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PubMed1976

Medication for hyperkinetic children.

The hyperkinetic syndrome is a symptom complex of hyperactivity, short attention span, distractibility, impulsivity, learning difficulties, other behaviour problems and 'equivocal' neurological signs. However, none of these terms has ever been objectively defined and at present diagnosis is largely a matter of clinical judgement. In the management of the disorder, drugs do have a place but the decision to use medication is a complex procedure diagnostically and therapeutically calling for the highest in clinical skill and medical supervision. The most useful medication at present is the stimulant group of drugs, particularly dextroamphetamine and methylphenidate. Antipsychotic drugs are sometimes useful but carry the risk of depressing higher CNS functions such as attention and cognition. Other drugs which have been shown to be of value include tricyclic antidepressants (although their effect is less predictable and less striking than that of the stimulants) and pemoline.

Anti-Anxiety Agents↗
PubMed2006

Effects of modafinil on cognitive performance and alertness during sleep deprivation.

The performance- and alertness-sustaining/restoring effects of modafinil during sleep deprivation in normal, healthy adults were reviewed. Results indicate that modafinil is efficacious for sustaining/restoring objective performance and alertness during sleep deprivation with few adverse effects. At appropriate dosages, modafinil restores performance and alertness to non-sleep deprived levels. Modafinil also impairs post-sleep deprivation recovery sleep, but from the few studies available addressing this issue, it is unclear whether these sleep impairments translate into post-sleep performance impairments. Further research is needed to determine whether modafinil restores performance on simple cognitive tasks only or whether modafinil additionally restores executive functions (e.g., abstract thought, critical reasoning, planning, decision-making, situational awareness, and effective judgment) which are critical in most modern operational settings. In addition, studies are needed to determine whether modafinil use during sleep deprivation is preferable to that of other available controlled stimulants (such as dextroamphetamine) or non-controlled stimulants (such as caffeine). Such studies would be comprised of direct, head-to-head comparisons among various stimulants across a range of dosages.

Arousal↗
PubMed1995

Neuropsychiatric sequelae of stroke and traumatic brain injury: the role of psychostimulants.

OBJECTIVE: The primary purpose of this article is to review certain neuropsychiatric sequelae of stroke and traumatic brain injury (TBI), and the role of the psychostimulants methylphenidate (MPD) and dextroamphetamine (DAMP) in their treatment. METHOD: A general review of the topic is presented. Controlled and uncontrolled studies involving the use of the psychostimulants are discussed. These consist of 11 studies listed with Medline 2000 that deal specifically with stroke or head injury, with the oldest study reviewed dating back to 1984. Studies concerning the use of psychostimulants in the medically or neurologically ill are reviewed to the extent that they are pertinent. RESULTS: The current literature consists primarily of uncontrolled case studies. However, these are reviewed and found to suggest a role for the use of the psychostimulants, which is discussed. CONCLUSIONS: In general, these drugs appear to be a reasonable treatment choice for certain types of mood, behavior, and cognitive symptoms following brain injury. However, it is noted that larger scale controlled studies are needed to adequately assess the clinical usefulness of these drugs.

Brain Damage, Chronic↗
PubMed2004

Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.

Adult↗
PubMed2001

Practice parameters for the treatment of narcolepsy: an update for 2000.

Successful treatment of narcolepsy requires an accurate diagnosis to exclude patients with other sleep disorders, which have different treatments, and to avoid unnecessary complications of drug treatment. Treatment objectives should be tailored to individual circumstances. Modafinil, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, selegiline, pemoline, tricyclic antidepressants, and fluoxetine are effective treatments for narcolepsy, but the quality of published clinical evidence supporting them varies. Scheduled naps can be beneficial to combat sleepiness, but naps seldom suffice as primary therapy. Regular follow up of patients with narcolepsy is necessary to educate patients and their families, monitor for complications of therapy and emergent of other sleep disorders, and help the patient adapt to the disease.

