Frequência do uso de metilfenidato no Brasil: uma revisão sistemática com meta-análise
Frequência do uso de metilfenidato no Brasil: uma revisão sistemática com meta-análise
Data
2020
Autores
Gomes, Vanessa da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: O metilfenidato foi o psicoestimulante mais consumido no mundo no ano de 2018. Além de ser o principal medicamento prescrito para o tratamento do transtorno do déficit de atenção com hiperatividade, seus efeitos potenciais sobre a cognição aumentaram a utilização indiscriminada por adolescentes, estudantes universitários e adultos jovens com finalidades diversas às médicas, como o aprimoramento cognitivo. Objetivo: Compilar sistematicamente estudos sobre o uso do metilfenidato no Brasil analisando a frequência de uso e identificando os subgrupos de usuários e seus motivos de uso. Métodos: Foi conduzida uma revisão sistemática englobando bases de dados indexadas (MEDLINE, LILACS, SciELO, EMBASE, PyscINFO e Scopus) e literatura cinzenta. Foram selecionados estudos transversais que avaliassem a frequência de uso do metilfenidato em crianças, adolescentes e adultos brasileiros. A seleção dos estudos e extração dos dados foi conduzida por uma dupla de revisores de forma independente e pareada. Além da análise descritiva foi realizada uma análise qualitativa dos estudos por meio dos critérios específicos do instrumento Joanna Briggs Institute (JBI) e, quando possível, foram conduzidas meta- análises de proporções de acordo com os subgrupos e motivos declarados de uso do metilfenidato, com destaque para o uso com intuito de aprimoramento cognitivo e tratamento do transtorno do déficit de atenção com hiperatividade. O protocolo da revisão sistemática foi registrado no International Prospective Register of Systematic Reviews sob o número CDR42020156789. Resultados: Após a condução das estratégias de buscas até a data de janeiro de 2020, foram recuperados 794 resultados. Ao final do processo de seleção, 24 estudos foram incluídos na revisão sistemática, sendo 19 realizados em adultos e 5 em crianças. Após a investigação das possíveis fontes de heterogeneidade nos estudos com adultos, só foram incluídos na meta-análise os estudos que adotaram amostras probabilísticas e que citaram o metilfenidato no instrumento de coleta de dados. Quando comparados com estudantes de outros cursos em geral, estudos com estudantes de medicina apresentaram uma frequência maior de relato de uso do metilfenidato para o aprimoramento cognitivo, sendo de 22,19% (IC95%: 18,54 a 26,33%, I2 : 57%, 6 estudos, n = 1.121) enquanto apenas, 5,47% (IC95%: 4,30 a 6,93%, I2 :0%, 2 estudos, n = 1.171) dos estudantes de outros cursos referiram o uso com este mesmo motivo. Para o tratamento do transtorno do déficit de atenção com hiperatividade, apenas 1,76% (IC95%: 0,81 a 3,80%, I2 : 81%, 4 estudos, n = 12.984) estudantes referiram o uso. O motivo para o uso do metilfenidato nas crianças, com uma frequência relatada nos estudos variando de 2,2% a 17,3% foi para o tratamento do transtorno do déficit de atenção com hiperatividade. Devido à presença importante de heterogeneidade e o número limitado dos estudos recuperados não foi possível a realização de meta- análise nos estudos em crianças. Conclusão: Os achados demonstraram uma frequência importante de uso de metilfenidato além de suas indicações médicas previstas. Estudantes de diversas áreas acadêmicas fazem uso do metilfenidato, contudo, os estudantes de medicina apresentaram uma frequência maior de uso em comparação aos outros cursos, com o objetivo de aprimoramento cognitivo. Nas crianças o uso do metilfenidato esteve vinculado ao tratamento do transtorno do déficit de atenção com hiperatividade. O contexto identificado orienta a necessidade de implementação políticas públicas e protocolos clínicos sobre o uso de metilfenidato, visando a redução dos riscos associados ao seu uso indiscriminado.
