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Popit S, Serod K, Locatelli I, Stuhec M. Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. Eur Psychiatry 2024; 67:e68. [PMID: 39381949 DOI: 10.1192/j.eurpsy.2024.1786] [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: 10/10/2024] Open
Abstract
BACKGROUND The estimates of attention-deficit hyperactivity disorder (ADHD) prevalence across various studies are significantly variable, contributing to uncertainty in ADHD prevalence estimation. Previous systematic reviews and meta-analyses have attributed this variability primarily to the methodological characteristics of the studies, including the diagnostic criteria, source of information, and impairment requirement for the diagnosis. METHODS Review identified studies reporting ADHD prevalence in representative samples of children and adults in Europe and worldwide. Studies that were conducted in the general population were included. We focused on studies that report ADHD prevalence based on clinical diagnosis (clinical diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases criteria, other diagnostic tools, such as various scales or interviews based on clinical diagnostic criteria). PubMed/Medline was searched to identify relevant articles published until 2024/2/01. The study was registered in PROSPERO (CRD42020200220) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic review and meta-analysis. RESULTS In total, 117 studies were subjected to full evaluation. In the meta-analysis, 103 studies representing 159 independent datapoints were included. The overall prevalence of ADHD in register studies was 1.6%, 95% CI [0.9; 3.0], in survey studies 5.0%, 95% CI [2.9; 8.6], in one-stage clinical studies 4.2%, 95% CI [2.9; 6.0], and in two-stage clinical studies 4.8%, 95% CI [4.0; 5.8]. CONCLUSIONS Exact comparisons among studies with different diagnostic criteria and types of sampling can impact prevalence estimates. When comparing data from methodologically different studies, these factors need to be considered.
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Affiliation(s)
- Sara Popit
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
- Pomurske lekarne, Murska Sobota, Slovenia
| | - Klara Serod
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Igor Locatelli
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
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Michielsen M, Böhmer MN, Vermeulen RCH, Vlaanderen JJ, Beekman ATF, Kooij JJS. ADHD, sleep, chronotype and health in a large cohort of Dutch nurses. J Psychiatr Res 2024; 174:159-164. [PMID: 38636152 DOI: 10.1016/j.jpsychires.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Affiliation(s)
- M Michielsen
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands.
| | - M N Böhmer
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands
| | - R C H Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Jenalaan 18d, 3584 CK, Utrecht, Utrecht, the Netherlands
| | - J J Vlaanderen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Jenalaan 18d, 3584 CK, Utrecht, Utrecht, the Netherlands
| | - A T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center/VUmc, Oldenaller 1, 1081 HL, Amsterdam, the Netherlands
| | - J J S Kooij
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center/VUmc, Oldenaller 1, 1081 HL, Amsterdam, the Netherlands
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Borgert M, Melin A, Hollander AC, Rahman S. Prenatal maternal PTSD as a risk factor for offspring ADHD: A register-based Swedish cohort study of 553 766 children and their mothers. Eur Psychiatry 2024; 67:e22. [PMID: 38425211 DOI: 10.1192/j.eurpsy.2024.21] [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: 03/02/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is highly heritable, though environmental factors also play a role. Prenatal maternal stress is suggested to be one such factor, including exposure to highly distressing events that could lead to post-traumatic stress disorder (PTSD). The aim of this study is to investigate whether prenatal maternal PTSD is associated with offspring ADHD. METHOD A register-based retrospective cohort study linking 553 766 children born in Sweden during 2006-2010 with their biological parents. Exposure: Prenatal PTSD. Outcome: Offspring ADHD. Logistic regression determined odds ratios (ORs) with 95% confidence intervals (CIs) for ADHD in the offspring. Adjustments were made for potential covariates, including single parenthood and possible indicators of heredity measured as parental ADHD and maternal mental disorders other than PTSD. Subpopulations, excluding children with indicators of heredity, were investigated separately. RESULTS In the crude results, including all children, prenatal PTSD was associated with offspring ADHD (OR: 1.79, 95% CI: 1.37-2.34). In children with indicators of heredity, the likelihood was partly explained by it. Among children without indicators of heredity, PTSD was associated with offspring ADHD (OR: 2.32, 95% CI: 1.30-4.14), adjusted for confounders. CONCLUSIONS Prenatal maternal PTSD is associated with offspring ADHD regardless of indicators of heredity, such as parental ADHD or maternal mental disorder other than PTSD. The association is partly explained by heredity and socioeconomic factors. If replicated in other populations, preferably using a sibling design, maternal PTSD could be identified as a risk factor for ADHD.
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Affiliation(s)
- Michael Borgert
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health, Stockholm, Sweden
| | - Amandah Melin
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health, Stockholm, Sweden
| | - Anna-Clara Hollander
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health, Stockholm, Sweden
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Stockholm, Sweden
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Lindström T, Bergman TH, Annerstedt M, Forster M, Bölte S, Hirvikoski T. Psychometric Properties of the Parental Stress Scale in Swedish Parents of Children with and without Neurodevelopmental Conditions. Scand J Child Adolesc Psychiatr Psychol 2024; 12:10-22. [PMID: 38645569 PMCID: PMC11027036 DOI: 10.2478/sjcapp-2024-0002] [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] [Indexed: 04/23/2024] Open
Abstract
Background Parents of children with neurodevelopmental conditions (NDC) are at risk of experiencing elevated levels of parental stress. Access to robust instruments to assess parental stress is important in both clinical and research contexts. Objective: We aimed to evaluate the psychometric properties of a Swedish version of the Parental Stress Scale (PSS), completed by parents of 3- to 17-year-old children, with and without NDCs. Method Main analyses were conducted on data from three independent samples: a community sample (n=1018), a treatment-seeking sample of parents of children with various disabilities (n=653), and a sample of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) who themselves reported varying ADHD symptom severities (n=562). Additional analyses were enabled by the use of data from a complementary test-retest sample (n=337). Results The internal consistency of the PSS was good (Cronbach's alpha, α=.87) and its test-retest reliability moderate (ICC=.66). The scale correlated in the expected direction with related constructs (r=.50-.56 in the community sample). An exploratory factor analysis found its internal structure to reflect two aspects of parental stress: Lack of Parental Rewards and Role Satisfaction (factor 1, α=.90) and Parental Stressors and Distress (factor 2, α=.85). The treatment-seeking parents of children with disabilities reported higher parental stress than community reference parents (p<.001; Cohen's d=1.17). Moreover, we found that parents with high ADHD symptom severity reported higher parental stress than parents with low ADHD symptom severity (p<.001; d=0.39). Conclusion In summary, we found evidence in support of the reliability and validity of the PSS, which overall was judged to be useful as a measure of parental stress in a Swedish context. In addition, our results underline the importance of considering parental stress and related needs in assessments and intervention planning involving families of children with NDCs.
