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Objective:To evaluate the efficacy of modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride in the treatment of attention deficit hyperactivity disorder (ADHD).Methods:Randomized controlled trial. A total of 200 children with ADHD admitted to our hospital from January 2020 to January 2022 were selected as observation subjects by prospective cohort study, and were divided into two groups according to the random number table method. The control group was given oral administration of atomoxetine hydrochloride capsules, and the observation group was given self-made Qingxin Buqi Pinggan Decoction on the basis of the control group. Both groups were treated continuously for 3 months. Before and after treatment, the Traditional Chinese Medicine symptoms were scored, and the core symptoms of the children were evaluated by Swanson Nolan and Pelham-versionⅣ (SNAP-Ⅳ), and the hyperactivity tendency was assessed by Parent Symptom Questionnaire (PSQ). The serum cortisol (COR) and adrenocorticotropic hormone (ACTH) levels were measured by chemiluminescence immunoassay. Adverse reactions during treatment were observed and clinical efficacy was evaluated.Results:The total effective rate was 97.0% (97/100) in observation group and 88.0% (88/100) in control group ( χ2=5.84, P=0.016). After treatment, the scores of restlessness, hyperactivity, unsteadiness, emaciation, lusterless complexion and restless sleep in the observation group were significantly lower than those in the control group ( t=17.90, 11.79, 10.01, 23.27, 11.79, 12.03, P<0.01). The scores of impulsivity factor, learning factor, hyperactivity factor, behavior factor, psychosomatic factor and anxiety factor were significantly lower than those in the control group ( t=4.65, 42.83, 10.01, 41.89, 39.42, 18.30, P<0.01). The scores of attention deficit, hyperactivity-impulsivity and behavior performance were significantly lower than those in the control group ( t=11.68, 9.69, 28.42, P<0.01). After treatment, the levels of serum COR [(337.26±17.22) nmol/L vs. (275.51±15.49) nmol/L, t=26.66] and ACTH [(24.47±1.12) ng/L vs. (19.23±1.43) ng/L, t=28.85] were significantly higher in observation group than those in the control group ( P<0.01). During treatment, the incidence rate of adverse reactions was 6.0% in observation group and 5.0% in control group ( χ2=0.10, P=0.756). Conclusion:Modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride can improve the clinical symptoms of children with ADHD, reduce the degree of hyperactivity disorder, increase the levels of serum COR and ACTH, and enhance the clinical efficacy.
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El trastorno por déficit de atención e hiperactividad afecta al 5 % de los niños en edad escolar. Se presenta una serie de 82 niños con este trastorno no asociado a enfermedades neurológicas ni a discapacidad intelectual o trastorno del espectro autista, atendidos durante un período de 8 meses en Neuropediatría: 57 casos de tipo combinado, 23 de tipo inatento y 2 de predominio hiperactivo. Tiempo medio de seguimiento: 7 ± 2,8 años (rango: 4-14,6). Compartían seguimiento con Psiquiatría 16 pacientes. Nunca recibieron tratamiento por decisión parental 12 pacientes. De los 70 que recibieron, en 20, hubo demora en el inicio del tratamiento. Tiempo medio de demora: 20 meses ± 1,6 años (rango: 1 mes y 6 años). Tiempo medio de tratamiento: 44 meses ± 2,6 años (rango: 1 mes y 10,5 años). El 90 % de los pacientes (63) que iniciaron tratamiento continuaban tomándolo en la última revisión
Attention deficit disorder with hyperactivity has a high prevalence affecting 5 % of school-age children. We present a case series of 82 children with said disorder not associated with neurological diseases or intellectual disability or autism spectrum disorder, treated during a period of 8 months in a neuropediatrics clinic: 57 cases of combined type, 23 of inattentive type and 2 of overactive predominance. Average follow-up time: 7 ± 2.8 years (range: 4-14.6); 16 patients shared follow-up with Psychiatry; 12 patients never received treatment by parental decision. Of the 70 who received it, in 20 there was a delay in the start of treatment. Average delay time: 20 months ± 1.6 years (range: 1 month and 6 years). Average treatment time: 44 months ± 2.6 years (range: 1 month and 10.5 years); 90 % of the patients (63) who started treatment were under treatment at the last control
