La transición del adolescente con trastorno por déficit de atención con hiperactividad: Implicaciones para el tratamiento del adulto / Transition of adolescents with attention deficit/hyperactivity disorder. Implications for treatment of adults

El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo crónico, complejo y multifactorial asociado con elevadas tasas de concurrencia con otros trastornos psiquiátricos, junto con problemas y repercusiones en diferentes áreas del funcionamiento del individuo. El TDAH no es exclusivo de la edad infanto-juvenil, estimándose una persistencia del 40-60% en la edad adulta, de modo que entre 2.5 y 5% de adultos continúan presentando este trastorno. La adolescencia es una etapa en la que se producen grandes y continuos cambios y que se asocia con una menor adherencia al tratamiento, una mayor vulnerabilidad a la aparición de problemas académicos, más conductas de riesgo, el inicio en el consumo de sustancias y la aparición de otros trastornos comórbidos. Se produce también la transición a los servicios o unidades de adultos, siendo necesaria una mayor coordinación entre los servicios infanto-juveniles y de adultos para asegurar una continuidad de la intervención en una etapa d e la vida en la que el paciente es especialmente vulnerable. Como en el caso de los niños y adolescentes, el tratamiento recomendado en el adulto con TDAH es el abordaje multimodal y multidisciplinar, que combina la medicación con estrategias psicológicas o psicosociales, como la psicoeducación, la terapia cognitivo conductual o el coaching, adaptadas a las necesidades individuales de cada paciente. Los fármacos psicoestimulantes son considerados de primera elección en adultos por las guías clínicas.

Attention deficit hyperactivity disorder (ADHD) is a chronic, complex and multifactorial neurodevelopmental disorder associated with high rates of concurrent psychiatric disorders, along with problems and complications on different areas of individual functioning. ADHD is not exclusively a childhood disorder, 40-60% persisting into adulthood with an estimated prevalence of 2.5-5%. Adolescence is a stage where great and continuous changes occur, associated with a lower adherence to treatment, a greater vulnerability to the emergence of academic problems, more risk-behaviors, the onset of substance use and higher rates of other comorbid disorders. The transition to adult services or units also occurs at this stage, requiring greater coordination between child/adolescent and adult services to ensure continuity of care in a phase of life in which the patient is particularly vulnerable. As in the case of children and adolescents, the recommended treatment for adults with ADHD is the multimodal and multidisciplinary approach, that combines medication with psychological or psychosocial strategies, such as psycho-education, cognitive behavioral therapy or coaching, adapted to the individual needs of each patient. Clinical guidelines recommend psycho-stimulant drugs as first-line treatments for adult patients with ADHD.

Cocaine- and Amphetamine-Regulated Transcript (CART) Peptide Plays Critical Role in Psychostimulant-Induced Depression

Cocaine- and amphetamine-regulated transcript (CART) peptide is a widely distributed neurotransmitter expressed in the central nervous systems. Previously, several reports demonstrated that nucleus accumbal-injected CART peptide positively modulated behavioral sensitization induced by psychostimulants and regulated the mesocorticolimbic dopaminergic pathway. It is confirmed that CART peptide exerted inhibitory effect on psychostimulant-enhanced dopamine receptors signaling, Ca2+/calmodulin-dependent kinase signaling and crucial transcription factors expression. Besides modulation of dopamine receptors-related pathways, CART peptide also exhibited elaborated interactions with other neurotransmitter receptors, such as glutamate receptors and γ-aminobutyric acid receptors, which further account for attribution of CART peptide to inhibition of psychostimulant-potentiated locomotor activity. Recently, CART peptide has been shown to have anxiolytic functions on the aversive mood and uncontrolled drug-seeking behaviors following drug withdrawal. Moreover, microinjection of CART peptide has been shown to have an anti-depressant effect, which suggests its potential utility in the mood regulation and avoidance of depression-like behaviors. In this review, we discuss CART pathways in neural circuits and their interactions with neurotransmitters associated with psychostimulant-induced depression.

