Dikkat eksikliği ve hiperaktivite bozukluğunda metilfenidat, atomoksetin ve kombine tedavinin etkinliği

Yıl 2018, Cilt: 43 Sayı: Ek 1, 15 - 23, 29.12.2018

Emel Sarı Gökten

https://doi.org/10.17826/cumj.408139

Öz

Amaç: Çalışmamızın amacı dikkat eksikliği ve hiperaktivite bozukluğunun medikal tedavisinin (metilfenidat, atomoksetin ve kombine terdavi) belirtiler üzerinde sağladığı etkinliği değerlendirmektir.

Gereç ve Yöntem: Bu amaçla metilfenidat, atomoksetin ve kombine tedavi (metilfenidat+atomoksetin) alan üç grup olgunun belirtilerindeki azalma Conner’s Ana/Baba Derecelendirme Ölçeği ile tedavi öncesi ve düzenli tedavinin birinci yılında değerlendirildi. Araştırmaya 104 olgu alındı. Metilfenidat grubunda 82 olgu (%78.8), Atomoksetin grubunda 14 olgu (%13.5) ve Kombine Tedavi grubunda 8 olgu (%7.ç7) mevcuttu.

Bulgular: Her üç tedavi grubunda Conner’s alt kategorilerinin tümünün puanlarında iyileşme saptandı, ancak puanlardaki azalma sadece Metilfenidat alan grupta anlamlılık düzeyine ulaştı. Conner’s alt kategori puanlarındaki azalma gruplar arasında karşılaştırıldığında anlamlı farklılığın olmadığı saptandı.

Sonuç: Dikkat eksikliği ve hiperaktivite bozukluğu tedavisinde ilaç tedavilerinin her biri belirtilerde iyileşme sağlamakla birlikte aralarındaki etkinlik farklılıklarının daha iyi anlaşılabilmesi için daha geniş örneklemli ve ilaç gruplarının birbirine eşit sayıda olgu ile oluşturulduğu prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

DEHB, metilfenidat, atomoksetin, kombine tedavi

Efficacy of methylphenidate, atomoxetine and combined therapy in treatment of attention deficit/hyperactivity disorder

Öz

Purpose: The purpose of this research is to evaluate treatment efficacy of methylphenidate, atomoxetine and combined therapy in attention deficit/hyperactivity disorder.

Materials and Methods: For this purpose, decrease in attention deficit/hyperactivity disorder symptoms were evaluated before treatment and at the end of the first year in treatment with Conner’s Parent Rating Scale in three groups named Methylphenidate, Atomoxetine and Combined Therapy. 104 cases were included in the study. There were 82 cases (78.8%) in the Methylphenidate group, 14 cases (13.5%) in the Atomoxetine group and 8 cases (7.7%) in the Combined Therapy group.

Results: In all three treatment groups, all of the Conner’s subcategories improved in scores, but the reduction in scores was significant only in the Methylphenidate group. The decrease in Conner’s subcategory scores was not significant when compared between the groups.

Conclusions: All  of the drug treatments improved in symptoms of Attention Deficit/Hyperactivity Disorder but prospective studies are needed with large samples and equally distributed in drug groups in order to better understand the differences in effectiveness between them.

