Showing papers on "Hyperkinetic disorder published in 2020"
TL;DR: This guideline updates and replaces the previous NICE guideline CG72 (2008) and was used in conjunction with NICE technology appraisal guideline TA98 (2006), which covered some of the treatments for ADHD, such as methylphenidate, atomoxetine and dexamfetamine.
Abstract: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobiological disorders of childhood. ADHD is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (Text Revision) (DSM-V-TR) and is termed ‘hyperkinetic disorder’ in the International Classification of Diseases, 10th revision (ICD-10).1
There are three principle features of ADHD:
The diagnosis is based on a combination of these symptoms, in excess of what is normal for age or developmental stage. There is likely to be considerable impact on a child’s social, emotional and cognitive development, resulting in significant difficulties within the home, social and educational settings.
A meta-analysis of 154 studies estimated a worldwide prevalence of around 5% using the ICD/DSM criteria.2 A further 5% of children are thought to have substantial difficulties with these symptoms but do not meet the diagnostic threshold for diagnosis.3
This guideline updates and replaces the previous NICE guideline CG72 (2008). This was used in conjunction with NICE technology appraisal guideline TA98 (2006), which covered some of the treatments for ADHD, such as methylphenidate, atomoxetine and dexamfetamine.
This guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health (NCCMH), a collaboration of organisations within the mental health field. There was input from service users, carers and professionals from psychiatry, paediatrics, clinical psychology, education, general practice, nursing and child and adolescent mental health services. The guideline is intended for use in children over the age of 3 years up to adulthood. See box 1 for a link to the full …
62 citations
TL;DR: The SNAP-IV is a valid outcome measure for use in randomized controlled trials and clinical settings, and is best used as a screening rather than a diagnostic tool for ADHD.
Abstract: The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) is a widely used scale that measures the core symptoms of attention deficit hyperactivity disorder (ADHD). However, there are contradictory findings regarding factor structure. Factor structure and measurement equivalence/invariance analysis on parent and teacher SNAP-IV for children referred for an ADHD assessment (N = 250; 6-17 years), revealed a two-factor structure provided the best fit. SNAP-IV scores were also compared with clinician diagnosis of ADHD and research diagnoses of ADHD and hyperkinetic disorder. Parent ratings of inattention and hyperactivity/impulsivity were good predictors of research but not clinician diagnosis. For teacher ratings, only hyperactivity/impulsivity scores were associated with research and clinician diagnosis. SNAP-IV scores showed high sensitivity but low specificity to clinician diagnosis. The SNAP-IV is a valid outcome measure for use in randomized controlled trials and clinical settings, and is best used as a screening rather than a diagnostic tool for ADHD.
52 citations
TL;DR: Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group, and concurrent dispensations of multiple addictive drugs were common in this population.
Abstract: It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates the use of dispensed ADHD medications in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of ADHD medications, co-dispensations of other potentially addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are investigated. Information about all dispensed ADHD medication, OAT opioids, and the defined potentially addictive drugs were recorded from the Norwegian Prescription Database. Dispensation rates, the types, and the doses of dispensed ADHD medications were estimated by summarizing the number of dispensations, and the dispensed doses. Logistic regression analyses were employed to assess the associations between ADHD medication, and OAT opioid use, and dispensations of other potentially addictive drugs and DAAs against hepatitis C infection. A total of 9235 OAT patients were included. The proportion of patients who were dispensed ADHD medication increased from 3.5 to 4.6% throughout the study period. The three most dispensed CAS were short- and intermediate-acting methylphenidate (55%), lisdexamphetamine (24%), and dexamphetamine (17%) in 2017. Buprenorphine, rather than methadone, as OAT opioid (adjusted odds ratio: 1.6, CI: 1.2–2.1) was associated with being dispensed ADHD medication. Among patients who received CAS and OAT opioids each calendar year, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). Sixty percent of patients receiving ADHD medications were also dispensed other addictive drugs concomitantly in 2017. Similar results were found in 2015 and 2016. Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs were common in this population. Understanding the underlying reasons for such prescribing is essential, and research on how to optimize ADHD medication of patients with ADHD receiving OAT is needed.
