Esta dissertação explora o tema da medicalização. A pesquisa toma como objeto a promoção do fármaco Cloridrato de Metilfenidato, conhecido pelo nome comercial: Ritalina®. Trata-se de uma droga psicoestimulante atualmente estabelecida como tratamento de primeira linha para o TDA/H (Transtorno de Déficit de Atenção/Hiperatividade). A literatura especializada afirma que o TDA/H é uma doença de alta prevalência em crianças em idade escolar, sendo o “distúrbio neurocomportamental” mais comum na infância. Dados epidemiológicos sobre a expansão da prevalência do TDA/H e sobre aumento do consumo da Ritalina® somados às complexas relações entre diversos atores (indústria farmacêutica, pesquisadores e publicitários) sugerem que, além da apropriação dos modos de vida das pessoas pela medicina, está sendo estabelecido um vasto mercado corporativo. Este trabalho acompanha a trajetória da Ritalina® a partir da análise de material promocional destinado a profissionais da área médica. As propagandas examinadas foram encontradas através do buscador google e do Portal de Periódicos da Capes (periodicos.capes.gov.br) e compreendem o período de 1956 - quando Ritalina® foi lançada nos EUA – até 1979. Selecionei 32 informes publicitários para serem analisados, baseando-me em critérios como qualidade das imagens, confiabilidade e origem das fontes. Os anúncios mostram que este psicofármaco foi inicialmente indicado para problemas distintos como depressão, fadiga, letargia e narcolepsia. Ao fim da década de 1960 a Ritalina® passa a ser reconhecida como tratamento eficaz para “crianças hiperativas”. Argumento que ao considerarmos propagandas produzidas por laboratórios farmacêuticos como documentos legítimos é possível contribuir para resgatar aspectos históricos de determinada droga que de outro modo poderiam passar desapercebidos, uma vez que este tipo de material caracteriza-se como um elemento imprescindível no arsenal persuasivo dessas empresas. / This dissertation examines the promotion and advertisement for Ritalin (a trade name for methylphenidate). Ritalin® is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include hyperactivity, difficulty staying focused, paying attention and difficulty controlling behavior. The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD) are highly variable. The current study aims to examine how Ritalin®, originally promoted by Ciba as a mild antidepressant, became the drug of first choice to treat ADHD (known at the time as hyperactivity or minimal brain dysfunction). This dissertation examines the development of methylphenidate treatment and the expansion of the diagnostic category of ADHD through the analysis of pharmaceutical advertisements for Ritalin® in US and Canadian medical journals published between 1956 and 1970’s. Most of the journals were retrieved from Portal de Periódicos da Capes and MEDLINE searches. I selected a sample of 32 advertisements to analyze, based mainly on image quality. These pharmaceutical advertisements show that this psychotropic initially market for mild depression and mood disorders, fatigue, lethargy and narcolepsy. By the end of the 60’s, Ritalin is being shown – and renowned – as an effective treatment for “hyperactive children”. I suggest that when we consider pharmaceutical advertisement material as a legitimate documental source, it is possible contributing to retrieve historical aspects of a specific drug, which might otherwise go unnoticed, since this type of material is characterized as an essential component in the persuasive arsenal of those companies.