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Affiliation(s)
- Therese Lindström
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Tiina Holmberg Bergman
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mathilde Annerstedt
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Tatja Hirvikoski
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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López-Pinar C, Selaskowski B, Braun N, Fornés-Ferrer V, Euscher R, Matthies S, Jans T, van Elst LT, Jacob C, Huss M, Sobanski E, Retz W, Roesler M, Retz-Junginger P, Alm B, Kis B, Abdel-Hamid M, Colla M, Berger M, Lux S, Philipsen A. Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial. Psychiatry Res 2023; 330:115610. [PMID: 37992514 DOI: 10.1016/j.psychres.2023.115610] [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: 06/16/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).
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Affiliation(s)
- Carlos López-Pinar
- Department of Psychobiology and Basic Psychology, University of Valencia, Valencia, Spain; Department of Psychology, European University of Valencia, Valencia, Spain.
| | | | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Rebekka Euscher
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Thomas Jans
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Christian Jacob
- Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany; Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Hornborg C, Axrud R, Vicente RP, Merlo J. Socioeconomic disparities in attention deficit hyperactivity disorder (ADHD) in Sweden: An intersectional ecological niches analysis of individual heterogeneity and discriminatory accuracy (IEN-AIHDA). PLoS One 2023; 18:e0294741. [PMID: 37983221 PMCID: PMC10659213 DOI: 10.1371/journal.pone.0294741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
We aimed (i) to gain a better understanding of the demographic and socioeconomical distribution of ADHD risk in Sweden; and (ii) to contribute to the critical discussion on medicalization, i.e., the tendency to define and treat behavioural and social problems as medical entities. For this purpose, we analysed the risk of suffering from ADHD in the whole Swedish population aged between 5 and 60 years, across 96 different strata defined by combining categories of gender, age, income, and country of birth. The stratified analysis evidenced considerable risk heterogeneity, with prevalence values ranging from 0.03% in high income immigrant women aged 50-59, to 6.18% in middle income immigrant boys aged 10-14. Our study questions the established idea that behavioural difficulties conceptualized as ADHD should be primarily perceived as a neurological abnormality. Rather, our findings suggest that there is a strong sociological component behind how some individuals become impaired and subject to medicalization.
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Affiliation(s)
- Christoffer Hornborg
- Department of Sociology and Work Science, University of Gothenburg, Göteborg, Sweden
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Welfare, Social Innovation and Sustainability in Rural Areas, Campus Västervik, Västervik, Sweden
| | - Rebecca Axrud
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Raquel Pérez Vicente
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Primary Health Care Research, Region Skåne, Malmö, Sweden
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Jansson L, Löhman M, Östlund M, Domingo B. Effects of one single-dose methylphenidate compared to one single-dose placebo on QbTest performance in adults with untreated ADHD: a randomized controlled trial. BMC Psychiatry 2023; 23:762. [PMID: 37848887 PMCID: PMC10583300 DOI: 10.1186/s12888-023-05231-8] [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] [Received: 09/16/2022] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Treatment of adults with attention-deficit/hyperactivity disorder (ADHD) primary involves methylphenidate (MPH). Earlier studies have identified placebo responders to increase toward the end of the treatment periods. However, little is known about the immediate effects of placebo on the core symptoms of ADHD in adults. The present study aimed to examine the effects of one single-dose MPH compared to one single-dose placebo during clinical assessments with continuous performance tests (CPT). METHODS In a randomized study with cross-over design, 40 adults between 19 and 64 years (72.5% women) with untreated ADHD were consecutively enrolled. The study comprised two trial days with four days in between. The QbTest was performed twice on the same day, before and 80 min after intake of one single-dose 20 mg immediate release methylphenidate (IR-MPH) and with one single-dose placebo, in randomized order. RESULTS Performance improved in QbInattention, F (3, 117) = 38.25, p < 0.001, after given IR-MPH (mean diff = 1.14) and after placebo (mean diff = 0.60) with the effect sizes 1.17 and 0.63 respectively. IR-MPH improved performance in QbActivity (mean diff = 0.81, p < 0.001) and QbImpulsivity (mean diff = 0.46, p < 0.04). The proportion of improvements (a decrease by ≥ 0.5 Qb-score) in the parameters QbInattention, QbActivity and QbImpulsivity were 90%, 60% and 52.5%, respectively. After given placebo, corresponding proportions were 60%, 30% and 35%, respectively. CONCLUSIONS There seems to be an immediate placebo response in the core symptom inattention. The effect of placebo cannot be ruled out and must be taken in consideration during drug trials with continuous performance tests (CPTs). TRIAL REGISTRATION ClinicalTrials.gov; Identifier: NCT02473185.
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Affiliation(s)
- Lennart Jansson
- Psychiatric Clinic, Region Västmanland, 721 89, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Monica Löhman
- Psychiatric Clinic, Region Västmanland, 721 89, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Mona Östlund
- Psychiatric Clinic, Region Västmanland, 721 89, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Blanca Domingo
- Psychiatric Clinic, Region Västmanland, 721 89, Västerås, Sweden.
- Centre for Clinical Research, Uppsala University, Västerås, Sweden.
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Giacobini M, Ahnemark E, Medin E, Freilich J, Andersson M, Ma Y, Ginsberg Y. Epidemiology, Treatment Patterns, Comorbidities, and Concomitant Medication in Patients with ADHD in Sweden: A Registry-Based Study (2018-2021). J Atten Disord 2023; 27:1309-1321. [PMID: 37282510 DOI: 10.1177/10870547231177221] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate treatment patterns for ADHD in Sweden. METHOD Observational retrospective study of patients with ADHD from the Swedish National Patient Register and Prescribed Drug Register, 2018 to 2021. Cross-sectional analyses included incidence, prevalence, and psychiatric comorbidities. Longitudinal analyses (newly diagnosed patients) included medication, treatment lines, duration, time-to-treatment initiation, and switching. RESULTS Of 243,790 patients, 84.5% received an ADHD medication. Psychiatric comorbidities were common, particularly autism among children, and depression in adults. Most frequent first-/second-line treatments were methylphenidate (MPH; 81.6%) and lisdexamfetamine dimesylate (LDX; 46.0%), respectively. In the second-line, LDX was most frequently prescribed (46.0%), followed by MPH (34.9%), then atomoxetine (7.7%). Median treatment duration was longest for LDX (10.4 months), followed by amphetamine (9.1 months). CONCLUSION This nationwide registry study provides real-life insights into the current epidemiology of ADHD and the changing treatment landscape for patients in Sweden.
