title: Divergence by ADHD subtype in smoking cessation response to OROS-methylphenidate.
abstract: BACKGROUND
  Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition subclassified in DSM-IV according to its core symptoms domains as (a) predominantly inattentive (ADHD-IN), (b) predominantly hyperactive/impulsive (ADHD-H), and (c) combined inattentive and hyperactive/impulsive (ADHD-C). Whether these subtypes represent distinct clinical entities or points on a severity continuum is controversial. Divergence in treatment response is a potential indicator of qualitative heterogeneity. This study examined smoking cessation response by ADHD subtype to osmotic-release oral system methylphenidate (OROS-MPH).
  
  
  METHODS
  Male and female adult smokers (ADHD-C = 167 and ADHD-IN = 87) were randomized to receive OROS-MPH or placebo as augmentation treatment to nicotine patch and counseling. Logistic regression was conducted to test the effect of OROS-MPH versus placebo on prolonged smoking abstinence by ADHD subtype.
  
  
  RESULTS
  The subtypes were similar in baseline demographic, smoking, and psychiatric history but differed in smoking cessation response to OROS-MPH or placebo as a function of nicotine dependence level. The 3-way interaction was significant; χ(2)(1) = 8.22, p < .01. Among highly dependent smokers, the prolonged abstinence rates were greater with OROS-MPH than with placebo in the ADHD-C group (60% vs. 31.3%, respectively, p < .05) but higher with placebo than with OROS-MPH in the ADHD-IN group (60% vs. 11.8%, respectively, p < .01). Abstinence rates did not differ by subtype or treatment among smokers who were less nicotine dependent.
  
  
  CONCLUSIONS
  Contrasting treatment response and divergence in the impact of nicotine dependence level support the hypothesis of ADHD subtypes as distinct clinical entities and may indicate the need and directions for personalized targeted treatments of smokers with ADHD.
authors.affiliation: New York State Psychiatric Institute, Columbia University Medical Center, Psychiatry, Clinical Therapeutics, New York, NY, USA. lsc3@columbia.edu
authors.forename: Lirio S
authors.initials: LS
authors.lastname: Covey
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Hu
authors.forename: Judith
authors.initials: J
authors.lastname: Weissman
authors.forename: Ivana
authors.initials: I
authors.lastname: Croghan
authors.forename: Lenard
authors.initials: L
authors.lastname: Adler
authors.forename: Theresa
authors.initials: T
authors.lastname: Winhusen
mesh_terms: D000328:Adult; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification* / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D037001:Directive Counseling; D004311:Double-Blind Method; D005006:Ethnicity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D016017:Odds Ratio; D012907:Smoking / Q000188:drug therapy* / Q000523:psychology; D020340:Tobacco Use Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D008774:Methylphenidate