10 citations
TL;DR: The pharmacotherapy for ADHD is well established but needs systematic evaluation in Intellectual Disability (ID) populations and the evidence base is limited, though promising, for dexamfetamine, clonidine, and guanfacine.
Abstract: ADHD causes significant distress and functional impairment in multiple domains of daily life. Therefore, diagnosis and treatment are important to improve the quality of life of people. The pharmaco...
9 citations
TL;DR: Delivering hyperpolarizing currents into the STN readily alleviated the hyperkinetic behaviors in the two animal models and in the clinical case, with an evident increase in subthalamic burst discharges in electrophysiological recordings.
Abstract: Modulation of subthalamic nucleus (STN) firing patterns with injections of depolarizing currents into the STN is an important advance for the treatment of hypokinetic movement disorders, especially Parkinson’s disease (PD). Chorea, ballism and dystonia are prototypical examples of hyperkinetic movement disorders. In our previous study, normal rats without nigro-striatal lesion were rendered hypokinetic with hyperpolarizing currents injected into the STN. Therefore, modulation of the firing pattern by injection of a hyperpolarizing current into the STN could be an effective treatment for hyperkinetic movement disorders. We investigated the effect of injecting a hyperpolarizing current into the STNs of two different types of hyperkinetic animal models and a patient with an otherwise uncontrollable hyperkinetic disorder. The two animal models included levodopa-induced hyperkinetic movement in parkinsonian rats (L-DOPA-induced dyskinesia model) and hyperkinesia induced by an intrastriatal injection of 3-nitropropionic acid (Huntington disease model), covering neurodegeneration-related as well as neurotoxin-induced derangement in the cortico-subcortical re-entrant loops. Delivering hyperpolarizing currents into the STN readily alleviated the hyperkinetic behaviors in the two animal models and in the clinical case, with an evident increase in subthalamic burst discharges in electrophysiological recordings. Application of a hyperpolarizing current into the STN via a Deep brain stimulation (DBS) electrode could be an effective general therapy for a wide spectrum of hyperkinetic movement disorders.
7 citations
TL;DR: Patients, for example, with externalizing symptoms were more prone to receive medication and/or psychotherapy than the average child diagnosed with ADHD in case of equal access to both treatment options.
Abstract: Objective: The aim of this study is to identify characteristics predicting the use of medication and/or psychotherapy after a first ADHD diagnosis. Method: This cohort study was based on German claims data including 12,250 treatment-naive children aged 5 to 12 years with an incident ADHD diagnosis in 2010. Logistic regression models were used to estimate associations between children's characteristics at first diagnosis and the chosen treatment within the following 5 years. Results: Medication use was associated with male sex, an ADHD diagnosis "with hyperactivity," comorbid depression, and comorbid developmental and conduct disorders. Male sex and comorbid neurotic and somatoform, conduct, and emotional disorders were associated with psychotherapy only. Receiving both treatments-instead of medication only-was associated with comorbid depression, neurotic and somatoform, conduct, and emotional disorders. Conclusion: In case of equal access to both treatment options, patients, for example, with externalizing symptoms were more prone to receive medication and/or psychotherapy than the average child diagnosed with ADHD.
6 citations
TL;DR: The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.
Abstract: Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people.,Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline.,Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis.,Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence.,The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.,This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.
4 citations
TL;DR: Lamotrigine monotherapy holds the largest body of evidence, concluding that no significant risk of ADHD exists among the offspring, and Disentangling the effect of AEDs from epilepsy itself and examining polytherapy are challenges that merit additional investigations.
