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Unsubstantiated diagnoses and treatments
Published in Herman Staudenmayer, Environmental Illness, 2018
Parents’ despair of coping with their hyperactive children is compounded by physician attitude (positive or negative); absence of a data-driven, recognized cause for ADHD; and the absence of effective treatments (Forbes, 1982). Biological psychiatry hypothesizes neurotransmitter imbalance. Many ADHD children have benefited from treatment with stimulant drugs including methylphenidate (Ritalin), dextroamphetamine (dexedrine), or magnesium pemoline (Cylert). But, the drugs are not a long-term panacea and there are risks of adverse side-effects. Selective use of drugs where demonstrated to be effective remains problematic. The parents’ and adolescents’ negative attitudes toward drugs in general often is not discriminating, creating problems of compliance.
Countermeasures for Driver Fatigue
Published in Gerald Matthews, Paula A. Desmond, Catherine Neubauer, P.A. Hancock, The Handbook of Operator Fatigue, 2017
Use of stimulants. Stimulant use is one of the means of dealing with increasing fatigue while driving. The most widely used and well-documented stimulants are caffeine, amphetamines, and modafinil. The latter two are prescription drugs and so not normally available to drivers. Caffeine, on the other hand, is readily available and is a very common means of overcoming fatigue effects. There is good evidence (Smith, 2002; Bonnet, Balkin & Dinges, 2005) of the effectiveness of caffeine for increasing alertness and reducing fatigue, especially in low arousal situations such as driving. Also important for driving is the fact that caffeine improves performance for tasks requiring sustained attention, especially when alertness is already diminished such as after time without sleep. A study of the effectiveness of caffeine for managing fatigue while driving after restricted or no overnight sleep showed that around 200mg caffeine (equivalent to two to three cups) reduced safety-related incidents in a driving simulator (Reyner & Horne, 2000). Caffeine in the form of an energy drink produced similar beneficial effects on driving (Reyner & Horne, 2002). Further, caffeine in combination with a short nap (<15 minute duration) has been shown to be even more effective than either countermeasure alone in terms of benefits for driving performance and the duration of those performance benefits (Reyner & Horne, 1997; Sagaspe et al., 2007).
Aviation Neuropsychology
Published in Carrie H. Kennedy, Gary G. Kay, Aeromedical Psychology, 2013
Given that ADHD is currently the most prevalent psychiatric disorder found in children and adolescents it should not be surprising that aviation neuropsychologists are increasingly encountering referrals of aviators and individuals seeking initial aeromedical certification who have a history of treatment for ADHD. According to a recent report in the New York Times (Schwarz and Cohen 2013), data from the U.S. Centers for Disease Control and Prevention shows that “nearly one in five high school age boys and 11 percent of school-age children overall have received a medical diagnosis of attention deficit hyperactivity disorder.” This disorder is characterized by distractibility, inattention, hyperactivity, impulsivity, disorganization, and restlessness. By definition, the condition first appears in childhood and often improves but does not disappear with maturation. The pharmacological treatment of ADHD typically involves the use of stimulant medications that generally preclude medical certification. Aviators with mild ADHD who do not require treatment with stimulant medications may be certified by the FAA. However, evaluation by a neuropsychologist is required. The evaluation focuses on the severity of attentional and executive function deficits in the absence of medication. The FAA’s current specifications for evaluation of individuals with a history of ADHD or for those reporting use of medications used to treat ADHD can be found in the Guide for Aviation Medical Examiners (FAA 2013).
A Systematic Review of Stimulant Use in Civilian and Military Aviation
Published in The International Journal of Aerospace Psychology, 2021
Alex M. Ehlert, Patrick B. Wilson
Additionally, there are strict restrictions on when prescription stimulants can be used, the timing of their use, and cumulative doses that are authorized during operations (J. A. Caldwell et al., 2009). Detailed records are kept during each operation, and pilots are evaluated by flight surgeons immediately after (J. A. Caldwell et al., 2009; Kenagy et al., 2004). Major side effects observed in this systematic review appeared when pilots were either not routine caffeine users and took a tablet on an empty stomach (Belland & Bissell, 1994), or when the maximum allowable dose of dextroamphetamine was taken, which was more than three times the median dose across all pilots (Kenagy et al., 2004). Based on the results of this review, there is limited evidence to suggest that stimulants pose a substantial risk of serious side effects when used within the current regulations.
Application of molecular imaging technology in neurotoxicology research
Published in Journal of Environmental Science and Health, Part C, 2018
Xuan Zhang, Qi Yin, Marc Berridge, Che Wang
Methylphenidate, another CNS stimulant, is widely used to treat attention deficit disorder and attention deficit hyperactivity disorder (ADHD). It has been proven that treatment with MPH can efficiently alleviate the primary symptoms in approximately 70% of children with ADHD. Methylphenidate may exert its effects through the blockade of the DAT and the NET, and increases monoamine signaling at the synapse.[56–59] Recently, medical use of MPH has been over-used owing to the high prevalence of ADHD, persisting symptoms in adolescents and adults, and over-diagnosis of ADHD. This has raised concerns regarding its long-term side effects and potential toxicity to the CNS.[65–70] To determine whether chronic MPH exposure during development is associated with subsequent long-term cognitive deficits, drug-induced neurochemical changes were explored by monitoring changes in the uptake (binding) of radiotracers (e.g., FDG, glucose metabolism marker; [18F]-AV133, a marker of vesicular monoamine transporter type 2 [VMAT2]; and 4-18F-ADAM, a radioligand for SERT), in specific regions of interest in the nonhuman primate brain.[70–72] According to these microPET/CT studies, gluocose metabolism in the cerebellum was significantly decreased in both the low- and the high-dose MPH groups. Compared to the control group, the SERT levels significantly increased in the high-dose MPH-treated NHPs in frontal cortex, caudate, putamen, thalamus, and midbrain. Monoamine transporter type 2 levels in thalamus, caudate, putamen, temporal lobe of the cortex, and midbrain were decreased in the low-dose MPH-treated NHPs and decreased in the temporal lobe of the cortex and midbrain in the high-dose group.
Fatally injured drivers in Norway 2005–2015—Trends in substance use and crash characteristics
Published in Traffic Injury Prevention, 2019
Anja Valen, Stig Tore Bogstrand, Vigdis Vindenes, Joachim Frost, Magnus Larsson, Anders Holtan, Hallvard Gjerde
Benzodiazepines, z-hypnotics, and opioids were grouped as medicinal drugs. Amphetamines, methylphenidate, and cocaine were grouped as stimulants. The drivers were divided into 4 age groups: <25, 25–34, 35–44, and ≥45 years. Night was defined as from 10 p.m. to 4 a.m. and weekends from 10 p.m. Friday to 4 a.m. Monday. Time of RTC was categorized as weekday, weeknight, weekend day, and weekend night. Year of incidence was grouped into the time periods 2005–2010 and 2011–2015.