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Methylphenidate and attributions in boys with attention-deficit hyperactivity disorder.

In Experiment 1, 28 attention-deficit hyperactivity disorder (ADHD) boys underwent a double-blind, placebo-controlled medication assessment in a summer day-treatment program. Daily, boys were asked questions to assess their attributions for and evaluations of their behavior. Objective measures showed improved behavior with methylphenidate; however, boys tended to attribute their performance to effort rather than to medication, particularly when medicated. Experiment 2 involved 38 ADHD boys the following summer and replicated the procedures in Experiment 1, with the addition of a no-pill condition and a comparison of attributions for success and failure outcomes. Simply taking a pill (no-pill vs. placebo comparison) did not show significant effects, whereas the results of Experiment 1 were replicated with placebo-methylphenidate comparisons. Across drug conditions a self-enhancing attributional pattern was obtained; the majority of attributions for success were to ability or effort, whereas attributions for failure were to the pill or to counselors.

Attention↗

Methylphenidate response, psychopathology and tardive dyskinesia as predictors of relapse in schizophrenia.

Despite the proven efficacy of acute and maintenance pharmacotherapy in schizophrenia, practical methods for identifying patients who require continuous treatment to prevent relapse have not been established. We hypothesized that a pathologic overactivity of mesolimbic and mesocortical dopamine neural systems, that mediates positive psychotic symptoms in the acute phase of the illness, persists in some outpatients who are vulnerable to relapse despite appearing clinically stable. To test and determine if putative measures of central nervous system dopamine activity predict outcome, 41 stable outpatients receiving neuroleptic maintenance treatment underwent provocative tests with methylphenidate in a randomized double-blind placebo controlled design in which behavioral, neuromotor, biochemical, and cardiovascular responses were measured. Patients were then withdrawn from medication and monitored for 52 weeks, or until relapse. The results indicate that psychotic symptoms and their activation by methylphenidate, and the presence of tardive dyskinesia are associated with each other and with a higher risk of relapse. These findings partially support our hypothesis and offer potentially useful measures for the identification of candidates for reduced dose neuroleptic maintenance treatment strategies in schizophrenia.

Adolescent↗

[Neuropsychological follow-up of attention deficit/hyperactive disorder in adulthood before and after treatment with methylphenidate].

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is frequently overlooked. Motor restlessness, impulsivity, low frustration tolerance, and conduct disorders are diagnostically ambiguous, but are predominantly ascribed to affective disorders, anxiety disorders, and personality disorders. Furthermore, substance-induced addiction may develop consecutively to untreated ADHD. We report on a case of primary diagnosis of ADHD in adulthood with secondary cocaine dependency, who was neuropsychologically assessed before and following treatment with methylphenidate. Frequency of errors and reaction time in performance on attention tests, concentration tasks, and multiple stimuli-/reaction tasks improved under treatment with methylphenidate. ADHD may be treated efficiently even after primary diagnosis in adulthood. Differential diagnosis of ADHD should be considered in disorders associated with motor hyperactivity, impulsivity, stress intolerance and conduct disorders.

Adult↗

[The use of methylphenidate in children: analysis of prescription usage based in routine data of the statutory health insurance bodies concerning drug prescriptions].

UNLABELLED: In Germany only few data is available on the use of stimulants in the treatment of Attention Deficit/Hyperactivity Disorder. For the first time a full survey of health insurance data was carried out on methylphenidate prescriptions from 2000 to 2001 in an East German District. 783 patients of the total cohort received at least one prescription for methylphenidate. In our sample, the treatment prevalence more than doubled in the observation period from 0.6 % to 1.4 % in children aged between 5 and 15 years, this age group representing the largest treatment group. Younger children, adolescents and adults were only rarely treated. The treatment was undertaken predominantly by paediatricians, general practitioners and neurologists/psychiatrists/child psychiatrists. Prescriptions were issued by one, or by not more than two doctors. CONCLUSION: In Mecklenburg-Vorpommern the prevalence of stimulant treatment has clearly increased. Since diagnosis-related data is not available it is not possible to assess the indications for treatment. Further studies should serve to evaluate the correspondence between diagnosis and therapy in relation to stimulant medication.

Adolescent↗

[Methylphenidate double-blind trial: indication and performing].