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Affiliation(s)
- MaiBritt Giacobini
- PRIMA Barn-Och Vuxenpsykiatri AB, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | | | - Emma Medin
- LIME/Karolinska Institutet, Stockholm, Sweden
- Parexel International, Stockholm, Sweden (affiliation at time of study)
| | - Jonatan Freilich
- Parexel International, Stockholm, Sweden
- Umeå University, Umeå, Sweden
| | | | - Yuanjun Ma
- Parexel International, Stockholm, Sweden
| | - Ylva Ginsberg
- Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Becker P, Rask M, Safipour J, Gunnarsson AB. Selfcare Strategies Shown to Be Useful in Daily Life for Adults Diagnosed with Attention Deficit Hyperactivity Disorder - A Systematic Review. Issues Ment Health Nurs 2023; 44:825-833. [PMID: 37669505 DOI: 10.1080/01612840.2023.2234477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Adults with ADHD experience a wide range of difficulties in daily life, and RNs and other healthcare professionals need to know how to support them. The aim was to conduct a systematic review of which selfcare strategies adults with ADHD use and need in order to manage daily life. A literature review based on the PRISMA model was performed, and seven articles with a qualitative design were found. Data were analyzed with thematic analysis. The analysis generated one major theme Enabling ways to manage the consequences of disability in daily life based on three subthemes; Establishing ways of acting to help yourself, Finding encouraging and helping relationships, and Using external aids for managing daily life. Professionals may benefit from knowing about these selfcare strategies when meeting people with ADHD.
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Affiliation(s)
- Petra Becker
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Jalal Safipour
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - A Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Langley K, Del Pozo-Banos M, Daalsgard S, Paranjothy S, Riglin L, John A, Thapar A. Can a nation-wide e-cohort of ADHD and ASD in childhood be established using Welsh routinely available datasets? BMJ Open 2023; 13:e071851. [PMID: 37604636 PMCID: PMC10445352 DOI: 10.1136/bmjopen-2023-071851] [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] [Received: 01/13/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research. DESIGN Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of directly assessed individuals with ADHD. SETTING This study used data from the Welsh Secure Anonymised Information Linkage Databank in Wales, UK. Routinely collected data from primary care, emergency department and hospital admissions were linked at person level. PARTICIPANTS All individuals in Wales, UK born between 1 January 1991 and 31 December 2000. Individuals with a recorded diagnosis of ADHD and/or ASD by age 18 years were identified using International Classification of Diseases, 10th Revision and National Health Service (NHS) READ codes and matched to 3 controls each and 154 individuals with ADHD recruited from an established research study. OUTCOME MEASURES Recorded service use for anxiety and depression, alcohol and drug use and self-harm including emergency department use in young adulthood (age 16-25 years). RESULTS 7726 individuals had a recorded diagnosis of ADHD (80% male) and 5001 of ASD (79% male); 1.4% and 0.9% of the population, respectively. Cox's regression analyses showed ADHD was associated with increased risks of anxiety/depression (HR: 2.36, 95% CI: 2.20 to 2.53), self-harm (HR: 5.70, 95% CI: 5.07 to 6.40), alcohol (HR: 3.95, 95% CI: 3.42 to 4.56), drug use (HR: 5.88, 95% CI: 5.08 to 6.80) and emergency department service use (HR: 1.36, 95% CI: 1.31 to 1.41). Those with ASD were at increased risk of anxiety/depression (HR: 2.11, 95% CI: 1.91 to 2.34), self-harm (HR: 2.93, 95% CI: 2.45 to 3.50) and drug use (HR: 2.21, 95% CI: 1.66 to 2.95) but not alcohol use. The ADHD e-cohort were similar to the directly assessed cohort. CONCLUSIONS Our identification strategy demonstrated the feasibility of establishing a large e-cohort of those with ADHD/ASD with expected patterns of poorer early adult outcomes, demonstrating a valid method of identifying large samples for future longitudinal studies without selective attrition.
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Affiliation(s)
- Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | - Marcos Del Pozo-Banos
- Population Data Science, Swansea University, Swansea, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Søren Daalsgard
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | | | - Lucy Riglin
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences; Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Anita Thapar
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences; Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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Dobrosavljevic M, Larsson H, Cortese S. The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults. Expert Rev Neurother 2023; 23:883-893. [PMID: 37725058 DOI: 10.1080/14737175.2023.2250913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION There is a striking knowledge gap on ADHD in older adults, and the diagnosis as well as treatment for ADHD in this age group. AREAS COVERED The authors first review the literature on the prevalence, functional impairment, and health comorbidities of ADHD across the lifespan. Next, they address the diagnostic criteria for ADHD in adults according to the DSM/ICD, available screening/diagnostic tools, differential diagnosis, and the validity of diagnostic criteria for ADHD in older adults. Finally, the authors focus on empirical evidence on the prevalence rates, medication response, and safety of pharmacological treatment of ADHD in older adults, and national and international clinical guidelines on the treatment of ADHD in this age group. EXPERT OPINION It is expected that future editions of the DSM and ICD will provide specifiers to the standard ADHD criteria, to better inform the diagnosis of ADHD in older adults. It is also expected that the increasing number of epidemiological studies will provide rigorous estimates on the prevalence, incidence, and burden of ADHD in older adults. One may expect an increasing number of RCTs assessing the efficacy/effectiveness and tolerability/safety of pharmacological as well as non-pharmacological interventions which will inform future guidelines on ADHD in older adults.
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Affiliation(s)
- Maja Dobrosavljevic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Life and Environmental Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York, NY, USA
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Chen W, Epstein A, Toner M, Murphy N, Rudaizky D, Downs J. Enabling successful life engagement in young people with ADHD: new components beyond adult models of recovery. Disabil Rehabil 2023; 45:2288-2300. [PMID: 35944517 DOI: 10.1080/09638288.2022.2087763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine the lived experiences of young people successfully managing life with ADHD and investigate the applicability of adult models of Recovery to these individuals. METHODS Twenty-seven young people aged 15-31 years participated in qualitative interviews. Participants' success was indicated by employment, school attendance, absence of acute mental health episodes, or absence of chronic alcohol or drug use. Thematic analysis identified specific components of their life successes and challenges. RESULTS The emergent framework comprised four elements: (i) Recovernance (RE) (a portmanteau merging 'Recovery' and 'Maintenance'; ongoing adjustment to maintain one's personal best without an end point); (ii) Personal Optimization (PO) (continuously striving to maximize function and adjust one's goals given fluctuating impairments and internal resources); (iii) Self (S) (facing internal challenges and developing internal resilience); and (iv) Environment (E) (facing external challenges and fostering external resilience). These four elements yielded the acronym 'REPOSE'. CONCLUSIONS Recovery in young people with ADHD was not a linear journey, with many missteps leading to greater self-knowledge, life skills and mastery. Progress was leveraged on securely anchored internal and external resilience factors against the prospect of setbacks. Findings provide new concepts and novel lexicons to extend existing concepts in Recovery. Implications for rehabilitationCounselling and therapy for young people with ADHD should foster self-understanding, goal setting and self-vigilance as an ongoing process to build their capacity to tackle setbacks and adversities.Counselling and therapy for young people with ADHD focus on a strengths-based approach building internal and external resources, such as developing skills and establishing social connections that build infrastructure in the environment for meaningful participation.
