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Methylphenidate challenge followed by therapeutic drug monitoring in adults with attention deficit/hyperactivity disorder: Clinical effects and its predictors

Published online by Cambridge University Press:  23 March 2020

D. Piacentino ,
G. Giupponi ,
I. Maniscalco ,
S. Holzer ,
M. Pompili ,
P. Girardi  and
A. Conca
D. Piacentino
Affiliation:
Nesmos department (neurosciences, mental health, and sensory organs), Sapienza university of Rome, school of medicine and psychology, Sant’Andrea hospital, Rome, Italy Psychiatric department, San Maurizio hospital, sanitary agency of South Tyrol, Bolzano, Italy
G. Giupponi
Affiliation:
Psychiatric department, San Maurizio hospital, sanitary agency of South Tyrol, Bolzano, Italy
I. Maniscalco
Affiliation:
Psychiatric department, San Maurizio hospital, sanitary agency of South Tyrol, Bolzano, Italy
S. Holzer
Affiliation:
Specialistic outpatient service for ADHD in adults, sanitary agency of South Tyrol, Bolzano, Italy
M. Pompili
Affiliation:
Nesmos department (neurosciences, mental health, and sensory organs), Sapienza university of Rome, school of medicine and psychology, Sant’Andrea hospital, Rome, Italy
P. Girardi
Affiliation:
Nesmos department (neurosciences, mental health, and sensory organs), Sapienza university of Rome, school of medicine and psychology, Sant’Andrea hospital, Rome, Italy
A. Conca
Affiliation:
Psychiatric department, San Maurizio hospital, sanitary agency of South Tyrol, Bolzano, Italy Provincial service of developmental psychiatry and psychotherapy, sanitary agency of South Tyrol, Bolzano, Italy

Abstract

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Introduction

Attention deficit/hyperactivity disorder (ADHD) affects 5–6% of adults. Methylphenidate challenge is used to test functions such as concentration. Therapeutic drug monitoring (TDM) identifies optimal drug ranges in plasma.

Objectives/Aims

We aimed to: assess the clinical impact of the drug challenge in adults with ADHD; analyze the relationship with the drug plasma levels after the challenge; identify predictors of the challenge's clinical impact.

Methods

In 2015–2016, we recruited 45 consecutive adult DSM-5 ADHD outpatients (mean age ± SD = 35.3 ± 2.1 years; females = 64.4%) at the Bolzano hospital department of psychiatry. Before and after administration of methylphenidate 10 mg, we measured concentration, impulsivity, tension, and general well-being with a VAS and an interview. After two hours, TDM was performed. Deltas were calculated for pre-/post-challenge measures. Correlations were measured with Pearson's r/point-biserial coefficient. A generalized linear mixed model estimated the size of association between tension/general well-being improvement and patient characteristics.

Results

After the challenge, the mean improvement ± SD was 24 ± 22 for concentration, 17 ± 23 for impulsivity, 21 ± 28 for tension, 16 ± 24 for general well-being. The mean TDM ± SD was 4.6 ± 0.5 ng/mL. A negative correlation between TDM, tension (P = 0.009), and general well-being (P = 0.028) after the challenge emerged: higher drug plasma levels relate to less tension and greater general well-being. At the GLMM the main predictor for tension/general well-being improvement was psychopharmacological treatment (P = 0.011/P = 0.05, respectively). Older age and difficult tasks prevented improvement.

Conclusions

Methylphenidate challenge had a positive effect on all patients’ performance. TDM values were lower than literature ones, although the latter are usually obtained after the administration of methylphenidate 20 mg.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster Walk: Ethics and psychiatry/Philosophy and psychiatry/Others–Part 1
Information
European Psychiatry , Volume 41 , Issue S1: Abstract of the 25th European Congress of Psychiatry , April 2017 , pp. S332 - S333
Copyright
Copyright © European Psychiatric Association 2017
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