Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study

Medientyp: E-Artikel
Titel: Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study
Beteiligte: Asherson, Philip J.; Johansson, Lena; Holland, Rachel; Bedding, Megan; Forrester, Andrew; Giannulli, Laura; Ginsberg, Ylva; Howitt, Sheila; Kretzschmar, Imogen; Lawrie, Stephen M.; Marsh, Craig; Kelly, Caroline; Mansfield, Megan; McCafferty, Clare; Khan, Khuram; Müller-Sedgwick, Ulrich; Strang, John; Williamson, Grace; Wilson, Lauren; Young, Susan; Landau, Sabine; Thomson, Lindsay D. G.
Erschienen: Royal College of Psychiatrists, 2023
Erschienen in: The British Journal of Psychiatry
Sprache: Englisch
DOI: 10.1192/bjp.2022.77
ISSN: 1472-1465; 0007-1250
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Beschreibung: <jats:sec id="S0007125022000770_sec_a1"><jats:title>Background</jats:title><jats:p>Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.</jats:p></jats:sec><jats:sec id="S0007125022000770_sec_a2"><jats:title>Aims</jats:title><jats:p>To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.</jats:p></jats:sec><jats:sec id="S0007125022000770_sec_a3" sec-type="methods"><jats:title>Method</jats:title><jats:p>We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.</jats:p></jats:sec><jats:sec id="S0007125022000770_sec_a4" sec-type="results"><jats:title>Results</jats:title><jats:p>In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.</jats:p></jats:sec><jats:sec id="S0007125022000770_sec_a5" sec-type="conclusions"><jats:title>Conclusions</jats:title><jats:p>ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.</jats:p></jats:sec>
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