OBJECTIVE: The primary aim of this study was to investigate the acute impact of methylphenidate (MPH) on sleep parameters in attention-deficit/hyperactivity disorder (ADHD) children. The second aim was to investigate the different effects of intermediate- and longacting MPH on sleep parameters. The third aim was to test the different effects of dose and age on sleep parameters. METHODS: Ninety-three ADHD children were enrolled and randomized to two different MPH preparations. Baseline and daily sleep diaries were evaluated for four weeks after taking medication. Weekday and weekend bedtimes, wake-up times, sleep latencies and total sleep times were compared by weeks. RESULTS: After taking MPH, there was a significant delay in bedtimes and a significant reduction of total sleep time (TST) both on weekdays and at weekends. There was also a significant delay in wake-up time on weekdays. However, the difference was applied to younger age group children only. There was no difference in changes of TST between metadate-CD and OROS-MPH. There also was no difference in changes of TST with different doses of MPH. CONCLUSION: MPH had negative impacts on sleep among young ADHD children, but different preparations and doses did not affect the result.
Child ; Humans ; Methylphenidate ; Phenazines

Attention-deficit/hyperactivity disorder (ADHD) is one of the common psychiatric problems in childhood. The symptoms of ADHD tend to last for adulthood and the patients suffer from various comorbid problems and functional impairments. Methylphenidate (MPH) is the first choice of pharmacotherapy for ADHD and many researches have demonstrated its efficacy. We reviewed the clinical trials for efficacy of MPH focusing on Osmotic-Controlled Release Oral delivery System Methylphenidate (OROS MPH). It was identified that MPH improved core symptom of ADHD, peer relationship and health related quality of life and might improve various aspects of cognitive function. It was proved that the efficacy of OROS MPH was better than placebo and comparable to immediate release MPH (IR MPH) dosed three times daily in various studies. Especially, parent's preference of OROS MPH was better than IR MPH. The efficacy of MPH for academic achievement was equivocal. Long-term efficacy of OROS MPH was also inconclusive and further study is necessary.
Achievement ; Humans ; Methylphenidate ; Phenazines ; Quality of Life

Attention-deficit/hyperactivity disorder (ADHD) is one of the common psychiatric problems in childhood. The symptoms of ADHD tend to last for adulthood and the patients suffer from various comorbid problems and functional impairments. Methylphenidate (MPH) is the first choice of pharmacotherapy for ADHD and many researches have demonstrated its efficacy. We reviewed the clinical trials for efficacy of MPH focusing on Osmotic-Controlled Release Oral delivery System Methylphenidate (OROS MPH). It was identified that MPH improved core symptom of ADHD, peer relationship and health related quality of life and might improve various aspects of cognitive function. It was proved that the efficacy of OROS MPH was better than placebo and comparable to immediate release MPH (IR MPH) dosed three times daily in various studies. Especially, parent's preference of OROS MPH was better than IR MPH. The efficacy of MPH for academic achievement was equivocal. Long-term efficacy of OROS MPH was also inconclusive and further study is necessary.
Achievement ; Humans ; Methylphenidate ; Phenazines ; Quality of Life

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder with an onset of symptoms before 7 years of age, often starting as early as the preschool years. The off-label use of methylphenidate (MPH) for 3- to 6-year-old preschool children with ADHD is being more common, although MPH is not licensed for use in children younger than age 6 years, in most countries. Despite the limited data, the review of the literature suggests that MPH meets evidence based criteria as beneficial and safe for carefully diagnosed ADHD preschool children. Carefully monitored administration of evidence-based psychotropic medication in preschool children with ADHD may be indicated if psychosocial treatments are ineffective.
Child ; Child, Preschool ; Humans ; Methylphenidate ; Off-Label Use ; Phenazines

