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López-Hernández AE, Miquel-López C, García-Medina JJ, García-Ayuso D. Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder. Acta Ophthalmol 2024; 102:e842-e850. [PMID: 38337176 DOI: 10.1111/aos.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake. METHODS A cohort of 100 participants, including 50 individuals with ADHD and 50 age- and sex-matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non-cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings. RESULTS We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non-cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049). CONCLUSIONS Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.
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Affiliation(s)
- A Eusebio López-Hernández
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
| | - Carmen Miquel-López
- Servicio de Oftalmología, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - José Javier García-Medina
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Servicio de Oftalmología, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Diego García-Ayuso
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
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Sedgwick-Müller JA, Müller-Sedgwick U, Adamou M, Catani M, Champ R, Gudjónsson G, Hank D, Pitts M, Young S, Asherson P. University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN). BMC Psychiatry 2022; 22:292. [PMID: 35459116 PMCID: PMC9027028 DOI: 10.1186/s12888-022-03898-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is associated with poor educational outcomes that can have long-term negative effects on the mental health, wellbeing, and socio-economic outcomes of university students. Mental health provision for university students with ADHD is often inadequate due to long waiting times for access to diagnosis and treatment in specialist National Health Service (NHS) clinics. ADHD is a hidden and marginalised disability, and within higher education in the UK, the categorisation of ADHD as a specific learning difference (or difficulty) may be contributing to this. AIMS This consensus aims to provide an informed understanding of the impact of ADHD on the educational (or academic) outcomes of university students and highlight an urgent need for timely access to treatment and management. METHODS The UK Adult ADHD Network (UKAAN) convened a meeting of practitioners and experts from England, Wales, and Scotland, to discuss issues that university students with ADHD can experience or present with during their programme of studies and how best to address them. A report on the collective analysis, evaluation, and opinions of the expert panel and published literature about the impact of ADHD on the educational outcomes of university students is presented. RESULTS A consensus was reached that offers expert advice, practical guidance, and recommendations to support the medical, education, and disability practitioners working with university students with ADHD. CONCLUSIONS Practical advice, guidance, and recommendations based on expert consensus can inform the identification of ADHD in university students, personalised interventions, and educational support, as well as contribute to existing research in this topic area. There is a need to move away from prevailing notions within higher education about ADHD being a specific learning difference (or difficulty) and attend to the urgent need for university students with ADHD to have timely access to treatment and support. A multimodal approach can be adapted to support university students with ADHD. This approach would view timely access to treatment, including reasonable adjustments and educational support, as having a positive impact on the academic performance and achievement of university students with ADHD.
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Affiliation(s)
- Jane A. Sedgwick-Müller
- Health and Community Services, Government of Jersey, St Helier, Jersey. Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) & Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care (FNFNM), King’s College London, London, UK
| | - Ulrich Müller-Sedgwick
- Adult Neurodevelopmental Service, Health and Community Services, Government of Jersey, St Helier, Jersey. Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Marco Catani
- Natbrainlab, Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | - Rebecca Champ
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Gísli Gudjónsson
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | - Dietmar Hank
- Adult ADHD Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Mark Pitts
- Adult ADHD and Autism Outpatient Service, South London & Maudsley NHS Foundation Trust, London, UK
| | - Susan Young
- Psychology Services Limited, Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Philip Asherson
- Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
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Management of anxiety disorders in children with attention-deficit hyperactivity disorder: a narrative review. Int Clin Psychopharmacol 2021; 36:1-11. [PMID: 33086253 DOI: 10.1097/yic.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety disorders are common comorbidities of attention deficit/hyperactivity disorder (ADHD) and conversely, ADHD is prevalent among anxious youths. A variety of treatments, both psychopharmacological and nonpsychopharmacological, are used to manage combined ADHD/anxiety disorder. This article aims to review the literature on the treatment of ADHD with comorbid anxiety disorders, and make evidence-based recommendations for clinical practice. In most cases, when ADHD is the primary condition, stimulants are the first-line of treatment, frequently resulting not only in improvement in ADHD symptoms but also alleviating the symptoms of the comorbid anxiety disorder. Stimulant treatment is relatively safe and well-tolerated in ADHD with comorbid anxiety disorder. When the stimulant administration does not attenuate the severity of the comorbid anxiety disorder, a treatment that targets specifically the anxiety disorder should be added. This recommendation, however, might be challenged by the impressive efficacy of atomoxetine for both the ADHD and anxiety disorder symptoms. Adjunctive cognitive-behavior therapy for anxiety disorder symptoms is strongly recommended and is considered superior to medication alone. Other options include adding pharmacological treatment for the anxiety symptoms. In moderate and severe cases of comorbid Ads, selective serotonin reuptake inhibitors can be added to the stimulants, with the required caution.
