12 Further evidence comes from the reevaluation of a woman with ADHD, who was smoking 15 cigarettes per day at, the time of first investigation with TRODAT-1, showing no remarkable elevation of DAT; 4 weeks of intake of 3×5 mg methylphenidate led to a marked reduction similar to the other patients in this group. One year later, the patient stopped the KRX-0401 chemical structure nicotine and methylphenidate intake; 2 years after the first investigation she returned with increased complaints Inhibitors,research,lifescience,medical of ADHD. At this time she underwent another TRODAT-1 SPECT scan, presenting with a 19% elevation compared with the first scan with nicotine and a 61 % elevation compared with the second

scan with nicotine and methylphenidate (Figure 6). This finding is in accordance with the opinion that, the effect, of nicotine on DAT does not result, in a persistent, loss of DAT.32 In this context, it is of interest that an investigation with [123I]β-CIT SPECT showed no altered striatal uptake in smokers versus controls,33 a potential parallel Inhibitors,research,lifescience,medical to the above mentioned findings of no DAT elevation in ADHD with this method. Figure 5. DAT availability in the striatum of a 53-year-old nonsmoker before (A), after 5 hours of intake of 20 mg methylphenidate (Ritalin SR®) (B), and 3 months later after 5 hours of wearing a 17.5 mg/24 h nicotine skin patch (C), shown by specific accumulation … Figure 6 DAT availability in the striatum of a 29-year-old female smoker with ADHD before (A),

Inhibitors,research,lifescience,medical after 4 weeks of intake of 3×5 mg methylphenidate (Ritalin®) per day (B), and 2 years later after 1 year of cessation of nicotine abuse Inhibitors,research,lifescience,medical and intake of methylphenidate, … Treatment of adults Most patients need multimodal therapy: psychoeducation concerning the special aspects of ADHD is essential. Many patients have problems with their self-esteem due to a misunderstanding of the symptoms and a childhood with parents suffering from ADHD-especially impulsivity-and they need additional psychotherapy.

Treatment with stimulants is the drug therapy of first choice34 and is approved in Inhibitors,research,lifescience,medical the USA for adults (dmethylphenidate and amphetamines); stimulants for first adult ADHD are as effective as in children. An investigation performed in the year 2000 in Germany showed that only 0.024‰ of the adults registered in the public health system – that is 90% of the adult, population – was treated with methylphenidate in Germany at, this time (Figure 7).35 That is about one out of 40 000 and includes all kinds of treatments, including for narcolepsy and other psychiatric diseases. Figure 7. Percentage of patients treated with methylphenidate in relation to age in the years 1998 (N=65 412), 1999 (N=64 701) and 2000 (N=63 115) in a German district. Reproduced from reference 35: Ferber L v, Lehmkuhl G, Köster I, et al. Methylphenidatgebrauch … In the treatment, of adults with ADHD we start with a daily dose of 5 mg, reaching 15 mg methylphenidate after 14 days of treatment.