Lyfjameðferð barna og fullorðinna á Íslandi við ADHD

1. Lyfjameðferð barna og fullorðinna á Íslandi við ADHD Matthías Halldórsson ADHD ráðstefna Grand Hóteli 25.-26. september 2008

3. Bók Thomas E. Brown: 1. kafli • Myth: ADD is just a lack of willpower. Persons with ADD focus well on things that interest them; they could focus on any tasks if they really wanted to. • Fact: ADD looks very much like a willpower problem, but it isn’t. It’s essentially a chemical problem in the management systems of the brain.

4. Bók Thomas E. Brown: 9. kafli • Myth: Medications for ADD are likely to cause longer-term problems with substance abuse or other health concerns, especially when used by children. • Fact: The risks of using appropriate medications to treat ADD are minimal, whereas the risks of not using medication to treat ADD are significant. The medications used for ADD are among the best researched for any disorder.

5. Methylphenydat (N05BA04) LyfjaheitiMarkaðsleyfi á íslandi • Stuttverkandi lyf Ritalín 30/12 1965 (< 5 klst) Equazím 26/1 2004 • Langverkandi lyf Concerta 26/9 2002 (> 5 klst) Ritalín Uno 16/10 2002

6. Kynskipt algengi metylfenídatnotkunar meðal barna (0 - 17 ára) á Íslandi 1989-2007

9. Hvaða læknar hófu lyfjameðferð við ADHD hjá börnum og ungl. árið 2007

14. Fáir læknar skrifa megnið af ávísunum á methylfenidat • Fjöldi ávísana ALLS á methylfenidat fyrir 18+ 6251 (100%) • Efsti læknir 1718 (28%) • 10 Efstu (9 efstu eru geðlæknar) 3927 (62%)

18. Fjöldi þeirra karla og kvenna á öllum aldri sem fengið hafa a m k einn lyfseðil lyf við ADHD miðað við 1000 íbúa árið 2007

19. Fjöldi þeirra sem fengið hafa a m k einn lyfseðil lyf við ADHD miðað við 1000 íbúa eftir aldri árið 2007

20. Fjöldi þeirra sem nota örvandi lyf útskrifuð af lækni í USA* og Íslandi Börn Fullorðnir USA 3,5 milljón 1,5 milljón (Deilt með1000) (3500) (1500) Ísland 1974 1172+109 = 1281 * Börn á Íslandi vísar til aldurshópsins 0-17 ára, en í USA er miðað við 0-19 ára

21. Biederman J. Wilens T. Mick E. Spencer T. Faraone SV. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. [Comparative Study. Journal Article. Research Support, U.S. Gov't, P.H.S.] Pediatrics (1999) 104(2):e20,

22. Grein Farone og Wilens í J Clin Psychiatry. 2007;68 Suppl 11:15-22. Review : Effect of stimulant medications for attention-deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse “Prospective longitudinal studies show that attention-deficit/hyperactivity disorder (ADHD) is a risk factor for subsequent substance use disorders. These studies also suggest that ADHD pharmacotherapy in childhood reduces the risk for substance use disorders. Misuse and diversion of prescribed stimulants occur among a minority of ADHD patients, especially those with conduct or substance use disorders. Long-acting stimulants may be less likely to be misused or diverted.”

24. J Biederman í American Journal of Psychiatry 2008; 165:597–603: Stimulant Therapy and Risk for Subsequent Substance Use Disorders in Male Adults With ADHD Conclusions: The findings revealed no evidence that stimulant treatment increases or decreases the risk for subsequent substance use disorders in children and adolescents with ADHD when they reach young adulthood”

25. Vinnulag við greiningu og meðferð athyglisbrests með ofvirkni (ADHD) Útgefið í desember 2007 http://www.landlaeknir.is > leitarorð: ADHD Höfundar: Gísli Baldursson Páll Magnússon H. Magnús Haraldsson Matthías Halldórsson

26. Takmarkanir á útskrift övandi lyfja Eftirritunarskyld lengi 1986 - “gulu kortin” landlæknisembættisins 2001 - afnám gulu kortanna 2004 - lyfjaskírteini með verklagsreglum TR 2007 - vinnulagsreglur landlæknisembættisins

27. International ADHD Consensus Statement: January 2002 We, the undersigned consortium of international scientists, are deeply concerned about the periodic inaccurate portrayal of attention deficit hyperactivity disorder (ADHD) in media reports. This is a disorder with which we are all very familiar and toward which many of us have dedicated scientific studies if not entire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction. Occasional coverage of the disorder casts the story in the form of a sporting event with evenly matched competitors. The views of a handful of non-expert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views had equal merit. Such attempts at balance give the public the impression that there is substantial scientific disagreement over whether ADHD is a real medical condition. In fact, there is no such disagreement --at least no more so than there is over whether smoking causes cancer, for example, or whether a virus causes HIV/AIDS.

28. International ADHD Consensus Statement (frh.) This is why leading international scientists, such as the signers below, recognize the mounting evidence of neurological and genetic contributions to this disorder. This evidence, coupled with countless studies on the harm posed by the disorder and hundreds of studies on the effectiveness of medication, buttresses the need in many, though by no means all, cases for management of the disorder with multiple therapies. These include medication combined with educational, family, and other social accommodations. This is in striking contrast to the wholly unscientific views of some social critics in periodic media accounts that ADHD constitutes a fraud, that medicating those afflicted is questionable if not reprehensible, and that any behavior problems associated with ADHD are merely the result of problems in the home, excessive viewing of TV or playing of video games, diet, lack of love and attention, or teacher/school intolerance.

29. Samantekt • ADHD er algeng röskun með líffræðilegar orsakir og sterkan erfðaþátt. • Greining byggist á ákveðnum greiningarskilmerjum varðandi hegðun • Einbeitingarerfiðleikar, ofvirkni og hvatvísi einkenna ADHD • ADHD kemur fram í bernsku og einkenni flytjast í mismiklum mæli fram á fullorðinsár • Ein mest rannsakaða geðröskun sem um getur • Síður rannsakað hjá fullorðnum en börnum • Miklu algengara hjá strákum, en algengi jafnast hjá kynjum á fullorðinsárum • Greining er kerfisbundin og byggist á upplýsingum víða að • Lyf, einkum örvandi lyf og atomoxetín, virka best á kjarnaeinkennin • Lyfjanotkun við ADHD eykst hröðum skrefum alls staðar • Algengara hér en á Norðurlöndunum, en sviðað og í Bandaríkjunum • Örvandi lyf eru misnotuð • Fíklar og fangar eiga helst ekki að nota örvandi lyf – fremur Strattera • Má ekki nota nema greining hafi verið gerð á áreiðanlegan hátt • Spurning hversu fagleg greining er á ADHD fullorðinna hér á landi