Severe liver injury after initiating therapy with atomoxetine in two children.

Lim JR, Faught PR, Chalasani NP, Molleston JP.

From the Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis; and the Departments of Pathology and Laboratory Medicine, and Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis.

J Pediatr. 2006 Jun;148(6):831-834.

Two children presented with acute hepatitis after starting therapy with atomoxetine (Strattera(R)). In one child, no competing diagnosis could be identified, and liver injury resolved completely on withdrawal of the medication. In the second child, the evaluation was suggestive of type 1 autoimmune hepatitis; she subsequently improved with removal of atomoxetine and concomitant immunosuppressive therapy. Atomoxetine may cause clinically significant hepatotoxicity either by metabolic idiosyncrasy or by inducing autoimmune hepatitis.

Determinants of Adherence to Methylphenidate and the Impact of Poor Adherence on Maternal and Family Measures

Susan S.F. Gau, Hsin-Yi Shen, Miao-Churn Chou, Ching-Shu Tang, Yen-Nan Chiu, Churn-Shiouh Gau

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 3:286-297.

Objective: The aim of this study was to examine the association between adherence to immediaterelease methylphenidate (IR MPH) and maternal psychological distress, parenting style, parent– child relationship, and perceived family support.

Methods: The sample consisted of 307 children with attention-deficit hyperactivity disorder (ADHD) (271 boys and 36 girls), 6–17 years of age, who had been treated with IR MPH for the past 6 months. The measures included the Chinese Health Questionnaire, Parental Bonding Instrument, Family APGAR, and Home Behaviors of the Social Adjustment Inventory for Children and Adolescents.

Results: Reasons for poor adherence (n = 79; 25.7%) included forgetting medication (72.7%), the medication having no effect (20.0%), and refusing medication (12.7%). Increased age and three-times-daily administration were the major predictors for poor adherence to IR MPH. Poor adherence was associated with increased degree of maternal psychological distress, indifferent parenting, maternal overprotection/control, poor family support, decreased interaction with parents, and increased problems at home.

Conclusions: Findings indicate that multiple daily dosing of MPH increases the likelihood of poor adherence, particularly in adolescents, and that poor adherence is associated with impaired maternal/family process. Once-daily administration of MPH is necessary to improve adherence and to decrease the possible exacerbation of tense parent–child relationships caused by poor drug adherence.

Concomitant Use of Atomoxetine and OROSR-Methylphenidate in a 10-Year-Old Child Suffering from
Attention-Deficit/Hperactivity Disorder with Comorbid Bipolar Disorder and Tourette Syndrome.

Sol Jaworowski, Fortu Benarroch, Varda Gross-Tsur

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 3:365-370.

Atomoxetine and OROS® methylphenidate were successfully used concomitantly in a 10- year-old boy suffering from attention-deficit/hyperactivity disorder (ADHD) with comorbid bipolar disorder and Tourette syndrome (TS). The child received valproic acid, clonidine, and ziprasidone concurrently. Because possible side effects of pharmacological treatment for one diagnosis may exacerbate a comorbid condition, contingent management strategies, when using polypharmacy, are mandated

Brain Magnetic Resonance Spectroscopy in Sydenham's Chorea and ADHD.

Margari L, Ventura P, Portoghese C, Presicci A, Buttiglione M, Cuonzo FD.

Child Neurological and Psychiatric Service, Department of Neurological and Psychiatric Sciences, University of Bari, Italy.

Pediatr Neurol. 2006 Jun;34(6):467-73.

This report presents clinical, laboratory, and neuroimaging findings in a 7-year-old male with Sydenham's chorea associated with attention-deficit hyperactivity disorder. Western immunoblotting revealed serum anti-human basal ganglia tissue antibodies. Magnetic resonance imaging results were normal. Proton magnetic resonance spectroscopic imaging disclosed increased choline/creatine ratio in basal ganglia, frontal, and parieto-occipital areas, and decreased N-acetyl aspartate/creatine ratio in both basal ganglia and frontal areas. Moreover magnetic resonance spectroscopy revealed a peak between 3.6-4.2 ppm of unclear significance. The findings of this study are compared with the previous magnetic resonance spectroscopic studies reported on Sydenham's chorea and attention-deficit hyperactivity disorder. Magnetic spectroscopic imaging suggests an autoimmune basal ganglia damage in the pathogenesis of Sydenham's chorea and fronto-striatal impairment in attention-deficit hyperactivity disorder. In the present case, the previous history of an attention-deficit hyperactivity disorder suggests that this neurobehavioral disorder could be a risk factor for Sydenham's chorea in children with rheumatic fever.

Once-Daily OROSR Methylphenidate Is Safe and Well Tolerated in Adolescents With Attention-Deficit/Hyperactivity Disorder

James J. McGough, Keith McBurnett, Oscar Bukstein, Timothy E. Wilens, Laurence Greenhill, Marc Lerner, Mark Stein

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 3:351-356.

This 8-week, open-label extension of a double-blind study reports on safety data for 171 adolescents with attention-deficit/hyperactivity disorder (ADHD) who received once-daily OROS® methylphenidate (MPH) (18–72 mg/day). Headache, anorexia, and insomnia were the most frequently reported treatment-related adverse events. The incidence of adverse events was not related to dose. OROS MPH was safe and well tolerated at doses up to 72 mg/day.