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Biomedical subjects

Raul R Silva

Publications and source records attributed to Raul R Silva.

17 recordsLinked to original sources
PubMed2006

Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of this study was to assess changes in symptomatology of attention-deficit/ hyperactivity disorder (ADHD) with extended-release dexmethylphenidate (d-MPHER) versus placebo in a laboratory classroom setting. METHODS: This double-blind, placebo-controlled, crossover study randomized 54 children 6-12 years of age, stabilized on methylphenidate 20-40 mg/day. Patients participated in a practice day, then received 5 days of treatment with d-MPH-ER 20 mg/day or placebo. After a 1-day wash-out, they returned to the classroom and received 1 dose of their assigned treatment. Evaluations occurred predose and at postdose hours 1, 2, 4, 6, 8, 9, 10, 11, and 12. Children were then crossed over to the alternate treatment, using identical protocol. Primary efficacy variable was the Swanson, Kotkin, Agler, M-Flynn, and Pelham rating scale (SKAMP)-Combined scores, and primary analysis time point was 1 hour postdose; secondary efficacy variables over 12 hours included SKAMP-Attention and -Deportment scores and written math test results. Safety was assessed by adverse event (AE) recording following each period. Vital signs were recorded at each visit; laboratory tests were conducted at screening and final visit. RESULTS: D-MPH-ER 20 mg/day showed a significant advantage over placebo as early as 1 hour postdose on SKAMP-Combined scores (p < 0.001). When analyzing the entire sample of 54 children, d-MPH-ER maintained significant superiority over placebo from hours 1 through 12 (p-values ranged from < 0.001 to 0.046). D-MPH-ER was well tolerated, with no severe AEs reported. CONCLUSIONS: D-MPH-ER is safe and effective and improves classroom attention, deportment, and performance in children with ADHD.

Aptitude Tests↗
PubMed2005

Review and comparison of the long acting methylphenidate preparations.

The stimulants have been the mainstay of pharmacologic treatment for over fifty years. Methylphenidate is the most frequently prescribed of the stimulant agents. In the past, one of the main drawbacks of these agents was the abbreviated duration of action. Over the last few years three longer acting methylphenidate preparations have been released to the market. Though all these agents contain the same chemical compound they do vary in a number of ways. In this article we will present how the formulations compare in their technology and the differences in their delivery systems. We will also compare the available literature that focus on head to head comparisons in terms of pharmacokinetics studies and those reports that present efficacy data. Finally, we will suggest based on a theoretical framework on how to approach selecting an agent based on the results of these trials and the individual needs of the patient.

Central Nervous System Stimulants↗
PubMed2005

The use of psychostimulants in pervasive developmental disorders.

Many children with Pervasive Developmental Disorders (PDD) display problematic behaviors similar to those seen in children with Attention Deficit Hyperactivity Disorder (ADHD). This paper will look at the controversy concerning diagnosing comorbid ADHD in children who meet criteria for PDD and review the existing literature examining the efficacy of stimulants in these particular set of behaviors or symptom clusters (hyperactivity, impulsivity and inattention). The potential drawbacks of using stimulants in a population of children and adolescents who exhibit symptoms of PDD and ADHD will be discussed. Finally, this review will also attempt to define potential areas of future research to examine the utility of the psychostimulants in children and adolescents with PDD and symptoms of ADHD.

Adolescent↗
PubMed2005

Review of benzodiazepine use in children and adolescents.

Clinically, benzodiazepines are used in adult populations much more frequently than in children and adolescents. There may be a number of reasons for this disparity including a dearth of well controlled clinical studies and the issue of dependence associated with long term use. However, over a ten year span there has been nearly a three fold increase in the use patterns for these agents in the child population. In open studies much of the literature has indicated potentially useful results, but these findings have not been replicated when more refined methodological studies have been conducted. The lack of encouraging results in these later studies may be attributable to a number of factors such as modest sample sizes and less than optimal patient selection. Nonetheless, with increasing prescriptions being written for these agents it is not clear what is compelling clinicians to use them. In this paper we will review the available literature on benzodiazepine use in the child and adolescent population, focusing primarily on psychiatric applications.

Adolescent↗
PubMed2005

A rating scale for disruptive behavior disorders, based on the DSM-IV item pool.

DSM IV includes three clusters of items that are used to establish diagnoses for the Disruptive Behavior Disorders: Attention Deficit, Conduct, and Oppositional Defiant. In this report, we examine the feasibility of using the items in each cluster to form a rating scale. We studied eighty-four consecutive school-aged referrals to an inner-city child and adolescent Psychiatry clinic. Case diagnosis was established with a clinician's KID-SCID assessment. Parents and teachers rated the 41 DSM items on four-point scales, and completed the Conners' Rating Scales, in English or Spanish. In this paper we report psychometrics of the new scale, the Rating Scale for Disruptive Behavior Disorders (RS-DBD), along with the agreement among parents and teachers, and concurrence between the new scales and the relevant Conners' scales. While, the parent and teacher ratings may provide a useful index for severity of behavioral disturbance in the home and school environments, it will not establish a diagnosis. There was a great deal of comorbidity among diagnostic groups.

Adolescent↗
PubMed2003

Early intervention with traumatized children.

With the events of September 11th, childhood trauma has come to the forefront of national attention. One of the common psychiatric outcomes of trauma is Posttraumatic Stress Disorder (PTSD). Despite the fact that certain vulnerabilities may contribute to the development of PTSD in traumatized youth, the existence of an identifiable stressor provides a unique opportunity for early intervention. Cognitive Behavioral Treatment (CBT) interventions are considered by many to be the mainstay of treatment of children and adolescents with PTSD. More severe cases of PTSD are often treated with medications in the community. In this article we present a CBT program--developed by our site--STAIR--and provide useful guides and rationales for clinicians to work with when treating this population. We will also briefly review the available literature on the psychopharmacologic interventions to help guide the physician when confronted with such treatment decisions.

Adaptation, Psychological↗
PubMed2003

Prediction of treatment response in geriatric depression from baseline folate level: interaction with an SSRI or a tricyclic antidepressant.

Depressed geriatric patients have lower levels of folate (FOL) than controls. Also, FOL supplement can reduce depressive morbidity. One hypothesis consistent with this is that FOL deficiency causes a lowering of CNS serotonin that contributes to depression. The present report is from one site of a multicenter study that compared an SSRI (sertraline) with a nonspecific tricyclic antidepressant (nortriptyline) in geriatric depressed patients. We added measures of FOL at baseline and outcome for 22 depressed patients older than 60 years. Both treatments were effective. At baseline, FOL levels were within the normal range. Higher FOL levels at baseline predicted greater improvement. Further study of FOL interaction with SSRI is warranted. For the group treated with the SSRI, baseline FOL level was a more efficient predictor of improvement, especially for results on a self-rating depression scale (POMS).

Aged↗