9 research outputs found
The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project
Objective:
The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age.//
Method:
Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age.//
Results:
The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable.//
Conclusion:
Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth
The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents:Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project
Objective: The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age.Method: Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age.Results: The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable.Conclusion: Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.</p
The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents:Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project
Objective: The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age.Method: Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age.Results: The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable.Conclusion: Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.</p
Aggressive behaviour in children and adolescents with Conduct Disorder or Oppositional Defiant Disorder: neuropsychological characterization and drug treatments. Preliminary analysis of data from the European MATRICS project
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) have significant long-term implications and pose a serious public health problem, nevertheless efficacy of therapeutic intervention, including medications, remains unclear. Recently there has been rapid progress in understanding the neuropsychological characterization and the neurobiology of CD and of Callous-Unemotional (CU) traits, including the physiological and neuroanatomical functioning. Evidence are controversial but it is likely that different etiological pathways lead to either a CD with CU traits with predominant instrumental aggression (low emotional reactivity, dysfunction in emotional empathy, lower amygdala reactivity), or to a CD with reactive aggression (exaggerated affective response, deficit in the processing of social stimuli-affective, increased amygdala responsiveness).
With the aim of implementing the knowledge on CDs and identifying new targets of potential pharmacological therapies, withn the FP7, the European Commission funded the MATRICS project (Multidisciplinary Approaches to Translational Research In Conduct Syndromes), including studies finalized to identify neural, genetic and molecular factors involved in the pathogenesis of aggression/antisocial behaviour in preclinical models and clinical samples.
The main objectives of the clinical study (MATRICS_WP6-1) were to characterize the neuropsychological/autonomic profiles of aggressive children and adolescents with CD/ODD compared to typical development controls (TDC), to highlight features associated with CU traits, and to identify the neuropsychological/physiological mechanisms underlying the acute responses to different drugs.
In order to accurately select the drugs to be included into the trial, a systematic review and meta-analysis was conducted on the evidence of effectiveness of the treatments for aggression in CD: methylphenidate (MPH) and risperidone showed the largest effects on aggression in randomized controlled trials; other antipsychotics showed clinical efficacy on CD, but this was mainly revealed by open-label studies; only few studies included patients with CD as a primary diagnosis and/or discriminated between different types of aggression or reported measures of CU traits.
The clinical study was designed on the assumption that gaining a deeper definition of the neuropsychological/physiological characteristics underlying CD and of the profile of acute responses to drugs would help identify the potential mechanisms of action of these substances and facilitate the development of new pharmacological treatments. It incorporated a case-control study followed by a randomized, single-dose, cross-over, placebo-controlled, single-blind study including the CD/ODD cohort only.
The assessment implied a set of neuropsychological tests from the CANTAB battery and the new EMOTICOM battery (for “cold” and "hot" executive functions), the recording of autonomic measures such as heart rate and skin conductance, and the collection of serial saliva samples for cortisol levels. For the single-dose trial patients were re-evaluated after being randomized to take a single dose of placebo and two of the four study drugs (MPH or atomoxetine, and aripiprazole or risperidone).
The main preliminary results reveal that aggressive CD/ODD subjects show: deficit in sustained attention and memory skills; difficulties in recognizing emotions and in affective attentional control; anomalies in decision-making, risk assessment (reduced response to rewards and punishments) and moral judgment. Higher CU traits seem associated with more impaired emotion processing (particularly negative ones). Single doses of MPH and atomoxetine improve accuracy in measures of affective attentional control; limited evidence of effects of aripiprazole and risperidone were detected. No drug led to significant impairment in cognitive performance. CU traits do not seem to predict different responses to medications
The pharmacological treatment of aggression in children and adolescents with conduct disorder. Do callous-unemotional traits modulate the efficacy of medication?
Background: Children and adolescents with conduct disorder (CD) show repetitive and persistent patterns of aggressive behaviour and the more severe forms are often associated with callous-unemotional (CU) traits. Objectives: To systematically review and, where data are adequate, conduct meta-analyses on the efficacy of medication on aggression in children and adolescent with CD considering the impact of CU traits. Results: Few studies have investigated patients with CD as primary diagnosis, and few of these have discriminated between different types of aggression or reported measures of CU traits. Methylphenidate and risperidone showed the largest effects on aggression in randomized controlled trials; other antipsychotics showed clinical efficacy on CD but this evidence is mainly revealed by open label trials. There is some low quality evidence to support a small effect of mood stabilizers and other agents. There were only two papers describing the effects of CU traits thus providing inconclusive results. Conclusion: Considering heterogeneity of the disorder, more proof-of-concept clinical studies are needed to define effects of medication and role of CU traits
Profili cognitivi e disturbi psicopatologici. Evidenze neurobiologiche, diagnosi, trattamento
Il volume fa luce sugli aspetti più recenti legati ai disturbi psicopatologici e ai relativi profili cognitivi, analizzando gli aspetti neurobiologici, le teorie maggiormente accreditate e gli ultimi studi e ricerche svolte in questo settore. Presenta inoltre gli aspetti diagnostici, di assessment e di trattamento evidence based presenti nella letteratura scientifica internazionale.
In particolare, il volume affronta questi temi:
– disturbi del controllo degli impulsi e della condotta;
– le difficoltà diagnostiche nei disturbi del neurosviluppo (bambini prescolari, ADHD, DOP e autismo)
– il Disturbo da Tic e la complessa comorbidità
– condotte autolesive non suicidarie e suicidalità come fenomeno trans-nosografico
– ADHD e complessità diagnostica: evidenze neurobiologiche di assessment e
trattament
Neuropsychological Characterization of Aggressive Behavior in Children and Adolescents with CD/ODD and Effects of Single Doses of Medications:The Protocol of the Matrics_WP6-1 Study
Aggressive behaviors and disruptive/conduct disorders are some of the commonest reasons for referral to youth mental health services; nevertheless, the efficacy of therapeutic interventions in real-world clinical practice remains unclear. In order to define more appropriate targets for innovative pharmacological therapies for disruptive/conduct disorders, the European Commission within the Seventh Framework Programme (FP7) funded the MATRICS project (Multidisciplinary Approaches to Translational Research in Conduct Syndromes) to identify neural, genetic, and molecular factors underpinning the pathogenesis of aggression/antisocial behavior in preclinical models and clinical samples. Within the program, a multicentre case-control study, followed by a single-blind, placebo-controlled, cross-over, randomized acute single-dose medication challenge, was conducted at two Italian sites. Aggressive children and adolescents with conduct disorder (CD) or oppositional defiant disorder (ODD) were compared to the same age (10–17 y) typically developing controls (TDC) on a neuropsychological tasks battery that included both “cold” (e.g., inhibitory control, decision making) and “hot” executive functions (e.g., moral judgment, emotion processing, risk assessment). Selected autonomic measures (heart rate variability, skin conductance, salivary cortisol) were recorded before/during/after neuropsychological testing sessions. The acute response to different drugs (methylphenidate/atomoxetine, risperidone/aripiprazole, or placebo) was also examined in the ODD/CD cohort in order to identify potential neuropsychological/physiological mechanisms underlying aggression. The paper describes the protocol of the clinical MATRICS WP6-1 study, its rationale, the specific outcome measures, and their implications for a precision medicine approach
The impact of methylphenidate on pubertal maturation and bone age in ADHD children and adolescents: results from the ADHD drugs use chronic effects (ADDUCE) project
Objective: the short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age.Method: participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age.Results: the medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable.Conclusion: our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.</p