Use of methylphenidate among children in Iceland 1989-2006

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSTUDY OBJECTIVE: To determine the prevalence of methylphenidate use among children in Iceland and show utilization trends from 1989 to 2006. Patterns of use were analyzed by sex, age and region of habitation, short-acting vs. long-acting formulations and presciber's specialty. MATERIALS AND METHODS: A descriptive observational study. Data was retrieved from the nationwide Register on Prescribed Drugs in Iceland and the Icelandic Directorate of Health surveillance system on prescribed methylphenidate. The study population encompassed the total pediatric population (0-18 year-olds) in Iceland during the study period. Total, sex-, age, and region-specific yearly prevalence rates were computed. Specific prevalence rates of short-acting and long-acting methylphenidate use were compared. Prescribed volume and number of prescriptions were analyzed in relation to specialty of prescriber. Prevalence ( per thousand) was defined as the number of children per 1,000 children in the population who received at least one methylphenidate prescription in the given year. RESULTS: The total prevalence of methylphenidate use among children (0-18) in Iceland was 0.2 per thousand in 1989 and 25.1 per thousand in 2006. Overall use was three times more common among boys than girls. Prevalence was highest at age 10, 77.4 per thousand among boys and 24.3 per thousand among girls. A variance in use between regions was detected. Prevalence of short-acting methylphenidate use decreased from 2003 (18.7 per thousand) to 2006 (6.8 per thousand), while prevalence of long-acting medication increased from 14.4 per thousand to 24.6 per thousand. In 2006 pediatricians were the most common prescribers of methylphenidate to children in Iceland, accounting for 41% of prescriptions. CONCLUSION: Use of methylphenidate among children in Iceland increased considerably from 1989 to 2004, when a plateau seems to have been reached. In accordance with the trend in many Western countries, a rise in use of long-acting drugs was detected concurrently with a steep decrease in use of short-acting drugs. Compared to utilization rates in Europe, prevalence of methylphenidate use among children in Iceland is high.Inngangur: Markmið rannsóknarinnar var að greina algengi og þróun metýlfenídatnotkunar meðal barna á Íslandi frá árinu 1989 til 2006. Mynstur notkunar var greint eftir kyni, aldri og búsetu sjúklings, verkunartíma lyfs og sérgrein læknis sem ávísaði lyfinu. Efniviður og aðferðir: Lýsandi áhorfsrannsókn sem byggir á gögnum úr lyfjagagnagrunni Landlæknisembættisins, tölfræðigrunni Tryggingastofnunar ríkisins (TR) og gögnum Landlæknisembættisins um lyf undir sérstöku eftirliti. Þýði rannsóknar voru íslensk börn á aldrinum 0-18 ára á rannsóknartímabili. Gögn um lyfjanotkun voru greind með tilliti til kyns, aldurs og búsetu sjúklings, verkunartíma lyfs (stuttverkandi, langverkandi áhrif) og sérgrein læknis. Algengi metýlfenídatnotkunar (%0) var skilgreint sem fjöldi einstaklinga á hverja 1000 íbúa sem innleysti eina eða fleiri lyfjaávísun á metýlfenídat ár hvert. Niðurstöður: Algengi metýlfenídatnotkunar meðal barna (0-18 ára) á Íslandi hækkaði úr 0,2%0 árið 1989 í 25,1 %0 árið 2006. Notkun var að jafnaði þrisvar sinnum algengari meðal drengja en stúlkna. Algengið var árið 2006 hæst við 10 ára aldur (drengir 77,4 %0, stúlkur 24,3%0). Meðalársalgengi metýlfenídatnotkunar 2004 til 2006 var hæst meðal drengja á Suðurnesjum (44,80%0) og stúlkna á Norðurlandi vestra (17,06%0) en lægst á Vestfjörðum (drengir 23,44%0, stúlkur 8,06%0). Notkun stuttverkandi metýlfenídats minnkaði frá árinu 2003 (18,7%0) til ársins 2006 (6,8%0) en notkun langverkandi metýlfenídats jókst úr 14,4%0 í 24,6%0. Barnalæknar ávísuðu oftast lækna metýlfenídatlyfjum, 41% af heildarfjölda ávísana árið 2006. Ályktanir: Notkun metýlfenídats meðal íslenskra barna jókst töluvert frá upphafi rannsóknartímabils fram til ársins 2004 þegar ákveðnu jafnvægi virðist hafa verið náð. Líkt og víða hefur notkun langverkandi lyfja aukist á kostnað stuttverkandi lyfjaforms. Samanborið við önnur Evrópulönd er notkun metýlfenídats á Íslandi mikil

