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Salud Mental
ISSN: 0185-3325
[email protected]
Instituto Nacional de Psiquiatría Ramón de la
Fuente Muñiz
México
García, Gerardo
Fármacos estimulantes y psiquiatría infantil. Una revisión de su aplicación en el trastorno por
déficit de atención con hiperactividad en niños
Salud Mental, vol. 26, núm. 2, abril, 2003, pp. 33-41
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
Distrito Federal, México
Available in: http://www.redalyc.org/articulo.oa?id=58222604
Abstract
In 1937 a serendipitous observation discovered the effects of amphetamines on disruptive behavior. Today, stimulant medications
are available for clinical use and they are prescribed for the treatment of attention deficit/hyperactivity disorder (ADHD) in the
childhood and adolescence, and sometimes in adults, but another conditions, such as narcolepsy, may be also the focus of
stimulants use. Literature on stimulant medications is voluminous and in most cases a stimulant is the first-choice medication.
These products are clearly effective at least in the short-term. After large numbers of research studies and 60 years of clinical
experience in patients, there is more knowledge about stimulant use in children and adolescents than about any other drug. The
increase in the diagnosis of ADHD over the past decade seems to reflect an increase in the recognition of the disorder and has led
in turn to a dramatic increase in the prescription of stimulants. Nowadays, methylphenidate is the drug of choice in the treatment,
although skeptics people in the United States argue that the increases indicate an inappropriate use of these products. The diverse
and conflicting opinions about this topic have resulted in confusion for families, care providers, educators and policymakers, and
child psychiatrists face a significant challenge in clinical practice. The decision to medicate is based on the presence of ADHD and
persistent target symptoms sufficiently severe to cause functional impairment at school and usually also at home and with peers.
Although medication is the most powerful and best documented intervention, some symptoms may not respond to it. Some parents
and patients are resistant to the use of medication and some patients experience unacceptable side effects or limited efficacy. The
careful clinician balances the risks of the untreated disorder and the expected benefits of medication as compared to other
treatments. A baseline for target symptoms is useful before starting medication. Faithful adherence to a prescribed regime requires
cooperation among the parents, the patient, school staff and often additional caretakers. Medications may be used incorrectly or
completely avoided because of parental factors such as lack of perceived need for the drug, carelessness, inability to afford
medication, misunderstanding of instructions, complex schedules of administration and family dynamics. Both developmental and
psychopathological factors may impede the patients cooperation. The pharmacokinetics of the stimulants is characterized by rapid
absorption, low plasma protein binding and rapid extracellular metabolism. Although several pathways are involved in their
metabolism, up to 80% may be excreted unchanged in the urine. Both absorption and bioavailability may increase if stimulants are
taken after meals. Traditional products like methylphenidate (MPH) and dl-amphetamine (AMP) have been available in two
versions: short-acting and long-acting; in the case of pemoline, the pharmacology is different.
Keywords
Stimulants, Attention Deficit Hiperactivity Disorder,
pharmacological treatment.
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