Oros Methylphenidate in the Treatment of Adults with Adhd: A 6-Month,Open-Label,Follow-Up Study

Abstract

Background

This open-label trial followed a previously reported randomized, placebo-controlled trial of osmotic release oral system (OROS) methylphenidate (MPH) for the treatment of personality disorder (PD). Important findings from the double-blind phase are reexamined for long-term significance.

Methods

Of 41 patients who completed the double-blind, placebo-controlled trial, 34 continued into this open-label phase. The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) measured outcome. Patients were categorized using previously defined attention-deficit/hyperactivity disorder (ADHD) groups: ADHD alone, ADHD with emotional dysregulation (ADHD + ED), and ADHD plus emotional dysregulation plus oppositional symptoms (ADHD + ED + ODD); and 3 post hoc personality categories: patients with no PD (PD-negative), patients with 1 PD (PD-positive), and patients meeting criteria for 2 or more PDs (PD-plus).

Results

Three WRAADDS-defined ADHD dimensions improved at similar levels (attention + disorganization, 61%; hyperactivity + impulsivity, 60%; and emotional dysregulation, 66%). All ADHD subgroups (ADHD alone, ADHD + ED, and ADHD + ED + ODD) improved. ADHD + ED + ODD patients had the highest level of social maladjustment at baseline and showed the most long-term improvement in this area. PD-plus patients were less likely to complete the study or show improvement. Sixty-five percent of treatment responders were on moderate doses (<54 mg/d) of OROS MPH. Vital signs and ECGs did not differ from baseline.

Conclusions

Eighteen (44%) patients completed the trial. All 3 ADHD dimensions showed similar, well-maintained improvement. Patients with several PDs responded poorly to treatment in this small trial.

Keywords

ADHD adult OROS MPH Concerta long-term open-label personality disorder

Get full access to this article

View all access options for this article.

References

Weiss

Hechtman

Milroy

. Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Psychiatry. 1985;24:211–220.

Barkley

Fischer

Smallish

. The persistence of attention deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002;111: 279–289.

Wood DR Reimherr

Wender

. Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report. Arch Gen Psychiatry. 1976;33:1453–1460.

Wilens

McBurnett

Stein

. ADHD treatment with once-daily OROS methylphenidate: final results from a long-term open-label study. J Am Acad Child Adolesc Psychiatry. 2005;44:1015–1023.

Wolraich

Greenhill

Pelham

. Randomized, controlled trial of OROS methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108:883–892.

Wilens

Newcorn

Kratochvil

. Longterm atomoxetine treatment in adolescents with attention-deficit/hyperactivity disorder. J Pediatr. 2006; 149:112–119.

Biederman

Mick

Surman

. A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006;59:829–835.

Reimherr

Williams

Strong

. A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007;68:93–101.

Fallu

Richard

Prinzo

. Does OROS-methylphenidate improve core symptoms and deficits in executive function? Results of an open-label trial in adults with attention deficit hyperactivity disorder. Curr Med Res Opi. 2006;22:2557–2566.

10.

Biederman

Spencer

Wilens

, and the SLI381.304 Study Group. Long-term safety and effectiveness of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr. 2005;10:16–25.

11.

Adler

Spencer

Milton DR . Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. J Clin Psychiatry. 2005;66:294–299.

12.

Berry

Orman

Cooper

. Safety and efficacy of OROS methylphenidate in adults with ADHD. Poster presented at: 55th Annual Meeting of the American Academy of Child and Adolescent Psychiatry; October 23–28, 2007; Boston, MA.

13.

Adler

Spencer

McGough

. Longterm effectiveness and safety of dexmethylphenidate extended-release capsules in adult ADHD. J Attn Disord. 2009;12:449–459.

14.

Jensen

Hinshaw

Kraemer

. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40:147–158.

15.

Robison

Reimherr

Gale

. Personality disorders in ADHD Part 2: the effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010;22:94–102.

16.

Weissman

Bothwell

Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 1976;33:1111–1115.

17.

Reimherr

Marchant

Strong

. Emotional dysregulation in adult ADHD and response to ato-moxetine. Biol Psychiatry. 2005;58:125–131.

18.

Jacobsberg

Perry

Frances

Diagnostic agreement between the SCID-II screening questionnaire and the Personality Disorder Examination. J Pers Assess. 1995;65:428–433.

19.

Smith

Klein

Benjamin

. Validation of the Wisconsin Personality Disorders Inventory-IV with the SCID-II. J Pers Disord. 2003;17:173–187.

20.

Williams

Reimherr

Marchant

. Assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate. Ann Clin Psychiatry. 2010;22:84–93.

21.

Faraone

Spencer

Aleardi

. Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psycho-pharmacol. 2004;24:24–29.