Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 80
Filtrar
1.
J Clin Psychiatry ; 81(5)2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32926603

RESUMO

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is present in 25%-50% of parents of children with ADHD, compromising parenting and child behavioral treatment. Efforts to treat multiplex ADHD families have not compared behavioral parenting interventions to parent psychopharmacology without confounds of other treatments. This report describes a pilot early intervention study directly comparing parent lisdexamfetamine dimesylate (LDX) to behavioral parent training (BPT) in families in which the mother had currently untreated ADHD and the young child displayed ADHD symptoms. METHODS: Mothers with ADHD (N = 35) of 4- to 8-year-old stimulant-naive children (N = 35) were randomly assigned to an 8-week trial of LDX (starting at 20 mg/d and titrated to a maximum of 70 mg/d) or BPT. Outcomes included multi-method, multi-informant measures of (1) maternal ADHD symptoms (Conners' Adult ADHD Rating Scales) and impairment (Clinical Global Impressions-Severity of Illness scale [CGI-S] and CGI-Improvement scale [CGI-I]), (2) parenting (Alabama Parenting Questionnaire [APQ] and Dyadic Parent-Child Interaction Coding System, Fourth Edition), and (3) child ADHD symptoms (Conners Parent Rating Scale Revised-Short Form and Conners Early Childhood Scale) and impairment (CGI-S, CGI-I, and Child Impairment Rating Scale). RESULTS: At 8 weeks, both treatments improved mothers' self-reported emotion regulation and mothers' functioning on the CGI, but only LDX improved mothers' self-reported core ADHD symptoms. LDX was associated with improvement in parents' perception of their own ADHD symptoms (Conners Inattention [P < .0001] and ADHD Index scores [P < .0001]) and their child's ADHD symptoms (P = .009). Fifty-six percent of the mothers treated with LDX (n = 10) were "much" or "very much" improved with regard to their adult ADHD based on the CGI-I scores versus 6% of mothers receiving BPT (n = 1; P = .003). BPT improved parenting on self-reported positive parenting (P = .007), inconsistent discipline (P > .0001), and corporal punishment (P = .001), while LDX improved reported inconsistent discipline (P = .001) and corporal punishment (P = .04) on the APQ, consistent with prior research. In contrast to parental LDX, which did not improve observed parenting, BPT was associated with increased positive parenting during child-directed play (P = .0002) and clean-up (P = .04) and less negative parenting (P = .04) during child-directed play. Six percent of children (n = 1) whose mothers were randomized to LDX (n = 18) were "much" or "very much" improved on the CGI-I compared to 35% (n = 16) of those treated with BPT (P = .04). CONCLUSIONS: LDX and BPT each had unique effects on maternal ADHD symptoms and parenting, but modest effects on at-risk children. In general, LDX was more effective at treating mothers' core ADHD symptoms, but both LDX and BPT improved mothers' emotion regulation, and BPT resulted in more consistent effects on parenting measures via both maternal report and direct observation. As most children remained significantly impaired after 8 weeks of unimodal treatment, combination treatment and/or longer treatment duration may be necessary to improve functioning of multiplex ADHD families. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01816074​.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Comportamental/métodos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Mães/psicologia , Poder Familiar , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Poder Familiar/psicologia , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
3.
Psychopharmacology (Berl) ; 237(8): 2233-2255, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32601988

RESUMO

RATIONALE: Agonist-based pharmacologic intervention is an accepted approach in treatment of opioid and tobacco use disorders. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate usefulness of an agonist approach as treatment of (psycho)stimulant use disorder (PSUD). METHODS: We reviewed PubMed/Medline, LILACS, and ClinicalTrials.gov databases searching for randomized, double-blind, placebo-controlled, parallel-design studies evaluating outcomes of individuals treated for cocaine- or amphetamine-type substance use disorder. We combined results of all trials that included the following prescription psychostimulants (PPs): modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine). The combined sample consisted of 2889 patients. Outcomes of interest included the following: drug abstinence (defined as 2-3 weeks of sustained abstinence and the average maximum days of consecutive abstinence), percentage of drug-negative urine tests across trial, and retention in treatment. We conducted random-effects meta-analyses and assessed quality of evidence using the GRADE system. RESULTS: Thirty-eight trials were included. Treatment with PPs increases rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95% CI = (1.06, 5.62)] in patients with PSUD, particularly those with cocaine use disorder (very low-quality evidence). Prescription amphetamines were particularly efficacious in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and higher doses of PPs were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)] (moderate-quality evidence). Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)]. There was no effect of PPs on the retention in treatment. CONCLUSION: Prescription psychostimulants, particularly prescription amphetamines given in robust doses, have a clinically significant beneficial effect to promote abstinence in the treatment of individuals with PSUD, specifically the population with cocaine use disorder.


Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Anfetamina/uso terapêutico , Cocaína/uso terapêutico , Método Duplo-Cego , Humanos , Dimesilato de Lisdexanfetamina/uso terapêutico , Metilfenidato/uso terapêutico , Modafinila/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
5.
Pediatr Emerg Care ; 36(2): e96-e98, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929391

RESUMO

Radiopaque densities can be observed on imaging after the ingestion of either foreign bodies or some medications. Our case report discusses an 11-year-old boy with autism spectrum disorder and attention deficient disorder who presented to the emergency department because of concerns for constipation and dehydration. Incidentally, an abdominal x-ray showed numerous radiopaque densities throughout his intestines in addition to his constipation. He was admitted, and his home regimen was reviewed to attempt to identify a potential source for these radiopaque densities. This case presented an interesting teaching opportunity in the identification of the radiopaque densities and review of pharmacokinetics.


Assuntos
Abdome/diagnóstico por imagem , Bezoares/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Fumarato de Quetiapina/efeitos adversos , Abdome/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/tratamento farmacológico , Bezoares/complicações , Criança , Constipação Intestinal/complicações , Diagnóstico Diferencial , Corpos Estranhos/complicações , Humanos , Dimesilato de Lisdexanfetamina/efeitos adversos , Dimesilato de Lisdexanfetamina/uso terapêutico , Masculino , Fumarato de Quetiapina/uso terapêutico , Radiografia Abdominal , Tomografia Computadorizada por Raios X
6.
Braz J Psychiatry ; 42(3): 314-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859793

RESUMO

OBJECTIVE: To report the successful use of lisdexamfetamine in the management of narcolepsy. METHODS: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. RESULTS: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. CONCLUSION: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.


Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Narcolepsia/tratamento farmacológico , Sonolência , Ganho de Peso/efeitos dos fármacos , Perda de Peso/efeitos dos fármacos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Curr Neuropharmacol ; 18(2): 126-135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31660835

RESUMO

OBJECTIVE: To systematically review the literature on the therapeutic use of amphetamine, lisdexamfetamine and methylphenidate in elderly population with and without dementia. METHODS: We conducted two researches on the PubMed, Scopus and Embase using the keywords ("elderly") AND ("amphetamine" OR "methylphenidate" OR "lisdexamfetamine") and then ("Alzheimer" OR "dementia") AND ("amphetamine" OR "methylphenidate" OR "lisdexamfetamine"). RESULTS: Twenty-nine papers met all the eligibility criteria. The results are encouraging as 81.5% of the studies showed clinical improvement of the investigated condition. CONCLUSION: Amphetamines and methylphenidate are probably effective strategies for different conditions in the elderly population. However, further studies are needed to provide more robust evidence on efficacy, dosage and safety for this population.


Assuntos
Anfetamina/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Metilfenidato/uso terapêutico , Idoso , Demência/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Humanos
8.
Clin Neuropharmacol ; 42(6): 214-216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31725476

RESUMO

OBJECTIVES: The purpose of this retrospective chart review was to evaluate lisdexamfetamine dimesylate (LDX) in the treatment of pediatric binge eating disorder (BED). METHODS: We examined the clinical records of 25 patients, 12 to 19 years of age, who were prescribed LDX and had a diagnosis of BED between 2014 and 2017. RESULTS: Binge eating disorder in adolescents was highly comorbid with attention deficit hyperactivity disorder, mood and anxiety disorders, and severe obesity. Fifteen participants reported some level of improvement of their BED symptoms with LDX treatment. Posttreatment body mass index (BMI) percentile was not significantly reduced, and all but 2 participants remained in their same BMI classification. Lisdexamfetamine dimesylate treatment duration was not associated with change in BMI percentile, and the medication was well tolerated. CONCLUSIONS: Lisdexamfetamine dimesylate may have clinical utility for BED in adolescents, but randomized, placebo-controlled studies of its efficacy, tolerability, and safety in this population are needed.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Dimesilato de Lisdexanfetamina/uso terapêutico , Adolescente , Índice de Massa Corporal , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
9.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31598212