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of methylphenidate HCL OROS extended-release (OROS-MPH) among children with attention deficit hyperactivity disorder (ADHD) who had been previously treated with methylphenidate HCL immediate-release (MPH-IR). METHODS: The sample included 102 children aged 6-12 (9.4+/-2.6) years who had been diagnosed with ADHD according the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association, 1994) and who were attending seven centers in Korea. All participants had been medicated with a stable dose of MPH (10-60 mg/day) for at least 3 weeks before entry into the study. Doses of OROS-MPH were comparable to daily doses of MPH. Efficacy was assessed at baseline (day 0) and at day 28 with the Inattentive-Overactive with Aggression (IOWA) Conners Rating Scale, which was completed by parents/caregivers and teachers, the Peer Interaction Rating Items, which were completed by teachers, and the Clinical Global Impression (CGI) scale, which was completed by child psychiatrists. Paired t-tests were used, and P-values were set at the 0.05 level. RESULTS: Of the subjects, 92.2% were boys and 79.4% were students in the first to fourth grades of elementary school. 72% were diagnosed with the combined type of ADHD, 23% were diagnosed with the inattentive type, and 5% were diagnosed with the hyperactive-impulsive type. The results of the parents' responses to the Inattention/Hyperactivity (I/H) and Oppositional/Defiant (O/D) subscales of the IOWA Conners scale indicated statistically significant improvement in childrens behavior after 4 weeks of treatment with OROS-MPH (t=6.28, p<.001, t=4.12, p<.001). However, the teachers' responses to the Conners I/H and O/D subscales indicated no significant improvement at 4 weeks. The teachers also reported no significant improvements under the OROS-MPH compared with the MPH-IR condition with respect to peer interactions. Scores on the CGI scale showed that 46.1% of children with ADHD were rated by psychiatrists as "minimally improved", 27.5% as "much improved," 1.0% as "very much improved," 3.9% as "minimally worse," and 16.7% as showing "no change". Children exhibited significantly fewer tics with OROS-MPH treatment than with MPH-IR treatment (19.6% vs. 27.7%). We found no differences between in sleep and appetite problems according to medication. CONCLUSION: The results of this study indicated that an MPH-IR regimen can be successfully changed to a once-daily OROS-MPH regimen without any serious adverse effects. The changes in parent/caregiver IOWA Conners ratings suggested that OROS-MPH improved the control of symptoms after school, a finding that is consistent with the 12-h duration of action of this medication. Because the therapeutic effect of OROS-MPH is sufficiently longer than that of a b.i.d. dose of MPH-IR, OROS-MPH had significant positive effects on oppositional/defiant behavior in addition to its effects on the core symptoms of ADHD.
Aged ; Aggression ; Appetite ; Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Iowa ; Korea ; Methylphenidate ; Phenazines ; Psychiatry ; Tics

OBJECTIVE: The core deficit of attention deficit hyperactivity disorder (ADHD) is associated with frontal cortex and related circuitry. Children with ADHD and a medication history have shown atypical brain activation in prefrontal and striatal brain regions during cognitive challenge. We investigated two cognitive control operations such as interference suppression (IS) and response inhibition (RI) in children with ADHD. We also assessed the brain functions affected by the methylphenidate (MPH) effect by comparing the blood-oxygen level dependent (BOLD) signals in ADHD children on and off medication. METHODS: Eight children (9-11 years of age) with combined-type ADHD underwent rapid event-related functional magnetic resonance imaging (fMRI) during performance of a modified flanker task. Two fMRI (3.0 T) scans were conducted with a one week interval-one with MPH treatment and the other without. Functional maps were generated through group averaging and performance-based correlational analyses. RESULTS: Performances of the two cognitive control operations did not differ significantly between on-MPH and off-MPH status other than the reaction time to incongruent stimuli in ADHD children. In those affected by MPH treatment, an increased activation in the right prefrontal cortex during incongruent task was observed relative to a neutral trial in children with ADHD. CONCLUSION: On the treatment of MPH, the ADHD children exhibited increased activation of the right frontal cortex during interference suppression. This finding suggested that MPH affected the right frontal cortex in ADHD compensating for a reduced level of interference suppression. Future studies will be required to ascertain the MPH effect of cognitive brain regions among large number of children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Brain ; Child ; Humans ; Magnetic Resonance Imaging ; Methylphenidate ; Phenazines ; Prefrontal Cortex ; Reaction Time

