Attention deficit disorder stimulants

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). 

Methylphenidate is a CNS stimulant similar to amphetamine however, in usual doses it has a more expressed action on mental activity rather than physical or motor activity. In therapeutic doses it does not raise blood pressure, respiratory rate, or increase heart rate. All of these effects as well as a number of others are associated with general excitement of the CNS. Tremor, tachycardia, hyperpyrexia, and a state of confusion can result from using large doses. It is used in treating moderate depression and apathetic conditions, and also as an adjuvant drug for treating attention deficit disorder in children.Synonyms of this dmg are meridil, ritalin, and others. 

The therapeutic indications for the psychomotor stimulants are quite limited. They are beneficial in the treatment of the hyperkinetic syndrome (attention deficit-hyperactivity disorder with minimal brain dysfunction). This is generally a childhood disease characterized by hyperactivity, inability to concentrate, and impulsive behavior. Amphetamines and the more extensively used methylphenidate paradoxically are quite effective in calming a large proportion of children with this disorder. Pemoline Cylert) is also used in the treatment of attention deficit disorder with hyperkinetic behavior. The mechanism by which these compounds are effective in this disorder is not known. 

D. Attention deficit-hyperkinetic disorder and attention deficit disorder are among only a few approved uses of the psychomotor stimulants of the amphetamine type. 

Schmidt, K., Solanto, M.V., and Sanchez, M. (1984) The effect of stimulant medication of academic performance, in the context of multimodal treatment, in attention deficit disorders with hyperactivity. / Clin Psychopharm 4 100—103. 

Swanson JM, McBurnett K, Wigan T, et al. Effect of stimulant medication on children with attention deficit disorder a review of reviews. Except Child 1993 60 154-162. 

Atomoxetine is a selective inhibitor of the norepinephrine reuptake transporter. Its actions, therefore, are mediated by potentiation of norepinephrine levels in noradrenergic synapses. It is used in the treatment of attention deficit disorders (see below). Atomoxetine has surprisingly little cardiovascular effect because it has a clonidine-like effect in the central nervous system to decrease sympathetic outflow while at the same time potentiating the effects of norepinephrine in the periphery. However, it may increase blood pressure in some patients. Norepinephrine reuptake is particularly important in the heart, particularly during sympathetic stimulation, and this... 

Injection of botulinum toxin A at the site of problematic tics is sometimes helpful. Treatment of any associated attention deficit disorder (eg, with clonidine patch, guanfacine, pemoline, methylphenidate, or dextroamphetamine) or obsessive-compulsive disorder (selective serotonin reuptake inhibitors or clomipramine) may be required. Bilateral thalamic stimulation is sometimes worthwhile in otherwise intractable cases. 

Perhaps even more important in children is the issue of bipolar disorder. Mania and mixed mania have not only been greatly underdiagnosed in children in the past but also have been frequently misdiagnosed as attention deficit disorder and hyperactivity. Furthermore, bipolar disorder misdiagnosed as attention deficit disorder and treated with stimulants can produce the same chaos and rapid cycling state as antidepressants can in bipolar disorder. Thus, it is important to consider the diagnosis of bipolar disorder in children, especially those unresponsive or apparently worsened by stimulants and those who have a family member with bipolar disorder. These children may need their stimulants and antidepressants discontinued and treatment with mood stabilizers such as valproic acid or lithium initiated. 

Although there are many disorders of attention, ranging from lack of appropriate sleep or motivation in a normal person, to medication side effects to any number of psychiatric and cognitive disorders, here we will only discuss attention deficit disorder, the disorder of attention for which there is the greatest use of stimulant medications as therapeutic agents. 

The most commonly used agents to enhance attention in attention deficit disorder are the stimulants methylphenidate and ( -amphetamine. Other effective stimulants are not as widely used, pemoline because of liver toxicity and methamphetamine because of its greater abuse potential. Methylphenidate and ( -amphetamine act predominantly by releasing dopamine from presynaptic dopamine terminals (Figs. 12— 2 and 12—3). These agents not only block the dopamine transporter but may actually... 