Attention Deficit Hyperactivity Disorder (ADHD) has become the disorder of the nineties. The name has been bandied about by experts, teachers, parents, lay people and specifically the media, however, when a child or children are diagnosed with this disorder, parents, and in particular for this study, mothers, are left feeling confused, frightened and uncertain. The method of treatment is the specific study of this research. Ritalin is the most popular form of treatment utilised for the alleviation of symptoms, yet mothers are afraid they are drugging their children or taking the easy way out. Constant media hype and ignorance exacerbate the mother’s experiences and they are left in a quandary of which course to follow. The purpose of this research was to investigate if mothers share similar experiences when administering Ritalin for the treatment of symptoms of ADHD. Literature indicates enormous controversy surrounding this disorder and in particular the treatment methods recommended to alleviate symptoms. There are two strongly opposed camps regarding the negativity or positivity toward utilising this schedule 7 drug. Media publicity intensifies the individual’s uncertainty of administering this drug and suggests bad parenting as the reason mothers resort to Ritalin. The goal of this study is to highlight the mother’s experiences and to become aware of their feelings and isolation when being advised that their child or children have ADHD. The lack of awareness and the uncertainty of which course to follow seems to have profound affects and cause mothers to have negative experiences. The purpose of this research is to see if mothers share similar experiences regarding the administering of Ritalin as a treatment method for ADHD. The researcher is hopeful that the outcome of this small study will assist experts, counselors and lay people to empathize and recognize the mother’s plight in this regard, and consequently for them not to feel as troubled and unaided without this knowledge. Finally, she expects that the research may help mothers to be aware that they are not alone with their predicament and sense of apprehension and uncertainty regarding the administering of a drug like Ritalin to assist in alleviating the symptoms presented. / Dissertation (MA (Counselling Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

This investigation was an analysis of the effects of methylphenidate (MPH; trade name: Ritalin) on drug reward using the conditioned place preference (CPP) behavioral paradigm in a rodent model and underlying mechanisms of this effect. Animals were conditioned in adolescence from postnatal day (P)33-39) or P44-49 with saline, 1 or 5 mg/kg MPH. Rats administered 5 mg/kg but not 1 mg/kg MPH, resulted in a significant preference that was more robust in younger male adolescent rats. The 5 mg/kg dose of MPH also resulted in a significant decrease of the dopamine transporter in both the nucleus accumbens and striatum, revealing dopamine clearance is decreased by MPH in brain areas that mediate reward. Finally, MPH-induced CPP was blocked by the dopamine D1 but not D2 antagonist, demonstrating the importance of the D1 receptor in the rewarding effects of MPH. These results demonstrate that dopamine mediates the rewarding effects of MPH in adolescence.

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Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

This investigation was an analysis of the interaction of adolescent exposure to methylphenidate (MPH; trade name: Ritalin) on nicotine sensitization and conditioned place preference (CPP) in a rodent model and underlying mechanisms of this effect. Animals were treated IP with 1 mg/kg MPH or saline using a ―school day‖ regimen of five days on, two days off, from postnatal day (P) 28-50. During the final two weeks of MPH treatment, animals were either behaviorally sensitized to nicotine (0.5 mg/kg free base) or saline for 10 days, or conditioned to nicotine or saline using the CPP behavioral paradigm. In addition, three days after behavioral sensitization was complete, animals were analyzed for stress behavior using the forced swim stress behavioral test. In addition, 24 hours after post-test conditioning animals were analyzed for the effect of a clinically relevant dose of pre-exposed MPH (1mg/kg) and nicotine treatment on the expression of BDNF in the nucleus accumbens and dorsal hippocampus. Behavioral results revealed that adolescent pre-exposure to MPH blunted nicotine behavioral sensitization in both male and female rats during the first week of testing. However, MPH enhanced nicotine CPP in both adolescent male and female rats. Interesting, animals administered MPH demonstrated a significantly decreased latency to immobility in the forced swim stress behavioral test. In addition, pre-exposure to a 1 mg/kg dose of MPH appears to have sensitized the BDNF response to nicotine in females as compared to all other groups.

This study analyzed repeated methylphenidate (MPH) administration and its effects on brain-derived neurotrophic factor (BDNF) in the dorsal striatum and nucleus accumbens of male and female adolescent rats. In Experiment 1, rats were administered intraperitoneal (ip) saline, 1, 3, or 5 mg/kg dose of MPH every second day from postnatal day (P)33–P49. Locomotor activity was analyzed for 10 min after each administration. Results revealed that the 1 mg/kg dose of MPH produced locomotor suppression, however, the 5 mg/kg dose of MPH produced locomotor sensitization and robust behavioral activation in females as compared to males. In Experiment 2, animals were administered ip saline or the 5 mg/kg dose of MPH using an identical regimen but a 30 min behavioral test was employed. Dorsal striatum and nucleus accumbens tissue was assayed for BDNF at P50. Females demonstrated sensitization to MPH and increased locomotor activation compared to males. Interestingly, females given MPH demonstrated a significant 42% decrease of striatal BDNF whereas males administered MPH demonstrated a significant 50.4% increase of striatal BDNF compared to controls. There were no effects on accumbal BDNF. This report demonstrates robust sex differences in the behavioral response, but sex-dependent changes in striatal BDNF in response to MPH in adolescence.