RESUMO

Eating disorders are serious psychiatric illnesses with high rates of morbidity and mortality. Effective treatments have traditionally included behaviorally focused therapies as well as several medication strategies. Recent years have seen promising developments in these treatments, including additional support for family-based approaches for children and adolescents, new evidence for "third-wave" behavioral therapies, and new support for the use of lisdexamfetamine for binge eating disorder and olanzapine for anorexia nervosa. Case study and pilot data are beginning to show limited support for neuromodulatory interventions targeting brain regions thought to be involved in eating disorders. This review summarizes treatment developments over the last several years and points towards future directions for the field.


Assuntos
Anorexia Nervosa , Transtorno da Compulsão Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos , Adolescente , Anorexia Nervosa/terapia , Terapia Comportamental , Transtorno da Compulsão Alimentar/terapia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Dimesilato de Lisdexanfetamina/uso terapêutico
10.
Lakartidningen ; 1162019 Sep 17.
Artigo em Sueco | MEDLINE | ID: mdl-31529419

RESUMO

Emerging evidence supports a prevalence overlap between ADHD and bulimia nervosa/binge eating disorder. A high degree of ADHD symptoms may have a negative impact on recovery in eating disorders with loss of control over the eating, bingeing and purging. Screening/diagnostic evaluation of ADHD in all persons with loss of control over the eating/bingeing/purging eating disorders is required. For patients diagnosed with ADHD, treatment with stimulants can be tested and evaluated for both eating disorders and ADHD symptoms. While there is evidence that lisdexamfetamine reduces symptoms of binge eating disorder, rigorous studies evaluating ADHD treatment, including medication, for bulimia nervosa are still missing.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/tratamento farmacológico , Bulimia Nervosa/complicações , Bulimia Nervosa/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos da Alimentação e da Ingestão de Alimentos/tratamento farmacológico , Humanos , Dimesilato de Lisdexanfetamina/uso terapêutico
11.
Qual Life Res ; 28(12): 3385-3394, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473907

RESUMO

PURPOSE: The Yale-Brown Obsessive Compulsive Scale modified for Binge Eating (Y-BOCS-BE) assesses the obsessiveness of binge eating thoughts and compulsiveness of binge eating behaviors. The findings of this study extend previously published Y-BOCS-BE psychometric evaluations in adults with binge eating disorder (BED). METHODS: Data from three phase 3 lisdexamfetamine dimesylate studies in adults with BED (two randomized, double-blind, placebo-controlled short-term efficacy studies; one double-blind, placebo-controlled, randomized-withdrawal maintenance-of-efficacy study) were used. Psychometric evaluations included assessment of Y-BOCS-BE dimensionality, internal consistency, convergent validity, test?retest reliability, and determinations of clinically meaningful improvement using distribution- and anchor-based methods. RESULTS: Domain specification analyses determined that the Y-BOCS-BE possessed a bifactor structure composed of a general binge eating severity domain and three subdomains (obsessive/compulsive, restraint, and control). Y-BOCS-BE internal consistency was maximized at week 12 (Cronbach?s ?, 0.95) and test?retest reliability was maximized in the 8-week retest interval from week 4 to week 12 across all no-change anchors (r?=?0.74?0.90). Likewise, convergent validity of the Y-BOCS-BE across all validators was maximized at week 12 (all r???0.66). Meaningful improvement for Y-BOCS-BE total scores was estimated to require score reductions of 12 to 17 points depending on the anchor. CONCLUSIONS: The Y-BOCS-BE is a valuable tool for assessing BED symptoms. Maximization of Y-BOCS-BE reliability and validity at later study time points may be related to both treatment effects and improved insight into BED by participants during the study.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adulto , Transtorno da Compulsão Alimentar/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtorno da Conduta , Método Duplo-Cego , Feminino , Humanos , Dimesilato de Lisdexanfetamina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Adulto Jovem
12.
J Adolesc Health ; 65(6): 784-789, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31350122