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Pehlivanidis A, Papanikolaou K, Mantas V, Kalantzi E, Korobili K, Xenaki LA, Vassiliou G, Papageorgiou C. Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC Psychiatry 2020; 20:423. [PMID: 32847520 PMCID: PMC7449076 DOI: 10.1186/s12888-020-02828-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose. METHODS The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group. RESULTS At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025). CONCLUSIONS Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.
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Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Katerina Papanikolaou
- Department of Child Psychiatry, National and Kapodistrian University of Athens, Medical School, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Vasilios Mantas
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Eva Kalantzi
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Kalliopi Korobili
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Georgia Vassiliou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Charalambos Papageorgiou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
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Grazioli VS, Gmel G, Rougemont-Bücking A, Baggio S, Daeppen JB, Studer J. Attention deficit hyperactivity disorder and future alcohol outcomes: Examining the roles of coping and enhancement drinking motives among young men. PLoS One 2019; 14:e0218469. [PMID: 31216319 PMCID: PMC6584013 DOI: 10.1371/journal.pone.0218469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Although there is evidence that Attention Deficit Hyperactivity Disorder (ADHD) symptoms are positively related to alcohol use and related problems among young adults, little research has examined the mechanisms that might explain this association. In response, this study examined the mediating effects of coping and enhancement drinking motives on the prospective associations between ADHD symptoms and alcohol outcomes. Method Participants (N = 4,536) were young men from the Cohort Study on Substance Use Risk Factors. Measures of ADHD symptoms and those of drinking motives, heavy episodic drinking (HED) and alcohol use disorder symptoms were used from the baseline and 15-month follow-up assessments. Results Findings indicated that the associations of ADHD-inattention symptoms with alcohol use disorder (AUD) symptoms and with HED were partially and completely mediated through drinking motives, respectively, whereas drinking motives did not mediate the ADHD-hyperactivity/impulsivity-symptoms-alcohol outcomes associations. Conclusion Results indicated that coping and enhancement motives partially explained the ADHD-inattention symptoms—subsequent alcohol outcomes association. These findings suggest that interventions targeting enhancement and coping motives may help prevent problematic drinking among young men with elevated ADHD-inattention symptoms.
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Affiliation(s)
- Véronique S. Grazioli
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
- * E-mail:
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Canada
- University of the West of England, Bristol, United Kingdom
| | | | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
| | | | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Lowry LS, Schatz NK, Fabiano GA. Exploring Parent Beliefs and Behavior: The Contribution of ADHD Symptomology Within Mothers and Fathers. J Atten Disord 2018; 22:1255-1265. [PMID: 25555630 DOI: 10.1177/1087054714562587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To use a multi-method approach to examine the association of parental ADHD and gender with observed and self-reported parenting beliefs and behaviors. METHOD Seventy-nine mother-father dyads completed measures of child behavior and impairment, parenting beliefs and behaviors, and self- and partner ratings of ADHD symptoms and functional impairment. Forty-five parents also completed structured parent-child interactions. RESULTS A hierarchical linear model suggests impairment in functional domains may be associated with negative emotions about parenting and less effective parenting strategies. For fathers, greater severity of partner-reported symptoms of ADHD may be associated with greater frequency of negative talk during parent-child interactions. CONCLUSION Findings suggest that higher levels of parental ADHD symptoms and functional impairment may be associated with reported beliefs and behaviors related to parenting. Differences emerged among mothers' and fathers' use of parenting strategies when self- and other-report of ADHD symptoms and impairment were assessed.
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Vogel SWN, Ten Have M, Bijlenga D, de Graaf R, Beekman ATF, Kooij JJS. Distribution of ADHD symptoms, and associated comorbidity, exposure to risk factors and disability: Results from a general population study. Psychiatry Res 2018; 267:256-265. [PMID: 29940457 DOI: 10.1016/j.psychres.2018.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.