Subject(s)
Humans , Male , Female , Child , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Pediatrics , Attention Deficit Disorder with Hyperactivity/therapy , Epidemiology, Descriptive , Retrospective Studies , Tics , Learning Disabilities , NeurologyABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. ADHD often persists into adulthood, with resultant impairments of social, academic and occupational functioning. ADHD is a very common disease during childhood and, the pooled overall prevalence of ADHD was found to be 5.29%. When screening for ADHD, clinicians should try to develop rapport with patients and their caregivers to increase the likelihood that they will follow the diagnostic process and treatment. The current drugs that have received Food and Drug Administration-approval for ADHD include stimulants (methylphenidate and dextroamphetamine) and non-stimulants (atomoxetine, guanfacine, and clonidine). Stimulants improve inattention, hyperactivity, and impulsivity in addition to decreasing disruptive behaviors and promoting academic achievement and the maintenance of appropriate friendships. In order to enhance drug compliance, the use of long-acting stimulants is increasing. Atomoxetine is a selective norepinephrine reuptake blocker, the effects of which may take 2 to 6 weeks to be noticeable. Furthermore, α2 agonists may help to improve behavioral side effects, tics, and sleep problems during stimulant or atomoxetine use. Common side effects of stimulants and atomoxetine include headache, stomachache, and loss of appetite. Routine electorcardiography before medication is not recommended unless there is a specific indication. Methylphenidate and atomoxetine are safe as first line therapies, and their side effects are well tolerated.
Subject(s)
Humans , Appetite , Atomoxetine Hydrochloride , Attention Deficit Disorder with Hyperactivity , Caregivers , Compliance , Drug Therapy , Friends , Guanfacine , Headache , Impulsive Behavior , Mass Screening , Methylphenidate , Neurodevelopmental Disorders , Norepinephrine , Prevalence , Problem Behavior , TicsABSTRACT
OBJECTIVES: This study analyzed the prevalence of attention deficit hyperactivity disorder (ADHD) medication use among children and adolescents in Korea between January 1, 2007 and December 31, 2011. METHODS: Using the Korea National Health Insurance claims database, we identified patients between one and 17 years of age who had at least one medical claim for the diagnosis of ADHD (International Classification of Diseases, 10th revision: F90.0). The annual prevalence of ADHD diagnoses was calculated, using national census data from Statistics Korea on the population aged between one and 17 years as the denominator. The prevalence was age-standardized using the 2010 population as the standard population. The number of patients who were treated with methylphenidate and/or atomoxetine and the prevalence of total patients with ADHD that were treated with either drug were also calculated for each year. All analyses were stratified according to gender and age group (1-5 years, 6-12 years, and 13-17 years). RESULTS: The number of patients diagnosed with ADHD increased from 72,704 persons (0.71%) in 2007 to 85,468 persons (0.93%) in 2011. The annual age-standardized prevalence of ADHD diagnoses increased from 0.67% in 2007 to 0.94% in 2011. The prevalence of methylphenidate use among children and adolescents with ADHD decreased from 73.91% in 2007 to 70.33% in 2011, whereas that of atomoxetine use increased from 5.77% in 2009 to 13.09% in 2011. CONCLUSIONS: While methylphenidate remains the most commonly prescribed ADHD drug, the use of atomoxetine has increased.
