There was no previous meta-analysis investigating the efficacy/tolerability of psychostimulants for symptoms of attention-deficit hyperactivity disorder (ADHD) in preschool children.

Databases including PubMed, the Cochrane Library, EMBASE, ScienceDirect, and ClinicalTrials.gov were searched from inception to March 2022 for randomized controlled trials (RCTs) on therapeutic efficacy of psychostimulants against ADHD symptoms in preschool children (age ≤6 years) compared with placebos. Primary outcomes were (a) changes in ADHD symptoms evaluated by validated rating scales from parents’/teacher’s observation, or (b) post-intervention improvements in neuropsychological performance. Secondary outcomes were risks of adverse events.

Meta-analysis of nine eligible trials including 544 preschool children (mean age=4.86 years, female=11.98%, median treatment duration=4.33 weeks) supported the efficacy of psychostimulants against global symptoms from observations of parents (Hedges’ g=0.6152, p<0.0001) and teachers (Hedges’ g=0.6563, p=0.0039). Efficacy of psychostimulants was also noted against symptoms of inattention and hyperactivity/impulsivity, especially the latter (i.e., main symptoms in preschool children). Moreover, male gender, older age, and longer treatment duration were associated with better efficacy. Regarding adverse events, only the risk of poor appetite was higher in the psychostimulant group (odds ratio [OR]=2.39). However, the qualities of evidence were low to very low, indicating potential discrepancy between the true and estimated effect.

Our results showed that psychostimulants might be beneficial for preschool children with ADHD, especially hyperactivity/impulsivity from teachers’ observation, with tolerable side effects. Nevertheless, the true magnitude of the effect needs to be confirmed with more research due to low to very low certainty of the evidence.

We present the case of a 65-year-old woman with multiple and chronic psychosomatic symptoms. Due to motor impairments she was diagnosed in 2009 with Parkinson’s Disease (PD) by the neurology department and empirical treatment with levodopa was prescribed. However, the patient increased her levodopa intake by three times the recommended dose. The patient presented many adverse effects, including psychotic symptoms, that were interrupted after the levodopa intake was ended during a two month internament in a psychiatric unit. Dopamine dysregulation syndrome (DDS) is a condition in which patients with PD increase their levodopa intake without an objective worsening of motor symptoms. Higher-than-prescribed doses are taken by patients who develop tolerance and dependence to dopaminergic agonists.

To analyse the prevalence of DDS, its diagnosis and treatment as well as the identification of risk factors.

A case report is presented alongside a review of the relevant literature regarding DDS.

The available evidence suggests that the main risk factors for DDS are a history of mood disorders and behavioural disorders, but more studies are needed. Given that DDS is considered a rare adverse effect, physicians usually overlook voluntary dose increase by patients.

DDS, even though uncommon, has severe adverse effects such as dependence and acute psychosis. Before prescription of dopamine agonists, individual risk factors (such as psychiatric comorbidities or history of substance abuse) should be assessed. Also, patients and families should be informed and trained in alarm signs detection. Further studies would be justified to determine DDS prevalence, early diagnosis and treatment.

No significant relationships.

We present the case of a 65-year-old woman who was prescribed levodopa by the Neurology department due to motor symptoms that were not clearly suggestive of a diagnosis of Parkinson’s Disease (PD). Before that, the patient had never showed any hallucinations or delusions. After years of increasing doses of levodopa, the diagnosis of PD was withdrawn. However, during the treatment the patient developed severe psychosis with severe impairment of social functioning. Levodopa is the most effective treatment for motor symptoms in PD. However, it might involve difficulties in dose-control and may present with deletereous complications and adverse effects.

To analyse the incidence of pharmacological psychotic symptoms after levodopa treatment.

A case report is presented alongside a review of the available literature regarding psychotic symptoms in patients treated with levodopa.

Hallucinations and delusions are prevalent symptoms of PD. Nonetheless, they could also be potential side-effects of levodopa treatment. When psychotic symptoms occur, they are commonly attributed to the natural course of the disease. Available evidence does not provide with clear guidelines to distinguish the iatrogenic syndrome from the one caused by the disease itself. Our patient, whose PD diagnosis was dismissed, presented extreme psychotic symptoms which disappeared after the discontinuation of levodopa treatment.

Levodopa is an effective treatment with important risks which must not be overlooked. Adverse effects of the drug could have been minimized by making an accurate differential diagnosis of PD. Individualized benefit-risk balance previous to prescription and a close follow-up should be standardized.

No significant relationships.