Hyperkinetic disorder. A review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAttention-deficit/hyperactivity disorder or hyperkinetic disorder is a clinically defined syndrome characterised by age inappropriate deficits in sustained attention, impulsivity and overactivity. Despite extensive investigation, a specific neuroanatomical, physiological, biochemical, or psychological origin has not been identified. Diagnosis is based on detailed medical and developmental history, symptom rating scales, psychological assessment and medical evaluation. Increases in diagnosis and treatment of the disorder have elicited public and professional concern. The main focus in this article is on this disorder in children and adolescents and includes practical information on assessment and treatment. Other disorders, which may be either comorbid with or mistaken for hyperkinetic disorder, are reviewed in less detail.Ofvirkniröskun er heilkenni einkenna á sviði hreyfiofvirkni, hvatvísi og athyglisbrests sem eru í ósamræmi við aldur og þroska. Þrátt fyrir aukna þekkingu á líffræðilegum og sálfræðilegum þáttum röskunarinnar hefur ekki tekist að finna sértæka orsök. Við greiningu er nákvæm sjúkrasaga mikilvæg en einnig er stuðst við staðlaða einkennamatskvarða, sálfræðilegt mat og læknisfræðilega skoðun. Aukning í greiningu og meðferð röskunarinnar hefur verið til umræðu, bæði meðal almennings og fagfólks. Í þessari yfirlitsgrein er reynt að gera röskuninni skil á sem hagnýtastan hátt, bæði varðandi greiningu og meðferð en ekki er farið nákvæmlega í fylgiraskanir eða mismunagreiningar

Medication use and treatment characteristics of children referred to the outpatient ADHD-clinic at the Department of Child and Adolescent Psychiatry, the National University Hospital

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenMaterial and methods: Data was accumulated by retrospectively looking at the records of 102 children of both sexes between 3 and 15 years of age, referred to the ADHD outpatient clinic during the period June 1, 1998 - May 31, 1999. A semi-structured diagnostic parent interview was used to assess childhood psychiatric disorders according to ICD-10. The ADHD Rating Scale- IV, the Home Situations Questionnaire and the Child Behavior Checklist were completed by the parents. Teachers filled out the ADHD Rating Scale and the Teacher Report Form as well as a form evaluating the child's academic progress. To assess intellectual functioning, WISC-III or WPPSI-R were administered. Medical evaluation was performed and drug treatment recorded. Results: Seventy-two children fulfilled ICD-10 diagnostic criteria of hyperkinetic disorder. High rates of other behavioural disorders, especially oppositional defiant disorder and a significant frequency of emotional disorders were recorded. Nearly two-thirds of the children had been started on medication prior to referral, most often amytryptiline and methylphenidate. Eleven children received combined pharmacotherapy but 35% had not received any drug treatment. Psychopharmacotherapy for most of the children was started between the age of four and eight years. Behaviour management counselling and parent training was recommended in most cases. Conclusions: Thirty children did not meet full hyperkinetic disorder diagnostic criteria, but these children may nonetheless have manifested high levels of symptoms. Most of the children were started on tricyclic antidepressants rather than stimulants which is unusual compared with international research and practice. The reason is unclear but may reflect the high rate of comorbidity but also doctors' preferences.Tilgangur: Greining og meðferð við ofvirkniröskun hefur aukist mjög á undanförnum árum. Lítið er vitað um meðferðarhefðir hér á landi. Rannsóknin lýsir lyfja- og sálfélagslegri meðferð hjá hópi barna sem vísað var til ofvirknimóttöku við göngudeild barna-og unglingageðdeildar Landspítalans (BUGL). Jafnframt voru greiningar og fylgiraskanir skoðaðar. Efniviður og aðferðir: Rannsóknin er afturskyggn og tekur til 102 barna og unglinga á aldrinum 3-15 ára sem komu til athugunar vegna ofvirkni eða gruns um ofvirkni á göngudeild BUGL á tímabilinu 1. júní 1998 til 31. maí 1999. Greiningarviðtal við foreldra var byggt á ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) greiningarskilmerkjum, stuðst var við staðlaða hegðunarmatskvarða sem útfylltir voru af foreldrum og kennurum, vitsmunaþroski barnsins var metinn og læknisskoðun gerð með tilliti til líkamlegs og andlegs ástands. Niðurstöður: Alls greindust 72 börn með ofvirkniröskun. Algengasta fylgiröskunin var mótþróaþrjóskuröskun bæði í þeim hópi barna sem greindist með ofvirkniröskun og þeim sem fengu aðra fyrstu greiningu. Hjá umtalsverðum hluta hópsins greindust einnig tilfinningaraskanir. Algengast var að lyfjameðferð væri hafin milli fjögurra og átta ára aldurs. Amitriptýlín og metýlfenýdat voru oftast valin sem fyrsta meðferð en önnur lyf voru mun sjaldnar notuð og hjá 35% barnanna hafði lyfjameðferð ekki verið reynd. Við komu voru 56 börn á lyfjameðferð og 11 þeirra fengu fleiri en eitt lyf. Algengasta sálfélagslega meðferðarúrræðið var að bjóða foreldrum upp á sérstök ráðgjafarviðtöl. Næst algengast var meðferðartilboð um þjálfunarnámskeið og fræðslunámskeið. Ályktanir: Umtalsverður hluti þeirra barna sem vísað var til göngudeildar BUGL vegna gruns um ofvirkni uppfyllti ekki greiningarskilmerki um ofvirkniröskun. Notkun þríhringlaga þunglyndislyfja í byrjun meðferðar virðist ennfremur mun algengari en víðast hvar erlendis. Ástæðan er óljós en kann að vera há tíðni fylgiraskana eða einstaklingsbundið val þeirra lækna sem í hlut eiga

