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Yim Chan from Psychiatrist Connect, Hariram Ganesh from Pediatrician Nation Commented on a Post
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Considering a combined approach

Methylphenidate is a classic treatment for ADHD in children. Its immediate-release (IR) form lasts between 2 and 4 hours, whereas long-acting, or extended-release (XR), lasts about 8 hours. On its own, immediate-release methylphenidate can be used as a bridge to help children with evening symptoms and homework completion, but this needs to be taken every 4 hours, thus resulting in multiple daily doses.

Systematic literature reviews found IR stimulants to be more widely misused or diverted than XR stimulants, which could be a factor in selecting long-acting treatments that do not need supplementation.

For which patients would it be appropriate to use IR formulations?

What are the key attributes (or benefits) of IR and XR formulations that you consider for individual patients?

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  • from Psychiatrist Connect August 08, 2022
    Extended release ensure better outcomes and compliance It is rare that IR are beneficial in most children
  • from Pediatrician Nation August 08, 2022
    Yes compliance is difficult in immediate release compared to extended release. I prefer concerta.,
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Epigenetics and ADHD: Reflections on Current Knowledge, Research Priorities and Translational Potential - Molecular Diagnosis & Therapy

Attention-deficit/hyperactivity disorder (ADHD) is a common and debilitating neurodevelopmental disorder influenced by both genetic and environmental factors, typically identified in the school-age years but hypothesized to have developmental origins beginning ..... see more

Source : https://link.springer.com/article/10.1007/s40291-022-00609-y



Conclusion: We conclude that the field of epigenetics and ADHD is promising but is still in its infancy, and the potential for transformative translational applications remains a distant goal. Nevertheless, rapid methodological advances, together with the rise of collaborative science and increased availability of high-quality, longitudinal...

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Deciphering the Diversity of Mental Models in Neurodevelopmental Disorders: Knowledge Graph Representation of Public Data Using Natural Language Processing

Background: Understanding how individuals think about a topic, known as the mental model, can significantly improve communication, especially in the medical domain where emotions and implications are high. Neurodevelopmental disorders ..... see more

Source : https://www.jmir.org/2022/8/e39888



Conclusions: We show for the first time that generating KGs from web-based data can capture the complex needs of families dealing with ADHD or ASD. Moreover, we showed points of convergence between families and health professionals’ KGs.

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Association between ADHD and vision problems. A systematic review and meta-analysis - Molecular Psychiatry

To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function. Based on a pre-registered ..... see more

Source : https://www.nature.com/articles/s41380-022-01699-0



Discussion: ADHD is associated with some self-reported and objectively ascertained functional vision problems, but not with structural alterations of the eye. Further studies should clarify the causal relationship, if any, between ADHD and problems of vision.

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Neuropsychiatric risk in children with intellectual disability of genetic origin: IMAGINE, a UK national cohort study

Children with genomic variants and intellectual disability are at an increased risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk. Early genomic investigations of ..... see more

Source : https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00207-3/fulltext



Interpretation: Children with genomic variants and intellectual disability are at an increased risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk. Early genomic investigations of children with intellectual disability could facilitate the identification of the most...

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Oral, intranasal, and intravenous abuse potential of serdexmethylphenidate, a novel prodrug of d-methylphenidate

Abstract Abstract Serdexmethylphenidate (SDX) chloride (Cl) is a novel prodrug of d-methylphenidate (d-MPH). These studies evaluated the abuse potential of SDX Cl when administered orally, intranasally (IN), and intravenously (IV). ..... see more

Source : https://www.tandfonline.com/doi/full/10.1080/03007995.2022.2076474



Conclusions: These findings indicate that the novel d-MPH prodrug, SDX, has lower abuse potential than d-MPH and support its classification as a C-IV controlled substance.


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  • August 02, 2022
    Key Points • Source: Current Medical Research and Opinion • Conclusion: “These findings indicate that the novel d-MPH [d-methylphenidate] prodrug, SDX [serdexmethylphenidate], has lower abuse potential than d-MPH and support its classification as a Show More
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Conclusions: The close association between pediatric OCD, ADHD, and tic disorders can be defined as a specific subtype of pediatric OCD, characterized by more conduct problems, a chronically stable course of OCD symptoms, and poorer treatment outcomes. Correlational analyses in a longitudinal design and the inclusion of an impulsivity scale...

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New Drugs to Treat ADHD: Opportunities and Challenges in Research and Development

Since the landmark MTA (Multimodal Treatment of ADHD) trial unequivocally demonstrated the efficacy of methylphenidate, catecholaminergic drugs, especially stimulants, have been the therapeutic mainstay in treatment of Attention-Deficit Hyperactivity Disorder ..... see more

Source : https://link.springer.com/chapter/10.1007/7854_2022_332



Conclusion: Substantial improvements in ADHD pharmacotherapy have been achieved by the almost exclusive use of once-daily medications and prodrugs, e.g. lisdexamfetamine and Azstarys®, which improve compliance, deliver greater efficacy and reduce risks for diversion and abuse.


