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Other Behavioral and Emotional
Disorders
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Adderall vs. Methylphenidate (Ritalin) for Attention
Deficit Hyperactivity Disorder
The most commonly prescribed medication for children with attention
deficit hyperactivity disorder (ADHD) is methylphenidate (for example,
Ritalin). However, its effects may be short-lived and some children do
not respond to it at all. Researchers at the State University of New
York at Buffalo recently compared the effectiveness (and effects of)
methylphenidate (MPH) with another drug, Adderall, in 21 children with
ADHD between the ages of 6 and 12 years old. The results from this small
study showed that a single morning dose of Adderall resulted in the same
changes in behavior throughout the school day as MPH taken twice a day.
A single dose of MPH in the morning appeared less effective than taking
MPH twice a day or taking one dose of Adderall, and its effects wore
off by early to mid-afternoon.
Adderall may offer a good alternative for children when a two-dose per
day regimen is a problem. This study was conducted in the context of
an intensive summer treatment program that included behavioral elements
as well. More research is needed to compare these medications and dosing
options in a regular school setting.
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New Drug May Better Help Prevent Alcoholism Relapse
Opiate antagonists are drugs that can decrease the pleasurable effects
of drinking alcohol and therefore can be useful for people trying to
quit drinking, particularly during the first few months. Naltrexone (ReVia)
is an opiate antagonist that has been shown to be effective in preventing
drinking relapses but can cause intolerable nausea in some people. In
addition, this drug may damage the liver as the dose is increased. This
limits its usefulness because liver disease and a history of heavy drinking
often go hand-in-hand.
A newer opiate antagonist, nalmefene, may offer a promising alternative.
A recent study showed that over a 12-week treatment period, patients
taking nalmefene were almost two-and-one-half times less likely to relapse
compared with those taking a placebo. Also, there was no evidence
that this medication caused liver problems or other serious side effects.
While some patients taking nalmefene experienced nausea, none skipped
their doses or stopped treatment for this reason. Nalmefene may become
a good first-choice drug to help treat alcohol dependence.
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Guidelines for Diagnosis and Evaluation of Children
with ADHD
Attention deficit hyperactivity disorder (ADHD) affects
7–10% of children, making it the most common neurobehavioral disorder
among children. Over the past decade, the number of prescriptions for
stimulant medication to treat ADHD in children has ballooned, creating
fears of over-diagnosis. Surveys show a lack of uniform criteria for
diagnosis of ADHD and variations in the amount of stimulants prescribed
by physicians. In an effort to develop a standard national framework
for diagnosis and evaluation of ADHD in children of 6 to 12 years of
age, the American Academy of Pediatrics formed a committee to review
the existing literature and develop consistent guidelines.
The committee recommends that primary care clinicians evaluate for ADHD
children who are inattentive, hyperactive, impulsive, academic underachievers,
and those who have behavioral problems. Because these symptoms are rarely
obvious in a clinical setting, parents or other caregivers who notice
these problems should inform the child’s physician. When parents
don’t bring up these concerns, physicians should inquire about the
symptoms of ADHD.
According to the guidelines, a diagnosis of ADHD requires that a child
meet the specific criteria of the Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition. These involve displaying numerous
symptoms of inattention, hyperactivity, and impulsivity in at least two
settings. By completing ADHD-specific questionnaires, parents or caregivers
and classroom teachers must provide evidence of the core symptoms of
the disorder, duration of symptoms, the degree of functional impairment,
and associated conditions. According to the guidelines, nonspecific questionnaires
are not adequate for the diagnosis of children with ADHD. The guidelines
recommend that evaluation for ADHD also include an assessment for coexisting
conditions such as conduct and oppositional defiant disorder, mood disorders,
anxiety disorders, and learning disabilities. Coexisting conditions affect
roughly one-third of children with ADHD. Recommendations do not include
the use of brain imaging, EEG, and thyroid hormone screens as diagnostic
tests for ADHD.
These guidelines provide a starting point for clinicians in the assessment
of ADHD in children of 6 to 12 years of age. Further research is necessary
to develop guidelines for other age ranges.
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Young Men and Women with Anorexia Nervosa or Inflammatory
Bowel Disease at Greater Risk for Osteoporosis
We usually think of osteoporosis as a condition that primarily strikes
older women as a result of the aging process. However, certain disorders
and medications can also lead to bone loss in younger people, both male
and female. Two recent studies from the Annals of Internal Medicine show
that bone loss is significantly more likely to occur in young men and
women suffering from anorexia nervosa or inflammatory bowel disease than
in the general population.
Researchers evaluated the loss of bone tissue in women with the eating
disorder anorexia nervosa by measuring bone mineral density at different
regions of the skeleton. More than 90% of the women had significant bone
loss at one or more skeletal regions. Depending on the region measured,
this bone loss put 13–24% of the women at risk for fractures. Physicians
commonly prescribe estrogen to slow bone loss in postmenopausal women.
Estrogen is also given to women who do not menstruate regularly, which
is the case for many women with anorexia. Interestingly, in this study,
women who used estrogen experienced the same levels of bone loss as women
who did not. The researchers theorized that poor nutrition might decrease
the effectiveness of estrogen in preserving bone. The results also showed
that current weight, independent of other factors, is the best predictor
of bone density in anorectic women.
In a separate study, researchers sought to determine the risk of bone
fractures associated with osteoporosis in patients with inflammatory
bowel disease. Results of the study showed that patients with the disease
had a 40% greater risk of hip, spine, wrist, or rib fractures than healthy
people. Researchers are still uncertain what factors contribute to bone
loss in these patients. They speculate that corticosteroids, which are
used to treat inflammatory bowel disease, may play a role, and that cigarette
smoking, lower levels of sex hormones, and low dietary intake of calcium
and vitamin D may also contribute to bone loss.
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