Safety and tolerability of once versus twice daily atomoxetine in adults with ADHD.

Adler L, Dietrich A, Reimherr FW, Taylor LV, Sutton VK, Bakken R, Allen AJ, Kelsey D.

School of Medicine, New York University, New York, NY, USA.

Ann Clin Psychiatry. 2006 Apr-Jun;18(2):107-13.

Background. Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder characterized by hyperactivity, impulsiveness, and inattention that affects 4% of adults. Atomoxetine hydrochloride is an FDA-approved treatment for adult ADHD, but no studies have clarified whether there are advantages to once versus twice daily dosing.

Methods. This randomized, double-blind, multicenter study compared safety and tolerability of 80 mg atomoxetine QD versus 40 mg atomoxetine BID in 218 adults with ADHD. Treatment-emergent adverse events (TEAEs), laboratory values, vital signs, weight, electrocardiograms, scores on the Arizona Sexual Experiences Scale, and efficacy (using the Conners' ADHD Rating Scale-Investigator Rated: Screening Version) were assessed.

Results. The overall incidence for any one TEAE was low. There was no significant treatment group difference in likelihood of patients experiencing >/=1 of the four most commonly observed TEAEs (dry mouth, insomnia, nausea, and erectile dysfunction). Frequency of nausea was significantly lower in the 40 mg BID group (16.4%) than the 80 mg QD group (32.4%; p = .007). There were no unexpected safety results. Although both QD and BID treatments were efficacious, the reduction in scores was greater for BID treatment.

Conclusions. Data indicate both dosing strategies are safe, well tolerated, and efficacious in the treatment of adult ADHD. Changes in dosing strategy are unlikely to be accompanied by safety risks, implying that there is room for prescribers to use discretion and to base dosing strategies on individual factors.

Subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD): Distinct or Related Disorders Across Measurement Levels?

Baeyens D, Roeyers H, Walle JV.

Department of Psychology, Developmental Disorders, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, B - 9000, Ghent, Belgium, Dieter.Baeyens@ugent.be.

Child Psychiatry Hum Dev. 2006 Jun 6; [Epub ahead of print]

The aim of this literature review is to assess the current state of knowledge regarding differences and similarities between the inattentive (IA) and combined (C) subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD) in order to detail challenges concerning further conceptualization, diagnostics, and treatment. The literature on ADHD-IA and ADHD-C was reviewed and contrasted across genetic, neuroanatomical, neurophysiological/ neurochemical, neuro(psycho)logical, and clinical psychiatric measurement levels. It was found that the more fundamental the measurement level, the less unambiguous evidence is found for subtype differences. Only on the clinical psychiatric diagnostic level, do more or less clear-cut differences in cognitive, social, academic, and behavioural functioning emerge. In conclusion, fundamental research that compares ADHD-IA and ADHD-C is relatively rare. At this point, only irrefutable phenomenological evidence of subtype differences seems to be available, even in attention problems which are presumed to be identical. The question as to whether both subtypes should be considered as two independent disorders was not adequately resolved.

Gestational age, birthweight and the risk of hyperkinetic disorder.

Linnet KM, Wisborg K, Agerbo E, Secher NJ, Thomsen PH, Henriksen TB.

Perinatal Epidemiology Research Unit, Dept. of Obstetrics and Pediatrics, Aarhus Hospital, Denmark.

Arch Dis Child. 2006 Jun 5; [Epub ahead of print]

OBJECTIVES: To study the association between gestational age and birthweight and the risk of clinically verified hyperkinetic disorder. DESIGN: A nested case-control study with incidence density sampling.

SETTING: Danish longitudinal registers. Patients: 834 cases and 20,100 controls.

MAIN OUTCOME MEASURE: Hyperkinetic disorder.

RESULTS: Compared with children born at term, children born with gestational ages of 34 to 36 completed weeks had a 70% increased risk of hyperkinetic disorder (rate ratio (RR) 1.7, 95% confidence interval (CI) 1.2-2.5). Children with gestational ages below 34 completed weeks had an almost three-fold increased risk (RR 2.7, 95% CI 1.8-4.1). Children born at term with birthweights between 1500 and 2499 grams had a 90% increased risk of hyperkinetic disorder (RR 1.9, 95% CI 1.2-2.9), and children with birthweights between 2500 and 2999 grams had a 50% increased risk (RR 1.5, 95% CI 1.2-1.8) compared with children born at term with birthweights above 2999 grams. The results were adjusted for socio-economic status of the parents, family history of psychiatric disorders, conduct disorders, comorbidity, and maternal smoking during pregnancy. Results related to birthweight were unchanged after adjusting for differences in gestational age.

CONCLUSIONS: Children born preterm, also close to term, and children born at term with low birthweights (1500-2499 grams) have an increased risk of clinically verified hyperkinetic disorder. Our findings have important public health perspectives because the majority of preterm babies are born close to term.

A package of interventions to reduce school dropout in public schools in a developing country : A feasibility study.

Graeff-Martins AS, Oswald S, Obst Comassetto J, Kieling C, Rocha Goncalves R, Rohde LA.

Dept. of Psychiatry, Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil, 90035-003.

Eur Child Adolesc Psychiatry. 2006 Jun 6; [Epub ahead of print]

OBJECTIVE: School dropout rates are staggeringly high in developing countries, even for elementary school children. This study aims to assess the feasibility and initial efficacy of a package of interventions tailored to reduce school dropout in public schools in an urban city in Brazil.

METHOD: Two public schools with similar high rates of dropout in elementary grades were selected. In one of them, a package of universal preventive interventions was implemented during a school year, including two workshops with teachers, five informative letters to parents, three meetings with parents at school, a telephone helpline at school, and a 1-day cognitive intervention. For children who stayed ten consecutive days out of school without reason, mental health assessment and referral to mental health services in the community were offered. In the second school, no intervention was implemented.

RESULTS: After this 1-year intervention, there were significant differences between the two schools in rates of both dropout (P < 0.001) and absenteeism in the last trimester (P < 0.05; effect size = 0.64). In the intervention school, 18 (45%) youths returned to school after intervention among the 40 at-risk students. Moderate engagement of school staff was the main logistic problem.

CONCLUSIONS: Our findings suggest that programs combining universal primary preventive strategies and interventions focused on at-risk students can be implemented and useful in developing countries to reduce school dropout.

Attention-deficit hyperactivity disorder in girls: epidemiology and management.

Staller J, Faraone SV.

SUNY Upstate Medical University, Syracuse, New York 13210, USA. stallerj@upstate.edu

CNS Drugs. 2006;20(2):107-23.

Attention-deficit hyperactivity disorder (ADHD) in girls is a topic of growing research and clinical interest. For many years, girls with ADHD have been ignored and overshadowed by hyperkinetic and impulsive boys, but they are now attracting interest in an effort to understand the similarities and differences in the prevalence, symptoms, familial risk, comorbidities and treatment of ADHD in the two sexes. A review of past and current literature finds that the symptoms of ADHD are not sex specific, but that identification of girls with ADHD is hampered by parental and teacher bias, and confusion. Girls are more likely to be inattentive without being hyperactive or impulsive, compared with boys. Girls and boys share the same familial risk patterns, as well as similar, although not identical, comorbidity or impairment patterns. The risk of non-treatment is as great in girls as it is in boys; up to 70-80% of identified children will have persistent symptoms and impairment that extends into adolescence and adulthood. Treatment modalities are equally effective in girls and boys. Stimulants, non-stimulants and behavioural modalities are the mainstays of effective treatment.