| Abstract [eng] |
Objective. Conduct a search on and analyse the literature and clinical descriptions on the peculiarities of pharmacological treatment of attention deficit and hyperactivity disorder in children and adolescent and to draw up summaries and proposals for such pharmacological treatment. Methods. The literature review was conducted in “PubMed”, “ScienceDirect” and “Cochrane Library” databases from 01.12.2022 to 01.03.2022. The search was conducted using combinations of the following keywords in English: “ADHD”, “children OR adolescent”, “treatment OR pharmacotherapy”, “psychostimulants”, “antipsychotics”, “polypharmacy”. The period of publication was not limited and only literature in English was selected. 24 articles were included in the literature review. Results. Multimodal treatment with psychostimulant monotherapy can be ineffective when more severe and complex form of attention deficit and hyperactivity disorder is observed. In such cases the treatment is adjusted by prescribing several groups of drugs, commonly, psychostimulants and antipsychotics. At present there is a lack of comprehensive published guidelines for this polypharmacy. Combined stimulant and antipsychotic treatment is most commonly prescribed off-label for comorbid behavioural disorder and aggression. Often these comorbidities occur in the context of attention deficit and hyperactivity disorder and comorbid conditions such as autistic spectrum disorder and emotional dysregulation disorders, hence polypharmacy is also observed in the presence of these conditions. Polypharmacy is associated with increased extrapyramidal (stimulant-antipsychotic disorder), hormonal (hyperprolactinaemia) and cardiometabolic (weight gain, cardiovascular effects) side effects due to the complex pharmacological interaction between these groups of drugs. The use of combined stimulant and antipsychotic therapy is commonly observed among adolescent boys aged 10-14 years from residential child care communities or dysfunctional families and is mostly associated with the prevalence of comorbid behavioural disorder and aggression, as well as with lack of psychosocial interventions in this population. Conclusions. More aggressive pharmacological treatment with psychostimulants and antipsychotics among children and adolescent with attention deficit and hyperactivity disorder is observed. Such treatment is particularly common among children and adolescents from residential child care communities or dysfunctional families, hence it would be useful in the future guidelines to define the role of social workers in monitoring patients’ conditions and providing psychosocial interventions. |
