Efficacy and safety of established and off-label ADHD drug therapies for cognitive impairment or attention-deficit hyperactivity disorder symptoms in bipolar disorder: A systematic review by the ISBD Targeting Cognition Task Force

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2024-03-03 DOI:10.1111/bdi.13414

Kamilla W. Miskowiak, Zacharias K. Obel, Riccardo Guglielmo, Caterina del Mar Bonnin, Christopher R. Bowie, Vicent Balanzá-Martínez, Katherine E. Burdick, Andre F. Carvalho, Annemieke Dols, Katie Douglas, Peter Gallagher, Lars V. Kessing, Beny Lafer, Kathryn E. Lewandowski, Carlos López-Jaramillo, Anabel Martinez-Aran, Roger S. McIntyre, Richard J. Porter, Scot E. Purdon, Ayal Schaffer, Paul R. A. Stokes, Tomiki Sumiyoshi, Ivan J. Torres, Tamsyn E. Van Rheenen, Lakshmi N. Yatham, Allan H. Young, Eduard Vieta, Gregor Hasler

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Abstract

Background

Abnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off-label ADHD therapies in BD.

Methods

We included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials.

Results

Seventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment-related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro-cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias.

Conclusions

Methylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.

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针对双相情感障碍认知障碍或注意力缺陷多动障碍症状的既有和标示外注意力缺陷多动障碍药物疗法的疗效和安全性：ISBD认知目标工作组的系统回顾。

背景：多巴胺和去甲肾上腺素信号的异常与双相情感障碍（BD）和注意缺陷多动障碍（ADHD）的认知障碍有关。因此，ISBD认知靶向工作组的这项系统性综述旨在调查已确立的和标签外的ADHD疗法对BD认知和/或ADHD症状可能产生的益处以及安全性：我们纳入了针对BD患者的ADHD药物研究，这些研究涉及认知和/或安全措施。我们遵循《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analysis，PRISMA）2020 声明的程序。从开始到 2023 年 6 月，我们在 PubMed、Embase 和 PsycINFO 上进行了检索。两位作者使用修订版 Cochrane 协作的随机试验偏倚风险工具对研究进行了独立审查：共确定了17项研究（N = 2136），调查对象包括阿莫达非尼（k = 4，N = 1581）、哌醋甲酯（k = 4，N = 84）、安非他明（k = 4，N = 249）、氯尼丁（k = 1，N = 70）、利司他丁（k = 1，N = 25）、混合苯丙胺盐（k = 1，N = 30）或莫达非尼（k = 2，N = 97）。三项研究调查了认知能力，四项研究调查了多动症症状，十项研究调查了安全性。三项研究发现与治疗相关的多动症症状减轻：两项涉及哌醋甲酯，一项涉及苯丙胺盐。一项研究发现，莫达非尼对某些认知领域有促进认知的作用。没有观察到（低）躁狂症的风险增加。五项研究存在低度偏倚风险，十一项研究存在中度偏倚风险，一项研究存在严重偏倚风险：结论：哌醋甲酯或混合苯丙胺盐可改善BD患者的ADHD症状。结论：哌醋甲酯或混合苯丙胺盐可改善 BD 患者的 ADHD 症状，但对认知能力的疗效证据有限。这些药物与情绪稳定剂同时使用不会增加躁狂症风险。需要开展进一步的深入研究，以评估在接受精神刺激剂治疗的同时服用情绪稳定剂的 BD 患者的认知能力。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.