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Affiliation(s)
- Suzan W N Vogel
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Denise Bijlenga
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
| | - J J Sandra Kooij
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
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Khadka S, Stevens MC, Aslanzadeh F, Narayanan B, Hawkins KA, Austad CS, Raskin SA, Tennen H, Wood RM, Fallahi C, Potenza MN, Pearlson GD. Composite impulsivity-related domains in college students. J Psychiatr Res 2017; 90:118-125. [PMID: 28273441 DOI: 10.1016/j.jpsychires.2017.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/25/2016] [Accepted: 02/17/2017] [Indexed: 01/23/2023]
Abstract
Impulsivity is a complex, multidimensional construct with prior theoretically and empirically derived characterizations of impulsivity-related behaviors varying considerably among studies. We assessed college students (N = 440) longitudinally with five impulsivity-related self-reported assessments and two computerized behavioral measures. Using a combination of exploratory and confirmatory factor analysis (CFA), we derived then validated several composite impulsivity-related domains (CIRDs). These factors replicated, in large part, findings from a previous study conducted by our group in an independent sample that used a similar analytical approach. The four CIRDs derived in current study are: 'Impulsive action', 'Approach/Appetite Motivation', 'Impulsivity/Compulsivity' and 'Experience and thrill seeking/Fearlessness'. Subsequent psychometric analyses found these CIRDs were relatively stable over the two-year period. Moreover, multiple regression analysis found that CIRD profiles associated with clinical and behavioral characteristics including anxiety, depression, attention deficit hyperactivity disorder and substance use symptomology. Overall, our data suggest that empirically-derived CIRDs have potential for organizing previous impulsivity-related constructs into a more naturalistic framework where distinct constructs are often expressed together in the same individuals. This framework might facilitate future research of neuropsychiatric disorder risk and etiology.
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Affiliation(s)
- Sabin Khadka
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA.
| | - Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Farah Aslanzadeh
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA
| | - Balaji Narayanan
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA
| | - Keith A Hawkins
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Carol S Austad
- Central Connecticut State University, New Britain, CT, USA
| | | | - Howard Tennen
- University of Connecticut, School of Medicine, Farmington, CT, USA
| | - Rebecca M Wood
- Central Connecticut State University, New Britain, CT, USA
| | | | - Marc N Potenza
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Child Study Ctr., Yale University, New Haven, CT, USA; The National Center on Addictions and Substance Abuse, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford HealthCare Corporation, Hartford, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA
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Magnin E, Maurs C. Attention-deficit/hyperactivity disorder during adulthood. Rev Neurol (Paris) 2017; 173:506-515. [DOI: 10.1016/j.neurol.2017.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/14/2022]
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Brikell I, Kuja-Halkola R, Larsson H. Heritability of attention-deficit hyperactivity disorder in adults. Am J Med Genet B Neuropsychiatr Genet 2015; 168:406-413. [PMID: 26129777 DOI: 10.1002/ajmg.b.32335] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/15/2015] [Indexed: 11/07/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Symptoms often persist into adulthood, with a prevalence of 2.5-5% in adult populations. Twin studies in childhood consistently report high heritabilities of 70-80%, while studies in adult samples show only moderate heritability of 30-40% when estimated from self-ratings. This review summarizes the available research on the heritability of ADHD in adults. Three key findings are outlined: (i) self-ratings lead to relatively low heritability estimates of ADHD, independent of age and whether ratings refer to current or retrospective symptoms; (ii) studies relying on different informants to rate each twin within a pair (i.e., self-ratings and different parents/teachers rating each twin in a pair) consistently yield lower heritability estimates than studies relying on ratings from a single informant; (iii) studies using cross-informant data via either combined parent and self-ratings or clinical diagnoses information suggest that the heritability of ADHD in adults could be as high as 70-80%. Together, the reviewed studies suggest that the previously reported low heritability of ADHD in adults is unlikely to reflect a true developmental change. Instead, the drop in heritability is better explained by rater effects related to a switch from using one rater for both twins in a pair (parent/teacher) in childhood, to relying on self-ratings (where each twin rates themselves) of ADHD symptoms in adulthood. When rater effects are addressed using cross-informant approaches, the heritability of ADHD in adults appears to be comparable to the heritability of ADHD in childhood. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jeoung BJ. The relationship between attention deficit hyperactivity disorder and health-related physical fitness in university students. J Exerc Rehabil 2014; 10:367-71. [PMID: 25610821 PMCID: PMC4294439 DOI: 10.12965/jer.140175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/17/2014] [Indexed: 11/22/2022] Open
Abstract
College students with a tendency toward attention deficit/hyperactivity disorder (ADHD) tend to act impulsively because they cannot control their behavior. They display low academic achievement and insufficient social skills, and are at high risk for alcoholism and drug abuse. Although various intervention methods have been used to reduce ADHD tendency (e.g., improving physical fitness and participating in sports and exercise), there are few studies on the relationship between ADHD and health-related physical fitness. Accordingly, this study explored the relationship between ADHD symptoms in college students and physical fitness. We measured health-related physical fitness and ADHD in 86 male college students using a self-report rating scale. The results showed the following. First, a significant relationship was found between ADHD tendency and inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and abdominal fat. Push-ups were associated with ADHD tendency and the inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept subtests. Grip strength was significantly related to inattention/memory problems. Second, risk factors for ADHD tendency significantly increased for male college students with low muscular strength and endurance relative to those with greater muscular strength and endurance. Risk factors also significantly increased for male college students with high rates of abdominal obesity.