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Objective: The study was designed to determine (1) the pharmacokinetic (PK) profile of dexmethylphenidate (d-MPH) after oral administration of three dosage strengths of a new treatment containing d-MPH and a novel prodrug, serdexmethylphenidate (SDX); (2) the dose proportionality of the different SDX/d-MPH dosages; and (3) the steady-state...

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AZSTARYS® (serdexmethylphenidate and dexmethylphenidate)

Sponsored

INDICATION

AZSTARYS is a central nervous system (CNS) stimulant indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients 6 years and older.

 

IMPORTANT SAFETY INFORMATION

WARNING: ABUSE AND DEPENDENCE

  • CNS stimulants, including AZSTARYS, other methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy

Please see additional Important Safety Information below.

ADHD symptom coverage throughout the day with a once-daily dose of AZSTARYS1

AZSTARYS Desktop2

AZSTARYS_Mobile2

 

Available in 3 dosage strengths that may be taken with or without food as part of your patient's morning routine.

aThe mixture should be consumed within 10 minutes and cannot be stored for future use.
 

SEE HOW AZSTARYS CAN MEET YOUR PATIENTS' NEEDS


ADHD, Attention Deficit Hyperactivity Disorder.

IMPORTANT SAFETY INFORMATION (continued)

Contraindications

  • Known hypersensitivity to serdexmethylphenidate, methylphenidate, or other product components. Bronchospasm, rash, and pruritus have occurred with AZSTARYS. Hypersensitivity reactions such as angioedema and anaphylactic reactions have occurred with other methylphenidate products.
  • Concomitant treatment with a monoamine oxidase inhibitor (MAOI) or use of an MAOI within the preceding 14 days, because of the risk of hypertensive crisis.

Warnings and Precautions

  • Sudden death has been reported in association with CNS stimulant treatment at recommended doses in pediatric patients with structural cardiac abnormalities or other serious heart problems. In adults, sudden death, stroke, and myocardial infarction have been reported at recommended doses. Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmias, coronary artery disease, or other serious heart problems.
  • CNS stimulants cause an increase in blood pressure and heart rate. Monitor all patients for hypertension and tachycardia.
  • Exacerbation of Pre-existing Psychosis: May exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. Induction of a Manic Episode in Patients with Bipolar Disorder: May induce a mixed/manic episode in patients with bipolar disorder. Prior to initiating treatment, screen for risk factors for developing a manic episode (e.g., comorbid or history of depressive symptoms, or a family history of suicide, bipolar disorder, or depression). New Psychotic or Manic Symptoms: At recommended doses, may cause psychotic or manic symptoms (e.g., hallucinations, delusional thinking, or mania) in patients without a history of psychotic illness or mania. Discontinue if symptoms occur.
  • Cases of painful and prolonged penile erections and priapism have been reported with methylphenidate products. Immediate medical attention should be sought if signs or symptoms of prolonged penile erections or priapism are observed.
  • CNS stimulants, including AZSTARYS, are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms are usually intermittent and mild; very rare sequelae include digital ulceration and/or soft tissue breakdown. Carefully observe patients during treatment for digital changes. Further evaluation may be required, including referral.
  • CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients. Monitor height and weight at appropriate intervals in pediatric patients. Treatment may need to be interrupted in children not growing or gaining weight as expected.

Adverse Reactions

  • Based on accumulated data from other methylphenidate products, the most common (>5% and twice the rate of placebo) adverse reactions are appetite decreased, insomnia, nausea, vomiting, dyspepsia, abdominal pain, weight decreased, anxiety, dizziness, irritability, affect lability, tachycardia, and blood pressure increased.

Drug Interactions

  • Adjust dosage of antihypertensive drug as needed. Monitor blood pressure.
  • Avoid use of AZSTARYS on the day of surgery if halogenated anesthetics will be used.

Please click here for Full Prescribing Information, including Boxed WARNING.
 

Reference: 1. AZSTARYS. Prescribing information. Corium Inc; 2021. 

 

CoriumLogo

 

AZSTARYSLogo

© 2022 Corium, Inc. All Rights Reserved.
COM-AZS-002179 05/22

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Late offspring effects of antenatal thyroid screening - PubMed

doi: 10.1093/bmb/ldac018. Online ahead of print. 1 Endocrinology and Diabetes Department, Prince Philip Hospital, Llanelli, UK. 2 Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK. 3 Diabetes Department, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35868487/


Relevance: Thyroid dysfunction in pregnancy is associated with adverse offspring outcomes and recent birth-cohort studies suggest that even mild degrees of thyroid dysfunction may be linked with a range of late cognitive and behavioural effects in childhood and adolescence.

