Citation

Levy F. Aust. N. Zeal. J. Psychiatry 2013; 47(3): 217-221.

Affiliation

School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, Australia.

Copyright

(Copyright © 2013, Royal Australian and New Zealand College of Psychiatrists, Publisher SAGE Publishing)

DOI

10.1177/0004867412450754

PMID

22689336

Abstract

Objective: To review literature relevant to a possible prediction of stimulant side effects in attention deficit hyperactivity disorder (ADHD), with implications for guidelines.Method: Recent literature on inverted-U effects of dopamine in the prefrontal cortex (PFC), default mode processing, and motor circuits relevant to stimulant side effects is reviewed.Results: The literature on inverted-U effects in the PFC suggests that catechol-O-methyltransferase (COMT) Met versus Val polymorphisms may predict excess dopaminergic effects, including headache and introversion in Met/Met subjects, but therapeutic effects in Val/Val subjects, while dopamine transporter polymorphisms may predict motor side effects. In particular, an understanding of 'inverted-U' effects helps to explain why some children may experience side effects while others show improvements at similar dose ranges.Conclusion: Genetic prediction of stimulant side effects should be investigated, particularly given recent controversies in relation to National Health and Medical Research Council guidelines for stimulant use. A better understanding of treatment-emergent effects will also provide a better understanding of therapeutic effects.

Language: en