phases, where probabilities changed every 10-30 trials. The catecholamine transporter blocker methylphenidate enhanced participants' ability to adapt learning rate: Under methylphenidate, compared with placebo, participants exhibited higher learning rates in volatile relative to stable phases. Furthermore, this effect was significant only with respect to direct learning based on the participants' own experience, there was no significant effect on inferred-value learning where stimulus values had to be inferred. These data demonstrate a causal link between catecholaminergic modulation and the adjustment of the meta-learning parameter learning rate.
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Affiliation(s)
- Jennifer L Cook
- School of PsychologyUniversity of BirminghamBirminghamUnited Kingdom
| | - Jennifer C Swart
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
| | - Monja I Froböse
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
| | - Andreea O Diaconescu
- Translational Neuromodeling Unit, Institute for Biomedical EngineeringUniversity of Zurich and ETH ZurichZurichSwitzerland
- Department of PsychiatryUniversity of BaselBaselSwitzerland
- Krembil Centre for Neuroinformatics,CAMHUniversity of TorontoTorontoCanada
| | - Dirk EM Geurts
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Department of PsychiatryRadboud University Medical CentreNijmegenNetherlands
| | - Hanneke EM den Ouden
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Department of PsychiatryRadboud University Medical CentreNijmegenNetherlands
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20
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Nigam M, Zadra A, Boucetta S, Gibbs SA, Montplaisir J, Desautels A. Successful Treatment of Somnambulism With OROS-Methylphenidate. J Clin Sleep Med 2019; 15:1683-1685. [PMID: 31739860 PMCID: PMC6853387 DOI: 10.5664/jcsm.8040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022]
Abstract
None Somnambulism is a non-rapid eye movement sleep parasomnia with potential for significant injury as well as functional nighttime and daytime impairment. Clonazepam is frequently used as first line pharmacotherapy. However, the optimal treatment of somnambulism has not been established. In this article, we present the cases of two patients with severe somnambulism who showed a significant therapeutic response to osmotic release oral system methylphenidate (OROS-MPH). In addition to its practical therapeutic implications, this first report of the successful treatment of somnambulism with OROS-MPH may provide additional insight into the neurobiological underpinnings of this medical condition.
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Affiliation(s)
- Milan Nigam
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Soufiane Boucetta
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Steve A. Gibbs
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
- Neurology Service, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
- Neurology Service, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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Lee MR, Rohn MC, Zanettini C, Coggiano MA, Leggio L, Tanda G. Effect of systemically administered oxytocin on dose response for methylphenidate self-administration and mesolimbic dopamine levels. Ann N Y Acad Sci 2019; 1455:173-184. [PMID: 31074517 PMCID: PMC10014164 DOI: 10.1111/nyas.14101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/01/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
The neuropeptide oxytocin (OT) alters behaviors related to the administration of drugs of abuse, including stimulants. OT also plays a key role in social bonding, which involves an interaction between OT and dopamine (DA) in the nucleus accumbens (NAc). The nature of the interaction between OT and DA in the striatum in the context of psychostimulants is unclear. We investigated the effect of OT, delivered intraperitoneally, on the methylphenidate (MP) dose-response function for self-administration in rats. Food was used as a control condition. In a microdialysis study, we measured the effect of intraperitoneal OT on MP-stimulated striatal DA levels. Systemic OT pretreatment caused a downward shift in the MP dose-response function for self-administration, while having no effect on motor activity. OT also caused a reduction in food self-administration, although a significantly higher dose of OT was required for this effect compared with that required for a reduction of MP self-administration. Systemic OT pretreatment caused a potentiation of MP-stimulated DA levels in the NAc shell but not in the core. The significance of these findings is discussed, including the potential of OT as a therapeutic agent for addictive disorders.
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Affiliation(s)
- Mary R. Lee
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD
| | - Matthew C.H. Rohn
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD
| | - Claudio Zanettini
- Medications Development Program, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
| | - Mark A. Coggiano
- Medications Development Program, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD
- Medications Development Program, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Gianluigi Tanda
- Medications Development Program, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
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King N, Floren S, Kharas N, Thomas M, Dafny N. Glutaminergic signaling in the caudate nucleus is required for behavioral sensitization to methylphenidate. Pharmacol Biochem Behav 2019; 184:172737. [PMID: 31228508 PMCID: PMC6692216 DOI: 10.1016/j.pbb.2019.172737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/11/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/25/2023]
Abstract
Methylphenidate (MPD) is a widely prescribed psychostimulant for the treatment of attention deficit hyperactivity disorder, and is growing in use as a recreational drug and academic enhancer. MPD acts on the reward/motive and motor circuits of the CNS to produce its effects on behavior. The caudate nucleus (CN) is known to be a part of these circuits, so a lesion study was designed to elucidate the role of the CN in response to acute and chronic MPD exposure. Five groups of n = 8 rats were used: control, sham CN lesions, non-specific electrolytic CN lesions, dopaminergic-specific (6-OHDA toxin) CN lesion, and glutaminergic-specific (ibotenic acid toxin) CN lesions. On experimental day (ED) 1, all groups received saline injections. On ED 2, surgeries took place, followed by a 5-day recovery period (ED 3-7). Groups then received six daily MPD 2.5 mg/kg injections (ED 9-14), then three days of washout with no injection (ED 15-17), followed by a re-challenge with the previous 2.5 mg/kg MPD dose (ED 18). Locomotive activity was recorded for 60 min after each injection by a computerized animal activity monitor. The electrolytic CN lesion group responded to the MPD acute and chronic exposures similarly to the control and sham groups, showing an increase in locomotive activity, i.e. sensitization. The dopaminergic-specific CN lesion group failed to respond to MPD exposure both acute and chronically. The glutaminergic-specific CN lesion group responded to MPD exposure acutely but failed to manifest chronic effects. This confirms the CN's dopaminergic system is necessary for MPD to manifest its acute and chronic effects on behavior, and demonstrates that the CN's glutaminergic system is necessary for the chronic effects of MPD such as sensitization. Thus, the dopaminergic and glutaminergic components of the CN play a significant role in differentially modulating the acute and chronic effects of MPD respectively.
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Affiliation(s)
- Nicholas King
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Samuel Floren
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Natasha Kharas
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Ming Thomas
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Nachum Dafny
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States.
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23
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Acosta DL, Fair CN, Gonzalez CM, Iglesias M, Maldonado N, Schenkman N, Valle SM, Velez JL, Mejia L. Nonmedical use of d-Amphetamines and Methylphenidate in Medical Students. P R Health Sci J 2019; 38:185-188. [PMID: 31536633] [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: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of medical and nonmedical use of prescription attention deficit hyperactive disorder (ADHD) stimulant medication among medical students. MATERIALS AND METHODS An IRB approved 19-question web survey was sent out to all students from a Puerto Rico (PR) medical school to assess use of ADHD medication. Out of the 250 stu-dents consulted there was a response of 152 surveys. Data was cross-referenced and compared with data from other studies. RESULTS/DISCUSSION From the results gathered, the study's sample had a higher prevalence of use than the 15% reported in previous studies, reaching 47.4%. Among students who had used these drugs, 89.4% indicated using it without a prescription. 86.8% of all respondents used some form of stimulant or substance in order to cope with the academic workload of medical school, includ-ing coffee, energy drinks, cigarettes, and alcohol. The majority of students (60.5%) considered study techniques workshops and exercise programs to succeed academically. CONCLUSION This study suggests a higher prevalence of ADHD medication use amongst the PR medical student sample compared to findings reported of US medical students, as well as a high prevalence related to nonmedical use as a means for medical students to cope with their training. The nonmedical use of stimulants in the medical school setting remains of utmost public health and clinical concern. The results of this study could help develop proper workshops and non-pharmacological techniques to help medical students cope with their workload.
