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Shebl EM, Abu Bakr Elsaid NM, Hassan HA, Kamal D, Araby E. Attention-deficit hyperactivity disorder in Egyptian medical students and how it relates to their academic performance. J Family Community Med 2023; 30:287-294. [PMID: 38044975 PMCID: PMC10688586 DOI: 10.4103/jfcm.jfcm_59_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The neurobehavioral disorder, known as attention-deficit hyperactivity disorder (ADHD), is characterized by impulsivity, hyperactivity, and a lack of focus. In addition, it is connected to poor academic performance. The purpose of this study was to determine the prevalence of ADHD and its effect on their academic performance among medical students. MATERIALS AND METHODS This web-based cross-sectional study was conducted among medical students of four medical colleges during December 2021 and April 2022. Data was collected using a self-administered questionnaire comprising Wender Utah Rating Scale and adult ADHD Self-Report Scale [ASRS]. The link to Google Form survey was distributed to students through academic emails and WhatsApp. Data analyzed using SPSS; Chisquare test or Fisher's exact test as appropriate, were used to determine statistical significance. RESULTS A total of 990 students filled online questionnaire; 54.7% were females.. The estimated prevalence of ADHD in Egyptian medical students was 11%. Students who had childhood ADHD were significantly linked with the present ADHD (r = 0.54, P < 0.001). There was a negative correlation between the ASRS score for ADHD and students' GPA (r = 0.2, P < 0.001). No statistically significant association was observed between ADHD and sex, type of university, and academic level. of the students. CONCLUSION ADHD is prevalent among medical students. Since most of our students with adult ADHD also had preexisting childhood ADHD, it is crucial that the primary care services, especially school health services, have appropriate standards for the early identification and management of ADHD. Health authorities should conduct a comprehensive health education campaign to raise public awareness of ADHD and its risk factors, the clinical picture, and the burden.
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Affiliation(s)
- Eman M. Shebl
- Department of Public Health and Community Medicine, Benha University, Benha, Egypt
| | - Noha M. Abu Bakr Elsaid
- Department of Public Health, Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, King Salman International University, South Sinai, Egypt
| | - Hend A. Hassan
- Department of Public Health and Community Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Doaa Kamal
- Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Eman Araby
- Department of Public Health and Community Medicine, Benha University, Egypt
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2
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Więckiewicz G, Stokłosa I, Stokłosa M, Więckiewicz W, Gorczyca P, Gondek TM. Psychoactive substance use in patients diagnosed with attention-deficit/hyperactivity disorder: an exploratory study. Front Psychiatry 2023; 14:1184023. [PMID: 37496681 PMCID: PMC10366592 DOI: 10.3389/fpsyt.2023.1184023] [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] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) was originally treated as a neurodevelopmental disorder that occurs mainly in children and tends to diminish or disappear with age, but we now know that symptoms persist into adulthood in over 50% of ADHD patients. Undiagnosed individuals often turn to psychoactive substance to minimize the negative aspects of functioning and improve quality of life. Methods The study was conducted online using random sampling through a Facebook group administered by physicians and targeted to patients diagnosed with ADHD. The study was naturalistic and exploratory, therefore no hypothesis was made. 438 correctly completed questionnaires were received. Analysis of the results showed that people with ADHD turn to psychoactive substances relatively frequently. Results The most commonly used stimulants include alcohol, marijuana, 3,4-methylenedioxymethamphetamine (MDMA), amphetamine/methamphetamine, and psilocybin. In the study population, methylphenidate is the most commonly used drug among patients. After treatment with psychostimulants, the majority of respondents note a decrease in symptoms of hyperactivity disorder, especially in male patients. Conclusion It is necessary to perform proper diagnostics and actively look for ADHD symptoms in patients who tend to use psychoactive substances.
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Affiliation(s)
- Gniewko Więckiewicz
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Iga Stokłosa
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maciej Stokłosa
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Włodzimierz Więckiewicz
- Department of Prosthodontics, Faculty of Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Gorczyca
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Victor R, Gondwal R, Avinash P, Singhania R. Decoding the link between substance dependence and attention deficit hyperactivity disorder in adults: A cross-sectional study from North India. Ind Psychiatry J 2023; 32:397-401. [PMID: 38161447 PMCID: PMC10756592 DOI: 10.4103/ipj.ipj_47_23] [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] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) and Substance dependence are often thought to be linked as they are found to co-exist in many individuals. ADHD is estimated to be an essential indicator for the development of substance use disorder. Aim and Objective: To explore the relationship between different substance dependence and ADHD. Methods and Materials This cross-sectional single-interview study was done at a tertiary care hospital in which a total of 153 Cases presenting to the Psychiatry OPD in a period of 03 months were selected serially based on inclusion and exclusion criteria. The diagnosis of substance dependence was made as per ICD-10 criteria. These subjects were then evaluated for the presence of ADHD and physical and psychological symptoms using the Adult ADHD self-rating scale and Maudsley's Addiction Profile. Results The majority of our study subjects were aged between 24-29 years (45%) and were predominantly males (98.7%). Most of our subjects were dependent on smack (adulterated heroin) (38.5%) followed by cannabis (27.4%) and alcohol (18.3%). When evaluated for ADHD using the ADHD self-rating scale, we found that almost one-third of the study population had ADHD (33%). Prevalence of ADHD was maximum in the subjects with cannabis dependence (47.6%) followed by tobacco/smoking (38.8%), cocaine (33%), and alcohol (21.5%). This association was statistically significant for cannabis (p = 0.035). The standard mean of both the physical as well as psychological symptoms experienced by subjects was higher in the ADHD group compared to the non-ADHD group which was statistically significant (p < 0.05). Conclusion While managing patients with substance dependence we need to target both underlying ADHD and any co-morbid physical and psychological illness if present for holistic recovery of the patient.
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Affiliation(s)
- Robin Victor
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rohit Gondwal
- Department of Psychiatry, State Mental Health Institute, Dehradun, Uttarakhand, India
| | - Priyaranjan Avinash
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rachit Singhania
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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4
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Guo N, Koerts J, Tucha L, Fetter I, Biela C, König M, Bossert M, Diener C, Aschenbrenner S, Weisbrod M, Tucha O, Fuermaier ABM. Stability of Attention Performance of Adults with ADHD over Time: Evidence from Repeated Neuropsychological Assessments in One-Month Intervals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15234. [PMID: 36429952 PMCID: PMC9690645 DOI: 10.3390/ijerph192215234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Neuropsychological assessments of attention are valuable sources of information in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). However, it is unclear whether the attention performance of adults with ADHD is stable or fluctuates over time, which is of great importance in the interpretation of clinical assessments. This study aimed to explore the stability of attention performance of adults with ADHD in repeated assessments at one-month intervals. Twenty-one adults diagnosed with ADHD took part in this study by completing selective attention and vigilance tests three times, each one month apart. Test scores of participants were compared with and interpreted based on test norms. A considerable proportion of 'below average' performance scores were observed in most of the variables of selective attention and vigilance in all three assessments. Further, selective attention and vigilance performance scores did not differ significantly between the three repeated assessments. Finally, the majority of participants received consistent test score interpretations across the three repeated assessments. This study confirms previous research and highlights abnormal selective attention and vigilance performance in adults with ADHD. Further, this study preliminarily demonstrates relatively stable attention performance across repeated assessments, which has the potential to support clinical assessment, treatment planning, and evaluation.
