[Therapeutic practice of bisphosphonate use and related pharmaceutical issues I]. / A biszfoszfonátok alkalmazásának gyakorlata és aktuális gyógyszerészeti vonatkozásai I.

The therapeutic use of Bisphosphonates was common in Hungary for the past two and a half decades. The main clinical application of Bisphosphonates is the therapy of osteoporosis and bone manifestations of malignant diseases. Patients' quality of life depends on the prevalence of the typical fragility fractures and their complications. Bisphosphonates are the basis of the therapy in both therapeutic areas, since they are able to decrease progression of the disease. In patients with good compliance adequate therapy is proven to minimize the number of bone fractures. In the present paper we summarize the pharmacological knowledge of the therapeutic use of Bisphosphonates in the two main therapeutic areas: osteoporosis and osseal manifestations of malignancies. In the second part of our paper we present analysis of the prescribed bisphosphonate drug use, reimbursed by the National Health Insurance Fund. Our results provide data on the changes of druguse and reimbursement strategy of Bisphosphonates in Hungary. Our data highlights the fact that pharmacists have to pay a special attention to the growing aging population affected by osteoporosis, moreover there should be a special focus on osteoporotic patients, since there is a decreasing rate of treated patients. To help lowering this therapeutic gap in osteoporosis, pharmacists should take an active role in the therapy management.

[Bisphosphonate use and related pharmaceutical issues II]. / A biszfoszfonátok alkalmazásának gyakorlata és aktuális gyógyszerészeti vonatkozásai II.

UNLABELLED: Bisphosphonates have basic role in decreasing progression of malignant bone processes as well as in the prevention and therapy of osteoporosis. Use of bisphosphonates is common in Hungary since 20 years. In the past decade their reimbursement has been changed several times, the use of generics decreased the price of bisphosphonates. In this paper we analyze the consumption of prescribed bisphosphonates in Hungary. DATA: Prescription data of the National Health Insurance Fund of Hungary. METHOD: We analysed the prescribed bisphosphonates between 2006-2014. We examined the type and amount of bisphosphonates used by years. After identifying therapy areas of use, we calculated the years of therapy from the DOT data. From this data we estimated the mean bisphosphonate therapy costs and costs falling for the patients. Changes in the reimbursement system regarding these medications was analysed. RESULTS: Bisphosphonate years of therapy was decreasing in osteoporosis over the 9 years examined. In oncology bisphosphonate use shows stability in drug consumption. In both therapeutic areas the proportion in therapy choice of specific bisphosphonates has changed. Bisphosphonate reimbursement costs paid by the Hungarian reimbursement system was approx. 8 billion HUF in osteoporosis and 4,7 billion HUF in oncology in 2006. Changes of the reimbursement strategy, the compulsory generic use and decreasing consumption in osteoporosis has significantly reduced the overall costs by 2014. CONCLUSION: According to our results bisphpsphonate use in oncology is moderate in Hungary, a decreasing consumption can be detected in osteoporosis, that is still expected to decrease. The use of generics reduced bisphosphonate therapy costs and also overall health care costs. In osteoporosis patients cost have substantially lowered.

[Outcome of a one-year behavior therapy weight loss program]. / A viselkedésterápia eredményeinek vizsgálata az elhízás kezelésében egy év távlatában.

INTRODUCTION: Treatment of obesity has become one of the most challenging issues. AIM: The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up. METHOD: The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form]. RESULTS: 87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern. CONCLUSIONS: The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.

[From life events to symptoms of anxiety and depression: the role of dysfunctional attitudes and coping]. / Az életeseményektol a depressziós és szorongásos panaszokig: a diszfunkcionális attitudök és a megküzdés szerepe a patogenezis folyamatában.

