An open trial of pargyline in the treatment of attention deficit disorder, residual type

Twenty-two patients who met the Utah criteria for attention deficit disorder, residual type (hyperactivity, minimal brain dysfunction in adults) received an open trial of pargyline (Eutonyl). Of these 22 patients, 13 (59%) showed a moderate to marked therapeutic response. Clinically useful features of pargyline in the treatment of attention deficit disorder, residual type are that its duration of action is greater than 24 hours and that it has not been abused. Pargyline inhibits monoamine oxidase, type B, and its therapeutic efficacy is compatible with the hypothesis that decreased phenethylaminergic function, dopaminergic function, or both play a role in the etiology of the disorder.     

Effects of levodopa on attention deficit disorder,residual type

In an open, uncontrolled study, levodopa was administered to a carefully selected group of adult patients with Attention Deficit Disorder, Residual Type. Most of the patients showed an initial positive response to levodopa, which rapidly disappeared. Ultimately, none of the patients showed a sustained response, although 88% demonstrated a long-lasting positive response to standard stimulant treatment.     

A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults

Thirty-seven adult patients meeting the Utah criteria for attention deficit disorder, residual type, were entered into a double-blind crossover trial of methylphenidate and placebo. A moderate-to-marked therapeutic response occurred in 21 (57%) of the patients while receiving methylphenidate and in four (11%) while receiving placebo, a highly significant difference statistically and clinically. The responding patients showed significant improvement in the following areas: attentional difficulty, motor overactivity, affective lability, and impulsivity. The diagnosis of attention deficit disorder, residual type, should be considered in patients with prominent complaints of impulsivity, restlessness, emotional lability, and hot temper who do not suffer from schizophrenia or major mood disorder and do not have symptoms of schizotypal or borderline personality disorders.     

Revised criteria for detecting alcoholic patients with attention deficit disorder, residual type

The DSM-III symptoms of attention deficit disorder, residual type in adult alcoholic patients may be classified more accurately using the absolute number of symptoms reported rather than the symptom constellation required by strict DSM-III criteria.     

Monoamine oxidase inhibitor in the treatment of attention deficit disorder of residual type. Apropos of a case

Attention deficit disorder is common in children and it may continue during adolescence and adulthood. Some psychotropic drugs can improve the social, school and professional adaptation. A 16 year old girl suffering from an attention deficit disorder of the residual type according to the DSM III criteria was treated by toloxatone, a new monoamine oxidase inhibitor. According to clinical improvement observed with this drug, it may be considered as a new symptomatic treatment of this disorder.     

An open-label trial of tomoxetine in pediatric attention deficit hyperactivity disorder.

OBJECTIVE: To collect pilot data assessing the safety, tolerability, and efficacy of tomoxetine, a nonstimulant norepinephrine enhancer, in pediatric attention deficit hyperactivity disorder (ADHD). METHODS: An open-label trial of tomoxetine in pediatric ADHD was conducted as part of a multisite clinical trial. Following a baseline assessment, an ascending dose titration was completed during 10 weekly visits. RESULTS: Ten subjects were enrolled at baseline, with eight completing the study. Seven of the eight remaining subjects met efficacy criteria. Significant decreases in symptom severity ratings by parents and study investigators were found. The medication was well tolerated, with transient appetite suppression the most frequently reported side effect. However, subjects' weights remained stable across study visits. DISCUSSION: These preliminary findings suggest that tomoxetine may hold promise as a treatment for pediatric ADHD.     

Age and education effects in the diagnosis of attention deficit disorder, residual type in an alcoholic population

Two self-report measures that have been used to screen an alcoholic population for Attention Deficit Disorder, Residual Type (ADD-RT) are the Childhood Symptom Checklist and a listing of the DSM-III criteria. Both measures have evidence supporting their validity as screening instruments for ADD-RT in alcoholics. This study further explores the properties of these instruments by determining whether the age or educational level of alcoholic patients relates to their performance on these measures. No differences were found between the scores of younger and older patients. However, alcoholic patients with more education had fewer DSM-III symptoms of ADD-RT, but did not have fewer symptoms on the Childhood Symptom Checklist. The difference in performance on these two previously consistent measures is noted. Future research might explore the possibility that the DSM-III symptoms of ADD-RT are more sensitive to functional deficits in adults than the Childhood Symptoms Checklist, which asks for symptoms of Attention Deficit Disorder as a child.     

