Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial.

BACKGROUND: Data on the efficacy and safety of methylphenidate in adults with attention deficit/ hyperactivity disorder (ADHD) are lacking in Europe. This study was undertaken to report on the efficacy and safety of methylphenidate in an adult out-patient population with ADHD, and to compare results with US data. METHOD: A double-blind randomized cross-over trial comparing methylphenidate and placebo in 45 adults with ADHD with childhood onset was performed in a dose-titration design. Methylphenidate was titrated from 0.5 mg/kg per day in week 1 up to 1.0 mg/kg per day in week 3. RESULTS: Response rates using methylphenidate varied between 38 and 51%, and using placebo between 7 and 18% (p<0.05), depending on outcome measure used. Although the overall percentage of subjects having any side effect on both methylphenidate and placebo was rather high, side effects on methylphenidate over and above those on placebo were few and mild. CONCLUSIONS: Methylphenidate proves to be an effective and well tolerated treatment for symptoms of ADHD in adults in the short term. Future research should study the long-term response and clarify the impact of gender, co-morbidity, socio-economic status and IQ on response rates in adults with ADHD.

Effects of ventricular shunt treatment of normal pressure hydrocephalus on psychological functions.

A prospective trial for diagnosis, treatment and evaluation of normal pressure hydrocephalus (NPH) was carried out in 30 consecutive patients (12 women, 18 men, mean age: 61 years, range 21-80). The clinical diagnosis was based on the presence of one or more of the three clinical elements of NPH: gait disturbance, incontinence and mental deterioration as well as radiological criteria of ventricular enlargement. Preoperatively, physical and radiological investigations and psychological tests were routinely performed. Cognitive functions such as fluency, selective attention and motor speed were re-examined within 24 hours after spinal tap of 40-50 cc. of CSF. Results of shunting were confirmed by CT scans and evaluated by means of psychological tests at least 3 months postoperatively. Psychological tests included IQ tests and tests for memory, selective attention and motor speed. Results indicate that spinal tap had no predictive value for the results after shunting as far as psychological functions are concerned. Shunt treatment showed an effect on cognitive functions of distractibility of attention and motor speed, but not on intelligence of memory. Three patients deteriorated, eleven remained stable and sixteen showed significant improvement on psychological tests, mainly those for attention, motor speed and memory, but rarely did any improvement of intelligence occur.