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Brancati GE, De Rosa U, De Dominicis F, Petrucci A, Nannini A, Medda P, Schiavi E, Perugi G. History of Childhood/Adolescence Referral to Speciality Care or Treatment in Adult Patients with Attention-Deficit/Hyperactivity Disorder: Mutual Relations with Clinical Presentation, Psychiatric Comorbidity and Emotional Dysregulation. Brain Sci 2023; 13:1251. [PMID: 37759852 PMCID: PMC10526193 DOI: 10.3390/brainsci13091251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that only rarely remits in adulthood. While several studies underlined differences between child and adult ADHD, the relationship between adult clinical presentation and early referral/treatment has been rarely investigated. In our study, 100 adults with ADHD were recruited and subdivided according to a history of referral to speciality care or treatment with methylphenidate (MPH) during childhood/adolescence. The early referral was associated with a history of disruptive behaviors during childhood/adolescence. Current ADHD symptoms were more pronounced in patients first referred during childhood/adolescence but never treated with MPH. Early MPH treatment was associated with lower rates of mood disorders and lower severity of emotional dysregulation at the time of assessment. Negative emotionality mediated the relationship between MPH treatment and mood disorders comorbidity. ADHD patients first referred during childhood/adolescence are characterized by more externalizing features than those first referred in adulthood. MPH treatment during the developmental age may have a role in preventing mood disorders in patients with ADHD, possibly by reducing emotional dysregulation.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | | | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Alessandro Nannini
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
| | - Pierpaolo Medda
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (P.M.)
| | - Elisa Schiavi
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (P.M.)
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56100 Pisa, Italy (A.N.)
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2
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Taubin D, Wilson JC, Wilens TE. ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy. Child Adolesc Psychiatr Clin N Am 2022; 31:515-530. [PMID: 35697399 DOI: 10.1016/j.chc.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Co-occurring ADHD and substance use disorder (SUD) is a common clinical presentation associated with significant impairment requiring careful evaluation, diagnosis, and treatment. Treatment with medication, along with cognitive behavioral therapy, is generally regarded as effective in addressing symptoms and impairments associated with both disorders. Options for pharmacotherapy include stimulant and nonstimulant therapies administered with careful monitoring of dosage and compliance to optimize efficacy. In high-risk groups such as college students and/or those with SUD, prescribers should address risks of stimulant misuse and diversion through patient and family education, medication monitoring, and other risk-reducing practices.
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Affiliation(s)
- Daria Taubin
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Julia C Wilson
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Child Psychiatry Service, Massachusetts General Hospital, 55 Fruit Street, YAW 6A, Boston, MA 02114, USA; Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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3
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Assayag N, Berger I, Parush S, Mell H, Bar-Shalita T. Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052541. [PMID: 35270233 PMCID: PMC8909105 DOI: 10.3390/ijerph19052541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. Methods: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale—Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. Results: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. Conclusion: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.
