ADHD lyfin

Ég hef verið að glíma við veikindi sem valda því að ég er rúmliggjandi, get ekki unnið, og get ekki gert neitt sem ég hef gaman að. Hér er ætlun mín að skrifa um þau lyf sem hjálpa mér mest; og það sem veldur því að ég fæ ekki eins góða aðstoð og ég gæti fengið.

ADHD lyfin sem við einbeitum okkur að í þessari grein eru Elvanse (lisdexamfetamine), Attentin (dextroamphetamine), og methylphenidate lyfin.

Framleiðandi lyfs skrifar uppástungu um vanalegan lágmarks og hámarksskammt þessara lyfja (og annarra). Á Íslandi er vanalegur hámarksskammtur Elvanse 70 mg, en vanalegur hámarksskammtur Attentin er 40 mg. Í Bandaríkjunum er vanalegur hámarksskammtur Attentin 60 mg (fyrir drómasýki). Sjá orðalag: "Usual dose is 5 to 60 mg per day in divided doses, depending on the individual patient response".

Markmið læknis er að skrifa upp á skammt sem hámarkar svörun á meðan hann lágmarkar aukaverkanir og áhættu. Lækni er leyfilegt að skrifa upp á skammt sem er hærri en vanalegur hámarksskammtur. Þetta er ekki óalgengt með ADHD lyfin. Sjúklingar eru einstaklingar og svara lyfjunum misvel. Gott er að hafa í huga að uppástunga framleiðanda um vanalegan hámarksskammt er viðmið en ekki ófrávíkjanlegar reglur.

"[...] Elvanse um skammtastærðir að vettugi, segir Karl [formaður Geðlæknafélags Íslands] geðlæknum á Íslandi heimilt að skrifa út stærri skammta ef þeir telja það nauðsynlegt. Það sama gildi á Norðurlöndunum. "

Alma D. Möller, Landlæknir: "En það má heldur ekki gleyma því að í undantekningartilvikum þá geta stærri skammtar átt rétt á sér."

Markmið þessarar greinar er að skoða gögn um vanalega hámarksskammta, og ræða notkun Elvanse og Attentin við ADHD, geðhvarfasýki (bipolar disorder), geðklofa (schizophrenia), þunglyndi, drómasýki (narcolepsy) og fíknisjúkdómum.

Vanalegur hámarksskammtur

Review of the Impact of Exceeding Recommended Doses

Hér skoðum við ástralska rannsókn á því að fara fram úr vanalegum hámarksskammti við meðferð á ADHD.

Lykilniðurstöður:

• Það eru engin vísindaleg gögn fyrir vanalegum hámarksskammti lyfjanna. Vanalegur hámarkskammtur er byggður á hefð frekar en sönnunargögnum.
• Skammtinn á að velja með því að auka hann hægt og rólega, og hámarka svörun án alvarlegra aukaverkanna. Hjá sumum sjúklingum þýðir þetta að fara þurfi yfir vanalegan hámarksskammt.
• Höfundar benda á að skammtinn ætti að hafa eins lítinn og hægt er, en þó eins háan og þörf er á.
• Sumir sjúklingar geta verið óvenjulegir, eða svara skammti fyrir utan vanalegan hámarks- og lágmarksskammt.
• Lítið er vitað um einstaklinga sem fá ekki nægilega bót sinna mála á vanalegum hámarksskammti.
• Háan skammt (Attentin > 50 mg, Elvanse > 70 mg) má nota í Ástralíu eftir umsókn til NSW MoH.
• Engar alvarlegar aukaverkanir komu fram hjá einstaklingum á hærri en vanalegum hámarksskammti.

Rannsóknin:

https://pubmed.ncbi.nlm.nih.gov/32300972/

Dose Adjustment of Stimulants for Children with Attention-Deficit/Hyperactivity Disorder: A Retrospective Chart Review of the Impact of Exceeding Recommended Doses

In stimulant-treated attention-defcit/hyperactivity disorder (ADHD), the optimal dose is determined by titration followed by ongoing dose adjustment over time, aiming for maximum efficacy without unacceptable side effects [1, 2]. Little is known about children who are not adequately treated when they reach a designated maximum dose, or the consequences of exceeding this dose.

Although there are many studies demonstrating the efficacy of stimulants for children with ADHD, there is a distinct paucity of scientific data to support maximum dose limits for stimulant medication, with current practices guided by convention rather than evidence [3].

