1
|
Di Nicola M, Callovini T, Pepe M, De Mori L, Montanari S, Bartoli F, Carrà G, Sani G. Substance use disorders in adults with attention-deficit/hyperactivity disorder: The role of affective temperament. J Affect Disord 2024; 354:253-257. [PMID: 38494133 DOI: 10.1016/j.jad.2024.03.059] [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] [Received: 11/23/2023] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Substance Use Disorders (SUD) are common in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Although predictors of SUD in this population are relevant for prevention and treatment, they need further clarification. Affective temperaments potentially associated with SUD in adult ADHD patients were explored. METHODS ADHD patients with and without SUD were compared for sociodemographic, clinical, and psychological characteristics through: Adult ADHD Self-Report Scale; Wender Utah Rating Scale; Temperament Evaluation Memphis for Pisa, Paris, and San Diego-Autoquestionnaire. Logistic regression investigated factors associated with SUD. RESULTS We included one-hundred and thirty-six ADHD patients with (n = 51, 37.5 %) and without SUD (n = 85, 62.5 %). The presence of SUD was associated with irritable temperament (p = 0.009), as well as more frequent school failure (p = 0.038), legal problems (p = 0.039), and lifetime suicide attempts (p = 0.014). LIMITATIONS The cross-sectional design, the relatively small sample size, and the use of self-administered questionnaires. CONCLUSIONS This study confirms the greater overall severity of adult ADHD-SUD compared with ADHD-only patients and suggests the potential role of irritable temperament as a predictor of substance-related problems.
Collapse
Affiliation(s)
- Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Tommaso Callovini
- Department of Medicine and Surgery, Università Milano-Bicocca, Monza, Italy
| | - Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo De Mori
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Montanari
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, Università Milano-Bicocca, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, Università Milano-Bicocca, Monza, Italy; Division of Psychiatry, University College London, London, UK
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
2
|
Cannabis use in Attention - Deficit/Hyperactivity Disorder (ADHD): A scoping review. J Psychiatr Res 2023; 157:239-256. [PMID: 36508935 DOI: 10.1016/j.jpsychires.2022.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatments for Adult ADHD include stimulants, two non-stimulant medications, as well as cognitive-behavioral therapy (CBT). These pharmacological agents are often associated with side effects, contributing to poor treatment adherence. Patients with ADHD have regularly stated that cannabis has helped improve their ADHD symptoms; however, scientific literature describing the effects of cannabis on symptoms of ADHD is scarce. METHODS We systematically searched MEDLINE, EMBASE, EMCARE, PsycINFO, Web of Science, Cochrane Library, and Clinicaltrials.gov. The searches included all publications in English up to June 27, 2022. We included both experimental and observational studies that assessed the effect of cannabis on ADHD symptomatology and neuropsychiatric outcomes. To synthesize our current understanding of the potential effects of cannabis use on ADHD symptoms and pathophysiology, and the effects of ADHD on cannabis use, data was extracted from each study regarding the characteristics of its population, methods used to assess both cannabis consumption and ADHD symptoms, and key findings. RESULTS Our scoping review included a total of 39 studies. Only one study employed a randomized and placebo-controlled design to directly measure the effect of cannabis on ADHD, and no significant effect was observed for the study's primary outcome, the QbTest (Est = -0.17, 95% CI -0.40 to 0.07, p = 0.16). Most of the literature consists of cross-sectional studies that evaluate the association between ADHD severity and cannabis use. 15 studies addressed the neuropsychiatric effects of cannabis on ADHD by employing either a battery of neuropsychiatric tests or neuroimaging. The concentration and amount of THC and CBD used were not well measured in most of the studies. Although some studies indicated that cannabis improved ADHD symptoms, most studies indicated it worsened or had no effect on ADHD symptoms. CONCLUSIONS Given the current evidence, cannabis is not recommended for people with ADHD. Limitations of the literature include the absence of objective measurements for cannabis exposure and ADHD symptoms, heterogenous definitions, oversampling, and small sample sizes.
Collapse
|
3
|
Luderer M, Seidt J, Gerhardt S, Hoffmann S, Vollstädt-Klein S, Reif A, Sobanski E. Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder. Front Psychiatry 2023; 14:1112843. [PMID: 36950259 PMCID: PMC10025293 DOI: 10.3389/fpsyt.2023.1112843] [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: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Rationale Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD. Methods We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest®) that also measures motor activity objectively. Results Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups. Conclusion Questionnaires are more useful in assessing ADHD core symptoms than the QbTest®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.