Hyperkinetic disorders or attention-deficit/hyperactivity disorders (ADHD) are among the psychiatric diagnoses most often encountered in children and adolescents. Symptoms include inattention, hyperactivity and impulsivity. Within the multi-modal treatment system, the therapy with psychostimulants (e. g. methylphenidate) proved to be an effective in patients with ADHD. A double-blind trial is indicated in cases of unclear efficacy of methylphenidate at initial application or if psychostimulants have regularly been applied for more than one year with an leave-out trial delivering unequivocal results. Further it is helpful in verifying potential undesirable side effects and improving patients' compliance.

Adolescent↗

Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study.

Functional MRI revealed differences between children with Attention Deficit Hyperactivity Disorder (ADHD) and healthy controls in their frontal-striatal function and its modulation by methylphenidate during response inhibition. Children performed two go/no-go tasks with and without drug. ADHD children had impaired inhibitory control on both tasks. Off-drug frontal-striatal activation during response inhibition differed between ADHD and healthy children: ADHD children had greater frontal activation on one task and reduced striatal activation on the other task. Drug effects differed between ADHD and healthy children: The drug improved response inhibition in both groups on one task and only in ADHD children on the other task. The drug modulated brain activation during response inhibition on only one task: It increased frontal activation to an equal extent in both groups. In contrast, it increased striatal activation in ADHD children but reduced it in healthy children. These results suggest that ADHD is characterized by atypical frontal-striatal function and that methylphenidate affects striatal activation differently in ADHD than in healthy children.

Adolescent↗

Effects of methylphenidate on avoidance learning in the aged rat.

Twenty Sprague Dawley rats, aged 22 to 26 months were given subcutaneous injections of 4.5 mg/kg methylphenidate or distilled water. Twelve minutes after the single injection was given, rats began 90 trials of avoidance conditioning. Drug animals made significantly more correct responses than did the control animals. tresults indicate that use of methylphenidate in aged rats improved avoidance learning.

Aging↗

Response to methylphenidate in boys with attention-deficit hyperactivity disorder.

The response to methylphenidate was examined in 36 boys, aged 7-11 y, with attention-deficit hyperactivity disorder (ADHD) in a double-blind, placebo-controlled, crossover design. Hyperactivity and conduct problems were significantly reduced during methylphenidate treatment. Stimulant medication was associated with improvements on tests of sustained attention, working memory and motor steadiness. When individual changes were studied, it was found that 83% showed a significant improvement in their hyperactivity at home or at school, and for 60% their levels of hyperactive behaviour were within the normal range. High levels of hyperactivity at school and relatively low age were significant predictors of normalization of hyperactivity in at least one setting. However, these predictors could only classify correctly 71% of the children. In clinical practice a trial with stimulants is indicated in ADHD children who show symptoms that are sufficiently severe to cause impairment at home and at school.

Analysis of Variance↗

Pharmacokinetic interactions between cyclosporine and bupropion or methylphenidate.

A 10-year-old boy with a history of heart transplantation had a potentially life-threatening decrease in his cyclosporine (CSA) blood levels during administration of bupropion. Subsequently he had an increase in CSA levels while receiving methylphenidate. These occurrences represent potential drug-drug interactions in children not previously documented in the literature. The CSA-bupropion and CSA-methylphenidate interactions merit further investigation, particularly because psychotropic agents are often prescribed in combination with immunosuppressants in transplantation patients of all ages.

Antidepressive Agents, Second-Generation↗

Rate dependency revisited: understanding the effects of methylphenidate in children with attention deficit hyperactivity disorder.

Although stimulants are widely prescribed for the treatment of attention deficit hyperactivity disorder (ADHD), their calming effects are not easily understood. One hypothesis derived from preclinical studies is that stimulants exert "rate-dependent" effects that are inversely related in magnitude and direction to the baseline rate of activity or distraction. Previously, compelling support for this hypothesis has been lacking. We provide preliminary evidence that methylphenidate exerts rate-dependent behavioral effects in children with ADHD. Activity and attention were quantified in children with ADHD tested on placebo and different doses of methylphenidate using objective measures. Higher doses altered activity and attentiveness in a rate-dependent manner after correction for regression-to-the-mean artifacts. These findings illustrate a clear inverse association between symptom severity and degree of therapeutic response that is crucial for our understanding of stimulant effects and effective clinical treatment of ADHD.

Attention↗

Long-term methylphenidate treatment down-regulates c-fos in the striatum of male CD-1 mice.

