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Objective: Attention- Deficit/ Hyperactivity Disorder (ADHD) is one of the most common neuro-psychiatric disorders of childhood with a global prevalence of 5-10%. Methylphenidate (MPH) is widely used in pharmacological management of ADHD. It is available in both immediate (IR) and osmotic-release (OROS) forms. Previous studies, both from our country and others reported that the efficacy and tolerability of OROS MPH is equal to IR form. A previous study from Turkey reported that the side effect of weight loss may be dependent on dose of OROS MPH. A common practice in pharmacological management of ADHD is augmentation with risperidone to target irritability, aggression insomnia and impulsivity. However, as far as the authors are aware, no study from Turkey up to now compared the side effect profiles of patients with ADHD using OROS MPH augmented with risperidone with those being managed with OROS MPH only.
Materials Methods: This study was conducted at the outpatient department of Child and Adolescent Psychiatry in Abant Izzet Baysal University Medical Faculty. The records of 6074 patients who applied to the study center in between January 2012 and 2013 were screened for presenting complaints and those applying for "inattention" and "hyperactivity" were recorded. It was found that 332 patients were referred for those two complaints. A second review for missing data, records of laboratory values and diagnoses changed in subsequent interviews as well as side effect forms resulted in 51 patients. Side effects of stimulant drugs and risperidone were evaluated with Side effect forms from Connor 2013.
Results: The records of 51 patients (84.3 % male) with a mean age of 10.0 (S.D. 2.7) were analyzed. The mean scores for Turgay's Scales completed by parents and teachers were 36.0 (S.D. 16.9) and 33.1 (S.D. 20.1), respectively. The mean scores for inattention, hyperactivity, oppositionality and conduct symptoms endorsed by parents were; 13.4 (S.D. 6.3), 12.8 (S.D. 8.8), 9.0 (S.D. 5.8) and 1.6 (S.D. 2.9); respectively while those endorsed by teachers were 13.3 (S.D. 5.9), 11.2 (S.D. 10.3), 7.8 (S.D. 6.8) and 1.9 (S.D. 3.3); respectively. It was found that patients using higher doses of OROS MPH tended to have higher total scores as reported by parents (Chi square 7.6, dF=3, p=0.06) and that they also tended to be older (p=0.07). They also tended to have higher inattentive symptoms as reported by teachers (p=0.06) while they had significantly elevated hyperactive-impulsive symptoms as reported by parents (p=0.04, all Mann-Whitney U test). No side effect apart from onychophagia was found to differ with OROS MPH dose (Chi Square= 7.9, dF=3, p=0.05). As for risperidone, only sexual side effects seem to increase with dose (p=0.03). No difference in tolerability between patients using OROS MPH only and those using OROS MPH and risperidone could be found.
Conclusion: Augmentation with risperidone does not seem to affect tolerability of OROS MPH in children and adolescents with ADHD. Our results should be supported with future studies.