ADHD medication use has grown substantially, yet, little is known about treatment-seeking and prescription practices in the absence of ADHD diagnoses. This project utilized data from the National Comorbidity Survey-Adolescent Supplement, a survey of adolescent psychiatric disorders in the U.S. Rates of medication use, and the influence of prescriber specialty and treatment encouragement, on medication use were investigated among adolescents with ADHD, sub-threshold ADHD, and without ADHD. Findings showed that a small but notable proportion of adolescents in the sub-threshold and no ADHD groups took medication for ADHD. Encouragement from psychiatrists but prescriptions from family doctors were associated with medication use. These findings suggest that adolescents with minimal symptoms may be medicated for behaviour within the range of normal, whereas those with numerous symptoms may not be receiving adequate treatment. Second opinions may assist in proper dosage and treatment. The influence of encouragement from psychiatrists and prescribing physicians is discussed.

Research relating to illicit use of prescription stimulants (IUPS) has, for the most part, focused on describing behaviors of IUPS. However, there have been few attempts to measure IUPS in a consistent manner or determine how to best predict IUPS in an effective and concise manner. Data from Mississippi State University undergraduates (N = 703) were analyzed to create two shortorm measures to predict lifetime IUPS. The data-driven shortorm consisted of 15 items and 5 factors, and accurately classified 74.8% of participants as users versus non-users. The hand-picked shortorm consisted of 8 items and 5 factors, and accurately classified 84.6% of participants as users versus non-users. Results of this study can begin to provide information and possible tactics for briefly and quickly measuring risk for IUPS, particularly in applied settings, like university health centers or academic admissions. Future directions for research include testing these created shortorm measures with longitudinal data collection, validating the measures on different populations, and determining if these measures can accurately predict specific behaviors related to IUPS (e.g., diversion, IUPS within certain time frames).

The present study used the Health Belief Model (HBM) to better understand how perceived susceptibility and severity (perceived threat) can contribute to college student’s willingness to use non-prescription stimulants (NPS). Prior research has shown that as the perceived threat of use increased college student’s intentions to use NPS has decreased (Sattler, Mehlkop, & Graeff, 2013). The psychology research pool was used to recruit 1067 non-user undergraduate students to complete the vignettes and the survey. Participants were given one of sixteen different vignettes that manipulated the perceived threat for academic and health consequences associated with NPS use. Data analyses showed that a combination of high perceived academic threat (high susceptibility and severity) along with high health susceptibility yielded the lowest willingness to use NPS. Therefore, the higher susceptibility that an academic and health consequence will occur along with the higher severity of an academic consequence will occur predicted the lowest intentions to use NPS. Future research should continue to examine what factors can best deter non-users and users from using NPS.

No description available.

Class of 2016 Abstract / Objectives: To first educate undergraduates involved in social sororities about prescription stimulant medications and to evaluate the effectiveness of an educational intervention in influencing the attitudes and beliefs regarding prescription stimulant medication use of undergraduates involved in social sororities. Methods: The intervention, an educational session, was presented to undergraduates involved in social sororities. The questionnaire collected demographic data regarding gender, age, ethnicity, race, undergraduate year, grade point average, type of sorority member, history of an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and previous or current non-medical use of prescription stimulants. The participants’ attitudes and beliefs on nine statements regarding prescription stimulants were queried pre- and post-intervention using a four-point Likert scale ranging from strongly disagree to strongly agree. To analyze changes in attitudes and beliefs, Mann-Whitney test was used. Results: One hundred sixty-three sorority members participated in the study. The average age of participants was 19 years with the majority of respondents identifying as an active sorority member (81%) and in their first year of undergraduate study (69%). There was a statistically significant change in beliefs regarding the safety (p < 0.01) and health risks (p = 0.02) associated with prescription stimulants. There was no significant difference in topics relating to addiction, legal issues of taking someone else’s prescription medications, emotional and academic outcomes from the use of prescription stimulants. Conclusions: The educational program presented by pharmacy students was effective in changing the beliefs and attitudes regarding safety and health risks of prescription stimulants among undergraduate students involved in social sororities.

