Lyfjamefer barna og fullorinna slandi vi ADHD

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Lyfjameðferð barna og fullorðinna á Íslandi við
ADHD

• Matthías Halldórsson
• ADHD ráðstefna
• Grand Hóteli 25.-26. september 2008

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Bók Thomas E. Brown 1. kafli

• Myth ADD is just a lack of willpower. Persons
  with ADD focus well on things that interest them
  they could focus on any tasks if they really
  wanted to.
• Fact ADD looks very much like a willpower
  problem, but it isnt. Its essentially a
  chemical problem in the management systems of the
  brain.

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Bók Thomas E. Brown 9. kafli

• Myth Medications for ADD are likely to cause
  longer-term problems with substance abuse or
  other health concerns, especially when used by
  children.
• Fact The risks of using appropriate medications
  to treat ADD are minimal, whereas the risks of
  not using medication to treat ADD are
  significant. The medications used for ADD are
  among the best researched for any disorder.

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Methylphenydat (N05BA04)

• Lyfjaheiti Markaðsleyfi á íslandi
• Stuttverkandi lyf Ritalín 30/12 1965
• (lt 5 klst) Equazím 26/1 2004
• Langverkandi lyf Concerta 26/9 2002
• (gt 5 klst) Ritalín Uno 16/10 2002

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Kynskipt algengi metylfenídatnotkunar meðal barna
(0 - 17 ára) á Íslandi 1989-2007
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Hvaða læknar hófu lyfjameðferð við ADHD hjá
börnum og ungl. árið 2007
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Fáir læknar skrifa megnið af ávísunum á
methylfenidat

• Fjöldi ávísana ALLS á methylfenidat fyrir
  18 6251 (100)
• Efsti læknir 1718 (28)
• 10 Efstu (9 efstu eru geðlæknar) 3927 (62)
  

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Fjöldi þeirra karla og kvenna á öllum aldri sem
fengið hafa a m k einn lyfseðil lyf við ADHD
miðað við 1000 íbúa árið 2007
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Fjöldi þeirra sem fengið hafa a m k einn
lyfseðil lyf við ADHD miðað við 1000 íbúa eftir
aldri árið 2007
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Fjöldi þeirra sem nota örvandi lyf útskrifuð af
lækni í USA og Íslandi

• Börn Fullorðnir
• USA 3,5 milljón 1,5 milljón
• (Deilt með1000) (3500) (1500)
• Ísland 1974 1172109 1281
• Börn á Íslandi vísar til aldurshópsins 0-17
  ára, en í USA er miðað við 0-19 ára

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• Biederman J. Wilens T. Mick E. Spencer T.
  Faraone SV.
• Pharmacotherapy of attention-deficit/hyperactivit
  y disorder reduces risk for substance use
  disorder.
• Comparative Study. Journal Article. Research
  Support, U.S. Gov't, P.H.S. Pediatrics (1999)
  104(2)e20,

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Grein Farone og Wilens í J Clin Psychiatry.
200768 Suppl 1115-22. Review Effect of
stimulant medications for attention-deficit/hypera
ctivity disorder on later substance use and the
potential for stimulant misuse

• Prospective longitudinal studies show that
  attention-deficit/hyperactivity disorder (ADHD)
  is a risk factor for subsequent substance use
  disorders. These studies also suggest that ADHD
  pharmacotherapy in childhood reduces the risk for
  substance use disorders. Misuse and diversion of
  prescribed stimulants occur among a minority of
  ADHD patients, especially those with conduct or
  substance use disorders. Long-acting stimulants
  may be less likely to be misused or diverted.

