hollyduck
04-16-08, 05:26 PM
[Note: this is quite a long article but looks well worthwhile. I have just posted short portions here. --Ducky]
New Research on Long-acting Psychostimulants in the Treatment of ADHD (http://cme.medscape.com/viewarticle/558128)
From Medscape
Although the issue of prevalence of attention deficit-hyperactivity disorder (ADHD) in adults and the longitudinal continuum in ADHD from childhood to adulthood is still debated, recent reports shed light on these issues. The National Comorbidity Survey -- Replication found prevalence of adult ADHD to be 4.4% with only 11% being treated within past year. Moreover, a meta-analysis revealed that with "full criteria for ADHD," the rate of persistence is 15%, but if you use the criteria for "ADHD in partial remission" from the Diagnostic and Statistical Manual of Mental Disorders , the rate of persistence is more in the area of 65%.
[...]
New pharmaceutical agents have been developed to meet the needs of adults who have impaired functioning because of ADHD symptoms and need long-lasting daily treatment without requiring multiple doses throughout the day. Many of my patients have commented on the frustration and irony of needing to remember to take pills during the day to keep them from being distracted. This article seeks to present some of the most recent reports on new agents that provide therapeutic coverage throughout the day. At present, 3 agents have received FDA approval for adult ADHD: mixed amphetamine salts extended release (MAS XR); dexmethylphenidate XR; and atomoxetine, a nonstimulant.
Dosing Strategies in the Adult
Two recent poster presentations from the 2007 APA meeting in San Diego, California, highlight the issue of dosing strategies. Olfson and colleagues analyzed a large database of US managed care plans from 2000 to 2004 to evaluate the doses of 4 stimulants for ADHD... Results indicate that in community treatment of ADHD, all 4 stimulants were significantly underdosed when compared with the dosing strategies used in clinical trials to afford robust symptom control ...
...For over 60% of the community patients, the mean maximum daily dose did not rise after the first prescription, and the authors commented that these maximum doses were approximately half the levels of doses used in research studies...[/B]
[...]
Conclusions
Some of the longitudinal studies that have followed children with ADHD through young adulthood have demonstrated very disheartening results. Two major longitudinal studies are the Montreal Longitudinal Study[30] and the New York Longitudinal Study.[31-33] Taken together, they have illustrated some of the tremendous educational/occupational, social, and family/parenting difficulties encountered by young adults with untreated ADHD. As these new agents further enhance our armentarium to fight ADHD, the clinician and patient now have more agents with which to target the treatment goal, full symptom remission and recovery.
[Complete article (http://cme.medscape.com/viewarticle/558128)]
New Research on Long-acting Psychostimulants in the Treatment of ADHD (http://cme.medscape.com/viewarticle/558128)
From Medscape
Although the issue of prevalence of attention deficit-hyperactivity disorder (ADHD) in adults and the longitudinal continuum in ADHD from childhood to adulthood is still debated, recent reports shed light on these issues. The National Comorbidity Survey -- Replication found prevalence of adult ADHD to be 4.4% with only 11% being treated within past year. Moreover, a meta-analysis revealed that with "full criteria for ADHD," the rate of persistence is 15%, but if you use the criteria for "ADHD in partial remission" from the Diagnostic and Statistical Manual of Mental Disorders , the rate of persistence is more in the area of 65%.
[...]
New pharmaceutical agents have been developed to meet the needs of adults who have impaired functioning because of ADHD symptoms and need long-lasting daily treatment without requiring multiple doses throughout the day. Many of my patients have commented on the frustration and irony of needing to remember to take pills during the day to keep them from being distracted. This article seeks to present some of the most recent reports on new agents that provide therapeutic coverage throughout the day. At present, 3 agents have received FDA approval for adult ADHD: mixed amphetamine salts extended release (MAS XR); dexmethylphenidate XR; and atomoxetine, a nonstimulant.
Dosing Strategies in the Adult
Two recent poster presentations from the 2007 APA meeting in San Diego, California, highlight the issue of dosing strategies. Olfson and colleagues analyzed a large database of US managed care plans from 2000 to 2004 to evaluate the doses of 4 stimulants for ADHD... Results indicate that in community treatment of ADHD, all 4 stimulants were significantly underdosed when compared with the dosing strategies used in clinical trials to afford robust symptom control ...
...For over 60% of the community patients, the mean maximum daily dose did not rise after the first prescription, and the authors commented that these maximum doses were approximately half the levels of doses used in research studies...[/B]
[...]
Conclusions
Some of the longitudinal studies that have followed children with ADHD through young adulthood have demonstrated very disheartening results. Two major longitudinal studies are the Montreal Longitudinal Study[30] and the New York Longitudinal Study.[31-33] Taken together, they have illustrated some of the tremendous educational/occupational, social, and family/parenting difficulties encountered by young adults with untreated ADHD. As these new agents further enhance our armentarium to fight ADHD, the clinician and patient now have more agents with which to target the treatment goal, full symptom remission and recovery.
[Complete article (http://cme.medscape.com/viewarticle/558128)]