Humans↗
PubMed1975

The role of posture in idiopathic oedema.

Idiopathic oedema is a common disorder in women, and is diagnosed by exclusion of known causes of oedema. In 26 of 31 patients studied, the oedema was shown to be orthostatic, i.e. induced by the upright posture and relieved by recumbency. Approximately half of the patients with orthostatic oedema are orthostatic sodium retainers owing to excessive transudation from presumably defecive capillaries with a consequent fall in plasma volume, reduction in glomerular filtration rate and, frequently, excessive renal tubular reabsorption of filtered sodium because of orthostatic hyperaldosteronism. The other patients are orthostatic water retainers, perhaps because of abnormal ADH secretion in the upright posture. Measurement of changes in sodium and water excretion in the recumbent and upright postures are described for the differentiation of these conditions. When conventional diuretic therapy and sodium restriction lose their effectiveness - as often happens after several months - orthostatic sodium retainers may be treated with a combination of the following sympathomimetic amines (dextroamphetamine or ephedrine) to reduce fluid transudation, spironolactone (Aldactone) to promote excretion during recumbency of sodium retained in the upright posture, the use of elastic stockings during the day, and a conventional diuretic together with recumbency from 20h00 most evenings. The last three measures are also useful in orthostatic water retention. Considerable symptomatic improvement can usually be accomplished by these means.

Adolescent↗
PubMed2001

Evaluation and treatment of ADHD.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) are present in as many as 9 percent of school-age children. ADHD-specific questionnaires can help determine whether children meet diagnostic criteria for the disorder. The recommended evaluation also includes documenting the type and severity of ADHD symptoms, verifying the presence of normal vision and hearing, screening for comorbid psychologic conditions, reviewing the child's developmental history and school performance, and applying objective measures of cognitive function. The stimulants methylphenidate and dextroamphetamine remain the pharmacologic agents of first choice for the management of ADHD. These agents are equally effective in improving the core symptoms of the disorder, but individual children may respond better to one stimulant medication than to another. Achievement of maximal benefit may require titration of the initial dosage and dosing before breakfast, before lunch and in the afternoon. The family physician should tailor the treatment plan to meet the unique needs of the child and family. Psychosocial, behavioral and educational strategies that enhance specific behaviors may improve educational and social functioning in the child with ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

[Prescribing ritalin in combined modality management of hyperactivity with attention deficit].

Attention Deficit Hyperactivity Disorder (ADHD) is a relatively frequent affection that can generate severe problems (school, social, professional) if no take in charge is done. Treatment of ADHD is generally multifactorial; it can associate medical treatment, comportemental and analytical psychotherapies, reeducation of associated disorders (orthophony, psychomotor reeducation) and educative approach. Methylphenidate, considered as therapeutic reference, is a central nervous system stimulant. It produces a stimulation of vigilance and superior mental activities, a diminution of fatigue sensation and sleep need, an anorexigen power and sympathomimetic effect. Its mechanism of action is abundantly studied and is not completely known. Principal hypothesis are: increase of chemical mediators biodisponsibility and change in cerebral blood flow delivery. In France, it is agreed since 1995 for treatment of ADHD in over 6 years-old child. Ritaline 10 mg is registered on the narcotic list and an initial hospital prescription is needed, reserved to specialists and/or to neurologic, psychiatric and pediatric services. Mid-1995, 2.8% (namely 1.5 millions) of 5 to 18 years-old american children have taken this drug. Methylphenidate is effective on each three principal symptoms of ADHD: it decreases the level of activity, it improves apprentice capacity, just as school performances and it eases social interactions. The therapeutic schedule at short and middle term is reassuring, with substantial profits on school, familiar and social plans, but unknowns subsist and opinions diverge about long term efficacity. Methylphenidate is not the only one used in ADHD treatment. Other products, like dextroamphetamine and pemoline have been used in the USA and are for those who can't tolerate methylphenidate or badly respond to it. Those other drugs are not commercialized in France. The limits of stimulating drugs (fear to favour toxicomania, undesirable effects that need to stop treatment or non-responsive hyperactive children), just as positives experiences with antidepressants (especially on enuresis) led to use tricyclic antidepressants as second-line agents in ADHD treatment. Their efficiency is less and their well known side-effects are sometimes constraining. Antidepressants that inhibit serotonin recapture, MAOI and bupropion, central antihypertensive, such as clonidine and guanfacine have been tried in ADHD treatment as third-line agents. They should be useful on non-responsive or patients who can't tolerate stimulants or tricyclic antidepressants. Analytical and comportemental psychotherapies are used in addition to medicamental treatment. Reeducation of troubles such as dyslexia, language delay, corporal scheme troubles or fine coordination trouble is obtained by orthophony and psychomotricity. It's very important to instaurate an educative strategy in order to contend inattention and hyperactivity. Regular conservations with parents and child are necessary. The whole american literature shows better efficiency of multimodal treatment of ADHD in child, as opposed to single stimulant treatment.

