Attention deficit hyperactivity disorder medications

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

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

Some psychiatric medications also produce a response within minutes of taking a single dose. Their therapeutic benefit can come very quickly. For example, taking a benzodiazepine such as diazepam (Valium) can quickly relieve panic and anxiety. Taking a stimulant can often rapidly relieve the symptoms of attention deficit-hyperactivity disorder (ADHD). When psychiatric medications work this quickly, we assume that the therapeutic benefit is a direct consequence of their initiating action in the synapse. 

Dopamine-Stimulating Medications. A variety of drugs that increase the availability of dopamine have been studied in cocaine addicts including L-DOPA, bupropion, amantadine, and methylphenidate. In small uncontrolled trials, these have shown some benefit, but definitive studies have yet to be performed. In addition, some dopamine-stimulating medications (in particular, the stimulants like methylphenidate or the amphetamines) are themselves subject to abuse, though, of note, this is typically not a problem when they are prescribed to patients who do not have a history of substance abuse such as, for example, in the treatment of attention deficit-hyperactivity disorder. 

In the past several years, attention deficit-hyperactivity disorder (ADHD) has received considerable attention from both the lay public and the medical and psychological communities. It has become one of the more controversial of the psychiatric disorders. There are several factors that contribute to this phenomenon. 

Stimulants. A handful of case reports hint that treatment with stimulants (meth-ylphenidate or dextroamphetamine) can help manage behavioral agitation in patients who have suffered a TBI. Certainly, stimulant therapy helps control the impulsivity and hyperactivity of children with attention deficit-hyperactivity disorder. Despite these encouraging signs, we have to discourage any routine use of stimulants when attempting to manage behavioral lability in TBI patients. Because stimulants have the potential to exacerbate behavioral lability, we recommend that they only be considered when other medication alternatives have been exhausted. 

The increasing use of stimulants in the United States to treat attention deficit hyperactivity disorder (ADHD) has aroused parental concern and compelled both medical professionals and the media to question the safety and efficacy of this type of treatment. Because ADHD is among the most common reasons for seeking mental health services for children, these questions are more pertinent than ever. This chapter will examine the history of stimulant use, the mechanism of action, pharmacokinetics, side effects, and issues related to their clinical use in children and adolescents. More detailed information on clinical applications is provided in Section III. 

Despite the overwhelming evidence for short-term effectiveness, only recently have studies begun to address long-term benefits of stimulant treatments. Prospective randomized controlled trials with durations of 12 to 24 months and doses up to 60 mg/day of MPH have been conducted to address this issue. The largest of these studies, the National Institute of Mental Health (NIMH)-sponsored Multimodal Treatment Study of Attention-Deficit Hyperactivity Disorder (MTA Study), showed that stimulants (either by themselves or in combination with behavioral treatments) lead to stable, long-term improvements in ADHD symptoms as long as the medication is taken (MTA Cooperative Group, 1999). 

DuPaul, G.J., and Barkley, R.A. (1998) Medication therapy. In Barkley, R.A., ed. Attention Deficit Hyperactivity Disorder A Handbook for Diagnosis and Treatment, 2nd ed. New York Guilford Press, pp. 573—612. 

Attention-deficit hyperactivity disorder has been treated with TCAs since the 1960s. The initial rationale for studies in this area rose from two separate medication needs (1) medications with longer effective half-lives (before the introduction of extended-release stim-... 

Sawyer, M.G., Rey, J.M., Graetz, B., Clark, J.J., and Baghurst, P.A. (2002) Use of medication by young people with attention-deficit/ hyperactivity disorder. Med ] Aust. (in press)... 

Rappley, M.D., Mullan, P.B., Alvarez, F.J., Eneli, I.U., Wang, J., and Gardiner, J.C. (1999) Diagnosis of attention-deficit/hyperactivity disorder and use of psychotropic medication in vety young children. Arch Pediatr Adolesc Med 153 1039-1045. 

This review of instruments for assessing psychopathology in toddlers, children, and adolescents is not intended to be comprehensive. For readers seeking more details, we recommend an extensive textbook, the Handbook of Psychiatric Measures, (Rush et ah, 2000), a detailed chapter (Aman and Pearson, 1999), and the disorder-specific chapters in Part III-B of this volume. Before describing specific instrument options, we summarize some basic principles that are applicable in clinical practice and in research on psychoactive medication. Although we use attention-deficit hyperactivity disorder (ADITD) as a frequent example, the principles are generally applicable to assessment of most disorders. 

Texas Children s Medication Algorithm Project Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-deficit/hyperactivity disorder. Part I. Attention-deficit/hyperactivity disorder. / Am Acad Child Adolesc Psychiatry 39 908—919. 

Pliszka, S.R., Greenhill, L.L., Crismon, M.L., Sedillo, A., Carlson, C., Conners, C.K., McCracken, J.T., Swanson, J.M., Hughes, C.W, Liana, M.E., Lopez, M., and Toprac, M.G. (2000b) The Texas Children s Medication Algorithm Project Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part II Tactics. Attention-deficit/hyperactivity disorder. / Am Acad Child Adolesc Psychiatry 39 920—927. 

Varley, C.K., Vincent, J., Varley, R, and Calderon, R. (2001) Emergence of tics in children with attention deficit hyperactivity disorder treated with stimulant medications. Compr Psychiatry 42 228-233. 

Zito, J.M., Safer, D.J., dosReis, S., Magder, L.S., Gardner, J.F., and Zarin, D.A. (1999) Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 153 1257-1263. 

Stimulants are a class of psychoactive medications approved by the U.S. Food and Drug Administration (FDA) for use in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and narcolepsy. A hst of available stimulants is shown in Table 6-1. 

NONSTIMULANT MEDICATION FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER... 

Psychostimulants are medications that can increase drive and performance. Their most frequent use is in attention deficit hyperactivity disorder (ADHD) and in narcolepsy. They are also called stimulants or, less commonl today, analeptics. 

Attention deficit hyperactivity disorder (ADHD) is one of the best studied and most effectively treated of all disorders in medicine. The data supporting its validity are more compelling than for many nonpsychiatric medical conditions ( 41, 42). A quarter-century of published treatment studies and clinical experience document the short-term effectiveness of pharmacological management (43). 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives tranquilizers can reduce anxiety and help patients with sleep disorders and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction. 

Although most of this chapter has focused on prescription sleep aids, there are a few prescription medications available to help you stay awake. The most commonly used OTC stimulant is caffeine. However, people with the sleep disorder narcolepsy are very sleepy during the day (no matter how much sleep they get) and often require prescription stimulants to alleviate their sleepiness. Stimulants are also prescribed for the treatment of attention deficit/hyperactivity disorder (ADHD, sometimes called ADD), asthma, and obesity. 

At present, there is no approved medical use for cannabis in patients with neurological disorders. However, it is illegally used for spasticity and ataxia in patients with multiple sclerosis and spinal cord injury, and for the treatment of trigeminal nerve pain and, to a lesser extent, attention deficit hyperactivity disorder. Individuals with spinal cord injury have reported a reduction in spasticity after cannabis use. 

In terms of approved medical use, the neuroleptics are often prescribed for children with autism, attention-deficit hyperactivity disorder (ADHD), and Tourette s syndrome. In addition, the popularity of the newer atypical neuroleptics for childhood bipolar disorder is growing rapidly, and sometimes these drugs are the only treatment offered. The neuroleptics are also commonly prescribed for the elderly in nursing homes or other insti-... 

Rappley MD, Eneli IU, Mullan PB, Alvarez FJ, Wang J, Luo Z, Gardiner JC (2002) Patterns of psychotropic medication use in very young children with attention-deficit hyperactivity disorder. J Dev Behav Pediatr 23 23-30... 

---