Cerebrospinal fluid homovanillic acid and 5-hydroxy-indoleacetic acid in adults with attention deficit disorder, residual type

Following the hypothesis that attention deficit disorder in adults (attention deficit disorder, residual type; ADD, RT), as well as in children, is associated with decreased central dopaminergic activity, the authors measured lumbar cerebrospinal fluid monoamine metabolites in a group of adults with ADD, RT and matched control subjects. Patients were then entered into a double-blind, placebo-controlled trial of methylphenidate. It was predicted that the patients would have lower levels of homovanillic acid (HVA), the major dopamine metabolite in humans. Patients who had a significant response to methylphenidate showed a trend in this direction. Nonresponding patients had significantly higher levels of HVA than controls.     

Effectiveness and safety of methylphenidate in adult attention deficit hyperactivity disorder in patients with epilepsy: an open treatment trial

OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety of methylphenidate treatment in epilepsy patients with comorbid adult attention deficit hyperactivity disorder (ADHD). METHODS: Six of 156 consecutive patients attending a tertiary epilepsy clinic for diagnostic evaluation of new seizures, 3 patients with epilepsy and 3 patients with psychogenic non-epileptic seizures, were diagnosed with comorbid adult ADHD. These 6 patients entered an open trial of methylphenidate 10 mg twice daily. Clinical improvement was assessed at 6 weeks of follow-up. RESULTS: Both groups showed clinical improvement of ADHD symptoms during treatment. None of the patients with comorbid epilepsy experienced adverse effects on seizure control or antiepileptic drug use. CONCLUSION: In this open trial methylphenidate was safely used in patients with epilepsy and adult ADHD. It was effective against adult ADHD, and there were no adverse effects on seizure severity and frequency. A randomized study is needed to further establish effectiveness and safety.     

Atomoxetine in the treatment of attention deficit hyperactivity disorder

Atomoxetine (Strattera, Eli Lilly & Co.) is a highly selective noradrenaline reuptake inhibitor and the first nonstimulant medication to be approved for the treatment of attention deficit hyperactivity disorder. Currently, nine published clinical trials have documented the safety and efficacy of atomoxetine in the treatment of children, adolescents and adults with attention deficit hyperactivity disorder and data presented throughout the past year at national scientific meetings has further addressed its utility. This article reviews the available information on atomoxetine, accompanied by a discussion of its clinical use.     

Response to methylphenidate in children with attention deficit hyperactivity disorder and manic symptoms in the multimodal treatment study of children with attention deficit hyperactivity disorder titration trial

OBJECTIVE: Recent reports raise concern that children with attention deficit hyperactivity disorder (ADHD) and some manic symptoms may worsen with stimulant treatment. This study examines the response to methylphenidate in such children. METHODS: Data from children participating in the 1-month methylphenidate titration trial of the Multimodal Treatment Study of Children with ADHD were reanalyzed by dividing the sample into children with and without some manic symptoms. Two "mania proxies" were constructed using items from the Diagnostic Interview Schedule for Children (DISC) or the Child Behavior Checklist (CBCL). Treatment response and side effects are compared between participants with and without proxies. RESULTS: Thirty-two (11%) and 29 (10%) participants fulfilled criteria for the CBCL mania proxy and DISC mania proxy, respectively. Presence or absence of either proxy did not predict a greater or lesser response or side effects. CONCLUSION: Findings suggest that children with ADHD and manic symptoms respond robustly to methylphenidate during the first month of treatment and that these children are not more likely to have an adverse response to methylphenidate. Further research is needed to explore how such children will respond during long-term treatment. Clinicians should not a priori avoid stimulants in children with ADHD and some manic symptoms.     

A pilot controlled trial of transdermal nicotine in the treatment of attention deficit hyperactivity disorder.

