Study of Methylphenidate-Related Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder at a Hospital in Northeast Thailand
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Abstract
Objective: To examine the prevalence and details of problems associated with the use of methylphenidate in children and adolescent patients with attention-deficit/hyperactivity disorder (ADHD) at the Northeastern Institute of Child and Adolescent Mental Health (NECAM)
Methods: A cross-sectional study was conducted in ADHD patients aged between 6 to 18, who were undergoing treatment with methylphenidate at the Northeastern Institute of Child and Adolescent Mental Health (NECAM) between October 2022 and January 2023. Methylphenidate-related problems (MRPs) were evaluated using the Pharmaceutical Care Network Europe (PCNE) version 9.1 tool and Naranjo's algorithm. Types and characteristics of problems, causes, resolution methods, and acceptance of problem-solving measures were analyzed in terms of frequency and percentage.
Results: The study included 286 patients with a mean age of 10.5 ± 2.9 years, of whom the majority (85.3%) were male. The median duration since ADHD diagnosis was 2.0 years (interquartile range: 0.8 to 4.1 years), and the median duration of methylphenidate treatment was 1.0 year (interquartile range: 0.4 to 2.9 years). Among the patients, 152 individuals (161 events) encountered MRPs, having a prevalence of 53.1%. The most common problems (56.5%) were safety-related issues, all stemming from adverse drug reactions, whereas 43.5% of the problems were related to treatment effectiveness. The top three adverse drug reactions were decrease in appetite (57.1%), nail biting (7.7%), and insomnia (7.7%). Most of effectiveness-related problems (94.3%) were attributed to patient knowledge and behavior, such as medication underuse, overuse, or lack of understanding about treatment. Both effectiveness and safety problems were primarily resolved at the patient level, with only a small proportion was resolved at professional level (2.5%) and by drug change (1.2%). Overall, the resolution of all issues was widely accepted and acknowledged (100.0%).
Conclusion: This study identified issues related to the use of methylphenidate in children and adolescent patients with ADHD, encompassing both treatment effectiveness and adverse reactions. Effective patient monitoring and collaboration among healthcare professionals, along with comprehensive patient education and communication, are recommended to prevent, detect, and address problems, thereby promoting positive treatment outcomes.
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