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Affiliation(s)
- Nana Guo
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
| | - Isabel Fetter
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
| | - Christina Biela
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
| | - Miriam König
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
| | - Magdalena Bossert
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
| | - Carsten Diener
- Department of Applied Psychology, SRH University Heidelberg, 69123 Heidelberg, Germany
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, 76307 Karlsbad-Langensteinbach, Germany
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, 69115 Heidelberg, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
- Department of Psychology, National University of Ireland, Maynooth, W23 F2H6 Maynooth, County Kildare, Ireland
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, The Netherlands
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Robinson CL, Parker K, Kataria S, Downs E, Supra R, Kaye AD, Viswanath O, Urits I. Viloxazine for the Treatment of Attention Deficit Hyperactivity Disorder. Health Psychol Res 2022; 10:38360. [DOI: 10.52965/001c.38360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review Attention deficit hyperactivity disorder (ADHD) is a widely diagnosed neurodevelopmental disorder giving rise to symptoms of hyperactivity, impulsivity, and inattentiveness that can impair daily functioning. Stimulants, such as methylphenidate and amphetamines, are the mainstay of treatment for ADHD. However, nonstimulant drugs such as viloxazine, atomoxetine, guanfacine, and clonidine are becoming more popular due to minimal adverse effects when compared to stimulants. Recent Findings Viloxazine is a selective norepinephrine reuptake inhibitor (NRI) originally used to treat depression in adults with activity in both the noradrenergic as well as serotonergic pathways. Studies have demonstrated its efficacy for its use in the treatment of ADHD. Unlike stimulants, viloxazine has a decreased chance of substance abuse, drug dependance, and withdrawal symptoms upon the cessation of therapy. Additionally, dopamine levels in the nucleus accumbens after treatment with viloxazine are elevated considerably less in comparison with traditional stimulant ADHD treatments. Viloxazine provides an alternative, nonstimulant approach to treating ADHD. Summary Viloxazine is a recently approved, non-stimulant medication functions by inhibiting the uptake of norepinephrine which has been seen to be decreased in patients with ADHD. When patients do not respond to first-line stimulants, cannot tolerate the side effects, or have contraindications to stimulants, viloxazine may be a nonstimulant option offering patients an increasing arsenal of medications to treat ADHD.
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Affiliation(s)
| | - Katelyn Parker
- Louisiana State University Health New Orleans School of Medicine
| | - Saurabh Kataria
- Louisiana State University Health Science Center at Shreveport
| | - Evan Downs
- Louisiana State University Health New Orleans School of Medicine
| | | | - Alan D. Kaye
- Louisiana State University Health New Orleans School of Medicine
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Envision Physician Services
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Sadek J, Saunders J. Treatment retention in opioid agonist therapy: comparison of methadone versus buprenorphine/naloxone by analysis of daily-witnessed dispensed medication in a Canadian Province. BMC Psychiatry 2022; 22:516. [PMID: 35908052 PMCID: PMC9338516 DOI: 10.1186/s12888-022-04175-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The last decade has shown a remarkable increase in the rates of illicit opioid use in Canada and internationally, which is associated with large increases in opioid related morbidity and mortality. While the differences between methadone and buprenorphine/naloxone in terms of retention have been studied outside Canada, the unique location and design of this study, gives it a specific significance. OBJECTIVES This study aims to describe the relative treatment retention rates for first episode opioid replacement treatment between methadone and buprenorphine/naloxone for patients receiving daily witnessed dispensed medications in Nova Scotia. METHODS A longitudinal retrospective descriptive study analyzing secondary data from the Nova Scotia Prescription Monitoring Program on patients 18 years of age and older who started first episode opioid agonist therapy with methadone or buprenorphine/naloxone for opioid use disorder in Nova Scotia between 2014 and 2018. Treatment episode was defined as date of initial opioid agonist prescription until there is a gap of greater than 6 days without receiving opioid agonist medication at a pharmacy. RESULTS One thousand eight hundred sixty-seven of whom were analyzed as they had at least 1 day in treatment. There was significant treatment dropout within the first 2 weeks of treatment, which did not show a significant difference between OAT medication (23.4% of buprenorphine/naloxone; 22.2% methadone). Median duration of retention in treatment was 58 days for those treated with buprenorphine/naloxone and 101 days for patients treated with methadone. Multivariate cox proportional hazards model showed that buprenorphine/naloxone use as compared to methadone lead to increased hazard of treatment dropout by 62% (HR = 1.62). Hazard rate of treatment dropout for patients below 25 years of age was calculated. (HR 1.53). Median duration of retention in treatment for this subgroup of patients younger than age 25 was 37.5 days for patients treated with buprenorphine/naloxone and 69 days for patients treated with methadone. CONCLUSIONS Our data suggests that methadone is a numerically superior medication for opioid use disorder when the metric of treatment retention is viewed in isolation, for our population in Nova Scotia. However, the results should be interpreted carefully considering the number of limitations of this study. There are social/accessibility, pharmacologic/safety, and patient preference factors which are also key in decision making when prescribing opioid agonist therapy. These must all be considered when deciding on which medication to initiate for a patient beginning a new treatment episode with OAT for opioid use disorder. This study should stimulate further research into this important area in addiction medicine.
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Affiliation(s)
- Joseph Sadek
- Department of Psychiatry, Dalhousie University, 810 Maplewood Lane, Halifax, NS, B3H 4k3, Canada.
| | - Joseph Saunders
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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7
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El Archi S, Barrault S, Brunault P, Ribadier A, Varescon I. Co-occurrence of Adult ADHD Symptoms and Problematic Internet Use and Its Links With Impulsivity, Emotion Regulation, Anxiety, and Depression. Front Psychiatry 2022; 13:792206. [PMID: 35492700 PMCID: PMC9045584 DOI: 10.3389/fpsyt.2022.792206] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and problematic Internet use (PIU) is associated with increased severity of PIU and poorer treatment outcomes. The main objective of this study was to examine the association between PIU and adult ADHD symptoms and determine whether adult ADHD symptoms were a predictor of PIU in the general adult population. We also examined the potential mediating role of the dimensional psychopathological factors, including anxiety, depression, impulsivity, and emotion regulation, in this relationship. To achieve these aims, we recruited 532 regular Internet users online from the general adult population. The participants completed an online questionnaire assessing PIU (Internet Addiction Test), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), adult ADHD symptoms (Adult ADHD Self-Report Scale-V1.1), emotion regulation (Emotion Regulation Questionnaire), and impulsivity (UPPS-P Impulsive Behavior Scale). We conducted a multiple regression analysis to determine the predictors of PIU and mediation analyses to identify the psychopathological mediators of the association between adult ADHD symptoms and PIU. PIU was observed in 17.9% of our sample. A significantly higher proportion of respondents with PIU screened positive for adult ADHD symptoms compared to respondents without PIU (50.5 vs. 21.7%; p < 0.001). Individuals with PIU reported significantly higher scores than those without PIU for anxiety and depressive symptoms, impulsivity, and the emotion regulation strategy of expressive suppression. Additionally, they had significantly lower scores than those without PIU on cognitive reappraisal than non-problematic Internet users. In addition to adult ADHD symptoms, the multiple regression analysis revealed that PIU was also positively predicted by depressive symptoms, positive urgency, lack of perseverance, and expressive suppression, and is negatively predicted by cognitive reappraisal and negative urgency. The mediation analysis showed that lack of perseverance, positive urgency, and depressive and anxiety symptoms were partial mediators of the relationship between adult ADHD symptoms and PIU. Our results highlight the significant co-occurrence of PIU and adult ADHD symptoms. This study also provides support for a theoretical model in which impulsivity dimensions, emotion regulation strategies, as well as the tendency to anxiety and depressive symptoms, may play a mediating role in this co-occurrence. In summary, the findings emphasize the need to assess these psychological characteristics in problematic Internet users, as they can be a factor of clinical complexity, as well as the importance of targeting them as part of integrated interventions for both adult ADHD symptoms and PIU.
