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Biomedical subjects

Philip Hazell

Publications and source records attributed to Philip Hazell.

At least 19 recordsLinked to original sources
PubMed2007

Pharmacological management of attention-deficit hyperactivity disorder in adolescents: special considerations.

Approximately one-half of children medicated for attention-deficit hyperactivity disorder (ADHD) will continue to experience sufficient impairment during adolescence to warrant the continuation of their treatment; a smaller number of people with ADHD may require treatment for the first time during adolescence. The academic and social demands of adolescence can exaggerate the impairment caused by attentional problems, as adolescents, more so than children, have activities in the afternoon and evening that will tax their attentional abilities. Stimulant and nonstimulant medications are likely to be as effective for adolescent patients as they are for younger children, provided treatment adherence is satisfactory. Long-acting medications are preferred over immediate-release compounds as they provide better coverage of symptoms throughout the day. Patterns of comorbidity with ADHD change from childhood to adolescence and may require a shift in treatment strategy. The choice of time to discontinue treatment should be a decision shared by the clinician and the patient. A negotiated trial of time off treatment followed by a review of the patient's symptoms can avert premature discontinuation of treatment.

Adolescent↗
PubMed2006

Comorbid oppositional defiant disorder and the risk of relapse during 9 months of atomoxetine treatment for attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine the influence of comorbid oppositional defiant disorder (ODD) on the relative risk (RR) of relapse during 9 months of treatment with atomoxetine for attention-deficit/hyperactivity disorder (ADHD). METHOD: Four hundred and sixteen children and adolescents with ADHD whose symptoms remitted during initial 10-week, open-label atomoxetine treatment were randomly assigned to continue with atomoxetine or placebo. RESULTS: In all, 43% met criteria for comorbid ODD. A total of 17% of patients with comorbid ODD relapsed (CGI-Severity score >or= 3 and ADHD Rating Scale total score of 90% or more of baseline at study entry on two consecutive visits) during atomoxetine treatment, compared with 26% of patients without comorbid ODD (RR 0.67, 95% CI 0.42-1.06). Mean time to relapse was not significantly different [mean (SE) days to relapse, ADHD/ +ODD: 215 (7.38); ADHD/-ODD: 211 (7.61); log rank p = 0.08]. This finding is placed within the context of atomoxetine affording an overall protection against relapse compared with placebo (RR 0.59, 95% CI 0.43-0.80). CONCLUSIONS: Comorbid ODD does not influence the rate of relapse of patients with ADHD during longer-term treatment with atomoxetine. Atomoxetine protects against the relapse of ADHD symptoms regardless of the presence or absence of comorbid ODD.

Adolescent↗
PubMed2006

Mental health of children in foster and kinship care in New South Wales, Australia.

OBJECTIVES: To report baseline mental health measures from the Children in Care study, a prospective epidemiological study of children in court-ordered foster and kinship care in New South Wales, Australia. METHODS: Mental health, socialization and self-esteem were assessed in 347 children in a statewide mail survey, using two carer-report checklists, the Child Behavior Checklist (CBCL) and the Assessment Checklist for Children (ACC). RESULTS: Children in the study had exceptionally poor mental health and socialization, both in absolute terms, and relative to normative and in-care samples. Levels and rates of disturbance for children in foster care exceeded all prior estimates. Rates of disturbance for children in kinship care were high, but within the range of prior estimates. Boys presented with higher scope and severity of mental health problems than girls on the CBCL, while gender-specific patterns of disturbance were shown on the ACC. A moderate age effect was accounted for by children's age at entry into care. CONCLUSIONS: Children in care are at high risk of mental health problems. Psychological support for the children and their carers is an essential secondary prevention strategy. Implications for service delivery are discussed.

Age Factors↗
PubMed2005

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition.

OBJECTIVE: To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. METHODS: Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation. RESULTS: Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation. CONCLUSIONS: The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.

Adolescent↗
PubMed2005

What is a clinically important level of improvement in symptoms of attention-deficit/hyperactivity disorder?