Adolescent↗
PubMedDate not supplied

Attention-deficit hyperactivity disorder in adults.

It has been estimated that 30% to 70% of children who are diagnosed as having attention-deficit hyperactivity disorder (ADHD) will continue to show symptoms of the condition as adults. Since the prevalence of ADHD among school children may be 3% or more, its prevalence among adults may be 1% or 2%. The third revised edition of the Diagnostic and Statistical Manual (1987) of the American Psychiatric Association lists three essential features for the diagnosis of ADHD: "developmentally inappropriate inattention, impulsiveness, and hyperactivity." Other conditions associated with ADHD in adults include learning disabilities (or their sequelae), general anxiety disorder, drug and alcohol abuse, and dysthymic and cyclothymic disorders. Strong correlations have been found between ADHD and oppositional defiant and conduct disorders in children and an increased risk for antisocial disorders in adults. A combination of genetic, biologic, and environmental factors appears to be implicated in the etiology of ADHD. The management of adult ADHD requires a multimodal approach. The patient needs to be informed of the cause of his or her impulsive and often self-destructive behavior. Many patients will have learning difficulties that require evaluation and remediation by specialists in learning disabilities. Psychotherapy can help the patients resolve disturbances in perceptions of self and others and family therapy can address difficulties in the adult's relationships with family members. Pharmacotherapy of adult ADHD includes the use of central nervous system stimulants, such as methylphenidate, dextroamphetamine, and pemoline, of the tricyclic antidepressants imipramine and desimipramine, and of other antihypertensive, analgesic, and antimanic drugs.

Adult↗
PubMed2003

Role of executive function in ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with behavioral therapy and noradrenergic and dopaminergic pharmacotherapy with psychostimulants such as methylphenidate and dextroamphetamine. Stimulants primarily have dopaminergic and noradrenergic mechanisms of action, with blockade at the dopamine transporter reducing reuptake, resulting in an increase in these neurotransmitters at the synapse. Theoretically, inattention, hyperactivity, and impulsivity in ADHD may be due to underlying executive functioning, alerting, and orienting deficits, and the nonstimulant modafinil could be beneficial in managing symptoms of ADHD by improving these components of attention that accompany wakefulness. Although modafinil exhibits a small degree of dopaminergic action by blocking the dopamine transporter, the major effect of modafinil may be attributable to neuronal activity in the hypothalamus, particularly pertaining to the recently discovered peptides hypocretin 1 and 2 (also known as orexin A and B). However, further placebo-controlled and flexible-dose studies are needed to determine the efficacy of modafinil in treating the symptoms of ADHD in children and adults.

Adult↗
PubMed2005

Fatigue in military aviation: an overview of US military-approved pharmacological countermeasures.