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Affiliation(s)
- Sarah El Archi
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France
| | - Servane Barrault
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,CHRU of Tours, Centre de Soins d'Accompagnement et de Prévention en Addictologie (CSAPA 37), Tours, France.,Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
| | - Paul Brunault
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,CHRU of Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,University of Tours, UMR 1253, iBrain, INSERM, Tours, France
| | - Aurélien Ribadier
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
| | - Isabelle Varescon
- Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
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8
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Elliott BL, D'Ardenne K, Mukherjee P, Schweitzer JB, McClure SM. Limbic and Executive Meso- and Nigrostriatal Tracts Predict Impulsivity Differences in Attention-Deficit/Hyperactivity Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:415-423. [PMID: 34051394 DOI: 10.1016/j.bpsc.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Impulsivity is a defining characteristic of attention-deficit/hyperactivity disorder (ADHD), which has been associated with substance use disorders, higher accident rates, and lower educational and occupational outcomes. The meso- and nigrostriatal pathways of the dopamine system are hypothesized to be functionally heterogeneous, supporting diverse cognitive functions and impairments, including those associated with ADHD. We tested whether human midbrain pathways (where dopaminergic cell bodies originate) between the substantia nigra (SN) and ventral tegmental area (VTA) and the striatum differed between participants with ADHD and typically developing adolescent and young adult participants. We also assessed whether pathway connectivity predicted impulsivity regardless of diagnosis. METHODS Diffusion tensor imaging data were used to predict impulsivity (parent and self-report ratings, task-based behavioral measures) from participants with ADHD and typically developing adolescent and young adult participants (n = 155; 86 male, 69 female). Using probabilistic tractography, we mapped these pathways and divided the tracts into limbic, executive, and sensorimotor based on frontostriatal connectivity. ADHD and typically developing participants differed on all behavioral measures of impulsivity. We used correlation and machine learning analyses to test for a relationship between tract probabilities and impulsivity regardless of diagnosis. RESULTS Participants with ADHD had stronger structural connectivity between SN/VTA regions and the limbic striatum, weaker connectivity with the executive striatum, and no significant differences in sensorimotor tracts. Increased tract integrity between the limbic striatal and SN/VTA regions predicted greater impulsivity, while increased integrity between executive striatal and SN/VTA regions predicted reduced impulsivity. CONCLUSIONS These findings support the theory that functional diversity in the dopamine system is an important consideration for understanding dysfunction in ADHD.
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Affiliation(s)
- Blake L Elliott
- Department of Psychology, Arizona State University, Tempe, Arizona.
| | | | - Prerona Mukherjee
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California; MIND Institute, University of California, Davis, Sacramento, California
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California; MIND Institute, University of California, Davis, Sacramento, California
| | - Samuel M McClure
- Department of Psychology, Arizona State University, Tempe, Arizona
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9
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Cardullo S, Gómez Pérez LJ, Cuppone D, Sarlo M, Cellini N, Terraneo A, Gallimberti L, Madeo G. A Retrospective Comparative Study in Patients With Cocaine Use Disorder Comorbid With Attention Deficit Hyperactivity Disorder Undergoing an rTMS Protocol Treatment. Front Psychiatry 2021; 12:659527. [PMID: 33841218 PMCID: PMC8026860 DOI: 10.3389/fpsyt.2021.659527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Adult attention-deficit/hyperactivity disorder (ADHD) is associated with high comorbidity with other psychiatric diseases, including cocaine use disorder (CocUD). Given the common fronto-striatal dysfunction, ADHD patients often use cocaine as self-medication for ameliorating symptoms by increasing striatal dopamine release. Yet, comorbidity with ADHD is related to poor treatment outcomes. CocUD has been treated with transcranial magnetic stimulation (TMS), but no studies investigated the outcomes in patients comorbid with ADHD. Methods: Twenty-two ADHD/CocUD and 208 CocUD-only participants received a high-frequency (15 Hz) rTMS treatment stimulating the left-DLPFC. We investigated whether both groups of patients shared similar demographic and clinical characteristics at baseline. Then, we monitored the effect of treatment testing for potential differences between groups. Results: At baseline demographic, toxicology and clinical features were not different between the two groups except for global severity index (GSI from SCL-90): patients of ADHD/CocUD group reported higher general symptomatology compared to the CocUD-only group. Concerning the effect of treatment, both groups significantly improved over time regarding cocaine use, craving, and other negative affect symptoms. No differences were observed between groups. Conclusions: To our knowledge, this is the first study comparing the demographic characterization and rTMS clinical improvements of patients with a dual diagnosis of ADHD and CocUD against CocUD-only patients. Cocaine use and common self-reported withdrawal/abstinence symptoms appear to benefit from rTMS treatment with no differences between groups. Future studies are needed to further investigate these preliminary results.
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Affiliation(s)
| | | | - Diego Cuppone
- Fondazione Novella Fronda, Piazza Castello, Padova, Italy
| | - Michela Sarlo
- Department of Communication Sciences, Humanities and International Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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10
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Miovský M, Lukavská K, Rubášová E, Šťastná L, Šefránek M, Gabrhelík R. Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity. Eur Addict Res 2021; 27:87-96. [PMID: 32781442 DOI: 10.1159/000508571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. OBJECTIVE To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. METHODS A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25-34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. RESULTS ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson's r's = 0.30-0.42, p's < 0.001) and the symptoms of hyperactivity disorder (r's = 0.24-0.30, p's < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). CONCLUSIONS The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.
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Affiliation(s)
- Michal Miovský
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia,
| | - Kateřina Lukavská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Eva Rubášová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lenka Šťastná
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Martin Šefránek
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
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11
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Fluyau D, Revadigar N, Pierre CG. Systematic Review and Meta-Analysis: Treatment of Substance Use Disorder in Attention Deficit Hyperactivity Disorder. Am J Addict 2020; 30:110-121. [PMID: 33289928 DOI: 10.1111/ajad.13133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/20/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treating substance use disorder (SUD) in patients with co-occurring attention deficit hyperactivity disorder (ADHD) and SUD may lower medical, psychiatric, and social complications. We conducted a systematic review with meta-analysis to investigate the clinical benefits of pharmacological interventions to treat SUD in patients with ADHD. METHODS Articles were searched on Cochrane Central Register of Controlled Trials, PubMed, EBSCO, Google Scholar, Embase, Web of Science, and Ovid MEDLINE from 1971 to 2020. Data for SUD treatment as primary study endpoints and ADHD symptoms management as secondary outcomes were synthesized using random-effects model meta-analysis. Studies (N = 17) were included. The principal measure of effect size was the standardized mean difference (SMD). PROSPERO registration: CRD42020171646. RESULTS The pooled effect of pharmacological interventions compared with placebo was small for the reduction in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001), abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001), craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002), and the reduction in the frequency of ADHD symptoms (SMD = 0.420, 95% CI: [0.259, 0.582], P < .001). The pooled effect was moderate for the management of withdrawal symptoms (SMD = 0.577, 95% CI: [0.389, 0.764], P = .001]) and the decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001). CONCLUSION AND SCIENTIFIC SIGNIFICANCE The magnitude of benefits for pharmacological interventions varies. Despite some limitations, it was positive. This meta-analysis is the first to appraise the benefits of medications to treat SUD in ADHD. It is the groundwork for treatment and risk mitigation. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Dimy Fluyau
- Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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12
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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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13
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Gupta S, Bhatia G, Sarkar S, Chatterjee B, Balhara YPS, Dhawan A. Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study. Indian J Psychiatry 2020; 62:501-508. [PMID: 33678830 PMCID: PMC7909024 DOI: 10.4103/psychiatry.indianjpsychiatry_705_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/07/2020] [Accepted: 06/17/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment. METHODS This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD-) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals. RESULTS About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status. CONCLUSION Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Gayatri Bhatia
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biswadip Chatterjee
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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14
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Rapoport E, Muthiah N, Keim SA, Adesman A. Family Well-being in Grandparent- Versus Parent-Headed Households. Pediatrics 2020; 146:peds.2020-0115. [PMID: 32747472 DOI: 10.1542/peds.2020-0115] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping. METHODS Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children. RESULTS Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (β = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (βadj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (βadj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children. CONCLUSIONS Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.