UNLABELLED: The aim of the present study was a systematic path-analytical investigation between the effects of life events, dysfunctional attitudes and coping strategies in relation with the exhibited depressive and anxiety symptoms in patients with mental disorders. METHODS: Self-report data of 234 patients from our outpatient psychotherapy unit were analyzed. Life events, dysfunctional attitudes, coping strategies as well as symptoms of anxiety and depression were assessed by self-administerd questionnaires. Statistical methods included structural equation modelling, which enables the estimation of the magnitude and strength of individual variables within an overarching casual model, thus yielding a complex view on the possible processes underlying the development of the clinical symptoms of anxiety and depression. RESULTS: Our findings indicate that both the number of negative life events and their subjectively experienced intensity contributed to the increase of dysfunctional attitudes. The presence of dysfunctional attitudes decreased the use of problem-focused coping strategies and increased the use of emotion-focused coping strategies. The use of problem-focused coping decreased symptom occurrence and emotion-focused coping strategies increased the frequency of symptoms of anxiety and depression. Our findings suggest that dysfunctional need for achievement and perfectionism directly increase the probability of depressive symptom manifestation. The attitude of external locus of control showed a significant relationship with anxiety symptoms through emotion-focused coping strategies and directly as well. CONCLUSION: Restructuring dysfunctional attitudes and developing problem-focused coping strategies are an important part of psychotherapeutic interventions aiming to decrease anxiety and depressive symptoms.

[Quality of life in Hungarian patients with cystic fibrosis]. / Cystás fibrosisban szenvedo betegek életminoségének felmérése Magyarországon.

INTRODUCTION: Cystic fibrosis is a progressive multisystemic disease which affects the quality of life of patients. AIM: The aim of the study was to evaluate quality of life in Hungarian patients with cystic fibrosis. METHODS: Validated Hungarian translation of The Cystic Fibrosis Questionnaire - Revised was used to measure quality of life. Clinical severity was determined on the basis of Shwachman-Kulczycki score. Lung function was measured using spirometry. RESULTS: 59 patients were included from five centres in Hungary. The relationships between 8-13 year-old children self-report and parent proxy report was 0.77 (p<0.001) in physical functioning, 0.07 (p<0.001) in emotional functioning, 0.51 (p<0.001) in eating, 0.21 (p<0.001) in treatment burden, 0.54 (p<0.001) in body image, 0.49 (p<0.001) in respiratory symptoms and 0.40 (p<0.001) in digestive symptoms domains. CONCLUSIONS: In contrast to physical domains weak correlations were observed between answers obtained from children and their parents in psychosocial domains. The perception of both patients and their parents should be assessed when measuring quality of life in paediatric patients with cystic fibrosis.

[Adherence, methodology and studies in Hungary]. / Beteg-együttmuködés, módszertani kérdések és hazai vizsgálatok.

Adherence to therapies is a primary determinant of treatment success. Poor adherence has a negative impact on clinical benefits and therefore reduces the overall effectiveness of health care systems. Numerous methods have been used in attempts to adequately assess patient adherence. The choice of a method for measuring adherence should be based on the usefulness and reliability of the method in light of the researcher's or clinician's goals, taking into account the advantages and disadvantages of the method. The current paper aims to summarize the available measurement methods with their strengths and weaknesses and to present the published studies on adherence within the Hungarian population. The evaluated survey results suggest the importance to improve patient adherence in Hungary. Health care professionals, especially pharmacists have potential influence on adherence and patient's behaviour. It is hoped that this review will lead to help policy development and action to enhance adherence.

Psychiatric symptoms of patients with primary mitochondrial DNA disorders.

BACKGROUND: The aim of our study was to assess psychiatric symptoms in patients with genetically proven primary mutation of the mitochondrial DNA. METHODS: 19 adults with known mitochondrial mutation (MT) have been assessed with the Stanford Health Assessment Questionnaire 20-item Disability Index (HAQ-DI), the Symptom Check List-90-Revised (SCL-90-R), the Beck Depression Inventory-Short Form (BDI-SF), the Hamilton Depression Rating Scale (HDRS) and the clinical version of the Structured Clinical Interview for the the DSM-IV (SCID-I and SCID-II) As control, 10 patients with hereditary sensorimotor neuropathy (HN), harboring the peripheral myelin protein-22 (PMP22) mutation were examined with the same tools. RESULTS: The two groups did not differ significantly in gender, age or education. Mean HAQ-DI score was 0.82 in the MT (range: 0-1.625) and 0.71 in the HN group (range: 0-1.625). Level of disability between the two groups did not differ significantly (p = 0.6076). MT patients scored significantly higher on the BDI-SF and HDRS than HN patients (12.85 versus 4.40, p = 0.031, and 15.62 vs 7.30, p = 0.043, respectively). The Global Severity Index (GSI) of SCL-90-R also showed significant difference (1.44 vs 0.46, p = 0.013) as well as the subscales except for somatization. SCID-I interview yielded a variety of mood disorders in both groups. Eight MT patient (42%) had past, 6 (31%) had current, 5 (26%) had both past and current psychiatric diagnosis, yielding a lifetime prevalence of 9/19 (47%) in the MT group. In the HN group, 3 patients had both past and current diagnosis showing a lifetime prevalence of 3/10 (30%) in this group. SCID-II detected personality disorder in 8 MT cases (42%), yielding 3 avoidant, 2 obsessive-compulsive and 3 personality disorder not otherwise specified (NOS) diagnosis. No personality disorder was identified in the HN group. CONCLUSIONS: Clinicians should be aware of the high prevalence of psychiatric symptoms in patients with mitochondrial mutation which has both etiologic and therapeutic relevance.