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Affiliation(s)
- Wai Chen
- Fiona Stanley Hospital, Perth, Australia
- Graduate School of Education, The University of Western Australia, Perth, Australia
- School of Psychology and Exercise Sciences, Murdoch University, Perth, Australia
- School of Medicine (Fremantle), Notre Dame University Australia, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
- Curtin enAble Institute, Curtin University, Perth, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Nada Murphy
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Daniel Rudaizky
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Ahlberg R, Du Rietz E, Ahnemark E, Andersson LM, Werner-Kiechle T, Lichtenstein P, Larsson H, Garcia-Argibay M. Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems. BMC Psychiatry 2023; 23:336. [PMID: 37173664 PMCID: PMC10176742 DOI: 10.1186/s12888-023-04713-z] [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] [Received: 10/19/2022] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan. METHOD A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up). RESULTS 31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD. CONCLUSION Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden.
| | - E Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Ahnemark
- Department of Neuropsychiatry, Region Stockholm, Stockholm, Sweden
| | | | - T Werner-Kiechle
- Global Medical Affairs, Shire International GmbH, Zug, Switzerland
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Larsson
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Garcia-Argibay
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
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14
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Löhman M, Domingo B, Östlund M, Jansson L. Contrasting expectancy effects with objective measures in adults with untreated ADHD during QbTest. Scand J Psychol 2023. [PMID: 36786078 DOI: 10.1111/sjop.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
Expectancy has been associated with neuropsychological assessments and cognitive performance. However, little is known about the effects of expectations in clinical assessments during drug trials with continuous performance tests (CPTs). In a randomized, double-blind study with cross-over design, we examined if the participants' self-reported expectations changed after one-single dose immediate release methylphenidate (MPH) and after one-single dose placebo during the QbTest. Forty adults between 19 and 64 years (72.5% women) with un treated ADHD were consecutively enrolled in the study and their assessments of expected performance, mental effort, perceived performance and help from the pill were analyzed. The study comprised two trial days with four days in between. The QbTest was performed twice on the same day, before and 80 minutes after a pill. Our study demonstrates that there were expectancy effects during CPTs. Participants reported lower mental effort and improved their performance in the coronary parameter QbInattention both after MPH and after placebo. No significant differences in expected performance were reported. The participants seemed to show some uncertainty when assessing their expected performance, however, they could evaluate their performance afterwards. In clinical practice, the focus should be on reinforcing patients' expectations in order to increase treatment effects.
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Affiliation(s)
- Monica Löhman
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Blanca Domingo
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Mona Östlund
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Lennart Jansson
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
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15
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Ramos-Quiroga JA, Richarte V, Soto I, Targhetta M, Ward J, Perulero N. The Prevalence and Treatment of ADHD in Spain: A Retrospective Cohort Analysis. J Atten Disord 2023; 27:273-282. [PMID: 36373564 DOI: 10.1177/10870547221136226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Estimate the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD) and analyze variations in its treatment across Spain. METHOD Analyses were performed using IQVIA's clinical practice RealWorld Database, the electronic medical records of some 1 million patients from 2013 to 2018. MPH treatment was assessed using the Defined Daily Dose (DDD), MPH sales were extracted from IQVIA's Sell-Out database and the number of active psychiatrists from IQVIA's OneKey Database. RESULTS Significantly higher ADHD prevalence and incidence (1) in children than in adults and (2) in males compared to females. 91% of patients take MPH. Regional variations in MPH consumption range from 247 Daily Dose per Inhabitant (DDI) per 100,000 inhabitants to 414. CONCLUSION ADHD continues to be underdiagnosed and undertreated, particularly in adults, and more so in females. The lack of diagnostic tools for adults and the variations in treatment across the country need to be addressed.
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Affiliation(s)
- Jose Antonio Ramos-Quiroga
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Vanesa Richarte
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Isabel Soto
- IQVIA Information S.A., Madrid, Comunidad de Madrid, Spain
| | | | - John Ward
- IQVIA RDS S.L, Madrid, Comunidad de Madrid, Spain
| | - Núria Perulero
- IQVIA Information S.A., Madrid, Comunidad de Madrid, Spain
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Vňuková M, Ptáček R, Děchtěrenko F, Weissenberger S, Ptáčková H, Braaten E, Raboch J, Anders M, Klicperová-Baker M, Goetz M. Prevalence of ADHD Symptomatology in Adult Population in the Czech Republic: A National Study. J Atten Disord 2023; 27:447-454. [PMID: 36691347 DOI: 10.1177/10870547221147547] [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: 01/25/2023]
Abstract
BACKGROUND ADHD is a common neurodevelopmental disorder frequently diagnosed between the ages 7 and 10 years. We measured ADHD symptomatology in a representative sample of the Czech population. MATERIAL AND METHODS Data collection was performed in January 2019 through the European National Panel. The respondents completed a demographic questionnaire focusing on ADHD history and a standardized questionnaire, the Adult ADHD Self-Report Scale (ASRS) screener for ADHD symptomatology in adulthood. RESULTS From the sample of 1,518 respondents, 3% of the respondents reported having been diagnosed with ADHD/hyperkinetic disorder in their lifetime. According to ASRS scoring, 119 respondents were classified as suspected ADHD. Overall, more males than females reported ADHD symptomatology. Age was also significantly associated with ASRS. Education status yielded no significant results. CONCLUSION Our study documents that the prevalence of ADHD symptomatology in adults is comparable with that in Western countries despite the different historical and health care backgrounds.
