Sociodemographic and Clinical Predictors of Response in Manic Episodes: A Naturalistic, Prospective, Cohort Study.

BACKGROUND: Response to treatment of a manic episode is dependent on several sociodemographic and clinical factors as reported by researchers from other countries. The prescription of mood stabilizers and/or antipsychotics for manic episode depends on these factors. There is a lack of availability of data from India on this topic. Hence, this study was planned to identify the predictors of pharmacological response. MATERIALS AND METHODS: Forty-two patients with a diagnosis of bipolar affective disorder current episode manic were enrolled and assessed for sociodemographic variables and clinical variables such as age of onset, family history, comorbidities, index episode, and number of past episodes. They were divided into four groups depending on the treatment they were receiving, namely, lithium with an antipsychotic (n = 25), lithium with divalproex and an antipsychotic (n = 8), divalproex with an antipsychotic (n = 5), and the miscellaneous group (n = 4). The primary outcome measure was improvement in the Young Mania Rating Scale score and secondary outcome measure was duration of ward stay. RESULTS: There was a significant improvement in all the treatment modalities and it was comparable. There was no significant impact of any sociodemographic or clinical variable on treatment outcome except that females had significantly better response than males. There was nearly significant shorter duration of hospitalization in the lithium and antipsychotics groups compared to divalproex group. CONCLUSION: All treatment modalities are equally efficacious in the management of manic episode in short term. However, lithium and antipsychotics tend to produce early response than divalproex. Other sociodemographic and clinical predictors were not significantly associated with response.

Comparative efficacy of methylphenidate and atomoxetine in oppositional defiant disorder comorbid with attention deficit hyperactivity disorder.

BACKGROUND: Oppositional defiant disorder (ODD) is frequently comorbid with attention deficit hyperactivity disorder (ADHD) and is associated with substantial functional impairments. Methylphenidate and atomoxetine are well-established drugs for the management of ADHD. Some studies from Western countries have reported these drugs to be effective in the management of ODD comorbid with ADHD. This study aimed to assess if methylphenidate and atomoxetine are efficacious in treating Indian children with ODD comorbid with ADHD. SUBJECTS AND METHODS: In this prospective, open-label study, 37 patients of age 6-14 years with a diagnosis of ODD comorbid with ADHD randomly received either methylphenidate (dose 0.2-1 mg/kg/day) or atomoxetine (dose 0.5-1.2 mg/kg/day) for 8 weeks. Improvements in ADHD and ODD symptoms were assessed using Vanderbilt ADHD diagnostic parent rating scale (VADPRS). RESULTS: At 8 weeks, there were statistically significant improvements in both ADHD and ODD symptoms in both methylphenidate and atomoxetine groups, as per VADPRS. The improvements produced and tolerability was comparable in the two groups. 80% of the patients from methylphenidate group and 64.3% patients from atomoxetine group ceased to fulfill the criteria for the presence of ODD at 8 weeks. CONCLUSIONS: Methylphenidate and atomoxetine are effective in the treatment of ODD comorbid with ADHD in short duration.

Cross-sectional study of self-reported ADHD symptoms and psychological comorbidity among college students in Chandigarh, India.

BACKGROUND: Existence of attention deficit hyperactivity disorder (ADHD) in adults is scantily researched in India. There is dearth of information on prevalence of ADHD in college students worldwide. Further, fewer studies in the past have evaluated the impact of ADHD on the psychological well-being of college students. AIMS: To study the prevalence of ADHD among college students and psychological problems related to ADHD. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: A total of 237 students were recruited from various medical, engineering, and commerce and arts colleges of Chandigarh, India. They were administered the Adult ADHD Self Report Scale v1.1(ASRS) and the Wender Utah Rating Scale (WURS) to diagnose adult ADHD. To assess comorbidities; General Health Questionnaire-12 (GHQ); Zung Depression Rating Scale (ZDRS); Rosenberg's Self-Esteem Scale (RSES);and questions on emotional stability, social problems, and substance use (alcohol, tobacco, and cannabis) were administered on all participants. RESULTS: A total of 13 students (5.48%) fulfilled the criteria for adult ADHD. These students experienced significantly higher emotional instability and low self-esteem than those without ADHD (N = 224). The occurrence of psychological problems, depression, social problems, and substance abuse was comparable in students with and without ADHD. CONCLUSIONS: ADHD is prevalent among the college students studying in the most competitive institutes as well. Students with ADHD experience higher emotional instability and poor self-esteem than others. It has little effect on their psychological well-being and social adjustment. Prompt detection and management of ADHD in college students may help them deal with these problems effectively.

Comparative short term efficacy and tolerability of methylphenidate and atomoxetine in attention deficit hyperactivity disorder.

OBJECTIVE: To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD). DESIGN: Open label randomized parallel group clinical trial. SETTING: Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012. PARTICIPANTS: 69 patients (age 6-14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine. INTERVENTION: Methylphenidate (0.2-1 mg/kg/d) or atomoxetine (0.5-1.2 mg/kg/d) for eight weeks. MAIN OUTCOME MEASURES: Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects. RESULTS: Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (-0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021). CONCLUSIONS: Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable. TRIAL REGISTRATION NO.: CTRI/2011/08/001981.

A Follow-up Study of Academic Functioning and Social Adjustment in Children with Attention Deficit Hyperactivity Disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) persists in a majority of adolescents. It has been reported that ADHD patients have poor social functioning and risk for developing co-morbid psychiatric illnesses. AIMS: To determine the retention of diagnosis of ADHD and to assess social adjustment, academic functioning and co-morbidities at follow-up. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: ADHD patients of 5-14 years of age who came to the out-patient department from 2005 to 2008 were contacted telephonically. Fifty one patients could be contacted. Parents of patients were interviewed using Vanderbilt ADHD Diagnostic Parent Rating Scale for diagnosing ADHD and co-morbidities. Social Adjustment Inventory for Children and Adolescent was administered for assessing their academic and social functioning. Chi square test, Mann-Whitney Test, Kruskal-Wallis Test, and Pearson's product moment correlations were used for statistical analysis. RESULTS: At current assessment, out of 51 patients, 38 were still fulfilling diagnosis of ADHD. Of these, 21 were of inattention type, 3 were hyperactive, and 14 were of combined type. Social functioning and academic functioning were significantly better in those who currently did not fulfill the criteria for ADHD (N=13). Twelve patients developed features of oppositional defiant disorder (ODD)/conduct disorder (CD) at follow-up. CONCLUSIONS: ADHD persists in the majority of adolescents. Decline with age is seen more in hyperactive/impulsive symptoms than inattentive symptoms. Several adolescents also develop features of ODD/CD in addition to poorer functioning. Continuation of treatment is crucial to prevent such consequences.