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Affiliation(s)
- Eli Rapoport
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
| | - Nallammai Muthiah
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio; and
| | - Andrew Adesman
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York; .,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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15
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Darcey VL, Serafine KM. Omega-3 Fatty Acids and Vulnerability to Addiction: Reviewing Preclinical and Clinical Evidence. Curr Pharm Des 2020; 26:2385-2401. [DOI: 10.2174/1381612826666200429094158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/06/2020] [Indexed: 01/05/2023]
Abstract
Omega-3 (N3) fatty acids are dietary nutrients that are essential for human health. Arguably, one of their most critical contributions to health is their involvement in the structure and function of the nervous system. N3 fatty acids accumulate in neuronal membranes through young adulthood, becoming particularly enriched in a brain region known to be the locus of cognitive control of behavior-the prefrontal cortex (PFC). The PFC undergoes a surge in development during adolescence, coinciding with a life stage when dietary quality and intake of N3 fatty acids tend to be suboptimal. Such low intake may impact neurodevelopment and normative development of cognitive functions suggested to be protective for the risk of subsequent substance and alcohol use disorders (UD). While multiple genetic and environmental factors contribute to risk for and resilience to substance and alcohol use disorders, mounting evidence suggests that dietary patterns early in life may also modulate cognitive and behavioral factors thought to elevate UD risk (e.g., impulsivity and reward sensitivity). This review aims to summarize the literature on dietary N3 fatty acids during childhood and adolescence and risk of executive/ cognitive or behavioral dysfunction, which may contribute to the risk of subsequent UD. We begin with a review of the effects of N3 fatty acids in the brain at the molecular to cellular levels–providing the biochemical mechanisms ostensibly supporting observed beneficial effects. We continue with a review of cognitive, behavioral and neurodevelopmental features thought to predict early substance and alcohol use in humans. This is followed by a review of the preclinical literature, largely demonstrating that dietary manipulation of N3 fatty acids contributes to behavioral changes that impact drug sensitivity. Finally, a review of the available evidence in human literature, suggesting an association between dietary N3 fatty and neurodevelopmental profiles associated with risk of adverse outcomes including UD. We conclude with a brief summary and call to action for additional research to extend the current understanding of the impact of dietary N3 fatty acids and the risk of drug and alcohol UD.
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Affiliation(s)
- Valerie L. Darcey
- Georgetown University, Interdisciplinary Program in Neuroscience, Washington DC, United States
| | - Katherine M. Serafine
- Department of Psychology, The University of Texas at El Paso, El Paso, TX 79968, United States
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16
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Ahmadalipour A, Mehdizadeh Fanid L, Zeinalzadeh N, Alizadeh M, Vaezi H, Hassanpour Aydinlou Z, Noorazar SG. The first evidence of an association between a polymorphism in the endocannabinoid-degrading enzyme FAAH (FAAH rs2295633) with attention deficit hyperactivity disorder. Genomics 2020; 112:1330-1334. [DOI: 10.1016/j.ygeno.2019.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022]
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17
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Lohit SR, Babu GN, Sharma S, Rao S, Sachin BS, Matkar AV. Prevalence of Adult ADHD Co-morbidity in Alcohol Use Disorders in a General Hospital Setup. Indian J Psychol Med 2019; 41:523-528. [PMID: 31772438 PMCID: PMC6875837 DOI: 10.4103/ijpsym.ijpsym_464_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/18/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Attention deficit hyperactive disorder (ADHD) symptoms persisting into adulthood can influence the course and outcome of alcohol use disorders (AUDs). A cross-sectional study was conducted to assess the prevalence of adult ADHD in patients admitted with AUDs in a general hospital setup. METHODS In this study, 100 consecutive inpatients with alcohol use disorder (AUD) were evaluated for the diagnosis of ADHD. Patients with AUD were assessed with Severity of Alcohol Dependence Questionnaire, Clinical Institute Withdrawal Assessment for Alcohol and Adult ADHD Self Report Scale. Among the subjects who screened positive for adult ADHD on ASRS, diagnosis of adult ADHD was confirmed using the DSM 5 diagnostic interview. Epi-Info Version 7.2 was used for data entry and analysis. Mann Whitney test and Chi-square test (or Fisher's Exact test) were used for statistical analysis. RESULTS Twenty-one subjects screened positive for adult ADHD. Among them, 19 subjects had a confirmative diagnosis of adult ADHD. Patients with adult ADHD comorbid with AUDs showed accelerated progression towards dependence, and early relapses. CONCLUSIONS In all, 19% of treatment-seeking inpatients with AUDs have co-morbid adult ADHD. Regular screening of AUD patients for adult ADHD and addressing the psychopathology may improve the treatment outcome.
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Affiliation(s)
| | - Girish Nanjundappa Babu
- Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Shilpi Sharma
- Department of Psychiatry, CIP, Ranchi, Jharkhand, India
| | - Suprita Rao
- Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | | | - Abhay Vishwas Matkar
- Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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18
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Moore E, Sunjic S, Kaye S, Archer V, Indig D. Adult ADHD Among NSW Prisoners: Prevalence and Psychiatric Comorbidity. J Atten Disord 2016; 20:958-967. [PMID: 24134874 DOI: 10.1177/1087054713506263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Given the paucity of research among prisoners, this study aimed to examine the prevalence and psychiatric comorbidity associated with adult ADHD. METHOD The study was conducted at four NSW correctional facilities (2 male; 2 female). RESULTS Thirty-five percent of the sample screened positive for adult ADHD, and 17% of the sample met criteria for a full diagnosis. After adjustment, benzodiazepine dependence, borderline personality disorder, social phobia, antisocial personality disorder, and a number of lifetime psychological disorders remained significantly and independently associated with the diagnosis of adult ADHD. Lowering the threshold on the ADHD Self-Rating Scale to ≥3 (vs. ≥4) increased the sensitivity (80%-93%), but lowered the specificity (55%-47%). CONCLUSION Adult ADHD among NSW prisoners is elevated, with substance use disorders and psychiatric comorbidity common. A greater acceptance of this disorder among prisoners, and appropriate treatment, is warranted.
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Affiliation(s)
- Elizabeth Moore
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
| | - Sandra Sunjic
- Justice and Forensic Mental Health Network, Ermington, Australia
| | | | - Vicki Archer
- Justice and Forensic Mental Health Network, Pagewood, Australia
| | - Devon Indig
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
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19
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Ostojic D, Miller CJ. Association Between Pubertal Onset and Symptoms of ADHD in Female University Students. J Atten Disord 2016; 20:782-91. [PMID: 24874346 DOI: 10.1177/1087054714535249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This exploratory study investigated how the timing of female pubertal maturation was associated with the symptoms of ADHD in a non-clinical female undergraduate sample (N = 253). METHOD Participants (Mage = 20.2 ± 1.7 years) completed a set of self-report rating scales examining pubertal onset and ADHD symptoms and related deficits. RESULTS Logistic regression analysis indicated that early puberty was associated with elevation in symptoms, including difficulties in attention (odds ratio [OR] = 1.270, p = .019), emotion regulation (OR = 1.070, p = .038), and more risky behavior (OR = 1.035, p = .045). That is, increased symptom endorsement was shown to significantly help classify those who reported having an earlier pubertal onset relative to their peers. CONCLUSION Findings highlight the potential role of sex hormones during puberty in explaining the gender differences in prevalence rates of ADHD and symptom profiles.
