La gestion pharmacologique du traitement du TDAH

IF 0.5 4区医学 Q4 PSYCHIATRY

Annales medico-psychologiques Pub Date : 2025-03-01 DOI:10.1016/j.amp.2024.08.026

Laura Parigny , Stéphanie Bioulac , Louise Carton

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引用次数: 0

Abstract

Background and issues

The management of Attention Deficit Hyperactivity Disorder (ADHD) relies on non-medicinal measures as first-line treatment, and when these are insufficient, on medication. In France, methylphenidate is recommended as a first-line treatment, but its prescription requires particular attention.

Objectives

This article explores the pharmacological aspects of methylphenidate and other drug strategies available in France for optimal management of ADHD.

Materials and methods

A narrative review of the scientific literature was carried out by consulting PubMed and Google Scholar, in addition to the latest recommendations issued by the Haute Autorité de Santé (HAS) and the Agence Nationale de Sécurité du Médicament (ANSM). Inclusion criteria included articles in French and English, published between 2000 and 2023, on the efficacy and safety of methylphenidate and other drugs used in the treatment of ADHD and its comorbidities.

Results

Methylphenidate is a psychostimulant drug that acts by inhibiting the reuptake of dopamine and noradrenaline, and its prescription is governed by narcotics regulations. The extension of indications to adults and the variety of formulations offers several options for improving efficacy and minimizing side effects. Methylphenidate requires careful evaluation and monitoring of its efficacy and safety. Some psychostimulant and non-psychostimulant alternatives exist to enrich the therapeutic arsenal for patients whose benefit/risk balance is against methylphenidate, but remain few in number.

Discussion and conclusions

Pharmacological management implies the need for a personalized approach to increase benefits, while reducing potential adverse effects. The prospect of marketing authorization in France for new drugs such as lisdexamfetamine and atomoxetine could broaden the available therapeutic arsenal and improve personalized management of ADHD.

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ADHD治疗的药理学管理

背景和问题注意缺陷多动障碍（ADHD）的管理依赖于非药物措施作为一线治疗，当这些措施不足时，药物治疗。在法国，哌醋甲酯被推荐作为一线治疗，但其处方需要特别注意。目的：本文探讨了哌甲酯的药理学方面和其他在法国可用于ADHD最佳管理的药物策略。材料和方法除了参考法国高等医学管理局（HAS）和法国国家sansm发布的最新建议外，还咨询了PubMed和谷歌Scholar对科学文献进行了叙述性审查。纳入标准包括2000年至2023年间发表的法语和英语文章，内容涉及哌甲酯和其他用于治疗ADHD及其合并症的药物的有效性和安全性。结果哌醋甲酯是一种通过抑制多巴胺和去甲肾上腺素再摄取而起作用的精神兴奋剂，其处方符合麻醉药品法规。成人适应症的扩展和配方的多样性为提高疗效和减少副作用提供了几种选择。哌甲酯需要仔细评估和监测其有效性和安全性。存在一些精神兴奋剂和非精神兴奋剂替代品，以丰富对哌甲酯有利/危险平衡的患者的治疗武库，但数量仍然很少。讨论与结论药理学管理意味着需要个性化的方法来增加收益，同时减少潜在的不良反应。利地胺他明和阿托西汀等新药在法国获得上市许可的前景可能会扩大现有的治疗药库，并改善ADHD的个性化管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales medico-psychologiques 医学-精神病学

CiteScore

1.30

自引率

33.30%

发文量

196

审稿时长

4-8 weeks

期刊介绍： The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.