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Affiliation(s)
- Martina Vňuková
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Radek Ptáček
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Simon Weissenberger
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Ellen Braaten
- 2nd Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
| | - Jiří Raboch
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Anders
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Michal Goetz
- 2nd Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
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Gémes K, Taipale H, Björkenstam E, Rahman S, Gustafsson K, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden. Front Psychiatry 2023; 14:1152286. [PMID: 37168083 PMCID: PMC10165120 DOI: 10.3389/fpsyt.2023.1152286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Long-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults. Methods and results We conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes. Conclusion Besides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- *Correspondence: Katalin Gémes,
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Lisa Ekselius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
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Prevalence trends and individual patterns of ADHD medication use in pregnancy in Norway and Sweden, 2010-2019. Eur J Clin Pharmacol 2023; 79:173-180. [PMID: 36445458 PMCID: PMC9816174 DOI: 10.1007/s00228-022-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to describe recent trends in ADHD medication use in pregnancy in Norway and Sweden, including prevalence, individual characteristics, and patterns of use. METHODS We studied ADHD medication use (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine, guanfacine) by year and age in pregnancies from 2010 to 2019 identified from the medical birth registers (gestational age ≥ 22 weeks) linked to prescribed drug registers (Norway, N = 577,116; Sweden, N = 1,118,988). We compared characteristics of those who used any ADHD medication in pregnancy to no use in pregnancy. Discontinuation was defined as no use after first trimester. RESULTS ADHD medication use increased from 2010 to 2019 by 3.0 users per 1000 pregnancies in Norway (from 2.5 to 5.5/1000) and by 6.3 per 1000 in Sweden (from 1.6 to 7.9/1000), mainly driven by methylphenidate and since 2015 by lisdexamfetamine. Medication use has increased among pregnant individuals of all age groups, with higher use among the youngest. Pregnant individuals who used ADHD medication were less likely to be married/cohabiting, more likely be nulliparous and to smoke. They had particularly high use of co-medication with antidepressants, anxiolytics/hypnotics, and opioids: 42% in Norway and 65% in Sweden used at least one additional class of psychotropic medication. Most individuals discontinued ADHD medication in pregnancy (85% Norway, 78% Sweden). CONCLUSION ADHD medication use during pregnancy increased in Norway and Sweden in the last decade. However, discontinuation rates during pregnancy were high. Those who used ADHD medication had more risk factors for pregnancy complications including low parity, smoking, and other psychotropic drug use.
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Tan HX, Md Kamal A, Thurairajasingam S, Phipps ME. Addressing Emotional Dysregulation and Potential Pharmacogenetic Implication of 5-HTTLPR Genotype in Attention Deficit Hyperactivity Disorder. Complex Psychiatry 2023; 9:70-88. [PMID: 37404870 PMCID: PMC10315004 DOI: 10.1159/000529732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 02/08/2023] [Indexed: 08/24/2023] Open
Abstract
Background This review unpacks the emotional presentation of externalizing behaviors in attention deficit hyperactivity disorder (ADHD), by diving into the psychophysiology, neurophysiology, and neurogenetics in relation to executive function. The correlations among these three variables are identified, showing that standard assessments for ADHD leave out the emotional dysregulation element. This may lead to suboptimal management outcomes during the developmental progression into adolescence and adulthood. Summary The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood. Key Messages The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.
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Affiliation(s)
- Hao Xuan Tan
- Medical Education Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Sunway Campus), Subang Jaya, Malaysia
| | - Adam Md Kamal
- Medical Department, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | | | - Maude Elvira Phipps
- Department of Human Genetics, Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Sunway Campus), Subang Jaya, Malaysia
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Oscarsson M, Nelson M, Rozental A, Ginsberg Y, Carlbring P, Jönsson F. Stress and work-related mental illness among working adults with ADHD: a qualitative study. BMC Psychiatry 2022; 22:751. [PMID: 36451126 PMCID: PMC9714234 DOI: 10.1186/s12888-022-04409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness. METHODS Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants' well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews. RESULTS The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities. CONCLUSION Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.
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Affiliation(s)
- Martin Oscarsson
- Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden.
| | - Martina Nelson
- grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alexander Rozental
- grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Ylva Ginsberg
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Per Carlbring
- grid.10548.380000 0004 1936 9377Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Fredrik Jönsson
- grid.10548.380000 0004 1936 9377Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
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Gémes K, Björkenstam E, Rahman S, Gustafsson K, Taipale H, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. Occupational Branch and Labor Market Marginalization among Young Employees with Adult Onset of Attention Deficit Hyperactivity Disorder-A Population-Based Matched Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127254. [PMID: 35742503 PMCID: PMC9223828 DOI: 10.3390/ijerph19127254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
We compared labor market marginalization (LMM), conceptualized as days of unemployment, sickness absence and disability pension, across occupational branches (manufacturing, construction, trade, finance, health and social care, and education), among young employees with or without attention deficit hyperactivity disorder (ADHD) and examined whether sociodemographic and health-related factors explain these associations. All Swedish residents aged 19–29 years and employed between 1 January 2005 and 31 December 2011 were eligible. Individuals with a first ADHD diagnosis (n = 6030) were matched with ten controls and followed for five years. Zero-inflated negative binomial regression was used to model days of LMM with adjustments for sociodemographic and health-related factors. In total, 20% of those with ADHD and 59% of those without had no days of LMM during the follow-up. The median of those with LMM days with and without ADHD was 312 and 98 days. Having an ADHD diagnosis was associated with a higher incidence of LMM days (incident rate ratios (IRRs) 2.7–3.1) with no differences across occupational branches. Adjustments for sociodemographic and health-related factors explained most of the differences (IRRs: 1.4–1.7). In conclusion, young, employed adults with ADHD had a higher incidence of LMM days than those without, but there were no substantial differences between branches, even after adjusting for sociodemographic and health-related factors.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Correspondence:
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Department of Medical Sciences, Uppsala University, 75185 Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Niuvanniemi Hospital, FI-70240 Kuopio, Finland;
- School of Pharmacy, University of Eastern Finland, FI-70211 Kuopio, Finland
| | | | - Lisa Ekselius
- Department Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden;
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
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22
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Heal DJ, Smith SL. Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology. J Psychopharmacol 2022; 36:680-703. [PMID: 34318734 PMCID: PMC9150143 DOI: 10.1177/02698811211032475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Binge-eating disorder (BED) is a common psychiatric condition with adverse psychological and metabolic consequences. Lisdexamfetamine (LDX) is the only approved BED drug treatment. New drugs to treat BED are urgently needed. METHODS A comprehensive review of published psychopathological, pharmacological and clinical findings. RESULTS The evidence supports the hypothesis that BED is an impulse control disorder with similarities to ADHD, including responsiveness to catecholaminergic drugs, for example LDX and dasotraline. The target product profile (TPP) of the ideal BED drug combines treating the psychopathological drivers of the disorder with an independent weight-loss effect. Drugs with proven efficacy in BED have a common pharmacology; they potentiate central noradrenergic and dopaminergic neurotransmission. Because of the overlap between pharmacotherapy in attention deficit hyperactivity disorder (ADHD) and BED, drug-candidates from diverse pharmacological classes, which have already failed in ADHD would also be predicted to fail if tested in BED. The failure in BED trials of drugs with diverse pharmacological mechanisms indicates many possible avenues for drug discovery can probably be discounted. CONCLUSIONS (1) The efficacy of drugs for BED is dependent on reducing its core psychopathologies of impulsivity, compulsivity and perseveration and by increasing cognitive control of eating. (2) The analysis revealed a large number of pharmacological mechanisms are unlikely to be productive in the search for effective new BED drugs. (3) The most promising areas for new treatments for BED are drugs, which augment noradrenergic and dopaminergic neurotransmission and/or those which are effective in ADHD.
