Psychiatry - August 2008 - (Page 27)

[trend watch] impact of uncontrolled ADHD on driving performance. Poor driving records that include multiple speeding tickets, multiple accidents, and ignoring driving regulations at times resulting in points on one’s drivers license or loss of license are seen in many young adults with ADHD.13 Safe driving demands that one remain attentive. It is possible that minimizing peak-trough medication-related attention problems by using longacting ADHD medications might also help boost driving performance and improve traffic safety as well, though additional research is needed in this area. When deciding on which medication to prescribe a patient with ADHD, it is important to keep in mind that prescribing short-acting ADHD medications in some situations can also be advantageous. For example, a number of patients will benefit from the addition of a short-acting stimulant taken at 5 or 6 o’clock in the evening, sometimes to supplement a long- or another short-acting medication given earlier in the day. Attention and other ADHD symptoms then improve for a night class or important evening meeting, without keeping the patient awake all night. If a clinician is concerned about how a particular patient will respond to a dosage titration or whether he or she will be able to tolerate a stimulant, sometimes it is best to begin with short-acting agents. This may also be the case when ADHD is comorbid with other psychiatric or medical disorders that potentially could worsen with use of a stimulant. Some individuals even with significant ADHD manage to cope extremely well or they have structured their lives in such a way that taking an ADHD medication on an as-needed basis for special situations is all they really need. And in these cases, a short-acting formulation would be optimal. In the end, it comes down to a judgment call by the clinician after consultation with each individual patient, his or her family, and other sources if needed. The clinician weighs the risks and benefits of the various ADHD medications and discusses these openly with the patient and his or her family. The safety and tolerability of long-acting medications are similar to those of short-acting medications, appear to have a somewhat lower risk of abuse and diversion, and may be associated with significant improvements in medication adherence, while short-acting medications may allow for more flexibility with the dosing frequency, titration, and determining drug tolerability and can be taken on an asneeded basis when coverage is only needed for a few hours. 6. 7. 8. 9. REFERENCES 1. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Overall, illicit drug use by American teens continues gradual decline in 2007. Ann Arbor (MI): University of Michigan News Service. www.monitoringthefuture.org. Accessed 18 December 2007. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future: National Survey Results on Drug Use, 1975–2005, Vol II, College Students and Adults ages 19–45. NIH publication 06-5884. Bethesda (MD): National Institute on Drug Abuse, 2006. Teter CJ, McCabe SE, LaGrange K, et al. Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Pharmacotherapy. 2006;26:1501–1510. Wilens TE, Gignac M, Swezey A, et al. Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. J Am Acad Child Adolesc Psychiatry. 2006;45:408–414. Williams RJ, Goodale LA, Shay-Fiddler MA, et al. Methylphenidate and dextroamphetamine abuse in substance- 10. 2. 11. 3. 12. 4. 13. 5. abusing adolescents. Am J Addict. 2004;13:381–389. Swanson J, Gupta S, Lam A, et al. Development of a new once-a-day formulation of methylphenidate for the treatment of attentiondeficit/hyperactivity disorder: proof-ofconcept and proof-of-product studies. Arch Gen Psychiatry. 2003;60:204–211. Spencer TJ, Biederman J, Ciccone PE, et al. PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short- and longacting oral methylphenidate. Am J Psychiatry. 2006;163:387–395 Kollins SH, Rush CR, Pazzaglia PJ, et al. Comparison of acute behavioral effects of sustained-release and immediaterelease methylphenidate. Exp Clin Psychopharmacol. 1998;6:367–374. Jasinski DR, Krishnan S. Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers. J Psychopharmacol. 2008 Jul 17. [Epub ahead of print]. Kollins SH. A qualitative review of issues arising in the use of psychostimulant medications in patients with ADHD and comorbid substance use disorders. Curr Med Res Opin 2008;24(5):1345–1357. Capone NM, McDonnell T, Buse J, Kochhar A. Persistence with common pharmacologic treatments for ADHD. Poster presented at: Annual International Conference of Children and Adults with Attention Deficit/Hyperactivity Disorder; October 27, 2005; Dallas, TX. Weisler RH. Review of long-acting stimulants in the treatment of attention deficit hyperactivity disorder. Expert Opin Pharmacother. 2007;8(6):745–758. Barkley RA, Murphy KR, Dupaul GI, Bush T. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc. 2002;8(5):655–672. [AUGUST] Psychiatry 2008 27 http://www.monitoringthefuture.org

Table of Contents Feed for the Digital Edition of Psychiatry - August 2008

Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.