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Affiliation(s)
- Bog Ja Jeoung
- Department of Exercise Rehabilitation & Welfare, College of Health Science, Gachon University, Incheon, Korea
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Hirvikoski T, Waaler E, Lindström T, Bölte S, Jokinen J. Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): an open clinical feasibility trial. ACTA ACUST UNITED AC 2014; 7:89-99. [PMID: 24863143 PMCID: PMC4340972 DOI: 10.1007/s12402-014-0141-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/14/2014] [Indexed: 11/12/2022]
Abstract
The aim of this pilot study was to investigate the feasibility and effectiveness of a new psychoeducative intervention program (PEGASUS) for adults with ADHD and their significant others in a psychiatric outpatient context. At three outpatient psychiatric clinics, adults with ADHD and their significant others took part in PEGASUS, a psychoeducational program based on theories from cognitive behavioral therapy, neuropsychology, and cross-disciplinary evidence regarding ADHD. In total, 108 adults were allocated to treatment (51 with ADHD and their 57 significant others). Feasibility was evaluated regarding suitability of the intervention at a psychiatric outpatient clinic and treatment completion. Preliminary efficacy was evaluated per protocol from baseline to post-intervention (n = 41 adults with ADHD and 40 significant others). In a feasibility analysis, the intervention was judged to be a suitable treatment option for 94.5 % of all individuals with a primary diagnosis of ADHD at an outpatient psychiatric clinic. In total, 43 out of 51 allocated individuals with ADHD (84.3 %) completed the intervention. The corresponding figures for their significant others were 42 out of 57 (73.7 %). Knowledge about ADHD increased, and both the quality of relationships and psychological well-being improved from baseline to post-intervention in all participants. The significant others reported a reduction in the subjective burden of care, such as worry and guilt. The objective burden of care (such as financial problems) did not change. The findings support the potential value of psychoeducation for adults with ADHD and their significant others. An ongoing randomized controlled trial will generate further evidence concerning the PEGASUS program.
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Affiliation(s)
- T Hirvikoski
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), CAP Research Center, Karolinska Institutet, Gävlegatan 22B, 11330, Stockholm, Sweden,
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Estévez N, Eich-Höchli D, Dey M, Gmel G, Studer J, Mohler-Kuo M. Prevalence of and associated factors for adult attention deficit hyperactivity disorder in young Swiss men. PLoS One 2014; 9:e89298. [PMID: 24586672 PMCID: PMC3930697 DOI: 10.1371/journal.pone.0089298] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The present study aimed to measure the prevalence of adult attention deficit hyperactivity disorder (ADHD) in a large, representative sample of young Swiss men and to assess factors associated with this disorder. METHODS Our sample consisted of 5656 Swiss men (mean age 20 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed with the World Health Organization (WHO) adult ADHD Self Report Screener (ASRS). Logistic regression analyses were conducted to assess the association between ADHD and several socio-demographic, clinical and familial factors. RESULTS The prevalence of ADHD was 4.0%, being higher in older and French-speaking conscripts. A higher prevalence also was identified among men whose mothers had completed primary or high school/university and those with a family history of alcohol or psychiatric problems. Additionally, adults with ADHD demonstrated impairment in their professional life, as well as considerable mental health impairment. CONCLUSION Our results demonstrate that ADHD is common among young Swiss men. The impairments in function and mental health we observed highlight the need for further support and interventions to reduce burden in affected individuals. Interventions that incorporate the whole family also seem crucial.
