Psychiatric comorbidity with substance misuse in children and teenagers.

Reducing disability and dependency after a stroke is an important clinical objective. We examine what is known about the use of dexamphetamine in patients recovering from an acute stroke, and consider whether further clinical studies should be undertaken. Dexamphetamine has repeatedly been shown to enhance recovery after experimental brain injury in animals, the best effects being seen when dexamphetamine is combined with lesion-specific motor training or sensory stimulation. Postulated mechanisms for these beneficial effects in animals are in keeping with contemporary theories of neurophysiological rehabilitation in man. There have been few clinical studies of dexamphetamine during rehabilitation after an acute stroke. Four controlled trials demonstrated a tendency to an improved outcome when dexamphetamine was paired with therapy and administered 3-30 days after an ischaemic stroke. However, clinical studies to date have been small, included only highly selected patients, and have not addressed possible confounding effects of the drug on mood and untreated depression. Dexamphetamine has previously been used under supervision in medically ill patients and appears to be safe and well-tolerated. There is a need for well-designed studies to assess further the safety and efficacy of dexamphetamine in rehabilitation after stroke.

Dexamphetamine treatment in stroke.

Concerns about the toxicities of psychomotor stimulants originate primarily from effects seen at high doses, when stimulants are abused. Low dose use in the apathetic medically ill patient has been generally associated with only minimal, short lived side effects, which are detailed herein. Confusion may be worsened in already delirious patients. Anxiety, psychosis, cardiovascular effects, insomnia, and tremor may occur but infrequently require discontinuation. Appetite is normally stimulated in the medically ill. In fact, stimulants are frequently utilized in the medically ill largely because of their minimal toxicity. The history of U.S. stimulant abuse in the twentieth century is briefly discussed. Abuse of prescribed stimulants appears to be infrequent. Over-zealous concern regarding abuse has previously led to unfortunate declines in appropriate utilization of stimulants, e.g., for attention deficit disorder. Guidelines for prescribing stimulants in light of abuse potential are included.

Scott A. Spier

Papers

Toxicity and Abuse of Prescribed Stimulants