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Affiliation(s)
- Naama Assayag
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Itai Berger
- Pediatric Neurology, Pediatric Division, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva 8443944, Israel;
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Haim Mell
- Department of Criminology, Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
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Virtanen S, Sidorchuk A, Fernández de la Cruz L, Brander G, Lichtenstein P, Latvala A, Mataix-Cols D. Association of Tourette Syndrome and Chronic Tic Disorder With Subsequent Risk of Alcohol- or Drug-Related Disorders, Criminal Convictions, and Death: A Population-Based Family Study. Biol Psychiatry 2021; 89:407-414. [PMID: 33229038 DOI: 10.1016/j.biopsych.2020.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND It remains unclear if individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) have an elevated risk of subsequent substance misuse. METHODS In this population-based cohort study, we investigated the association between ICD diagnoses of TS/CTD and substance misuse outcomes, accounting for psychiatric comorbidity and familial factors. The cohort included all individuals living in Sweden at any time between January 1, 1973, and December 31, 2013. Substance misuse outcomes were defined as an ICD code of substance use-related disorder or cause of death, or as a substance use-related criminal conviction in the nationwide registers. RESULTS The cohort included 14,277,199 individuals, of whom 7832 had a TS/CTD diagnosis (76.3% men). TS/CTD was associated with an increased risk of any subsequent substance misuse outcomes (adjusted hazard ratio [aHR], 3.11; 95% confidence interval [CI], 2.94-3.29), including alcohol-related disorder (aHR, 3.45; 95% CI, 3.19-3.72), drug-related disorder (aHR, 6.84; 95% CI, 6.32-7.40), substance-related criminal convictions (aHR, 2.56; 95% CI, 2.36-2.77), and substance-related death (aHR, 2.54; 95% CI, 1.83-3.52). Excluding psychiatric comorbidities had little effect on the magnitude of the associations, with the exception of attention-deficit/hyperactivity disorder, which attenuated the risk of any substance misuse outcomes (aHR, 2.00; 95% CI, 1.82-2.19). The risk of any substance misuse outcomes in individuals with TS/CTD was substantially attenuated but remained significant when compared with their unaffected siblings (aHR, 1.74; 95% CI, 1.53-1.97). CONCLUSIONS TS/CTD were associated with various types of subsequent substance misuse outcomes, independently of psychiatric comorbidity and familial factors shared between siblings. Screening for drug and alcohol use should become part of the standard clinical routines, particularly in patients with comorbid attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Suvi Virtanen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Luderer M, Sick C, Kaplan-Wickel N, Reinhard I, Richter A, Kiefer F, Weber T. Prevalence Estimates of ADHD in a Sample of Inpatients With Alcohol Dependence. J Atten Disord 2020; 24:2072-2083. [PMID: 29308693 DOI: 10.1177/1087054717750272] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: ADHD is common in patients with alcohol dependence, but prevalence results are inconsistent. We investigated ADHD prevalence in a complex design to avoid over- or underdiagnosing. Method: Patients with alcohol dependence starting long-term residential treatment were included. A structured interview (Diagnostic Interview for ADHD in Adults [DIVA]) was conducted on all patients. DIVA results indicating childhood or adulthood ADHD were assessed in successive diagnostic interviews by two expert clinicians. Results: 415 of 488 patients had completed the entire diagnostic assessment. ADHD prevalence was 20.5%. DIVA results correlated moderately with experts' diagnoses. In patients with ADHD, a higher comorbid illicit substance use was prevalent and alcohol dependence started earlier and was more severe. Conclusion: This study provides the largest sample on ADHD prevalence in alcohol dependent inpatients. Despite great efforts to avoid overestimation, we found every fifth patient to have ADHD. ADHD diagnosis should not be based solely on a structured interview but should be clinically confirmed.