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Affiliation(s)
- David J Heal
- David J Heal, DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
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23
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Li L, Chang Z, Sun J, Jangmo A, Zhang L, Andersson LM, Werner-Kiechle T, Ahnemark E, D’Onofrio BM, Larsson H. Association Between Pharmacological Treatment of Attention-Deficit/Hyperactivity Disorder and Long-term Unemployment Among Working-Age Individuals in Sweden. JAMA Netw Open 2022; 5:e226815. [PMID: 35476068 PMCID: PMC9047436 DOI: 10.1001/jamanetworkopen.2022.6815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Adults with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for unemployment. Pharmacological treatment is effective in reducing the core symptoms of ADHD, but whether it helps to reduce the unemployment rate among adult patients remains unclear. OBJECTIVE To investigate the association between use of ADHD medication and long-term unemployment in working-age adults with ADHD. DESIGN, SETTING, AND PARTICIPANTS Data for this population-based cohort study were extracted from Swedish national registers. Among 25 358 individuals with ADHD born from 1958 to 1978, 12 875 middle-aged adults among the workforce were included. The longitudinal cohort was followed up from January 1, 2008, to December 31, 2013. Data were analyzed from March 1, 2020, through May 31, 2021. EXPOSURES Use of medication for ADHD during the previous 2 years was the main exposure, as both categorical and continuous variables. MAIN OUTCOMES AND MEASURES Yearly accumulated unemployed days were derived from the Public Employment Service, and long-term unemployment was defined as 90 or more days of unemployment per year. Overall and sex-specific relative risks (RRs) with 95% CIs were estimated using generalized estimating equations. RESULTS Among 12 875 individuals with ADHD (5343 women [41.50%] and 7532 men [58.50%]; mean [SD] age, 37.9 [5.6] years), the use of ADHD medications during the previous 2 years was associated with a 10% lower risk of long-term unemployment in the following year (adjusted RR, 0.90 [95% CI, 0.87-0.95]). An association between use of ADHD medications and long-term unemployment was found among women (RR, 0.82 [95% CI, 0.76-0.89]) but not men (RR, 0.96 [95% CI, 0.91-1.01]). Longer treatment duration was associated with a lower risk of subsequent long-term unemployment among women (RR for use of 1-6 months, 0.86 [95% CI, 0.78-0.95]; RR for use of 18-24 months, 0.72 [95% CI, 0.58-0.90]; P < .001 for trend). Within-individual comparisons showed that the long-term unemployment rate was lower during periods of ADHD medication treatment compared with nontreatment periods (RR, 0.89; 95% CI, 0.85-0.94). CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that the use of ADHD medication is associated with a lower risk of subsequent long-term unemployment for middle-aged women. These findings should be considered together with the existing knowledge of risks and benefits of ADHD medication when developing treatment plans for working-age adults.
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Affiliation(s)
- Lin Li
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Ewa Ahnemark
- Medical Affairs, Shire Sweden AB, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Chen L, Mittendorfer-Rutz E, Björkenstam E, Rahman S, Gustafsson K, Taipale H, Tanskanen A, Ekselius L, Helgesson M. Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood. J Atten Disord 2022; 26:723-734. [PMID: 34154443 PMCID: PMC8785279 DOI: 10.1177/10870547211025605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. METHOD In total, 9718 individuals diagnosed with incident ADHD in young adult age (19-29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. RESULTS Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39-1.71); low educational level (HR = 1.97; 95%CI 1.60-2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35-2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17-2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66-2.80), autism (HR = 1.87; 95%CI 1.42-2.46), anxiety (HR = 1.34; 95%CI 1.22-1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. CONCLUSION Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.
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Affiliation(s)
- Lingjing Chen
- Karolinska Institutet, Stockholm, Sweden,Lingjing Chen, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, Stockholm SE-171 77, Sweden.
| | | | - Emma Björkenstam
- Karolinska Institutet, Stockholm, Sweden,Uppsala University, Sweden
| | | | | | - Heidi Taipale
- Karolinska Institutet, Stockholm, Sweden,Niuvanniemi Hospital, Kuopio, Finland,University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Karolinska Institutet, Stockholm, Sweden,Niuvanniemi Hospital, Kuopio, Finland
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25
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Seo JC, Jon DI, Shim SH, Sung HM, Woo YS, Hong J, Park S, Seo JS, Bahk WM. Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder Among Adults and Children/Adolescents in Korea. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:126-134. [PMID: 35078955 PMCID: PMC8813326 DOI: 10.9758/cpn.2022.20.1.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. METHODS This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. RESULTS We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (> 18 years) during this period. Among adult and children/ adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74-61.93) and 78.72% (95% CI 78.53- 78.91) had at least one psychiatric comorbidity, respectively. CONCLUSION Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.