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Affiliation(s)
- Dionisio L Acosta
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Chelsea N Fair
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Cinthia M Gonzalez
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Maite Iglesias
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Nataly Maldonado
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Nathan Schenkman
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Samuel M Valle
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Jorge L Velez
- Program in Doctor of Medicine, San Juan Bautista School of Medicine, Caguas, PR
| | - Luis Mejia
- Associate Professor Department of Biochemistry and Pharmacology, San Juan Bautista School of Medicine, Caguas, PR
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Jornay PM -- evening-dosed methylphenidate for ADHD. Med Lett Drugs Ther 2019; 61:126-8. [PMID: 31386648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Wang LJ, Lee SY, Chou WJ, Lee MJ, Tsai CS, Lee TL, Yang CJ, Yang KC, Chen CK, Shyu YC. Testicular Function After Long-Term Methylphenidate Treatment in Boys with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2019; 29:433-438. [PMID: 30575416 DOI: 10.1089/cap.2018.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/06/2023]
Abstract
Objective: Treating attention-deficit/hyperactivity disorder (ADHD) with methylphenidate (MPH) has become increasingly common, while both animal studies and case reports have previously suggested that MPH may exert adverse effects on the reproductive system or gonadal hormones. This study aims to investigate whether long-term MPH treatment of boys with ADHD can induce testicular dysfunction (TD). Methods: A nationwide cohort that included 59,746 boys diagnosed with ADHD and 52,008 healthy subjects retrieved from the National Health Insurance database in Taiwan was also observed between 1999 and 2011. TD was defined by the International Classification of Diseases, 9th revision, Clinical Modifications codes (257.0, 257.1, 257.2, 257.8, or 257.9). Cumulative time of MPH use was categorized into nonuse, short-term use (1-365 days), and long-term use (>365 days). We compared the rate of TD diagnosis between ADHD patients and controls and analyzed the risk of developing a TD after MPH treatment. Results: Compared with the control group (0.06%), the ADHD group had a higher comorbidity rate of TD (0.14%) (adjusted odds ratio [aOR] = 1.95, 95% confidence interval [95% CI]: 1.26-3.04, p = 0.003). However, MPH did not significantly influence the risk of developing TD (adjusted hazard ratio = 1.40, 95% CI: 0.77-2.54, p = 0.272). Compared with ADHD boys without MPH treatment, patients who were prescribed short-term MPH (aOR = 0.96, 95% CI: 0.51-1.82, p = 0.900) and long-term MPH (aOR = 1.40, 95% CI: 0.69-2.83, p = 0.351) showed no significance associated with an increased risk of developing TD. Conclusions: Our nationwide cohort showed that long-term treatment with MPH has no harmful effect on the testosterone function of ADHD patients. However, due to the increased comorbidity rate of ADHD and TD, early recognition and detection of TD in ADHD children have the potential to change the trajectory of TD morbidity later in life.
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Affiliation(s)
- Liang-Jen Wang
- 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- 2Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- 3Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Jing Lee
- 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Shu Tsai
- 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tung-Liang Lee
- 4Department of Microbiology, Soochow University, Taipei, Taiwan
| | - Chun-Ju Yang
- 5Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kang-Chung Yang
- 5Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- 5Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- 6Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Keelung, Taiwan
| | - Yu-Chiau Shyu
- 5Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- 7Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
- 8Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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Hollis C, Chen Q, Chang Z, Quinn PD, Viktorin A, Lichtenstein P, D'Onofrio B, Landén M, Larsson H. Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study. Lancet Psychiatry 2019; 6:651-658. [PMID: 31221557 PMCID: PMC6646837 DOI: 10.1016/s2215-0366(19)30189-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a clinical concern that prescribing methylphenidate, the most common pharmacological treatment for attention-deficit hyperactivity disorder (ADHD), might increase the risk of psychotic events, particularly in young people with a history of psychosis. We aimed to determine whether the risk of psychotic events increases immediately after initiation of methylphenidate treatment or, in the longer term, 1 year after treatment initiation in adolescents and young adults with and without a previously diagnosed psychotic disorder. METHODS In this cohort study, we used population-based observational data from the Swedish Prescribed Drug Register, the National Patient Register, and the Total Population Register, three population-based registers containing data on all individuals in Sweden, to attain data on sex, birth, death, migration, medication use, and psychotic events for all eligible participants. We screened individuals on these registers to identify those receiving methylphenidate treatment, and who were aged 12-30 years at the start of treatment, for their inclusion in the study. We used a within-individual design to compare the incidence of psychotic events in these individuals during the 12-week periods immediately before and after methylphenidate initiation. Longer term risk was assessed by comparing the incidence of psychotic events 12 weeks before methylphenidate initiation and during a 12-week period one calendar year before the initiation of methylphenidate with the incidence of these events during the 12-week period one calendar year after methylphenidate initiation. We estimated the incidence rate ratios (IRR) and 95% CIs of psychotic events after the initation of methylphenidate treatment, relative to the events before treatment, which were defined as any hospital visit (inpatient admission or outpatient attendance, based on data from the National Patient Register) because of psychosis, using the International Classification of Diseases version 10 definition. Analyses were stratified by whether the individual had a history of psychosis. FINDINGS We searched the Swedish Prescribed Drug Register to find eligible individuals who had received methylphenidate between Jan 1, 2007 and June 30, 2012. 61 814 individuals were screened, of whom 23 898 (38·7%) individuals were assessed and 37 916 (61·3%) were excluded from the study because they were outside of the age criteria at the start of treatment, they had immigrated, emigrated, or died during the study period, or because they were administered other ADHD medications. The median age at methylphenidate initiation was 17 years, and a history of psychosis was reported in 479 (2·0%) participants. The IRR of psychotic events in the 12-week period after initiation of methylphenidate treatment relative to that in the 12-week period before treatment start was 1·04 (95% CI 0·80-1·34) in adolescents and young adults without a history of psychosis and 0·95 (0·69-1·30) among those with a history of psychosis. INTERPRETATION Contrary to clinical concerns, we found no evidence that initiation of methylphenidate treatment increases the risk of psychotic events in adolescents and young adults, including in those individuals with a history of psychosis. Our study should reassure clinicians considering initiating methylphenidate treatment for ADHD in adolescents and young adults, and it challenges the widely held view in clinical practice that methylphenidate should be avoided, or its use restricted, in individuals with a history of psychosis. FUNDING Swedish Research Council, National Institute of Mental Health, UK National Institute of Health Research Nottingham Biomedical Research Centre.