Methylphenidate (Ritalin) is routinely prescribed to children with attention deficit hyperactivity disorder, but little is known about its long-term consequences on brain development. We treated pre- and peri-pubertal male CD-1 mice with repeated injections of methylphenidate hydrochloride (MPH) and quantified the expression of the immediate early gene c-fos in the striatum. A single injection of MPH (5 or 40 mg/kg) significantly elevated FOS immunoreactivity in the striatum in a dose-dependent manner, compared with saline. Repeated MPH treatment attenuated the effect of a single challenge dose of MPH on striatal c-fos expression. These results replicate those observed with rats and indicate that long-term use of MPH may alter neural activity by down-regulation of gene expression in the striatum.

Animals↗

Methylphenidate in stroke patients with depression.

The treatment of depression after stroke is a difficult clinical problem. Many of the medications used to treat patients with depression in the general population have significant potential side effects that are of particular concern in elderly patients. We reviewed the records of ten patients with stroke treated with methylphenidate for depression during an inpatient rehabilitation program. Improvement was noted in seven patients. This suggests that methylphenidate in the treatment of post-stroke depression merits further study.

Aged↗

Effects of methylphenidate on cognitive function and gait in patients with Parkinson's disease: a pilot study.

Twenty-one patients with Parkinson's disease were studied before and 2 h after the administration of a single dose of 20 mg of methylphenidate. In response to methylphenidate, attention significantly improved, whereas memory and visual-spatial performance were unchanged. Gait speed, stride time variability, and Timed Up and Go times (demonstrated measures of fall risk) significantly improved. These findings suggest a new potential pharmacologic means of enhancing mobility and decreasing fall risk in Parkinson's disease.

Aged↗

The concurrent use of lithium and methylphenidate in a child.

The case of a young boy with symptoms of both attention deficit and affective disorders is presented. The patient was successfully treated with a combination of lithium and methylphenidate. Issues about comorbidity and polypharmacy in children are raised, and the concommitant use of lithium and methylphenidate in a child is discussed.

Attention Deficit Disorder with Hyperactivity↗

Clinical effects of a controlled trial of methylphenidate on adolescents with attention deficit disorder.

Forty-eight attention deficit disorder patients, 12 to 18 years old and without previous stimulant therapy, received a double-blind trial of methylphenidate and placebo for 3 weeks each. Stimulant treatment produced mild side effects and weight reduction. Methylphenidate significantly reduced teachers' and parents' ratings of hyperactivity, inattention, and oppositionality. In addition, patients rated themselves as clinically improved and reported elevated subjective mood during stimulant therapy. Treatment benefits were comparable for patients with and without concurrent conduct or oppositional disorder as well as those with and without past or present depressive disorders. These results support the continued effectiveness of stimulant therapy for attention deficit disorder in adolescence. However, the magnitude of clinical effectiveness reported was smaller than previously found in younger patients.

Adolescent↗

Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH: a preliminary report.

The effect of methylphenidate on aggression in adolescents diagnosed with both aggressive conduct disorder and attention deficit disorder with hyperactivity was assessed in nine male adolescents. After three open trials, a placebo controlled double-blind design was used. During methylphenidate treatment of the six double-blind subjects, there was a significant reduction of aggressivity (p's less than 0.05), as measured by the Adolescent Antisocial Behavior Checklist. Conners Teacher Rating Scale Hyperactivity and Aggression scores were in the predicted directions, but the differences were not statistically significant.

Adolescent↗

Adverse side effects of methylphenidate among mentally retarded children with ADHD.

The adverse side effects of methylphenidate were evaluated in 27 children with attention deficit hyperactivity disorder and IQs of 48 to 74 who participated in a double-blind study of two doses of methylphenidate and placebo. A checklist of 13 side effects, generated from the Physician's Desk Reference, was completed by teachers. Rates of irritability, anxiety, moodiness, and activity level decreased significantly when comparing the placebo with drug conditions. However, medication for six (22%) of the children was discontinued because of the appearance of motor tics (three children) and severe social withdrawal (two children), suggesting that mentally retarded children with attention deficit hyperactivity disorder may be at a greater risk for developing these side effects than the nonretarded population.

Anxiety↗

The effects of methylphenidate and lithium on attention and activity level.

Seven psychiatrically hospitalized prepubertal children were treated with methylphenidate, placebo, lithium carbonate alone and in combination with methylphenidate. Children met DSM-III-R criteria for both disruptive behavior disorder and bipolar or major depressive disorder by structured interview and consensus diagnosis. Parents, children, teachers, staff, and raters were blind to medication condition. Children were rated weekly on measures of attention and activity to determine whether medications alone or in combination produced a differential effect on these variables. The nosological and practical implications of the results are discussed.

Arousal↗