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Steady-state visual evoked potentials in children with neurofibromatosis type 1: associations with behavioral rating scales and impact of psychostimulant medication - PubMed

Impaired processing of rhythmic visual stimulation was evidenced in children with NF1 through measures of SSVEP responses. Those responses seem to be more reduced in children with NF1 who exhibit ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35869419/



Conclusions: Impaired processing of rhythmic visual stimulation was evidenced in children with NF1 through measures of SSVEP responses. Those responses seem to be more reduced in children with NF1 who exhibit more symptoms of inattention and emotional/behavioral problems in their daily life. SSVEPs are potentially sensitive...

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Sleep EEG evidence of delayed brain maturation in attention deficit hyperactivity disorder: a longitudinal study

You do not currently have access to this article. Don't already have an Oxford Academic account? Register Sleep EEG evidence of delayed brain maturation in attention deficit hyperactivity disorder: a ..... see more

Source : https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsac163/6648473?redirectedFrom=fulltext&login=false



Conclusions: This is the first longitudinal study to reveal electrophysiological evidence of a maturational lag associated with ADHD. In addition, our findings revealed basically unaltered sleep macrostructure but altered sleep homeostasis associated with ADHD.

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Altered neural flexibility in children with attention-deficit/hyperactivity disorder - Molecular Psychiatry

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, and is often characterized by altered executive functioning. Executive function has been found to be supported by ..... see more

Source : https://www.nature.com/articles/s41380-022-01706-4



Conclusion: The present study found that neural flexibility is altered in children with ADHD and demonstrated the potential clinical utility of neural flexibility to identify children with ADHD, as well as to monitor treatment responses and disease severity.

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Homicidal Ideation in Youth With Attention-Deficit/Hyperactivity Disorder

This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher's ..... see more

Source : https://www.psychiatrist.com/pcc/neurodevelopmental/adhd/homicidal-ideation-youth-with-attention-deficit-hyperactivity-disorder/



Relevance: Large-scale homicides and mass shootings are increasingly prevalent in the United States. While a complex interplay of personal and social motivations drives perpetrators, public attention often turns to the role of psychiatric illnesses. Child psychiatrists are often called to assess, predict, and mitigate the risk of violence...

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  • July 20, 2022
    Key Points • Source: The Primary Care Companion for CNS Disorders • Relevance: “We present the case of a 14-year-old patient with attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD), admitted for homicidal ideations Show More
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Amygdala subnuclei volumes and anxiety behaviors in children and adolescents with autism spectrum disorder, attention deficit hyperactivity disorder, and obsessive-compulsive disorder - PubMed

Alterations in the structural maturation of the amygdala subnuclei volumes are associated with anxiety behaviors in adults and children with neurodevelopmental and associated disorders. This study investigated the relationship between ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35819018/


Conclusion/Relevance: Amygdala subnuclei volumes may be key to identifying children with neurodevelopmental disorders or those with OCD who are at high risk for anxiety. Findings may inform the development of targeted behavioral interventions to address anxiety behaviors and to assess the downstream effects of such interventions.

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Case of Treatment-Resistant Aggression in the Context of a Medically Underserved Community

Aggression tends to decrease as a child matures and develops conflict resolution skills. However, aggression can persist if children are exposed to consistent negative stimuli, such as poor parenting and ..... see more

Source : https://www.cureus.com/articles/99601-case-of-treatment-resistant-aggression-in-the-context-of-a-medically-underserved-community



Conclusion: It is imperative that current primary care physicians, such as pediatricians and family medicine physicians, in underserved areas receive training necessary to recognize and address relevant psychosocial contributors. Ultimately, the overarching solution is to improve access to mental healthcare services, especially for low...

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A Robust Movement Quantification Algorithm of Hyperactivity Detection for ADHD Children Based on 3D Depth Images

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental disorders. Hyperactivity is a typical symptom of ADHD in children. Clinicians diagnose this symptom by evaluating the ..... see more

Source : https://ieeexplore.ieee.org/document/9829220



Relevance: In movement detection, we explore a new local search algorithm to detect any potential motions of children based on three newly designed evaluation metrics. In the movement quantification, two parameters are investigated to quantify the participation degree and the displacements of each body part in the movements. This system is...

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How interactions between ADHD and schools affect educational achievement: a family-based genetically sensitive study - PubMed

doi: 10.1111/jcpp.13656. Online ahead of print. 1 PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway. 2 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35789088/


Conclusions: Although ADHD symptoms and genetic risk tend to hinder achievement, schools where their effects are weaker do exist. Differences between schools in support for children with ADHD should be evened out.