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Thirty-one hyperactive adolescents treated with methylphenidate for at least 6 months demonstrated no significant deviation from expected height and weight growth velocities. In contrast to findings in prepubertal children, these results suggest that early adolescent growth is insensitive to methylphenidate.
OBJECTIVE: The authors examined the efficacy of methylphenidate in the treatment of depression in a group of older, medically ill patients. METHOD: Sixteen patients underwent an 8-day double-blind, randomized, placebo-controlled crossover trial; 13 completed the trial. RESULTS: Statistically and clinically significant treatment responses were found. CONCLUSIONS: These results support the use of methylphenidate in older, medically ill patients in whom rapid resolution of depressive symptoms is crucial.
This study was undertaken to evaluate trends and toxicity of pediatric methylphenidate exposures; 1993 to 1999 national poison center data were analyzed. There were 12,917 exposures, increasing from 927 in 1993 to 2,445 in 1999. The majority of children during the entire study period experienced no effect (60.3%) or minor effects (28.7%), with no fatalities. Most common reasons were unintentional general or therapeutic errors in children under 13 years and suicide attempt in adolescents. Adolescents were more likely to experience clinical toxicity, hospitalizations and more serious outcomes. The trend of increasing frequency of methylphenidate exposures reported to poison centers exactly parallels increasing therapeutic use.
This report examines the feasibility of double blind individual trials of methylphenidate versus placebo in a general pediatric practice to assess benefit of this medication in the treatment of attention deficit disorder. Children presenting with the diagnosis of attention deficit disorder were enrolled in a three-week protocol. The first week was a baseline week during which teachers and parents completed the Connors rating scales. During the second and third weeks of each trial, placebo or methylphenidate was given for a week each in an unknown order to parents, teachers or the investigator. Respective Connors rating scales were also completed for each of these weeks. At the end of the third week, the three parent questionnaires and the three teacher questionnaires were returned to the investigator for scoring and disclosure about findings. During a pilot period, 53% of the trials were improperly completed. Reasons for this were addressed and with simple measures the rate of successful completion was raised to 83%. During the study phase, 43% of the children were found to be hyperactive but they did not benefit from medication. In six trials there was disagreement between teachers and parents. The completed trials and many of the incompleted trials were helpful in the assessment of the children with attention deficit disorder and their response to medication. It is felt that this approach is suitable for a private general pediatric practice.
It has been reported that during the past decade the prevalence of attention-deficit/hyperactivity disorder (ADHD) (ICD-9-CM code 314.00 or 314.01) and its pharmacologic treatment have increased dramatically in the United States. Herein, a single national data source is used to discern trends in the prevalence of U.S. office-based visits resulting in a diagnosis of ADHD, and trends in the prescribing of stimulant pharmacotherapy (including methylphenidate) for its treatment. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1995, for children aged 5 through 18 years, were utilized for this analysis. Results indicate that the number of office-based visits documenting a diagnosis of ADHD increased from 947,208 in 1990, to 2,357,833 in 1995. Between 1990 and 1995, the number of visits by girls diagnosed with ADHD rose 3.9-fold (p < 0.05), and the mean patient age increased by more than 1 year, from 9.7 in 1990, to 10.8 in 1995 (p < 0.05). The percentage of office-based visits resulting in a diagnosis of ADHD increased from 1.1% of all visits in this age group in 1990, to 2.8% by 1995. We discerned a 2.3-fold increase (p < 0.05) in the population-adjusted rate of office-based visits documenting a diagnosis of ADHD; a 2.9-fold increase (p < 0.05) in the population-adjusted rate of ADHD patients prescribed stimulant pharmacotherapy; and a 2.6-fold increase (p < 0.05) in the population-adjusted rate of ADHD patients prescribed methylphenidate.
Interferon-Alpha (IFN) has been effective in the treatment of chronic viral infections and cancer albeit the added risk of severe depression. The literature has reported effectiveness in the use of antidepressants for interferon-induced depression. We report a case of severe protracted depression induced by IFN in a patient diagnosed with melanoma who responded rapidly to a course of methylphenidate using the Hamilton Depressive Rating Scale. Methylphenidate appeared to be effective in the treatment of neurovegetative symptoms of major depression induced by IFN. This report provides further clinical evidence that the neurovegetative symptoms of depression might respond better to a norepinephrine uptake inhibitor or psycho-stimulants.
This article reviews pharmacological, animal, and human evidence regarding the abuse liability of methylphenidate (MPH). Findings are not always consistent, but evidence converges to suggest that although intravenous methylphenidate has some abuse potential, there is very little potential for oral MPH abuse. Furthermore, the available data suggests that children with Attention-Deficit/Hyperactivity Disorder (ADHD) who are treated with MPH are at lower risk for substance use disorder later in life. More longitudinal, prospective studies are needed to assess the long term effects of MPH treatment in ADHD.
Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety, and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).
Methlyphenidate is one of two stimulant drugs used in the management of the Hyperkinetic Reaction in children. It has been known to have side effects such as dyskinesia, but this case details the emergence of dystonia and dyskinesia when the simultaneous use of methylphenidate and a phenothiazine was followed by withdrawal of the phenothiazine. It is postulated that the use of phenothiazine resulted in a post-synaptic supersensitivity which precipitated dystonia and dyskinesia when phenothiazine was withdrawn and methylphenidate reinstituted. It is also suggested that the phenothiazine dopamine-blocking action may necessitate the use of larger quantities of stimulant in order to produce the desired effect.