Consumo de modafinilo en profesionales de la salud mental: reporte de un caso y revisión bibliográfica / Modafinil use in mental health professionals: case report and bibliographic review

INTRODUCCIÓN El presente estudio busca comenzar un abordaje inicial del fenómeno del consumo de Modafinilo en profesionales de la Salud Mental en Chile y los factores precipitantes que promueven el consumo de esta sustancia psicoestimulante. OBJETIVOS: Realizar una revisión bibliográfica respecto del consumo de Psicoestimulantes en Profesionales de la Salud Mental; identificar el psicoestimulante de más fácil acceso; buscar y contactar a profesionales de la salud mental del SSMC que consuman activamente Modafinilo e Identificar los posibles factores precipitantes asociados al consumo de Modafinilo. MATERIAL Y MÉTODOS: Reporte de caso y análisis de discurso de una entrevista en profundidad, identificando las categorías centrales que estructuran la experiencia del profesional respecto de su consumo. RESULTADOS Y DISCUSIÓN: De acuerdo al análisis de la entrevista, podemos destacar cuatro factores que desencadenan el consumo habitual de la sustancia psicoestimulante: la narcolepsia, sobrecarga laboral, sobrecarga emocional y el fácil acceso al Modafinilo. CONCLUSIONES: La bibliografía existente es muy escasa; este estudio se constituye como una primera aproximación al abordaje de este tema a nivel nacional; la sobrecarga emocional cobra gran importancia ya que complementa la dependencia fisiológica; los estados emocionales que generan y mantienen el consumo en el profesional se ven asociados a eventos ambientales, y la dependencia psicológica es una realidad inseparable de la dependencia fisiológica.

BACKGROUND: The present study aims to start an initial approach to the phenomenon of Modafinil use in mental health professionals in Chile, and the precipitating factors that promote the consumption of this psychostimulant substance. OBJETIVES: To carry out a bibliographic review regarding the use of Psychostimulants in Mental Health Professionals; to identify the most easily accessible psychostimulant; to find and contact mental health professionals who actively consume Modafinil and to identify the possible precipitating factors associated with consumption of Modafinil. METHODS: Case report and discourse analysis of an in-depth interview, identifying the central categories that structure the professional's experience regarding their consumption. RESULTS AND DISCUSSION: According to the analysis of the interview, we can highlight four factors that trigger the habitual consumption of the psychostimulant substance: Narcolepsy, work overload, emotional overload and easy access to Modafinil. CONCLUSIONS: The existing literature is very scarce; this study constitutes a first approach of this topic at national level; emotional overload is of great importance since it complements the physiological dependence; the emotional states that generate and maintain consumption in the professional are seen associated with environmental factors, and psychological dependence is an inseparable reality of physiological dependence.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III): Pharmacological Treatment

The objective of this review is the revision of the Korean practice parameters for the pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) based on the change in the diagnostic system from DSM-IV-TR to DSM-5 and psychopharmacological developments. For the evidence-based approach, the authors conducted a review of the literature, including controlled clinical trials, studies of the side effects of drugs, toxicology and meta-analyses from the United States and Europe, as well as recent research conducted in Korea. The review committee composed of Korean experts on ADHD reviewed the revised parameters. This revised version reveals how to use central nervous system psychostimulants, non-stimulants such as atomoxetine and alpha2 agonists, and other medication for ADHD, and how to manage the adverse effects of such medication. At the end of this revised version, the authors propose recommendations for the pharmacotherapy of ADHD.

The Effect of Hippotherapy and Medication on Children with Attention Deficit Hyperactivity Disorder: A Pilot Study / 신경정신의학

OBJECTIVES: This study researched the clinical effects of hippotherapy and medication in attention deficit hyperactivity disorder (ADHD) children. METHODS: The study employed an open label randomized controlled trial. Participants were 10 children of ages between 6 and 12 years. These subjects were placed in 2 groups : the hippotherapy group and the medication group. Evaluation tools used in this study include Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version, the Wechsler Intelligence Scale for Children-IV, Korean Child Behavior Check List (K-CBCL), ADHD rating scale (ARS), Clinical Global Impression (CGI), and Quantitative electroencephalography (QEEG). RESULTS: Grossly scores of investigator-administered ADHD rating scale (ARS-I), K-CBCL, and CGI-Severity of Illness scale were improved in both the hippotherapy and the medication group. The ARS-I scores of the Hippotherapy group were not significantly different from baseline after 12 weeks. In the QEEG, theta/beta ratio of Pz area in the hippotherapy group was significantly different from baseline. Children treated with medication showed significant difference from baseline in ARS-I, K-CBCL subscales, and QEEG. CONCLUSION: The use of hippotherapy could be a viable treatment strategy as a part of a multimodal therapy for children with ADHD. This pilot study provides good prospects for future studies to document these positive trends on larger samples.

