OBJECTIVE: Attention Deficit/Hyperactivity Disorder(ADHD) and tic disorders are relatively common childhood onset neuropsychiatric disorders, and these two disorders frequently cooccur in some individual. Although the efficacy of psychostimulants is well established in ADHD, as many as 25% of children fail to respond to psychostimulant treatment due either to a lack of efficacy or to intolerable side effects including exacerbations of tics. Guanfacine, a selective alpha2A-adrenergic agonist, was recently introduced for the treatment of children with ADHD. This study is to evaluate the efficacy and safety of guanfacine in children with ADHD and comorbid habit disorders and to identify subgroups of children who may have a more favorable response to guanfacine. METHODS: Twenty five children who were 6 to 16 years old were enrolled in an open trial of guanfacine for two months. Primary outcome measures were DuPaul Parent and Teacher Rating Scales, Conners Parent and Teacher Rating Scales and Yale Global Tic Severity Scale. Paired t-test and multiple logistic regression were performed to evaluate symptom improvement and to examine predictor variables for positive drug response. RESULTS: Severity of ADHD symptoms and tics after guanfacine administration was significantly reduced at each follow-up point in the ratings completed by both parents and teachers and in clinical evaluation, compared to their pre-medication status. Children with moderate ADHD symptoms responded more favorably to guanfacine than children with mild or severe symptoms. CONCLUSION: These findings suggest that guanfacine may be a safe and an effective medication for ADHD children who cannot benefit from psychostimulants, but more definitive research strategies are needed for future investigation.
Adolescent ; Child ; Comorbidity ; Follow-Up Studies ; Guanfacine* ; Humans ; Logistic Models ; Outcome Assessment (Health Care) ; Parents ; Tic Disorders ; Tics ; Weights and Measures

Tics are brief, rapid and repetitive movement and sounds that are either simple or complex in presentation. Tics can be preceded by a premonitory urge (sensation) that decreases after tic is completed. The fourth edition of Diagnostic Statistical Manual of Mental Disorder (DSM- IV) includes diagnoses for Tourettes disorder, chronic motor or vocal tic disorder, transient tic disorder and tic disorder not otherwise specified (Table 1) according to the duration of tic symptoms and degree of complexity. The purposes of treatment of tic disorders must be set up based on the comprehensive evaluation of developmental profiles, strength, weakness, family situation, and school adaptation status. The family education must be included early in treatment process and psychosocial treatment including the cognitive behavioral therapy will be needed to develop and maintain the self-efficacy in controlling the tic symptoms. The most effective and efficient method for the reduction of tic symptoms, however, are drug treatment. The pharmacotherapy is usually one component of treatment for chronic tic disorder and Tourettes disorder. The gold standard for tic reduction is the dopaminergic receptor blocking agent (or antipsychotic agent, neuroleptics). The primary drugs are haloperidol, pimozide, and risperidone. Among theses, risperidone will be the primary choice because of its low side effect profiles, esp, neurologic side effects. In the near future, the studies on the efficacy of the olanzapine, quetiapine and ziprasidone will be more reported. As second line drugs, clionidine, guanfacine, nicotine related drugs can be considered.
Cognitive Therapy ; Diagnosis* ; Drug Therapy ; Education ; Guanfacine ; Haloperidol ; Humans ; Mental Disorders ; Nicotine ; Pimozide ; Risperidone ; Tic Disorders* ; Tics ; Tourette Syndrome

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. ADHD often persists into adulthood, with resultant impairments of social, academic and occupational functioning. ADHD is a very common disease during childhood and, the pooled overall prevalence of ADHD was found to be 5.29%. When screening for ADHD, clinicians should try to develop rapport with patients and their caregivers to increase the likelihood that they will follow the diagnostic process and treatment. The current drugs that have received Food and Drug Administration-approval for ADHD include stimulants (methylphenidate and dextroamphetamine) and non-stimulants (atomoxetine, guanfacine, and clonidine). Stimulants improve inattention, hyperactivity, and impulsivity in addition to decreasing disruptive behaviors and promoting academic achievement and the maintenance of appropriate friendships. In order to enhance drug compliance, the use of long-acting stimulants is increasing. Atomoxetine is a selective norepinephrine reuptake blocker, the effects of which may take 2 to 6 weeks to be noticeable. Furthermore, α2 agonists may help to improve behavioral side effects, tics, and sleep problems during stimulant or atomoxetine use. Common side effects of stimulants and atomoxetine include headache, stomachache, and loss of appetite. Routine electorcardiography before medication is not recommended unless there is a specific indication. Methylphenidate and atomoxetine are safe as first line therapies, and their side effects are well tolerated.
Appetite ; Atomoxetine Hydrochloride ; Attention Deficit Disorder with Hyperactivity ; Caregivers ; Compliance ; Drug Therapy ; Friends ; Guanfacine ; Headache ; Humans ; Impulsive Behavior ; Mass Screening ; Methylphenidate ; Neurodevelopmental Disorders ; Norepinephrine ; Prevalence ; Problem Behavior ; Tics

It is known that stimulation of the α(2A)-adrenoceptors (α(2A)-ARs) by the selective α(2A)-AR agonist guanfacine produces an important and beneficial influence on prefrontal cortical (PFC) cognitive functions such as spatial working memory and selective attention. However, it is unclear whether stimulation of the α(2A)-ARs has a similar effect on fear conditioning that involves the amygdala and hippocampus. Here, we show that systemically administered guanfacine significantly enhances spatial learning of rats in the Lashley maze: compared with controls, the rats treated with guanfacine required significantly fewer trials and made significantly fewer errors to reach learning criterion. However, guanfacine produced no effect on acquisition of contextual and auditory fear memories. The present study suggests that beneficial effect of α(2A)-AR stimulation is task-dependent: guanfacine improves spatial learning but not fear conditioning.
Adrenergic alpha-2 Receptor Agonists ; pharmacology ; Animals ; Behavior, Animal ; drug effects ; Conditioning (Psychology) ; drug effects ; Fear ; drug effects ; Guanfacine ; pharmacology ; Maze Learning ; drug effects ; Memory ; drug effects ; Rats ; Spatial Behavior ; drug effects