ADHD and Hyperkinetic Disorder by Tobias Banaschewski & Alessandro Zuddas & Philip Asherson & Jan Buitelaar & David Coghill

Author:Tobias Banaschewski & Alessandro Zuddas & Philip Asherson & Jan Buitelaar & David Coghill
Language: rus
Format: mobi
ISBN: 9780198724308
Publisher: Oxford University Press
Published: 2015-07-27T21:00:00+00:00

The onset of clinical effectiveness of ATX is slower than that of

stimulants: as for tricyclic antidepressants (see section 5.6.4), it may vary between 2 and 4 weeks (and possibly longer in some individuals).

5.3.3.1 Interaction with other drugs

Concomitant administration of fluoxetine or paroxetine, drugs that

inhibit the CYP2D6 activity, results in higher plasma levels of ATX.

Likewise, slower metabolism of ATX and higher plasma levels should

be expected during concomitant use of other drugs that inhibit the

macological treatments

CYP2D6 system Although there are case reports in the literature

and despite it having become common practice in some countries to

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combine ATX with stimulants where there appears to be a lack of

R 5

treatment response with mono-therapy, it must be noted that there

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has been no systematic investigation of concomitant use for this

combination or for ATX with any other drug for the treatment of

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ADHD. In particular safety data is lacking for this combination. Possible interactions between ATX and other drugs for ADHD treatment

have not been systematically studied.

5.4 Clinical efficacy

5.4.1 Short term efficacy

5.4.1.1 Stimulants

There is substantial evidence supporting the efficacy and effectiveness of stimulants (MPH in particular) in reducing ADHD symptoms over treatment periods up to a year and in doses up to 60 mg daily. Numerous

placebo-controlled randomized control trials confirm the substantial short-term benefit (SIGN 2001, Banaschewski et al., 2006, NICE 2008).

Stimulants reduce restlessness, inattentiveness and impulsiveness mark-edly and rapidly. Effect sizes on hyperactivity symptoms are typically 60 between 0.8 and 1.1. The response rate to stimulants is at least 70% and, if non-responders are treated with the second stimulant, the cumulative response rate is at least 95% (Efron et al. 1997). The corresponding numbers needed to treat (NNT; a measure of outcome, see Box 5.2) are

between 3 and 5. Stimulants have also been documented to improve the quality of social interactions, decrease aggression and increase compliance. Patients with ADHD and comorbid anxiety or disruptive disorders have as robust a response of their ADHD symptoms to stimulants as do patients who do not have these comorbid conditions: MPH effects on anxiety or oppositional defiant behaviour per se are, however, controversial. Nevertheless, taking stimulants, the hyperactive child is rated by peers as more cooperative, greater fun to be with, and is more likely to be considered to be a best friend. Medication may not enhance the hyperactive child’s social judgement or eliminate their negative perceptions of their peers; a longer period of treatment may be required to counteract the negative reputation of a hyperactive child and to eliminate social deficits.

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