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Affiliation(s)
- Chris Hollis
- National Institute of Health Research (NIHR) MindTech MedTech Cooperative, NIHR Nottingham Biomedical Research Centre and Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden
| | - Brian D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden; Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Instituet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
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Grebla R, Setyawan J, Park C, Richards KM, Nwokeji ED, Pawaskar M, Haim Erder M, Lawson KA. Examining the heterogeneity of treatment patterns in attention deficit hyperactivity disorder among children and adolescents in the Texas Medicaid population: modeling suboptimal treatment response. J Med Econ 2019; 22:788-797. [PMID: 30983465 DOI: 10.1080/13696998.2019.1606814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
Objectives: To examine suboptimal responses (SR) in attention deficit hyperactivity disorder (ADHD) among pediatric patients in the Texas Medicaid program receiving osmotic-release oral system methylphenidate (OROS-MPH) or lisdexamfetamine (LDX) and apply an SR prediction model to identify patients most likely to experience an SR to either OROS-MPH or LDX therapies. Methods: A retrospective cohort study was conducted using Texas Medicaid claims data of ADHD children and adolescents (6-17 years of age) initiating OROS-MPH or LDX. Primary SR endpoints were drug discontinuation, switching, and augmentation 12-months post-ADHD drug initiation. Logistic regression models were developed to predict SR to OROS-MPH and LDX in 1:1 matched groups of children and adolescent cohorts. Results: A total of 3,633 children and 1,611 adolescents were matched for each cohort. SR was observed among more children (76.4% vs 72.3%; p < 0.001) and adolescents (82.7% vs 78.2%; p = 0.002) initiating OROS-MPH compared to LDX. Patient sub-groups with the highest predicted risk of OROS-MPH SR experienced significantly lower observed SR rates (p < 0.05) when initiating LDX (children: 80.6% for OROS-MPH vs 75.8% for LDX; OR = 0.75, 95% CI = 0.60-0.94; adolescents: 87.2% for OROS-MPH vs 80.6% for LDX; OR = 0.61, 95% CI = 0.41-0.89). For patients with highest predicted SR rates to LDX, observed SR rates were not significantly different between patients initiating LDX or OROS-MPH. Conclusions: This study demonstrated how a personalized medicine approach using administrative claims data can be used to identify sub-groups of child and adolescent ADHD patients with different risks for suboptimal response with OROS-MPH or LDX in a Medicaid population.
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Affiliation(s)
- Regina Grebla
- a Global Outcomes Research and Epidemiology , Shire, Lexington , MA , USA
| | - Juliana Setyawan
- a Global Outcomes Research and Epidemiology , Shire, Lexington , MA , USA
| | - Chanhyun Park
- b Health Outcomes Division , The University of Texas at Austin, College of Pharmacy , Austin , TX , USA
| | - Kristin M Richards
- b Health Outcomes Division , The University of Texas at Austin, College of Pharmacy , Austin , TX , USA
| | - Esmond D Nwokeji
- b Health Outcomes Division , The University of Texas at Austin, College of Pharmacy , Austin , TX , USA
| | - Manjiri Pawaskar
- a Global Outcomes Research and Epidemiology , Shire, Lexington , MA , USA
| | - M Haim Erder
- a Global Outcomes Research and Epidemiology , Shire, Lexington , MA , USA
| | - Kenneth A Lawson
- b Health Outcomes Division , The University of Texas at Austin, College of Pharmacy , Austin , TX , USA
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Salman T, Nawaz S, Ikram H, Haleem DJ. Enhancement and impairment of cognitive behaviour in Morris water maze test by methylphenidate to rats. Pak J Pharm Sci 2019; 32:899-903. [PMID: 31278697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Methylphenidate (MPD), a psycho-stimulant is a prescription medicine for the treatment of Attention deficit hyperactivity disorder (ADHD). The drug is also being increasingly used by general population for enhancing cognition. Only few preclinical studies have been carried out on the effects of MPD on cognition and these studies show either an enhancement or impairment of memory following the administration of MPD. The present study was designed to evaluate the effects of different doses of methylphenidate on acquisition and retention of memory in Morris water-maze test. Twenty four male Albino Wistar rats (weighing 180-220gm) were randomly assigned to four groups: (1) Control (2) 0.5mg/kg (3) 2.5mg/kg (4) 5 mg/kg methylphenidate. Animals received drug or water orally before training phase. Memory acquisition was monitored 2hrs post drug administration while memory retention was determined next day. It was found that the clinically relevant doses of methylphenidate (0.5mg/kg and 2.5mg/kg) improved memory acquisition and its retention but higher dose (5mg/kg) impaired both. We suggest that MPD-induced increase of catecholamine neurotransmission may have a role in the improvement of water maze performance while agonist activity of the drug for 5HT-1A receptor in the impaired performance at high doses. Food intake and body weight changes were not affected by MPD administration due to short-term administration of the drug. Results may help in improving pharmaco-therapeutic use of MPD for ADHD.
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Affiliation(s)
- Tabinda Salman
- Dr. Panjwani Center for Molecular Medicine and Drugs Research, International Center for Chemical & Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Shazia Nawaz
- Dr. Panjwani Center for Molecular Medicine and Drugs Research, International Center for Chemical & Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Huma Ikram
- Neurochemistry and Biochemical Neuropharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi, Pakistan
| | - Darakhshan Jabeen Haleem
- Dr. Panjwani Center for Molecular Medicine and Drugs Research, International Center for Chemical & Biological Sciences, University of Karachi, Karachi, Pakistan / Neurochemistry and Biochemical Neuropharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi, Pakistan
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Surman C, Ceranoglu A, Vaudreuil C, Albright B, Uchida M, Yule A, Spencer A, Boland H, Grossman R, Rhodewalt L, Fitzgerald M, Biederman J. Does L-Methylfolate Supplement Methylphenidate Pharmacotherapy in Attention-Deficit/Hyperactivity Disorder?: Evidence of Lack of Benefit From a Double-Blind, Placebo-Controlled, Randomized Clinical Trial. J Clin Psychopharmacol 2019; 39:28-38. [PMID: 30566416 PMCID: PMC6750952 DOI: 10.1097/jcp.0000000000000990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Interventions for attention-deficit/hyperactivity disorder (ADHD) may be inadequate for some patients. There is evidence that supplementation with L-methylfolate augments antidepressant agent effects and thus might also augment ADHD treatment effects by a common catecholaminergic mechanism. METHODS Forty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ADHD participated in a randomized, double-blind, placebo-controlled, 12-week trial of 15 mg of L-methylfolate in combination with osmotic-release oral system methylphenidate. Osmotic-release oral system methylphenidate was dose optimized over the first 6 weeks. We evaluated the effects on ADHD symptoms, self-report on the Behavior Rating Inventory of Executive Function of executive function, methylphenidate dosing, neuropsychological test measures, the Adult ADHD Self-report scale, emotional dysregulation, social adjustment, and work productivity, as well as moderating effects of body mass index, autoantibodies to folate receptors, and select genetic polymorphisms. RESULTS L-Methylfolate was well tolerated, with no significant effect over placebo except improvement from abnormal measures on the mean adaptive dimension of the ASR scale (χ = 4.36, P = 0.04). Methylphenidate dosing was significantly higher in individuals on L-methylfolate over time (χ = 7.35, P = 0.007). Exploratory analyses suggested that variation in a guanosine triphosphate cyclohydrolase gene predicted association with higher doses of methylphenidate (P < 0.001). CONCLUSIONS L-Methylfolate was associated with no change in efficacy on measures relevant to neuropsychiatric function in adults with ADHD, other than suggestion of reduced efficacy of methylphenidate. Further investigation would be required to confirm this effect and its mechanism and the genotype prediction of effects on dosing.