Collapse
Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- *Correspondence: Mathias Luderer,
| | - Johanna Seidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| |
Collapse
|
4
|
Hernandez M, Levin FR. Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives. Psychiatr Clin North Am 2022; 45:503-514. [PMID: 36055735 PMCID: PMC11032069 DOI: 10.1016/j.psc.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Rates of cannabis use have been rising in the US due to the increasing legalization/decriminalization of cannabis products for medical and recreational use. Individuals with attention-deficit hyperactivity disorder (ADHD) may be at an increased risk of experiencing cannabis use problems due to deficits in self-regulation. This article explores motivations for cannabis use in ADHD populations. Research on the neural correlates and therapeutic potential of cannabis use are reviewed.
Collapse
Affiliation(s)
- Mariely Hernandez
- Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 43, New York, NY 10032, USA.
| | - Frances R Levin
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032, USA
| |
Collapse
|
5
|
Jiang K, Liu L, Pan C, Ge Y, Zheng A, Li Y, Li Y. The study of functional connectivity of attention cognitive impairment in children with nocturnal enuresis. Int J Dev Neurosci 2022; 82:646-653. [PMID: 35895636 DOI: 10.1002/jdn.10218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022] Open
Abstract
We aimed to explore the brain functional connectivity mechanism of attention cognitive impairment in children with nocturnal enuresis (NE). Children with NE often show attention cognitive deficit, but its brain mechanism remains unclear. Most previous studies have only focused on a single brain region, without involving the association among brain regions. In this study, 26 NE and 26 normal children were selected. Functional magnetic resonance imaging (fMRI) and integrated visual and auditory continuous performance test (IVA-CPT) were performed. The 12 key brain regions of the dorsal attention network (DAN), default mode network (DMN), and ventral attention network (VAN) were selected as areas of interest, and 66 groups of functional connectivity (FC) were analyzed among these 12 brain regions. The correlation between FC and IVA-CPT in the two groups was analyzed. The FC values showed that the groups with significant differences between NE and normal children were lFEF-aMPFC, rFEF-lIFG, rFEF-rIPS, and lAG-VFC (P<0.05), and the FC value of lAG-VFC was positively correlated with the Full-Scale Attention Quotient (FAQ). Our results showed that attention deficit in children with NE was associated with all three networks and was relative to the FC among the three attention networks. DAN was the brain network most related to attention cognition in children with NE, and most of the brain regions with abnormal connectivity in NE were related to the prefrontal lobe. The lAG was also an important brain region in attention impairment in NE.
Collapse
Affiliation(s)
- Kaihua Jiang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.,Department of Pediatrics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, China
| | - Liangqing Liu
- Department of Radiology, Affiliated WuJin Hospital of Jiangsu University, Changzhou, China
| | - Chenzhu Pan
- Department of Pediatrics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, China
| | - Yawen Ge
- Department of Pediatrics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, China
| | - Aibin Zheng
- Department of Pediatrics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, China
| | - Yamin Li
- Department of Pediatrics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| |
Collapse
|
6
|
Badrfam R, Zandifar A, Barkhori Mehni M, Farid M, Rahiminejad F. Comorbidity of adult ADHD and substance use disorder in a sample of inpatients bipolar disorder in Iran. BMC Psychiatry 2022; 22:480. [PMID: 35854247 PMCID: PMC9295524 DOI: 10.1186/s12888-022-04124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The study of the relationship between adult Attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received more attention in recent years and there is limited information in this area. On the other hand, there is a significant comorbidity between ADHD and bipolar disorder with substance use disorder. In this study, we investigated the prevalence of comorbidity of adult ADHD and substance use disorder among a group of bipolar patients admitted to a psychiatric hospital. METHODS One hundred fifty patients from a total of 200 consecutive patients who were referred to the emergency department of Roozbeh Psychiatric Hospital in Tehran, diagnosed with bipolar disorder based on the initial psychiatric interview and needed hospitalization, were evaluated again by an experienced faculty member psychiatrist by using a subsequent interview based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5). They were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5) questionnaire to confirm the diagnosis of bipolar disorder and the comorbidity of adult ADHD and substance use disorder. RESULTS From 150 patients diagnosed with bipolar disorder, 106 patients (70.7%) had adult ADHD. 89 patients (59.3%) had substance use disorder and 58 patients (38.7%) had both of these comorbidities with bipolar disorder. Comorbidity of adult ADHD was associated with the earlier onset of the first mood episode in bipolar disorder (p value = 0.025). There was no statistically significant relationship between substance use disorder and age of onset of the first episode. (P value = 0.57). CONCLUSIONS Due to the limitations of studies on adult ADHD comorbidity with bipolar disorder, especially in hospital settings, as well as the increased risk of association with substance use disorder, further multicenter studies in this area with larger sample sizes can increase awareness in this regard.
Collapse
Affiliation(s)
- Rahim Badrfam
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahdi Barkhori Mehni
- grid.411705.60000 0001 0166 0922Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Farid
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Rahiminejad
- Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|