Safety and Tolerability of OROS Methylphenidate for the Treatment of ADHD

We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.

Safety and Tolerability of OROS Methylphenidate for the Treatment of ADHD

We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.

Psychiatric Treatment of Ruminative Vomiting and the Associated Weight Loss in an Adolescent Boy with Autism: A Case Report

We treated the persistent ruminative vomiting of a 13-year-old autistic boy by using a behavioral and psychopharmacological approach in a closed ward. Before the interventions, the patient had lost about 10kg of body weight due to very high-frequency ruminative vomiting. Together with psychopharmacological trials, the psychiatric treatment included a combination of a behavioral approach and food regulation that emphasized food restrictions, and we provided regular light meals. There was a considerable reduction of the ruminative vomiting and 2kg weight gain was achieved during the admission. These therapeutic gains were maintained at the 4-month follow-up assessment and the vomiting symptom reached a near-zero level and the weight loss were recovered by about 8kg. The issues related to the treatment approaches for ruminative vomiting with autism are discussed.

Effects of Amisulpride Administration on Body Weight and Metabolic Abnormalities in Mice

OBJECTIVES: This study was conducted to examine the effects on food intake, body weight, and metabolic parameters by amisulpride administration in male and female mice, comparing the effects of risperidone and vehicle administration. METHODS: Female and male C57BL/6 mice were grouped into low dose amisulpride(1.5mg/kg), high dose amisulpride(15mg/kg), risperidone(0.1mg/kg) and vehicle. Drugs were administered once daily through intraperitoneal injection over 21days. Body weight was measured weekly and food intake was measured daily. Levels of triglyceride, glucose, insulin and prolactin were determined at the end of experiment(on day 22). RESULTS: In the female mice, low and high dose amisulpride as well as risperidone caused significant weight gains. But weight gains in amisulpride groups were numerically smaller than that of risperidone group. In male mice, only high dose amisulpride caused significant weight gain. Among weight gain groups, only weight gain of male mice with high dose amisulpride was significantly associated with increased food intake. Weight gain group in female mice did not show significant correlation with food intake. In male mice, both amisulpride groups showed significantly high plasma insulin levels compared to vehicle. In female and male mice, low and high dose amiulpride groups showed significant high plasma prolactin levels compared to vehicle. Tri-glyceride level were not significantly changed in all groups. Glucose level was changed significantly only in male risperidone group. CONCLUSIONS: Administration of amisulpride caused more significant weight gains in female and male mice than controls but changes of metabolic parameters were different according to sex of mice. Our results suggest that different mechanisms of amisulpiride are likely to affect weight gain between male and female mice.

A Study on Impulsivity and Brain Dysfunction in Criminal Adolescents / 신경정신의학

OBJECTIVES: Recently, the number of adolescent criminals hospitalized for evaluation or treatment of mental illness is increasing. The aim of this study was to provide basic information for the evaluation and treatment of adolescent misconducts, based on their impulsivity. METHODS: Barrat's impulsivity test was done to 64 adolescent criminals under age of 18 who were admitted to a Juvenile School between Oct. 1, 2003 and June 30, 2004. According to their recognizing impulsivity scores, the upper 30% group (high impulsivity group: HIG) and the lower 30% group (low impulsivity group: LIG) were selected. The two groups were compared on socio-demographic data, crime characteristics, psychiatric diagnoses, Evoked Potential Latency and Amplitude, Cognitron and IQ. RESULTS: 1) The high impulsivity group had lower IQ than the low impulsivity group (p<0.01). 2) No difference was found in the seriousness of committed crimes, number of crimes and the age of first committed crimes. However, the high impulsivity group fended acting alone in committing crimes (p<0.05), and more frequently upeated same crimes (p<0.01). 3) Evoked potential latency was prolonged on FzN100 (p<0.05), CzN100 (p<0.05), PzN100 (p<0.01) and amplitude was increased on FzN100 (p<0.05), CzN100 (p<0.05), PzN100 (p<0.05) in high impulsivity group. 4) High impulsivity group showed lower scores on NOCR (p<0.01), NOCYR (p<0.01), NOCNR (p<0.01) in Cognitron. PzN100 (p<0.05) latency prolongation. CzN100 latency prolongation had positive correlation with PzN100 latency prolongation (p<0.05). 5) While the misconduct was most common problem in both groups, more ADHD diagnosis was identified in the high impulsivity group. The most frequent medical problem in low impulsivity group was with diseases of internal medicine (p<0.01) and anxiety disorders (p<0.01). CONCLUSION: The adolescent criminals with high impulsivity tend to have lower intelligence and commit crimes repeatedly. They are frequently diagnosed to have ADHD. When they are compared to low impulsivity group, big differences are found in prolonged evoked potential latency and increased amplitude on N100. Hence, in the treatment and rehabilitative programs for them, considering these characteristics may be helpful.