Uncomfortable working and sleeping environments, high operational tempos, sustained operations, and insufficient staffing make fatigue a growing concern. In aviation, where a single mistake can cost millions of dollars, it is essential to optimize operator alertness. Although behavioral and administrative fatigue countermeasures should comprise the "first line" approach for sustaining aircrew performance, pharmacological fatigue countermeasures are often required. Various components of the U.S. military have authorized the use of specific compounds for this purpose. Hypnotics such as temazepam, zolpidem, or zaleplon can mitigate the fatigue associated with insufficient or disturbed sleep. Alertness-enhancing compounds such as caffeine, modafinil, or dextroamphetamine can temporarily bridge the gap between widely spaced sleep periods. Each of these medications has a role in sustaining the safety and effectiveness of military aircrews. The present paper provides a short overview of these compounds as well as factors to be considered before choosing one or more to help manage fatigue.

Acetamides↗
PubMed1991

Stimulants and antidepressant pharmacokinetics in hyperactive children.

Psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD), is well established. The central nervous system stimulants, especially dextroamphetamine and methylphenidate, are the drugs of choice. Response is rapid, consistent and predictable. Most children respond to one or the other when a trial of both stimulants are given across wide dose ranges (Elia et al. 1991). The efficacy of pemoline is also well established, but its variable onset and duration of action in children has made it a secondary treatment. Tricyclic antidepressants also produce rapid behavioral effects in ADHD, at doses less than those used for depression. Adverse effects are a limiting factor for continued treatment as well as the fact that beneficial effects are often short-lived.

Antidepressive Agents↗
PubMed1987

Recognition and treatment of attention deficit disorder.

The proposed etiologies, clinical features, prognosis, and drug therapy of attention deficit disorder (ADD) are reviewed. Attention deficit disorder is a common neurobehavioral problem in children that manifests as hyperactivity, impulsivity, and inattention. It may persist into adolescence and adulthood and predispose the patient to antisocial and substance-abuse disorders. Stimulant agents are the drugs of first choice for pharmacologic treatment of ADD. Methylphenidate is the most frequently used stimulant because of its reduced potential for abuse and less troublesome adverse effects compared with dextroamphetamine. Stimulant medications are usually well tolerated, with nervousness and insomnia being the most common adverse effects. The potential for stimulant-induced growth suppression during long-term treatment should be dealt with prospectively by providing drug holidays. Tricyclic antidepressants and monoamine oxidase inhibitors may be used in patients who do not respond adequately to stimulant agents. Low doses of the antipsychotic agents haloperidol, chlorpromazine, or thioridazine may be used as adjunctive treatment for ADD symptoms of hyperactivity and aggressiveness. Attention deficit disorder is not a benign disorder that children necessarily outgrow. Pharmacologic therapy should be combined with nonpharmacologic therapy to provide the greatest long-term benefits.

Antidepressive Agents↗
PubMed1986

Effects of ethanol and amphetamine on inert gas narcosis in humans.

The effects of ethyl alcohol (1 ml/kg body weight), dextroamphetamine (15 mg), and nitrous oxide (20%) on reaction time were investigated in 6 subjects with a 2-, 3-, and 4-choice serial reaction time task. Each drug was assessed separately and in combination with nitrous oxide. The error rate was held constant. Neither ethanol and nitrous oxide nor amphetamine and nitrous oxide influenced the slope of the Hick-Hyman function, but the former combination increased the intercept while the latter decreased it. The drugs, either alone or in combination, shifted the frequency distributions of the reaction times as a whole, rather than modifying either their shapes or the pattern of the response latencies around an error. These results indicate that the drugs have a common pattern of effects on reaction time and that alcohol exacerbates narcosis while amphetamine ameliorates it. This is interpreted as support for the view that narcosis causes a nonspecific slowing of information processing by decreasing arousal.

Adult↗
PubMed1978

Microcrystalline identification test of some amphetamines and hydrochlorothiazide: collaborative study.