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Affiliation(s)
- Mathias Luderer
- Dept. of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Germany.,Feuerlein Center of Translational Addiction Medicine
| | | | | | - Iris Reinhard
- Dept. of Biostatistics, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Germany
| | | | - Falk Kiefer
- Dept. of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Germany.,Feuerlein Center of Translational Addiction Medicine
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Vuijk PJ, Martin J, Braaten EB, Genovese G, Capawana MR, O’Keefe SM, Lee BA, Lind HS, Smoller JW, Faraone SV, Perlis RH, Doyle AE. Translating Discoveries in Attention-Deficit/Hyperactivity Disorder Genomics to an Outpatient Child and Adolescent Psychiatric Cohort. J Am Acad Child Adolesc Psychiatry 2020; 59:964-977. [PMID: 31421235 PMCID: PMC7408479 DOI: 10.1016/j.jaac.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Genomic discoveries should be investigated in generalizable child psychiatric samples in order to justify and inform studies that will evaluate their use for specific clinical purposes. In youth consecutively referred for neuropsychiatric evaluation, we examined 1) the convergent and discriminant validity of attention-deficit/hyperactivity disorder (ADHD) polygenic risk scores (PRSs) in relation to DSM-based ADHD phenotypes; 2) the association of ADHD PRSs with phenotypes beyond ADHD that share its liability and have implications for outcome; and 3) the extent to which youth with high ADHD PRSs manifest a distinctive clinical profile. METHOD Participants were 433 youth, ages 7-18 years, from the Longitudinal Study of Genetic Influences on Cognition. We used logistic/linear regression and mixed effects models to examine associations with ADHD-related polygenic variation from the largest ADHD genome-wide association study to date. We replicated key findings in 5,140 adult patients from a local health system biobank. RESULTS Among referred youth, ADHD PRSs were associated with ADHD diagnoses, cross-diagnostic ADHD symptoms and academic impairment (odds ratios ∼1.4; R2 values ∼2%-3%), as well as cross-diagnostic variation in aggression and working memory. In adults, ADHD PRSs were associated with ADHD and phenotypes beyond the condition that have public health implications. Finally, youth with a high ADHD polygenic burden showed a more severe clinical profile than youth with a low burden (β coefficients ∼.2). CONCLUSION Among child and adolescent outpatients, ADHD polygenic risk was associated with ADHD and related phenotypes as well as clinical severity. These results extend the scientific foundation for studies of ADHD polygenic risk in the clinical setting and highlight directions for further research.
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Affiliation(s)
- Pieter J. Vuijk
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Ellen B. Braaten
- Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston
| | - Giulio Genovese
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Michael R. Capawana
- Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston
| | - Sheila M. O’Keefe
- Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston
| | - B. Andi Lee
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Hannah S. Lind
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Jordan W. Smoller
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA,Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston
| | | | - Roy H. Perlis
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA,Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston,Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston
| | - Alysa E. Doyle
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA,Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston,Correspondence to Alysa E. Doyle, PhD, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN 6240, Boston, MA 02114
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Boland H, DiSalvo M, Fried R, Woodworth KY, Wilens T, Faraone SV, Biederman J. A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. J Psychiatr Res 2020; 123:21-30. [PMID: 32014701 DOI: 10.1016/j.jpsychires.2020.01.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of literature from large databases and registries to assess the effects of ADHD medication on associated functional outcomes. STUDY DESIGN A literature search was performed in PubMed, PsycINFO, MEDLINE, and Web of Science for articles published prior to January 2019. Sample size, age range, country of origin, medication type, number of functional events and non-events, odds ratios and hazard ratios, and means and standard deviations were extracted. Random-effects meta-analyses were conducted for 21 studies examining functional outcomes. RESULTS 40 articles were included. The majority suggest a robust protective effect of ADHD medication treatment on mood disorders, suicidality, criminality, substance use disorders, accidents and injuries, traumatic brain injuries, motor vehicle crashes, and educational outcomes. Similarly, the meta-analyses demonstrated a protective effect of medication treatment on academic outcomes, accidents and injuries, and mood disorders. CONCLUSIONS These findings suggest that ADHD medication treatments are associated with decreases in the risks for a wide range of ADHD-associated functional outcomes supporting efforts aimed at early diagnosis and treatment of individuals with ADHD.
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Affiliation(s)
- Heidi Boland
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.