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20
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Perugi G, Vannucchi G. The use of stimulants and atomoxetine in adults with comorbid ADHD and bipolar disorder. Expert Opin Pharmacother 2015; 16:2193-204. [PMID: 26364896 DOI: 10.1517/14656566.2015.1079620] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) persists into adulthood in about 50% of the affected children, with high rates of comorbidity with bipolar disorder (BD). Stimulants and atomoxetine (ATX) are effective treatments for ADHD, but their use in adults with comorbid BD (ADHD-BD) has not been extensively studied and may be problematic. AREAS COVERED The aim of the paper is to summarize the available literature regarding the use of these medications in ADHD-BD adult patients. Results of randomized-controlled and open-label trials, case reports, and case series are reviewed. We also reviewed data relative to some specific issues of this comorbidity in adults, especially substance use disorder, malingering, and stimulants misuse. EXPERT OPINION ADHD-BD may be associated with more severe symptoms, course, and worst outcome of both conditions. The frequent coexistence with alcohol and substance abuse may further complicate treatment management. Stimulants are the most effective medications for ADHD, but their use may be contraindicated in the presence of a comorbid drug abuse or in patients that simulate or exaggerate ADHD symptoms in order to obtain stimulants for diversion or abuse. ATX may be effective in the treatment of ADHD symptoms in BD patients, with a modestly increased risk of (hypo)manic switches and destabilization of the mood disorder when utilized in association with mood stabilizers. In the majority of the cases, a hierarchical approach is desirable, with mood stabilization preceding the treatment of ADHD symptoms. Although systematic trials on the use of stimulants and ATX in ADHD-BD comorbidity in adulthood are necessary, both treatments should be considered possible options to be carefully evaluated once the patient has been stabilized.
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Affiliation(s)
- Giulio Perugi
- a 1 University of Pisa, Psychiatry Unit, Department of Clinical and Experimental Medicine , Via Roma 67, Pisa, Italy +390 508 35414 ; +390 502 1581 ; .,b 2 Institute of Behavioral Sciences "G. De Lisio" , Pisa, Italy
| | - Giulia Vannucchi
- b 2 Institute of Behavioral Sciences "G. De Lisio" , Pisa, Italy
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Mamey MR, Barbosa-Leiker C, McPherson S, Burns GL, Parks C, Roll J. An application of analyzing the trajectories of two disorders: A parallel piecewise growth model of substance use and attention-deficit/hyperactivity disorder. Exp Clin Psychopharmacol 2015; 23:422-7. [PMID: 26389639 PMCID: PMC4658254 DOI: 10.1037/pha0000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers often want to examine 2 comorbid conditions simultaneously. One strategy to do so is through the use of parallel latent growth curve modeling (LGCM). This statistical technique allows for the simultaneous evaluation of 2 disorders to determine the explanations and predictors of change over time. Additionally, a piecewise model can help identify whether there are more than 2 growth processes within each disorder (e.g., during a clinical trial). A parallel piecewise LGCM was applied to self-reported attention-deficit/hyperactivity disorder (ADHD) and self-reported substance use symptoms in 303 adolescents enrolled in cognitive-behavioral therapy treatment for a substance use disorder and receiving either oral-methylphenidate or placebo for ADHD across 16 weeks. Assessing these 2 disorders concurrently allowed us to determine whether elevated levels of 1 disorder predicted elevated levels or increased risk of the other disorder. First, a piecewise growth model measured ADHD and substance use separately. Next, a parallel piecewise LGCM was used to estimate the regressions across disorders to determine whether higher scores at baseline of the disorders (i.e., ADHD or substance use disorder) predicted rates of change in the related disorder. Finally, treatment was added to the model to predict change. While the analyses revealed no significant relationships across disorders, this study explains and applies a parallel piecewise growth model to examine the developmental processes of comorbid conditions over the course of a clinical trial. Strengths of piecewise and parallel LGCMs for other addictions researchers interested in examining dual processes over time are discussed.
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Affiliation(s)
- Mary Rose Mamey
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,Corresponding author: Please address all requests for reprints to Mary Rose Mamey, Department of Psychology, Johnson Tower 310, Washington State University, Pullman, WA, 99164-4820, U.S.A.; Phone: (949) 933-4700;
| | - Celestina Barbosa-Leiker
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - Sterling McPherson
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - Craig Parks
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - John Roll
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
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22
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Clarke T, Tickle A, Gillott A. Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:154-63. [PMID: 26187185 DOI: 10.1016/j.drugpo.2015.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/07/2015] [Accepted: 06/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent research has suggested that the prevalence of problematic substance use within the Asperger syndrome population has previously been underestimated. Furthermore, there is some indication that problematic substance use might take place to manage the traits of Asperger syndrome; however this possibility has yet to be examined in detail. This study aimed to address this omission by exploring individuals' perceptions of their substance use in relation to their diagnosis of Asperger syndrome. METHODS Eight participants were recruited from either a specialist Asperger syndrome service or a drug and alcohol service. Participants were interviewed regarding their views of which factors led to their development and maintenance of problematic substance use, specifically in relation to their experience of having been diagnosed with Asperger syndrome. Thematic analysis was conducted on the interview transcripts. RESULTS Six main themes were identified: self-medication; social facilitation; discrepancy between need and support; defining problematic substance use; substance use of peers, and recreational use of substances. The two themes of social facilitation and self-medication are focused on within this paper as they most closely reflect the more prominent bodies of literature in relation to the research aim. CONCLUSIONS Participants reported that substances were used to act as a social facilitator to compensate for social deficits by increasing confidence in social settings and increasing participants' ease with which they communicate. The self-medication of psychological distress was reported and was associated with depression, anxiety and sleep difficulties. The study ends with a reflection on the method of data collection, the implications for clinical practice and suggestions for future research.
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Affiliation(s)
- Thomas Clarke
- Division of Psychiatry and Applied Psychology, School of Medicine, YANG Fujia Building, The University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom.
| | - Anna Tickle
- Division of Psychiatry and Applied Psychology, School of Medicine, YANG Fujia Building, The University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, United Kingdom
| | - Alinda Gillott
- Nottingham City Asperger Service, Department of Learning Disabilities, Highbury Hospital, Highbury Road, Bulwell, Nottingham NG6 9DR, United Kingdom
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Nehlin C, Nyberg F, Öster C. The patient's perspective on the link between ADHD and substance use: a qualitative interview study. J Atten Disord 2015; 19:343-50. [PMID: 25359762 DOI: 10.1177/1087054714554618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate how adult individuals with ADHD perceive the role of alcohol and drugs in their lives. A secondary aim was to identify factors that those individuals consider useful in the treatment and prevention of co-occurring ADHD and substance use disorders (SUDs). METHOD A qualitative interview study with ADHD outpatients (n = 14) at a psychiatric clinic. Data were analyzed based on pre-defined areas of interest using a deductive content analysis method. RESULTS The yearning for belongingness was identified as an important driving force underlying substance use. The participants felt that alcohol/drugs helped them being normal and thus respected and accepted. Early diagnosis of ADHD was perceived essential to avoid SUD. CONCLUSION Adults with ADHD may have strong rational and emotional reasons for the use of alcohol and drugs. When planning for the treatment of adult ADHD, investigation of personal reasons for alcohol/drug use deserves a place.
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Affiliation(s)
| | | | - Caisa Öster
- Uppsala University, Sweden Uppsala University Hospital, Sweden
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Davies MA, Stilley CS. Personality Traits in Adults With Attention Deficit Hyperactivity Disorder: Implications for Clinical Practice. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Guideline for Screening, Diagnosis and Treatment of ADHD in Adults with Substance Use Disorders. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9496-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Burke A, Austin TL. The Problem of Identifying and Diagnosing Adult Attention Deficit Hyperactive Disorder (AADHD): Results and Implications of a South African Study. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2010.10820375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Burke A, Austin TL, Waldeck C. Adult ADHD in a Student Population: Preliminary Findings. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2011.10820426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Attention-deficit hyperactivity disorder (ADHD) in adults attending addiction treatment in Ireland: preliminary international ADHD in substance-use disorders prevalence study (IASP) results. Ir J Psychol Med 2013; 30:171-177. [PMID: 30189493 DOI: 10.1017/ipm.2013.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Attention-deficit hyperactivity disorder (ADHD) is a neuro-behavioural disorder characterised by early onset of persistent inattention-disorganisation and hyperactivity-impulsivity. Symptoms causing significant impairment in psychosocial function commence in childhood and heighten the risk for early substance experimentation and potential development of substance-use disorders (SUD). The research aimed to estimate the occurrence of adult attention-deficit hyperactivity disorder (ADHD) in new treatment cases of adults attending addiction treatment services. METHODS The Adult ADHD Symptoms Rating Scale (ASRS) self-administered questionnaire was administered on entry and 2 weeks later for first admissions to inpatient and outpatient addiction treatment settings The ASRS is a validated and reliable 18-item self-report scale derived from the DSM-IV-TR diagnostic criteria for ADHD, comprising nine items on inattention and nine items on hyperactivity/impulsivity. RESULTS A total of 47 new treatment cases took part in the study. The occurrence of ADHD among SUDs in this sample was 13% (n = 6). Four of the participants were being treated for Problem Poly Substance use, whereas two participants were being treated for Problem Drug use. None of the participants screening positive for ADHD were being treated for Problem Alcohol use. Of the positively screened cases, all were male, predominantly single and unemployed. CONCLUSIONS The ASRS screening instrument may be a useful tool to detect ADHD co-morbidity in SUD treatment-seeking cases. More research is needed to appropriately develop the SUD treatment pathways for adolescent and adult ADHD sufferers in Ireland.