OBJECTIVE: To compare the desired and actual reduction in scores on a parent reported behaviour rating scale in a naturalistic sample of children and adolescents who had been treated with psychostimulant medication, referenced to global ratings of treatment benefit. METHOD: Forty-five parents reporting poor global response to psychostimulant treatment, 44 reporting moderate response, and 49 reporting a high response retrospectively completed Conners rating scales describing their child prior to treatment, the child currently, and how the parent hoped the child would be following treatment. RESULTS: Percentage actual improvement in behaviour rating scales from baseline ranged from around 25% for the poor responders to above 50% for the high responders. Desired improvement was above 50%, with no significant difference between the groups on level of expectation. CONCLUSIONS: Percentage cut points used to indicate clinical improvement reported in previous controlled trials of psychostimulant medication are probably too low, and could lead to an overestimate of treatment effect. Expectation of treatment benefit is unlikely to contribute to variation in treatment response.

Adolescent↗
PubMed2005

Do adrenergically active drugs have a role in the first-line treatment of attention-deficit/hyperactivity disorder?

Adrenergically active drugs used for the treatment of attention-deficit/hyperactivity disorder (ADHD) include the alpha-agonists, monoamine oxidase inhibitors, tricyclics and the selective noradrenergic re-uptake inhibitors. In addition to a longer duration of treatment effect than the predominantly dopaminergic psychostimulant drugs, a theoretical advantage of the adrenergically active drugs is a lesser tendency to aggravate common comorbidities of ADHD, such as anxiety, obsessionality, depression and tics. Nevertheless, adrenergically active drugs have always been considered second-line treatments to the psychostimulant drugs. No study has demonstrated superiority of adrenergically active drugs over the psychostimulants in reducing the core symptoms of ADHD, although several small trials have suggested 'equivalence'. The case for superiority of the adrenergically active drugs over psychostimulants in alleviating comorbid symptoms remains largely unproven, as there have been few comparative trials. Safety data have favoured the psychostimulant drugs. The advantage of once daily or morning and evening dosing of the adrenergically active drugs has been diminished since the introduction of sustained release preparations of methylphenidate and amphetamine. Although adrenergically active drugs may be the preferred treatment in the presence of severe comorbidity, for the most part they remain second-line treatment for ADHD.

Adrenergic Agents↗
PubMed2004

A prospective, multicenter, open-label assessment of atomoxetine in non-North American children and adolescents with ADHD.

OBJECTIVE: The aim of this study was to study treatment response to atomoxetine in a large, multicenter study of non-North American patients with ADHD. METHODS: A total of 604 children and adolescents with ADHD were enrolled in a 10-week open-label trial with atomoxetine prior to randomization to a double-blind relapse prevention phase at 33 sites in the United Kingdom, continental Europe, Israel, South Africa, and Australia. All patients had ADHD symptom severity at least 1.5 standard deviations above United States age and gender norms for their diagnostic subtype as measured by the investigator-scored ADHD Rating Scale (ADHD RS). Outcomes were assessed by analysis of change in the ADHD RS; functional and psychosocial outcomes were assessed using the Child Health Questionnaire (CHQ). RESULTS: At endpoint, ADHD RS total scores decreased by an average of 56.7%, and 69% of patients were rated as having no or minimal symptoms. Significant improvement was observed in psychosocial and functional outcomes. Discontinuations attributed to adverse events were < 4%. CONCLUSION: These open-label data, gathered in an international setting, add to our knowledge of the value of atomoxetine in treating ADHD symptoms, as well as its safety and tolerability.

Adolescent↗
PubMed2004

Review of new compounds available in Australia for the treatment of attention-deficit hyperactivity disorder.

OBJECTIVE: To examine the pharmacodynamic and pharmacokinetic properties, efficacy, safety and cost of Ritalin LA, Concerta and Strattera, three compounds recently released in Australia for the treatment of attention-deficit hyperactivity disorder (ADHD). METHODS: MEDLINE was searched for relevant review articles and primary treatment studies. Data were augmented by product information supplied by the respective manufacturers. Costing information was obtained by surveying five community pharmacy outlets in Newcastle-Lake Macquarie, New South Wales. RESULTS: The three compounds reviewed have similar tolerability and efficacy to immediate-release methylphenidate, with the advantage of once daily dosing. The properties of these agents, particularly Strattera, make them less able to be abused. Ritalin LA may be superior to Concerta in controlling symptoms of ADHD in the first 4 h following ingestion, but the data should be interpreted with caution. CONCLUSIONS: The newer treatments for ADHD offer advantages over immediate-release methyphenidate in dosing schedule and duration of action that may be of particular benefit to adolescent and adult patients. Prescription of these medications may be limited by their expense to the patient.

Adolescent↗