| | - Timothy Wilens
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Joseph Biederman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Quantifying the Protective Effects of Stimulants on Functional Outcomes in Attention-Deficit/Hyperactivity Disorder: A Focus on Number Needed to Treat Statistic and Sex Effects. J Adolesc Health 2019; 65:784-789. [PMID: 31350122 PMCID: PMC6874726 DOI: 10.1016/j.jadohealth.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to help quantify the protective effects of stimulant treatment on important functional outcomes in attention-deficit/hyperactivity disorder (ADHD) using the number needed to treat (NNT) statistic and examine whether these effects are moderated by sex. METHODS Subjects were derived from three independent samples, two similarly designed case-control, 10-year prospective follow-up studies of boys and girls with and without ADHD grown up and a cross-sectional randomized clinical trial of lisdexamfetamine on driving performance and behavior. For all studies, subjects were evaluated with structured diagnostic interviews. To measure psychopharmacologic treatment in the follow-up studies, we collected information about each subject's stimulant medication use, age at onset, and age at termination of treatment. Subjects in the driving study underwent two driving simulation assessments (premedication and after 6 weeks of treatment on lisdexamfetamine or placebo). For each outcome, we ran a logistic regression model that included an interaction between sex and treatment status. Lifetime rates were used to calculate the NNT statistic. We also calculated adjusted NNT statistics that accounted for sex, age, socioeconomic status, and family intactness. RESULTS The NNTs were very low, ranging from 3 to 10. No interaction effects with sex were detected (all p > .05). The adjusted NNTs mostly remained the same with the exception of any substance use disorder, which increased after controlling for age. CONCLUSIONS Stimulants have strong protective effects on functional outcomes in youth with ADHD that are not moderated by sex. These results support the critical importance of early identification and treatment of children with ADHD of both sexes.
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Yaghubi M, Zargar F. Effectiveness of Mindfulness-based Relapse Prevention on Quality of Life and Craving in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 10:250-259. [PMID: 31263524 PMCID: PMC6593172 DOI: 10.22122/ahj.v10i4.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Quality of life (QOL) is always considered as a final consequence of clinical trials, interventions, and health care. The results of studies indicate that addiction leads to lower QOL. However, studies have been conducted on the effectiveness of mindfulness-based interventions on improving QOL. The aim of this study was to investigate the efficacy of mindfulness-based relapse prevention (MBRP) on QOL and craving in methadone-treated patients. Methods This study was conducted in Qom, Iran, in 2017. A sample of 70 methadone-treated patients were randomly selected and assigned to two groups (intervention and control). Participants in both groups completed the 36-item Short Form (SF-36) QOL Questionnaire and Craving Beliefs Questionnaire (CBQ) at the beginning of the study (pre-test), 8 weeks after the study (post-test), and two months after the study (follow up). In this study, the experimental group received 8 training sessions on mindfulness prevention, while the control group did not receive general information about addiction and did not receive any psychological intervention. Finally, data of 63 patients were analyzed with the SPSS software, chi-square test, t-test, and repeated-measures ANOVA. Findings The results of repeated-measures ANOVA showed that there was no significant difference between intervention and control groups in the pre-test, but MBRP in the intervention group significantly increased the scores of QOL and decreased the scores of craving, significantly (P < 0.001). Conclusion The findings of present study indicate that MBRP training can increase the psychological and physical health in dependent methadone-treated patients and decrease craving. These findings suggest that mindfulness training can be used as an effective intervention for improving QOL and reducing craving.
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Affiliation(s)
- Mehdi Yaghubi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Zargar
- Associate Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications. Curr Opin Psychiatry 2019; 32:300-306. [PMID: 31008730 DOI: 10.1097/yco.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Attention-deficit and hyperactivity disorder (ADHD) often presents with comorbid substance use disorders (SUD). Due to similarities in key symptoms of both disorders and suboptimal efficacy of the available treatments, clinicians are faced with difficulties in the diagnosis and treatment of these patients with both disorders. This review addresses recent publications between 2017 and 2019 on the etiology, prevalence, diagnosis and treatment of co-occurring ADHD and SUD. RECENT FINDINGS ADHD is diagnosed in 15-20% of SUD patients, mostly as ADHD with combined (hyperactive/inattentive) presentation. Even during active substance use, screening with the Adult ADHD Self-Report Scale (ASRS) is useful to address whether further diagnostic evaluation is needed. After SUD treatment, the diagnosis of ADHD generally remains stable, but ADHD subtype presentations are not. Some evidence supports pharmacological treatment with long-acting stimulants in higher than usual dosages. Studies on psychological treatment remain scarce, but there are some promising findings on integrated cognitive behaviour therapy. SUMMARY Diagnosis and treatment of patients with comorbid ADHD and SUD remain challenging. As ADHD presentations can change during active treatment, an active follow-up is warranted to provide treatment to the individuals' personal strengths and weaknesses.
