Resumo
O Transtorno do Déficit de Atenção e Hiperatividade (TDAH) é o distúrbio do neurodesenvolvimento mais diagnosticado e tratado com uso de medicações no mundo. Estima-se que cerca de metade da população portadora do transtorno irá preencher critérios para o Transtorno do Uso de Substâncias em algum momento da vida. A cannabis é uma planta que conta com mais de 100 extratos e que apresenta evidências robustas de eficácia no tratamento de algumas doenças e é também a substância ilícita mais consumida por portadores de TDAH no mundo. A presente revisão buscou aferir, através da estratégia PICOS, como o uso da cannabis pode interferir na apresentação clínica do TDAH e se os portadores do transtorno podem obter benefícios terapêuticos do seu uso. Publicações dos últimos cinco anos foram coletadas nas bases de dados escolhidas, com posterior análise das informações e confronto entre autores. Foi observado que o uso da cannabis no contexto do Transtorno do Uso de Substância (TUS) foi associado à piores pontuações nas escalas clínicas do TDAH, porém seu uso de forma prescrita foi associado com melhora do quadro clínico. Ainda, não foram encontrados esquemas posológicos validados para o uso medicamentoso da cannabis e seus compostos, revelando a necessidade de maior produção científica com bom valor metodológico.
Referências
ABDA. 10. Crianças com TDAH podem ter outros transtornos associados? Disponível em: <https://tdah.org.br/quantas-criancas-com-tdah-possuem-um-segundo-transtorno-comorbidade>. Acesso em: 14 dez. 2023. AGT. United Nations Office on Drugs and Crime. Disponível em: <https://www.unodc.org/unodc/index.html>.
AKSOY, U. et al. Attention deficit hyperactivity disorder (ADHD) symptoms and Adult ADHD Diagnosis in adult men with cannabis dependence. HEALTHMED, v. 6, n. 6, p. 1925–1929, 2012.
AMERICAN PSYCHIATRIC ASSOCIATION. (2014). Manual diagnóstico e estatístico de transtornos mentais: DSM-5 [Recurso eletrônico]. (5a ed.; M. I. C. Nascimento, Trad.). Porto Alegre, RS: Artmed.
ANGOLD, A.; COSTELLO, E. J.; ERKANLI, A. Comorbidity. Journal of Child Psychology and Psychiatry, v. 40, n. 1, p. 57–87, jan. 1999.
ASHERSON, P. et al. Adult attention-deficit hyperactivity disorder: key conceptual issues. The Lancet Psychiatry, v. 3, n. 6, p. 568–578, jun. 2016.
BIEDERMAN, J. et al. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. American Journal of Psychiatry, v. 152, n. 11, p. 1652–1658, nov. 1995.
BILBAO, A.; SPANAGEL, R. Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. BMC Medicine, v. 20, n. 1, 19 ago. 2022.
BOLEA-ALAMAÑAC, B. et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, v. 28, n. 3, p. 179–203, 12 fev. 2014.
BOSSONG, M. G. et al. Δ9-Tetrahydrocannabinol Induces Dopamine Release in the Human Striatum. Neuropsychopharmacology, v. 34, n. 3, p. 759–766, 27 ago. 2008.
BOSSONG, M. G. et al. P.1.i.006 Further human evidence for striatal dopamine release induced by administration of Δ9-tetrahydrocannabinol (THC). European Neuropsychopharmacology, v. 25, p. S302, set. 2015.
BRANDT, A.; REHM, J.; LEV-RAN, S. Clinical Correlates of Cannabis Use Among Individuals With Attention Deficit Hyperactivity Disorder. The Journal of Nervous and Mental Disease, v. 206, n. 9, p. 726–732, 1 set. 2018.
BRASIL. Lei 8080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Brasília, DF: Diário Oficial da União, 1990.
BRASIL. Ministério da Saúde. Relação Nacional de Medicamentos Essenciais
Rename 2022. Brasília, DF: Ministério da Saúde, 2022. Disponível em:
https://www.gov.br/saude/pt-br/composicao/sectics/daf/rename/20210367-rename-2022_final.pdf acesso em 09 abr. 2023.
BROWN, T. E. ADD/ADHD and impaired executive function in clinical practice. Current Attention Disorders Reports, v. 1, n. 1, p. 37–41, mar. 2009.
