The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder

  title={The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder},
  author={Heather Ashton and Peter Gallagher and Brian Moore},
  journal={Journal of Psychopharmacology},
  pages={602 - 610}
Children who have taken psychostimulants long term for attention deficit/hyperactivity disorder (ADHD) are now presenting at adult psychiatry clinics at an age at which bipolar disorder and schizophrenia may first appear and at which pregnancy is a possibility. Doctors who may have little experience in the management of ADHD or use of psychostimulants are faced with decisions on whether to continue or withdraw medication. A literature search conducted to clarify these issues revealed that… 

Adult ADHD: Questioning Diagnosis and Treatment in a Patient with Multiple Psychiatric Comorbidities

The potential benefits and adverse effects of stimulants in the treatment of adult ADHD and mood disorders are considered and the learning points of this complicated, but not uncommon, clinical case are reviewed.

Bupropion for attention deficit hyperactivity disorder (ADHD) in adults.

Low-quality evidence that bupropion decreased the severity of ADHD symptoms and increased the proportion of participants achieving clinical improvement is found, suggesting a possible benefit in clinical improvement in adults with ADHD.

Safety of stimulant treatment in attention deficit hyperactivity disorder: part II

  • R. Merkel
  • Psychology, Medicine
    Expert opinion on drug safety
  • 2010
This paper is a continuation of an earlier paper that reviewed the safety profile of newer stimulant agents, especially in relation to special populations, and is a thorough review of safety concerns in stimulants.

A retrospective claims analysis of combination therapy in the treatment of adult attention-deficit/hyperactivity disorder (ADHD)

ATX and LAS are the most likely drugs to be used as monotherapy in managing adult ADHD, and predictors of combination therapy for LAS and for ATX were modeled for patients covered by commercial plans.

Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology

Initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence and it is hoped that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

Safety of therapeutic methylphenidate in adults: a systematic review of the evidence

  • J. Godfrey
  • Psychology, Medicine
    Journal of psychopharmacology
  • 2009
There is little information on the long-term safety of methylphenidate in adults, although the number of serious adverse effects reported to regulatory authorities has, so far, been low.

The Retrospective Diagnosis of Attention-Deficit/Hyperactivity Disorder in Adolescents: Family Physicians' Challenges

The sources of information currently utilized by physicians for conducting a retrospective diagnosis of ADHD in adolescents were assessed as well as patterns of differences in treatment practices based on the preferred sources of assessment information utilized.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD

This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated.

Safety of stimulant treatment in attention deficit hyperactivity disorder: part I

The use of the newer stimulant agents shows a safety profile of frequent, but usually mild side effects that are generally safe in special populations and the risk of developing long-term substance abuse with attention deficit hyperactivity disorder is small and may decrease with proper treatment.

Effects of a Psychosocial Intervention on the Executive Functioning in Children With ADHD

The conclusion was drawn that psychosocial interventions with children with ADHD can have a positive effect on some executive functions.



Stimulants: use and abuse in the treatment of attention deficit hyperactivity disorder.

  • K. FoneD. Nutt
  • Psychology, Medicine
    Current opinion in pharmacology
  • 2005

Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care.

Data contained within this medical record review suggest that adult ADHD is a substantial source of morbidity in both psychiatric and PCP settings.

Does stimulant therapy of attention‐deficit/hyperactivity disorder beget later substance abuse?

It is suggested that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.

Prevalence and Characteristics of Adolescent Patients with Co-Occurring ADHD and Substance Dependence

Results indicate 31% of patients have current ADHD diagnosis and 20% reported illicit diversion of Schedule II medication, which may be risky for an SUD population since individuals with SUD may have a higher likelihood of abusing or diverting the medications.

Attention-deficit hyperactivity disorder

Attention-Deficit/Hyperactivity Disorder in Adults

It is important for primary care physicians to identify patients with adult ADHD and ensure that they receive effective treatment, as symptoms result in impaired performance in academic, occupational, and social spheres.

Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder

Untreated ADHD was a significant risk factor for SUD in adolescence in boys with attention-deficit/hyperactivity disorder and pharmacotherapy was associated with an 85% reduction in risk for Sud in ADHD youth.

Adults with ADHD

How ADHD in adults can be readily diagnosed and treated, despite resembling or coexisting with other psychiatric disorders is described.

Nonstimulant treatment of adult attention-deficit/hyperactivity disorder.

A Boy Who Stops Taking Stimulants for “ADHD”: Commentaries on a Pediatrics Case Study

Eight commentaries on a case study of an adolescent boy who announces that he no longer needs the methylphenidate he was prescribed for ADHD and had been taking for the last five years are presented.