Electroencephalography as a clinical tool for diagnosing and monitoring attention deficit hyperactivity disorder: a cross-sectional study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.The aim of this study was to develop and test, for the first time, a multivariate diagnostic classifier of attention deficit hyperactivity disorder (ADHD) based on EEG coherence measures and chronological age.The participants were recruited in two specialised centres and three schools in Reykjavik.The data are from a large cross-sectional cohort of 310 patients with ADHD and 351 controls, covering an age range from 5.8 to 14 years. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria using the K-SADS-PL semistructured interview. Participants in the control group were reported to be free of any mental or developmental disorders by their parents and had a score of less than 1.5 SDs above the age-appropriate norm on the ADHD Rating Scale-IV. Other than moderate or severe intellectual disability, no additional exclusion criteria were applied in order that the cohort reflected the typical cross section of patients with ADHD.Diagnostic classifiers were developed using statistical pattern recognition for the entire age range and for specific age ranges and were tested using cross-validation and by application to a separate cohort of recordings not used in the development process. The age-specific classification approach was more accurate (76% accuracy in the independent test cohort; 81% cross-validation accuracy) than the age-independent version (76%; 73%). Chronological age was found to be an important classification feature.The novel application of EEG-based classification methods presented here can offer significant benefit to the clinician by improving both the accuracy of initial diagnosis and ongoing monitoring of children and adolescents with ADHD. The most accurate possible diagnosis at a single point in time can be obtained by the age-specific classifiers, but the age-independent classifiers are also useful as they enable longitudinal monitoring of brain function.Icelandic Technology Development Fund 071201007 Landspitali University Hospital Research Fun

A population-based study of stimulant drug treatment of ADHD and academic progress in children.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.We evaluated the hypothesis that later start of stimulant treatment of attention-deficit/hyperactivity disorder adversely affects academic progress in mathematics and language arts among 9- to 12-year-old children. We linked nationwide data from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. The study population comprised 11,872 children born in 1994-1996 who took standardized tests in both fourth and seventh grade. We estimated the probability of academic decline (drop of ≥ 5.0 percentile points) according to drug exposure and timing of treatment start between examinations. To limit confounding by indication, we concentrated on children who started treatment either early or later, but at some point between fourth-grade and seventh-grade standardized tests. In contrast with nonmedicated children, children starting stimulant treatment between their fourth- and seventh-grade tests were more likely to decline in test performance. The crude probability of academic decline was 72.9% in mathematics and 42.9% in language arts for children with a treatment start 25 to 36 months after the fourth-grade test. Compared with those starting treatment earlier (≤ 12 months after tests), the multivariable adjusted risk ratio (RR) for decline was 1.7 (95% confidence interval [CI]: 1.2-2.4) in mathematics and 1.1 (95% CI: 0.7-1.8) in language arts. The adjusted RR of mathematics decline with later treatment was higher among girls (RR, 2.7; 95% CI: 1.2-6.0) than boys (RR, 1.4; 95% CI: 0.9-2.0). Later start of stimulant drug treatment of attention-deficit/hyperactivity disorder is associated with academic decline in mathematicsPfizer Novartis University of Iceland Icelandic Centre for Research (RANNIS