Introduction: Methylphenidate was the most consumed psychological stimulator in the world in 2018. In addition, it is the main medication prescribed for the treatment of attention deficit hyperactivity disorder. The potential effect of increasing cognition contributes to a rise in the indiscriminate use by adolescents, college students and young adults, with cognitive improvement as the goal, regardless of its medical purposes. Objective: To compile systematic studies on the use of methylphenidates in Brazil, analyzing the frequency of use and identifying the subgroups of users and their motivations for usage. Methods: A systematic review was conducted involving indexed databases (MEDLINE, LILACS, SciELO, EMBASE, PyscINFO and Scopus) and gray literature. It was made a selection of cross-sectional studies that evaluated how often the methylphenidate was used by Brazilian children, adolescents and adults.The selection of studies and data extraction was conducted by an independent and paired double review. In addition to the descriptive analysis, a qualitative analysis of the studies was carried out using instruments from the Joanna Briggs Institute (JBI) and, when possible, meta-analysis of proportions were conducted according to the subgroups and declared reasons for using methylphenidate, with emphasis on the use with the intention of cognitive improvement and treatment of attention deficit hyperactivity disorder. The systematic review protocol was registered in the International Prospective Registry of Systematic Reviews under number CDR42020156789. Results: After conducting the search strategies, dating until January 2020, 794 results were retrieved. At the end of the selection process, 24 studies were included in the systematic review, 19 of which were carried out in adults and 5 in children. After an investigation of the possible sources of heterogeneity in studies with adults, they were also included in the meta-analysis of studies that adopted probabilistics and that cited or methylphenidate in the data collection instrument. When compared to students from other courses in general, studies with medical students show a higher frequency of use of methylphenidate for cognitive improvement, being 22.19% (95% CI: 18.54 to 26.33%, I2: 57%, 6 studies, n = 1.121) while only 5.47% (95% CI: 4.30 to 6.93%, I2: 0%, 2 studies, n = 1.171) of students from other courses referenced use for the same reason . For the treatment of attention deficit hyperactivity disorder, only 1.76% (95% CI: 0.81 to 3.80%, I2: 81%, 4 studies, n = 12,984). The reason for the use of methylphenidate in children, with a frequency related to studies ranging from 2.2% to 17.3%, was for the treatment of attention deficit hyperactivity disorder. Accepting an important presence of heterogeneity and a limited number of retrieved studies, it was not possible to perform a meta-analysis in studies in children. Conclusion: The findings demonstrated an important frequency of use of methylphenidate in addition to its necessary medical indications. Students from different academic areas use methylphenidate, however, medical students have a higher frequency of use compared to other courses, with the aim of cognitive improvement. In children, the use of methylphenidate was linked to the treatment of attention deficit hyperactivity disorder. The identified context guides the need to implement public policies and clinical protocols on the use of methylphenidate, applying the reduction of risks associated with its indiscriminate use.
Introduction: Methylphenidate was the most consumed psychological stimulator in the world in 2018. In addition, it is the main medication prescribed for the treatment of attention deficit hyperactivity disorder. The potential effect of increasing cognition contributes to a rise in the indiscriminate use by adolescents, college students and young adults, with cognitive improvement as the goal, regardless of its medical purposes. Objective: To compile systematic studies on the use of methylphenidates in Brazil, analyzing the frequency of use and identifying the subgroups of users and their motivations for usage. Methods: A systematic review was conducted involving indexed databases (MEDLINE, LILACS, SciELO, EMBASE, PyscINFO and Scopus) and gray literature. It was made a selection of cross-sectional studies that evaluated how often the methylphenidate was used by Brazilian children, adolescents and adults.The selection of studies and data extraction was conducted by an independent and paired double review. In addition to the descriptive analysis, a qualitative analysis of the studies was carried out using instruments from the Joanna Briggs Institute (JBI) and, when possible, meta-analysis of proportions were conducted according to the subgroups and declared reasons for using methylphenidate, with emphasis on the use with the intention of cognitive improvement and treatment of attention deficit hyperactivity disorder. The systematic review protocol was registered in the International Prospective Registry of Systematic Reviews under number CDR42020156789. Results: After conducting the search strategies, dating until January 2020, 794 results were retrieved. At the end of the selection process, 24 studies were included in the systematic review, 19 of which were carried out in adults and 5 in children. After an investigation of the possible sources of heterogeneity in studies with adults, they were also included in the meta-analysis of studies that adopted probabilistics and that cited or methylphenidate in the data collection instrument. When compared to students from other courses in general, studies with medical students show a higher frequency of use of methylphenidate for cognitive improvement, being 22.19% (95% CI: 18.54 to 26.33%, I2: 57%, 6 studies, n = 1.121) while only 5.47% (95% CI: 4.30 to 6.93%, I2: 0%, 2 studies, n = 1.171) of students from other courses referenced use for the same reason . For the treatment of attention deficit hyperactivity disorder, only 1.76% (95% CI: 0.81 to 3.80%, I2: 81%, 4 studies, n = 12,984). The reason for the use of methylphenidate in children, with a frequency related to studies ranging from 2.2% to 17.3%, was for the treatment of attention deficit hyperactivity disorder. Accepting an important presence of heterogeneity and a limited number of retrieved studies, it was not possible to perform a meta-analysis in studies in children. Conclusion: The findings demonstrated an important frequency of use of methylphenidate in addition to its necessary medical indications. Students from different academic areas use methylphenidate, however, medical students have a higher frequency of use compared to other courses, with the aim of cognitive improvement. In children, the use of methylphenidate was linked to the treatment of attention deficit hyperactivity disorder. The identified context guides the need to implement public policies and clinical protocols on the use of methylphenidate, applying the reduction of risks associated with its indiscriminate use.
Description
Palavras-chave
Systematic Review, Meta-Analysis, Child, Students, Methylphenidate, Metanálise, Revisão Sistemática, Criança, Estudantes, Metilfenidato
Citação
Gomes VS. Frequência do uso de metilfenidato no Brasil: uma revisão sistemática com meta-análise. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde]. Instituto Nacional de Cardiologia; 2020.