RESUMO

PURPOSE: The aim of the study was to help quantify the protective effects of stimulant treatment on important functional outcomes in attention-deficit/hyperactivity disorder (ADHD) using the number needed to treat (NNT) statistic and examine whether these effects are moderated by sex. METHODS: Subjects were derived from three independent samples, two similarly designed case-control, 10-year prospective follow-up studies of boys and girls with and without ADHD grown up and a cross-sectional randomized clinical trial of lisdexamfetamine on driving performance and behavior. For all studies, subjects were evaluated with structured diagnostic interviews. To measure psychopharmacologic treatment in the follow-up studies, we collected information about each subject's stimulant medication use, age at onset, and age at termination of treatment. Subjects in the driving study underwent two driving simulation assessments (premedication and after 6 weeks of treatment on lisdexamfetamine or placebo). For each outcome, we ran a logistic regression model that included an interaction between sex and treatment status. Lifetime rates were used to calculate the NNT statistic. We also calculated adjusted NNT statistics that accounted for sex, age, socioeconomic status, and family intactness. RESULTS: The NNTs were very low, ranging from 3 to 10. No interaction effects with sex were detected (all p > .05). The adjusted NNTs mostly remained the same with the exception of any substance use disorder, which increased after controlling for age. CONCLUSIONS: Stimulants have strong protective effects on functional outcomes in youth with ADHD that are not moderated by sex. These results support the critical importance of early identification and treatment of children with ADHD of both sexes.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Exame para Habilitação de Motoristas/estatística & dados numéricos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Adolescente , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais
13.
Psychiatr Clin North Am ; 42(2): 253-262, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046927

RESUMO

Medications are a useful adjunct to nutritional and psychotherapeutic treatments for eating disorders. Antidepressants are commonly used to treat bulimia nervosa; high-dose fluoxetine is a standard approach, but many other antidepressants can be used. Binge eating disorder can be treated with antidepressants, with medications that diminish appetite, or with lisdexamfetamine. Anorexia nervosa does not generally respond to medications, although recent evidence supports modest weight restoration benefits from olanzapine.


Assuntos
Anorexia Nervosa/tratamento farmacológico , Antidepressivos de Segunda Geração/uso terapêutico , Transtorno da Compulsão Alimentar/tratamento farmacológico , Bulimia Nervosa/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Fluoxetina/administração & dosagem , Dimesilato de Lisdexanfetamina/uso terapêutico , Humanos
14.
J Med Econ ; 22(8): 788-797, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30983465

RESUMO

Objectives: To examine suboptimal responses (SR) in attention deficit hyperactivity disorder (ADHD) among pediatric patients in the Texas Medicaid program receiving osmotic-release oral system methylphenidate (OROS-MPH) or lisdexamfetamine (LDX) and apply an SR prediction model to identify patients most likely to experience an SR to either OROS-MPH or LDX therapies. Methods: A retrospective cohort study was conducted using Texas Medicaid claims data of ADHD children and adolescents (6-17 years of age) initiating OROS-MPH or LDX. Primary SR endpoints were drug discontinuation, switching, and augmentation 12-months post-ADHD drug initiation. Logistic regression models were developed to predict SR to OROS-MPH and LDX in 1:1 matched groups of children and adolescent cohorts. Results: A total of 3,633 children and 1,611 adolescents were matched for each cohort. SR was observed among more children (76.4% vs 72.3%; p < 0.001) and adolescents (82.7% vs 78.2%; p = 0.002) initiating OROS-MPH compared to LDX. Patient sub-groups with the highest predicted risk of OROS-MPH SR experienced significantly lower observed SR rates (p < 0.05) when initiating LDX (children: 80.6% for OROS-MPH vs 75.8% for LDX; OR = 0.75, 95% CI = 0.60-0.94; adolescents: 87.2% for OROS-MPH vs 80.6% for LDX; OR = 0.61, 95% CI = 0.41-0.89). For patients with highest predicted SR rates to LDX, observed SR rates were not significantly different between patients initiating LDX or OROS-MPH. Conclusions: This study demonstrated how a personalized medicine approach using administrative claims data can be used to identify sub-groups of child and adolescent ADHD patients with different risks for suboptimal response with OROS-MPH or LDX in a Medicaid population.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Medicaid/estatística & dados numéricos , Metilfenidato/uso terapêutico , Adolescente , Estimulantes do Sistema Nervoso Central/administração & dosagem , Criança , Preparações de Ação Retardada , Feminino , Humanos , Revisão da Utilização de Seguros , Dimesilato de Lisdexanfetamina/administração & dosagem , Masculino , Metilfenidato/administração & dosagem , Estudos Retrospectivos , Texas , Estados Unidos
15.
J Clin Psychiatry ; 80(2)2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30817099

