Förskrivningen av läkemedel mot adhd till både barn och vuxna har nästan fyrfaldigats på fem år, visar nya siffror. Var man bor i landet avgör om man får en adhd-diagnos eller inte. Nu vill Socialstyrelsen ha regler för både utredning och behandling.

Swesse skrev:Intressant! Undrar om det kan bero på något annat än ökad medvetenhet om ADHD?

Den dramatiska ökningen beror bland annat på större kunskap om funktionshindret, att alla specialister i psykiatri numera har rätt att skriva ut medlen och att fler tar sina mediciner under lång tid. Därför menar Björn Kadesjö, överläkare vid Sahlgrenska universitetssjukhuset i Göteborg, att ökningstakten var väntad.

slackern skrev:

Swesse skrev:Intressant! Undrar om det kan bero på något annat än ökad medvetenhet om ADHD?

Så här stod det i artikeln som blev länkad. Så ja det verkar som det eller hur tolkar du det som står?

Den dramatiska ökningen beror bland annat på större kunskap om funktionshindret, att alla specialister i psykiatri numera har rätt att skriva ut medlen och att fler tar sina mediciner under lång tid. Därför menar Björn Kadesjö, överläkare vid Sahlgrenska universitetssjukhuset i Göteborg, att ökningstakten var väntad.

Iridia skrev:Bra och balanserad artikel tycker jag.

Fint att de tar upp både fördelar & risker, och både att man kanske är lite väl snabb att medicinera barn så att de ska passa bättre in i skolans fyrkantiga hål, samtidigt som det var bra att man även nämner minskad risk för missbruk senare i livet om man får medicin i tid.

Frågan är bara hur tidigt man ska medicinera. Jag tycker det är total galenskap att ge mediciner till barn innan puberteten medan deras hjärna fortfarande utvecklas. Och risken att de börjar missbruka torde inte heller vara särskilt stor innan tonåren. Visserligen är hjärnan fortfarande under utveckling även i tonåren men där är det kanske fråga om att väga risker mot varandra. Mediciners oerhört mycket lägre doser mot gatudroger och alkohol (som ungdomar på något sätt alltid lyckas få tag i om de verkligen vill) och den ökade risken att hamna snett redan från början om man inte ens klarar att gå ut högstadiet för att man inte kan koncentrera sig.

Användandet av adhd-läkemedel ökar bland barn och unga. I vissa län har hela 6 procent av alla pojkar fått adhd-medicin utskrivet till sig.

Behandlingen med centralstimulerande läkemedel mot adhd ökar bland både flickor och pojkar, visar Socialstyrelsens årliga lägesrapport inom vård och omsorg.

Av alla utskrivna recept går 80 procent till pojkar, allra mest i åldersgruppen 10–14 där i snitt 3,2 procent av alla pojkar får adhd-läkemedel utskrivet.

Wine skrev:DN - Allt vanligare att barn får adhd-medicin
Publicerad 2012-02-01 10:39

Användandet av adhd-läkemedel ökar bland barn och unga. I vissa län har hela 6 procent av alla pojkar fått adhd-medicin utskrivet till sig.

Behandlingen med centralstimulerande läkemedel mot adhd ökar bland både flickor och pojkar, visar Socialstyrelsens årliga lägesrapport inom vård och omsorg.

Av alla utskrivna recept går 80 procent till pojkar, allra mest i åldersgruppen 10–14 där i snitt 3,2 procent av alla pojkar får adhd-läkemedel utskrivet.

Det skiljer tydligen väldigt mycket mellan olika landsting vad gäller utskrivningen av ADHD-medicin.

linneajohansson skrev:Jag läste också det i DN. Men Wine, varför länkar du inte KÄLLAN istället för en tidningsartikel? Det känns lite mer opartiskt:
http://www.socialstyrelsen.se/nyheter/2 ... blandaldre

As humans migrated out of Africa around 50,000 years ago and moved across the planet, evolution may have latched onto a gene linked to risk-taking and adventurousness.

The idea, first put forward by Chuansheng Chen at the University of California, Irvine, more than a decade ago, was originally met with scepticism. Now Luke Matthews of Harvard University and Paul Butler of Boston University have shown that a link between two versions of a specific gene and ancient migration patterns stands up to rigorous analysis.

The DRD4 gene codes for a dopamine receptor in the brain. It exists in several versions, or alleles, and studies have shown that people tend to have slightly different personality traits depending on which they have. The 4R allele, for instance, is associated with being even-tempered, reflective and prudent. The less common 7R and 2R versions have been linked to impulsive and exploratory behaviour, risk-taking and the ability to shrug off new situations. Matthews and Butler think that migrants with these versions were better able to deal with dangerous, fluctuating situations and more likely to survive and reproduce under those conditions.