A clinical trial of methylphenidate/placebo on 39 patients is described. Fifteen of 20 parents not keen to give their child methylphenidate did give it, after the trial had shown it was effective. Five out of 19 parents keen to give their child methylphenidate were persuaded not to after it was shown that it was ineffective. Some of the difficulties with the trial are described for example, parents confusing the days the drug is to be given, parents and teachers not filling in the questionnaires and the resistance of certain professionals to giving medication. Patients seem to be more accepting of recommendations to give medication or not, after a medication/placebo trial demonstrated efficacy or lack of efficacy.
The present investigation examined the effects of methylphenidate on impulsivity in children with attention-deficit hyperactivity disorder (ADHD). A task was designed to measure empirically the ADHD child's proclivity to blurt out incorrect answers before giving a final and/or correct response. Twenty-six ADHD children referred for double-blind placebo-controlled assessment of medication responsiveness and 14 non-ADHD controls were given a visual search word-matching task to assess impulsive responding. An analysis of covariance showed that ADHD children on methylphenidate made fewer impulsive errors than ADHD children on placebo. The control group made fewer impulsive errors than the ADHD children in the placebo condition, but the performance of the ADHD children on medication approximated the performance of the children without ADHD. These preliminary findings suggest that the word-matching task may be a useful tool for assessing impulsive responding and determining the benefits of stimulant medication on impulsivity.
Children with Williams syndrome frequently present with symptoms of attention deficit hyperactivity disorder (ADHD), but there is little information that stimulant medication is useful in this population. A series of double-blind, placebo-controlled case studies was used to evaluate the cognitive and behavioral effects of methylphenidate on four children with Williams syndrome. Teachers and mothers completed behavioral rating scales and cognitive tests of attention, learning and memory, and academic productivity and accuracy in mathematics in each medication condition. Two of the children responded favorably in terms of decreased impulsivity, decreased irritability, and lower activity level as well as improved ability to pay attention. Methylphenidate is a useful adjunct in the treatment of some children with Williams syndrome.
Psychostimulants such as methylphenidate have been used for depression in cancer patients. We report the successful use of methylphenidate to treat depression in 10 consecutive patients with advanced cancer. A rapid onset of effect was noted. Appetite, concentration, fatigue, and sedation also improved in some persons. No severe side effects were noted.
OBJECTIVE: This study evaluates the efficacy, duration of action, and tolerability of methylphenidate transdermal system (MTS) in children with ADHD. METHOD: Participants were dose optimized over 5 weeks utilizing patch doses of 10, 16, 20, and 27 mg applied in the morning and worn for 9 hours. Following optimization, 80 participants were randomized to 1 week of MTS or placebo followed by 1 week of the opposite treatment. Laboratory classroom sessions conducted after each randomized week included blinded ratings of attention, behavior, and academic performance. RESULTS: MTS was well tolerated and displayed significant improvement compared with placebo. Improvements were seen at the first postdose time point measured and continued through 12 hours. CONCLUSIONS: Treatment with MTS resulted in statistically significant improvements on all efficacy measures. Time course and therapeutic effects of MTS suggest that this novel methylphenidate delivery system is an efficacious once-daily treatment for ADHD.
About one third of manic patients show a decreased Electroencephalographic Vigilance Level (EVL). In two patients with recurrent manias the hypothesis was tested that the EEG may be used to predict the therapeutic response to methylphenidate. Patient A (with a decreased EVL) responded rapidly to methylphenidate with a considerable reduction of symptoms and a clear increase of EVL, whereas patient B (normal EVL) did not show any change, neither clinically nor in the EEG.
Stimulants, such as methylphenidate, are extensively used in the treatment of attention deficit disorder. In the present study, we used a double-blind placebo-controlled, prospective protocol to evaluate the effects of methylphenidate (MP) (dose 0.1 and 0.33 mg/kg three times daily) on the late event-related potentials, some of which are considered biological attention correlates. Sixteen patients, 6-15 years old, were tested, using an auditory target selection paradigm. The latencies of N200 and amplitudes of P150 increased with MP (p less than 0.01). These effects are in the direction of normal maturational change. The latencies of P300 tended to be shorter in adolescents than in children, and with high MP dose the P300 latencies became even shorter in adolescents but were prolonged in children (p less than 0.05). This pattern of change supports the view that pharmacological interactions with various cerebral phenomena including cognition may be age-specific.
Methylphenidate is a first-line therapy for attention deficit hyperactivity disorder, the most prevalent neuropsychiatric disorder of childhood. The compound is a piperidine and the D-threo-isomer is considered the biologically active form. The compound is available in multiple short- and long-acting preparations, having different delivery systems leading to varying kinetics without clear superiority in efficacy or tolerability at the group level. Common adverse effects are insomnia, appetite disturbance, stomach ache, headache and dizziness. Its mechanism of action is linked to the monoamines dopamine and norepinephrine. The compound appears to predominantly increase the synaptic concentration of dopamine, presumably via inhibition of the dopamine transporter DAT1. There also appears to be effects on presynaptic vesicular trafficking and distribution of dopamine. Both immediate- and sustained-release preparations of methylphenidate have proven efficacy in children and adults with attention deficit hyperactivity disorder. Analysis of the National Institutes of Health-sponsored multimodal treatment study of attention deficit hyperactivity disorder supports a combined medication and behavioral therapy approach.
The authors present the results of the treatment with methylphenidate in 24 children with attention deficit disorder based on DSM-III. The prescribed dose was 5 to 10 mg per day, once or twice a day. The results were good in 79.1% of the patients and poor in 16.6%. The drug was withdrawn in one patient because of side effects and the evaluation of efficacy was not possible. Side effects occurred in 2 children (headache and/or nausea). The therapeutic response and the side effects are compared with the literature. The authors claim attention to the efficacy and safety of the treatment with methylphenidate.