RESUMO

OBJECTIVE: To describe clinical characteristics and lisdexamfetamine dimesylate (LDX) treatment effects, based on gender and age, in adults diagnosed with moderate to severe binge eating disorder (BED). METHODS: Adults diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-defined BED of moderate to severe severity were randomized to 12 weeks of dose-optimized LDX (50 or 70 mg) or placebo in 2 studies (conducted from November 26, 2012, to September 25, 2013 [study 1] and from November 26, 2012, to September 20, 2013 [study 2]). These post hoc analyses pooled data by gender (men vs women) and age (< 40 vs ≥ 40 years) across studies; reported P values are nominal (descriptive and unadjusted). RESULTS: The pooled safety analysis and full analysis sets included 745 and 724 participants, respectively (men, n = 105 and n = 97; women, n = 640 and n = 627; < 40 years, n = 398 and n = 386; ≥ 40 years, n = 347 and n = 338). Across subgroups, most participants had a body mass index ≥ 30 kg/m² (63.0%-75.5%). The mean baseline number of binge eating days/wk was comparable across gender (4.6-4.7) and age (4.6-4.9), as was Yale-Brown Obsessive Compulsive Scale modified for Binge Eating (Y-BOCS-BE) total score (gender, 20.42-21.70; age, 21.40-21.63). Least squares mean (95% CI) treatment differences nominally favored LDX in all subgroups (all P < .001) for changes from baseline in binge eating days/wk at weeks 11-12 and in Y-BOCS-BE total score at week 12; no interactions by gender or age were reported. Consistent with the overall profile of LDX, across all subgroups LDX was associated with higher frequencies of treatment-emergent adverse events than placebo and with increases in blood pressure and pulse. CONCLUSIONS: Across gender and age, participants exhibited comparable clinical characteristics and responses to dose-optimized LDX compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT01718483 and NCT01718509.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Dimesilato de Lisdexanfetamina/uso terapêutico , Adolescente , Adulto , Fatores Etários , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Dimesilato de Lisdexanfetamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
16.
Psychiatry Res Neuroimaging ; 286: 53-59, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-30903953

RESUMO

We examined the effects of lisdexamfetamine (LDX) treatment on ventral prefrontal cortex (VPFC) and striatal brain activation in binge eating disorder (BED). We hypothesized that participants with BED have an abnormal brain response to palatable food cues, and that VPFC and striatal regions would respond to such cues after LDX treatment. Twenty women with moderate to severe BED consented to a 12-week, open-label trial of LDX with fMRI before and after treatment. Twenty obese women without BED served as healthy controls and received one fMRI. LDX was started at 30 mg/d with a target of 70 mg/d at week 12. At baseline, women with BED showed greater activation in ventrolateral prefrontal cortex (VLPFC), striatum, and globus pallidus to food pictures and brain activation to food pictures predicted clinical outcome at 12 weeks. After 12 weeks of LDX treatment, BED women showed significant reductions in globus pallidus activation. Reductions in ventromedial prefrontal cortex (VMPFC) and thalamus activation specifically correlated with binge eating and obsessive-compulsive symptom reductions, respectively. Results suggest that BED is characterized by an abnormally large VPFC-subcortical brain response to palatable foods that LDX treatment helps modify. Moreover, VPFC-subcortical activation at baseline is a potential biomarker of LDX response.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Inibidores da Captação de Dopamina/uso terapêutico , Dimesilato de Lisdexanfetamina/uso terapêutico , Rede Nervosa/efeitos dos fármacos , Obesidade/tratamento farmacológico , Adulto , Transtorno da Compulsão Alimentar/diagnóstico por imagem , Transtorno da Compulsão Alimentar/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Corpo Estriado/diagnóstico por imagem , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/fisiologia , Inibidores da Captação de Dopamina/farmacologia , Feminino , Humanos , Dimesilato de Lisdexanfetamina/farmacologia , Pessoa de Meia-Idade , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiologia , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Projetos Piloto , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/efeitos dos fármacos , Córtex Pré-Frontal/fisiologia , Resultado do Tratamento
17.
Expert Opin Pharmacother ; 20(6): 679-690, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30696303