The Amphetamine Years is a history of psychostimulant drugs and their clinical applications in post-World War II American medicine. Comprising such well-known substances as the amphetamines (Benzedrine, Dexedrine), methylphenidate (Ritalin), and phenmetrazine (Preludin), this class of pharmaceuticals has been among the most widely consumed in the past half-century. Their therapeutic uses for a variety of indications such as depression, obesity, and attention-deficit/hyperactivity disorder (ADHD) in children, not to mention their relevance for a number of different medical specialties, reveals that psychostimulants have occupied an important, if underappreciated role in the practice of modern medicine. In this dissertation, I illuminate the various ways in which physicians, particularly psychiatrists, put these drugs to work in clinical practice. In short, I contend that physicians exploited the wide range of physiological and psychological effects of psychostimulants and made a place for them in different therapeutic settings, even ones characterized by competing views and theories about the workings of the human body and mind. My dissertation is distinguished by two prominent themes. First, I emphasize the clinician perspective as a vehicle for understanding the history of the psychostimulants, as well as related developments in psychiatry, pharmacotherapy, and the political economy of drugs, in the second half of the twentieth century. Scholars such Nicolas Rasmussen, David Courtwright, and Ilina Singh have elucidated the history of psychostimulants by emphasizing how pharmaceutical companies positioned their products in the medical marketplace. My dissertation takes a different, yet complimentary approach by studying clinicians, themselves, to further historical comprehension of the place of these pharmaceuticals within postwar medicine, society, and culture. Second, I advance the concept of "therapeutic versatility" to explain their historical trajectories. The complex set of psychological and physical effects these drugs produced made them ideal for a diverse range of therapeutic applications, which explains why they were embraced by many different medical specialties, why they were marketed by manufacturers for a variety of indications, and why they have enjoyed an enduring therapeutic lifespan, in spite of increasing efforts since the mid-1960s to regulate their availability and control their consumption. In addition to these two overarching themes, I advance five specific arguments in my dissertation. First, I contend that pharmaceutical markets were simultaneously created by the drug industry and clinicians. Pharmaceutical firms' efforts to develop markets for their products have been well documented by historians, but in my dissertation, I underscore the role also played by clinicians in discerning drugs' applications. Second, I argue that twentieth-century psychiatry's conception of illness and therapeutics may not be served best by strictly dividing its history along lines of institutional and outpatient treatment. Third, I demonstrate how the use of psychostimulants by analytically oriented psychiatrists during the 1950s complicates historical notions of paradigm shift from a psychodynamic to biological orientation. Psychotherapy and psychopharmacology were not competing paradigms; in practice, doctors often employed both. Fourth, I assert that an appreciation of psychiatrists' empirical and eclectic approaches to the use of drugs is necessary to comprehend the rise of psychiatric pharmacotherapy in the postwar era. Finally, I contend that in order to understand the relationship between medical applications of psychostimulants and their extramedical consumption, it is necessary to conceive of a plurality of distinct "amphetamine cultures," each characterized by a unique set of relationships between physician-prescribers, patient-consumers, pharmaceutical firms, and political authorities.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T10:43:20Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T12:49:14Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) / Made available in DSpace on 2015-01-30T12:49:14Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) Previous issue date: 2014-04-28 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The attention deficit/hyperactivity disorder is a neurodevelopmental disorder provided in the International C lassification of Diseases (ICD) characterizing a continuing pattern of attention deficit and/or hyperactivity/impulsivity with more intense and higher rates than what presented by individuals at the same development level. This dissertation was organized u sing the models of scientific articles analyzing the results from school performance by students of the Colégio de Aplicação (a school maintained by a university) of the Federal