Medication

Date: 2015-10-07; view: 469.

methylphenidate (Ritalin) 10 mg tablets

Stimulant medications are the medical treatment of choice.^[126][127] There are a number of non-stimulant medications, such as atomoxetine, that may be used as alternatives.^[126] There are no good studies of comparative effectiveness between various medications, and there is a lack of evidence on their effects on academic performance and social behaviors.^[128] While stimulants and atomoxetine are generally safe, there are side-effects and contraindications to their use.^[126] Medications are not recommended for preschool children, as their long-term effects in such young people are unknown.^[22][129] There is very little data on the long-term benefits or adverse effects of stimulants for ADHD.^[130] Any drug used for ADHD may haveadverse drug reactions such as psychosis and mania,^[131] though methylphenidate-induced psychosis is uncommon. Regular monitoring of individuals receiving long-term stimulant therapy for possible treatment emergent psychosis has been recommended.^[132] Tolerance to the therapeutic effects of stimulants can occur,^[93] and abrupt withdrawal is not recommended.^[133] People with ADHD have an increased risk of substance abuse, and stimulant medications reduce this risk.^[134][135] Stimulant medications in and of themselves however have the potential for abuse and dependence.^[136] Guidelineson when to use medications vary internationally, with the UK's National Institute of Clinical Excellence, for example, recommending use only in severe cases, while most United States guidelines recommend medications in nearly all cases.^[137] Deficiency in zinc is more commonly found in ADHD children compared to other children. There is evidence that zinc supplementation can benefit ADHD children who have low zinc levels.^[138]

Prognosis

Children diagnosed with ADHD have significant difficulties in adolescence, regardless of treatment.^[139][140] In the United States, 37 percent of those with ADHD do not get a high school diploma even though many of them will receive special education services.^[141] A 1995 briefing citing a 1994 book review says the combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish high school.^[142] Also in the US, less than 5 percent of individuals with ADHD get a college degree^[143] compared to 28 percent of the general population.^[144] The proportion of children meeting the diagnostic criteria for ADHD drops by about 50 percent over three years after the diagnosis. This occurs regardless of the treatments used and also occurs in untreated children with ADHD.^{[108][145][146]} ADHD persists into adulthood in about 30 to 50 percent of cases.^[8] Those affected are likely to develop coping mechanisms as they mature, thus compensating for their previous ADHD.^[9]
Больным СДВГ назначают сильнодействующие препараты, механизм которых не до конца изучен и могут иметь самые различные побочные эффекты и так называемые "реакции" - неблагоприятный ответ организма на препарат, обычно не зарегистрированный в официальном тестировании препарата и нередко списываемый психиатром на симптом заболевания или соматическое, не касающееся лечения. Известны случаи, когда после начала приёма препаратов у пациента обнаруживались симптомы, так или иначе связанные с веществом, которое он принимает от СДВГ. Например, подросток из США, принимавший риталин, ворвался в школу с отцовским ружьём и расстрелял 15 сверстников.

Epidemiology

ADHD's global prevalence is estimated at 3 to 5 percent in people under the age of 19. There is, however, both geographical and local variability among studies. Children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East.^[148] Published studies have found rates of ADHD as low as 2 percent and as high as 14 percent among school-aged children.^[149] The rates of diagnosis and treatment of ADHD are also much higher on the east cast of the United States than on its west coast.^[150] The frequency of the diagnosis differs between male children (10%) and female children (4%) in the United States.^[151] This difference between genders may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.^[152]

Rates of ADHD diagnosis and treatment have increased in both the UK and the US since the 1970s. In the UK an estimated 0.5 per 1,000 children had ADHD in the 1970s, while 3 per 1,000 received ADHD medications in the late 1990s. In the US in the 1970s 12 per 1,000 children had the diagnosis, while in the late 1990s 34 per 1,000 had the diagnosis and the numbers continue to increase.^[22]

In the UK in 2003 a prevalence of 3.6 percent is reported in male children and less than 1 percent is reported in female children.^[22]:134