Hyperkinetic disorders

The basal ganglia are a group of subcortical nuclei which are components of modular circuits involved in many cortical functions. They have received considerable attention from basic scientists and clinicians alike because of their prominent involvement in movement disorders, a spectrum of diseases including disorders which are characterized by poverty of movement (hypokinetic disorders), as well as disorders characterized by excess movement (hyperkinetic disorders). It has become clear in recent years that most basal ganglia disorders are not restricted to motor disturbances, but involve cognitive and emotional features as well. 

Patients who have received neuroleptics for long periods of time may develop a hyperkinetic disorder of the extrapyramidal system characterized by involuntary, purposeless movements affecting many parts of the body. This is known as tardive dyskinesia. Most commonly, these are manifested in a syndrome involving abnormal movements of the tongue, mouth and masticatory muscles. There are also choreoathetoid movements of the extremities. The mechanism by which these symptoms develop remains unknown. 

Racemic f/zreo-methylphenidate was approved for the treatment of fatigue, nausea, and depression in 1955 under the brand name Ritalin , and was first used in children in 1958 with an approval for hyperkinetic disorder (ADHD) in 1960. Methylphenidate has an even shorter half-life than amphetamine, and its use in treating ADHD was limited by the fact that schoolchildren would need to visit a nurse during the day to take a second dose of this scheduled drug (in order to maintain efficacy throughout the entire school day). In humans, injecting methylphenidate produces effects similar to intravenous cocaine, but oral methylphenidate is adsorbed very slowly from the gut into the blood and takes an unusually long time (estimated 2.5 h) to reach a peak concentration... 

Disorders of adult personality and behaviour (ICD 10 codes F60-F69), mental retardation (ICD 10 codes F70-F79), disorders of psychological development (ICD 10 codes F80-F89), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (ICD 10 codes F90-F98) and unspecified mental disorder (ICD 10 code F99) are all often non-specific and/or cannot be treated with conventional psychopharmacological medicaments. For example, disorders of sexual behaviour have been treated with hormone therapies or antagonists and hyperkinetic disorders and other disruptive behaviour disorders in children have been treated with stimulants such as methylphenidate (Ritalin ). 

Which of the following classes of agents is useful in the treatment of attention deficit hyperkinetic disorder ... 

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

In 1995, Bramble published a study on the prescription frequency of antidepressants by British child psychiatrists (Bramble, 1995). A brief postal questionnaire was circulated to 350 members of the British Royal College of Psychiatrists, Child and Adolescent Psychiatry Specialist Sections. There was a 71% response rate, and 85% of the 238 respondents had employed antidepressants, the most popular of these being amitriptyline and imipramine. Nearly one-third of the psychiatrists at that time used neuroagents occasionally, and the SSRIs were used only very rarely. The antidepressant medication was used for a wide range of child and adolescent disorders beyond those of depression and nocturnal enuresis. Approximately 20% of the prescriptions were given for ADHD (hyperkinetic disorder), conduct disorder, and a few cases of autistic disorder. Clomipramine was apparently given for OCD. On the basis of these 1994 data. Bramble concluded that British child psychiatrists tend to use antidepressant medication far less often than American psychiatrists. 

Attention-deficit hyperactivity disorder is called hyperkinetic disorder in the ICD-10, which does not include the same subtypes as those in the DSM. According to the DSM-IV, ADHD is a broader definition than that given for HKD (hyperkinetic disorder) in the ICD-... 

These criteria result in a much lower prevalence of hyperkinetic disorder, with estimates in the range of 1-5%, as compared to 5-10% in school-aged children for ADHD. In the ICD-10 there is a lower possibility of diagnosing children with attention deficit without hyperactivity. In the ICD-10 another diagnosis of other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence must be used. However, the combined condition of hyperkinetic disorder and conduct disorder is delineated under the diagnosis hyperkinetic conduct disorder. ... 

Pompideau Group (2000) Attention Deficit/ Hyperkinetic Disorders Their Diagnosis and Treatment with Stimulants. Strasbourg Council of Europe. 

Sindelar, B. (2000) Diagnosis and treatment prectices in the field of ADD/ADHD/HD in Europe In Pompideau Group, eds. Attention Deficit/Hyperkinetic Disorders Their Diagnosis and Treatment with Stimulants. Strasbourg Council of Europe, pp. 55-101. 

Central Nervous System Stimulants Central nervous system stimulants include agents such as the amphetamines (Dexedrine) and methylphenidate hydrochloride (Ritalin), used to elevate mood, suppress appetite, and control hyperkinetic disorders in children. Other examples include the illegal drugs methamphet-amine and cocaine. The mechanism of action of these drugs is to augment actions of the adrenergic nervous system. 

Attmtion deficit hyperactivity disorder (ADHD) is characterised by inattention, impulsivity and motor overactivity, present before the age of 7 years, and causing pervasive impairment across situations as opposed to occvuring only at school or within the home. Some diagnostic systems use the narrower definition of hyperkinetic disorder rather than ADHD. Hj erkinetic disorder is reported to affect 1-2% of school-aged children in the United Kingdom and ADHD 5%. 

Methylphenidate (see above) is effective in children with ADHD and hyperkinetic disorder, reducing... 

ICD-10 hyperkinetic disorder is more restrictive and requires more pervasive and... 

Swanson, J., Castellanos, R, Murias, M., LaHoste, G., and Kennedy, J. (1998) Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder and Hyperkinetic Disorder, Curr. Opinion Neurobiol. 8,263-271. 

Linnet KM, Wisborg K, Secher NJ, Thomsen PH, Obel C, Dalsgaard S, Henriksen TB. Coffee consumption during pregnancy and the risk of hyperkinetic disorder and ADHD a prospective cohort study. Acta Pediatr (Oslo) 2009 98 173-9. 

Metabolism Guanfacine has been recently approved for the treatment of attention-deficit disorder in children aged 6-12 years. A case of excessive weight gain of 9.53 kg in 4 weeks has been reported in a 7-year-old boy treated with extended-release guanfacine for attention-deficit hyperkinetic disorder [34 ]. 

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