RESUMEN
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder characterized by developmentally inappropriate levels of inattention, hyperactivity and impulsivity. Although much evidence supports the use of psychostimulants as a first-line treatment in children and adolescents, up to 30% of patients may have an inadequate response to these medications. For these patients, addition of an α2-adrenoceptor agonist can further improve ADHD symptoms. The α2-adrenoceptor agonists may work in a synergistic fashion with stimulants through regulation of prefrontal cortex function. Early studies were completed with immediate-release clonidine (CLON-IR), which requires multiple daily doses and achieves a higher maximum concentration more rapidly than the more recently developed extended-release clonidine (CLON-XR). Pharmacokinetic properties of CLON-XR may be responsible for differences in efficacy and tolerability between the CLON-IR and CLON-XR formulations. Recent double-blind, placebo-controlled trials have shown that extended-release α2-adrenoceptor agonists are safe and effective, both as monotherapy and as adjunctive treatment with stimulants. This review will focus on clonidine used in conjunction with stimulants to optimize treatment of ADHD.
Asunto(s)
Agonistas alfa-Adrenérgicos/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Clonidina/uso terapéutico , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Agonistas alfa-Adrenérgicos/efectos adversos , Agonistas alfa-Adrenérgicos/farmacocinética , Agonistas alfa-Adrenérgicos/farmacología , Anfetamina/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Presión Sanguínea/efectos de los fármacos , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Clonidina/administración & dosificación , Clonidina/efectos adversos , Clonidina/farmacocinética , Clonidina/farmacología , Quimioterapia Combinada , Electrocardiografía/efectos de los fármacos , Humanos , Metilfenidato/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: Anorexia nervosa and bulimia nervosa are known to occur in children although prevalence studies are lacking. METHOD: Using a newly developed self-report instrument, the Kids' Eating Disorders Survey (KEDS), 3,175 students (1,610 females, 1,565 males) enrolled in grades 5 to 8 were surveyed. RESULTS: More than 40% of respondents reported feeling fat and/or the wish to lose weight. These frequencies of weight control behaviors were reported, many of which were significantly greater in girls than boys (*p < 0.05, chi-square): dieting (31.4%*), fasting (8.7%*), diet pill use (2.4%*), vomiting (4.8%), diuretic use (1.5%). The effects of age, grade, weight, and race on responses are reviewed. CONCLUSIONS: Findings demonstrate that development of prevention programs aimed at recognizing problem eating behavior in children is indicated.