They looked at the frequency of 7R and 2R in 18 indigenous populations spread along the routes humans took from Africa to Europe, Asia and the Americas. The further away from Africa they were, the more likely they were to have either of these two versions (American Journal of Physical Anthropology, DOI: 10.1002/ajpa.21507).

The problem with Chen's 1999 study was that populations can share alleles simply by chance, which might create the illusion of a link between, say, distance travelled and certain alleles. To overcome this, Matthews and Butler modelled how alleles randomly show up in populations. They discovered that the distribution of 7R and 2R is not random, and were able to demonstrate a statistically significant link between the alleles and migration.

The study suggests that some small portion of the behaviours that characterise populations may be down to genetics, and that cultural actions like mass migration can modify our genes, says Matthews.

Marcus Munafò, a biological psychologist at the University of Bristol, UK, cautions that variations in the DRD4 gene are numerous and complex, making its exact behavioural effects hard to pin down. But he agrees that it is likely that some differences in behaviour have been generated by genetic selection.

Researchers are beginning to play with the idea that our culture could be influencing evolution, says Robert Moyzis of the University of California, Irvine. He has shown that 7R arose as a rare mutation 40,000 to 50,000 years ago, after we left Africa, then spread rapidly in human populations. The 2R allele is a modified version that arose in Asia less than 10,000 years ago.

He has also shown that people diagnosed with attention deficit hyperactivity disorder are twice as likely to have the 7R allele. He thinks some of what we consider ADHD symptoms, like rapidly shifting focus and quick movements, are actually survival traits that were selected for during our migration out of Africa.

Bara liten effekt på sikt av medicin mot adhd

De läkemedel som skrivs ut mot adhd är inte särskilt effektiva på sikt visar studier. Trots det ökar utskrivningen av läkemedel kraftigt.


Som vi rapporterade om i förra veckan så har utskrivningen av läkemedel till barn med adhd i Örebro län fyrdubblats på fem år.

Men innan mediciner sätts in ska barn i första hand få psykosociala insatser. Det säger Alexander Håkansson som är psykolog och psykoterpaeut och undervisar om adhd på universitet i Örebro.
- Rekommendationerna från Läkemedelsverket och Socialstyrelsen är, som jag förstår det, att i första hand börja med psykosociala insatser och gå över till läkemedel om man finner att de psykosociala insatserna inte är tillräckliga, berättar Alexander Håkansson.

Han betonar att det rör sig om en rekommendation, inta om någon tvingande regel. Så hur gör man inom sjukvården i Örebro län? Ja, det beror alldeles på vad du lägger in i begreppet.

Pyskosocialt stöd ges alltid säger Anita Ivarsson, chef för barn- och ungdomspsykiatriska verksamheten, men behandling som beteendeterapi eller liknande erbjuds inte. Det är läkare Jan Pilotti kritisk mot:

- Jag har sett många exempel på när man sitter in medicin på väldigt lösa boliner, säger han och berättar om patienter med oklara diagnoser där läkare sätter in medicinering för att pröva.

- Så ska man inte behandla barn. Man ska sätta ordentliga diagnoser! fortsätter Pilotti och betonar att det finns andra behandlingsalternativ som familjeterapi och miljöterapi.

Pilotti är specialist i barn- och ungdomspsykiatri. Både han och Alexander Håkansson på universitetet påpekar att starka påtryckningar kommer från läkemedelsbolagen. Förra året fick 783 unga patienter i åldrarna 5 till 19 år läkemedel mot adhd i Örebro län, vilket alltså är nästan fyra gånger så många som fem år innan.

Men medicinerna är inte särskilt effektiva på sikt, berättar Alexander Håkansson.

- Om man tittar på långtidsuppföljningar från USA så ser det ut som att läkemedel inte har så positiv effekt som man tidigare hoppats på, säger han.

Efter ett par år är skillnaderna inte så stora mellan de som får och de som inte får läkemedel, enligt studierna.

- Kanske måste man börja titta lite mer på hur man kan öka psykologiska eller psykosociala behandlingsmetoder eftersom det inte tycks som att allt ordnar sig med läkemedel, säger Alexander Håkansson.

A Colorado University study in 2010 showed that when 150 adolescents diagnosed with the disorder were given sessions of cognitive-behavioural therapy plus an inactive sugar pill (which they were told was a Ritalin-type drug), their symptoms disappeared just as effectively as in 150 adolescents who were given both the therapy and a chemically active Ritalin-type drug.