Anahtar Kelimeler

ADHD, methylphenidate, atomoxetine, combined therapy, conner’s

Kaynakça

• Döpfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U, Bella Study Group. How of-ten do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample–results of the BELLA study. Eur Child Adolesc Psychiatry 2008; 17(1):59-70.
• Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adoles-cents. J Child Psychol Psychiatry 2015; 56(3):345-365.
• DSM-5 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing, 2013.
• Mash EJ, Barkley RA (Eds.). Treatment of childhood disorders. Guilford press, 2006.
• Kayaalp L. Dikkat eksikliği ve hiperaktivite bozukluğu. İ.Ü.Cerrahpaşa Tıp Fakültesi Tıp Eğitimi Etkinlikleri: Türkiye’de Sık Karşılaşılan Psikiyatrik Hastalıklar. Sempozyum Dizisi, 2008; 62:147-152.
• Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS. Trends in medication treat-ment for ADHD. J Atten Disord 2007; 10(4):335-342.
• Wolraich M, Greenhill LL, Pelham W, Swanson J, Wilens T, Palumbo D, et al. Random-ized controlled trial of OROS Methylphenidate in children with Attention Defi-cit/Hyperactivity Disorder. Pediatrics 2001; 108:883-892.
• Spencer T, Biederman J, Coey B, Geller D, Crawford M, Bearman SK, et al. A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2002; 59:649-656.
• Spencer TJ, Biederman J, Wilens T, Harding M, O’Donnell D, Griffin S. Pharmacother-apy of attention deficit hyperactivity disorder across the life cycle: a literature review. J Am Acad Child Adolesc Psychiatry 1996; 35:409-432.
• Spencer TJ, Biederman J, Wilens TE, Faraone SV. Novel treatments for ADHD in children. J Clin Psychiatry 2002; 63(suppl 12):16-22.
• Spencer TJ, Heiligenstein J, Biederman J, Faries D, Kratochvil C, Conners CK, et al. Results from 2 proof of concept, placebo-controlled studies of atomoxetine in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2002; 63:1140-1147.
• Şengül C, Şengül CB, Kiliç EÖ, Dilbaz N. Dikkat Eksikliği Hiperaktivite Bozukluğu Psikofarmakolojisinde Yeni Gelişmeler. Klinik Psikofarmakoloji Bulteni 2005; 15(4).
• Savaşır I, Şahin N. Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R) El Kitabı. Türk Psi-kologlar Derneği Yayınları, Ankara, 1995; 13-52.
• Dereboy Ç, Şenol Ş, Şener Ş, Dereboy İF. Conners ana baba derecelendirme ölçeği uyarlama çalışması. 10.Ulusal Psikoloji Kongre Özet Kitabı 1998.
• Marquand AF, De Simoni S, O’daly OG, Williams SC, Mourao-Miranda J, Mehta MA. Pattern classification of working memory networks reveals differential effects of methylphenidate, atomoxetine, and placebo in healthy volunteers. Neuropsychopharmacology 2011; 36(6):1237.
• Kratochvil CJ, Heiligenstein JH, Dittmann R, Spencer TJ, Biederman J, Wernicke J, et al. Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial. J Am Acad Child Adolesc Psychiatry 2002; 41(7):776-784.
• Spencer T, Biederman J, Wilens T, Prince J, Hatch M, Jones J, et al. Effectiveness and tolerability of tomoxetine in adults with attention deficit hyperactivity disorder. Am J Psychiatry 1998; 155:693–695.
• Michelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, et al. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose–response study. Pediatrics 2001; 108:E83.
• Faraone SV, Biederman J, Spencer T, Michelson D, Adler L, Reimherr F, et al. Effica-cy of atomoxetine in adult attention-deficit/hyperactivity disorder: a drug–placebo re-sponse curve analysis. Behav Brain Funct 2005; 1:16.
• Kemner JE, Starr HL, Ciccone PE, Hooper-Wood CG, Crockett RS. Outcomes of OROS (R) methylphenidate compared with atomoxetine in children with ADHD: a multi-center, randomized prospective study. Adv Ther 2005; 22:498–512.
• Starr HL, Kemner J. Multicenter, randomized, open-label study of OROS methylphenidate versus atomoxetine: treatment outcomes in African-American children with ADHD. J Natl Med Assoc 2005; 97:11S–16S.
• Newcorn JH, Kratochvil CJ, Allen AJ, Casat CD, Ruff DD, Moore RJ, et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. Am J Psychi-atry 2008; 165:721–730.
• Navarra R, Graf R, Huang Y, Logue S, Comery T, Hughes Z, et al. Effects of atomoxe-tine and methylphenidate on attention and impulsivity in the 5-choice serial reaction time test. Prog Neuro-Psychopharmacol Biol Psychiatry 2008; 32(1):34-41.