RESUMO

INTRODUCTION: Binge eating disorder (BED) is the most common eating disorder and was newly recognized in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). BED is frequently associated with obesity and the metabolic syndrome, as well as with other psychiatric diseases, such as mood (49%), anxiety (41%), and substance use (22%) disorders. BED is highly prevalent and carries a high burden of mental and physical illness and disability. However, BED is frequently under-recognized and under-treated. AREAS COVERED: This paper reviews the main pharmacological treatments for BED and provides an expert opinion based on the available evidence and on the authors' clinical experience with patients affected by BED. EXPERT OPINION: Several medications have proven to be effective for the treatment of BED, including Lisdexamfetamine (LDX), topiramate as well as anti-anxiety and antidepressant medications. To date, LDX is the only FDA approved medication for BED. Consequently, as a general rule, the use of an FDA approved medication should always be preferred. However, when in the presence of concomitant psychiatric conditions such as anxiety or depression, other medications that have proven efficacy in those comorbid conditions can be used and may contextually provide a benefit for BED.


Assuntos
Transtorno da Compulsão Alimentar/tratamento farmacológico , Dimesilato de Lisdexanfetamina/uso terapêutico , Topiramato/uso terapêutico , Antidepressivos/uso terapêutico , Humanos , Obesidade/tratamento farmacológico
18.
Ann Pharmacother ; 53(2): 121-133, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30117329

RESUMO

OBJECTIVE: Psychostimulants are the first-line treatment in adults with attention-deficit hyperactivity disorder (ADHD). This meta-analysis aimed to evaluate the efficacy, acceptability, and tolerability of lisdexamfetamine (LDX), mixed amphetamine salts (MASs), modafinil (MDF), and methylphenidate (MPH) in comparison with placebo. DATA SOURCES: We systematically searched PubMed/MEDLINE and Clinicaltrials.gov in May 2016, along with CENTRAL and EU Clinical Trials Register in February 2016, for the randomized, double-blind, placebo-controlled, parallel-group clinical trials conducted on adults diagnosed with ADHD. STUDY SELECTION AND DATA EXTRACTION: Substantial comorbidity, substance abuse or dependence, and nonpharmacological interventions represented grounds for exclusion. Published reports were the sole source for data extraction. Improvement in ADHD symptoms was the primary outcome. Random-effects model meta-analysis was applied to calculate the standardized mean difference (SMD) with 95% CIs. DATA SYNTHESIS: The search retrieved 701 records, of which 20 studies were eligible for analysis. High effect size (expressed as SMD) in reducing ADHD symptoms was observed for LDX (-0.89; 95% CI = -1.09, -0.70), whereas MASs (-0.64; 95% CI = -0.83, -0.45) and MPH (-0.50; 95% CI = -0.58, -0.41) reduced symptoms moderately compared with placebo. No efficacy was shown for MDF (0.08; 95% CI; -0.18, 0.34). Relevance to Patient Care and Clinical Practice: In this meta-analysis, the efficacy, tolerability, and acceptability of psychostimulants were compared with that for placebo. Five of the included trials have not been evaluated in any of the previously published meta-analyses. CONCLUSIONS: The results suggest that LDX has the largest effect size and has a promising potential for treating adults with ADHD.


Assuntos
Anfetamina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Dimesilato de Lisdexanfetamina/uso terapêutico , Metilfenidato/uso terapêutico , Modafinila/uso terapêutico , Adulto , Anfetamina/química , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Método Duplo-Cego , Humanos , Sais/uso terapêutico , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...