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Affiliation(s)
- Natalia Estévez
- Institute of Social and Preventive Medicine, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | | | - Michelle Dey
- Institute of Social and Preventive Medicine, Zurich, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Asherson P, Akehurst R, Kooij JJS, Huss M, Beusterien K, Sasané R, Gholizadeh S, Hodgkins P. Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord 2012; 16:20S-38S. [PMID: 22377849 DOI: 10.1177/1087054711435360] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. METHOD A review of the literature over the past 10 years was performed using OVID. RESULTS Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. CONCLUSION The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.
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Kooij JJS, Huss M, Asherson P, Akehurst R, Beusterien K, French A, Sasané R, Hodgkins P. Distinguishing comorbidity and successful management of adult ADHD. J Atten Disord 2012; 16:3S-19S. [PMID: 22498754 DOI: 10.1177/1087054711435361] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Given high rates of comorbidity, lack of awareness and global acceptance, and varying guidelines for its management, adult ADHD may be an especially difficult condition to diagnose and treat. The objective of this review was to explore and characterize similarities and differences among comorbidities associated with adult ADHD. METHOD A review of the literature over the past 10 years was performed using Ovid. RESULTS A myriad of comorbid conditions such as impulse-control/personality, anxiety, mood, substance use, learning, and sleep disorders overlap with adult ADHD. Furthermore, a number of such conditions have symptoms that can mimic those of ADHD, including hyperactivity, impulsivity, inattention, and disruption of circadian rhythms, adding to the complexity of recognition and diagnosis of ADHD in adults. Extensive research shows that adults with ADHD appear to benefit from treatment with stimulant medications in similar ways as children, including significant improvements on driving performance. However, fear surrounding the abuse of stimulants is an important issue. Nevertheless, evidence suggests that children with ADHD who are treated with stimulant medication are less likely to develop a substance use disorder in adolescence and adulthood. CONCLUSION There are a wide range of comorbidities with adult ADHD with many having overlapping symptoms. The benefits observed with ADHD treatment, however, emphasize the importance of recognition and treatment of adult ADHD.
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Hosain GMM, Berenson AB, Tennen H, Bauer LO, Wu ZH. Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women. J Womens Health (Larchmt) 2012; 21:463-8. [PMID: 22303821 DOI: 10.1089/jwh.2011.2825] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study was undertaken to assess the association between adult attention deficit/hyperactivity disorder (ADHD) symptoms and high-risk sexual behavior. METHODS This cross-sectional study interviewed 462 low-income women aged 18-30 years. We used the 18-item Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist to assess ADHD symptoms. Risky sexual behaviors included sex before 15 years of age, risky sex partners in lifetime, number of sex partners in the last 12 months, condom use in the last 12 months, alcohol use before sex in the last 12 months, traded sex in lifetime, and diagnosed with sexually transmitted infection (STI) in lifetime. RESULTS Mean ADHD symptom score was 19.8 (SD±12.9), and summary index of all risky sexual behavior was 1.77 (SD±1.37). Using unadjusted odds ratios (OR), women who endorsed more ADHD symptoms reported engaging in more risky sexual behaviors of all types. However, when multivariable logistic regression was applied adjusting for various sociodemographic covariates, the adjusted ORs remained significant for having risky sex partners and having ≥3 sex partners in the prior 12 months. We observed some differences in risky sexual behavior between two domains of ADHD. CONCLUSIONS The ADHD symptom score appears to be associated with some risky sexual behaviors and deserves further attention. A brief ADHD screening can identify this high-risk group for timely evaluation and safe sex counseling.