General and domain-specific neurocognitive impairments in deficit and non-deficit schizophrenia.

Earlier studies suggested more severe overall cognitive impairments in deficit versus non-deficit schizophrenia; however, the specific contribution of different cognitive domains to this overall cognitive impairment remains unclear. The purpose of this study was to compare the two subtypes in general cognitive functioning as well as in individual cognitive domains using the composite score approach. One hundred and forty-three patients fulfilling the criteria for the deficit syndrome were compared with 123 patients diagnosed with non-deficit schizophrenia. Neurocognitive functioning was assessed by a neuropsychological test battery measuring the domains of sustained vigilance/attention, working memory, short-term memory, verbal memory, cognitive flexibility, and ideation fluency. Using the raw neuropsychological measures, we calculated a global index of cognitive impairment and domain-specific composite z-scores. Association between these composite scores and the deficit syndrome was examined by logistic regression analysis. After adjusting for relevant covariates including sex, age, education, smoking, and antipsychotic dose, results indicated a significant increase in the likelihood of deficit syndrome as a function of global (OR = 5.40; 95% CI 3.02-9.65) as well as domain-specific impairments (OR > 2 for all individual domains except for short-term memory). Cognitive flexibility was an independent predictor (OR = 2.92; 95% CI 1.47-5.80), whereas other cognitive domains demonstrated no unique contribution to the general cognitive impairment. Patients with deficit schizophrenia suffer from a more severe degree of neurocognitive impairment, which is qualitatively similar to the dysfunction seen in non-deficit schizophrenia. However, our results indicate that cognitive flexibility is specifically impaired in deficit versus non-deficit patients and may therefore represent a core feature of this subtype.

Health-related quality of life and utility in patients receiving biological and non-biological treatments in rheumatoid arthritis.

Biological treatments earn increasing significance in the treatment of rheumatoid arthritis (RA) but are associated with high incremental cost-effectiveness ratio compared to conventional antirheumatic treatments such as disease-modifying antirheumatic drugs. As the most important objective of medical technologies should be to increase life years and/or patients' health-related quality of life (HRQoL), measuring QoL and utility in RA patients treated with biological therapies is crucial. The objective of this study is to compare the utility and QoL of patients treated with biological (n = 85) and non-biological (n = 168) antirheumatic drugs in Hungary in a cross-sectional non-interventional study. A measure of impairment (Disease Activity Score (DAS)-28), QoL measure (EuroQol five Dimension (EQ-5D) Visual Analogue Scale (VAS), Rheumatoid Arthritis Quality of Life (RAQoL)) and utility measures (indirect: EQ-5D index, direct: time trade-off (TTO)) were applied using an interview method. The Pearson correlation was used to assess the strength of the relationship of different measures in the total study group (n = 253). The EQ-5D index (biological treatment: 0.608, non-biological treatment: 0.483; P = 0.012) and DAS-28 (biological treatment: 3.8, non-biological treatment: 4.5; P = 0.003) showed statistically significant difference between the two subcohorts after adjusting data by age, gender and disease duration. Our results indicate that patients on biological treatment have lower disease activity and higher utility; however, it was not statistically significant in all cases. According to our knowledge, TTO was not used previously in Hungarian RA patients. Utility data concerning biological treatments are essential for cost-utility models in health technology assessment reports for public reimbursement.