Subject(s)
Adolescent , Child , Humans , Atomoxetine Hydrochloride , Attention Deficit Disorder with Hyperactivity , Censuses , Classification , Diagnosis , Korea , Methylphenidate , National Health Programs , Prescriptions , PrevalenceABSTRACT
Objective To observe the therapeutic effect of methylphenidate hydrochloride controlled-release tablets (OROS-MPH) on attention-deficit hyperactivity disorder (ADHD). Methods Seventy-two cases of children with ADHD were randomly divided into treatment group (40) and control group (32). Cases of treatment group were given 0.8-1.0 mg??kg-1 of OROS-MPH for three months. Cases of control group were given 1.2-1.4 mg??kg-1 of atomoxetine hydrochloride for three months. After 12 weeks treatment, children were evaluated by Wechsler intelligence test, Integrated visual and auditory continuous performance test (IVA-CPT), the SNAP-Ⅳ effect assessment scale and TESS scale. Results The treatment efficiency was similar in both groups. Attention deficit and hyperactivity in both groups were improved obviously. Wechsler intelligence score was significantly elevated ( P<0. 05), SNAP-Ⅳ score was significantly decreased ( P<0. 05), and IVA-CPT score was increased significantly after treatment ( P<0.05) . The changes of scores on hyperactivity, auditory attention and visual attention were more in OROS-MPH group than those in atomoxetine group(P<0.05). There was loss of appetite in 10 children of OROS-MPH group and in 14 children of atomoxetine group. There was drowsiness in 1 child of OROS-MPH group and in 5 children of atomoxetine group, as well as difficulty to fall asleep in 6 children of OROS-MPH group and 1 child of atomoxetine group (P<0.05). One child developed a transient spasm after 4-month treatment. Conclusion Both of OROS-MPH and atomoxetine hydrochloride can improve learning ability and the symptom of attention deficit and hyperactivity, and they are similarly effective and safe in children with ADHD, but OROS-MPH can work faster.
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Objective To evaluate the therapeutic efficacy of atomoxetine hydrochloride for attention deficit hyperactivity disorder (ADHID) combined with Tourette syndrome (TS).Methods Twenty-six cases of children with ADHD combined with TS were firstly diagnosed American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-Ⅳ) of ADHD and TS were treated with atomoxetine.The symptoms were improved and conditions were assessed based on the fourth version of ADHD parent rating scale and the severity of Yale comprehensive pumping quantity during pre-treatment,the 2nd,4th,6th and the 8 week of therapeutic courses,respectively.The adverse reaction was observed.Results 1.Compared with pre-treatment,attention deficit scores after treatment were statistically different (t =8.41,9.97,all P ＜ 0.05) in the 6th,8th week of therapeutic courses;hyperactivity /imnpulsivity scores were statistically different (Z =-4.39,-4.47,-4.46,all P ＜0.05) in the 4th,6th,8th week; Motor tics scores were statistically different (t =18.30,18.67,20.32,all P ＜ 0.05) in the 4th,6th,8th week; The vocal tic score:the second weeks already had statistically different(t =5.45,P ＜ 0.05); And the impaired function score were statistical significance (Z =-3.95,-3.94,all P ＜ 0.05) at the 6th and 8th week.2.The effective rate of ADHD and TS was 7.69％ and 15.38％,respectively in the 2td week.The curative effect had no statistical significance (x2 =0.188,P ＞0.05).But at the tourth week of assessment,and the rates of curative effect were respectively 19.23％ and 46.15 ％.It had statistical significance (x2 =3.923,P ＜ 0.05).In the 6th,8th weeks,there was no significant difference between the 2 efficiency (x2 =0.083,0.103,all P ＞0.05).3.During the treatment,no severe adverse reaction had appeared.Conclusions Atomoxetine in ADHD comorbid TS had exact curative effect and no obvious adverse reactions.In the treatment of ADHD,hyperactivity / impulsivity effect is better than the attention deficit.In the treatment of TS,vocal tics onset is better than the motor tics.In comparison of ADHD with TS,TS symptoms improve faster than ADHD in the onset,but the final effect is quite.