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Affiliation(s)
- G M Monawar Hosain
- Department of Ob-Gyn, University of Texas Medical Branch, Galveston, Texas, USA
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Marzinzik F, Wahl M, Krüger D, Gentschow L, Colla M, Klostermann F. Abnormal distracter processing in adults with attention-deficit-hyperactivity disorder. PLoS One 2012; 7:e33691. [PMID: 22457783 PMCID: PMC3310872 DOI: 10.1371/journal.pone.0033691] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 02/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subjects with Attention-Deficit Hyperactivity Disorder (ADHD) are overdistractible by stimuli out of the intended focus of attention. This control deficit could be due to primarily reduced attentional capacities or, e. g., to overshooting orienting to unexpected events. Here, we aimed at identifying disease-related abnormalities of novelty processing and, therefore, studied event-related potentials (ERP) to respective stimuli in adult ADHD patients compared to healthy subjects. METHODS Fifteen unmedicated subjects with ADHD and fifteen matched controls engaged in a visual oddball task (OT) under simultaneous EEG recordings. A target stimulus, upon which a motor response was required, and non-target stimuli, which did not demand a specific reaction, were presented in random order. Target and most non-target stimuli were presented repeatedly, but some non-target stimuli occurred only once ('novels'). These unique stimuli were either 'relative novels' with which a meaning could be associated, or 'complete novels', if no association was available. RESULTS In frontal recordings, a positive component with a peak latency of some 400 ms became maximal after novels. In healthy subjects, this novelty-P3 (or 'orienting response') was of higher magnitude after complete than after relative novels, in contrast to the patients with an undifferentially high frontal responsivity. Instead, ADHD patients tended to smaller centro-parietal P3 responses after target signals and, on a behavioural level, responded slower than controls. CONCLUSION The results demonstrate abnormal novelty processing in adult subjects with ADHD. In controls, the ERP pattern indicates that allocation of meaning modulates the processing of new stimuli. However, in ADHD such a modulation was not prevalent. Instead, also familiar, only context-wise new stimuli were treated as complete novels. We propose that disturbed semantic processing of new stimuli resembles a mechanism for excessive orienting to commonly negligible stimuli in ADHD.
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Affiliation(s)
- Frank Marzinzik
- Department of Neurology, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
- Department of Psychiatry, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
| | - Michael Wahl
- Department of Neurology, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
| | - Doris Krüger
- Department of Neurology, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
| | - Laura Gentschow
- Department of Psychiatry, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
| | - Michael Colla
- Department of Psychiatry, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
| | - Fabian Klostermann
- Department of Neurology, Campus Benjamin Franklin, Charité–University Medicine, Berlin, Germany
- * E-mail:
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Culpepper L, Mattingly G. Challenges in identifying and managing attention-deficit/hyperactivity disorder in adults in the primary care setting: a review of the literature. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494335 DOI: 10.4088/pcc.10r00951pur] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/19/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine how to screen for and establish a correct diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults and to identify the outcomes associated with untreated ADHD. DATA SOURCES PubMed was searched using the key words ADHD, adult, diagnosis, and primary care from the years 1999 to 2009. STUDY SELECTION This search produced 50 publications. DATA EXTRACTION Publications were screened for data specific to the diagnosis or management of adult patients with ADHD in the primary care setting. DATA SYNTHESIS The estimated prevalence of ADHD in adults throughout the United States is 4.4% or approximately 10 million adults. Adults with ADHD by definition must experience impairment from the symptoms of ADHD in at least 2 areas of their life. Despite significant impairment, only 1 in 10 adults with ADHD have received ADHD treatment within the past year. Given the high rates of undertreatment, primary care physicians, who provide much of the general adult mental health care in the United States, are increasingly charged with making the diagnosis of ADHD in adults. ADHD symptoms are often masked by comorbid psychiatric conditions or patient adaptations such as choice of occupation. One of the ADHD assessment tools, a short 6-item screener, can simplify identification and management of ADHD in adults and help identify which patients may require further evaluation. CONCLUSIONS Primary care physicians should consult with other members of the health care community such as psychiatrists and psychologists when necessary, but should also develop a level of comfort with diagnosing and treating ADHD.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University, Massachusetts, USA.
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Liu K, Liang X, Kuang W. Tea consumption maybe an effective active treatment for adult attention deficit hyperactivity disorder (ADHD). Med Hypotheses 2011; 76:461-3. [PMID: 21277687 DOI: 10.1016/j.mehy.2010.08.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/18/2010] [Accepted: 08/28/2010] [Indexed: 02/05/2023]
Abstract
Adult attention-deficit/hyperactivity disorder (ADHD) is an increasingly recognized Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorder associated with significant functional impairment in multiple domains. Although stimulant has the most empirical support as treatment for ADHD in adults, because of the poor treatment compliance, many adults with the disorder continue to experience significant residual symptoms. Tea is a kind of stimulant and many adults like to drink it. The caffeine in tea can reduce one's fatigue, increase people's self-confidence, motivation, alertness, vigilance, efficiency, concentration, and cognitive performance. This report proposes that tea consumption maybe an effective active treatment for adult ADHD.