Attention-deficit hyperactivity disorder shares copy number variant risk with schizophrenia and autism spectrum disorder

Publisher's version (útgefin grein).Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable common childhood-onset neurodevelopmental disorder. Some rare copy number variations (CNVs) affect multiple neurodevelopmental disorders such as intellectual disability, autism spectrum disorders (ASD), schizophrenia and ADHD. The aim of this study is to determine to what extent ADHD shares high risk CNV alleles with schizophrenia and ASD. We compiled 19 neuropsychiatric CNVs and test 14, with sufficient power, for association with ADHD in Icelandic and Norwegian samples. Eight associate with ADHD; deletions at 2p16.3 (NRXN1), 15q11.2, 15q13.3 (BP4 & BP4.5–BP5) and 22q11.21, and duplications at 1q21.1 distal, 16p11.2 proximal, 16p13.11 and 22q11.21. Six of the CNVs have not been associated with ADHD before. As a group, the 19 CNVs associate with ADHD (OR = 2.43, P = 1.6 × 10−21), even when comorbid ASD and schizophrenia are excluded from the sample. These results highlight the pleiotropic effect of the neuropsychiatric CNVs and add evidence for ADHD, ASD and schizophrenia being related neurodevelopmental disorders rather than distinct entities.We are grateful to the participants and we thank the staff at the Research Recruitment Center. We also thank the staff at deCODE genetics core facilities and all our colleagues for their important contribution to this work. We are grateful to the Benefit Society for Children with Disabilities (Styrktarfélag Lamaðra og Fatlaðra; SLF) for their participation. The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreements’ no. 115008 (NEWMEDS) and no. 115300 (EUAIMS), of which resources are composed of EFPIA in-kind contribution and financial contribution from the European Union’s Seventh Framework Programme (EU-FP7/2007–2013), from EU-FP7 grants no. 602450 (IMAGEMEND) and no. 502805 (Aggressotype), EU-FP7-People-2011-IAPP grant no. 286213 (PsychDPC), and The Research Council of Norway (#226971, 229129, 223273, 213694, 248778), the KG Jebsen Stiftelsen (SKGJ-MED-002 and SKGJ-MED-008), and The South-East Norway Health Authority (#2012–132).Peer Reviewe

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Prognosis in patients having irritable bowel syndrome

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIrritable bowel syndrome (IBS) is among the most common gastrointestinal disorders. In this survey, the prognosis of patients diagnosed with IBS was examined. In 1982, 81 (2.9%) of the inhabitants in Egilsstaðir health care district had diagnosed IBS on their medical records (ICCH 558). Twelve years later, in 1994, the health records of those patients were examined. Information was gathered through a questionnaire, which 76% answered. Of those who answered 28% had no longer any symptoms, but 38% experienced symptoms once a month or more frequently. The medical records of 11 patients who died were checked, revealing that two had had a confirmed gastrointestinal disease, but not in the colon.Iðraólga (irritable bowel syndrome) er algengt sjúkdómsástand í meltingarfærum. Í þessari rannsókn voru athuguð afdrif sjúklinga með iðraólgu. Árið 1982 hafði 81 (2,9%) íbúi í Egilsstaðalæknishéraði sjúkdómsgreininguna iðraólga skráða í sjúkraskrá (ICCH 558). Arið 1994, 12 árum síðar, voru afdrif þessara sjúklinga könnuð. Upplýsinga var aflað með spurningalista og var svörun 76%. Af þeim sem svöruðu reyndust 28% bafa orðið einkennalausir, en 38% höfðu áfram einkenni mánaðarlega eða oftar. Sjúkraskrár 11 látinna voru kannaðar. Sjúkdómar í meltingarfærum voru staðfestir hjá tveimur þeirra, en í hvorugu tilvikanna var um sjúkdóm í ristli að ræða