Long-term outcomes of stimulant medication in attention-deficit hyperactivity disorder.
ABSTRACT The rate of prescribing of stimulant medication for the treatment of attention-deficit hyperactivity disorder (ADHD) has been progressively increasing in countries such as the USA and Australia. In the short term, stimulant medication is effective in reducing the symptoms of ADHD and appears well tolerated with relatively minor side effects. In the long term, much of the benefit of stimulant medication disappears after medication is ceased. Studies have demonstrated only marginal improvements in adult outcomes following a period of treatment in childhood. This may be owing to the beneficial effects being masked by the variability of the condition, the developmental changes in symptomatology that happen with maturation and the substantial influence of social and environmental factors. Stimulant medication may give some protection against later substance abuse. Stimulant medication may slightly elevate the blood pressure and possibly increase susceptibility to seizures and to tics and Tourette syndrome. Starting treatment with stimulant medication is usually associated with weight loss and a transient slowing of the height velocity, although it is believed that most children catch up during puberty. No studies were found that listed strokes or heart attacks as potential or actual complications, although one individual from a group of normal controls died suddenly of cardiac arrest in adolescence. It would appear that the medical complications associated with amphetamine addiction are not relevant to the therapeutic use of stimulant medication in the treatment of ADHD, although there is limited information on extended periods of treatment lasting 10 years or more.
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ABSTRACT: These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Pringsheim T, Steeves T. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD007990. DOI: 10.1002/ 14651858.CD007990.pub2Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane CollaborationEvidence-Based Child Health A Cochrane Review Journal 07/2012; 7(4).
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ABSTRACT: The ability to be aware of and to interact with the external environment is a basic evolutionary requirement of all higher organisms requiring intact alertness. Hypersomnia and excessive daytime sleepiness (EDS) relate to the inability to maintain an alert state during the major waking periods of the day. Up until recently, somnolence arising due to sleep pathology was misunderstood as a sign of laziness or even malingering by many medical practitioners and society-at-large. The discovery of the orexin/hypocretin receptor system as a key mediator in abnormal daytime sleepiness as well as growing interest in the daytime cognitive impact of common sleep disorders have played important roles in improving scientific and public awareness of hypersomnia as a clinical entity. Hypersomnia, EDS and fatigue are among the most common manifestations of sleep disorders affecting quality of life (QOL) and productivity. In an increasingly interconnected global economy where workload and productivity have shifted towards cognitive as opposed to physical labour, research is now focusing more than ever on the impact of disorders causing somnolence during desired wake time. Similarly, scholastic/academic motivation and performance deficits are being noted in children and adolescents, in part due to the increased 24/7 availability of technology and entertainment options, usually at the expense of sufficient sleep. Other important implications of somnolence include the direct and indirect consequences of transport and occupational accidents, as well as disruption of family and social relationships. Clinical conditions causing this condition include obstructive sleep apnea (OSA), narcolepsy, idiopathic hypersomnia (IH), circadian disturbances and most commonly, self-imposed insufficient sleep syndrome. In conditions such as insomnia, restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS), the association with frank daytime somnolence is more controversial although patients do complain of impaired daytime cognitive function. As the ‘baby-boom’ generation approaches old age, senescence-related deterioration of sleep quality and quantity is increasingly recognized as an important factor impacting QOL by affecting memory, cognitive function and vitality in activities of daily living (ADLs) including driving. Somnolence can be a serious and even life-threatening impairment. Often there is a gap between the subjective complaints of patients regarding the impact of hypersomnia/EDS on QOL and the ability to reliably measure this dysfunction. An important area of current research involves clarifying the nosology of daytime EDS symptoms, ranging from somnolence to fatigue or neurocognitive impairment. Improvements in diagnostic instruments assessing daytime function and ergonomic activities in relation to both healthy and pathological sleep processes will aid in better delineating these subjective and objective parameters.02/2008: pages 107-118;
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ABSTRACT: To examine the changes in partially responsive anxiety symptoms utilizing adjunctive treatment with the mixed amphetamine salt extended release (Adderall XR, MAX-XR) in the treatment of adult ADHD patients, with comorbid refractory anxiety. Consenting adult patients (n = 32) with confirmed diagnosis of generalized anxiety (GA) and comorbid (ADHD) participated in this open-label study. All patients had significant comorbid anxiety symptoms (HAM-A > 7) and failed to respond to 8-week trials of Serotonin Reuptake Inhibitors (SSRIs) or Norepinephrine Reuptake inhibitors (SNRIs). All patients were treated with the "Mixed Amphetamine salts Extended Release Adderall XR, (MAS-XR), as adjunctive to SSRIs or to SNRIs and were followed for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression severity subscale (CGI-S). Other scales included the Hamilton Anxiety Scale (HAM-A), the adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist, and Sheehan's disability scale. Baseline measures prior to the treatment with MAS-XR were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure, and weight changes was carried out at baseline and at end point. All patients completed this open-label trial. There was significant and robust resolution of symptoms of all effectiveness measures, including the symptoms of anxiety, as shown by changes from baseline in HAM-A, ASRS-v1.1, and CGI at 8 weeks. Also there was significant reduction in the disability score at 12 weeks. Patients tolerated the treatment, and there were no significant cardiovascular changes at 12 weeks. There was decrease in mean weight at 12 weeks by 2.2 kg (P < .001). Mixed amphetamine salts MAS-XR can be used in adult patients with ADHD and comorbid anxiety symptoms. Larger controlled studies are needed to support the effectiveness of mixed amphetamine salts in patients with comorbid anxiety symptoms. Treatments need to include the targeting of the ADHD symptoms effectively in order to achieve better resolution of anxiety symptoms.ADHD Attention Deficit and Hyperactivity Disorders 06/2010; 2(2):87-92.