A similar placebo effect was seen in a study of children whose parents and teachers were told they had been put on another kind of ADHD drug, called Adderall, which in fact was a placebo pill.

So what had happened? Dr Daniel Waschbusch of Florida International University, who led the research, says: ‘Thinking a child has received medication may induce positive expectations in parents and teachers. ‘In turn, this may influence how parents and teachers evaluate and behave towards the children.’

Such research indicates that a significant number of ADHD cases may be in the mind — both of young people and of their parents and teachers. The more we believe in ADHD, the more we see of it, and the more we dose children with potentially dangerous drugs without monitoring them for dangerous responses.

This latter concern is shared by Professor Peter Helms, a professor of child health at Aberdeen University, who recently published a study in the journal Drug Safety on ADHD drugs. ‘The effects on people who have been on the drugs for years is a potential problem. Clinical trials give us only short-term answers, as the trials last a year at the most. We should introduce monitoring systems to check what is happening with patients.’

Indeed, one important study in 2007 found there are no benefits to giving children medication after they have been taking the drug for three years. British GPs agree that many are left on Ritalin for more than three years, and often as many as six.

Furthermore, there is also disturbing evidence from studies on laboratory rats that giving Ritalin-type drugs to adolescents may cause them mental problems when they are adults. These may include memory damage and depression. In humans, there have been no studies to explore this, because it is illegal to test drugs on children.

Instead, something else is happening: we are effectively witnessing an uncontrolled chemical trial that involves the mass-medication of thousands of youngsters across Britain. What is even more tragic is that we are not even trying to monitor these children for early evidence of the serious problems this may cause.

ADHD and the practice of science journalism as a deficit disorder

About two weeks ago, the journal PLoS ONE published an article titled "Why Most Biomedical Findings Echoed by Newspapers Turn Out to be False: The Case of Attention Deficit Hyperactivity Disorder."

After selecting the condition Attention Deficit Hyperactivity Disorder as a focus, the researchers searched databases that archived both medical research and newspaper publications during the 1990s. They found 47 papers in high-profile journals on ADHD and 347 resulting English language newspaper stories. They then selected the 10 papers that had received the most coverage. Of those papers, seven were based on new hypotheses about ADHD. Gonon's analysis of later papers found that six of those seven hypotheses were either refuted by other scientists or found to be flawed. The seventh received poor reviews. The remaining three were designed to confirm existing theories. Two held up well, one, as the literature showed, did not.

Because positive biomedical observations are more often published than those reporting no effect, initial observations are often refuted or attenuated by subsequent studies.

Flawed skrev:

Because positive biomedical observations are more often published than those reporting no effect, initial observations are often refuted or attenuated by subsequent studies.

Gäller knappast i Sverige där tidningarna lydigt följer i KMRs ledband....

The New York Times - A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise
By ALAN SCHWARZ and SARAH COHEN Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

And even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment.

A.D.H.D. has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.

“There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary A.D.H.D. researchers in the last 20 years. “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”

Iridia skrev:Fint att de tar upp både fördelar & risker, och både att man kanske är lite väl snabb att medicinera barn så att de ska passa bättre in i skolans fyrkantiga hål, samtidigt som det var bra att man även nämner minskad risk för missbruk senare i livet om man får medicin i tid.
...

The New York Times - No Link Seen Between Child Stimulant Use and Later Drug Abuse
By ALAN SCHWARZ Published: May 29, 2013

An analysis published Wednesday by the American Medical Association said children with attention deficit hyperactivity disorder who take stimulant medication do not have a lower risk over all for later substance abuse, contradicting the longstanding and influential message that such medicines tend to deter those with the disorder from abusing other substances.

“I always doubted the whole ‘protection’ argument, and I wasn’t the only one, but that message was really out there,” said Liz Jorgensen, an adolescent addiction specialist at Insight Counseling in Ridgefield, Conn. “Hopefully, this message will be heard loud and clear.”

Ms. Jorgensen said her clinic sees several new cases each month of adolescents whose introduction to drugs came from an A.D.H.D. diagnosis and prescription.

“It teaches them very boldly that this is the way to feel different — this is the way to feel better,” she said. “Aversion to prescription drugs can be lifted at that early age.”

Conclusions These results provide an important update and suggest that treatment of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders.

Flawed skrev:http://archpsyc.jamanetwork.com/article.aspx?articleid=1691781
Konstigt att de inte blir mer benägna att knarka då som du försöker påskina med din kreativa användning av irrelevanta citat.

Conclusions These results provide an important update and suggest that treatment of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders.