Psychopharmacological Therapies for ADHD

Series Gap:

Non-pharmacological treatments and lifestyle modification are not routinely discussed with patients. Evidence-based psychotherapy options are not always recommended. Often Psychaitrists feel hesitant prescribing medication for women in perinatal period. Improved familiarity with nutraceuticals in Psychiatry. Improved knowledge-base regarding evidence-based lifestyle modifications in behavioral health. Increased recommendation of specific  evidence-based psychotherapies.

Session Gap:

The evidence concerning benefits and risks of long-duration treatments of children with psychiatric disorders may not available or utilized by practitioners when making treatment decisions in the treatment of child and adolescent psychiatric disorders, particularly Attention-Deficit / Hyperactivity Disorder (ADHD).

Target Audience:

Adult and Child Psychiatry healthcare providers

Series Learning Objectives: As a result of this activity, participants should be able to:

1. Review recommendations regarding non-pharmacological options to treat psychiatric disorders
2. Analyze the quality of evidence for/against the use of nutraceuticals
3. Evaluate existing evidence regarding the use of lifestyle-modification regimens in behavioral health
4. Describe medication options in perinatal psychiatry

Session Learning Objectives:

• • Review the putative mechanisms of action of the different medications used to treat Attention-Deficit / Hyperactivity Disorder (ADHD);
  • Choose  starting doses and maximum FDA approved doses of medications for children, adolescents and adults with ADHD;
  • Evaluate  the common and rare treatment-emergent side effects of medications used to treat ADHD

Speaker(s):

• Laurence Greenhill, MD

Planning Committee:

• Lada Alexeenko, MD, Department of Psychiatry
• Erick Ducut, MD, Department of Psychiatry
• Jie Zheng, MD, Chief of Medical Education
• Tenisha Jones, MLIS, Library Services
• Agnes Lau, Sr. Quality Specialist

Series Cultural and Linguistic Competency:

Lifestyle modification recommendations may vary greatly based on patients' diet, activity level and alcohol consumption. These may be contributed to by cultural factors. The acceptance of psychotherapeutic approaches may also vary based on cultural factors. Language is also a big contributor to compliance with a complex treatment regimen. Patients with language barriers are less likely to understand and comply with treatment regimens. 

Session Cultural and Linguistic Competency: 

• Child and Adolescent Psychiatric Disorders, including ADHD, a precursor of adult psychiatric  disorders in over 60% of cases
•  Males have higher rates of ADHD during school-age years, but the two sexes are equally vulnerable during the young adult age period
• Effective doses of medication for the treatment of ADHD differ among age groups, with adults with ADHD requiring higher doses of stimulant medication than preschoolers or  school-age children with ADHD.

Series References: 

• The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. Firth J et al.  World Psychiatry. 2019 Oct;18(3):308-324
• Pharmacological and non-pharmacological treatments for major depressive disorder in adults: A systematic review and network meta-analysis.Chen Chen, Weiguang Shan. Psychiatry Research 281 (2019) 112595
• -Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic  Review and Meta-Analysis. Andre Russowsky Brunoni, Mariana Lopes, Ted J. Kaptchuk, Felipe Fregni,  Psychiatry Res. 2019 Oct 2
• Nutraceuticals and nutritional supplements for the treatment of bipolar disorder: protocol for a systematic review. Ashton MM et al. BMJ Open. 2019 Apr 4;9(4)
• The Role of Dietary Supplements in Depression and Anxiety - A Narrative Review.Hoffmann K, Emons B, Brunnhuber S, Karaca S, Juckel G. Pharmacopsychiatry. 2019 Jul 8.
• Food Components with the Potential to be Used in the Therapeutic Approach of Mental Diseases. Fernández M,  Valero-Cases E, Rincon-Frutos L. Curr Pharm Biotechnol. 2019;20(2):100-113. 
• Treatment of Psychosis and Mania in the Postpartum Period Veerle Bergink et al. Obstet Gynecol Clin North Am. 2018 Sep;45(3):483-494. 
• Perinatal Sleep Problems: Causes, Complications, and Management. Wilkerson AK, Uhde TW. Obstet Gynecol Clin North Am. 2018 Sep;45(3)
• Postpartum psychiatric disorders .Samantha Meltzer-Brody et al. Nat Rev Dis Primers. 2018 Apr 26
• Treatment of psychosis and mania in the postpartum period. Bergink V,  et al, Am J Psychiatry. 2015 Feb 1;172(2)

Session References:

• Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, Atkinson LZ, Tessari L, Banaschewski T, Coghill D, Hollis C, Simonoff E, Zuddas A, Barbui C, Purgato M, Steinhausen HC, Shokraneh F, Xia J, Cipriani A. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis.  Lancet Psychiatry. 2018;5(9):727.
• Drugs for ADHD. Med Lett Drugs Ther 2020 Jan 27;62(1590):9-15
• Childress A, Findling RL, Wu J, Kollins SH, Wang Y, Martin P, Roberson B. Lisdexamfetamine dimesylate for preschool children with Attention-Deficit / Hyperactivity Disorder, J Child Adolesc Psychopharmacology, 30 (3): 128-136.
• Greenhill LL, Pliszka S, Dulcan MK.  The Work Group on Quality Issues, American Academy of Child and Adolescent Psychiatry.  Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents and Adults. J Amer Acad Child Adolesc Psychiatry.  2002;41:26S-49S.
• Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M Swanson J, McGough J, Wigal S, Wigal T, Vitiello B, Skrobala A, Posner K, Ghuman J, Cunningham C, Davies M, Chuang S, Cooper T. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1284-1293.
• Hennissen L, Bakker MJ, Banaschewski T, Carucci S, Coghill D, Danckaerts M, Dittman RQ, Hollis C, Kovshoff H, McCarthy S, Nagy P, Sonuga-Barke E, Wong IC, Zuddas A, Rosenthal E, Buitelaar JK, ADDUCE Consortium. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS Drugs 2017;199–215.
• Hinshaw SP, Arnold LE; For the MTA Cooperative Group. ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge.  Wiley Interdisciplinary Reviews. Cognitive Science. 2015;6:39.
• Jangmo A, Stalhandske A, Chang Z, Chen Q, Almqvist C, Feldman I, Bulik C, Lichtenstein P, D’Onfrio B, Kuja-Halkota R, Larsson H. Attention-Deficit/Hyperactivity Disorder, school performance, and effect of medication. J Am Acad Child Adolesc Psychiatry 2019;58(4):423-432.
• Jensen PS, Hinshaw SP, Swanson JM, et al. Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. Journal of Developmental and Behavioral Pediatrics. 2001;22(1):60–73
• Joensen, B., Meyer, M., & Aagaard, L. (2017). Specific Genes Associated with Adverse Events of Methylphenidate Use in the Pediatric Population: A Systematic Literature Review. Journal of Research in Pharmacy Practice. 6(2), 65–72
•  Markowitz JS, Straughn AB, Patrick KS. Advances in the Pharmacotherapy of Attention-Deficit–Hyperactivity Disorder: Focus on Methylphenidate Formulations. Pharmacotherapy. 2003;23(10):1281–1299.
• McGough JJ, Biederman J, Greenhill L, et al. Pharmacokinetics of SLI381 (Adderall XR), an Extended-Release Formulation of Adderall. J Amer Acad Child Adolesc Psychiatry. 2003;42:684-691.
• McGough JJ, Strum A, Cowen J, Tung K, Salgari GC, Leuchter AF, Cook IA, Sugar CA, Loo SK,  Double-blind, sham-controlled, pilot study of trigeminal nerve stimulantion for attention-deficit / hyperactivity disorder. J Amer Acad Child Adolesc Psychiatry, 2019; 58: 403.
• Molina BS, Hinshaw SP, Swanson JM, et al; MTA Cooperative Group. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry. 2009;48(5):484–500.
• Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R. Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics. 2009;123(2):611–616.
• The MTA Cooperative Group. A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Archives of General Psychiatry. 1999;56(12):1073–1086.
• Murray DW, Arnold LE, Swanson J, et al. A clinical review of outcomes of the multimodal treatment study of children with attention-deficit/hyperactivity disorder (MTA). Current Psychiatry. 2008;10(5):424–431.
• National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: Diagnosis and management. NICE guideline [NG87], March 2018. Available from: https://www.nice.org.uk/guidance/NG87
• Newcorn JH et al., Atomoxetine and osmotically released methylphenidate for the treatment of attention-deficit hyperactivity disorder: acute comparison of differential response. Am J Psychiatry 2008, 165:721. 
• Santosh PJ, Taylor E, Swanson J, Wigal T, Chuang S, Davies M et al. Refining the diagnoses of inattention and overactivity syndromes: A reanalysis of the Multimodal Treatment study of attention deficit hyperactivity disorder (ADHD) based on ICD-10 criteria for hyperkinetic disorder. Clinical Neuroscience Research. 2005 Dec;5(5-6):307-314
• Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff HA, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL et al., Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit / hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry. 2017;58(6):664-678.
• Vitiello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, Abikoff H, Molina B, Wells K, Wigal T, Jensen PS, Greenhill LL, Kaltman JR, Severe JB, Odbert C, Hur K, Gibbons R. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD. Am J Psychiatry 2012;169:167–177.
• Volkow ND, Wang GJ, Tomasi D, et al. Methylphenidate-elicited dopamine increases in ventral striatum are associated with long-term symptom improvement in adults with attention deficit hyperactivity disorder. Journal of Neuroscience. 2012;32(3):841–849.
• Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce K, Winner JD, Zurhellen W, Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactive Disorder.  2019 Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics.  October 2019;144(4).
• Zhu HJ, Patrick KS, Straughn AB, Reeves OT 3^rd, Bernstein H, Shi J, Johnson HJ, Knight JM, Smith AT, Malcolm RJ, Markowitz JS. Ethanol Interactions With Dexmethylphenidate and dl-Methylphenidate Spheroidal Oral Drug Absorption Systems in Healthy Volunteers.  Journal of Clinical Psychopharmacology. 2017 Aug;37(4):419-428

Disclosure:

The regular presenters and program planners of this case conference have disclosed that they have no relevant financial relationships with commercial interest (s). The CME Department has reviewed their disclosure information for the planner(s) and/or committee / faculty or this program and they do not have relationships that present a relevant financial conflict of interest.

Kaiser Permanente South San Francisco takes responsibility for the content, quality, and scientific integrity of this CME Activity.

Kaiser Permanente does not endorse any brand-name products.

Accreditation Statement:

Kaiser Permanente South San Francisco Medical Center is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.

Credit Statement:

The Kaiser Permanente South San Francisco Medical Center designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses may report up to a maximum total of 1.0 AMA PRA Category 1 Credit(s)™ towards the Continuing Medical Education requirements for license renewal by the California Board of Registered Nurses.