University of Goiás, 7 to 14 age group with and without ADHD diagnosis. Initia lly, the prospective observational study to assess comparative effectiveness involved 355 students and investigated the results from school performance by 60 of them before and during Methylphenidate - based treatment (MPH) and psychotherapy compared with th e control group. The students had their school performance and treatment adherence monitored for the first eight months. The literature review on the theme is presented in the first article submitted to the journal “Revista Ciência & Saúde Coletiva” (Journ al of Science and Collective Health), entitled “ Methylphenidate - based treatment and school performance by students with attention deficit/hyperactivity disorder : integrative literature review”. The review included scientific articles published from 2006 to 2013. Six hundred and sixteen out of the 629 articles found did not meet the criteria for inclusion and 13 were part of the sample. Most of the studies emphasized that the group of children with ADHD undergoing methylphenidate - based treatment improved the ir performance compared with the group of children with ADHD with no records for the treatment and stimulant - based therapies are more beneficial in the long term. The second article, entitled “Re/Assessment on the diagnosis of attention deficit/hyperactivi ty disorder in students ” presents the results from the clinical reassessment of 29 children previously diagnosed with ADHD or suspected ADHD. The reassessment confirmed the diagnosis of 74% of the children previously diagnosed and 70% of suspected ADHD. Th e third article, entitled “The use of methylphenidate for students with attention deficit/hyperactivity disorder and poor school performance” presents the major results of this study and proves that the use of methylphenidate - based treatment for students A DHD was associated with improved school records for basic mandatory disciplines . The medication had positive influence on school performance however even undergoing drug - based treatment the students were not able to achieve the levels of performance by stu dents without ADHD with typical school performance. / xii RESUMO O Transtorno de Déficit de Atenção/Hiperatividade é um transtorno do neurodesenvolvimento previsto no Código Internacional de Doenças e caracterizado por um quadro persistente de déficit de atenção e/ou de hiperatividade/impulsividade mais acentuado e grave do que o observado em outros indivíduos com o mesmo nível de desenvolvimento. A presente tese foi construída no modelo de artigos científicos que an alisou os resultados do desempenho acadêmico de escolares do Colégio de Aplicação da Universidade Federal de Goiás, de 7 a 14 anos com e sem diagnóstico de TDA/H. O estudo de caráter prospectivo, observacional e comparativo teve a participação inicial de 3 55 estudantes e investigou os resultados de desempenho escolar de 60 deles, antes e durante o tratamento com metilfenidato (MPH) e psicoterapia em comparação com um grupo controle. Os estudantes foram acompanhados em seu desempenho escolar e em adesão supe rvisionada ao tratamento durante o período de oito meses. A revisão de literatura do tema investigado é apresentada no primeiro artigo, submetido à “Revista Ciência & Saúde Coletiva”, intitulado “Tratamento com Metilfenidato e o desempenho de escolares com Transtorno de Déficit de Atenção/Hiperatividade: revisão integrativa da literatura”. A revisão incluiu artigos científicos publicados no período 2006 a 2013. Dos 629 artigos encontrados, 616 não atenderam aos critérios de inclusão e 13 fizeram parte da am ostra. A maioria dos estudos evidenciou que o grupo de crianças com TDA/H, em tratamento com MPH, mostrou melhor desempenho escolar em relação ao grupo com TDA/H sem histórico de tratamento. E que os tratamentos com estimulantes trazem mais benefícios quan do adotados em longo prazo. O segundo artigo intitulado “Re/Avaliação diagnóstica de Transtorno de Déficit de Atenção/Hiperatividade em escolares” apresenta os resultados da reavaliação clínica de 29 crianças, anteriormente, diagnosticadas com TDA/H ou cas os suspeitos. A re/avaliação confirmou o diagnóstico de 74% das crianças portadoras de diagnóstico e 70% dos casos suspeitos. Já o terceiro artigo intitulado: “A utilização do Metilfenidato por escolares com Transtorno de Déficit de Atenção/Hiperatividade e baixo desempenho escolar” apresenta os resultados principais desse estudo e constatou que o tratamento com Metilfenidato pelos escolares com TDA/H foi associado ao aumento das médias nos resultados da avaliação escolar das disciplinas elementares. A medi cação influenciou positivamente no desempenho dos estudantes, entretanto, mesmo em tratamento medicamentoso esses estudantes não atingiram o nível de desempenho dos escolares sem TDA/H com desempenho escolar típico.