ADHD Medication Adherence: Comorbidities Matter

What’s happening – People who take stimulants to treat attention deficit hyperactivity disorder (ADHD) are more likely to discontinue use if they also have one or more other psychiatric disorders, according to new research from the Lundbeck Foundation Initiative for Integrative Psychiatric Research. Stimulants can be effective in helping many people with ADHD to focus better, while also improving symptoms of hyperactivity and impulsiveness. Nonetheless, scientists at Lundbeck discovered that as many as half of those with ADHD and who have other psychiatric disorders are more likely to stop using their medication in the first 2 years compared to their counterparts who have only ADHD.

These findings, which appear in the American Journal of Psychiatry, are based on more than 9,000 individuals with ADHD in Denmark and represent the largest such study exploring this topic. The researchers, led by Isabell Brikell, hope that by gaining a better understanding of ADHD treatment adherence, clinicians will be better able to identify those patients likely to have poorer outcomes. Early identification may allow them to be more proactive in supporting and encouraging such vulnerable patients to continue following their treatment plan.

Why it’s complicated – While the majority of people with ADHD find relief with stimulants, some of them also experience troublesome side effects. Brikell’s team believes that for people with other psychiatric diagnoses, such as anxiety, bipolar disorder, or substance use disorder, these comorbidities may cause them to stop taking their medicine, or to switch to a non-stimulant form of treatment.

Reports and Perspectives

  • Psychiatric Times looks at the challenges that exist in getting teens and adults with ADHD to take stimulants over the long term to manage their symptoms.
  • ADDitude Magazine offers potential solutions to some of the barriers patients with ADHD face that may lead to lower medication compliance.
  • HCP Live shares study findings that reveal the effectiveness of using text messaging to encourage ADHD patients to take prescribed stimulants as directed.
  • @Medscape (publication) tweets: “New digital tools like smartphone apps and games benefit patients with ADHD by aiming to improve medication compliance and reduce symptoms.
  • @PaulJRosen (clinical psychologist, director of RACER Lab for ADHD research) reveals: “MYTH: Stimulant medications teach kids with #ADHD that is ok to use drugs. FACT: Medication reduces the risk of substance use in people with #ADHD. Most likely because it reduces impulsivity (and impulsive substance use), and improves overall functioning.”
  • @IsabellBrikell (post-doc researcher and study author) says: “Very happy to share our pre-print mapping genetics of clinical heterogeneity of #ASDHD in @iPSYCHdk. Novel ways of integrating epidemiology and genetics may help us understand phenotypic difference in ADHD.”

In Practice

Psy-Q Challenge

Why are individuals with attention deficit hyperactive disorder and co-occurring psychiatric disorders more likely to stop taking their ADHD medication? Matthew Edelstein, PsyD, BCBA-D, answers.

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Schizophrenia Breakthrough Drug May Avoid Unwanted Side Effects

What’s happening –  There may be new hope on the horizon for people with schizophrenia looking to avoid undesired metabolic effects that often come with antipsychotic treatment, such as weight gain. Researchers recently conducted a four-week trial looking at the effectiveness of a new type of drug, SEP-363856, to treat schizophrenia symptoms. The findings, led by Kenneth S. Koblan, PhD, are reported in the New England Journal of Medicine.

While current treatments for schizophrenia (namely, antipsychotics) can be clinically effective in addressing some of the positive symptoms of schizophrenia (eg, hallucinations and delusions, which the researchers explain can enhance a person’s view of life), they do not address negative symptoms of schizophrenia (eg, social withdraw, loss of interest in activities, difficulty sleeping). These treatments can also cause unwanted metabolic side effects, such as weight gain.

Treating Positive and Negative Symptoms of Schizophrenia

The new study, which included 245 participants, compared SEP-363856 – a non-D2 receptor binding oral Phase 3 FDA-designated breakthrough drug – to placebo. They discovered that SEP-363856 significantly helps patients to manage the full effects of schizophrenia – both the positive and negative implications. This finding is particularly important as many of the negative symptoms of schizophrenia precede the positive symptoms, which means that the drug may allow clinicians to treat patients sooner. Other studies have linked earlier treatment with achieving better patient outcomes. The scientists also found that side effects from SEP-363856 were mild, which could make it safer and easier for people to tolerate.