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Reid RC, Davtian M, Lenartowicz A, Torrevillas RM, Fong TW. Perspectives on the assessment and treatment of adult ADHD in hypersexual men. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.31] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Daigre C, Roncero C, Grau-López L, Martínez-Luna N, Prat G, Valero S, Tejedor R, Ramos-Quiroga JA, Casas M. Attention deficit hyperactivity disorder in cocaine-dependent adults: a psychiatric comorbidity analysis. Am J Addict 2013; 22:466-73. [PMID: 23952892 DOI: 10.1111/j.1521-0391.2013.12047.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/02/2011] [Accepted: 05/28/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Attention deficit hyperactivity disorder (ADHD) is highly prevalent among drug abusers. We studied the psychiatric comorbidity and characteristics of cocaine use in relation to the presence of ADHD among patients with cocaine dependence. METHODS A total of 200 cocaine-dependent patients attending an Outpatient Drug Clinic participated in the study. A systematic evaluation of ADHD (CAADID-II), the severity of addiction (EuropASI) and other axes I and II psychiatric disorders was made (SCID-I and SCID-II). A descriptive, bivariate, and multivariate analysis of the data was performed. RESULTS In the multivariate analysis, the identified risk factors for the development of ADHD were a history of behavioral disorder in childhood (OR: 3.04), a lifetime history of cannabis dependence in the course of life (OR: 2.68), and age at the start of treatment (OR: 1.08). The bivariate analysis showed ADHD to be associated with other factors such as male gender, age at start of cocaine use and dependence, the amount of cocaine consumed weekly, increased occupational alteration, alcohol consumption, general psychological discomfort, depressive disorder, and antisocial personality disorder. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE We conclude that ADHD is associated with increased psychiatric comorbidity and greater severity of addiction.
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Affiliation(s)
- Constanza Daigre
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Spain.
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Matthys F, Joostens P, Stes S, Tremmery S, Sabbe B. The Construction of the First Validated (Evidence Based) Guideline for Dual Diagnosis of ADHD and SUD; Data from Focus Groups. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-013-9438-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Miller CJ, Miller SR, Healey DM, Marshall K, Halperin JM. Are cognitive control and stimulus-driven processes differentially linked to inattention and hyperactivity in preschoolers? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:187-96. [PMID: 23330810 DOI: 10.1080/15374416.2012.759116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Temperament and attention-deficit/hyperactivity disorder (ADHD) are both typically viewed as biologically based behavioural constructs. There is substantial overlap between ADHD symptoms and specific temperamental traits, such as effortful control, especially in young children. Recent work by Martel and colleagues ( 2009 , 2011 ) suggests that cognitive control temperamental processes are more closely related to inattention symptoms, whereas stimulus-driven temperamental processes are linked to hyperactivity-impulsivity. The present study tested a model of temperament and ADHD symptoms in typically developing preschoolers and those at risk for ADHD using structural equation modelling. Data were from larger study on ADHD in a short-term longitudinal sample with parent/teacher reports and neurocognitive testing. Participants included 214 preschool children (72.9% male) from diverse ethnic/racial backgrounds and a wide range of socioeconomic status from a large metropolitan center. Cognitive control processes, such as effortful control, but not stimulus-driven processes, are related to inattention and hyperactivity. In contrast, stimulus-driven processes, such as emotional reactivity, were related only to hyperactivity symptoms longitudinally. These results suggest that early temperament behaviours and cognitive processes may be indicators of later childhood behavioural difficulties with lasting consequences.
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Affiliation(s)
- Carlin J Miller
- Department of Psychology, University of Windsor, Ontario, Canada.
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Wilens TE, Adler LA, Tanaka Y, Xiao F, D'Souza DN, Gutkin SW, Upadhyaya HP. Correlates of alcohol use in adults with ADHD and comorbid alcohol use disorders: exploratory analysis of a placebo-controlled trial of atomoxetine. Curr Med Res Opin 2011; 27:2309-20. [PMID: 22029549 PMCID: PMC3772672 DOI: 10.1185/03007995.2011.628648] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder are often comorbid in adults. The effects of ADHD treatment on comorbid alcohol use disorder have not been extensively studied. OBJECTIVE To assess correlates of ADHD and alcohol use outcomes in ADHD with comorbid alcohol use disorders, via a post-hoc exploratory subgroup analysis of a previously conducted, randomized, double-blind, placebo-controlled study of recently abstinent adults. METHODS Adults who had ADHD and alcohol use disorders and were abstinent for 4-30 days were randomized to daily atomoxetine 25-100 mg (mean final dose = 89.9 mg) or placebo for 12 weeks. Changes in ADHD symptoms from baseline to endpoint were assessed using the ADHD Investigator Symptom Rating Scale (AISRS) total score, alcohol use by the timeline followback method, and alcohol cravings by the Obsessive Compulsive Drinking Scale. RESULTS Of 147 subjects receiving atomoxetine (n = 72) or placebo (n = 75) in the primary study, 80 (54%) completed 12 weeks (n = 32 atomoxetine; n = 48 placebo). Improvements in ADHD symptoms on the AISRS correlated significantly with decreases in alcohol cravings (Pearson's r = 0.28; 95% confidence interval [CI] = 0.11-0.43; p = 0.002), and the correlation was most notable with atomoxetine (r = 0.29; CI [0.04 - 0.51]; p = 0.023) rather than with placebo (r = 0.24; CI [0.00-0.46]; p = 0.055). On-treatment drinking levels correlated with AISRS scores (r = 0.12; CI [0.05 -0.19]; p = 0.001). Relapse to alcohol abuse significantly correlated with worse ADHD symptoms on 15 of 18 items of the AISRS in the placebo group (p < 0.05 for each). CONCLUSIONS No baseline predictor (other than degree of sobriety) of alcohol use or ADHD outcomes emerged. ADHD symptom improvements correlated significantly with reductions in alcohol cravings, and relapse to alcohol abuse correlated significantly with worsening of most ADHD symptoms in the placebo group, but not in the atomoxetine group. This post-hoc subgroup analysis is of a hypothesis-generating nature, and the generalizability of the findings may be limited by exclusion of adults with common ADHD comorbidities from the base study. Further, prospective clinical trials in larger and more heterogeneous patient populations are warranted to confirm or reject these preliminary associations. TRIAL REGISTRATION (BASE STUDY): ClinicalTrials.gov identifier: NCT00190957.