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Affiliation(s)
- Jeong-Cheol Seo
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, Korea
| | - Hyung-Mo Sung
- Department of Psychiatry, Soonchunhyang University Gumi Hospital, Soonchunhyang University, Gumi, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeongwan Hong
- Department of Psychiatry, Iksan Hospital, Iksan, Korea
| | | | - Jeong Seok Seo
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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26
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Heal DJ, Gosden J, Smith SL. New Drugs to Treat ADHD: Opportunities and Challenges in Research and Development. Curr Top Behav Neurosci 2022; 57:79-126. [PMID: 35507283 DOI: 10.1007/7854_2022_332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Since the landmark MTA (Multimodal Treatment of ADHD) trial unequivocally demonstrated the efficacy of methylphenidate, catecholaminergic drugs, especially stimulants, have been the therapeutic mainstay in treatment of Attention-Deficit Hyperactivity Disorder (ADHD). We review the new drugs which have entered the ADHD formulary. The lessons learned from drug-candidates that have succeeded in clinical trials together with those that have not have also been considered. What emerges confirms and consolidates the hypothesis that clinically effective ADHD drugs indirectly or directly increase catecholaminergic neurotransmission in the prefrontal cortex (PFC). Attempts to enhance catecholaminergic signalling through modulatory neurotransmitter systems or cognitive-enhancing drugs have all failed. New drugs approved for ADHD are catecholaminergic reuptake inhibitors and releasing agents, or selective noradrenaline reuptake inhibitors. Triple reuptake inhibitors with preferential effects on dopamine have not been successful. The substantial number of failures probably accounts for a continued focus on developing novel catecholaminergic and noradrenergic drugs, and a dearth of drug-candidates with novel mechanisms entering clinical development. However, substantial improvements in ADHD pharmacotherapy have been achieved by the almost exclusive use of once-daily medications and prodrugs, e.g. lisdexamfetamine and Azstarys®, which improve compliance, deliver greater efficacy and reduce risks for diversion and abuse.
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Affiliation(s)
- David J Heal
- DevelRx Ltd, Nottingham, UK.
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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27
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Ekström L, Broström S, Dahl ML, Börjesson A. A Summary of Online Enquiries Submitted to Anti-doping Hotline 2005–2018. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:787954. [PMID: 36304044 PMCID: PMC9580816 DOI: 10.3389/frph.2021.787954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Anabolic Androgenic Steroid (AAS) abuse in the society is considered a health problem and has been associated with cardiovascular toxicity, endocrine disruption, as well as psychiatric symptoms such as aggression and cognitive dysfunction. Men and women abusing AAS, as well as persons in close relationship to AAS abusers, may encounter concerns. Subsequently, the Anti-Doping Hotline was formed 1993 to answers questions about doping in the society. Here we have reviewed 7,123 enquiries posted on the Anti-Doping Hotline website between 2005 and 2018 to see what type of questions were raised. Most questions (n = 2,924) involved AAS, 60% from abusers themselves, and 17% from a person close to an AAS abusers. Only 2.3% of the questions concerned AAS abusing women. Of the AAS specific questions most were from persons who sought personal advice regarding risks and side effects. Notably, the AAS abusers themselves were concerned about somatic side effects (e.g., gynecomastia) and problems related to the AAS injection. The persons in close relationship to an AAS abusers on the other hand, expressed concerns about psychiatric changes including mood swings and aggressivity. In addition to AAS, 26 and 13% of the questions involved dietary supplements and other doping substances, respectively. A gradual decrease of questions regarding ephedrine was noted, whereas the numbers of SARMs related questions increased during this time. Our results show that there is a continuous need to provide medical, nursing, and social support and counseling to AAS abusers and their next of kin.
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Affiliation(s)
- Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Broström
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Annica Börjesson
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28
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Orm S, Øie MG, Fossum IN, Andersen PN, Skogli EW. Declining Trajectories of Co-occurring Psychopathology Symptoms in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A 10-Year Longitudinal Study. Front Psychiatry 2021; 12:724759. [PMID: 34721102 PMCID: PMC8553244 DOI: 10.3389/fpsyt.2021.724759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: Our objective was to examine developmental trajectories of co-occurring psychopathology symptoms from childhood to young adulthood in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), individuals with Autism Spectrum Disorder (ASD), and typically developing (TD) individuals. Method: We assessed co-occurring psychopathology symptoms in 61 individuals with ADHD, 26 with ASD, and 40 TD individuals at baseline (T1; Mage = 11.72, 64% boys), 2-year follow up (T2; Mage = 13.77), and 10-year follow up (T3; Mage = 21.35). We analyzed trajectories of internalizing behaviors, externalizing behaviors, and total problems with linear mixed models. Results: From T1 to T3, the ADHD group displayed a small decline in internalizing behaviors (d = -0.49) and large declines in externalizing behaviors (d = -0.78) and total problems (d = -0.71). The ASD group displayed large declines in internalizing behaviors (d = -0.79), externalizing behaviors (d = -0.80), and total problems (d = -0.89). From T1 to T2, the decline in externalizing behaviors and total problems were significantly smaller in the ADHD group compared with the ASD group. The ADHD and the ASD group displayed more co-occurring symptoms compared with the TD group at T3. Conclusion: Individuals with ADHD and ASD, respectively, displayed declines in co-occurring symptoms from childhood to young adulthood. Individuals with ASD displayed an earlier decline compared with individuals with ADHD. Compared with TD individuals, individuals with ADHD and ASD, respectively, continued to display elevated levels of co-occurring symptoms in young adulthood.
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Affiliation(s)
- Stian Orm
- Division Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway
| | - Ingrid Nesdal Fossum
- Division Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Per Normann Andersen
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
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29
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Pojanapotha P, Boonnag C, Siritikul S, Chalanunt S, Kuntawong P, Wongpakaran N, Wongpakaran T. Helpful family climate moderates the relationship between perceived family support of ADHD symptoms and depression: a conditional process model. BMC Psychol 2021; 9:112. [PMID: 34321085 PMCID: PMC8317368 DOI: 10.1186/s40359-021-00615-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of attention deficit hyperactivity disorder (ADHD) are commonly comorbid with depression This study aimed to examine the relationship between ADHD symptoms and depression through perceived family support and to explore whether the magnitude of the relationship depended on the type of family climate of medical students. METHODS This cross-sectional study was conducted among 124 first year medical students in Thailand. Participants completed questionnaires on ADHD symptoms, depression, perceived family support, and 9 types of family climate. The questionnaires included the Adult ADHD Self-Report Scale Screener, Patient Health Questionnaire-9, and revised Thai Multidimensional Scale of Perceived Social Support. Mediational analysis was adopted to examine the mediating role of perceived family support in the relationship between ADHD symptoms and depression, while moderation analysis was applied to examine the extent of the relationship depending on family climate. RESULTS The relationship between ADHD symptoms and depression was moderate. Perceived family support partially mediated this relationship after controlling for age and sex. Among the types of family climate, only helpful family climate was a significant moderator of perceived family support and depression. The moderated mediation model increased the variance in depression from 17% by the mediation model to 21%. However, follow-up conditional mediational analysis showed that the indirect effect of ADHD symptoms on depression via perceived family support was not significant and that this effect did not vary linearly as a function of helpful family climate. CONCLUSION The findings of the study revealed that poor family support might be one risk of developing depression in the context of ADHD symptoms. Further study on providing intervention concerning family support among those with ADHD symptoms should be warranted. In addition, a study on helpful family climate in a larger sample size, in other populations, and in a longitudinal fashion for a more robust conclusion is encouraged.
