Background
This is an update of the original Cochrane Review published in Issue 4, 2011.
Attention deficit hyperactivity disorder (ADHD) is the most prevalent of the comorbid psychiatric disorders ...that complicate tic disorders. Medications commonly used to treat ADHD symptoms include stimulants such as methylphenidate and amphetamine; non‐stimulants, such as atomoxetine; tricyclic antidepressants; and alpha agonists. Alpha agonists are also used as a treatment for tics. Due to the impact of ADHD symptoms on the child with tic disorder, treatment of ADHD is often of greater priority than the medical management of tics. However, for many decades, clinicians have been reluctant to use stimulants to treat children with ADHD and tics for fear of worsening their tics.
Objectives
To assess the effects of pharmacological treatments for ADHD in children with comorbid tic disorders on symptoms of ADHD and tics.
Search methods
In September 2017, we searched CENTRAL, MEDLINE, Embase, and 12 other databases. We also searched two trial registers and contacted experts in the field for any ongoing or unpublished studies.
Selection criteria
We included randomized, double‐blind, controlled trials of any pharmacological treatment for ADHD used specifically in children with comorbid tic disorders. We included both parallel‐group and cross‐over study designs.
Data collection and analysis
We used standard methodological procedures of Cochrane, in that two review authors independently selected studies, extracted data using standardized forms, assessed risk of bias, and graded the overall quality of the evidence by using the GRADE approach.
Main results
We included eight randomized controlled trials (four of which were cross‐over trials) with 510 participants (443 boys, 67 girls) in this review. Participants in these studies were children with both ADHD and a chronic tic disorder. All studies took place in the USA and ranged from three to 22 weeks in duration. Five of the eight studies were funded by charitable organizations or government agencies, or both. One study was funded by the drug manufacturer. The other two studies did not specify the source of funding. Risk of bias of included studies was low for blinding; low or unclear for random sequence generation, allocation concealment, and attrition bias; and low or high for selective outcome reporting. We were unable to combine any of the studies in a meta‐analysis due to important clinical heterogeneity and unit‐of‐analysis issues.
Several of the trials assessed multiple agents. Medications assessed included methylphenidate, clonidine, desipramine, dextroamphetamine, guanfacine, atomoxetine, and deprenyl. There was low‐quality evidence for methylphenidate, atomoxetine, and clonidine, and very low‐quality evidence for desipramine, dextroamphetamine, guanfacine and deprenyl in the treatment of ADHD in children with tics. All studies, with the exception of a study using deprenyl, reported improvement in symptoms of ADHD. Tic symptoms also improved in children treated with guanfacine, desipramine, methylphenidate, clonidine, and a combination of methylphenidate and clonidine. In one study, tics limited further dosage increases of methylphenidate. High‐dose dextroamphetamine appeared to worsen tics in one study, although the length of this study was limited to three weeks. There was appetite suppression or weight loss in association with methylphenidate, dextroamphetamine, atomoxetine, and desipramine. There was insomnia associated with methylphenidate and dextroamphetamine, and sedation associated with clonidine.
Authors' conclusions
Following an updated search of potentially relevant studies, we found no new studies that matched our inclusion criteria and thus our conclusions have not changed.
Methylphenidate, clonidine, guanfacine, desipramine, and atomoxetine appear to reduce ADHD symptoms in children with tics though the quality of the available evidence was low to very low. Although stimulants have not been shown to worsen tics in most people with tic disorders, they may, nonetheless, exacerbate tics in individual cases. In these instances, treatment with alpha agonists or atomoxetine may be an alternative. Although there is evidence that desipramine may improve tics and ADHD in children, safety concerns will likely continue to limit its use in this population.
•The prevalence of diagnosed OCD in Canada is 1 in 100 people age 15 and older.•People with OCD are more likely to be diagnosed with other mental health conditions.•People with OCD are more likely to ...be diagnosed with alcohol or substance abuse.•The diagnosis of OCD is associated with adverse childhood experiences.
The objective of this study was to provide epidemiological data regarding obsessive compulsive disorder (OCD) in Canada, and examine related conditions, childhood experiences and healthcare utilization. A Statistics Canada population-based health survey was utilized (N = 25,097). The prevalence of diagnosed OCD in Canada was 0.93% (95% CI 0.75–1.11). People with OCD were younger and more likely to have lower incomes. They were more likely to have mood disorders including depression and bipolar disorder (both diagnosed conditions and by screening), and generalized anxiety disorder. The diagnosis of OCD was also associated with alcohol dependence and substance abuse and dependence. Negative childhood experiences were more common in people with OCD, with 72.33%(95% CI 62.25%–82.41%) of people with OCD having experienced some form of childhood maltreatment. Healthcare utilization was more frequent in people with OCD, but they were also more likely to desire help but feel as if they did not receive it. The higher proportion of people with OCD reporting not receiving the care they needed may reveal a crucial gap in treatment and available resources.
Movement disorders associated with antipsychotic medications are relatively common, stigmatising, and potentially disabling. Their prevalence in people with psychosis who are prescribed ...second-generation antipsychotics (SGAs) is uncertain, as is their level of recognition by clinicinas. We conducted meta-analyses of randomised controlled trials included in the Cochrane Database of Systematic Reviews on schizophrenia and schizophrenia-like psychoses to estimate the prevalence of new-onset dystonia, akathisia, parkinsonism, and tremor with SGAs (amisulpride, asenapine, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone, L-sulpiride, and ziprasidone) approved in Canada and the UK, comparing them with haloperidol and chlorpromazine. We used a random effects model because of the heterogeneity between-studies in drug dosage and method of ascertainment of movement disorders. Our systematic search yielded 37 Cochrane systematic reviews (28 for SGAs), which generated 316 informative randomised controlled trials (243 for SGAs). With respect to SGAs, prevalence estimates ranged from 1.4% (quetiapine) to 15.3% (L-sulpiride) for dystonia, 3.3% (paliperidone) to 16.4% (L-sulpiride) for akathisia, 2.4% (asenapine) to 29.3% (L-sulpiride) for parkinsonism, and 0.2% (clozapine) to 28.2% (L-sulpiride) for tremor. Prevalence estimates were not influenced by treatment duration, the use of a flexible or fixed dosing scheme, or whether studies used validated instruments for the screening/rating of movement disorders. Overall, we found high overlap on the prevalence of new-onset movement disorders across different SGAs precribed for established psychoses. Variations in prevalence figures across antipsychotic medications were observed for the different movement disorders. Differences in pharmacological properties, such as for the dopamine D2 R association rate and serotonin 5-HT2A antagonism, could contribute to this variation.
Abstract Tourette syndrome (TS) is a childhood onset neuropsychiatric disorder. The objective of this study was to compare self-perceived health status, health-related behaviors, and chronic health ...conditions in individuals with and without TS using population-based data. Data were derived from Canadian Community Health Survey (CCHS) 2010 and 2011 cycles. The CCHS is a national population-based cross-sectional survey that collects information related to health status for Canadians. We evaluated the association between TS and self-perceived health, health related behaviours and chronic health conditions. 122,884 Canadians participated with 122 participants diagnosed with TS. After controlling for age and sex, the TS population was significantly less likely to have good self-perceived physical health and significantly more likely to need help with instrumental activities of daily living. More individuals with TS were diagnosed with an anxiety disorder, a mood disorder, or asthma. We observed no significant differences in health related behaviours between individuals with TS and the general population other than a higher odds of consultation for mental health. Individuals with TS experience a higher frequency of anxiety and mood disorders, and require more assistance with activities of daily living than the general population.
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