The New South Wales (NSW) Ministry of Health (MoH) defines high dose (HD) as methylphenidate > 2 mg/kg/ day or > 108 mg/day; dexamphetamine > 1 mg/kg/day or >50 mg/day; lisdexamfetamine >70 mg/day [4]. HD may be approved by application to the NSW MoH including supporting documentation from the teacher. This retrospective cohort study compares the clinical characteristics and outcomes of children in whom the dose was adjusted over time to HD stimulant medication with a cohort treated optimally with regular dose (RD) medication.

is a pediatrician who prioritises dose optimisation, continuing dose adjustment into the HD (high dose) range if necessary

was obtained from the NSW MoH for all HD prescribing; all parents were aware that the dose exceeded the recommended maximum. While parents did not give specific written consent for HD, all contributed to the HD application by collecting the requisite documentation confirming medication efficacy at school.

Electronic records identified 52 HD and 118 RD children.

No serious complications (seizures, psychosis, heart attacks, strokes) occurred in either cohort.

this retrospective chart review, stimulant dose optimisation was based on the assessment of benefit versus adverse effects and was guided by reports of functioning at school and at home. In our practice, this meant that a significant number of children were taking more than the specified maximum dose.

Reassuringly, we did not find any significant effect of HD stimulant on blood pressure.

In 1989, Davy and Rogers promoted the principle “as small as possible but as high as necessary” [2]. Our study finally provides some clinical data derived from following this approach.

A physician’s goal is to find the most effective treatment for each patient. Some patients may be atypical or respond to a dose outside the previously tested range. It is important for such experience to be shared, so that over time the treatment options for a condition may increase, benefitting the affected individuals.

The work presented in this paper provides preliminary evidence of the efficacy and tolerability of exceeding the recommended doses of stimulants when treating ADHD. The children whose dose of stimulant was adjusted into the HD range to optimise functioning experienced more growth attenuation but recorded no other significant treatment complications. Where there was a perception of clinical benefit, HD stimulant was continued because this was felt by the parents to be in their child’s best interests. Determining the dose purely on clinical grounds by careful dose adjustment over time appears reasonable, but more data from better controlled studies are required to clarify the efficacy and tolerability of exceeding the recommended doses of stimulants when treating ADHD.

When children with attention-deficit/hyperactivity disorder (ADHD) are treated with stimulant medication, the dose is established clinically by dose adjustment over time. Little is known about children who are not adequately treated when they reach a designated maximum dose, or the consequences of exceeding this dose.

(high dose) was defined as methylphenidate >2 mg/kg/day or >108 mg/day; dexamphetamine >1 mg/kg/day or >50 mg/day; lisdexamfetamine >70 mg/day. In all children, the dose was adjusted over time to optimise the clinical response

Apart from growth attenuation, no serious complications were reported in the HD (high dose) group.

Conclusions: In this preliminary study, dose adjustment over time in some patients meant using higher doses than those generally recommended. Determining the dose purely on clinical grounds by careful dose adjustment over time appears reasonable, but more data on this issue is required to clarify the efficacy and tolerability of exceeding the recommended doses of stimulants when treating ADHD.

Drómasýki (e. narcolepsy)

Hér skoðum við bandaríska rannsókn á meðhöndlun drómasýki (e. narcolepsy). Í henni kemur fram gagnrýni á það að læknar skrifi oft ekki upp á meira en vanalegan hámarksskammt, sem bitnar á þessum sjúklingum.

Ath. að vanalegur hámarksskammtur Attentin (dextroamphetamine) í Bandaríkjunum er 60 mg, en er 40 mg á Íslandi. Þrátt fyrir þetta virðast 60 mg ekki duga fyrir þennan sjúklingahóp.

Drómasýki (e. narcolepsy) er taugasjúkdómur sem veldur því að viðkomandi getur ekki verið vakandi né sofandi í meira en nokkrar klukkustundir í senn. Þessi sjúkdómur veldur því að sjúklingar standa sig illa í vinnu og í félagslegum aðstæðum. Þar er eitt versta einkennið yfirþyrmandi dagsyfja (e. excessive daytime sleepiness). Þessi sjúkdómur veldur fötlun hjá mörgum, þ.a. þeir geta ekki unnið, með tilheyrandi áhrifum á félagslíf og líðan.

