The Treatment of ADHD: ADDenda

I can’t resist adding some extra ideas to Dr. Plyler’s review of Amy Arnsten’s article, Catecholamine Influences on Dorsolateral Prefrontal Networks 1.  As he indicated, ADHD is one of the conditions on which we focus in this practice.   Dr. Arnsten’s paper made several points that deserve special emphasis.

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Fine-Tuning our Understanding of the ADHD Brain

The greater our understanding of an illness state, the better we are able to treat it.  As one of the core disorders in our practice, we constantly review and update our knowledge on ADHD. In the course of a recent review, I came across a wonderful compilation issue on ADHD in Biological Psychiatry (Biol Psychiatry June 15 2011, vol. 69).  The review issue covers a wide range of topics from psychostimulants as cognitive enhancers to the molecular genetics of ADHD.  The most relevant and clinically applicable article, however, was Amy Arnsten’s paper on “Catecholamine Influences on Dorsolateral Prefrontal Cortical Networks” (Biol Psychiatry. 2011 June 15;69(12):e89-99).  She does a masterful job of presenting complex material in a clear and elegant manner.  Dr. Arnsten is able to capture the fluidity and dynamics of cortical functions associated with ADHD while still giving the reader anchor points that are useful in everyday clinical practice.

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Vyvanse – The New Kid on the Adhd Block.

ADHD is an increasingly recognized disorder and pharmaceutical companies are regularly developing new drugs and new formulations of older drugs in an attempt to gain an increasing share of this lucrative market. Whether the new pharmaceuticals bring actual therapeutic advantage or simply represent new ‘brands’ with similar effectiveness is an ongoing question. Vyvanse (Lisdexamfetamine dimesylate) is the newest arrival on this competitive turf. It was shown to be effective compared to placebo in two clinical trials of children ages 6-12 and in one trial in adults.

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