A Study on Impulsivity and Brain Dysfunction in Criminal Adolescents / 신경정신의학

OBJECTIVES: Recently, the number of adolescent criminals hospitalized for evaluation or treatment of mental illness is increasing. The aim of this study was to provide basic information for the evaluation and treatment of adolescent misconducts, based on their impulsivity. METHODS: Barrat's impulsivity test was done to 64 adolescent criminals under age of 18 who were admitted to a Juvenile School between Oct. 1, 2003 and June 30, 2004. According to their recognizing impulsivity scores, the upper 30% group (high impulsivity group: HIG) and the lower 30% group (low impulsivity group: LIG) were selected. The two groups were compared on socio-demographic data, crime characteristics, psychiatric diagnoses, Evoked Potential Latency and Amplitude, Cognitron and IQ. RESULTS: 1) The high impulsivity group had lower IQ than the low impulsivity group (p<0.01). 2) No difference was found in the seriousness of committed crimes, number of crimes and the age of first committed crimes. However, the high impulsivity group fended acting alone in committing crimes (p<0.05), and more frequently upeated same crimes (p<0.01). 3) Evoked potential latency was prolonged on FzN100 (p<0.05), CzN100 (p<0.05), PzN100 (p<0.01) and amplitude was increased on FzN100 (p<0.05), CzN100 (p<0.05), PzN100 (p<0.05) in high impulsivity group. 4) High impulsivity group showed lower scores on NOCR (p<0.01), NOCYR (p<0.01), NOCNR (p<0.01) in Cognitron. PzN100 (p<0.05) latency prolongation. CzN100 latency prolongation had positive correlation with PzN100 latency prolongation (p<0.05). 5) While the misconduct was most common problem in both groups, more ADHD diagnosis was identified in the high impulsivity group. The most frequent medical problem in low impulsivity group was with diseases of internal medicine (p<0.01) and anxiety disorders (p<0.01). CONCLUSION: The adolescent criminals with high impulsivity tend to have lower intelligence and commit crimes repeatedly. They are frequently diagnosed to have ADHD. When they are compared to low impulsivity group, big differences are found in prolonged evoked potential latency and increased amplitude on N100. Hence, in the treatment and rehabilitative programs for them, considering these characteristics may be helpful.

Body-Shape Satisfaction and Adjustment Functions in Obese Adolescent School Girls / 신경정신의학

OBJECTIVES: This study was designed to explore body-shape satisfaction and adjustment functions in 410 adolescent school girls. METHODS: After underweight, normal-weight and overweight groups were identified among 410 high school girls according to BMI(body mass index), we compared current weight & height, ideal weight & height, subtracted value of ideal weight from current weight, subtracted value of ideal height from current height, subtracted value of ideal BMI from current BMI, weight dissatisfaction, height dissatisfaction,body-shape dissatisfaction,and EAT-26(Eating attitude Test-26),OSIQ(Offer Self-Image Questionnaire for Adolescents), STAI(State-Trait Anxiety Inventory),BDI(Beck Depression Inventory),BITE(Bulimic Investigatory Test Edinburgh) among the three group. RESULTS: 1) The subjects consisted with overweight group(BMI > 25,N=27,6.6%), normal-weight group(19< or = BMI < or =25,N=278,67.8%),and underweight group(BMI<19, N=105, 25.6%). 2) In comparison to other groups, overweight group was significantly different in subtracted value of ideal weight from current weight and subtracted value of ideal height from current height. These results suggest that overweight group wants greater body-shape change than other groups. Overweight group was significantly shorter in height than underweight group there were no significant differences in ideal height among the groups. 3) Overweight group and normal-weight group showed significantly highter weight dissatisfaction than underweight group. There were no significant differences in height dissatisfaction and body-shape dissatisfaction among the three groups. All groups showed higher weight, height dissatisfaction and body-shape dissatisfaction except higher weight dissatisfaction in underweight group. 4) In comparison of overweignt group with other groups by mean difference of each scale, there was significant difference in superior adjustment subscale of the OSIQ and symptom subscale of the BITE between overweight group and other groups. There was also significant difference in symptom severity subscale of the BITE between overweight and underweight groups. There was no significant difference in EAT-26,STAI,BDI,other subscales of OSIQ among the groups. CONCLUSIONS: 1) The distribution rate of overweight group was lower than in western studies. 2) These results suggest that overweight group wants greater body-shape change than other groups, and overweight group may have binge-eating behavior and poor coping system.