Attention deficits

Treatment of attention deficit hyperactivity disorder (ADHD) in children with psychostimulants... 

Gibson AP, Bettinger TL, Patel NC, Crismon ML (2006) Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder. Ann Pharmacother 40 1134-1142... 

ATTENTION DEFICIT DISORDER If the child is hospitalized, the nurse enters a daily summary of the child s behavior in the patient s record. This provides a record of the results of therapy. 

Initial assessment of the child with attention deficit... 

Somoza EC, Winhusen TM, Bridge TP, et al An open-label pilot study of methylpheni-date in the treatment of cocaine-dependent patients with adult attention deficit/ hyperactivity disorder. J Addict Dis 23 77—92, 2004 Sora 1, Wichems C, Takahashi N, et al Cocaine reward models conditioned place preference can be established in dopamine- and in serotonin-transporter knockout mice. Proc Natl Acad Sci U S A 95 7699-7704, 1998 Soral, Hall FS, Andrews AM, etal Molecular mechanisms of cocaine reward combined dopamine and serotonin transporter knockouts eliminate cocaine place preference. Proc Nad Acad Sci U S A 98 5300-5305, 2001 Spear J, Alderton D Psychosis associated with prescribed dexamphetamine use 0etter). 

Amphetamines (speed sulph, sulphate, uppers, wake-ups, billy whizz, whizz, whites, base) are synthetic stimulants which as medicines have been formed into a variety of tablets. Their current medical use is very limited and in fact only dexamphetamine sulphate, Dexedrine, is now available for use solely in the treatment of narcolepsy. The only other amphetamine available for medical use is methylphenidate (Ritalin) for the treatment of attention deficit syndrome in children. As a street drug, amphetamine usually comes as a white, grey, yellowish or pinky powder. The purity rate of street powders is less than 10%, the rest being made up of milder stimulants such as caffeine, other drugs such as paracetamol or substances like glucose, dried baby milk, flour or talcum powder. 

Histamine produces its pharmacological actions by three subtypes of receptors the postsynaptic Hi and H2 receptors and the presynaptic H3 receptor. The H3 receptor is mainly located in the central nervous system (CNS), where it acts as an inhibitory autoreceptor in the central histaminergic neuronal pathways [176]. A number of therapeutic applications have been proposed for selective H3 receptor antagonists, including several CNS disorders such as Alzheimer s disease. Attention Deficit Hyperactivity Disorder, Schizophrenia, or for enhancing memory or obesity control. 

Reductions in aggressive behavior after treatment with amphetamine and other psyehomotor stimulants are seen in children and adolescents who have been diagnosed with hyperkinesis or attention deficit disorder. There is considerable disagreement about these diagnostic categories and about whether the violent outbursts and uncontrolled episodes of aggressive behavior are limited to the early developmental period or continue into adulthood (Mendelson et al. 1971 Minde et al. 1972). 

Attention-deficit/hyperactivity disorder Medical comorbidities include ... 

Comorbid conditions must be addressed in order to maximize desired outcomes. For comorbid bipolar disorder and attention-deficit/hyperactivity disorder when stimulant therapy is indicated, treatment of mania is recommended before starting the stimulant in order to avoid exacerbation of mood symptoms by the stimulant. 

Recommend a therapeutic plan, including initial doses, dosage forms, and monitoring parameters, for a patient with attention-deficit hyperactivity disorder. 

Differentiate between the available pharmacotherapy used for attention-deficit hyperactivity disorder with respect to pharmacology and pharmaceutical formulation. 

Recommend second-line and/or adjunctive agents that can be effective alternatives in the treatment of attention-deficit hyperactivity disorder when stimulant therapy is less than adequate. 

Recommend strategies for minimizing adverse effects of attention-deficit hyperactivity disorder medications. 

O To meet present attention-deficit hyperactivity disorder diagnostic criteria, patients need to display either hyperactivity, impulsivity, and/or inattentiveness before 7 years of age. 

The exact cause of attention-deficit hyperactivity disorder is unknown, but dysfunction in neurotransmitters norepinephrine and dopamine has been implicated as a key component. 

Attention-deficit hyperactivity disorder is rarely encountered without comorbid conditions. 

Treatment goals for attention-deficit hyperactivity disorder are to improve behavior, increase attention/response inhibition (ability to stay on task), and minimize side effects associated with pharmacotherapy. 

Pharmacotherapy is superior to behavioral therapy in the treatment of attention-deficit hyperactivity disorder. Behavior modification provided by parents and teachers in conjunction with pharmacotherapy improves treatment outcomes more than behavior therapy alone. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

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