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Affiliation(s)
- Craig Surman
- From the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
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Alam N, Wasi N, Naeem S, Kashif SS, Siddiqui T, Bashir L, Naz S, Ikram R. Methylphenidate increases the urinary excretion of vanillylmandelic acid in rats that is attenuated by buspirone co-administration. Pak J Pharm Sci 2019; 32:895-898. [PMID: 31103989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Methylphenidate is a psychostimulant used for the treatment of (ADHD) attention deficit hyperactivity syndrome in children and adults. After chronic administration it is known to produce behavioral disorders including anxiety. Previous studies demonstrated that co-administration of buspirone can reduce behavioral and cognitive adverse effects produced by methylphenidate. The aim of the present study is to measure the levels vanillylmandelic acid (VMA) excretion in urine following prolong administration of methylphenidate, buspirone and their combination. Samples of urine for the estimation of the urinary VMA excretion were collected from treated and control male Wistar rats. We found significant (P<0.01) raised urinary VMA excretion in methylphenidate group however significant (P<0.01) reduction in VMA levels were seen after buspirone co-administration. Excretion of VMA in urine would allow the monitoring of sympatho-adrenomedullary system activity. This study could be helpful to increase the clinical use of methylphenidate in the treatment of different disoders.
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Affiliation(s)
- Nausheen Alam
- Department of Pharmacology, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Nousheen Wasi
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Sadaf Naeem
- Jinnah Sind Medical University, Karachi, Pakistan
| | | | - Tuba Siddiqui
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Lubna Bashir
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Shazia Naz
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Rahila Ikram
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Oosterlaan J. Does methylphenidate improve academic performance? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2019; 28:155-164. [PMID: 29353323 DOI: 10.1007/s00787-018-1106-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD. Previous reviews on stimulant-related academic improvements are inconclusive and focus on task engagement. Recent literature suggests outcome-domain-specific medication effects that are larger for productivity than for accuracy. The aims of this study are quantifying methylphenidate effects on academic productivity and accuracy for math, reading, spelling; exploring the mediating or moderating effects of symptom improvements, demographic-, design- and disorder-related variables. PubMed, EMBASE, ERIC and PsycINFO were searched for articles reporting methylphenidate effects on academic productivity and accuracy. Thirty-four studies met entry criteria. Methylphenidate improved math productivity (7.8% increase, p < .001); math accuracy (3.0% increase, p = .001); increased reading speed (SMD .47, p < .001) but not reading accuracy. None of the mediators or moderators tested affected methylphenidate efficacy. Academic improvements were small compared to symptom improvements; qualitative changes limited to math. Clinicians should take this discrepancy into account when prescribing medication for ADHD.
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Affiliation(s)
| | - Marjolein Luman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Jaap Oosterlaan
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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Ibrahim K, Donyai P. What stops practitioners discussing medication breaks in children and adolescents with ADHD? Identifying barriers through theory-driven qualitative research. Atten Defic Hyperact Disord 2018; 10:273-283. [PMID: 29982921 PMCID: PMC6223995 DOI: 10.1007/s12402-018-0258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/29/2018] [Indexed: 11/24/2022]
Abstract
National and international guidelines on the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents call for annual reviews to assess continuing need for medication by considering brief periods without medication, referred to as 'Drug holidays'. However, drug holidays are reactively initiated by families, or recommended by practitioners if growth has been suppressed by medication rather than proactively to check the need. There is little evidence of planned, practitioner-initiated drug holidays from methylphenidate. The aim of this study was to identify what stops practitioners from routinely discussing planned drug holidays from methylphenidate with children, adolescents, and their parents. Practitioners involved in shared-care prescribing for children and adolescents with ADHD in one UK County were included. Interviews with 8 general practitioners (GPs) and 8 Child and Adolescent Mental Health Service (CAMHS) practitioners were conducted. Transcripts were analysed qualitatively against the components of the Capability-Opportunity-Motivation-Behaviour (COM-B) model. Possible interventions for increasing prescribers' engagement with planned drug holidays were considered in response. Multiple barriers to practitioner engagement in planned drug holidays from methylphenidate were identified. Capability, in terms of knowledge and skills, was not a barrier identified for CAMHS practitioners but was for GPs. Opportunity was a main barrier for both groups, who reported lack of time and the absence of educational material about drug holidays. Motivation was more complex to define, with CAMHS practitioners questioning the need for drug holidays and GPs being more accepting due to worries about long-term medication side effects as well as cost savings. 'Education' and 'enablement' interventions were identified as key activities targeting all three components, which could feasibly increase uptake of practitioner-initiated planned drug holidays from methylphenidate. The application of the COM-B system identified a number of key barriers to practitioner engagement with drug holidays in children and adolescents with ADHD. Accordingly, a number of interventions could be developed to facilitate change. For example, educating and training GPs about ADHD management and drug holidays, and developing a decision aid to help families make informed decisions about whether or not to implement drug holidays could be used.
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Affiliation(s)
- Kinda Ibrahim
- NIHR CLAHRC Wessex, University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Mailpoint 807, Tremona Road, Southampton, SO16 6YD, UK.
| | - Parastou Donyai
- Department of Pharmacy Practice, University of Reading, Reading, UK
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Alam N, Ikram R. Effect of haloperidol on behavioral sensitization and cognition in methylphenidate and buspirone-methylphenidate co-administered rats. Pak J Pharm Sci 2018; 31:1959-1965. [PMID: 30150195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Attenuation of methylphenidate-induced behavioral sensitization and cognitive tolerance by buspirone co-administration has been reported previously. Dopamine D2-receptors are considered to be important in methylphenidate-induced sensitization. This study was designed to monitor the responsiveness of D2 receptors following long-term methylphenidate, buspirone and their co-administration in rats by the challenge dose of haloperidol. Effects of haloperidol challenge dose (1 mg/kg i.p.) were monitored after 6 weeks (till the behavioral sensitization produced) from oral repeated (twice a day for 6 week) administration of methylphenidate (2mg/kg/day), buspirone (10mg/kg/day) and their co-administration. Motor activity was compared by using familiar environment of home cage and novel environment of open field and cognitive activity was compared by using water maze were monitored 30, 60, and 90 minutes post injection respectively. We found that haloperidol reduced motor activity in familiar as well as in novel environment and showed impaired cognitive performance in water maze. The effects were more pronounced in methylphenidate treated rats as compared to buspirone and methylphenidate co-administration treated rats. Increased response of haloperidol in methylphenidate treated rats can be explained in terms of super-sensitization of D2 receptors, which results in behavioral sensitization that is not observed in co-administration treated rats. Buspirone prevents D2 receptor's super-sensitization by increasing serotonergic inhibitory influence on dopamine neuron.
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Affiliation(s)
- Nausheen Alam
- Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Rahila Ikram
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
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Scherrer KS, Relly C, Hackenberg A, Berger C, Paioni P. Case report: narcolepsy type 1 in an adolescent with HIV infection-coincidence or potential trigger? Medicine (Baltimore) 2018; 97:e11490. [PMID: 30045272 PMCID: PMC6078734 DOI: 10.1097/md.0000000000011490] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Despite the acknowledged importance of environmental risk factors in the etiology of narcolepsy, there is little research on this topic. HIV as a trigger for narcolepsy has not been systematically investigated. PATIENT CONCERNS We describe a case of narcolepsy type 1 (NT1) in an adolescent with HIV infection presenting with increased daytime sleepiness and excessive weight gain. DIAGNOSES NT1 was diagnosed according to the criteria of the third edition of the International Classification of Sleep Disorders (ICSD-3). INTERVENTIONS Pharmacological treatment with methylphenidate. OUTCOMES Four months after initiation of methylphenidate therapy the increased daytime sleepiness improved and excessive weight gain stopped. LESSONS Diagnosis of NT1 can be challenging at disease onset and is often delayed, especially in the pediatric population, because symptoms usually evolve gradually. The case presented here raises the possibility that the HIV infection may play a role in the pathogenesis of NT1 serving as trigger for autoimmune-mediated destruction of hypocretin-secreting neurons.