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Slobodin O, Crunelle CL. Mini Review: Socio-Cultural Influences on the Link Between ADHD and SUD. Front Public Health 2019; 7:173. [PMID: 31294015 PMCID: PMC6606733 DOI: 10.3389/fpubh.2019.00173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/10/2019] [Indexed: 11/13/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Be'er Sheva, Israel
| | - Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Toxicological Center, Antwerp University, Antwerp, Belgium
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12
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Valero S, Bosch R, Corominas M, Barrau V, Ramos-Quiroga JA, Casas M. Remittance or persistence of attention deficit-hyperactivity disorder (ADHD) and its impact on recidivism in risky driving behaviors. TRAFFIC INJURY PREVENTION 2018; 19:701-707. [PMID: 30485128 DOI: 10.1080/15389588.2018.1505043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/22/2018] [Accepted: 07/22/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Recent data regarding the persistence or remittance of attention deficit-hyperactivity disorder (ADHD) diagnosis into adulthood raise the question of its possible role in crucial public health issues, including road safety, especially when neurocognitive capacities are challenged. METHODS The study included 611 participants with serious traffic violations. The Spanish version of the Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess psychopathology. They were grouped into 3 diagnostic conditions: non-ADHD, persistent ADHD (ADHD-P), and remittent ADHD (ADHD-R). Several risky driving behaviors were analyzed. RESULTS Although participants with ADHD have more driving violations relative to non-ADHD, ADHD-R, and ADHD-P drivers have similar profiles. ADHD-R and ADHD-P drivers are more prone to perform risky and recidivistic behaviors relative to non-ADHD counterparts (P = .044 and P = .047, respectively); ADHD-R and ADHD-P participants are statistically comparable in this proneness (P = .772). CONCLUSION These results suggest that the underlying core deficits of ADHD-attention and other executive disabilities-persist despite the fact that some people no longer reach the threshold for clinical diagnosis.
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Affiliation(s)
- S Valero
- a Group of Psychiatry, Mental Health and Addiction , Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
| | - R Bosch
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - M Corominas
- a Group of Psychiatry, Mental Health and Addiction , Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
| | - V Barrau
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - J A Ramos-Quiroga
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - M Casas
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
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Does exposure to parental substance use disorders increase offspring risk for a substance use disorder? A longitudinal follow-up study into young adulthood. Drug Alcohol Depend 2018; 186:154-158. [PMID: 29573650 PMCID: PMC5876721 DOI: 10.1016/j.drugalcdep.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The main aim of this study was to examine the risk of exposure to parental substance use disorders (SUD; alcohol or drug abuse or dependence) on the risk for SUD in offspring with and without attention deficit hyperactivity disorder (ADHD) followed into young adult years. METHODS Subjects were derived from two longitudinal case-control studies of probands of both sexes, 6-17 years, with and without DSM-III-R ADHD and their parents. Probands were followed for ten years into young adulthood. Probands with a parental history of non-nicotine SUD were included in this analysis. Exposure to SUD was determined by active non-nicotine parental SUD while the parent was living with their child after birth. Cox proportional hazard models were used to calculate the risk of non-nicotine SUD in offspring. RESULTS 171 of the 404 probands reassessed at ten-year follow up had a family history of parental SUD. 102 probands were exposed to active parental SUD. The average age of our sample was 22.2 ± 3.5 years old. Exposure to maternal but not paternal SUD increased offspring risk for an alcohol use disorder in young adulthood independently of ADHD status (OR: 2.7; 95% CI: 1.1, 6.9; p = 0.04). CONCLUSION Exposure to maternal SUD increases the risk for an alcohol use disorder in offspring ten years later in young adult years irrespective of ADHD status.
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