RESUMO
Objectives: Literature on ADHD has taken long strides recently as heaps of new data are pouring in through countless papers. Here, authors try to outline changing paradigms in ADHD practice. DSM-5 changes regarding the typology and diagnostic criteria are highlighted. Overview of co-morbidities, associations, developmental trajectories, and syndromic continuity across lifespan is outlined. Recent insights into aetiology and diagnostic tools are briefly discussed. New medications in the pipeline are also described. Methods: EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systemic Reviews were searched for all relevant updates in ADHD literature as of June, 2022. Results: DSM-5 brought about changes to the diagnostic criteria of ADHD. These included replacing types with presentations, pushing age to 12, and, incorporating adult diagnostic criteria. In the same vein, DSM-5 allows now for diagnosing concurrent ADHD and ASD. Associations of ADHD to allergy, obesity, sleep disorders, and, epilepsy have been demonstrated in recent literature. Neurocircuity underlying ADHD has been extended beyond frontal-striatal to include CTC as well as DMN accounting for ADHD heterogeneity. NEBA was FDA-approved to differentiate ADHD from hyperkinetic ID. Atypical antipsychotics use to address behavioural facets in ADHD is on the rise with no solid evidence-base. α-2 agonists are FDA-approved as monotherapy or adjunctive to stimulants. Pharmacogenetic testing is readily available for ADHD. Different formulations of stimulants abound on the market widening clinicians' repertoire. Stimulant-related exacerbation of anxiety and tics were challenged in recent studies. Drugs for ADHD in the pipeline include-dasotraline, armodafinil, tipepidine, edivoxetine, metadoxine, and memantine. Conclusions: Literature on ADHD keeps expanding towards advancing our understanding of the complex and heterogeneous intricacies of this commonplace neurodevelopmental disorder and hence informing better decisions on how best to manage its diverse cognitive, behavioural, social and medical facets.
Assuntos
Antipsicóticos , Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Adulto , Humanos , Criança , Ansiedade , Transtornos de AnsiedadeRESUMO
Avoidant/Restrictive Food Intake Disorder and misophonia seem to be overrepresented in autism spectrum disorder. Literature is mute on psychopharmacotherapy in these complex presentations. Here, authors report on a challenging case of low-functioning ASD child with comorbid ARFID and misophonia that responded favorably to a low-dose risperidone. This is followed by a brief discussion of purported pharmacodynamic mechanisms and relevant literature.
Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno Alimentar Restritivo Evitativo , Transtornos da Alimentação e da Ingestão de Alimentos , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/tratamento farmacológico , Transtorno Autístico/tratamento farmacológico , Criança , Humanos , RisperidonaRESUMO
Cystic fibrosis (CF) is a potentially fatal genetic disease that causes serious lung damage. With time, researchers have a more complete understanding of the molecular-biological defects that underlie CF. This knowledge is leading to alternative approaches regarding the treatment of this condition. Trikafta is the third FDA-approved drug that targets the F508del mutation of the CFTR gene. The drug is a combination of three individual drugs which are elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA). This trio increases the activity of the cystic fibrosis transmembrane conductance regulator (CFTR) protein and reduces the mortality and morbidity rates in CF patients. The effectiveness of Trikafta, seen in clinical trials, outperforms currently available therapies in terms of lung function, quality of life, sweat chloride reduction, and pulmonary exacerbation reduction. The safety and efficacy of CFTR modulators in children with CF have also been studied. Continued evaluation of patient data is needed to confirm its long-term safety and efficacy. In this study, we will focus on reviewing data from clinical trials regarding the benefits of CFTR modulator therapy. We address the impact of Trikafta on lung function, pulmonary exacerbations, and quality of life. Adverse events of the different CFTR modulators are discussed.
Assuntos
Transtorno Autístico , Endofenótipos , Transtorno Autístico/genética , Pai , Humanos , MasculinoAssuntos
Transtorno Autístico/psicologia , Transtorno Autístico/terapia , Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Eletroconvulsoterapia/métodos , Criança , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/psicologia , Masculino , Psicotrópicos/uso terapêutico , Resultado do TratamentoAssuntos
Citalopram/efeitos adversos , Hematúria/induzido quimicamente , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Adolescente , Citalopram/administração & dosagem , Humanos , Masculino , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagemAssuntos
Antidepressivos Tricíclicos/uso terapêutico , Transtorno Autístico/tratamento farmacológico , Sintomas Comportamentais/tratamento farmacológico , Tiazepinas/uso terapêutico , Transtorno Autístico/fisiopatologia , Sintomas Comportamentais/etiologia , Criança , Humanos , Masculino , Resultado do TratamentoAssuntos
Comportamento Infantil , Psiquiatria Infantil/métodos , Reserva Cognitiva , Transtornos Mentais , Idade de Início , Criança , Desenvolvimento Infantil , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Prognóstico , PsicopatologiaRESUMO
Stimulants-related bruxism has been previously reported; both diurnal and nocturnal. Here, authors report on a case of methylphenidate (MPH)-treated attention-deficit/hyperactivity disorder that developed nocturnal bruxism and failed multiple pharmacologic trials. Add-on clonidine has successfully helped with bruxisms while augmenting MPH response. This was achieved with great tolerability. This remains a viable option to deploy in such unusual clinical scenarios.