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.

Autor:	Asherson PJ; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Johansson L; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Holland R; Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Bedding M; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Forrester A; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK; and Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Giannulli L; Division of Psychiatry, The University of Edinburgh, UK., Ginsberg Y; Department of Clinical Neuroscience, Karolinska Institute, Sweden., Howitt S; Division of Psychiatry, The University of Edinburgh, UK; and Forensic Psychiatry, NHS State Hospitals Board for Scotland, UK., Kretzschmar I; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Lawrie SM; Division of Psychiatry, The University of Edinburgh, UK., Marsh C; Forensic Psychiatry, NHS Forth Valley Health Board, UK., Kelly C; Division of Psychiatry, The University of Edinburgh, UK., Mansfield M; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., McCafferty C; Forensic Nursing, NHS State Hospitals Board for Scotland, UK., Khan K; Forensic Psychiatry, NHS State Hospitals Board for Scotland, UK., Müller-Sedgwick U; Adult ADHD Service, Barnet, Enfield and Haringey Mental Health NHS Trust, UK., Strang J; Department of Addictions, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Williamson G; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Wilson L; Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Young S; Psychology Services, Psychology Services Limited, UK., Landau S; Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK., Thomson LDG; Forensic Psychiatry, NHS State Hospitals Board for Scotland, UK; and Division of Psychiatry, The University of Edinburgh, UK.
Jazyk:	angličtina
Zdroj:	The British journal of psychiatry : the journal of mental science [Br J Psychiatry] 2023 Jan; Vol. 222 (1), pp. 7-17.
DOI:	10.1192/bjp.2022.77
Abstrakt:	Background: 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. Aims: To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. Method: 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. Results: 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. Conclusions: 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.
Databáze:	MEDLINE
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