OBJECTIVE: To test the hypothesis that transdermal nicotine would be efficacious for the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD). METHOD: This was a double-blind, placebo-controlled, randomized, pilot trial that compared the effects of daily transdermal nicotine (5 mg/16 hrs) to placebo in children and adolescents with ADHD. There was a three-day washout period of all psychotropic medication followed by a one-week treatment period. RESULTS: All 10 subjects enrolled (six males, four females; mean age = 10 years, SEM = 0.8) completed the study. As assessed by the 48-item Conners Parent Rating Scale at endpoint and during the trial, there was a significantly greater reduction in ADHD symptoms on "Learning Problems" and "Hyperactivity" subfactors. Nausea, stomach ache, itching under patch and dizziness were the most frequently reported adverse effects associated with transdermal nicotine. CONCLUSIONS: While the results of this study support previous research indicating that nicotinic receptor modulation may be a potentially useful strategy for the treatment of ADHD, therapeutic uses of nicotine are limited due to side effects. Thus, future research should investigate ways of improving the therapeutic index of nicotinic ligands in the treatment of ADHD, such as testing selective nicotinic antagonists alone or in combination with cholinergic agonists.     

Dexmethylphenidate hydrochloride in the treatment of attention deficit hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) affects a large number of children. For decades, the stimulants have been the mainstay of pharmacological treatment for ADHD. Dexmethylphenidate (d-MPH), the d-isomer of the traditional racemic mixtures of d,l-threo-(R,R)-MPH, was recently introduced as another potential option in the stimulant class of medications. This paper reviews and summarizes the available research literature on d-MPH regarding pharmacodynamic, pharmacokinetic, chemical structure, receptor binding, toxicology, and clinical perspectives. d-MPH potentially may offer some advantages in the realms of absorption and duration of action compared with its racemic counterpart. The differences in pharmacokinetics and clinical implications of the immediate-release and extended-release forms of d-MPH are also compared and contrasted.     

Desipramine in the treatment of adolescents with attention deficit disorder

Twelve adolescents with attention deficit disorder were treated with desipramine in an open trial to assess its efficacy and safety. Eleven patients improved within 1 month, and improvement was sustained for 6-12 months without significant adverse effects in nine patients.     

Pharmacologic treatment of attention deficit hyperactivity disorder.

This article describes the role of psychostimulant medication in the treatment of attention deficit hyperactivity disorder. Included are the drugs' putative mechanisms of action, pharmacology, toxicology, indications for their use, short-term and long-term actions, adverse effects, specific dosing regimens, therapeutic monitoring techniques, alternative medications, and drug interactions.     

Pemoline treatment of adolescents with attention deficit hyperactivity disorder: a short-term controlled trial

BACKGROUND: Despite the increased recognition of attention deficit hyperactivity disorder (ADHD) in adolescents, few controlled studies have assessed treatments for this age group. Adolescent issues, such as embarrassment at receiving medication at school and experimentation with abusable substances, have accelerated efforts to find effective, well-tolerated treatments beyond traditional stimulants. Pemoline has been found effective for treating both children and adults with ADHD but has not been evaluated in adolescents with ADHD. METHODS: Twenty-one adolescents (mean age 14 years old) diagnosed with ADHD by structured and clinical interviews participated in a 10-week, double-blind crossover design study of pemoline. Dosing was optimized with robust doses up to 3 mg/kg/day in one to two doses. Clinical evaluations of ADHD, depression, anxiety, and oppositional defiant disorder (ODD) symptoms were assessed weekly. RESULTS: Adolescents with ADHD exhibited a marked response to pemoline treatment relative to placebo on the ADHD rating scale (p = 0.001), with an average reduction of 3.02 points per week of treatment. Sixty percent of adolescents responded to pemoline, compared to 11% treated with placebo. This response was independent of gender or lifetime psychiatric comorbidity. Pemoline was well tolerated, with patients averaging 2.88 mg/kg/day in two doses per day, with a mean dose at end of follow-up of 181.1 mg (SD 45.6, range 112.5-262.5 mg). Side effects were mild, and no adverse hepatic events occurred. CONCLUSIONS: These findings resemble those reported in children and adults with ADHD. This trial suggests pemoline is well tolerated and effective in adolescents and may be a particularly useful ADHD treatment for adolescents.