[Algorithms for the medical treatment of Attention-Deficit/Hyperactivity Disorder with specific co-morbidities].
BACKGROUND
In clinical practice Attention Deficit Hyperactivity Disorder (ADHD) is a challenge for diagnostic and therapeutic effort due to a number of co-morbidities, e.g., depression, anxiety disorders, Tourette Syndrome and impulsive aggression that can be a complication or a result of the core symptoms or evolve parallel to the basic disorder. The therapeutic strategies incorporate a multimodal access with a combination of psychosocial, psychotherapeutic and medical measures. The combination of various medical substances for an effective treatment of these co-morbidities, especially Serotonin-Reuptake Inhibitors (SSRIs) and atypical neuroleptics with psychostimulants has substantially reduced the occurrence of the main symptoms of the disorder in many cases and thus can also lead to a decrease in the occurrence of co-morbidities. Where this strategy fails to suffice, it is recommended to consider medical treatment strategies in combination with other substances that alternatively or in combination with psychostimulants increasingly positively influence co-morbid symptoms.


OBJECTIVE
Based on a Medline literature search we report the results of combined medical approaches for an effective medical treatment of the ADHD core symptoms accompanied by serious co-morbid symptoms. Hereby we focused on the above cited disorders. Combined treatment options that include psychostimulants are considered in particular. Moreover, recommendations for medical treatment strategies oriented to the clinical cardinal symptoms are presented in the form of algorithms. Evidence-based literature and practical experience are critically reviewed.


RESULTS
In most cases it will be sufficient to begin the treatment with a psychostimulant because co-morbid symptoms also will be significantly reduced. However, if the latter are in the foreground of the clinical picture, antidepressants or neuroleptics are to be considered as primary or equivalent treatment options.


CONCLUSIONS
Since in Germany most of the substances discussed are not licensed for use in paediatric treatment, proofs of efficacy in children are lacking. One also must reckon with the frequent occurrence of side effects. Finally, little data exist on treatments that include the use of psychostimulants.
Frölich
Jan
J
Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln. praxis-dr-froelich@t-online.de
Lehmkuhl
Gerd
G
Döpfner
Manfred
M
D000293:Adolescent; D000374:Aggression / Q000187:drug effects*; D000465:Algorithms; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018849:Controlled Clinical Trials as Topic; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D006801:Humans; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D013981:Tic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology
D011619:Psychotropic Drugs