Attention-deficit/hyperactivity stimulant 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. 

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). 

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. 

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. 

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. 

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. 

Firestone P, Musten, L. M., Pisterman, S. et al. (1998). Short-term side effects of stimulant medication are increased in preschool children with attention-deficit/hyperactivity... 

This is not always the case. Viagra stimulated a medical need that was not recognized prior to its introduction. Pharmaceutical companies try to stimulate patients and doctors to recognize some disorders as diverse as irritable bowel syndrome, social phobia, and attention deficit hyperactivity disorder (ADHD). 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

About a quarter of the 3 million campers in the 2,600 camps belonging to the American Camp Association are medicated for attention deficit disorder, psychiatric problems, or mood disorders, according to Peg L. Smith, chief executive officer. The proliferation of children on stimulants for attention deficit hyperactivity disorder (ADHD), antidepressants, or antipsychotic drugs is not only in the setting of camps. It is the extension of an increasingly common year-round regimen in schools and at home. 

The 14-year-old adolescent with attention deficit-hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin), a central nervous stimulant. Which statement indicates to the nurse that the adolescent understands the medication teaching ... 

Leibel S, Bloomberg G. Attention-deficit/hyperactivity disorder stimulant medication reaction masquerading as chronic cough. Arm Allergy... 

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. 

---