Abstract: The use of maternal antiepileptic drug (AED) during pregnancy is associated with an increased risk of cognitive adverse effects among the offspring. As new-generation AEDs continue to enter the market, evidence on their safety during pregnancy is limited yet necessary. To date, there are no published reviews summarizing the evidence of new-generation AED exposure in utero and the development of attention deficit-hyperactivity disorder (ADHD) in the offspring. The objective of this scoping review is to summarize the available evidence on the risk of ADHD after maternal exposure to new-generation AEDs during pregnancy. We searched EMBASE and MEDLINE for articles published from January 1988 to April 2020. New-generation AEDs were considered if marketed after 1988. ADHD was defined as attention-deficit hyperactivity disorder, hyperkinetic disorder, hyperkinesis, or conduct disorder. Of the total articles screened (n = 805), eight publications were finally included (seven cohort studies and one systematic review). Across the studies, the sample size of pregnant women exposed to AEDs ranged from 1 to 1383. Monotherapy was examined in six studies (mostly lamotrigine), while only two studies examined polytherapy. The included studies reported a range of adjusted relative risks, from 0.84 [0.59-1.19] to 1.63 [0.41-6.06]. Lamotrigine monotherapy holds the largest body of evidence, concluding that no significant risk of ADHD exists among the offspring. However, the available evidence is considered scarce and has several methodological limitations. Disentangling the effect of AEDs from epilepsy itself and examining polytherapies are challenges that merit additional investigations. Further comparative safety studies with longer follow-up periods and large sample sizes are needed to accurately quantify the true impact of new-generation AED exposure during pregnancy and ADHD in children.
3 citations
01 Oct 2020
TL;DR: The diagnostic prevalence of psychiatric disorders was different according to age and sex, and these patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients.
Abstract: Objectives This study aimed to examine the trend in diagnostic prevalence of psychiatric disorders in children and adolescents. Methods Individuals aged 0-18 years were included in the study based on the National Health Insurance Claims Data. To investigate the trends in diagnosis and diagnostic prevalence of psychiatric disorders reflecting the decrease in the birth rate, data were analyzed from 2010 as a reference year to 2015. Results The number of patients diagnosed with psychiatric disorder decreased annually, from 23,412 on 2010 to 18,821 on 2015. The most common disorder was hyperkinetic disorder in male and depressive episode in female. Although there was no significant change in overall diagnostic prevalence rate of psychiatric disorders, age groups <10 years and some disorders had significant changes in prevalence rate. This study classified the diagnostic prevalence by age into two unique patterns: group in which the diagnosis rate increases with age and group in which the diagnosis rate peaks at a certain age and then decreases. Conclusion Diagnostic prevalence of psychiatric disorders was different according to age and sex. These patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients. It is urgent to identify how these patterns change in young adults.
3 citations
Journal Article•
TL;DR: The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents.
Abstract: INTRODUCTION The eleventh revision of the International Classification of Diseases (ICD-11) is planned to be published in 2018. So called, "beta version" of the chapter of mental and behavioral disorders (ICD-11) is already available and it is considered that there will be no significant deviations in the final version. The DSM-5 was released in 2013. Changes related to mental disorders in child and adolescent psychiatry have been made in both of these classifications. To identify changes in the classifications of mental disorders in childhood and adolescent age in beta version of ICD-11 and DSM-5. METHODS Review of mental disorders in childhood and adolescent age and their classification in ICD-11 and DSM-5. RESULTS For disorders that are classified as "mental retardation" in ICD-10, a new term "intellectual development disorders" has been introduced in ICD-11, ie "intellectual disabilities" in DSM-5. Hyperactivity disorders and attention deficit is a separate entity in relation to ICD-10, in which it is classified as a hyperkinetic disorder. Asperger's syndrome, which is isolated from autism spectrum disorders in DSM-5, does not appear under that name in ICD-11 either. Elimination disorders are in a separate block MKB-11 and DSM-5. Speech and language disorders are classified as communication disorders in the DSM-5 classification. Selective mutism and anxiety separation disorder in childhood are in the block of anxiety and fear-related disorders in ICD-11, and among anxiety disorders in DSM-5, respectively. Reactive emotional disorder and disinhibited attachment disorder of childhood are classified as stress-related disorders in ICD-11 and DSM-5. CONCLUSIONS The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents. New entities have also been formed.
2 citations
15 Dec 2020
TL;DR: The study highlights school refusal as a symptom of one or two psychiatric disorder rather than psychosocial distress alone, indicating high psychiatric morbidity.
Abstract: Background: School refusal is not a diagnosis by itself but a behavior described when a child frequently refuses to go to school or remain in school. It is often associated with several psychiatric disorders. A prevalence rate of 5-10% is described in most studies. Several psychosocial factors, individual, familial, societal, school and medical are also known to play an important role. The study intends to explore the association of school refusal to either psychiatric disorder or to distress due to psychosocial factors.
Aim: To explore the psychosocial factors and psychopathology in children presented with school refusal.