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Affiliation(s)
- Karin Sofia Scherrer
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford, UK
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
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Fife D, Cepeda MS, Baseman A, Richards H, Hu P, Starr HL, Sena AG. Medication changes after switching from CONCERTA® brand methylphenidate HCl to a generic long-acting formulation: A retrospective database study. PLoS One 2018; 13:e0193453. [PMID: 29489906 PMCID: PMC5831385 DOI: 10.1371/journal.pone.0193453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Observational studies of switching from branded to generic formulations of the same drug substance often lack appropriate comparators for the subjects who switched. Three generic formulations were deemed equivalent to Concerta: an authorized generic (AG) identical except for external packaging, and two other generics (EG). Objective Compare the incidence of a combined endpoint (switching back to Concerta, changing the use of immediate release methylphenidate (MPH), stopping all long-acting methylphenidate, or starting a new medication) among people switched from Concerta to the AG versus the EG. Methods Cohort study from the Truven CCAE database of people aged 6 to 65 diagnosed with ADHD, treated with Concerta, and switched to the EG or to the AG formulation. Results In the EG arm 24.6% and in the AG arm 19.7% of subjects switched back to Concerta. The proportion of subjects meeting the combined endpoint was 39.5% in the EG arm, 32.9% in the AG arm, a crude risk ratio of 1.20 (95% CI 0.94, 1.54). After adjustment by propensity score stratification, the adjusted odds ratio (OR) was 1.23 (95% CI 0.90, 1.70). In an unplanned analysis using a different method of adjustment, the adjusted OR was 1.00 (95% CI 0.69, 1.44). Discussion This study did not detect a difference between the proportion of people who met the study endpoint in the two study arms, i.e. between those who switched to a generic formulation that was identical to Concerta except for external packaging and those who switched to the comparison generics. The high incidence of the combined endpoint in the AG arm demonstrates the need for an appropriate comparator in studies of this type. Trial registration ClinicalTrials.gov NCT02730572
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Affiliation(s)
- Daniel Fife
- Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, United States of America
- * E-mail:
| | - M. Soledad Cepeda
- Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, United States of America
| | - Alan Baseman
- Global Medical Safety, Janssen Research & Development, LLC, Horsham, PA, United States of America
| | - Henry Richards
- Established Products, Janssen Research & Development, LLC, Titusville, NJ, United States of America
| | - Peter Hu
- Clinical Biostatistics, Janssen Research & Development, LLC, Raritan, NJ, United States of America
| | - H. Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
| | - Anthony G. Sena
- Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, United States of America
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Kim SJ, Shonka S, French WP, Strickland J, Miller L, Stein MA. Dose-Response Effects of Long-Acting Liquid Methylphenidate in Children with Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD): A Pilot Study. J Autism Dev Disord 2018; 47:2307-2313. [PMID: 28474229 DOI: 10.1007/s10803-017-3125-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) symptoms are common in youth with autism spectrum disorders (ASD) and are frequently treated with stimulant medications. Twenty-seven children were randomized to different dose titration schedules, and ADHD symptoms, tolerability, and aberrant behaviors were assessed weekly during a 6-week trial with long-acting liquid methylphenidate (MPH). MPH at low to moderate doses was effective in reducing ADHD symptoms and was well tolerated in young children with ASD and ADHD. Future studies are needed to assess generalization and maintenance of efficacy.
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Affiliation(s)
- Soo-Jeong Kim
- University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Sophia Shonka
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | | | - Mark A Stein
- University of Washington, Seattle, WA, USA.
- Seattle Children's Research Institute, Seattle, WA, USA.
- Psychiatry, M/S OA.5.154, P. O. Box 5371, Seattle, WA, 98145-5005, USA.
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Snircova E, Marcincakova Husarova V, Ondrejka I, Hrtanek I, Farsky I, Nosalova G. QTc prolongation after ADHD medication. Neuro Endocrinol Lett 2018; 38:549-554. [PMID: 29504733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 01/02/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Multicenter studies have shown that cardiovascular risks of ADHD medication are extremely low. However, QTc length has been shown to be increased in smaller samples of patients or case reports after stimulant and atomoxetine medication. Based on recent studies of genetic polymorphisms associated with drug-induced QTc prolongation and polymorphisms linkage to regional populations, we hypothesized that the drug-induced QTc prolongation could be a factor of particular polymorphisms linked to specific regional populations undistinguished in multicenter studies. METHODS We included 69 patients from a region of central Slovakia, 36 patients were taking atomoxetine and 33 patients methylphenidate. QTc, heart rate, potassium levels and BMI were examined before and after 8 weeks of treatment. Therapeutic effect was measured by ADHD-RS-IV. RESULTS We found QTc prolongation after 8 weeks of treatment both with atomoxetine and methylphenidate that was neither followed by the significant changes in BMI and potassium levels nor the significant increase of heart rate. CONCLUSION This is the first study revealing QTc prolongation in the group of ADHD children from the same region after 8-week treatment with atomoxetine and methylphenidate, indicating the potential discrete abnormalities in cardiac functioning associated with polymorphisms in genes of dopaminergic and noradrenergic system.
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Affiliation(s)
- Eva Snircova
- Clinic of Psychiatry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | - Igor Ondrejka
- Clinic of Psychiatry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Igor Hrtanek
- Clinic of Psychiatry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ivan Farsky
- Clinic of Psychiatry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Gabriela Nosalova
- Institute of Pharmacology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
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Liang SHY, Yang YH, Kuo TY, Liao YT, Lin TC, Lee Y, McIntyre RS, Kelsen BA, Wang TN, Chen VCH. Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study. Res Dev Disabil 2018; 72:96-105. [PMID: 29121517 DOI: 10.1016/j.ridd.2017.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.
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Affiliation(s)
- Sophie Hsin-Yi Liang
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Tzu-Chin Lin
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Brent A Kelsen
- Language Center, National Taipei University, New Taipei City, Taiwan, ROC
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Vincent Chin-Hung Chen
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
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Abstract
OBJECTIVE To examine dispensing patterns of methylphenidate (MPH) to determine how socioeconomic status (SES), ethnocultural affiliation, and gender affect the medical treatment of ADHD. METHOD We reviewed MPH prescription records for year 2011 of children aged 6 to 18, from regional pharmacies serving homogeneous neighborhoods. RESULTS MPH prescriptions showed an increase in prevalence from 4.2% to 7.5% in the years 2007 to 2011, respectively. Jewish children were four times more likely to be prescribed MPH than Arab children, with significant discrepancies along SES and gender lines ( p < .001). Higher SES and male gender were associated with greater use of MPH. General pediatric prescription rates of MPH in all communities increased by 85%, compared with year 2007 statistics ( p < .001). CONCLUSION Prescription patterns for MPH in children reflect diagnostic patterns of ADHD that appear to be heavily influenced by additive factors of SES, cultural attitudes, and gender. Dispensing data provide valuable information for targeting underserved groups and defining potential areas of abuse.
