摘要:

ABSTRACTChildren and adolescents with attention deficit disorders (usually with comorbid conditions), who had shown inadequate therapeutic responses to methylphenidate, were treated by the addition of fluoxetine to methylphenidate. After 8 weeks in open trial, all 32 patients showed positive therapeutic responses in attention, behavior, and affect. Thirty of the 32 children showed clinically significant responses and the other two had statistically but not clinically significant responses. After 12 weeks of treatment, one patient showed a deterioration in clinical status. The children had improved report card grades in major academic subjects {p<0.0001), and showed significant improvements (p<0.0001) on the Children's Global Assessment Scale (C-GAS), Conners Parents Rating Scales (CPRS), and Children's Depression Inventory (CDI). Children who initially appeared more impaired on the C-GAS, CDI, CPRS, and GPA showed more improvement on the combined regimen. No significant side effects were observed, using a gradual elevation of fluoxetine dosage. About 40% of the patients showed substantial clinical effects with doses of fluoxetine below 20 mg daily. These preliminary results suggest that fluoxetine and methylphenidate in combination may be safe and effective for some children with attention-deficit hyperactivity disorder (and with comorbid anxiety or depressive symptoms) who do not show adequate responses to methylphenidate or fluoxetine alone.

ISSN:1044-5463    

DOI:10.1089/cap.1993.3.1

年代:1993

数据来源: MAL

摘要:

ABSTRACTThe basic and clinical research literature is reviewed to assess the possible role of serotonin (5HT) in the modulation of brain functions that appear to be altered in the disruptive behavior disorders of childhood. Although the number of 5HT cell bodies are remarkably few, numbering in the thousands, they project extensively to almost all brain areas and appear involved in a large number of psychophysiologic functions. This supports a dimensional (symptom-related) rather than a categorical (diagnoses-related) view of central 5HT dysfunction in human behavior. There is substantial evidence implicating 5HT systems in the modulation of motor activity, impulsive aggression, and learning and memory. In both animals and humans, reductions in 5HT function appear to exacerbate hyperactivity and aggression, and agents that potentiate 5HT transmission reduce activity and aggression. Nonetheless, the clinical literature is insufficient to implicate 5HT systems in ADHD. Aggression in adults directed at the self and others may be associated with altered indices of central 5HT activity, regardless of psychiatric diagnoses. Initial findings on aggression in children and adolescent populations are consistent with adult data. When selective serotonergic agents are used clinically to treat hyperactivity or aggression, their clinical effects appear acutely, in contrast with the time course of their antidepressant and anxiolytic actions. This suggests that the therapeutic effect on activity and aggression may be related to the acute activation of serotonergic receptors rather than to the down-regulatory changes that appear after long-term treatments and that coincide with the onset of antidepressant effects. Learning disabilities have been frequently associated with disruptive behavior disorders in children. Serotonergic systems appear to play a role in memory and learning processes, but it is likely that different memory and performance functions may be differentially regulated by serotonergic neural networks. Controlled trials of specific 5HT reuptake blockers, selective 5HT agonists, and 5HT antagonists should be encouraged, both in acute and chronic administration, in order to examine their potential for treating childhood hyperactivity, conduct disorders, and perhaps also the learning deficits present in these children.

ISSN:1044-5463    

DOI:10.1089/cap.1993.3.11

年代:1993

数据来源: MAL

摘要:

ABSTRACTThe Na,K pump is the indispensable component of excitable tissue that maintains transmembrane ion-based potentials. Adequate human data regarding the developmental trends in Na,K pump activity in childhood are unavailable, but human nonneuronal and animal studies demonstrate a developmental shift toward declining Na,K pump activity with increasing age. The decline in pump activity is paralleled by an age-related increase in intracellular sodium ions and a concomitant decrease in intracellular potassium ions. These changes appear to decrease the potential difference across neuronal membranes with advancing age, suggesting an increase in neuronal excitability. The Na,K-ATPase hypothesis of bipolar disorder proposes that manic symptoms are related to a modest decrease in Na,K pump activity and a consequent increase in neuronal excitability, whereas bipolar depression is consequent to a greater decrease in pump activity and a resultant decrease in neurotransmitter release. Changes in ion transport and distribution with age may offer an explanation for clinical observations of developmental variations in lithium response, including the apparent agerelated decline in maximal pretoxic lithium level, decline in therapeutic blood level range, and perhaps an increase in the therapeutic efficacy of lithium. The clinical implications of the hypothesis regarding the course of bipolar disorder would include an explanation of the increasing frequency and severity of episodes with advancing age. The hypothesis makes numerous predictions which are testable and suggests new avenues of pharmacological intervention.

ISSN:1044-5463    

DOI:10.1089/cap.1993.3.37

年代:1993

数据来源: MAL

摘要:

ABSTRACTAn 11-year-old child with obsessive-compulsive disorder, major depression, and attentiondeficit hyperactivity disorder was successfully treated with a combination of fluoxetine (mean 30 mg daily) and methamphetamine (sustained release 10 mg daily). Methamphetamine was selected because of the desirability of avoiding stimulants whose commercial formulations contain food dyes (this child appeared sensitive to tartrazine in dextroamphetamine and other agents), whose effects on hepatic metabolism were minimal (unlike methylphenidate) and whose mechanism of action is reliably rapid (unlike pemoline). Although methamphetamine carries the stigma of an abusable drug and has been implicated in neurotoxicity in animals when used at extremely high doses, methamphetamine may have certain advantages over other psychostimulants in some clinical situations. The combined use of fluoxetine and methamphetamine did not appear to be associated with significant adverse effects.

ISSN:1044-5463    

DOI:10.1089/cap.1993.3.53

年代:1993

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1993.3.x

年代:1993

数据来源: MAL