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  • Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study

  • Philip J. Asherson, Lena Johansson, Rachel Holland, Megan Bedding, Andrew Forrester, Laura Giannulli, Ylva Ginsberg, Sheila Howitt, Imogen Kretzschmar, Stephen M. Lawrie, Craig Marsh, Caroline Kelly, Megan Mansfield, Clare McCafferty, Khuram Khan, Ulrich Müller-Sedgwick, John Strang, Grace Williamson, Lauren Wilson, Susan Young, Sabine Landau, Lindsay D. G. Thomson
  • Journal:
    The British Journal of Psychiatry / Volume 222 / Issue 1 / January 2023
    Published online by Cambridge University Press:
    03 June 2022, pp. 7-17
    Print publication:
    January 2023
    • Article
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      • Open access
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  • Background

    Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.

    Aims

    To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.

    Method

    We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.

    Results

    In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.

    Conclusions

    ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.

The Cambridge History of Greek and Roman Warfare
  • Volume 2, Rome from the Late Republic to the Late Empire
  • Edited by Philip Sabin, Hans van Wees, Michael Whitby
  • Published online:
    28 March 2008
    Print publication:
    06 December 2007
  • Warfare was the single biggest preoccupation of historians in antiquity. In recent decades fresh textual interpretations, numerous new archaeological discoveries and a much broader analytical focus emphasising social, economic, political and cultural approaches have transformed our understanding of ancient warfare. Volume II of this two-volume History reflects these developments and provides a systematic account, written by a distinguished cast of contributors, of the various themes underlying the warfare of the Roman world from the Late Republic to the sixth-century empire of Justinian and his successors. For each broad period developments in troop-types, equipment, strategy and tactics are discussed. These are placed in the broader context of developments in international relations and the relationship of warfare to both the state and wider society. Numerous illustrations, a glossary and chronology, and information about the authors mentioned supplement the text. This will become the primary reference work for specialists and non-specialists alike.

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