Some unexpected clinical observations have become apparent after several decades of treating attention deficit disorder patients with potentially abusable stimulants (the psychopharmacology of stimulant abuse is discussed in Chapter 13). That is,... 

On the other hand, there is also the sense among many clinicians that attention deficit disorder is overdiagnosed and stimulants overprescribed and that these observations do not hold when stimulants are too freely prescribed. Nevertheless, there... 

In this chapter, we have looked at two topics in cognitive enhancement attention and memory. We have first reviewed the role of dopamine and norepinephrine/ noradrenaline in the neuropharmacology of attention, and then the syndrome of attention deficit disorder as a common problem associated with a disorder of attention. We then discussed the use of stimulants for improving attention, primarily in attention deficit disorder, and reviewed the pharmacological mechanisms of action of methylphenidate, d and 1 amphetamine, pemoline, and secondary therapies such as clonidine and guanfacine. 

To review the use of stimulants in disorders of attention, including attention deficit disorder in children and adults. 

Children with ADHD are inattentive, impulsive, and hyperactive. The areas of their brains that control attention and restraint do not function properly. Stimulant drugs, specifically amphetamines, have been used in the United States to treat children with inattention and hyperactivity disorders since the 1930s. MPH was also discovered to have a calming effect on hyperactive children and a focusing effect on those with attention deficit disorder (ADD). However, it was not until the 1960s that the U.S. Food and Drug Administration (FDA) approved methylphenidate for the treatment of ADHD. At the turn of the twenty-first century, approximately 90% of all methylphenidate was prescribed for ADHD children. Most of the rest was prescribed to treat adults with a sleeping sickness known as narcolepsy. 

Health officials are concerned with a trend of young people misusing stimulants that are used to treat attention deficit disorder. A survey of students, ages 11 to 18, suggest that many young people seek to obtain ADD medication without a prescription. 

D-TR, 5HT-TR [elevates 5HT Dopamine, stimulant calms children with hyperactivity-attention deficit disorder]... 

Methylphenidate (MPH, Ritalin ) is a central nervous system stimulant that is used for the treatment of attention deficit disorders, with and without hyperactivity, and narcolepsy. MPH has two chiral centres and is marketed as a racemic mixture. It is known that d-threo-MP is pharmacologically more active than l-threo-MPH. The drag is rapidly metabohzed in humans to the inactive ritalinic acid. High-throughput analysis with chiral selectivity is demanded for the bioanalysis of MPH and its major metabolite. 

Methylphenidate is a potent CNS. stimulant. Indication-include narcolcp.sy and attention-deficit disorder. The stnic-ture of the (2R.2 R) isomer of the threo racemic mixture a shown. 

Drimmer, E. J. (2003). Stimulant treatment of bulimia nervosa with and without attention-deficit disorder three case reports. Nutrition 19(1) 76-7. 

Indications Attention deficit disorder Category CNS stimulant Half-life 2.0-4.5 hours... 

Methamphetamine hydrochloride is an amphetamine that activates noradrenergic neurons causing CNS and respiratory stimulation and stimulates the satiety center in the brain, causing appetite suppression. It is indicated for treatment of attention deficit disorder in children it is a shortterm exogenous obesity adjunct. 

Methylphenidate is a mild stimulant prescribed to individuals (usually for children, and sometimes controversially) who have behavioral problems characterized by hyperactivity and short attention span. The National Institute of Mental Health estimates that approximately 3-5 percent of the general population has attention-deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). The administration of methylphenidate to children diagnosed with hyperactivity and/or attention-deficit disorder can have a calming effect on the children and can enable them to focus on schoolwork. Methylphenidate is also used to treat narcolepsy, a sleep disorder characterized by a permanent and overwhelming feeling of sleepiness and fatigue. 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

Methylphenidate (Ritalin) Mild CNS stimulant. Actions similar to d-amphetamine. Attention deficit disorder. Narcolepsy. n H... 

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