Efeito da ingestão de cafeína em diferentes tarefas de tempo de reação / Effect of caffeine ingestion on different reaction time tasks / Efecto de la ingesta de cafeína en diferentes tareas de tiempo de reacción

O estudo examinou os efeitos da ingestão de cafeína em diferentes tarefas de tempo de reação. Em duas sessões, 22 homens (22,4 ± 2,9 anos; 77,3 ± 5,4 kg) ingeriram placebo ou cafeína (3 mg/kg) 45 minutos antes do teste de tempo de reação simples visual (TRS visual), auditivo (TRS auditivo), audiovisual (TRS audiovisual) e de discriminação sensorial (TR discriminação sensorial). Não foram encontradas diferenças significativas no TRS auditivo e TR de discriminação sensorial, sendo encontradas diferenças significativas apenas no TRS visual (Cafeína: 242,1 ± 25,98 ms vs. Placebo: 254,34 ± 28,29 ms) e TRS audiovisual (Cafeína: 242,55 ± 31,27 ms vs. Placebo: 255,68 ± 30,02 ms). Os resultados comprovam o efeito psicoestimulante causado pelo consumo de cafeína no TRS visual e audiovisual.

The study examined the effects of caffeine ingestion on different reaction time tasks. In two sessions, 22 males (22.4 ± 2.9 years; 77.3 ± 5.4 kg) ingested placebo or caffeine (3 mg/kg) 45 minutes before the test of visual simple reaction time (Visual SRT), auditory (Auditory SRT), auditory-visual (Auditory-visual SRT) and of sensory discrimination (sensory discrimination RT). No significant difference was found in the auditory SRT and of sensory discrimination, significant difference was found only in the visual SRT (Caffeine: 242.1 ± 25.98 ms vs. Placebo: 254.34 ± 28.29 ms) and auditory-visual SRT (Caffeine: 242.55 ± 31,27 ms vs. Placebo: 255.68 ± 30.02 ms). The results confirm the psychostimulant effect caused by the consumption of caffeine on visual and auditory-visual TRS.

El estudio examinó los efectos de la ingestión de cafeína en diferentes tareas de tiempo de reacción. En dos sesiones, 22 hombres (22,4 ± 2,9 años; 77,3 ± 5,4 kg) ingeriran placebo o cafeína (3 mg/kg) 45 minutos antes de la prueba del tiempo de reacción simple visual (TR visual), auditivo (TR auditivo), audio-visual (TR audio-visual) y de la discriminación sensorial (TR discriminación sensorial). No se encontraron diferencias significativas en el TRS auditorio y TR de la discriminación sensorial, se encontraron diferencias significativas sólo en lo TRS visual (Cafeína: 242,1 ± 25,98 ms vs. Placebo: 254,34 ± 28,29 ms) e TRS audio-visual (Cafeína: 242.55 ± 31.27 ms vs. Placebo: 255.68 ± 30.02 ms). Los resultados muestran el efecto psicoestimulante causado por la ingesta de cafeína en TRS visual y audio-visual.

Interactions of Dopamine D1 and N-methyl-D-Aspartate Receptors are Required for Acute Cocaine-Evoked Nitric Oxide Efflux in the Dorsal Striatum

Alterations in nitric oxide (NO) release in response to psychostimulants in the striatum cause a plastic change contributing to the development and expression of addiction. In this study, regulation of NO efflux evoked by acute cocaine in the dorsal striatum was investigated using real-time detection of NO in vivo. We found that acute systemic injection of cocaine (20 mg/kg) increased NO efflux, which was reduced by the intrastriatal infusion of the dopamine D1 receptor antagonist, SCH23390 (7.5 nmol), and the dopamine D2 receptor agonist, quinpirole (5 nmol). Increased levels of NO efflux by acute cocaine were also reduced by the intrastriatal infusion of the N-methyl-D-aspartate (NMDA) receptor antagonists, MK801 (2 nmol) and AP5 (2 nmol). These findings suggest that interactions of dopamine D1 receptors and NMDA receptors after acute exposure to cocaine participate in the upregulation of NO efflux in the dorsal striatum.

The role of dopamine transporter in psychostimulant dependence / 中国药理学通报

Psychostimulant is a type of psychoactive substances that stimulate central and peripheral nervous system as well as induce drug dependence.A series of studies indicate that monoamine especially dopamine plays an important role in behavior and drug dependence,moreover,dopamine transporter(DAT)controls homeostasis of dopamine in neuron and transmission of dopamine pathways.Thus DAT might play an important role in the reward and behavioral stimulation of psychostimulant.