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      European guidelines on managing adverse effects of medication for ADHD

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          Abstract

          The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has therefore reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. However, several areas require further study to allow a more precise understanding of these risks.

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          Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.

          Sarah Lewington, Robert Clarke, Nawab Qizilbash … (2002)
          The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56000 vascular deaths (12000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
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            Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.

            Gerald S. Berenson, Sathanur R. Srinivasan, Weihang Bao … (1998)
            In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people. We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries. The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P<0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P<0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003). These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.
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              The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis

              Guilherme Polanczyk (2007)
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                Author and article information

                Contributors
                : JGraham3@nhs.net
                Journal
                Journal ID (nlm-ta): Eur Child Adolesc Psychiatry
                Title: European Child & Adolescent Psychiatry
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 1018-8827
                ISSN (Electronic): 1435-165X
                Publication date (Electronic): 3 November 2010
                Publication date PMC-release: 3 November 2010
                Publication date (Print): January 2011
                Volume: 20
                Issue: 1
                Pages: 17-37
                Affiliations
                [1 ]Child and Adolescent Psychiatry, The Centre for Child Health, Dundee, UK
                [2 ]Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, Mannheim, Germany
                [3 ]Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany
                [4 ]Karakter Child and Adolescent Psychiatry University Center Nijmegen, Nijmegen, The Netherlands
                [5 ]Centre for Neuroscience, University of Dundee, Dundee, Scotland, UK
                [6 ]Department Child and Adolescent Psychiatry, UZ Gasthuisberg, Leuven, Belgium
                [7 ]Psychosomatic Department, Children’s Hospital, University of Hamburg, Hamburg, Germany
                [8 ]Psychiatry and Psychotherapy of Childhood and Adolescence, University of Cologne, Cologne, Germany
                [9 ]The Hospital for Sick Children, University of Toronto, Toronto, Canada
                [10 ]Section of Developmental Psychiatry, Division of Psychiatry, University of Nottingham, Nottingham, UK
                [11 ]Pediatric Cardiology, University of Göttingen, Göttingen, Germany
                [12 ]Child and Adolescent Psychopathology Unit, Robert Debre Hospital, Paris VII University, Paris, France
                [22 ]Evelina Children’s Hospital, St Thomas’ Hospital, London, UK
                [13 ]Department of Psychological Medicine, Hospital for Children, Great Ormond Street, London, UK
                [14 ]Department of Clinical Neuropsychology, Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, The Netherlands
                [15 ]Social, Developmental and Psychiatry Research Centre, Institute of Psychiatry, London, UK
                [16 ]School of Psychology, University of Southampton, Southampton, UK
                [17 ]Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
                [18 ]University of London and Institute of Child Health, University College London, London, UK
                [19 ]Child Neuropsychiatry, Department of Neuroscience, University of Cagliari, Cagliari, Italy
                [20 ]Department of Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland
                [21 ]MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK
                Article
                Publisher ID: 140
                DOI: 10.1007/s00787-010-0140-6
                PMC ID: 3012210
                PubMed ID: 21042924
                SO-VID: 47e96546-e6cd-442f-8596-5f26df4bfe3f
                Copyright © © The Author(s) 2010
                History
                Date received : 24 March 2010
                Date accepted : 6 October 2010
                Categories
                Subject: Original Contribution
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2011

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: hks,children,adverse,european,guidelines,adhd,medication
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: hks, children, adverse, european, guidelines, adhd, medication

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