Metylfenidat vid ADHD : Effekt och säkerhet vid långtidsbehandling?

Sammanfattning: Introduction: During the last 10 years, the number of children and adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has increased. One of the factors is the advancement made within this scientific field, that has created an increased knowledge about ADHD. Another factor is a greater awareness of the condition. As more and more people are being diagnosed with ADHD, tailored medicinal products are being prescribed to a larger extent. ADHD is a neuropsychiatric impairment of function. Characteristic symptoms for the diagnosis are attention problems, excessive activity, difficulties completing task and possible impulse control problem. About five percent of all schoolchildren are diagnosed with ADHD and it has been considered more abundant among male than among females. Among the patients diagnosed whit ADHD, approximately one -fourth has a family member or relative with a similar problem. The most accepted biochemical theory suggests that the action of dopamine in the brain may explain symptoms as inadequate executive functions i.e. the processes in the brain responsible for the control and coordination of our behavior. Methylphenidate is a central stimulating, long acting medicinal product. The mechanism of action is not yet fully understood, but it is believed to inhibit the reuptake of noradrenaline and dopamine in presynaptic neurons, resulting in an increased amount of monoamines in the synaptic cleft. Then it comes to aspects of safety, for treatment with the central stimulating medicinal product, several parameters deserve attention such as side effects where short-term safety has been relatively well studied but there is a lack of long-term studies. Then it comes to cardiovascular effects, blood pressure increases in average approximately 3-4 mm Hg and the pulse rate increases around six beats /min in both children and adults. Objective: To study the effect and safety of long-term treatment of ADHD with methylphenidate. Method: The scientific articles for the literature study were retrieved by searching the PubMed database and five articles were chosen examining the long-term effects of methylphenidate. Results: The patients included in the studies were evaluated by experienced psychiatrist. The drug effect was assessed by different instruments like DSM-IV ADHD RS and SDS. The CGI-I rating scale assess the overall change in the disorder and CGI-S which helped to assess the patient ́s current condition. The results show that methylphenidate are well tolerated during long-term use and had a significantly better effect compared to placebo. Methylphenidate are proved also to increase the cerebral blood flow in thalamus which reflects increased dopamine neurotransmission due to the neurochemical imprinting of methylphenidate. Discussion: Overall, methylphenidate has a good effect in most persons but has several side effects and therefore is not appropriate for all and everyone. Common side effects are headache, insomnia, reduced weight increase and height increase. Every year, the medicinal treatment of ADHD should be reassessed due to the insufficient study basis regarding long-term treatment with methylphenidate. As many children and adults become long-term users, there is a great need for more long-term studies, covering several years