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Affiliation(s)
- Lutfi Jaber
- 1 The Bridge to Peace Community Pediatric Center, Taibe, Israel
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shmuel Rigler
- 3 Clalit Health Services, Tel Aviv, Israel
- 5 Hefer Authority, Israel
| | - Avinoam Shuper
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gary Diamond
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
- 6 Rose F. Kennedy Center, CERC, Albert Einstein College of Medicine, Bronx, NY, USA
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Bottelier MA, Schrantee A, Ferguson B, Tamminga HGH, Bouziane C, Kooij JJS, de Ruiter MB, Reneman L. Age-dependent effects of acute methylphenidate on amygdala reactivity in stimulant treatment-naive patients with Attention Deficit/Hyperactivity Disorder. Psychiatry Res Neuroimaging 2017; 269:36-42. [PMID: 28938219 DOI: 10.1016/j.pscychresns.2017.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 11/18/2022]
Abstract
In the present study, we investigate whether methylphenidate (MPH) affects emotional processing and whether this effect is modulated by age. We measured amygdala reactivity with functional Magnetic Resonance Imaging (fMRI) during processing of angry and fearful facial expressions in male stimulant treatment-naive patients with ADHD (N = 35 boys; N = 46 men) and 23 healthy control subjects (N = 11 boys; N = 12 men). In ADHD patients, we also measured amygdala reactivity 90min after an acute oral challenge with MPH (0.5mg/kg). Mean amygdala reactivity was analyzed for all subjects using a repeated measures analysis of variance (ANOVA). Whole-brain maps were analyzed for the patients only. At baseline, we found a age*diagnosis effect approaching significance (p = 0.05) in the right amygdala due to lower reactivity in children with Attention Deficit/Hyperactivity Disorder (ADHD) vs. controls (-31%), but higher reactivity in adults with ADHD vs. controls (+31%). MPH significantly reduced right amygdala reactivity in all patients, resulting in further reductions in children. In the left amygdala, reduction of amygdala reactivity was confined to adult ADHD patients whereas there was no change in children with ADHD. MPH-induced decrease of amygdala reactivity in adults might be a promising avenue for managing emotional dysregulation when replicated for chronic MPH treatment.
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Affiliation(s)
- Marco A Bottelier
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Child, and Adolescent Psychiatry, Triversum, Alkmaar, The Netherlands
| | - Anouk Schrantee
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Ferguson
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Center Rudolph Magnus, Department of Psychiatry, University Medical Center, Utrecht, The Netherlands
| | - Hyke G H Tamminga
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Dutch Autism and ADHD research center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cheima Bouziane
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, psycho-medical programs, Expertise Center Adult ADHD, Den Haag, The Netherlands
| | - Michiel B de Ruiter
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
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Dockree PM, Barnes JJ, Matthews N, Dean AJ, Abe R, Nandam LS, Kelly SP, Bellgrove MA, O'Connell RG. The Effects of Methylphenidate on the Neural Signatures of Sustained Attention. Biol Psychiatry 2017; 82:687-694. [PMID: 28599833 DOI: 10.1016/j.biopsych.2017.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/31/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although it is well established that methylphenidate (MPH) enhances sustained attention, the neural mechanisms underpinning this improvement remain unclear. We examined how MPH influenced known electrophysiological precursors of lapsing attention over different time scales. METHODS We measured the impact of MPH, compared with placebo, on behavioral and electrocortical markers while healthy adults (n = 40) performed a continuous monitoring paradigm designed to elicit attentional lapses. RESULTS MPH led to increased rates of target detection, and electrophysiological analyses were conducted to identify the mechanisms underlying these improvements. Lapses of attention were reliably preceded by progressive increases in alpha activity that emerged over periods of several seconds. MPH led to an overall suppression of alpha activity across the entire task but also diminished the frequency of these maladaptive pretarget increases through a reduction of alpha variability. A drug-related linear increase in the amplitude of the frontal P3 event-related component was also observed in the pretarget timeframe (3 or 4 seconds). Furthermore, during immediate target processing, there was a significant increase in the parietal P3 amplitude with MPH, indicative of enhanced perceptual evidence accumulation underpinning target detection. MPH-related enhancements occurred without significant changes to early visual processing (visual P1 and 25-Hz steady-state visual evoked potential). CONCLUSIONS MPH serves to reduce maladaptive electrophysiological precursors of lapsing attention by acting selectively on top-down endogenous mechanisms that support sustained attention and target detection with no significant effect on bottom-up sensory excitability. These findings offer candidate markers to monitor the therapeutic efficacy of psychostimulants or to predict therapeutic responses.
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Affiliation(s)
- Paul M Dockree
- School of Psychology, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Jessica J Barnes
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Natasha Matthews
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Angela J Dean
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Rafael Abe
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - L Sanjay Nandam
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Simon P Kelly
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Mark A Bellgrove
- School of Psychology, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Redmond G O'Connell
- School of Psychology, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
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Gomez-Sanchez CI, Carballo JJ, Riveiro-Alvarez R, Soto-Insuga V, Rodrigo M, Mahillo-Fernandez I, Abad-Santos F, Dal-Ré R, Ayuso C. Pharmacogenetics of methylphenidate in childhood attention-deficit/hyperactivity disorder: long-term effects. Sci Rep 2017; 7:10391. [PMID: 28871191 PMCID: PMC5583388 DOI: 10.1038/s41598-017-10912-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in which a significant proportion of patients do not respond to treatment. The objective of this study was to examine the role of genetic risk variants in the response to treatment with methylphenidate (MPH). The effectiveness of MPH was evaluated based on variations in the CGI-S and CGAS scales over a 12-month treatment period using linear mixed effects models. A total of 208 ADHD patients and 34 polymorphisms were included in the analysis. For both scales, the response was associated with time, extended-release MPH/both formulations, and previous MPH treatment. For the CGI-S scale, response was associated with SLC6A3 rs2550948, DRD4 promoter duplication, SNAP25 rs3746544, and ADGRL3 rs1868790. Interactions between the response over time and SLC6A3 and DRD2 were found in the CGI-S and CGAS scales, respectively. The proportion of the variance explained by the models was 18% for the CGI-S and 22% for the CGAS. In this long-term study, the effects of SLC6A3, DRD4, SNAP25, and ADGRL3 on response to treatment reflect those observed in previous studies. In addition, 2 previously unreported interactions with response to treatment over a 12-month period were found (SLC6A3 and DRD2).
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Affiliation(s)
- Clara I Gomez-Sanchez
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain
| | - Juan J Carballo
- Department of Psychiatry, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Rosa Riveiro-Alvarez
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain
| | - Victor Soto-Insuga
- Department of Pediatrics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Maria Rodrigo
- Department of Pediatrics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Ignacio Mahillo-Fernandez
- Epidemiology Unit, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, IIS- La Princesa University Hospital (IIS-IP). C/ de Diego Leon, 62, Madrid, 28006, Spain
| | - Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM + CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid. Ciudad Universitaria de Cantoblanco, Madrid, 28049, Spain
| | - Carmen Ayuso
- Department of Genetics, IIS - Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM). Avda. Reyes Católicos, 2, Madrid, 28040, Spain.
- Centre for Biomedical Research on Rare Diseases (CIBERER). C/ Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain.
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Greven P, Sikirica V, Chen YJ, Curtice TG, Makin C. Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany. Eur J Health Econ 2017; 18:893-904. [PMID: 27817164 PMCID: PMC5533820 DOI: 10.1007/s10198-016-0836-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. OBJECTIVE A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy. METHODS Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index. RESULTS No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients. CONCLUSIONS These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.