Lykilniðurstöður:

• 60 mg af Attentin (dextroamphetamine) dugir ekki til þess að stjórna dagsyfju og frammistöðuvandamálum sem þessi hópur glímir við.
• Sjúklingum með drómasýki á lyfjameðferð gengur illa í vinnu og illa félagslega (vanalegur hámarksskammtur er ekki nógu hár)
• Margir sjúklingar með drómasýki hætta á örvandi lyfjum því þeir telja þau ekki virka nógu vel. (Vanalegur hámarksskammtur ekki nógu hár).
• Höfundar benda á að þessir sjúklingar hafi ekki fengið að prófa nægilega háan skammt af Attentin (dextroamphetamine) því læknar þori oft ekki að fara fram yfir vanalegan hámarksskammt.
• Desoxyn (methamphetamine) frá 40 til 60 mg dugir til þess að þessi hópur getur staðið sig eins vel og venjulegt fólkl (e. healthy controls). Þ.e. það dugir til þess að þetta fólk gæti unnið og sinnt félagslífi.
  Desoxyn (Methamphetamine) er eingöngu í boði í Bandaríkjunum; en hærri skammtar en 60 mg af Attentin ættu að geta virkað eins vel.

Rannsóknin:

https://pubmed.ncbi.nlm.nih.gov/8341891/

Methamphetamine og drómasýki.

Eight pairs of subjects (each consisting of a narcoleptic and a control matched on the basis of age, sex, educational background and job) were evaluated under the following double-blind, randomized treatment conditions: baseline, placebo, low dose and high dose methamphetamine.

Previous studies have described marked differences between narcoleptics and normal controls with respect to physiological measures of arousal and ability to perform sedentary tasks requiring sustained attention (7,16). Our previous work has shown that treatment of narcolepsy with centrally acting sympathomimetics or other stimulants reduces, but does not eliminate, somnolence or performance deficits (7). Among these compounds, only dextroamphetamine and methyl-phenidate have narcolepsy listed as an indication. Not surprisingly, these two drugs are the most commonly prescribed pharmacotherapies for narcolepsy (17). However, using objective measures we have found that treatment with dextroamphetamine or methylphenidate, given in divided doses as large as 60 mg per day, does not normalize sleep tendency or performance (7). Furthermore, surveys indicate that narcoleptics receiving pharmacological treatment report that they function poorly at work and in social situations (17,18). It is likely that efforts to eliminate pathological somnolence with central nervous system (CNS) stimulants are not attempted due to physician concern regarding side effects and physician reluctance to prescribe doses of stimulants in excess of manufacturer’s suggested dosage levels (17,19,20). This survey also found that many narcoleptics discontinue use of all stimulant drugs because of perceived ineffectiveness and/or factors relating to drug availability. Our current findings may have profound implications for the management of disabled narcoleptics, who have never had an adequate trial of a stimulant at a dose that controls daytime somnolence and performance deficits to a point that permits essentially normal function throughout the day. Methamphetamine at doses of 40-60 mg allowed narcoleptics to function at levels comparable to those of unmedicated controls.

Geðklofi (e. schizophrenia)

Geðklofi (e. schizophrenia) er alvarlegur, krónískur, og hamlandi sjúkdómur. Núverandi meðferð með geðrofslyfjum tekur ekki á neikvæðum einkennum geðklofa, og getur gert neikvæð einkenni verri. Neikvæðu einkennin geta verið sérstaklega hamlandi. Þörf er á nýjum lausnum á því svæði.

Hér ætlum við að skoða þrjár rannsóknir, sú fyrsta er bandarísk.

Lykilniðurstöður:

• Ómeðhöndluð neikvæð einkenni geðklofa valda skerðingu á getu til að vinna, skerðingu á getu til að sinna félagslífi, og skerðingu á almennum lífsgæðum.
• Þörf er á áhrifaríkri meðferð á neikvæðum einkennum geðklofa.
• Meðferð á stabílum sjúklingum með geðklofa með örvandi lyfjum (methylphenidate, dextroamphetamine) gaf marktæka bætingu á neikvæðum einkennum, með ómarktækri hækkun á jákvæðum einkennum
• Önnur rannsókn sýndi að sjúklingar með mikil neikvæð einkenni svöruðu amfetamín meðferð. Meðferð með örvandi lyfjum getur aðstoðað ákveðin hóp með neikvæð einkenni (með stjórn á jákvæðum einkennum).
• Meðferð með allt að 250 mg af Elvanse (lisdexamfetamine) á stabílum sjúklingum með geðrof gekk án vandkvæða. Þessi hái skammtur var valinn vegna þess að geðrofslyfin minnka áhrif Elvanse á taugakerfið, kenning höfunda var því að þessir sjúklingar þyrftu hærri skammt en vanalegan hámarksskammt. Engar alvarlegar aukaverkanir komu upp.
• Mestar bætur komu fram hjá sjúklingum sem tóku meira en 150 mg af Elvanse (lisdexamfetamine).
• Geðrofslyfin geta gert neikvæðu einkennin verri.
• Bæting á vitsmunalegri getu geðrofssjúklinga kemur fram á d-amphetamine meðferð.

