Imaging the Effects of Stimulant Medication on Emotional Lability in Patients With ADHD

Study Overview
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Brief Summary
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The aim of this study is to examine the mechanisms by which stimulant medications reduce symptoms in patients with Attention Deficit Hyperactivity Disorder (ADHD). Using Magnetic Resonance Imaging (MRI), the investigators have found that the volumes of certain brain regions are reduced in patients with ADHD. The reduced volumes were much less pronounced if patients had been treated with stimulant medications, suggesting that stimulants may reduce the symptoms of ADHD by reversing these volume reductions. In a second and related study, the investigators found that in patients with ADHD, emotional processing was normalized when patients were taking stimulant medications. Both studies point to possible mechanisms by which stimulants are effective; however, a significant limitation of these findings is that they were derived from cross-sectional studies. In this current study, the investigators hope to replicate these treatment effects of stimulants in a prospective, controlled manner. The investigators plan to measure ADHD symptom severity in patients before and after 12-weeks of controlled treatment with either a stimulant medication or placebo while utilizing structural and functional MRI. Combining imaging with a randomized controlled trial will allow us to better assess the effects of stimulants on brain function and structure.

Detailed Description
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A cohort of 100 patients with ADHD will be recruited for a 12 week, double-blind, parallel, randomized controlled trial of Lisdexamfetamine (Vyvanse) versus placebo, with 50 patients randomized to Lisdexamfetamine and the other 50 patients to placebo. The investigators will acquire high-resolution, anatomical and functional MRI images at baseline and after 12 weeks of treatment. In addition, 75 age- and sex-matched healthy control subjects will be imaged at baseline.

Official Title
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Examining the Effects of Stimulant Medication on Emotional Lability in Patients With Attention Deficit Hyperactivity Disorder (ADHD)

Conditions
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Attention Deficit Hyperactivity Disorder

Intervention / Treatment
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* Drug: Lisdexamfetamine
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ADHD Participants: Meets Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria for a primary diagnosis of ADHD, any subtype. Healthy Control Participants: No current DSM-IV-TR Axis I psychiatric diagnosis. All Participants: Male or female, 6 - 25 years of age, and in good physical health English-speaking Exclusion Criteria: Current comorbid DSM-IV-TR Axis I psychiatric diagnosis or other symptomatic manifestations that, in the opinion of the examining physician, will contraindicate Lisdexamfetamine treatment or confound safety assessments Meets DSM-IV-TR criteria for active substance abuse and/or dependence Lifetime history of cocaine or stimulant abuse or dependence Actively suicidal Children and adolescents: Prior treatment with psychostimulants for longer than 1 month duration and/or treatment with psychostimulants within the past 4 months Adults: Treatment with psychostimulants within the past 12 months. Documented allergy or intolerance to Lisdexamfetamine or other stimulant medications. Taking other medications with central nervous system effects. History of seizure (other than febrile seizure) Diagnosis of hyperthyroidism, glaucoma, or other serious medical illness. Personal or family history of medical conditions, such as cardiovascular disease, that may interfere with study participation, or for which treatment with Lisdexamfetamine may pose a risk Pregnant or lactating MRI contraindications such as pacemaker, braces, etc. Full scale intelligence quotient (FSIQ) less than 70

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Two treatment arms plus sample of healthy controls, who were assessed at one time point
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Psychostimulant<br>30-70 mg capsule of Lisdexamfetamine once daily for 12 weeks | Drug: Lisdexamfetamine<br>* During the first 4 weeks of treatment, the dosage of Lisdexamfetamine will be adjusted based on the patient's response to the medication. The patient will then be maintained at the lowest effective dose for the remaining 8 weeks of treatment.<br>* Other names: Vyvanse;|
| Placebo Comparator: Placebo<br>30-70 mg capsule of placebo (sugar pill) once daily for 12 weeks | Drug: Placebo<br>* Placebo dosing will parallel that of Lisdexamfetamine.<br>* Other names: Sugar pill;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain Structure Volume | Brain structure volume measured in mm^3 | 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ADHD, Vyvanse, stimulant medication, ADD