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Affiliation(s)
- Peter Greven
- Institute of Child and Adolescent Psychiatry, Psychotherapy and Social Pediatrics, Berlin, Germany
- H:G University of Health and Sport, Technology and Arts, Berlin, Germany
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Abstract
The current studies utilized drift diffusion modeling (DDM) to examine how reinforcement and stimulant medication affect cognitive task performance in children with ADHD. In Study 1, children with (n = 25; 88 % male) and without ADHD (n = 33; 82 % male) completed a 2-choice discrimination task at baseline (100 trials) and again a week later under alternating reinforcement and no-reinforcement contingencies (400 trials total). In Study 2, participants with ADHD (n = 29; 72 % male) completed a double-blind, placebo-controlled trial of 0.3 and 0.6 mg/kg methylphenidate and completed the same task utilized in Study 1 at baseline (100 trials). Children with ADHD accumulated information at a much slower rate than controls, as evidenced by a lower drift rate. Groups were similar in nondecision time and boundary separation. Both reinforcement and stimulant medication markedly improved drift rate in children with ADHD (ds = 0.70 and 0.95 for reinforcement and methylphenidate, respectively); both treatments also reduced boundary separation (ds = 0.70 and 0.39). Reinforcement, which emphasized speeded accuracy, reduced nondecision time (d = 0.37), whereas stimulant medication increased nondecision time (d = 0.38). These studies provide initial evidence that frontline treatments for ADHD primarily impact cognitive performance in youth with ADHD by improving the speed/efficiency of information accumulation. Treatment effects on other DDM parameters may vary between treatments or interact with task parameters (number of trials, task difficulty). DDM, in conjunction with other approaches, may be helpful in clarifying the specific cognitive processes that are disrupted in ADHD, as well as the basic mechanisms that underlie the efficacy of ADHD treatments.
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Affiliation(s)
- Whitney D Fosco
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA.
| | - Corey N White
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
- Center for Children and Families, University at Buffalo, SUNY, Buffalo, NY, USA
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45
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Holmskov M, Storebø OJ, Moreira-Maia CR, Ramstad E, Magnusson FL, Krogh HB, Groth C, Gillies D, Zwi M, Skoog M, Gluud C, Simonsen E. Gastrointestinal adverse events during methylphenidate treatment of children and adolescents with attention deficit hyperactivity disorder: A systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. PLoS One 2017; 12:e0178187. [PMID: 28617801 PMCID: PMC5472278 DOI: 10.1371/journal.pone.0178187] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/08/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives To study in more depth the relationship between type, dose, or duration of methylphenidate offered to children and adolescents with attention deficit hyperactivity disorder and their risks of gastrointestinal adverse events based on our Cochrane systematic review. Methods and findings We use data from our review including 185 randomised clinical trials. Randomised parallel-group trials and cross-over trials reporting gastrointestinal adverse events associated with methylphenidate were included. Data were extracted and quality assessed according to Cochrane guidelines. Data were summarised as risk ratios (RR) with 95% confidence intervals (CI) using the inverse variance method. Bias risks were assessed according to domains. Trial Sequential Analysis (TSA) was used to control random errors. Eighteen parallel group trials and 43 cross-over trials reported gastrointestinal adverse events. All trials were at high risk of bias. In parallel group trials, methylphenidate decreased appetite (RR 3.66, 95% CI 2.56 to 5.23) and weight (RR 3.89, 95% CI 1.43 to 10.59). In cross-over trials, methylphenidate increased abdominal pain (RR 1.61, 95% CI 1.27 to 2.04). We found no significant differences in the risk according to type, dose, or duration of administration. The required information size was achieved in three out of four outcomes. Conclusion Methylphenidate increases the risks of decreased appetite, weight loss, and abdominal pain in children and adolescents with attention deficit hyperactivity disorder. No differences in the risks of gastrointestinal adverse events according to type, dose, or duration of administration were found.
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Affiliation(s)
- Mathilde Holmskov
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
- * E-mail:
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
- Psychological Institute, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Erica Ramstad
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Frederik Løgstrup Magnusson
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Helle B. Krogh
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Camilla Groth
- Pediatric Department E, Herlev University Hospital, Herlev, Denmark
| | - Donna Gillies
- Western Sydney Local Health District; Mental Health, Parramatta, Australia
| | - Morris Zwi
- Islington CAMHS, Whittington Health, London, United Kingdom
| | - Maria Skoog
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Swart JC, Froböse MI, Cook JL, Geurts DEM, Frank MJ, Cools R, den Ouden HEM. Catecholaminergic challenge uncovers distinct Pavlovian and instrumental mechanisms of motivated (in)action. eLife 2017; 6:e22169. [PMID: 28504638 PMCID: PMC5432212 DOI: 10.7554/elife.22169] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/24/2017] [Indexed: 01/06/2023] Open
Abstract
Catecholamines modulate the impact of motivational cues on action. Such motivational biases have been proposed to reflect cue-based, 'Pavlovian' effects. Here, we assess whether motivational biases may also arise from asymmetrical instrumental learning of active and passive responses following reward and punishment outcomes. We present a novel paradigm, allowing us to disentangle the impact of reward and punishment on instrumental learning from Pavlovian response biasing. Computational analyses showed that motivational biases reflect both Pavlovian and instrumental effects: reward and punishment cues promoted generalized (in)action in a Pavlovian manner, whereas outcomes enhanced instrumental (un)learning of chosen actions. These cue- and outcome-based biases were altered independently by the catecholamine enhancer melthylphenidate. Methylphenidate's effect varied across individuals with a putative proxy of baseline dopamine synthesis capacity, working memory span. Our study uncovers two distinct mechanisms by which motivation impacts behaviour, and helps refine current models of catecholaminergic modulation of motivated action.
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Affiliation(s)
- Jennifer C Swart
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Monja I Froböse
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jennifer L Cook
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Dirk EM Geurts
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael J Frank
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, United States
- Brown Institute for Brain Sciences, Brown University, Providence, United States
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke EM den Ouden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Mowinckel AM, Alnæs D, Pedersen ML, Ziegler S, Fredriksen M, Kaufmann T, Sonuga-Barke E, Endestad T, Westlye LT, Biele G. Increased default-mode variability is related to reduced task-performance and is evident in adults with ADHD. Neuroimage Clin 2017; 16:369-382. [PMID: 28861338 PMCID: PMC5568884 DOI: 10.1016/j.nicl.2017.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/01/2017] [Accepted: 03/23/2017] [Indexed: 11/03/2022]
Abstract
Insufficient suppression and connectivity of the default mode network (DMN) is a potential mediator of cognitive dysfunctions across various disorders, including attention deficit/hyperactivity disorder (ADHD). However, it remains unclear if alterations in sustained DMN suppression, variability and connectivity during prolonged cognitive engagement are implicated in adult ADHD pathophysiology, and to which degree methylphenidate (MPH) remediates any DMN abnormalities. This randomized, double-blinded, placebo-controlled, cross-over clinical trial of MPH (clinicaltrials.gov/ct2/show/NCT01831622) explored large-scale brain network dynamics in 20 adults with ADHD on and off MPH, compared to 27 healthy controls, while performing a reward based decision-making task. DMN task-related activation, variability, and connectivity were estimated and compared between groups and conditions using independent component analysis, dual regression, and Bayesian linear mixed models. The results show that the DMN exhibited more variable activation patterns in unmedicated patients compared to healthy controls. Group differences in functional connectivity both between and within functional networks were evident. Further, functional connectivity between and within attention and DMN networks was sensitive both to task performance and case-control status. MPH altered within-network connectivity of the DMN and visual networks, but not between-network connectivity or temporal variability. This study thus provides novel fMRI evidence of reduced sustained DMN suppression in adults with ADHD during value-based decision-making, a pattern that was not alleviated by MPH. We infer from multiple analytical approaches further support to the default mode interference hypothesis, in that higher DMN activation variability is evident in adult ADHD and associated with lower task performance.