Materials and Method: A descriptive study conducted on children attending Child and Adolescent Psychiatry OPD at ASHA Hospital with primary complaint of school refusal, from January 2018 to December 2018. Data pertaining to 33 new cases of school going children between 6 years and 18 years, with school refusal as main symptom were collected using a semi structured proforma. Various psychosocial factors which were broadly classified as individual, family, school, societal factors and other medical disorders were analyzed. Psychiatric diagnosis made using ICD 10 criteria was assessed. Data analyzed using SPSS software.
Results: About 6.6% of total new child cases in the year of 2018 were with primary complaint of School Refusal. Out of these 33 subjects, 30 (91%) had a psychiatric diagnosis at baseline. Depressive disorder (36.4%) was commonest followed by anxiety disorder (18.2%), conduct disorders (15.1%) and remaining Hyperkinetic disorder, mental retardation and bipolar disorders. Psycho-social factors influenced school refusal contributing to the psychiatric disorder.
Conclusion: The study highlights school refusal as a symptom of one or two psychiatric disorder rather than psychosocial distress alone, indicating high psychiatric morbidity. Further it emphasizes that the symptom need to be taken as an emergency and intervened. This would e
TL;DR: The review presents current data on the nature of cognitive deficit in children with hyperkinetic disorder, and possible pathophysiological mechanisms of the disease.
Abstract: The review presents current data on the nature of cognitive deficit in children with hyperkinetic disorder, and possible pathophysiological mechanisms of the disease. Considering possible neurobiological components of hyperkinetic disorder, attention is given to pathological functional connections underlying specific clinical manifestations of the disease.
TL;DR: This work will evaluate the performance of absolute difference method and adjusted method in a simulation study and propose a new method to adjust to the RTM effect.
Abstract: In order to show the effect of treatment, the change between two repeated psychometric measurements at the individual level should be estimated. The simplest method is to calculate the absolute dif...
01 Apr 2020
TL;DR: The hypothesis that pathological and steady increase in anxiety level leads to increase in the impulsivity level in children with hyperkinetic disorder is supported, causing an increase of anxiety level and aggravating the imbalance of the activity of monoamine systems.
Abstract: Clinical and biochemical features of anxiety in children with a hyperkinetic disorder, also known as a combined type of ADHD, have not been studied, although these data are extremely necessary for therapeutic intervention in cases of comorbidity of hyperkinetic and anxiety disorders. Objective: to study pathogenetic mechanisms and the role of anxiety level in the formation of the main symptoms of the disorder. Materials and methods. We examined 182 children with hyperkinetic disorder and 60 peers from control group aged 6–10 years. After clinical examination we studied the content of monoamines, their precursors, and metabolic products in daily urine. Assessment of the main clinical symptoms (inattention, hyperactivity, impulsivity) was carried out on the SNAP-IV scale. An assessment of the level of anxiety was carried out according to the questionnaire Lavrentieva G.P. and Titarenko T.M. Patients with hyperkinetic disorder were divided into subgroups according to the nature of the monoaminergic “profile”. The results of the study support the hypothesis that pathological and steady increase in anxiety level leads to increase in the impulsivity level in children with hyperkinetic disorder. And the main role in this process is played by the noradrenergic system and the weakening of the inhibitory effect of serotonin, causing an increase of anxiety level and aggravating the imbalance of the activity of monoamine systems.
04 Mar 2020
TL;DR: Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder with symptoms of hyperactivity, impulsivity, and inattention that is more common in children and adolescents.
Abstract: Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder with symptoms of hyperactivity, impulsivity, and inattention.1 It is estimated that the prevalence of ADHD worldwide is 5.29% in children and adolescents, and it is more common in males.2 ADHD is known as Hyperkinetic Disorder by the World Health Organization (WHO), and over a person’s lifetime, the symptoms and impact of the condition may vary considerably.2
Guidelines state symptoms must meet either International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria; cause moderate to severe functional impairment; and occur in more than one setting.1–4 Assessment for ADHD includes a thorough clinical examination, and a full developmental and psychosocial history, alongside information gathering from the family and school.1 ADHD must be diagnosed by a paediatrician, psychiatrist, or ADHD specialist.
Early diagnosis and intervention improves educational outcomes for children and is important for their social …