Cocaine use disorder is a serious public health issue for which no approved pharmacotherapies exist. The development of a pharmacotherapy for cocaine use disorder is a priority for the National Institute on Drug Abuse. Amphetamine maintenance has been shown to be effective to reduce cocaine use in double-blind placebo controlled clinical trials, but has not been approved due to concerns over safety and abuse liability. Development of new pharmacotherapies is facilitated by preclinical testing for effectiveness and identification of new targets for medication development. The first part of this dissertation develops a novel non-human primate cocaine self-administration choice procedure that is modeled after a human laboratory cocaine self-administration choice procedure to improve translational research and facilitate medication development. The second part of this dissertation is devoted to examining the mechanisms of amphetamine maintenance-induced decreases in cocaine use. In the novel non-human primate choice procedure, monkeys chose between injections of cocaine or food pellets (0, 1, 3 or 10) in a 9-choice discrete trials procedure. The reinforcers were available on concurrent independent progressive-ratio schedules. Monkeys chose between cocaine and food in a dose- and magnitude-dependent manner. Maintenance on 7 days of lisdexamfetamine and amphetamine decreased cocaine choices without decreasing food responding, providing evidence that this model may be able to predict drugs that will have clinical efficacy to decrease cocaine use. The next set of experiments examined the effects of amphetamine maintenance on the abuse-related behavioral (intracranial self-stimulation, ICSS) and neurochemical [nucleus accumbens dopamine (DA) and serotonin (5-HT)] effects of cocaine, methylenedioxypyrovalerone, and methamphetamine in rats. Amphetamine maintenance produced sustained increases in ICSS baseline responding and nucleus accumbens DA levels without affecting 5-HT levels. Amphetamine maintenance also attenuated the behavioral and neurochemical abuse-related effects of cocaine but not those of methamphetamine, and with MDPV, amphetamine maintenance decreased the abuse-related neurochemical effect of MDPV, but not the abuse-related behavioral effect. This suggests that amphetamine would likely be most effective against cocaine, least effective against methamphetamine and between the two for MDPV. These data suggest targets that selectively release DA will be the most effective against cocaine use disorder.

Class of 2017 Abstract / Objectives: To first educate undergraduates involved in social sororities about prescription stimulant medications and to evaluate the effectiveness of an educational intervention in influencing the attitudes and beliefs regarding prescription stimulant medication use of undergraduates involved in a social sorority. Methods: The intervention, an educational session, was presented to undergraduates involved in social sororities. Questionnaire that included demographic data of gender, age, ethnicity, race, undergraduate year, grade point average, type of member, history of an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and previous or current non-medical use of prescription stimulants were collected. The participants’ beliefs on nine statements regarding prescription stimulants were queried pre- and post-intervention using a four-point Likert scale ranging from strongly disagree to strongly agree. To analyze change in attitudes and beliefs, Mann-Whitney test was used. Results: One hundred sixty-three sorority members participated in the study. The average age of participants was 19 years with the majority of respondents identifying as an active sorority member (81%) and in their first year of undergraduate study (69%). There was a statistically significant change in beliefs regarding the safety (p < 0.01) and health risks (p = 0.02) associated with prescription stimulants. There was no significant difference in topics relating to addiction, legality, emotional and academic outcomes from the use of prescription stimulants. Conclusions: The education session was effective in changing participants’ beliefs on safety and health risks of nonmedical use of prescription stimulants.

In this thesis the neurocognitive deficits in adult ADHD and the effects of ADHD medication have been investigated in animals and in humans. Firstly, by utilising a translational behavioural paradigm we have characterised of a novel animal model of the core symptoms of adult ADHD. In the first study, the 5-choice continuous performance task (5C-CPT) was used to examine different forms of attention and impulsivity in female Lister-hooded adult rats. Subsequently rats were separated into subgroups according to their baseline levels of attention and impulsivity in the 5C-CPT. The low-attentive; LA subgroup and the high-attentive; HA subgroup were selected based on levels of sustained attention and vigilance. The second subgroups include animals with varying levels of motor impulsivity and response inhibition (high-impulsive; HI and low-impulsive; LI subgroups). This allowed for examination of the effects of ADHD medication (methylphenidate and atomoxetine) on attention and impulsivity in the subgroups of animals modeling the inattentive subtype (ADHD-I), and the impulsive symptoms in the combined (ADHD-C) and impulsive-hyperactive (ADHD-IH) subtypes. Both drugs significantly improved sustained attention and vigilance in LA animals only. In HI animals methylphenidate decreased motor impulsivity, however in LI also increased motor impulsivity. Atomoxetine decreased motor impulsivity and response disinhibition in HI animals only. The second animal study extended this by selecting a group of animals with combined deficits in both attention and impulsivity (ADHD-C group). This separation (ADHD-C) allowed for the investigation of potential novel therapeutic targets, revealing the cognitive effects of tolcapone and A-412997. Tolcapone increased vigilance and sustained attention and reduced response disinhibition in ADHD-C animals only, while A-412997 increased vigilance and reduced response disinhibition also in ADHD-C animals only. The first clinical study evaluated the core neurocognitive deficits, including emotion recognition abilities in medicated and unmedicated adult ADHD patients, compared with a group of healthy controls. The back-translational cognitive tasks used for the evaluation were taken from the Cambridge Automated Neuropsychological Test Battery (CANTAB). Unmedicated adults with ADHD showed core deficits in sustained attention, attentional set-shifting, response inhibition and spatial working memory. Medicated patients showed no impairments compared with controls; highlighting the importance of ADHD medication for improving these cognitive deficits in ADHD. In the second study, the emotion recognition ability of each group was assessed and compared to each other. The second study also examined if the emotion recognition impairments were as a result of a general cognitive dysfunction or are a specific impairment in social perception. The unmedicated ADHD patients showed deficits in the correct recognition of the negative emotions including; fear, anger, sadness and disgust compared with controls. The group of patients followed-up after starting treatment with methylphenidate showed significant improvements in the recognition of all four negative emotions. This improvement was improved to a level comparable to healthy controls. Interestingly, in the unmedicated ADHD group, anger recognition proved to be a specific deficit in social perception whereas sadness, disgust and fear were influenced by deficits in attention and working memory. Following treatment with methylphenidate, improvements in attention accounted for the improvements in sadness, fear and disgust recognition but not anger recognition. In conclusion the animal studies have shown that animals from within a normal population could be selected according to variations in levels of attention and impulsivity. The ADHD drugs had different effects on attention and impulsivity depending on the natural baseline levels of behaviour of the adult rats. These findings highlight the need for a patient stratification approach in adult ADHD; as different responses are dependent of differences in symptom expression. They also show some potential new therapeutic targets in the animal model, which warrant further exploration. The clinical studies highlight the range of neurocognitive deficits, including emotion recognition deficits in adult ADHD. Together these results highlight the importance of pharmacotherapy in ADHD, not only to treat the core symptoms of ADHD (inattention, impulsivity and hyperactivity) but also to improve the disabling emotion recognition deficits of this disorder.

Caffeine, a legal central nervous system stimulant, is commonly consumed by university students in a variety of ways with an implicit belief that it may increase cognitive function. The scientific literature on such benefits has been mixed. In low to moderate doses, caffeine has been shown to reduce fatigue and improve alertness and motor speed while high caffeine consumption is associated with undesirable effects including an inability to focus and increased generalized anxiety. Because the structure of caffeine closely resembles adenosine, it works as an antagonist to increase neuronal excitability. To clarify the effects of caffeine on the brain, this study will examine sensory stimulus-mediated neural synchrony within the prefrontal cortex, a region of the brain associated with executive decision-making as well as in coping with anxiety. When a train of clicks is presented at a particular frequency, neural networks in the brain show oscillatory entrainment at the same frequency. These oscillations represent neighboring neurons firing nearly simultaneously. Such synchronous activation of large networks of neurons is fundamental to the brain’s ability to process and respond to environmental cues and is conveniently measured by the technique of electroencephalography (EEG). EEG as an index of neural network function is well conserved across mammals and used as a translational biomarker to understand the pharmacological effects of drugs within preclinical and human drug development studies. Doses of caffeine mimicking the average range of consumption among college students (100-300 mg/day) are converted into doses suitable for SD rats (10.28 - 30.83 mg/kg) using the FDA’s allometric scaling tool. It is hypothesized that low and medium doses of caffeine may either improve or not affect prefrontal cortical synchrony while high doses may disrupt. The same group of rats will be used for all treatments, including vehicle, in a Latin square crossover design with at least 4 days of gap between dosing. The synchrony response will be evaluated at multiple time points, post-dose. Artifact-free EEG data is averaged to arrive at a synchrony response for each rat and these are further grouped based on treatment and time. Comparisons across treatment and time are done using a 2-factor repeated measures ANOVA, using well-known neural synchrony metrics like evoked power and intertrial phase coherence. These results should inform how caffeine affects the neurophysiological function of the rodent prefrontal cortex, a key region for prioritization, decision-making, and cognitive control. Findings from this study may explain why high doses of caffeine can be disruptive to mental function and performance and lay the groundwork for analogous future studies in humans. On the other hand, if synchrony is unaffected, a chronic regimen of caffeine exposure may be explored to mimic the human consumption pattern of this stimulant.

Objectives: To determine misuse of prescription stimulant medications among future health care providers at an Academic Health Sciences Center. Method: Data were collected via a 62-item anonymous online survey distributed to medical, pharmacy, and rehabilitative health (RT) students at a large Academic Health Sciences Center. The survey instrument collected demographic information related to the respondent’s healthcare discipline, year(s) in professional program, and if the participant had been diagnosed with a disorder requiring a prescription stimulant medication. Nonmedical prescription stimulant use, motivation for nonmedical use, deceptive practices, frequency of use, consequences of nonmedical use, and peer group nonmedical use were also collected. Results: In aggregate, 11.3% of responders reported misuse of prescription stimulants. The rate of misuse was similar for pharmacy (9.7%) and medicine (10.9%) students with a trend towards an increased rate of misuse in RT students (26.3%) (p 5 0.08) The response rates were 70.5% (225/319) for pharmacy, 47.6% (128/269) for medical, and 54.3% (19/33) for respiratory therapy students. The most common reasons for misusing prescription stimulants were to improve academic performance (25/44; 56.7%) and increase alertness/energy (29/44; 65.9%). The most commonly reported adverse reactions were lack of appetite (30/44; 68.2%) and difficulty sleeping (24/44; 54.5%). Implications: Given the stigma associated with prescription stimulant misuse, it is difficult to assess the breadth and depth of this problem. Physical and/or psychological dependence, altered clinical judgment, and violation of misconduct policies and laws are possible consequences of prescription stimulant misuse. This is the first survey to assess misuse by multiple disciplines on a single Academic Health Sciences campus.