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J Biederman í American Journal of Psychiatry
2008 165597603 Stimulant Therapy and Risk
for Subsequent Substance Use Disorders in Male
Adults With ADHD

• Conclusions The findings revealed no evidence
  that stimulant treatment increases or decreases
  the risk for subsequent substance use disorders
  in children and adolescents with ADHD when they
  reach young adulthood

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Vinnulag við greiningu og meðferð athyglisbrests
með ofvirkni (ADHD)

• Útgefið í desember 2007
• http//www.landlaeknir.is gt leitarorð ADHD
• Höfundar
• Gísli Baldursson
• Páll Magnússon
• H. Magnús Haraldsson
• Matthías Halldórsson

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Takmarkanir á útskrift övandi lyfja

• Eftirritunarskyld lengi
• 1986 - gulu kortin landlæknisembættisins
• 2001 - afnám gulu kortanna
• 2004 - lyfjaskírteini með verklagsreglum TR
• 2007 - vinnulagsreglur landlæknisembættisins

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International ADHD Consensus Statement January
2002

• We, the undersigned consortium of international
  scientists, are deeply concerned about the
  periodic inaccurate portrayal of attention
  deficit hyperactivity disorder (ADHD) in media
  reports. This is a disorder with which we are all
  very familiar and toward which many of us have
  dedicated scientific studies if not entire
  careers. We fear that inaccurate stories
  rendering ADHD as myth, fraud, or benign
  condition may cause thousands of sufferers not to
  seek treatment for their disorder. It also leaves
  the public with a general sense that this
  disorder is not valid or real or consists of a
  rather trivial affliction.
• Occasional coverage of the disorder casts the
  story in the form of a sporting event with evenly
  matched competitors. The views of a handful of
  non-expert doctors that ADHD does not exist are
  contrasted against mainstream scientific views
  that it does, as if both views had equal merit.
  Such attempts at balance give the public the
  impression that there is substantial scientific
  disagreement over whether ADHD is a real medical
  condition. In fact, there is no such disagreement
  --at least no more so than there is over whether
  smoking causes cancer, for example, or whether a
  virus causes HIV/AIDS.

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International ADHD Consensus Statement (frh.)

• This is why leading international scientists,
  such as the signers below, recognize the mounting
  evidence of neurological and genetic
  contributions to this disorder. This evidence,
  coupled with countless studies on the harm posed
  by the disorder and hundreds of studies on the
  effectiveness of medication, buttresses the need
  in many, though by no means all, cases for
  management of the disorder with multiple
  therapies. These include medication combined with
  educational, family, and other social
  accommodations. This is in striking contrast to
  the wholly unscientific views of some social
  critics in periodic media accounts that ADHD
  constitutes a fraud, that medicating those
  afflicted is questionable if not reprehensible,
  and that any behavior problems associated with
  ADHD are merely the result of problems in the
  home, excessive viewing of TV or playing of video
  games, diet, lack of love and attention, or
  teacher/school intolerance.

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Samantekt

• ADHD er algeng röskun með líffræðilegar orsakir
  og sterkan erfðaþátt.
• Greining byggist á ákveðnum greiningarskilmerjum
  varðandi hegðun
• Einbeitingarerfiðleikar, ofvirkni og hvatvísi
  einkenna ADHD
• ADHD kemur fram í bernsku og einkenni flytjast í
  mismiklum mæli fram á fullorðinsár
• Ein mest rannsakaða geðröskun sem um getur
• Síður rannsakað hjá fullorðnum en börnum
• Miklu algengara hjá strákum, en algengi jafnast
  hjá kynjum á fullorðinsárum
• Greining er kerfisbundin og byggist á upplýsingum
  víða að
• Lyf, einkum örvandi lyf og atomoxetín, virka best
  á kjarnaeinkennin
• Lyfjanotkun við ADHD eykst hröðum skrefum alls
  staðar
• Algengara hér en á Norðurlöndunum, en sviðað og í
  Bandaríkjunum
• Örvandi lyf eru misnotuð
• Fíklar og fangar eiga helst ekki að nota örvandi
  lyf fremur Strattera
• Má ekki nota nema greining hafi verið gerð á
  áreiðanlegan hátt
• Spurning hversu fagleg greining er á ADHD
  fullorðinna hér á landi