Gentian Violet ; Humans ; Iatrogenic Disease ; Phenazines ; Pneumonia, Bacterial ; diagnosis ; Sputum ; microbiology

Anti-Bacterial Agents ; therapeutic use ; Gentian Violet ; Humans ; Phenazines ; Pneumonia, Bacterial ; diagnosis ; drug therapy ; microbiology

OBJECTIVES: The purpose of this study was to investigate clinical characteristics of children and adolescents with autism spectrum disorders (ASDs) using methylphenidate (MPH). METHODS: Retrospective review of the charts of 79 children and adolescents with ASDs, who visited the Department of Child and Adolescent Psychiatry of Seoul National Hospital, from July 2010 to July 2011, was conducted. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity of illness (CGI-S) and Clinical Global Impression-Improvement (CGI-I) Scales. RESULTS: We found that MPH was prescribed in 23 (29.1%) children and adolescents. Of the 23 patients on MPH, 4 patients (17.4%) were on MPH monotherapy and 18 patients (78.3%) were using risperidone concomitantly. MPH was prescribed primarily for symptoms of hyperactivity and impulsivity in ASDs patients. The mean dosage of MPH was 26.2+/-11.1mg/day and mean duration of treatment was 31.9+/-28.7 months. Mean CGI-S score improved significantly from baseline to endpoint (from 5.4+/-0.6 to 4.1+/-0.9 ; p<.01). MPH was reported to be effective in 17 patients (17/23, 73.9%), and 10 patients (10/23, 43.5%) reported side effects. Side effects included decreased appetite (4/23, 17.4%), tic (2/23, 8.6%), sleep disturbances (2/23, 8.6%), headache (1/23, 4.3%) and irritability (1/23, 4.3%). CONCLUSION: The results of this study demonstrate that MPH may be used effectively and safely in children and adolescents with ASDs with hyperactivity and impulsivity. Future controlled trials are needed to confirm these findings.
Adolescent ; Adolescent Psychiatry ; Appetite ; Autistic Disorder ; Child ; Autism Spectrum Disorder ; Headache ; Humans ; Methylphenidate ; Phenazines ; Retrospective Studies ; Risperidone ; Tics

OBJECTIVES: The aim of this study was to examine the association of the ADRA2A MspI and DraI polymorphisms with methylphenidate (MPH) response in Korean children with ADHD. METHODS: The present study included 112 children and adolescents with ADHD (mean age=9.1+/-2.1 years), consisting of 92 boys (82.1%) and 20 girls (17.9%). ADHD was diagnosed based on the DSM-IV criteria using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). For the clinical evaluation of the ADHD subjects, the ADHD Rating Scale-IV (ADHD-RS) and Clinical Global Impression (CGI) were administered at baseline and 8 weeks after MPH treatment. ADRA2A MspI and DraI polymorphisms were genotyped. The chi2 test was used to evaluate the relationship between the ADRA2A genotype and the response to MPH. The correlation between the genotype of ADRA2A and the change in the ADHD-RS scores after MPH treatment was assessed using the analysis of variance test and t-test. The significance level was set at p=0.01. RESULTS: No significant association was found between the genotypes of the ADRA2A MspI or DraI polymorphisms and MPH treatment response according to the CGI-improvement score (p>0.05). Comparing the changes in ARS scores after MPH treatment according to the genotypes of the MspI or DraI polymorphisms, we found no significant differences between subjects with different genotypes (p>0.05). CONCLUSION: Our results do not support the significant association between the MspI genotype and MPH response in Korean ADHD subjects, which was previously reported. In addition, we document no evidence of association between the DraI polymorphism and MPH treatment response in the Korean ADHD population.
Adolescent ; Attention Deficit Disorder with Hyperactivity ; Child ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Humans ; Methylphenidate ; Mood Disorders ; Phenazines