Psychostimulants

Psychostimulants


Amphetamines
Amphetamines = sympathomimetic agents: 
mimic the actions of adrenaline.
Effects: (alerting response: fight or flight) Stimulate CNS: vasoconstriction, hypertension, tachycardia. tremor, restlessness, >motor activity, agitation, insomnia.
Abuse: violent behavior, paranoia, psychosis. Permanent (long term neurotoxicity): sleep dysfunction, sexual dysfunction, depression, movement disorders.
Psychostimulants: Amphetamines
1935-1946 - used to treat many things: schizophrenia, morphine addiction, smoking, heart block, head injury, radiation sickness, hypotension, sea-sickness, hiccups, caffeine dependence.
WWII - used to enhance performance of soldiers and ameliorate fatigue.
late 1940s - Large scale (oral) abuse evident with students and truck drivers. Used (ineffectively) for diet.
1960s - injectable abuse. Current abuse -- methamphetamine (including smoking and free-base).

Amphetamines
Current Medical uses:
Narcolepsy treatment.
ADHD treatment.


Non- Amphetamines
Ritalin (methylphenidate);
Ritalin-SR: sustained release;
Concerta: sustained release, newer form.

The mechanism of action for calming ADHD is unclear.
Theory: 1) increases dopamine, 2) increases serotonin, 3) balances dopamine & serotonin.

Non- Amphetamines
Cylert (pemoline).
Mechanism of action. Theory: potentiates dopamine.
Psychostimulants: Non- Amphetamines
Meridia (sibutramine). Antagonist; increases serotonin, norepinephrine, dopamine.
Was used for weight loss.

Non- Amphetamines
Modafinil.
Mechanism of action is unclear; probably unique.
Used to treat narcolepsy.


Treatment of ADHD
Psychostimulants can help with the core symptoms: inattention, impulsivity, hyperactivity, BUT NOT with the wide range of clinical problems in ADHD.
Psychostimulants do NOT help with: 35%-45% of “inattentive” type; 
10%-30% of “combined” type.

Neurofeedback: Treatment of ADHD
Neurofeedback (NF).
Lubar & Shouse, 1976 & 1979. Operant conditioning. Supported the hypotheses that > 12-15 Hz (SMR) or 16-20 Hz (beta) while < 4-8 Hz (theta) -- over sensorimotor or central frontal region -- improves attention & reduces impulsivity and hyperactivity. These findings are supported with numerous case studies.

Neurofeedback: Treatment of ADHD
Controlled Studies:
Linden, et al, 1996. N=18, age 5-15 w/ADHD. No meds. Randomized study: NF (40 sessions over 6 months) vs. waiting group. NF group > IQ and reduced ADHD sx. on a behavior rating scale.
Rossiter & LaVaque (1995). N=46, age 8-21 w/ADHD. Participants chose Ritalin or NF (20 sessions over 3 months). Both groups improved on TOVA (attention), and behavioral rating scales w/o significant difference.

Neurofeedback: Treatment of ADHD
Monastra et al, 2002. N=100, age 6-19. One year comprehensive program all received Ritalin, family therapy, & academic support. 51 received NF. All showed significant improvement in attention (TOVA) and behavior (ADDES) while using Ritalin. Only NF group sustained gains when Ritalin dc’d. QEEG showed significant reduction in cortical slowing in only the NF group. Parenting style effected behavior at home, but not in school.