Attention-deficit treatment

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... 

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. 

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). 

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 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. 

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. 

American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001 108 1033-1044. 

Wolraich ML, Wibbelsman CJ, Brown TE, et al. Attention-deficit/hyperactivity disorder among adolescents A review of the diagnosis, treatment, and clinical implications. Pediatrics 2005 115(6) 1734-1746. 

Brown CS and Cooke SC (1994). Attention deficit hyperactivity disorder, clinical features and treatment options. CNS Drugs, 1, 95-106. 

Reducing problematic behavior to biological causes calls for pharmaceutical solutions and here too powerful corporate interests foster such explanations. The redefinition of hyperactivity as Attention Deficit Disorder (ADD), for example, has significantly benefitted the pharmaceutical industry. The use of Ritalin as a treatment for ADD has doubled since 1995, and it is prescribed to over 4 million children in the US. Production of the drug is up 700 % since 1990, and 90 % of the production is consumed in the US where pharmaco-genomics is a burgeoning field. Europeans have been more cautious, and the International Narcotics Control Board of the UN has expressed concern about the growing tendency to redefine behavior as amenable to pharmaceutical modification. 

The answer is a. (Hardman, p 22L Katzang, p L3L) Methylphenidate is similar to amphetamine and acts as a CN5 stimulant, with more pronounced effects on mental than on motor activities. It is effective in the treatment of narcolepsy and attention-deficit hyperactivity disorders. 

Dresel, S., Krause, J., Krause, K. H. et al. Attention deficit hyperactivity disorder binding of 99mTc TRODAT-1 to the dopamine transporter before and after methylphenidate treatment. Eur. J. Nucl. Med. 27 1518-1524,2000. 

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. 

Elia J, Ambrosini PJ, Rapoport JL. Drug therapy treatment of attention-deficit-hyperactivity disorder. New Engl J Med 1999 340(10) 780-788. 

Greenhill LL, Ford RE. Childhood attention-deficit-hyperactivity disorder pharmacological treatments. In Nathan PE, Gorman JM (eds), A Guide to Treatments that Work, 2nd Edition. London Oxford University Press, 2002, pp 25-55. 

Jensen P. Longer term effects of stimulant treatments for attention-deficit/hyperactivity disorder. J Attention Disord 2002 6(Supplement 1) S17-S30. 

Rubia K, Smith A. Attention deficit-hyperactivity disorder current findings and treatment. Curr Opin Psychiatry 2001 14(4) 309-316. 

Spencer TJ, Biederman J, Wilens TE, Earaone SV. Novel treatments for attention-deficit/ hyperactivity disorder in children. J Clin Psychiatry 2002 62(Supplement 12) 16-22. 

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. 

Popovic B, Bhattacharya P, Sivaswamy L. (2(X)9) Lisdexamfetamine A prodrug for the treatment of attention-deficit/hyperactivity disorder. Am J Health-Sys Pharm 66 2005-2012. 

Gillberg C, Melander H, von Knorring AL, Janols LO, Themlnnd G Hagglof B, Eidevall-Wallin L, Gustafsson P, Kopp S. (1997) Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, donble-blind, placebo-controlled trial. Arch Gen Psychiatry 54 857-864. 

Attention deficit hyperactivity disorder (ADHD) For the treatment of ADHD in patients 6 years of age and older. Dexmethylphenidate is indicated as an integral part of a total treatment program for ADHD that may include other measures (eg, psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all patients. Stimulants are not intended for use in the patient who exhibits symptoms secondary to environmental factors or other primary psychiatric disorders, including psychosis. 

Attention deficit disorder (ADD)/Attention deficit hyperactivity disorder (ADHD) As an integral part of a total treatment program that typically includes other remedial... 

Amphetamine, dextroamphetamine, and methamphetamine also are indicated for attention deficit disorders in children, as part of a total treatment program. For complete prescribing information on the amphetamines for this and other uses, consult the general amphetamine monograph. 

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