Determinants of NSAID choice in rheumatoid arthritis--a drug utilization study.

Long term nonsteroidal anti-inflammatory drug (NSAID) medication is associated with gastrointestinal (GI) adverse events. This paper aimed to depict main determinants of NSAID drug choice (GI safe/traditional NSAIDs) in a rheumatoid arthritis (RA) patient sample (n=143). According to our logistic regression model, current/prior GI adverse events in the anamnesis was the only significant determinant of GI safer NSAID use (OR 3.1, p = 0.01). There was significant difference regarding most NSAIDs between the RA study sample and the total Hungarian population, suggesting that chronic administration could also influence the NSAID choice. GI safe NSAIDs were much preferred in the RA study sample than in the total population. In conclusion, the NSAID medication of the observed 143 patients was considered to be reasonable regarding both cardiovascular and GI safety.

[Osteoporosis and pharmaceutical care]. / Az oszteoporózis és a gyógyszerészi gondozás.

The increasing prevalence of osteoporosis is causing a substantial health burden. Compliance and adherence to osteoporosis management are of high priority, having a significant effect on the cost effectiveness of therapy. In this study, we aimed to summarize the literature on patient compliance in osteoporosis. Our findings indicate that 60% of the patients have some medication related problem, in particular, it is difficult to influence the patients to play an active role in their disease management and to keep a high level of persistence. Pharmaceutical care could help to reach optimal cooperation between patients and the heath care professional, as one of its main objective is to improve the rate of patient adherence in long-term drug therapy.

Factors associated with medication adherence in patients with chronic obstructive pulmonary disease.

BACKGROUND: Predictors of medication adherence are not well known in chronic obstructive pulmonary disease (COPD). It is therefore necessary to identify factors associated with adherence to improve the effectiveness of COPD management within real-world situations. OBJECTIVES: The goals of this study were to estimate adherence to respiratory medication and to identify factors related to adherence in COPD patients. METHODS: This was an observational, cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to respiratory therapy (Morisky Medication Adherence Scale), age, gender, smoking status, COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage], lung function [post-bronchodilator forced expiratory volume in 1 s (FEV(1))], treatment regimen for COPD, COPD medication costs per month paid by the patient and health-related quality of life (EuroQol 5-dimension questionnaire). A multivariate logistic regression analysis was performed to identify the independent predictors of adherence. RESULTS: Of the 170 participants (mean age 63.8 years, 41.8% male), 58.2% reported optimal adherence. Adherence to respiratory therapy was associated with age, current smoking status, number of respiratory drugs, number of daily respiratory drug doses and quality of life (p < 0.005). Adherence to respiratory therapy was not related to gender, GOLD stage, FEV(1) or COPD medication costs. CONCLUSIONS: Adherence to COPD medication regimens is poor. Less frequent dosing regimens could be an effective method to enhance adherence to respiratory therapy. Quality-of-life monitoring within clinical practice settings could facilitate improved medication adherence.

How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample.

The goal of the study was twofold: (1) to investigate the effect of different diagnostic criteria on prevalence estimates of adult attention deficit hyperactivity disorder (ADHD), and (2) to provide prevalence estimates of adult ADHD for the first time in a Hungarian sample. Subjects between 18 and 60 years were included in the screening phase of the study (N = 3,529), conducted in 17 GP practices in Budapest. Adult self-report scale 6-item version was used for screening. Out of 279 positively screened subjects 161 subjects participated in a clinical interview and filled out a self-report questionnaire to confirm the diagnosis. Beside DSM-IV diagnostic criteria, we applied four alternative diagnostic criteria: 'No-onset' (DSM-IV criteria without the specific requirement for onset); full/Sx (DSM-IV "symptoms only" criteria); and reduced/Sx (DSM-IV "symptoms only" criteria with a reduced threshold for symptom count). Crude prevalence estimates adjusted for the specificity and sensitivity data of the screener were 1.35% in the 'DSM-IV' group, 1.64% in the 'No-onset' group, 3.65% in the 'Sx/full' group and 4.16% in the 'Sx/reduced' group. Logistic regression analysis showed that ADHD was significantly more prevalent with younger age and male gender [chi(2) = 14.46; P = 0.0007]. Prevalence estimates corrected for the 'not-interviewed' subsample and adjusted for specificity and sensitivity data of the screener was 2.3% in males, 0.91% in females; 2.02% in the < or =40 years age group and 0.70% in the >40 years age group, based on DSM-IV diagnostic criteria. Prevalence rates found in this study are somewhat lower, but still are in line with those reported in the literature.