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Affiliation(s)
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Mads L. Pedersen
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Intervention Center, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Sigurd Ziegler
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. box 1171, Blindern, 0318 Oslo, Norway
| | - Mats Fredriksen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, 3103 Tønsberg, Norway
| | - Tobias Kaufmann
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Edmund Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience Kings College London, United Kingdom
| | - Tor Endestad
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Lars T. Westlye
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Guido Biele
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Norwegian Institute of Public Health, Division of Mental Health, 0403 Oslo, Norway
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Cortese S, D'Acunto G, Konofal E, Masi G, Vitiello B. New Formulations of Methylphenidate for the Treatment of Attention-Deficit/Hyperactivity Disorder: Pharmacokinetics, Efficacy, and Tolerability. CNS Drugs 2017; 31:149-160. [PMID: 28130762 DOI: 10.1007/s40263-017-0409-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psychostimulants are the recommended first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Methylphenidate is one of the most commonly used psychostimulants worldwide. Given that immediate-release and/or tablet/capsule formulations may decrease adherence to methylphenidate treatment, several drug companies have been developing novel long-acting and/or liquid/chewable formulations that may improve adherence as well as (for long-acting formulations) reduce abuse potential, decrease stigma associated with multiple administrations per day, and decrease the potential for adverse effects related to dosage peak. Here, we review the pharmacokinetics, efficacy, and tolerability of novel formulations of methylphenidate that are in development or have been approved by the US FDA or European Medicines Agency (EMA) in the last 5 years. We searched the websites of the FDA, EMA, ClinicalTrials.gov, and the pertinent drug companies. We also searched PubMed, Ovid databases (MEDLINE, PsycINFO, Embase + Embase classic), and ISI Web of Knowledge (Web of Science [Science Citation Index Expanded], Biological Abstracts, Biosis, Food Science and Technology Abstracts) to retrieve any additional pertinent information. We found data from trials for the following compounds: (1) methylphenidate extended-release oral suspension (MEROS; NWP06, Quillivant™); (2) methylphenidate extended-release chewable capsules (NWP09, QuilliChew ER™); (3) methylphenidate hydrochloride extended-release capsules (Aptensio XR™); (4) methylphenidate extended-release orally disintegrating tablets (XR-ODT; NT-0102, Cotempla™); (5) ORADUR technology (once-daily tamper-resistant formulation) methylphenidate sustained release (SR); and (6) methylphenidate modified-release (HLD-200; Bejorna™). Overall, available evidence based on trials suggests these compounds have good efficacy and tolerability. Future research should further explore the effectiveness and tolerability of these new formulations as well as their potential to improve adherence to treatment in the 'real world' via pragmatic trials.
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Affiliation(s)
- Samuele Cortese
- Academic Unit of Psychology, Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Building 44 Highfield Campus, Clinical and Experimental Sciences (CNS and Psychiatry) and Solent NHS Trust, Southampton, SO17 1BJ, UK.
- New York University Child Study Center, One Park Ave, 7th floor, New York, NY, 10016, USA.
| | - Giulia D'Acunto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56128, Calambrone, Italy
| | - Eric Konofal
- Pediatric Sleep Center, Hospital Robert Debré, 48 Bd Sérurier, 75019, Paris, France
- NLS-Pharma, Breitenweg 10, 6370, Stans, NW, Switzerland
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56128, Calambrone, Italy
| | - Benedetto Vitiello
- Division of Child and Adolescent Neuropsychiatry, University of Turin, Piazza Polonia 94, 10126, Turin, Italy
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Abstract
OBJECTIVE To directly compare the efficacy of methylphenidate and atomoxetine in improving symptoms, social functions, and quality of life among adults with ADHD. METHOD This was an 8-to-10-week, open-label, head-to-head, randomized clinical trial with two treatment arms: immediate-release methylphenidate (IR-methylphenidate; n = 31) and atomoxetine once daily ( n = 32). The outcome measures included ADHD symptom severity, quality of life, and functional impairments. RESULTS We found a significant reduction in overall ADHD symptoms and improvement in social functions and quality of life for both groups at Weeks 4 to 5 and Weeks 8 to 10. There was no significant difference in the slope of improvements over time except that atomoxetine was superior to IR-methylphenidate in reducing hyperactive/impulsive symptoms at Weeks 4 to 5. There was no significant group difference in the rates of adverse effects. CONCLUSION Both IR-methylphenidate and atomoxetine are well tolerated and efficacious in ethnic Chinese adults with ADHD.
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Affiliation(s)
- Hsing-Chang Ni
- 1 National Taiwan University Hospital, Taipei, Taiwan
- 2 National Taiwan University College of Medicine, Taipei, Taiwan
- 3 Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yu-Ju Lin
- 1 National Taiwan University Hospital, Taipei, Taiwan
- 2 National Taiwan University College of Medicine, Taipei, Taiwan
- 4 Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- 1 National Taiwan University Hospital, Taipei, Taiwan
- 2 National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Chun Huang
- 5 National Cheng Kung University Hospital, Tainan, Taiwan
| | - Li-Kuang Yang
- 1 National Taiwan University Hospital, Taipei, Taiwan
- 2 National Taiwan University College of Medicine, Taipei, Taiwan
- 6 Beitou Armed Forces Hospital, Taipei, Taiwan
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50
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Akyol Ardıç Ü, Ercan ES, Aygüneş D, Yüce D, Durak S, Kosova B. [Response With Methylphenidate to ADHD-Like Symptoms in Pervasive Developmental Disorder: Does CES-1 Enzyme Gene Polymorphism Have a Role?]. Turk Psikiyatri Derg 2017; 28:89-94. [PMID: 29192941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Methylphenidate is the first-choice medication for the Pervasive Developmental Disorders (PDDs), and comorbid Attention Deficit Hyperactivity Disorder (ADHD). But this approach generally results with poor outcomes, and increased adverse effects. It is aimed to investigate the comparison of cases who diagnosed with PDDs and Mild Mental Retardation (MR) and cases with pure ADHD in terms of the clinical response to MPH. Also we aimed to investigate the relations between CES-1 polymorphism gene and the clinical response to MPH. METHODS For clarifying this we searched for three polymorphisms (Arg199/His, Ser75/Asn, and Ile49/Val) in carboxylesterase-1 gene (CES-1) in the saliva of patients diagnosed with PDD+ADHD. Also, we assessed the clinical response to MPH by dimensional approach using the Attention Deficit Hyperactivity Disorder Rating Scale IV and Clinical Global Impression-Improvement scale. RESULTS PDD+ADHD groups had significantly higher Arg199/His polymorphism, and clinically responded poorer with symptoms sometimes even worsening to the MPH treatment compared with "pure" ADHD and ADHD+MR groups. CONCLUSION This is the first study that an association between Arg199/His polymorphism in CES1 and altered treatment response to MPH in patients with PDD that presents with symptoms of ADHD.
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