Why it’s complicated – The majority of study participants (82%) were white, despite the fact that other studies have found that Blacks and Latinos are disproportionately diagnosed with schizophrenia. This makes it essential for future studies to include a more diverse group of participants, and to examine the effects of the drug for a longer duration to better understand the drug’s full potential. Koblan’s team notes that SEP-363856 could be a part of a new class of psychotropic agents that have agonist activity at trace amine-associated receptor 1 (TAAR1) and 5-hydroxytryptaimine type 1A.

Disclosure: Koblan and some of the study’s co-authors are affiliated with Sunovion Pharmaceuticals, the developer of the drug.

Reports and Perspectives

  • The journal Neuroscience Biobehavioral Review published an article on TAAR1 receptor as a new psychiatric disorder drug target while the International Journal of Molecular Science reviewed the mechanism of SEP-363856 and Ned Tijdschr Geneeskd, a Dutch journal, looked at whether antipsychotics without dopamine receptor blockades represent promise or hype.
  • An article in Parkinson News Today explains that SEP-363856 shows potential to manage Parkinson-related psychosis.
  • Massive Science reports that SEP-363856 provides a new path for treating the negative symptoms of schizophrenia, as well as a way to intervene at an earlier stage of the disease progression.
  • Drug Discovery News shares the potential distinctions of SEP-363856 from other antipsychotics for schizophrenia.
  • The Warwick Beacon explores the latest schizophrenia treatments and mentions that SEP-363856 targets different brain receptors than other forms of treatment.
  • @2 Minute Medicine (physician author) says: “An oral compound, SEP-363856 was shown to significantly reduce the total score of the Positive and Negative Symptom Scale (PANSS) from baseline compare to placebo for patients with an acute exacerbation of schizophrenia…”

In Practice

 

Shortage of Spanish-Speaking Psychotherapists Impacts Mental Health Care

What’s happening – Hispanic patients with limited English proficiency (LEP) who seek medical attention for depression are more likely to seek non-pharmacological treatment approaches than their non-Hispanic counterparts. Yet, there is a shortage of behavioral health clinicians who speak Spanish to meet their mental health care needs.

A recent commentary in the American Journal of Psychotherapy by Christian Monsalve calls attention to the shortage of Spanish-speaking psychotherapists in the US (adding to the existing overall psychiatrist shortage in America). The gap is significant as it means a large number of people may be grappling with untreated mental health issues. The author also points out that when the therapist and patient speak the same language, patients typically report higher satisfaction and that they receive better health education.

While attending diversity training is a common way some providers try to improve the care of minority patient populations, Monsalve argues out that the value this brings can be limited. He contends that a more effective approach might be using experienced interpreters who not only translate the language but also shed light on cultural differences and help broker effective relationships between the clinician and the patient.

Why it’s complicated – In addition to the shortage of Spanish-speaking psychotherapists in the US, the author points out that those clinicians who do speak the language often charge more than Hispanic patients are able to afford, adding yet another barrier to mental health care access.

Reports and Perspectives

  • The American Psychiatric Association provides an overview for clinicians working with Latino/a and Hispanic patients, including calling attention to the impact that cultural differences can have on the presentation of symptoms.
  • The National Alliance on Mental Illness (NAMI) raises awareness about the many barriers that exist to accessing care for Hispanics and Latino/a patients.
  • An article in USA Today predicts that the need for Spanish-speaking psychotherapists will continue to grow at an alarming rate over the next decade.
  • @NCCorg (NWCatholicCounseling) tweets: “Cultural competence is key to providing successful counseling. If you or someone you know is seeking counseling with a Spanish-speaking therapist or if immigration or legal barriers are preventing access to care due to lack of insurance, reach out to NCC!”
  • @DrCamilaPulgar (Latinx-Suicide Researcher-Bilingual Therapist-Mental Health) shares: “Bilingual counseling and mental health services are suicide prevention. Latinx Spanish-speaking folks have nowhere to turn when they are feeling suicidal due to language barriers.”
  • @HispanicCaucus (Congressional Hispanic Caucus) says: “The bottom line is that a lot of people are not going into mental health, period, & that is especially so for Hispanics.” Latinos need culturally competent health & mental health profession. Learn more about the need for therapists who speak Spanish.

In Practice

Last Updated: Aug 26, 2021