CASTELLANOS, F. X. Quantitative Brain Magnetic Resonance Imaging in Attention-Deficit Hyperactivity Disorder. Archives of General Psychiatry, v. 53, n. 7, p. 607, 1 jul. 1996.
CASTELLS, X. et al. Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder. CNS Drugs, v. 25, n. 2, p. 157–169, fev. 2011.
CHANG, Z. et al. Risks and benefits of ADHD medication on behavioral and neuropsychiatric outcomes: a qualitative review of pharmacoepidemiology studies using linked prescription databases. Biological psychiatry, v. 86, n. 5, p. 335–343, 1 set. 2019.
CLASS, Q. A. et al. Fetal growth and psychiatric and socioeconomic problems: population-based sibling comparison. The British Journal of Psychiatry: The Journal of Mental Science, v. 205, n. 5, p. 355–361, 1 nov. 2014.
COETZEE, C.; TRUTER, I.; MEYER, A. Differences in alcohol and cannabis use amongst substance use disorder patients with and without comorbid attention-deficit/hyperactivity disorder. South African Journal of Psychiatry, v. 28, 18 abr. 2022.
COOPER, R. E. et al. Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. European Neuropsychopharmacology, v. 27, n. 8, p. 795–808, ago. 2017.
CORTESE, S. et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, v. 5, n. 9, p. 727–738, 7 ago. 2018.
COSTELLO, E. J. et al. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Archives of General Psychiatry, v. 60, n. 8, p. 837, 1 ago. 2003.
DENNIS, M. et al. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. Journal of substance abuse treatment, v. 27, n. 3, p. 197–213, 2004.
DUNNE, E. M. et al. ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: An accelerated gateway model. Addictive Behaviors, v. 39, n. 12, p. 1755–1758, dez. 2014.
FARAONE, S. V.; BUITELAAR, J. Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. European Child & Adolescent Psychiatry, v. 19, n. 4, p. 353–364, 10 set. 2009.
FARAONE, S. V. et al. Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, v. 1, n. 15020, p. 15020, 6 ago. 2015.
FILIPEK, P. A. et al. Volumetric MRI analysis comparing subjects having attention-deficit hyperactivity disorder with normal controls. Neurology, v. 48, n. 3, p. 589–601, 1 mar. 1997.
FISCHER, J. M. et al. Patient Experiences With Prescription Cannabinoids in Germany: Protocol for a Mixed Methods, Exploratory, and Anonymous Web-Based Survey. JMIR Research Protocols, v. 12, p. e38814–e38814, 21 mar. 2023.
GUDJONSSON, G. H. et al. An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. Journal of Child Psychology and Psychiatry, v. 53, n. 3, p. 304–312, 8 nov. 2011.
HERGENRATHER, J. Y. et al. Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients. Rambam Maimonides Medical Journal, v. 11, n. 1, 30 jan. 2020.
HORNER, B.; SCHEIBE, K. E. Prevalence and Implications of Attention-Deficit Hyperactivity Disorder Among Adolescents in Treatment for Substance Abuse. Journal of the American Academy of Child and Adolescent Psychiatry, v. 36, n. 1, p. 30–36, 1 jan. 1997.
HUNTLEY, Z. et al. Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units. BMC Psychiatry, v. 12, n. 1, dez. 2012.
HUPLI, A. Medical Cannabis for Adult Attention Deficit Hyperactivity Disorder: Sociological Patient Case Report of Cannabinoid Therapeutics in Finland. Medical Cannabis and Cannabinoids, v. 1, n. 2, p. 112–118, 23 nov. 2018.
JACOB, C. P. et al. Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. European Archives of Psychiatry and Clinical Neuroscience, v. 257, n. 6, p. 309–317, 1 abr. 2007.
KNOPIK, V. S. et al. Contributions of parental alcoholism, prenatal substance exposure, and genetic transmission to child ADHD risk: a female twin study. Psychological Medicine, v. 35, n. 5, p. 625–635, maio 2005.v
LEE, S.; HONG, S.-B. Thalamocortical functional connectivity and cannabis use in men with childhood attention-deficit/hyperactivity disorder. PLOS ONE, v. 17, n. 11, p. e0278162, 28 nov. 2022.
LEVENTHAL, A. M. et al. Psychiatric comorbidity in adolescent use and poly-use of combustible, vaporized, and edible cannabis products. Journal of Psychiatric Research, v. 124, p. 91–98, maio 2020.