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Affiliation(s)
- Kezhi Liu
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, PR China
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Boomsma DI, Saviouk V, Hottenga JJ, Distel MA, de Moor MHM, Vink JM, Geels LM, van Beek JHDA, Bartels M, de Geus EJC, Willemsen G. Genetic epidemiology of attention deficit hyperactivity disorder (ADHD index) in adults. PLoS One 2010; 5:e10621. [PMID: 20485550 PMCID: PMC2868902 DOI: 10.1371/journal.pone.0010621] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/20/2010] [Indexed: 01/01/2023] Open
Abstract
Context In contrast to the large number of studies in children, there is little information on the contribution of genetic factors to Attention Deficit Hyperactivity Disorder (ADHD) in adults. Objective To estimate the heritability of ADHD in adults as assessed by the ADHD index scored from the CAARS (Conners' Adult ADHD Rating Scales). Design Phenotype data from over 12,000 adults (twins, siblings and parents) registered with the Netherlands Twin Register were analyzed using genetic structural equation modeling. Main outcome measures Heritability estimates for ADHD from the twin-family study. Results Heritability of ADHD in adults is estimated around 30% in men and women. There is some evidence for assortative mating. All familial transmission is explained by genetic inheritance, there is no support for the hypothesis that cultural transmission from parents to offspring is important. Conclusion Heritability for ADHD features in adults is present, but is substantially lower than it is in children.
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Affiliation(s)
- Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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McIntosh D, Kutcher S, Binder C, Levitt A, Fallu A, Rosenbluth M. Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD. Neuropsychiatr Dis Treat 2009; 5:137-50. [PMID: 19557108 PMCID: PMC2695217 DOI: 10.2147/ndt.s4720] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Many patients present to their physician with depression as their primary symptom. However, depression may mask other comorbid disorders. This article presents diagnostic criteria and treatment recommendations (and monitoring) pertaining to the diagnosis of adult attention deficit hyperactivity disorder (ADHD), which may be missed in patients who present with depressive symptoms, or major depressive disorder (MDD). Other co-occurring conditions such as anxiety, substance use, and bipolar disorder are briefly discussed. METHODS A panel of psychiatrist-clinicians with expertise in the area of child and adolescent ADHD and mood disorders, adult mood disorders, and adult ADHD was convened. A literature search for recommendations on the diagnosis and treatment of co-occurring conditions (MDD, anxiety symptoms, and substance use) with adult ADHD was performed. Based on this, and the panel's clinical expertise, the authors developed a diagnostic algorithm and recommendations for the treatment of adult ADHD with co-occurring MDD. RESULTS Little information exists to assist clinicians in diagnosing ADHD co-occurring with other disorders such as MDD. A three-step process was developed by the panel to aid in the screening and diagnosis of adult ADHD. In addition, comorbid MDD, bipolar disorder, anxiety symptoms, substance use and cardiovascular concerns regarding stimulant use are discussed. CONCLUSION This article provides clinicians with a clinically relevant overview of the literature on comorbid ADHD and depression and offers a clinically useful diagnostic algorithm and treatment suggestions.