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Affiliation(s)
- Pichaya Pojanapotha
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | | | | | | | - Pimolpun Kuntawong
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
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30
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Al-Saad MSH, Al-Jabri B, Almarzouki AF. A Review of Working Memory Training in the Management of Attention Deficit Hyperactivity Disorder. Front Behav Neurosci 2021; 15:686873. [PMID: 34366803 PMCID: PMC8334010 DOI: 10.3389/fnbeh.2021.686873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Working memory deficits underlie many of the behavioural symptoms of ADHD. Alongside psychostimulant medications, strategies to improve working memory may play an important adjuvant role in the management of ADHD. In this study, we review the role of working memory deficits in ADHD, the evidence surrounding working memory training strategies in the management of the condition, and the factors affecting the success of these strategies in alleviating ADHD symptoms. More specifically, we review several non-pharmacological interventions that target working memory deficits in ADHD, with special emphasis on cognitive working memory training. We conclude that the development of evidence-based interventions such as computerised cognitive training (CCT) could provide an alternative or adjunct to the use of psychostimulants, especially in cases where side effects are a major issue.
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Affiliation(s)
- Maha Saleh Habsan Al-Saad
- Faculty of Medicine, Department of Clinical Physiology, King Abdulaziz University, Jeddah, Saudi Arabia.,Public Health Sector, General Directorate of Health Affairs in Najran, Ministry of Health, Najran, Saudi Arabia
| | - Basma Al-Jabri
- Faculty of Medicine, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer F Almarzouki
- Faculty of Medicine, Department of Clinical Physiology, King Abdulaziz University, Jeddah, Saudi Arabia
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31
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Savard J, Hirvikoski T, Görts Öberg K, Dhejne C, Rahm C, Jokinen J. Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder. J Behav Addict 2021; 10:839-847. [PMID: 34280126 PMCID: PMC8997222 DOI: 10.1556/2006.2021.00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/23/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Impulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity. METHODS Men with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors' Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files. RESULTS Approximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73-0.75) and attentional impulsivity (r = 0.36-0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001). DISCUSSION Self-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder. CONCLUSION Neurodevelopmental disorders and attentional impulsivity - including suitable interventions - should be further investigated in both disorders.
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Affiliation(s)
- Josephine Savard
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,ANOVA, Karolinska University Hospital, Stockholm, Sweden,Corresponding author. ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden. Tel.: (+46)8-517 732 00. fax: (+46)8-517 718 14. E-mail:
| | - Tatja Hirvikoski
- Department of Women’s and Children’s Health, Pediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden,Habilitation & Health, Stockholm Health Care Services, Region Stockholm, Sweden,Centre for Psychiatry Research, Region Stockholm, Stockholm, Sweden
| | - Katarina Görts Öberg
- ANOVA, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 118:282-289. [DOI: 10.1016/j.neubiorev.2020.07.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
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Werbart Törnblom A, Sorjonen K, Runeson B, Rydelius P. Who Is at Risk of Dying Young from Suicide and Sudden Violent Death? Common and Specific Risk Factors among Children, Adolescents, and Young Adults. Suicide Life Threat Behav 2020; 50:757-777. [PMID: 32012342 PMCID: PMC7497083 DOI: 10.1111/sltb.12614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Suicides and other sudden violent deaths are the most common causes of death among young people worldwide. This case-control study compared risk factors for suicide and other sudden violent death among young people. METHOD A total of 436 psychological autopsy interviews with next of kin were performed. The samples aged 10-25 years included 63 cases of suicide, 62 cases of other sudden violent death, and 104 matched living controls. Two stepwise multiple logistic regression analyses were performed. RESULTS The number of recent stressful life events was the only common risk factor for suicide and other sudden violent death. Specific risk factors for suicide were any form of addiction and being an inpatient in adult psychiatric care. Specific risk factors for other sudden violent death were lower elementary school results, lower educational level, and abuse of psychoactive drugs. CONCLUSIONS The suicide group seems to have been more vulnerable and exposed to different kinds of stressors, whereas the sudden violent death group seems to have been more acting out and risk-taking. Both groups must be the subject of prevention and intervention programs.
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Affiliation(s)
- Annelie Werbart Törnblom
- Department of Women's and Children's HealthCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
| | - Kimmo Sorjonen
- Division of PsychologyDepartment of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Bo Runeson
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
| | - Per‐Anders Rydelius
- Department of Women's and Children's HealthCentre for Psychiatry ResearchKarolinska InstitutetStockholm County CouncilStockholmSweden
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Allgulander C. Mental health care in Sweden. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lugnegård T, Bejerot S. Retrospective parental assessment of childhood neurodevelopmental problems: the use of the Five to Fifteen questionnaire in adults. BJPsych Open 2019; 5:e42. [PMID: 31530308 PMCID: PMC6537455 DOI: 10.1192/bjo.2019.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder and autism are increasingly recognised in adults. For a diagnostic evaluation, parental information on childhood development is needed. However, no instruments that retrospectively describe neurodevelopmental problems in childhood are validated for evaluating adults. The 181-item parent-report questionnaire Five to Fifteen (FTF) is nevertheless frequently used for assessments in adulthood. AIMS To examine if FTF is reliable for obtaining retrospective neurodevelopmental history among young adults. METHOD Details of parents who had assessed their children with the FTF for neuropsychiatric evaluation were retrieved and they were asked to complete the FTF again 10-19 years later. Agreements between original and retrospective scorings were analysed. RESULTS Long-term reliability for FTF varies considerably between individual items. Several difficulties are reported as more severe at the retrospective scoring than at the original scoring. A selection of 24 items (FTF-Brief) with good agreement over time, is presented for use in adult psychiatry settings. CONCLUSION Neuropsychiatric symptoms may fluctuate over time and become more prominent when demands increase. Informants' recollections of their child's neurodevelopmental symptoms may be a selection of symptoms that are longstanding rather than present at a specific age in childhood. DECLARATION OF INTEREST None.
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Affiliation(s)
- Tove Lugnegård
- Doctor, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Susanne Bejerot
- Doctor, School of Medical Sciences and the University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
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Chutko LS, Surushkina SY, Yakovenko EA, Anisimova TI, Antokhin EY, Kryukova EY. Cognitive control impairment in adult with attention deficit/hyperactivity disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:31-35. [DOI: 10.17116/jnevro201811812131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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