fluvoxamine and Attention-Deficit-Disorder-with-Hyperactivity

The purpose of this study was to conduct a systematic review of the pharmacological options available to treat patients diagnosed with attention-deficit hyperactivity disorder and anxiety disorder, for generating evidence on the safest, most-effective and tolerable pharmacotherapy. To this end, a systematic search was performed in three electronic databases (Medline, Scopus and Directory of Open Access Journals; December 2017). Randomized, double-blind, parallel-design clinical trials evaluating the efficacy, safety or tolerability of therapies for attention-deficit hyperactivity disorder and anxiety disorder in children and adolescents or adults were considered. A total of 1960 articles were retrieved from the databases, of which five studies were included in the qualitative synthesis. Two of these studies evaluated the drug atomoxetine, another study evaluated desipramine, and the remaining two studies evaluated methylphenidate, with fluvoxamine being associated with methylphenidate in one of the trials. Owing to the high heterogeneity among studies, it was not possible to combine data for meta-analyses. Although only few studies have been evaluated in this systematic review, the results point to a more significant benefit of atomoxetine. This is probably because this drug was studied in a wider age range and evaluated by more specific scales for both disorders. To further strengthen this evidence, randomized, controlled and multicenter clinical trials with larger sample sizes should be conducted.

Topics: Adolescent; Adult; Anxiety Disorders; Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Central Nervous System Agents; Child; Comorbidity; Desipramine; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Methylphenidate; Randomized Controlled Trials as Topic; Treatment Outcome

The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Child; Depressive Disorder; Desipramine; Fatal Outcome; Female; Fluvoxamine; Forensic Psychiatry; Humans; Imipramine; Male; Malpractice; Mental Disorders; Psychopharmacology; Schizophrenia; Thioridazine

This article looks at the most common drugs that are in use in child psychiatry, and discusses their main indications for use and possible side effects.

Topics: Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Child; Child Psychiatry; Drug Prescriptions; Drug Utilization; Fluoxetine; Fluvoxamine; Health Policy; Humans; Melatonin; Mental Disorders; Methylphenidate; Needs Assessment; Patient Selection; Practice Guidelines as Topic; Practice Patterns, Physicians'; Propylamines; Psychotropic Drugs; Risperidone; Sertraline; United Kingdom

Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children.. Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions-Improvement scores were also obtained.. Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global Impressions-Improvement-defined responder rate. Medications in both arms were well tolerated.. Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

Topics: Adolescent; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Comorbidity; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Methylphenidate; Selective Serotonin Reuptake Inhibitors

The authors examined 21 outpatients with obsessive-compulsive disorder for five neurological soft signs and abnormalities on two neuropsychological tests before and after 10 to 12 weeks of treatment with serotonin reuptake inhibitors. Patients showed a mean of 1.8 soft signs. Prevalences were finger-to-finger, 10%; adventitious movements, 29%; mirror movements, 33%; impaired cube drawing, 33%; and agraphesthesia, 76%. The Stroop Color and Word Test was abnormal in 10% and the Controlled Oral Word Association Test was abnormal in 14% of patients. Neither the presence of specific soft signs, the number of signs present, nor a combination of signs and test abnormalities predicted a poorer response to pharmacological treatment. Some baseline soft signs and abnormalities disappeared at endpoint in medication responders and nonresponders; no clear pattern of change emerged.

Topics: 1-Naphthylamine; Adult; Attention Deficit Disorder with Hyperactivity; Double-Blind Method; Female; Fluvoxamine; Frontal Lobe; Gyrus Cinguli; Humans; Male; Middle Aged; Neuropsychological Tests; Obsessive-Compulsive Disorder; Prognosis; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome

National differences in licensing laws suggest that the use of medications for the treatment of Tourette syndrome differs between European countries. However, variability in prescribing practices has never been investigated. This study aims to systematically examine European prescribing practices in Tourette syndrome.. All members of the European Society for the Study of Tourette syndrome actively prescribing for paediatric and/or adult Tourette syndrome populations were invited to complete an online questionnaire covering pharmacological treatment of the five main symptom domains of Tourette syndrome: tics, attention-deficit hyperactivity symptoms, obsessive-compulsive symptoms, anxiety and depression.. Response rates were good, with 44/57 (77%) members returning the questionnaire. Risperidone (n=13), methylphenidate (n=21) and sertraline (n=17) were the most commonly prescribed medications for the treatment of tics, attention-deficit hyperactivity symptoms and obsessive-compulsive symptoms, respectively. However, there was a large variability in both the medication choices and the dosages used for each of these symptom domains.. This is the first large-scale survey on prescribing habits for the pharmacological management of Tourette syndrome in Europe. In general, dopamine blockers were widely used for tics, selective serotonin reuptake inhibitors for depression, obsessive-compulsive symptoms and anxiety, and stimulants for attention-deficit hyperactivity symptoms, but there was high variation within these choices. Future studies need to target specific patient groups.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Anxiety; Aripiprazole; Atomoxetine Hydrochloride; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Clonidine; Depression; Europe; Fluoxetine; Fluvoxamine; Health Care Surveys; Humans; Methylphenidate; Obsessive-Compulsive Disorder; Physicians; Piperazines; Propylamines; Psychiatry; Quinolones; Risperidone; Sertraline; Sulpiride; Tourette Syndrome

A 59-year-old man, who was being trieated for schizophrenia, exhibited a concurrence of obsessive compulsive (OC) symptoms and neuroleptics-induced deficit syndrome (NIDS). His symptoms were remarkably improved by the discontinuation of neuroleptics followed by the introduction of fluvoxamine. He was originally a prudent, suspicious and unsociable person, the character of which corresponds to a schizotypal personality disorder. From his early twenties OC-symptoms appeared along the theme of cleanliness, health, and ethics. After the first half of his forties OC-symptoms worsened with the emergence of a depressive state. He consulted a psychiatric unit at the age of 49 for the first time and was diagnosed as having schizophrenia of a negative symptoms-dominant type associated with obsessive-compulsive disorder. He was started on haloperidol but the condition did not improved at all so that the dose was gradually increased. When he finally moved to our hospital at the age of 57, serious NIDS such as slow thinking, difficulty in concentration, decrease in emotional reaction, and dysphoria was recognized, in addition to parkinsonism. In order to improve the NIDS, we gradually decreased the dose and reduced the variety of neuroleptics and substituted them for risperidone alone. During these periods, no emergence of psychotic symptoms or worsening of OC-symptoms was realized. Accordingly he was admitted to our hospital and started on fluvoxamine, and the NIDS and OC-symptoms were markedly improved. In conclusion the use of neuroleptics specifically for OC-symptoms should be done very carefully in consideration of the possibility of provoking NIDS.

Topics: Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Fluvoxamine; Haloperidol; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Personality Disorders; Risperidone; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Serotonin syndrome, a potentially fatal iatrogenic complication of psychopharmacologic therapy, is most commonly reported with combinations of serotonergic medications. Serotonin syndrome is characterized by alterations in cognition, behavior, autonomic, and central nervous system function as a result of increased postsynaptic serotonin receptor agonism. We present the first reported case of serotonin syndrome after a single dose of fluvoxamine in a pediatric patient after ingestion of a single supratherapeutic dose of fluvoxamine.

Topics: Attention Deficit Disorder with Hyperactivity; Child; Diagnosis, Differential; Dose-Response Relationship, Drug; Emergencies; Fluvoxamine; Humans; Male; Neurologic Examination; Serotonin Syndrome

Topics: Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Attention Deficit Disorder with Hyperactivity; Clomipramine; Depressive Disorder; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder