4 Discussion Results from this study of six European BMS-777607 in vivo countries indicated that 14.1 % of children and adolescents diagnosed with and receiving medication for ADHD with no behavioral treatment were treated concomitantly with psychotropic

therapies, even though the psychiatric therapies were not product label indicated for ADHD treatment across Europe. The PCM rate of 14.1 % was observed in the sample of children and adolescents without epilepsy or Tourette syndrome and dropped less than a full percentage point (13.3 %), when examining sensitivity analyses with subsets of the children and adolescents who also had no reported evidence in their medical records of other pre-existing conditions, including schizophrenia, OCD, autism, alcohol abuse, or drug abuse. Furthermore, among all patient groups studied, the rate of PCM use was relatively stable and used to treat their ADHD, as reported by their treating physicians. By comparison, the administration rate of psychotropic medications, specifically second-generation antipsychotics, to children with ADHD as their only diagnosis was reported as 14 %

in a US study of Medicaid-enrolled children Everolimus chemical structure [23]. Although this study did not provide details of the use of multiple medications, patients taking co-medications were included in the analyses. A slightly higher rate of PCM use by patients with ADHD and no psychiatric co-morbidities (18 %) was reported by a nationwide physician survey conducted in the Netherlands [27]. This study also found significant

variation in PCM use across countries. Such a result is difficult to interpret and may relate to physician training and practice setting, national standards and insurance systems, treatment priorities, variability in other available resources such as family and community support or supportive educational Reverse transcriptase settings, cultural norms, or differences in approved medications. For example, Italy had the highest rate of PCM observed during this time period and did not have any long-acting stimulants approved for use, which may indicate the use of other medications to fill a potential gap in treatment therapy. Across all countries, important baseline differences were noted among patients receiving PCM relative to those who had ADHD monotherapy, suggesting differences in demographic and clinical characteristics between segments of the ADHD population. During the study observation period, PCM patients had more co-morbidities, greater occurrence of certain predominant symptoms, more use of behavioral therapy, greater patient engagement, and greater symptom impairment. After controlling for these baseline differences, patients with more pre-existing psychiatric co-morbidities or those who had a high level of impairment due to the symptom of anger were still more likely to receive PCM alongside their ADHD treatment.