Low-dose amphetamine salts and adult attention-deficit/hyperactivity disorder.

BACKGROUND: Effective treatments for attention-deficit/hyperactivity disorder (ADHD) in adults are still being defined. Pediatric studies have suggested that a mixed amphetamine salt product (Adderall) is safe and effective in the treatment of childhood forms of ADHD. Presently, there are no reports in the scientific literature concerning the safety and efficacy of Adderall in adults with ADHD, which is the focus of this study. METHOD: Twenty-four outpatients (mean age = 33.3 years) with DSM-IV ADHD were administered Adderall in an open-label fashion, starting at 5 mg p.o. b.i.d., with titration according to clinical response, across a 16-week period. Relatives or spouses of each patient completed serial checklists (including the Copeland Symptom Checklist and the Brown Attention-Deficit Disorder Scales). Prospectively collected data were analyzed retrospectively. RESULTS: Thirteen patients (54%) responded in a positive manner to Adderall, based on Clinical Global Impressions-Improvement scale scores. The mean end dose for responders was 10.77 mg/day (0.14 mg/kg/day). An intent-to-treat analysis revealed a decrease in the mean Copeland score from 99.05 to 63.3 (p < .001), while the mean Brown score dropped from 76.75 to 50.85 (p < .0001). Nine patients (38%) were poor responders or nonresponders to Adderall. Acute anxiety symptoms occurred in 4 of 7 patients with a comorbid anxiety diagnosis. CONCLUSION: Adderall may be an effective agent for the treatment of adult forms of ADHD, with positive responses occurring at relatively low doses, at least for some individuals. However, Adderall may precipitate anxiety in vulnerable individuals. Further study is required.

Guanfacine and secondary mania in children.

INTRODUCTION: Guanfacine hydrochloride is an alpha-2 adrenergic agonist, which has gained recent attention in the field of child and adolescent psychiatry. This medication has been described as effective in the management of attention-deficit hyperactivity and tic disorders, with minimal side effects. METHODS: Presented here are five cases of behavioral activation in children treated with guanfacine. RESULTS: In each instance the clinical presentation resembled an acute hypomanic or manic episode. The dose of guanfacine was 0.5 mg/day. Later investigation revealed that all of the youngsters had clear risk factors (clinical and/or familial) for bipolar disorder. CONCLUSIONS: It appears as though guanfacine may be capable of precipitating secondary mania in vulnerable children.

Risperidone and explosive aggressive autism.

Many autistic patients with mental retardation have difficulties with explosivity and aggression. They often prove resistant to various pharmacotherapeutic interventions. In this study, 11 male outpatients (mean 18.3 years) were administered risperidone in an open-label fashion. The risperidone was started at 0.5 mg daily, and titrated upwards until maximum clinical benefit occurred. Serial clinical interviews were conducted, and Conners Parent-Teacher Questionnaires (short form) were completed by the caretakers. Substantial clinical improvement was noted almost immediately in each patient, with aggression, self-injury, explosivity, and poor sleep hygiene most improved. The modal dose for optimal response was 0.5 mg bid. Weight gain was a significant side effect (average velocity of 0.47 kg per week), while none of the patients experienced extrapyramidal side effects.