LOFLIN, M. et al. Subtypes of Attention Deficit-Hyperactivity Disorder (ADHD) and Cannabis Use. Substance Use & Misuse, v. 49, n. 4, p. 427–434, 4 out. 2013.
MANSELL, H. et al. Pharmacokinetics and Perceptions of Children and Young Adults Using Cannabis for Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder: Protocol for a Mixed Methods Proof-of-Concept Study. JMIR Research Protocols, v. 10, n. 10, p. e31281, 18 out. 2021.
MANSELL, H. et al. Cannabis for the Treatment of Attention Deficit Hyperactivity Disorder: A Report of 3 Cases. Medical Cannabis and Cannabinoids, v. 5, n. 1, p. 1–6, 13 jan. 2022.
MCCANN, D. et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. The Lancet, v. 370, n. 9598, p. 1560–1567, nov. 2007.
MOLINA, B. S. G. et al. The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of the American Academy of Child & Adolescent Psychiatry, v. 48, n. 5, p. 484–500, maio 2009.
NIGG, J. T. et al. Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control. Biological Psychiatry, v. 63, n. 3, p. 325–331, fev. 2008.
PATEL, R. S. et al. Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents? Cureus, 7 jan. 2018.
POLANCZYK, G. et al. The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. American Journal of Psychiatry, v. 164, n. 6, p. 942–948, jun. 2007.
POSNER, J. et al. Dissociable attentional and affective circuits in medication-naïve children with attention-deficit/hyperactivity disorder. Psychiatry Research: Neuroimaging, v. 213, n. 1, p. 24–30, jul. 2013.
POSNER, J.; POLANCZYK, G. V.; SONUGA-BARKE, E. Attention-deficit hyperactivity disorder. The Lancet, v. 395, n. 10222, p. 450–462, fev. 2020.
SCHACHTER, H. et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. PubMed, v. 165, n. 11, p. 1475–88, 27 nov. 2001.
SIMON, V. et al. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry, v. 194, n. 3, p. 204–211, mar. 2009.
SPERA, V. et al. Does Cannabis, Cocaine and Alcohol Use Impact Differently on Adult Attention Deficit/Hyperactivity Disorder Clinical Picture? Journal of Clinical Medicine, v. 10, n. 7, 2 abr. 2021.
STEVENS, A. K. et al. Examining motivational pathways from adult attention-deficit/hyperactivity disorder symptoms to cannabis use: Results from a prospective study of veterans. Psychology of Addictive Behaviors, 3 set. 2020.
TAMM, L. et al. Impact of ADHD and cannabis use on executive functioning in young adults. Drug and Alcohol Dependence, v. 133, n. 2, p. 607–614, dez. 2013.
TAURINES, R. et al. Developmental comorbidity in attention-deficit/hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, v. 2, n. 4, p. 267–289, 10 nov. 2010.
TORRES-ACOSTA, N. et al. Cardiovascular Effects of ADHD Therapies. Journal of the American College of Cardiology, v. 76, n. 7, p. 858–866, ago. 2020.
VORUGANTI, L. N. P. et al. Cannabis induced dopamine release: an in-vivo SPECT study. Psychiatry Research: Neuroimaging, v. 107, n. 3, p. 173–177, out. 2001.
WALLACE, A. L. et al. Effects of Cannabis Use and Subclinical ADHD Symptomology on Attention Based Tasks in Adolescents and Young Adults. Archives of Clinical Neuropsychology, v. 34, n. 5, p. 700–705, 6 out. 2018.
WILENS, T. E. Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. Psychiatric Clinics of North America, v. 27, n. 2, p. 283–301, jun. 2004.
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Copyright (c) 2024 Gesley Ferreira Jerônimo , Tatiana Silva Ferreira de Almeida, Aline Ferreira de Araújo Jerônimo, Amanda Carolinne Araújo de Oliveira Farias , Gabriel Teixeira Xavier, Cínthia Andrade de Espíndola , Allana Renally Cavalcante Santos de Moraes , Sarah Fernandes Assis Gadelha Botêlho , Heitor Leonel de Paiva Lima , Eclésio Cavalcante Santos , Áurea Olívia Rodrigues Lopes Silva , Cristine Diniz Coutinho Cruz , Joycyelly Lourenço Garcia da Silva , Júlia Pedrosa de Farias Lima , Edenilson Cavalcante Santos