Predictors of Concomitant Use of Antipsychotics and Stimulants and Its Impact on Stimulant Persistence in Pediatric Attention Deficit Hyperactivity Disorder

Abstract

BACKGROUND: Concomitant use of stimulants and atypical antipsychotics is common in pediatric attention deficit hyperactivity disorder (ADHD). However, little is known about the determinants of concomitant use and its utility in the management of pediatric ADHD.

Cardiovascular Safety of Concomitant Use of Atypical Antipsychotics and Long-Acting Stimulants in Children and Adolescents With ADHD

“…It was defined as an inpatient claim occurring within 180 days of the index date with an ICD-9-CM diagnosis code associated with any mental health disorder (290.xx-319.xx). This approach has been used in past literature dealing with cardiac safety of stimulants in ADHD patients (Winterstein et al, 2007; Winterstein et al, 2009) and in studies measuring persistence to stimulant treatment in ADHD patients (Palli et al, 2012; Bali, Kamble, & Aparasu, 2015).…”

Real-world adherence assessment of lurasidone and other oral atypical antipsychotics among patients with schizophrenia: an administrative claims analysis

“…A 45 day definition was selected because, based on the properties and clinical use of oral atypical antipsychotics in schizophrenia, the medications are often dispensed for a 30 day interval (or 90 day interval). While other claims-based adherence studies of antipsychotics in the published literature have used 30 day 20,[29][30][31] , 60 day 32 , and 90 day 33,34 treatment gap definitions, this research chose a more stringent "treatment gap" (i.e. a period of 15 days after the last day of use of an initial prescription) to represent a reasonable therapy gap of 45 days (30 days þ15 gap days) to fill an antipsychotic.…”

Trends in attention-deficit and hyperactivity disorder (ADHD) medications among children and young adults in Ireland: a repeated cross-sectional study from 2005 to 2015

“…Negative binomial regression showed significant increases over time (per year) for ADHD prescribing rate in boys/men in the oldest age categories; that is, for [12][13][14][15] year age group (RR=1.04, 95% CI 1.03 to 1.05, p<0.0001) and [16][17][18][19][20][21][22][23][24] year age groups (RR=1.06, 95% CI 1.04 to 1.09, p<0.0001). For girls/women, significant increases over time were also found, similar to boys/men in the oldest age categories; for 12-15 year age group (RR=1.07, 95% CI 1.06 to 1.09, p<0.0001) and [16][17][18][19][20][21][22][23][24] year age groups (RR=1.13, 95% CI 1.11 to 1.15, p<0.0001).…”

“…8 10 A meta-analysis of studies which estimated the prevalence of ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) reported a prevalence of ADHD in 5.9%-7.1% in children and 5% in adults. 9 There is a paucity of data on the prevalence of ADHD in the Irish population; however, a school-based sample of urban [12][13][14][15] year-old children estimated that 3.7% met the criteria for ADHD. 7 Boys and men are more commonly affected than girls and women; epidemiological studies report male:female ratios of 3-4:1.…”

“…[17][18][19] Other psychotropic medication, including antipsychotics and antidepressants, may also be used in patients with ADHD to treat associated comorbidities. 14 In addition, studies have reported off-label use of psychotropics to treat ADHD. 20 The pharmacological management of ADHD has increased over the recent years in many countries.…”