A previously described procedure for the identification of methamphetamine, dl-deoxyephedrine, dextroamphetamine, and amphetamine and a new procedure for hydrochlorothiazide identification have been subjected to collaborative study. The method for the amphetamines depends upon their volatilization from a strongly basic solution into a hanging drop containing gold chloride and the formation of characteristic crystals. The hydrochlorothiazide method is direct: the I2-KI solution is added to an alkaline solution of hydrochlorothiazide to cause the deposition of characteristic crystals. Of the 40 unknown drug dosage form powders supplied to 10 collaborators, 39 were correctly identified. The results indicate that the amphetamine procedure is capable of distinguishing between methampetamine and dl-deoxyephedrine. The age of the gold chloride reagent is important in these tests. The official final action tests for dl-deoxyephedrine and methampetamine were modified and Table 36:04 has been revised to reflect these changes. The hydrochlorothiazide test has been adopted as official first action and added to Table 36:05.

Amphetamines↗
PubMed1995

Antidepressant-induced tardive dyskinesia: review and case report.

We report a case of clomipramine-induced tardive dyskinesia (TD) in the setting of chronic use of dextroamphetamine without prior use of neuroleptics, in which the movements persisted after discontinuation of the clomipramine. Other contributing factors include advanced age, history of alcohol abuse, and concomitant administration of hepatic enzyme inhibitors. Other cases of tricyclic-induced TD have occurred primarily in combination with neuroleptics, have involved antidepressants with antidopaminergic actions, or, as in the present case, have resulted from antidepressants with significant anticholinergic effects (n = 17). Predisposing risk factors and potential mechanisms in the precipitation of dyskinesias are discussed.

Aged↗
PubMed1995

Neuropsychological effects of amphetamine may correlate with personality characteristics.

Although the stimulant properties of amphetamine are well established, its effects on cognitive test performance in unfatigued normal adults are poorly documented. Seventeen healthy individuals received a single oral dose of dextroamphetamine (0.25 mg/kg) in a double-blind, placebo-controlled, crossover study. Neurocognitive tests, motor tests, and behavioral observations were performed. Personality information, based on the Tridimensional Personality Questionnaire (TPQ) was also gathered to explore a relationship between personality factors and response to the stimulant. With the exception of two measures of reaction time, there were no overall changes in performance on measures of memory or other cognitive functions. There was decreased reaction time on the continuous performance task (CPT) and increased accuracy of performance under minimal delay conditions in the spatial delay response task while subjects were receiving amphetamine. In addition, the novelty-seeking subscale was found to correlate with a measure of verbal memory. Individuals with higher scores on the novelty-seeking scale deteriorated under amphetamine, while those who had lower scores improved. These results suggest that some cognitive abilities of persons who may have relatively high dopaminergic tone are disrupted by amphetamine, while those with relatively low dopaminergic tone may have their performance enhanced.

Administration, Oral↗
PubMed1996

Attention-deficit/hyperactivity disorder: a diagnosis for the '90s.

Over the past few years, the lay and medical press increasingly have focused on attention-deficit/hyperactivity disorder (ADHD) as a widespread and common disorder of school-age children and adults. ADHD's cause remains unknown, but current research supports a neurobiological foundation. An ADHD diagnosis should focus on the three main components of the disorder: impulsivity, hyperactivity, and inattention. There are no specific tests, but the diagnosis is based on history, interview, physical examination, and developmental and psychological evaluation. Management should include a balanced treatment plan of pharmacologic methods combined with behavioral/psychological therapy and environmental manipulation. Current drug therapy supports the careful and closely monitored use of stimulants like methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert). Additionally, patients and their families are encouraged to seek individual, group, family, and marital therapy. Special adaptations for schools, homes, and workplaces are now also available. The NP's role in ADHD treatment is that of evaluator, coordinator, and monitoring clinician. Treatment goals are established with the patient and family; the NP assists in the completion of these goals through teaching, monitoring, and referring to community services when appropriate. While this multimodal treatment and management is complex, it supports the ADHD patient and his family.

Adolescent↗