Trends in the non-steroidal anti-inflammatory drug market in six Central-Eastern European countries based on retail information.

PURPOSE: The objective of this study was to evaluate the non-steroidal anti-inflammatory drug market of six Central and Eastern European countries. Trends and similarities were compared across the examined countries. METHODS: The Intercontinental Marketing Service Health database was used to determine consumption data between the years 2000 and 2007. We applied the anatomical therapeutical chemical-defined daily dose method, focussing on three major non-steroidal anti-inflammatory drug groups: conventional non-steroidal anti-inflammatory drugs, 'stronger cyclooxygenase 2 inhibitors' (all together as: non-cyclooxygenase 2 selective non-steroidal anti-inflammatory drugs) and selective cyclooxygenase 2 inhibitors. The main outcome measure was defined daily dose/1000 inhabitants/day. Different active agents have been distinguished between the three major groups. RESULTS: In total the non-steroidal anti-inflammatory drug group reached a 42.82-74.17 defined daily dose/1000 inhabitants/day volume in 2007, with an average total increase of 25.1% between 2002 and 2007. In the conventional non-steroidal anti-inflammatory drug group, diclofenac and ibuprofen have attained the highest consumption. Our results show a notable increase (325%, 2002-2007) of the 'stronger cyclooxygenase 2 inhibitor group' (nimesulide and meloxicam). Trends of selective cyclooxygenase 2 inhibitor volumes differ within the observed countries. CONCLUSION: Differences in the six countries concerning their NSAID consumption and market trends could not be explained with the inequalities in patient characteristics. The conventional NSAID retail gave the majority of the total NSAID market. The consumption of selective COX2 inhibitors in all of the six countries were much lower than in the US or Australia. The NSAID risk profile in the region is comparable to previous studies in other countries.

[Pharmacoeconomic impact of compliance]. / A terápiahuség egészség-gazdaságtani szempontjai.

Medication compliance has important consequences for clinical outcome and for health care costs. From the perspective of the pharmaceutical industry and the health-care provider it is necessary to incorporate non-compliance into pharmacoeconomics evaluations. The aim of the review was to give an overview of the pharmacoeconomics importance of medication compliance. The impact of non-compliance on health care costs and quality of life, as well as the cost-effectiveness of compliance and compliance enhancing interventions were evaluated. In summary, there is a clear need for more research on the field of non-compliance to find out more about the pharmacoeconomic impact of medication taking behaviour.

[Analysis of direct costs during the treatment of tuberculosis in childhood]. / Tuberkulózis kezelése során felmerülo direkt költségek elemzése gyermekkorban.

Incidence and prevalence of tuberculosis (TB) shows a decreasing tendency in Hungary. The medical care of these patients represents a substantial cost to the health services. We assessed the direct costs of paediatric patients with TB in a Hungarian hospital. Patients participating in the study were 9 children, with an average age of 11.17 +/- 6.34 years. In the study group there were two immigrant patients (22, 23%), two (22, 23%) had multidrug-resistant TB (MDR-TB), five patients (62.5%) were contacts, six (66, 67%) had extrapulmonary tuberculosis and three (33, 34% suffered from other co-morbidities. The average direct cost of pulmonary TB was 2920 Euros, direct cost of MDR-TB was between 7300-9120 Euros. MDR-TB increases one and half times the period spent in hospital, two and half times the cost of inpatient care. Extrapulmonary TB with concomitant disease causes 3-7 times higher expenditures to the health service. According to our results we found significant differences between the cost of actual therapy and resources available; thus the compensation needs to be solved.

[The assessment of oral NSAID use in patients with rheumatoid arthritis in Hungary--a cross sectional non interventional study]. / Orális nem-szteroid gyulladásgátló gyógyszerek felhasználásának vizsgálata a Budai Irgalmasrendi Kórház. II. Reumatológia Osztályának rheumatoid arthritises betegei között.

