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Psychostimulants constitute the most efficacious drugs in the treatment of attention-deficit hyperactivity/impulsivity disorder (ADHD). This chapter explores the variety of alternative nonstimulant drugs in the treatment of adult ADHD. Despite the generally robust behavioral effects of tricyclic antidepressants (TCAs), they have weaker cognitive effects in ADHD than the psychostimulants and often leave significant residual attentional effects. The anti-ADHD effects of TCAs seem to be independent of their antidepressant effects. Atomoxetine is a specific norepinephrine transporter reuptake blocker that has minimal affinity for other receptors. Adults experienced significant improvements in ADHD symptoms and demonstrated improvements in executive functioning. Clonidine, which at low dosages stimulates the presynaptic alpha-2 adrenergic autoreceptors, has been largely abandoned in the treatment of core symptoms of ADHD. One small preliminary study using a randomized, double-blind, crossover design examined the efficacy of methylphenidate (MPH) and lithium in treating ADHD in adults.
In both Prader-Willi syndrome (PWS) and 22q11 deletion syndrome [velo-cardio-facial syndrome (VCFS)], an increased risk for psychotic disorders is reported, which are as a rule not included in the behavioural phenotype of these two syndromes. For the description of a behavioural phenotype, the complete spectrum of physical, developmental, neuropsychological and psychiatric aspects is generally not taken into account. Moreover, psychiatric signs and symptoms often do not meet the criteria for a categorical diagnosis.
In this study, a further specification of psychotic symptoms in PWS and VCFS is shown as well as a proposal for a new model to ascertain predictors, including behavioural, for a genetic syndrome.
Over the past years, 27 patients with PWS and 19 with VCFS were referred for neuropsychiatric evaluation because of psychotic symptoms. In all the patients, a standardised psychiatric examination was performed; seven of the patients with VCFS were evaluated by means of an extensive neuropsychological battery.
In both patient groups, a rather specific psychopathological profile seemed to be present, which in the case of patients with PWS showed some resemblance with bipolar affective disorder. In patients with VCFS, no formal psychiatric diagnosis could be established. Because the psychopathological profiles were rather aspecific, they are not sufficient to predict membership of a certain syndrome.
A quantitative probabilistic approach toward the description of a (behavioural) phenotype is suggested. For such a procedure, large data sets and international collaboration are required.
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