Hér fyrir neðan set ég inn rannsóknirnar.

Rannsóknirnar:

https://pubmed.ncbi.nlm.nih.gov/25310201/

Safety and Pharmacokinetics of Lisdexamfetamine Dimesylate in Adults With Clinically Stable Schizophrenia A Randomized, Double-Blind, Placebo-Controlled Trial of Ascending Multiple Doses

Schizophrenia is a severe, chronic, and debilitating mental illness, which has a lifetime median prevalence of 4.6 per 1000.1 Negative symptoms of schizophrenia (NSS), which occur in up to 30% of patients,2 include blunted affect, alogia, avolition/ apathy, and anhedonia/asociality.3–5 Current pharmacologic treatments of schizophrenia have not demonstrated clinically important reductions in NSS.2,6–9 Persistence of such symptoms is associated with ongoing functional impairments including poor global psychosocial functioning, greater impairments in relationships and work activities, and reduced quality of life.6,10 Therefore, the need for effective NSS treatments remains.8,11

Several neurotransmitter systems have been implicated in the pathophysiology of schizophrenia (eg, dopamine, glutamate, γ-aminobutyric acid, serotonin, the cholinergic system). However, the primary focus of research has been on dopaminergic hyperactivity in subcortical regions.5,12,13 In contrast, dopaminergic hypoactivity in the prefrontal cortex has been implicated in the development of NSS.5,12

In stable outpatients with predominant NSS, psychostimulant treatment significantly decreased negative symptoms with a nonsignificant increase in positive symptoms.15 In a study by Sanfilipo et al,16 a subset of patients with schizophrenia who had more severe baseline negative symptoms had reduced NSS with amphetamine treatment. Therefore, dopamine-enhancing pharmacotherapies such as psychostimulants may be beneficial for selected patient populations with NSS (ie, those with adequate control of positive symptoms).17,18

Lisdexamfetamine dimesylate (LDX), a prodrug of d-amphetamine, is approved for the treatment of attention-deficit/ hyperactivity disorder (ADHD). After oral ingestion, LDX is converted to l-amphetamine and active d-amphetamine.19 However, because antipsychotic medications (eg, chlorpromazine and haloperidol) block dopamine receptors and inhibit the central stimulant effects of amphetamines,20,21 we hypothesized that patients with schizophrenia and predominant NSS who are maintained on a stable dose of antipsychotic medication may require a higher dose range of LDX to achieve optimal beneficial outcomes than the doses of LDX (20–70 mg/d) approved for the treatment of ADHD. There have been no studies on multiple doses of LDX at doses greater than 70 mg/d; therefore, the objective of this study was to assess the safety and pharmacokinetic properties as well as the clinical safety of multiple ascending doses of LDX in adult inpatients with stable schizophrenia receiving concomitant antipsychotic pharmacotherapy.

Study Design

this phase 1 randomized, double-blind, placebo-controlled, multiple–ascending dose study, the safety and pharmacokinetic properties of LDX (50–250 mg/d) were assessed in adult participants with schizophrenia who were stabilized on antipsychotic medication for 12 weeks or more before screening

Six dose-escalation periodswere planned. On day 1 of period 1, the participants were randomized (3:1) to once-daily ascending LDX doses (50, 70, 100, 150, 200, and 250 mg) or placebo for 5 days at each dose level, with no washout period between doses, for a total of 30 consecutive days (6 periods, 5 days each). The 5-day period for each dose escalation was chosen because it was considered to be an adequate dosing interval to achieve a pharmacokinetic steady state and because it was known from previous studies that titration of LDX every 5 days up to 250 mg was tolerated in healthy volunteers.

Of the 31 participants enrolled, 27 completed the study

No participant experienced a serious AE while on active treatment.

