Attention-deficit-hyperactivity disorder: An update

Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California 90033, USA.
Pharmacotherapy (Impact Factor: 2.2). 07/2009; 29(6):656-79. DOI: 10.1592/phco.29.6.656
Source: PubMed

ABSTRACT Attention-deficit-hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs social, academic, and occupational functioning in children, adolescents, and adults. In patients with ADHD, neurobiologic research has shown a lack of connectivity in key brain regions, inhibitory control deficits, delayed brain maturation, and noradrenergic and dopaminergic dysfunction in multiple brain regions. The prevalence of this disorder in the United States is 6-9% in youth (i.e., children and adolescents) and 3-5% in adults. Prevalence rates for youth are similar worldwide. Children with ADHD are at greater risk than children without ADHD for substance abuse and delinquency whether or not they receive drug therapy; however, early treatment with psychoeducation as well as drug therapy and/or behavioral intervention may decrease negative outcomes of ADHD, including the rate of conduct disorder and adult antisocial personality disorder. Drug therapy is effective for all age groups, even preschoolers, and for late-onset ADHD in adults. Stimulants, such as methylphenidate and amphetamine, are the most effective therapy and have a good safety profile; although recent concerns of sudden unexplained death, psychiatric adverse effects, and growth effects have prompted the introduction of other therapies. Atomoxetine, a nonstimulant, has no abuse potential, causes less insomnia than stimulants, and poses minimal risk of growth effects. Other drug options include clonidine and guanfacine, but both can cause bradycardia and sedation. Polyunsaturated fatty acids (fish oil), acetyl-L-carnitine, and iron supplements (for youth with low ferritin levels) show promise in improving ADHD symptoms. As long-term studies show that at least 50% of youth are nonadherent with their drug therapy as prescribed over a 1-year period, long-acting formulations (administered once/day) may improve adherence. Comorbid conditions are common in patients with ADHD, but this patient population can be treated effectively with individualized treatment regimens of stimulants, atomoxetine, or bupropion, along with close monitoring.

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    • "Given its pharmacokinetics and low cost, methamphetamine tends to be self-administered chronically and continuously in high doses when used in nonmedical contexts (Winger et al., 2004). Some psychostimulants, including methylphenidate, amphetamine , and methamphetamine are approved in the US for treatment of Attention Deficit Hyperactivity Disorder (ADHD) (Dopheide and Pliszka, 2009), weight control (Greenway and Caruso, 2005), and narcolepsy (Morgenthaler et al., 2007). Given their abuse potential, diversion can and does occur (Sembower et al., 2013; Sweeney et al., 2013). "
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    ABSTRACT: Treatment of psychostimulant addiction has been a major, and not fully met, challenge. For opioid addiction, there is strong evidence for the effectiveness of several medications. For psychostimulants, there is no corresponding form of agonist maintenance that has met criteria for regulatory approval or generally accepted use. Stimulant-use disorders remain prevalent and can result in both short-term and long-term adverse consequences. The mainstay of treatment remains behavioral interventions. In this paper, we discuss those interventions and some promising candidates in the search for pharmacological interventions.
    Neuropharmacology 04/2014; 87. DOI:10.1016/j.neuropharm.2014.04.002 · 4.82 Impact Factor
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    • "Moreover, when ADHD is untreated, there is increased prevalence of certain psychological disorders (e.g., major depression, bipolar disorder, conduct disorder, oppositional-defiant disorder, antisocial personality , substance use, and anxiety) (Faraone et al. 1997; Rasmussen and Gillberg 2000; Kollins et al. 2005; Biederman et al. 2006). However, early treatment may decrease negative outcomes of ADHD including the rate of conduct disorder and adult antisocial personality disorder (Dopheide and Pliszka 2009). There are both pharmacological and nonpharmacological (e.g., cognitive behavioral therapy [CBT]) treatments of ADHD. "
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    ABSTRACT: Prescription stimulants are often used to treat attention deficit hyperactivity disorder (ADHD). Drugs like methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) help people with ADHD feel more focused. However, misuse of stimulants by ADHD and nonaffected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks. In this review, we discuss recent advances in the use and increasing misuse of prescription stimulants among high school and college students and athletes. Given the widespread belief that stimulants enhance performance, there are in fact only a few studies reporting the cognitive enhancing effects of stimulants in ADHD and nonaffected individuals. Student athletes should be apprised of the very serious consequences that can emerge when stimulants are used to improve sports performance. Moreover, misuse of stimulants is associated with dangers including psychosis, myocardial infarction, cardiomyopathy, and even sudden death. As ADHD medications are prescribed for long-term treatment, there is a need for long-term safety studies and education on the health risks associated with misuse is imperative.
    Brain and Behavior 09/2012; 2(5):661-77. DOI:10.1002/brb3.78
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    • "Methylphenidate (Ritilin ® ) is one of the most widely prescribed stimulant medications used to combat the symptoms of attention deficit hyperactivity disorder (ADHD) (Dopheide and Pliszka, 2009) ADHD is classically a disorder of childhood and adolescence but ADHDresidual type is recognized in adulthood (DSM-IV-Task-Force, 2000). In a group of 18-44 year old adults examined the incidence of ADHD was 4.4% overall with 3.2% females and 5.4% males (Kessler et al., 2006). "
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    ABSTRACT: As more adults take the stimulant medication methylphenidate to treat attention deficit hyperactivity disorder (ADHD) residual type, the risk arises with regard to exposure during early development if people taking the medication become pregnant. We studied the neurobehavioral effects of methylphenidate in zebrafish. Zebrafish offer cellular reporter systems, continuous visual access and molecular interventions such as morpholinos to help determine critical mechanisms underlying neurobehavioral teratogenicity. Previously, we had seen that persisting neurobehavioral impairment in zebrafish with developmental chlorpyrifos exposure was associated with disturbed dopamine systems. Because methylphenidate is an indirect dopamine agonist, it was thought that it might also cause persistent behavioral impairment after developmental exposure. Zebrafish embryos were exposed to the ADHD stimulant medication methylphenidate 0-5 days post fertilization (12.5-50mg/l). They were tested for long-term behavioral effects as adults. Methylphenidate exposure (50mg/l) caused significant increases in dopamine, norepinepherine and serotonin on day 6 but not day 30 after fertilization. In the novel tank diving test of predatory avoidance developmental methylphenidate (50mg/l) caused a significant reduction in the normal diving response. In the three-chamber spatial learning task early developmental methylphenidate (50mg/l) caused a significant impairment in choice accuracy. These data show that early developmental exposure of zebrafish to methylphenidate causes a long-term impairment in neurobehavioral plasticity. The identification of these functional deficits in zebrafish enables further studies with this model to determine how molecular and cellular mechanisms are disturbed to arrive at this compromised state.
    Neurotoxicology and Teratology 07/2011; 33(6):668-73. DOI:10.1016/ · 3.22 Impact Factor
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