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Affiliation(s)
- Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
Modafinil is a wake-promoting agent that is pharmacologically different from other stimulants. It has been investigated in healthy volunteers, and in individuals with clinical disorders associated with excessive sleepiness, fatigue, impaired cognition and other symptoms. This review examines the use of modafinil in clinical practice based on the results of randomized, double-blind, placebo-controlled clinical trials available in the English language in the MEDLINE database. In sleep-deprived individuals, modafinil improves mood, fatigue, sleepiness and cognition to a similar extent as caffeine but has a longer duration of action. Evidence for improved cognition in non-sleep-deprived healthy volunteers is controversial.Modafinil improves excessive sleepiness and illness severity in all three disorders for which it has been approved by the US FDA, i.e. narcolepsy, shift-work sleep disorder and obstructive sleep apnoea with residual excessive sleepiness despite optimal use of continuous positive airway pressure (CPAP). However, its effects on safety on the job and on morbidities associated with these disorders have not been ascertained. Continued use of CPAP in obstructive sleep apnoea is essential. Modafinil does not benefit cataplexy.In very small, short-term trials, modafinil improved excessive sleepiness in patients with myotonic dystrophy. It was efficacious in fairly large studies of attention deficit hyperactivity disorder (ADHD) in children and adolescents, and was as efficacious as methylphenidate in a small trial, but has not been approved by the FDA, in part because of its serious dermatological toxicity. In a trial of 21 non-concurrent subjects, with 2-week treatment periods, modafinil was as effective as dexamfetamine in adult ADHD. Modafinil was helpful for depressive symptoms in bipolar disorder in a trial that excluded patients with stimulant-induced mania. A single dose of modafinil may hasten recovery from general anaesthesia after day surgery. A single dose of modafinil improved the ability of emergency room physicians to attend didactic lectures after a night shift, but did not improve their ability to drive home and caused sleep disturbances subsequently.Modafinil had a substantial placebo effect on outcomes such as fatigue, excessive sleepiness and depression in patients with traumatic brain injury, major depressive disorder, schizophrenia, post-polio fatigue and multiple sclerosis; however, it did not provide any benefit greater than placebo.Trials of modafinil for excessive sleepiness in Parkinson's disease, cocaine addiction and cognition in chronic fatigue syndrome provided inconsistent results; all studies had extremely small sample sizes. Modafinil cannot be recommended for these conditions until definitive data become available.Modafinil induces and inhibits several cytochrome P450 isoenzymes and has the potential for interacting with drugs from all classes. The modafinil dose should be reduced in the elderly and in patients with hepatic disease. Caution is needed in patients with severe renal insufficiency because of substantial increases in levels of modafinil acid. Common adverse events with modafinil include insomnia, headache, nausea, nervousness and hypertension. Decreased appetite, weight loss and serious dermatological have been reported with greater frequency in children and adolescents, probably due to the higher doses (based on bodyweight) used. Modafinil may have some abuse/addictive potential although no cases have been reported to date.
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Affiliation(s)
- Raminder Kumar
- Department of Family Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Nair R, Moss SB. Management of attention-deficit hyperactivity disorder in adults: focus on methylphenidate hydrochloride. Neuropsychiatr Dis Treat 2009; 5:421-32. [PMID: 19721722 PMCID: PMC2732009 DOI: 10.2147/ndt.s4101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 11/23/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in young adults and causes significant psychosocial impairment and economic burden to society. Because of the paucity of long-term evidence and lack of national guidelines for diagnosis and management of adult ADHD, most of the data are based on experience derived from management of childhood ADHD. This article reviews the current evidence for the diagnosis and management of adult ADHD with special emphasis on the role of methylphenidate hydrochloride preparations in its treatment. Methylphenidate hydrochloride, a stimulant that acts through the dopaminergic and adrenergic pathways, has shown more than 75% efficacy in controlling the symptoms of adult ADHD. Although concern for diversion of the drug exists, recent data have shown benefits in preventing substance use disorders in patients with adult ADHD.
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Affiliation(s)
- Rajasree Nair
- Baylor Family Medicine Residency at Garland, Garland, Texas, USA
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Culpepper L, Mattingly G. A practical guide to recognition and diagnosis of ADHD in adults in the primary care setting. Postgrad Med 2008; 120:16-26. [PMID: 18824822 DOI: 10.3810/pgm.2008.09.1904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is commonly perceived as a childhood disorder, but ADHD symptoms can persist into adulthood. The symptoms, deficits, and consequences associated with adult ADHD can have a profound impact on the daily lives of patients and their families. Self-awareness of ADHD symptoms can sometimes be difficult for adults who have lived with these symptoms since childhood. Attention-deficit/hyperactivity disorder is highly comorbid with other psychiatric disorders, and physicians should maintain a high index of suspicion and integrate screening for ADHD when they feel that psychiatric evaluation is indicated in their adult patients. Attention-deficit/hyperactivity disorder can be screened for in as little as 3 to 5 minutes with a variety of self-report or physician-implemented scales. An accurate diagnosis of ADHD in adults requires a comprehensive clinical interview that reviews representative symptoms starting in childhood that continue to cause impairment into adulthood. It is often helpful to interview or obtain information from family, friends, coworkers, or school records. With increasing understanding of ADHD in adults, the recent development of adult-specific diagnostic scales promises further improvement in the standard of care for this disorder. Appropriate treatment of ADHD in adults can provide dramatic symptomatic improvement with some of the largest treatment effects of any medical condition.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University, Boston, MA 02118, USA.
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