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Sokhadze E, Stewart CM, Tasman A, Daniels R, Trudeau D. Review of Rationale for Neurofeedback Application in Adolescent Substance Abusers with Comorbid Disruptive Behavioral Disorders. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/10874208.2011.595298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Problems of Self-Concept in a Patient Sample of Hypersexual Men With Attention-Deficit Disorder. J Addict Med 2011; 5:134-40. [DOI: 10.1097/adm.0b013e3181e6ad32] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Substance use and psychiatric symptoms in subjects referred to the Drug Addiction Services by the Prefecture. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00004632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Reske M, Delis DC, Paulus MP. Evidence for subtle verbal fluency deficits in occasional stimulant users: quick to play loose with verbal rules. J Psychiatr Res 2011; 45:361-8. [PMID: 20673916 PMCID: PMC3424267 DOI: 10.1016/j.jpsychires.2010.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
Abstract
Psychostimulants like cocaine and amphetamine are commonly abused by young adults who often state that they take these drugs to increase social or cognitive performance. The current study tested the hypothesis that individuals at early stages of occasional stimulant use show subtle executive dysfunctions such as verbal fluency deficits. 155 young (age 18-25), non-dependent occasional users of stimulants and 49 stimulant naïve comparison subjects performed the Delis-Kaplan Verbal Fluency test. Correlation and median split analyses were conducted to account for stimulant history and co-drug use. Compared to stimulant naïve subjects, occasional stimulant users generated significantly more responses on an over-learned verbal fluency task (Category Fluency), but at the expense of increased error rates (Set Loss and Repetition Errors). These performance differences were not related to lifetime uses of stimulants or marijuana. Taken together, these results support the hypothesis that individuals who are using stimulants occasionally exhibit subtle executive dysfunctions when required to generate verbal sets under time pressure. In particular, occasional stimulant users apply quickly but inaccurately verbal rules, which may represent a mix of diminished cognitive flexibility along with increased rigidity and impulsivity. This specific executive dysfunction may help to identify individuals at risk for stimulant use or dependence.
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Affiliation(s)
- Martina Reske
- Department of Psychiatry, University of California, San Diego (UCSD), USA,Institute of Neuroscience and Medicine 4, Forschungszentrum Juelich, Germany
| | - Dean C. Delis
- Department of Psychiatry, University of California, San Diego (UCSD), USA
| | - Martin P. Paulus
- Department of Psychiatry, University of California, San Diego (UCSD), USA,Psychiatry Service, Veterans Affairs San Diego Health Care System, USA,Correspondence should be sent to: Martin P Paulus Professor in Residence Department of Psychiatry Laboratory of Biological Dynamics and Theoretical Medicine University of California San Diego 8939 Villa La Jolla Dr. Suite 230 La Jolla CA 92037-0985 UCSD: VA: p: (858) 534-9444 p: (858) 642-3390 F: (858) 534-9450 F: (858) 642-1429 web: http://koso.ucsd.edu/~martin/index.html
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Vergara-Moragues E, González-Saiz F, Lozano Rojas O, Bilbao Acedos I, Fernández Calderón F, Betanzos Espinosa P, Verdejo García A, Pérez García M. Diagnosing adult attention deficit/hyperactivity disorder in patients with cocaine dependence: discriminant validity of Barkley executive dysfunction symptoms. Eur Addict Res 2011; 17:279-84. [PMID: 21912132 DOI: 10.1159/000329725] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 05/23/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the prevalence of adult attention deficit/hyperactivity disorder (ADHD) in a sample of cocaine-dependent patients, and to examine the discriminant validity of the Barkley's executive dysfunction scale in differentiating cocaine-dependent patients with and without ADHD. METHODS A cross-sectional design was used. A total of 166 cocaine-dependent subjects were assessed. The assessment instruments included: Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and 9 items from Current Behavior Scale Self-Report by Russell A. Barkley. RESULTS 14.5% (CI95%: 9.2-19.8%) prevalence of ADHD was observed in our sample. The Barkley's executive dysfunction items showed statistically significant differences between cocaine-dependent patients with ADHD and those patients without ADHD diagnosis. CONCLUSIONS The study data support Barkley's model - which posits the relevance of executive dysfunction among ADHD patients within a sample of cocaine dependents, and provides evidence of the discriminant validity of the Current Behavior Scale Self-Report for identifying ADHD symptoms in cocaine users.
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Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing MB, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10:67. [PMID: 20815868 PMCID: PMC2942810 DOI: 10.1186/1471-244x-10-67] [Citation(s) in RCA: 505] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 09/03/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.
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Affiliation(s)
- Sandra JJ Kooij
- PsyQ, psycho medische programma's, Department Adult ADHD, Carel Reinierszkade 197, Den Haag, The Netherlands
| | - Susanne Bejerot
- Department of Clinical Neuroscience, Karolinksa Institutet, Section Psychiatry, St. Goran, Stockholm, Sweden
| | - Andrew Blackwell
- University Department of Psychiatry, Addenbrookes Hospital, Cambridge, UK
| | - Herve Caci
- Pediatric Department, Hôpitaux Pédiatriques CHU-Lenval, 06200 Nice, France
| | - Miquel Casas-Brugué
- Servicio de Psiquiatria, Hospital Universitari Vall d' Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Pieter J Carpentier
- Reinier van Arkel Groep, Postbus 70058, 5201 DZ 's-Hertogenbosch, The Netherlands
| | - Dan Edvinsson
- Department of Neuroscience/Psychiatri Ulleråker, MK 75, S-750 17 Uppsala, Sweden
| | - John Fayyad
- Institute of Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon
| | - Karin Foeken
- Centre des Consultations, Institut A Tzanck, Mougins, France
| | - Michael Fitzgerald
- Department of Psychiatry, Trinity College Dublin (TCD), Dublin 2, Ireland
| | - Veronique Gaillac
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Sainte Anne Hospital Paris, France
| | - Ylva Ginsberg
- Affektiva mottagningen, M 59, Psykiatri Sydväst, 141 86 Stockholm, Sweden
| | - Chantal Henry
- Département de Psychiatrie Adulte, Unité Lescure, CH Charles Perrens, Bordeaux, France
| | - Johanna Krause
- Private clinic for psychiatry and psychotherapy, 11a Schillerstrasse, Ottobrunn, Germany
| | - Michael B Lensing
- Department of Child Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Iris Manor
- Geha Mental Health Center, Petach-Tiqva, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Helmut Niederhofer
- Department of Child Psychiatry, Regional Hospital of Bolzano, Via Guncina, Bolzano, Italy
| | - Carlos Nunes-Filipe
- Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal
| | - Martin D Ohlmeier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Pierre Oswald
- Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefano Pallanti
- Department of Neurosciences, Florence University, Florence, Italy
| | - Artemios Pehlivanidis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Josep A Ramos-Quiroga
- Programa Integral del Déficit de Atención en el Adulto (P.I.D.A.A), Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Rastam
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Lund University, Sweden
| | | | - Steven Stes
- ADHD Program, University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Kings College London, London, UK
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Dome P, Lazary J, Kalapos MP, Rihmer Z. Smoking, nicotine and neuropsychiatric disorders. Neurosci Biobehav Rev 2009; 34:295-342. [PMID: 19665479 DOI: 10.1016/j.neubiorev.2009.07.013] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/23/2009] [Accepted: 07/30/2009] [Indexed: 12/20/2022]
Abstract
Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.
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Affiliation(s)
- Peter Dome
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary.
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Fabricius V, Langa M, Wilson K. An exploratory investigation of co‐occurring substance‐related and psychiatric disorders. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890701680877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Müller DJ, Mandelli L, Serretti A, DeYoung CG, De Luca V, Sicard T, Tharmalingam S, Gallinat J, Muglia P, De Ronchi D, Jain U, Kennedy JL. Serotonin transporter gene and adverse life events in adult ADHD. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:1461-9. [PMID: 18214863 DOI: 10.1002/ajmg.b.30706] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Childhood attention deficit hyperactivity disorder (ADHD) symptomatology persists in a substantial proportion of cases into adult life. ADHD is highly heritable but the etiology of ADHD is complex and heterogeneous, involving both genetic and non-genetic factors. In the present article we analyzed the influence of both genetics and adverse life events on severity of ADHD symptoms in 110 adult ADHD patients. Subjects were genotyped for the norepinephrine transporter (NET), the catechol-O-methyltransferase (COMT), the serotonin transporter promoter polymorphism (SERTPR) and the more rare A/G variant within SERTPR. Three main outcomes were obtained: (1) adverse events showed a small but positive correlation with current ADHD severity; (2) NET, COMT and the A/G variant within SERTPR were not associated with ADHD severity; (3) taking into account stressors, the long (L) SERTPR variant showed a mild effect on ADHD, being associated with an increased severity, particularly as regard affective dysregulations; on the other hand, in subjects exposed to early stressors, it showed a protective effect, as compared to the short (S) variant. In conclusion, our data support the role of environmental factors in adult ADHD symptomatology. SERTPR may be involved in some features of the illness and act as a moderator of environmental influences in ADHD.