The mean observed values on the GMLT (Supplementary Table 4, Supplementary Digital Content 4, http://links.lww.com/JCP/A247) showed improvement compared with those of baseline for the LDX participants at all doses, with the greatest improvement occurring at doses of 100 mg or greater of LDX. In contrast, the placebo participants exhibited worse (ie, higher) GMLT scores compared with all LDX doses, and the participants receiving LDX at doses of 150 mg or less had less improvement than did the participants receiving LDX at doses of greater than 150 mg. All LDX doses were associated with no worsening of the mean Detection Task scores. However, the participants receiving LDX at doses less than 100 mg had numerically smaller improvements than did the participants receiving LDX at doses of 100 mg or greater (Supplementary Table 5, Supplementary Digital Content 5, http://links.lww.com/JCP/A248). This study evaluated the safety and pharmacokinetics of LDX in adults with stable schizophrenia treated with antipsychotic medication without associated depression or EPS who had mild to moderate positive and negative schizophrenia symptoms. Results demonstrated that adjunctive treatment with LDX across a wide range of ascending doses was well tolerated, with no unexpected TEAEs. The incidence of cardiovascular, neurological, and psychiatric TEAEs was generally similar across dose groups, and there was no overall worsening of neuropsychiatric or cardiovascular symptoms even after abrupt discontinuation of LDX treatment; in addition, only 1 patient on LDX withdrew because of exacerbation of schizophrenia. These findings support the notion that, although amphetamines have the potential to exacerbate psychotic symptoms, most patients in this study tolerated LDX without worsening of psychotic symptoms.16,17

A decrease in cognitive ability is a central clinical feature of schizophrenia, and antipsychotic medications have demonstrated effectiveness in reducing neurocognitive deficits in patients with schizophrenia but may worsen negative symptoms.39 Improvements in several cognitive functions (eg, executive function, visual attention, vigilance) were previously reported in patients with stable schizophrenia on antipsychotic medication administered a single challenge dose of d-amphetamine.40

Here, we found that concurrent administration of LDX at doses ranging from 50 to 250 mg/d to patients taking antipsychotic medication resulted in numeric improvement in the GMLT scores, a measure of executive function and visual learning, at all doses of LDX, with the greatest improvement occurring at doses of 100 mg/d or greater.

Consistent with previous findings over a wide range of ascending doses, the tolerability of LDX in adultswith clinically stable schizophrenia was consistent with reported safety data for LDX, there were no unexpected TEAEs, and abrupt cessation of treatment with LDX produced no remarkable symptoms and no increase in safety concerns.

Hér má finna tvær aðrar rannsóknir sem sýna bætingu með dextroamphetamine á vitsmunalegri getu, og bætingu á neikvæðum einkennum: https://pubmed.ncbi.nlm.nih.gov/16005384/ - https://pubmed.ncbi.nlm.nih.gov/3294284/

Fíknisjúkdómar

Hér skoðum við bandaríska rannsókn á eðli tengingar milli notkun ADHD lyfja hjá sjúklingum með ADHD og misnotkun eiturlyfja.

Lykilniðurstöður:

• Fíknisjúkdómar eru algengir hjá fólki með ADHD og auka dauðsföll í þessum hópi sjúklinga.
• Sjúklingur með ADHD sem tekur ADHD lyfin er ólíklegri til þess að misnota eiturlyf heldur en sjúklingur með ADHD sem tekur ekki ADHD lyfin.

Rannsóknin:

https://pubmed.ncbi.nlm.nih.gov/28659039/

Substance use disorders are major contributors to excess mortality among individuals with attention-deficit/hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events.

Prospective studies show that risk of substance use disorders is a persisting concern in ADHD (4, 5), at least in part because the two disorders share genetic influences (6–8).

Notably, Chang and colleagues (19) found that risk of substance-related problems was lower when ADHD patients in the Swedish population were prescribed stimulant medications.

To our knowledge, this national US study is the largest to date to examine whether stimulant and non-stimulant medication therapies for ADHD—widely used and efficacious in the short-term for core ADHD symptoms—are associated with differences in risk of substance-related problems.

These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

Hér má finna tvær rannsóknir á notkun ADHD lyfja við methamphetamine fíkn. Annars vegar Elvanse (upp í 250 mg) og hins vegar Attentin (SR) upp í 110 mg/d.

https://bmjopen.bmj.com/content/11/5/e044696

https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2009.02717.x

Þessi lyf eru notuð off-label í Bretlandi og Ástralíu við methamphetamine fíkn.

Í báðum rannsóknum minnkaði methamphetamine notkun sjúklinga.

Geðhvarfasýki (e. bipolar disorder)

Hér skoðum við bandaríska rannsókn á notkun Elvanse (lisdexamfetamine) við geðhvarfasýki.

