Search

Objective: There is little evidence to support the current stimulant dose upper limit restrictions in the treatment of attention deficit hyperactivity disorder (ADHD). Within Australasia, there is inconsistency in dose maxima in different jurisdictions. Clinician experience in this area may be worth gauging when trying to improve the understanding of optimal maximal dosing. Our objective was to survey prescribers' experience of whether the current stimulant maximum doses ever conflict with dose optimisation and how such conflicts are managed.Method: We conducted an anonymous online survey of health professionals treating children, adolescents and adults with ADHD.Results: Responses were received from 128 prescribers, mainly paediatricians (52%) and adult psychiatrists (39%). The designated maximum dose of stimulant was a constraint to dose optimisation experienced by 91% for the Product Information maxima and 82% for their respective state/territory regulations maxima. When clinically indicated, 72% would exceed the designated maxima, either with or without obtaining a second opinion or applying for special authority. Of the remaining 28%, the majority (16%) would opt for polypharmacy, with only two accepting a suboptimal dose.Conclusion: The current stimulant dose maxima act as a constraint to stimulant dose optimisation and may promote undertreatment and polypharmacy. [ABSTRACT FROM AUTHOR]

Objectives: This paper reviews the importance of transition to adult services for young people with ADHD.Method: Different models are described and evidence sought for their effectiveness in clinical practice.Results: Models of care for children with ADHD include specialised mental health services, individual paediatricians and child and adolescent psychiatrists. Although it might be expected that transition would be to equivalent adult teams or specialists, studies have shown that transition may not run smoothly, and the adult services are frequently inadequate. This may result in attrition from treatment or discharge to the general practitioner.Conclusions: Adult mental health services for transitioning young people with ADHD are under-resourced. The way forward may be a generic ADHD specialist or service, treating ADHD across the lifespan and avoiding the need for transition. [ABSTRACT FROM AUTHOR]

The focus of this paper is treatment of obesity in relation to the management of hedonic appetite. Obesity is a complex condition which may be potentiated by excessive reward seeking in combination with executive functioning deficits that impair cognitive control of behavior. Stimulant medications address both reward deficiency and enhance motivation, as well as suppressing appetite. They have long been recognized to be effective for treating obesity. However, stimulants can be abused for their euphoric effect. They induce euphoria via the same neural pathway that underlies their therapeutic effect in obesity. For this reason they have generally not been endorsed for use in obesity. Among the stimulants, only phentermine (either alone or in combination with topiramate) and bupropion (which has stimulant-like properties and is used in combination with naltrexone), are approved by the United States Food and Drug Administration (FDA) for obesity, although dexamphetamine and methylpenidate are approved and widely used for treating attention deficit hyperactivity disorder (ADHD) in adults and children. Experience gained over many years in the treatment of ADHD demonstrates that with careful dose titration, stimulants can be used safely. In obesity, improvement in mood and executive functioning could assist with the lifestyle changes necessary for weight control, acting synergistically with appetite suppression. The obesity crisis has reached the stage that strong consideration should be given to adequate utilization of this effective and inexpensive class of drug. [ABSTRACT FROM AUTHOR]

Background and aims:There is a clear need for a new approach to the treatment of obesity, which is inexpensive and is effective for establishing lifestyle change.We conducted a pilot study to evaluate whether dexamphetamine can be used safely, combined with diet and exercise, for treating obesity. Our ultimate aim is to develop a 6-month treatment program for establishing the lifestyle changes necessary for weight control, utilizing dexamphetamine for its psychotropic effect on motivation.We viewed the anorexigenic effect as an additional advantage for promoting initial weight loss. Methods: Obese adults were treated with dexamphetamine for 6 months (maximum of 30mg twice daily), diet, and exercise. Weight, electrocardiogram, echocardiogram, and blood pressure were monitored. Results:Twelve out of 14 completed 6 months treatment.Weight loss by intention to treat was 10.6 kg (95% CI 5.8-15.5, p <0.001). The mean weight gain in the 6 months after ceasing dexamphetamine was 4.5 kg (95% CI 1.9-7.2, p = 0.003), leaving a mean weight loss at 12 months from baseline of 7.0 kg (95% CI-13.4 to -0.6, p = 0.03). All reported favorable increases in energy and alertness. Dose-limiting symptoms were mood changes (2) and insomnia (2). None had drug craving on ceasing dexamphetamine, and there were no cardiac complications. Among the seven women, there was a significant correlation for those who lost mostweight on treatment to have the least regain in the following 6 months (r = 0.88, p = 0.009). Conclusion: Our treatment with dexamphetamine, diet, and exercise was well tolerated and effective for initial weight loss. Future research will focus on identifying baseline predictive variables associated with long-term weight control. [ABSTRACT FROM AUTHOR]

The article discusses a study that aims to investigate the effectiveness of stimulant medication on the amount of growth and pubertal development in boys suffering from attention deficit hyperactivity disorder (AHDH), a neurobehavioral disorder. Data collected from the control group with 174 recruits and the group of 65 subjects undergoing treatment was compared. It concluded that the ingestion of stimulant medication for over 3 years hampered the physical development during puberty.

The article discusses the concept of clinical pathways for medical decision making. It explores the benefits of the concept in improving clinical outcomes, reducing adverse events, and in minimising costs of treatments. Despite these benefits, the authors contend that clinical pathways have replaced conceptual thing in medicine and argue that this may disadvantage future clinical experts.

Abstract Evidence is provided that growth is an accurate indicator of prior treatment with stimulant medication. This is of utmost importance when interpreting clinical studies on attention-deficit/hyperactivity disorder (ADHD), as pretreated cohorts are likely to include fewer nonresponders and fewer individuals with intolerable side effects. In this respect, growth patterns are an excellent tool to identify pretreatment and thus address selection bias.