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Affiliation(s)
- Daniel J Müller
- Department of Psychiatry, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
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Arias AJ, Gelernter J, Chan G, Weiss RD, Brady KT, Farrer L, Kranzler HR. Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders. Addict Behav 2008; 33:1199-207. [PMID: 18558465 DOI: 10.1016/j.addbeh.2008.05.003] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/11/2008] [Accepted: 05/06/2008] [Indexed: 11/15/2022]
Abstract
UNLABELLED We examined the prevalence and course of psychiatric and substance dependence (SD) disorders in subjects with SD and attention deficit hyperactivity disorder (ADHD). METHOD We interviewed 1761 adults with a lifetime diagnosis of cocaine and/or opioid dependence using the Semi-Structured Assessment for Drug Dependence and Alcoholism. Generalized linear regression with generalized estimating equation analysis was used to examine the associations between a lifetime diagnosis of ADHD and indicators of clinical course, and to identify unique correlates of ADHD. RESULTS Lifetime ADHD prevalence in the SD sample was 5.22% (vs. 0.85% in a group of individuals without SD). ADHD was associated with an earlier age of first substance use, more SD and psychiatric diagnoses, a greater likelihood of attempted suicide, and more hospitalizations. After controlling for conduct disorder, there were unique effects of ADHD on age of first substance use and number of SD diagnoses. CONCLUSION In subjects with cocaine or opioid dependence, ADHD is associated with greater SD and psychiatric comorbidity and a more severe course of illness.
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Affiliation(s)
- Albert J Arias
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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Abstract
OBJECTIVE To develop and evaluate a questionnaire, the ADHD Impact Module for Adults (AIM-A), to dimension quality of life for adults with attention-deficit/hyperactivity disorder (ADHD). METHOD Six multi-item AIM scales were developed and evaluated in 317 participants enrolled in an open-label trial. Multitrait scaling analysis and correlations between the AIM-A and the ADHD Rating Scale were evaluated. Differences in scale scores based on severity (clinician rated), subtype, previous medication experience, and sensitivity to change were examined, and F statistics were compared for the AIM-A and the ADHD Rating Scale. RESULTS 100-80% scaling successes were observed for the AIM-A scales. Alpha coefficients were >or=.83. Significant correlations were observed (range: .494 to .200). The AIM-A discriminated based on severity, subtype, and medication experience (p <or= .01) and was sensitive to change (n = 23, p <or= .001). CONCLUSION Psychometric findings are encouraging. Future efforts will examine validity and responsiveness in larger clinical samples with different therapeutic interventions.
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Abstract
Attention deficit/hyperactivity disorder (ADHD), characterized by inattention, hyperactivity/impulsivity, or a combination of these, is being increasingly recognized in adults. Adult ADHD prevalence rates range from 1% to 4%. The pathophysiology of adult ADHD is likely multifactorial, including genetic, environmental, and neurobiological influences. Though ADHD diagnostic criteria per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) were developed based on child samples, the symptoms are believed to be similar in adults, with some developmental differences in symptom presentation. This article identifies common presenting complaints of adults who have ADHD and provides information useful for differential diagnosis of these patients. Specific strategies for pharmacological and nonpharmacological intervention are also presented.
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Affiliation(s)
- Shannon B Moss
- Baylor Family Medicine Residency at Garland, 601 Clara Barton Boulevard, Suite 340, Garland, TX 75042, USA.
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Chan YF, Dennis ML, Funk RR. Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. J Subst Abuse Treat 2007; 34:14-24. [PMID: 17574804 PMCID: PMC2238174 DOI: 10.1016/j.jsat.2006.12.031] [Citation(s) in RCA: 275] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 12/05/2006] [Accepted: 12/09/2006] [Indexed: 11/24/2022]
Abstract
As the field follows recommendations to introduce standardized assessments on substance, mental, and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age. This study examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment. Data are from 4,930 adolescents and 1,956 adults admitted to substance abuse treatment in multisite studies who were assessed with the Global Appraisal of Individual Needs and categorized into five age groups: <15, 15-17, 18-25, 26-39, and 40+ years. Two thirds of clients had a co-occurring mental health problem in the year prior to treatment admission. Across all ages, clients self-reporting criteria for past-year substance dependence were more likely than those who did not to have other co-occurring mental health problems (odds ratios of 2.9 to 8.8). The prevalence and patterns of co-occurring mental health problems, however, varied by age. Young adults (ages 18-25) were found to be most vulnerable to co-occurring problems.
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Affiliation(s)
- Ya-Fen Chan
- Chestnut Health Systems, Bloomington, IL 61701, USA.
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Friedlander AH, Yagiela JA, Mahler ME, Rubin R. The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder. J Am Dent Assoc 2007; 138:475-82; quiz 535, 537. [PMID: 17403737 DOI: 10.14219/jada.archive.2007.0199] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. TYPES OF STUDIES REVIEWED The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. RESULTS ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. CLINICAL IMPLICATIONS The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.
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Affiliation(s)
- Arthur H Friedlander
- Graduate Medical Education, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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Louzã MR, Mattos P. Questões atuais no tratamento farmacológico do TDAH em adultos com metilfenidato. JORNAL BRASILEIRO DE PSIQUIATRIA 2007. [DOI: 10.1590/s0047-20852007000500012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O tratamento farmacológico do transtorno do déficit de atenção com hiperatividade (TDAH) em adultos inclui o uso de psicoestimulantes, antidepressivos e atomoxetina, sendo o primeiro considerado a indicação de primeira escolha. A eficácia do metilfenidato foi demonstrada em adultos quando se empregavam doses maiores, proporcionalmente similares àquelas usadas em estudos em crianças. O perfil de eventos adversos do metilfenidato, incluindo aqueles relativos ao sistema cardiovascular, parece bastante seguro.
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Van den Bergh F, Spronk M, Ferreira L, Bloemarts E, Groenink L, Olivier B, Oosting R. Relationship of delay aversion and response inhibition to extinction learning, aggression, and sexual behaviour. Behav Brain Res 2006; 175:75-81. [PMID: 16965826 DOI: 10.1016/j.bbr.2006.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 07/31/2006] [Accepted: 08/02/2006] [Indexed: 11/30/2022]
Abstract
Impulsivity is an important symptom of many psychiatric disorders, and can be divided into two subtypes: response inhibition deficits and delay aversion. In the present study, we investigated the relationship between delay aversion and response inhibition, both to each other and to locomotion, extinction of conditioned responses, sexual behaviour, and aggressive behaviour. To that end, we quantified the behaviour of 24 rats in several tests. To measure response inhibition, rats were trained in a stop-signal task. In this operant task, rats were rewarded food if they inhibited execution of a response after presentation of an audible stop-signal. Delay aversion was measured in an operant task in which rats made a choice between a small, immediately available reward and a large reward available after a delay. The results showed that delay aversion and response inhibition were independent. Responses during extinction and various measures of aggressive behaviour were positively correlated to delay aversion. The speed of go-trials in the stop-task was correlated to non-aggressive behaviour. We conclude that the role of response inhibition in various behaviours is small, but delay aversion in particular contributes to several other behaviours, such as aggressive behaviour and extinction.
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Affiliation(s)
- Filip Van den Bergh
- Section Psychopharmacology and Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University. Sorbonnelaan 16, 3584CA Utrecht, The Netherlands
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