Lykilniðurstöður:

• Algengt er að nota örvandi lyf (t.d. amphetamine og methylphenidate) sem aukalyf við þunglyndi í geðhvarfasýki. Þessi leið er áhrifarík skv. “case reports”, “case series” og einu “open trial”.
• Í þessari rannsókn bætti Elvanse þunglyndi og dagsyfju sjúklinga
• Enginn fór í “hypomania” né “mania”, þetta er í takt við fyrri rannsóknir

Rannsóknin:

https://pubmed.ncbi.nlm.nih.gov/25340384/

No patient receiving LDX experienced a serious adverse event. The participant who was excluded by the investigators for medication tampering denied misuse of the study drug. There were no instances of suicidality, hypomania, or mania.

LDX produced significantly greater reductions in self-reported measures of depressive symptoms and excessive daytime sleepiness, significantly larger decreases in fasting levels of LDL and total cholesterol, and trend-level improvements in fatigue and binge eating. In the secondary analysis, LDX was found to be superior to placebo in reducing self-reported depressive symptoms, excessive daytime sleepiness, fatigue, binge eating behavior, triglyceride levels, LDL cholesterol levels, and total cholesterol levels, as well as in decreasing overall severity of depressive and bipolar symptoms at a trend level.

Although extremely preliminary, these findings are consistent with open-label reports of successful treatment of bipolar depression with methylphenidate and D-amphetamine, as well as with findings that LDX may improve metabolic parameters in patients with bipolar disorder (McIntyre et al., 2013). The lack of manic or hypomanic switch is consistent with findings from randomized controlled trials in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder, in whom stimulants did not cause worsening of mood symptoms (Scheffer et al., 2005; Findling et al., 2007).

Further trials of LDX and other psychostimulants for the treatment of bipolar depression seem warranted.

Sparnaður við meðhöndlun ADHD

Hér skoðum við eina sænska og eina bandaríska rannsókn.

Lykilniðurstöður:

• Sjúklingar með ADHD deyja frekar en heilbrigðir. Algengast er slysfarir. Fyrir utan mannúðarsjónarmið er þetta tapaður hagnaður fyrir ríkið.
• Sjúklingar með ADHD lenda frekar í alvarlegum bílslysum (skilgreint sem slys sem endar á gjörgæslu eða með dauða). Hjá karlmönnum með ADHD sem taka ADHD lyf lækkar áhættan um 58%.
• Talið er að 41% til 49% af slysum karlmanna með ADHD hefði mátt koma í veg fyrir ef þeir væru á ADHD lyfjum allan tímann.
• Í alvarlegum bílslysum meiðist fólk oft, jafnvel lamast eða deyr. Þetta er allt kostnaður fyrir ríkið (auk mannúðarsjónarmiða).
• Umferðaslys kosta um 2% af GDP af hagkerfi heimsins.
• Þar að auki eykur lyfjameðferð framleiðni sjúklinga í vinnu, og bætir líf þeirra bæði í vinnu og í félagslegum aðstæðum.

https://pubmed.ncbi.nlm.nih.gov/24477798/

Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study

Results: Compared with individuals without ADHD, male patients with ADHD (adjusted hazard ratio, 1.47; 95% CI, 1.32-1.63) and female patients with ADHD (1.45; 1.24-1.71) had an increased risk of serious transport accidents. In male patients with ADHD, medication was associated with a 58% risk reduction (hazard ratio, 0.42; 95% CI, 0.23-0.75), but there was no statistically significant association in female patients. Estimates of the population-attributable fractions suggested that 41% to 49% of the accidents in male patients with ADHD could have been avoided if they had been receiving treatment during the entire follow-up.

Conclusions and relevance: Attention-deficit/hyperactivity disorder is associated with an increased risk of serious transport accidents, and this risk seems to be possibly reduced by ADHD medication, at least among male patients. This should lead to increased awareness among clinicians and patients of the association between serious transport accidents and ADHD medication.

https://pubmed.ncbi.nlm.nih.gov/25726514/

DHD was associated with significantly increased mortality rates. People diagnosed with ADHD in adulthood had a higher MRR than did those diagnosed in childhood and adolescence. Comorbid oppositional defiant disorder, conduct disorder, and substance use disorder increased the MRR even further. However, when adjusted for these comorbidities, ADHD remained associated with excess mortality, with higher MRRs in girls and women with ADHD than in boys and men with ADHD. The excess mortality in ADHD was mainly driven by deaths from unnatural causes, especially accidents.

References