Acute effects of methylphenidate on neuropsychological parameters in adults with ADHD: possible relevance for therapy.

Recent research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), one of the most common mental disorders in childhood, continues into adulthood. In adulthood, however, pharmacotherapy with psychostimulants still is an off-label treatment. Because of this we routinely administer a test dose of methylphenidate (MPH) prior to a continuous medication and measure MPH effects quantitatively and repeatedly employing a neuropsychological test battery. To probe if the acute effects of MPH are indeed helpful in predicting longer-term efficacy of MPH treatment we retrospectively analyzed the neuropsychological test results of 34 patients on continuous MPH medication. Two testing sessions had been performed without MPH (at baseline and 24 h after a single dose intake to control possible training effects), one after a single dose and one after 3-6 months of regular intake of MPH. A significant improvement of performance in tests assessing attentional, memory and executive functions after single medication was maintained on long term medication in those 23 patients available for follow-up. These results indicate that beneficial short term effects of MPH predict longer-term effects and may thus be helpful in the decision for an off-label treatment. Controlled prospective studies are now necessary.

[Early intervention in alcohol abuse and addiction in general acute care hospitals]. / Frühintervention bei Alkoholmissbrauch und -abhängigkeit im Allgemeinkrankenhaus - Ergebnisse einer Explorationsstudie.

Early intervention has been shown to prevent alcohol-related diseases of the liver, the pancreas, and the gastrointestinal tract, as well as to reduce high blood pressure and the incidence of hospitalizations. At a general hospital, 27 patients were offered addiction counselling, six of whom were successfully referred to an outpatient addiction counsellor. However, prevalence rates of alcohol abuse and addiction were significantly lower than those reported in other studies. Similarly, referrals to addiction counselling were less frequent than in other programmes in which hospital staff had been specifically trained to identify problems of alcohol abuse and addiction and to initiate timely referrals. Intensive training of hospital staff as well as the provision of personal and logistical support at the hospital is crucial in the implementation of early intervention programmes for alcohol abuse and addiction in general hospitals.