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Callen EF, Clay T, Alai J, Goodman DW, Adler LA, Faraone SV. The Role of Age in Adult ADHD Quality Care: A Longitudinal Analysis of Electronic Health Record Data. J Atten Disord 2024; 28:913-922. [PMID: 38156704 DOI: 10.1177/10870547231218042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Several studies have shown that Adult ADHD presents differently in younger and older adults. We sought to assess the difference in care between these two groups using previously identified quality measures (QMs). METHODS Using electronic health record data, we matched a younger group of ADHD patients to an older group. We then assessed the achievement of the QMs using probit models with and without interaction terms. RESULTS The majority of QMs shown an increase in achievement for both groups over time. However, significant differences in quality of care between younger and older adult ADHD patients persisted. By the end of the study period, with the exception of three QMs, younger patients achieved the QMs more. CONCLUSION While, in general, the quality of care for adult ADHD increased from 2010 to 2020, there were still differences in care between younger and older adult ADHD patients.
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Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Tarin Clay
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Jillian Alai
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - David W Goodman
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- SUNY Upstate Medical University, Syracuse, USA
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Holborn T, Schifano F, Deluca P. No prescription? No problem: A qualitative study investigating self-medication with novel psychoactive substances (NPS). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104109. [PMID: 37422986 DOI: 10.1016/j.drugpo.2023.104109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The proliferation of Novel Psychoactive Substances (NPS) presents a challenge for global drug policy. The ease of online drug purchase and the emergence of the dark web have created new avenues for the growth of NPS. Despite the global nature of this issue, limited research has examined motivations of use. These include perceived safety or convenience, an interest in novel pharmacology and self-exploration. Recent evidence has suggested individuals may be self-medicating with NPS, however this phenomenon has yet to be thoroughly explored. This study aims to investigate the occurrence of NPS self-medication, identify the specific NPS involved, and understand the motivations behind their use. METHODS Discussions surrounding self-medication using NPS were collected between October 2022 and February 2023 via a content analysis of a Reddit community. Ninety-three threads, comprising 182,490 words and 5023 comments, were collected and cleaned. A frequency analysis was conducted to identify the NPS discussed, and data was analysed systematically through the process of iterative categorization (IC). RESULTS Our study revealed frequent discussions about the self-medication with several NPS, notably etizolam, clonazolam, diclazepam, flualprazolam, 2-FMA, 4F-MPH, 3-FPM and 3-MeO-PCP. Individuals were mainly self-treating ADHD, anxiety and depression. Motivations for choosing NPS included access, cost, legality and a dissatisfaction with conventional healthcare. Substances were often chosen based on a profile of "Functionality" and outcomes varied. The use of clonazolam was highlighted as particularly problematic. CONCLUSION The current study provides insight into the phenomenon of self-medication with NPS within an internet demographic, exploring the motivations behind why individuals choose NPS for a variety of disorders. The easy access to NPS and lack of scientific data pose a significant challenge for drug policy. Future policies should focus on improving healthcare providers knowledge of NPS use, removing barriers to adult ADHD diagnosis and rebuilding trust between individuals and addiction services.
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Affiliation(s)
- Tayler Holborn
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Fabrizio Schifano
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Paolo Deluca
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Batsel-Thomas S, Dennis M. Empowering Future Psychiatrists to Evaluate and Treat Adult Attention-Deficit/Hyperactivity Disorder. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:201-204. [PMID: 36348230 DOI: 10.1007/s40596-022-01725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/25/2022] [Indexed: 05/25/2023]
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Palma-Álvarez RF, Barta C, Carpentier PJ, Carruthers S, Crunelle CL, Demetrovics Z, Dom G, Faraone SV, Franck J, Johnson B, Kapitány-Fövény M, Kaye S, Konstenius M, Matthys F, Moggi F, Møller M, Schellekens A, Skutle A, van de Glind G, van Emmerik-van Oortmerssen K, Verspreet S, Schoevers RA, Wallhed S, Levin FR, Grau-López L, Casas M, van den Brink W, Ramos-Quiroga JA. Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:11-15. [PMID: 32561156 DOI: 10.1016/j.rpsm.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
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Affiliation(s)
- Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geert Dom
- Antwerp University (UA), Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; Psychiatric Center Mutiversum, Boechout, Belgium
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian Johnson
- Departments of Psychiatry and of Anesthesia, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Máté Kapitány-Fövény
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary; Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Sharlene Kaye
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Merete Møller
- Department for Substance Abuse Treatment, Østfold Hospital Trust, Norway
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | | | - Katelijne van Emmerik-van Oortmerssen
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sara Wallhed
- Stockholm Centre for Dependency Disorders, Sweden
| | - Frances R Levin
- Columbia University, the New York State Psychiatric Institute, New York, NY, USA
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Flores-García L, Lensing MB, Bjerke TN, Kvalnes M, Eisemann M. Positive and negative aspects of substance use and treatment goals among substance use disorder patients with and without attention deficit hyperactivity disorder: A qualitative study. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1682765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Lizbett Flores-García
- Division of Mental Health and Substance Abuse, unit ReStart, University Hospital of Northern Norway, NO. Postboks 6124, 9291, Tromsø, Norway
- Department of Psychology, The Arctic University of Norway, NO. N-9037, Tromsø, Norway
| | - Michael B. Lensing
- Division of Paediatric and Adolescent Medicine, NevSom- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, NO. Postboks 4956 Nydalen, Oslo 0424, Norway
| | - Trond N. Bjerke
- Department of Development, Research and Education. University Hospital of Northern Norway, NO. Postboks 6124, Tromsø 9291, Norway
| | - Martin Kvalnes
- Division of Mental Health and Substance Abuse, unit ReStart, University Hospital of Northern Norway, NO. Postboks 6124, 9291, Tromsø, Norway
| | - Martin Eisemann
- Department of Psychology, The Arctic University of Norway, NO. N-9037, Tromsø, Norway
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8
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Evren C, Umut G, Evren B. Relationship of self-mutilative behaviour with history of childhood trauma and adult ADHD symptoms in a sample of inpatients with alcohol use disorder. ACTA ACUST UNITED AC 2017; 9:231-238. [PMID: 28374193 DOI: 10.1007/s12402-017-0228-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to evaluate relationship of self-mutilative behaviour (SMB) with the severity of childhood trauma and adult attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of inpatients with alcohol use disorder (AUD). Participants included 188 inpatients with AUD. Participants were evaluated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Questionnaire (CTQ-28) and the Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale (Adult ADHD Scale). Among inpatients with AUD those who have a history of SMB constituted the SMB group (n = 57, 30.3%), and those without a history of SMB constituted the group without SMB (n = 131, 69.7%). Risk of high ADHD risk was 2.5 times higher among those with SMB. Adult ADHD Scale and CTQ-28 scores were also higher in the group with SMB. In the first backward logistic regression model, the severity of ADHD symptoms predicted the presence of SMB, together with the severity of childhood trauma, whereas in the second model, physical neglect and inattentive (IN) dimension of ADHD predicted the presence of SMB. These findings suggest that the higher severity of physical neglect and adult IN dimension of ADHD may be related to SMB among inpatients with AUD.
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Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey. .,Bakirkoy Prof. Dr. Mazhar Osman Ruh Sagligi ve Sinir Hastaliklari Egitim ve Arastirma Hastanesi, AMATEM Klinigi, Bakirkoy, Istanbul, Turkey.
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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