Continuous NSAID (nonsteroidal anti-inflammatory drug) therapy is associated with gastrointestinal (GI) and cardiovascular (CV) side effects. In this paper, the oral NSAID use of 143 patients with rheumatoid arthritis was assessed focusing on safety and farmacoeconomic aspects in a cross sectional non interventional study. The most widely used NSAIDs were meloxicam (n = 55, 38.5%) and diclofenac (n = 30, 21%). We found that coxibs were overused (n = 13, 9.1%) compared with the average total coxib consumption in Hungary. According to our results, drugs associated with GI friend side effect profile (meloxicam, celecoxib, etoricoxib) were much preferred in patients with previous GI events, than in patients with low GI risk. The previous occurrence of GI events were significantly higher (p = 0.019) in patients currently treated with safer NSAIDs, probably because of the so-called 'indication bias'. No statistically significant difference in patient's quality of life could be proved between NSAID drug groups. The uses of NSAIDs were considered to be rational concerning CV and GI risk as well as cost-effectiveness.

[Aspects of developing an education programme based on pulmonologists' appraisal related to chronic obstructive pulmonary disease]. / Egy oktatóprogram fejlesztésének lehetoségei tüdogyógyász szakorvosok krónikus obstruktív tüdobetegséggel kapcsolatos megítélése alapján.

Introduction: Chronic obstructive pulmonary disease (COPD) is a health burden for the patient and the society. We have sought to find the optimal education content to alleviate this burden. Aim: (1) To create patient education content based on the pulmonologists' opinion; (2) to understand the pulmonologists' attitudes and perceptions; (3) to evaluate the options to improve patient adherence. Method: We have performed 20 interviews with pulmonologists working in inpatient, outpatient and rehabilitation settings. The structure of the interviews has been designed to determine the key elements of a patient education programme and to discover perception and therapeutic attitudes. Results: The average COPD patient is a smoker, male, under-socialized, coughs, has dyspnoea and is older than 40 years. He does not take his illness seriously, and seeks medical attention only in case of worsening of the disease, and improvement in adherence is only present in such cases. The latter phenomenon is frequently transient, and limited to worse periods. Three adherence groups can be defined: marginal good adherence (approx. 10%), the average is around 30-40%, and minimal adherence (60%). Correct inhaler use should be taught in maximum three steps, which should be easily reproduced and explained. Conclusion: The aspects defining the framework of the education programme are the adequate patient profile (tailor-making), on-the-spot education in the pulmonology centre, the relationship between the patient and the doctors, patient attitudes and lifestyle changes (smoking cessation), and choosing the adequate inhaler. Orv Hetil. 2020; 161(3): 95-102.

Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): a meta-analysis.

Our objective was to conduct a meta-analysis of therapeutic efficacy of pharmacological treatment of adult ADHD based on data from controlled clinical trials. We used the search engines PubMed and Medline to identify relevant clinical trials. Short-term studies with double-blind parallel-group design were selected for the analysis. Altogether, we identified 11 trials that met the criteria, and investigated a total of 1991 subjects, 694 and 1297 of whom were treated with placebo or active medication, respectively. In order to pool efficacy data from studies with different characteristics, including different number of participants, different trial duration and measures of efficacy, the statistical effect sizes for each study had to be calculated. Our findings showed that the pooled effect size across all treatments was in the medium-to-high range (Cohen's d=0.65, p<0.0001 vs. placebo), and the effect size for stimulants (Cohen's d=0.67, p<0.0001 vs. placebo) was somewhat higher than for non-stimulant medications (Cohen's d=0.59, p<0.0001 vs. placebo). The current database of controlled trials for adult ADHD is relatively small, and does not include data for many of the potentially important agents. In addition, effect-size estimates for different classes of medications (i.e. stimulant and non-stimulant medications) were based on separate studies; head-to-head comparisons of various agents are severely lacking. Nonetheless, results of this meta-analysis across all ADHD medications in adult subjects demonstrated statistically significant and clinically robust improvement in symptom severity compared to placebo treatment.

Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis.

BACKGROUND: In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder. AIMS: To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis. METHOD: We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications. RESULTS: The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1-3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Meta-regression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample. CONCLUSIONS: Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.