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Wyler H, van Wijnkoop M, Smith A, Retz W, Liebrenz M, Buadze A. Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland. Front Psychiatry 2024; 15:1403618. [PMID: 38903643 PMCID: PMC11187301 DOI: 10.3389/fpsyt.2024.1403618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/10/2024] [Indexed: 06/22/2024] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is prevalent amongst offenders, increasing risks for aggressive and delinquent behaviors. Since ADHD and its symptoms can persist into adulthood, accurately diagnosing and maintaining diagnoses in offenders is crucial to ensure appropriate treatment and reduce recidivism. Methods This study employed a retrospective longitudinal design to investigate ADHD amongst adult offenders with a confirmed diagnosis of ADHD during childhood or adolescence at a Swiss forensic outpatient clinic between 2008 and 2021. N = 181 patient files were reviewed, including forensic expert witness assessments and treatment reports. We charted the adulthood trajectory of patients with a confirmed childhood/adolescence ADHD diagnosis, examining the course of their diagnoses. Results Of 181 patients, evidence indicated that 12 (7%) had an ADHD diagnosis in childhood/adolescence. In 1 (8%) of these 12 cases, the diagnosis was maintained throughout the observation period. For 4 patients (33%), a diagnosis was given in the first forensic psychiatric expert witness assessment in adulthood but subsequently dropped. In another 4 cases (33%), the diagnosis was dropped in adulthood but later re-assigned, whereas in 3 cases (25%), the diagnosis was discontinued throughout the observation period. In 50% of cases with a diagnostic change, the discontinuation of an adult ADHD diagnosis coincided with a newly diagnosed personality disorder (or vice versa). Conclusions Our findings highlighted considerable inconsistencies in the assignment of adult ADHD diagnoses amongst offenders. Whilst ADHD remission in adulthood occurs, the diagnostic variability in our results warrants detailed scrutiny. One possibility is that ADHD has similar fluctuations to conditions like depression, as argued elsewhere. Equally, diagnoses may become "lost", meaning they are not given even when applicable and replaced by other diagnoses. Additionally, residual symptoms may remain but beyond the diagnostic threshold. This is significant because untreated ADHD can increase re-offending risks and adverse health outcomes.
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Affiliation(s)
- Helen Wyler
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
- Faculty of Behavioural Sciences and Psychology, University of Lucerne, Lucerne, Switzerland
| | | | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Medical Center, Saarland University, Homburg, Germany
- University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Ana Buadze
- ADHD Specialty Clinic, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Auro K, Holopainen I, Perola M, Havulinna AS, Raevuori A. Attention-Deficit/Hyperactivity Disorder Diagnoses in Finland During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2418204. [PMID: 38935377 PMCID: PMC11211961 DOI: 10.1001/jamanetworkopen.2024.18204] [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] [Received: 11/24/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024] Open
Abstract
Importance Several reports suggest an increase in attention-deficit/hyperactivity disorder (ADHD) symptoms during the COVID-19 pandemic. This nationwide study assessed new ADHD diagnoses and ADHD prevalence before and during the pandemic. Objective To investigate trends in new ADHD diagnoses, prevalence, and ADHD medication use from 2015 to 2022 in Finland. Design, Setting, and Participants This longitudinal cohort study comprised the entire Finnish population. ADHD diagnoses and medication use were obtained from nationwide registers and assessed at 3 time points: in 2015 and before (2020) and after (2022) the pandemic. Data were analyzed from January 2015 to June 2022. Main outcomes and Measures New ADHD diagnoses, ADHD lifetime prevalence, and ADHD medication use. Results The cohort comprised 5 572 420 individuals (2 819 645 women [50.6%]). Lifetime prevalence of ADHD increased by 2.7-fold during 2015 to 2022; prevalence was 1.02% in 2015 (95% CI, 1.01%-1.03%), 1.80% in 2020 (95% CI, 1.79%-1.81%), and 2.76% in 2022 (95% CI, 2.75%-2.77%). Young men aged 13 to 20 years had the highest lifetime prevalence of 11.68% (95% CI, 11.56%-11.81%) in 2022. New ADHD diagnoses doubled during the pandemic, from 238 per 100 000 in 2020 to 477 per 100 000 in 2022. The pandemic-associated incremental increase in new diagnoses was 18.60% (95% CI, 16.47%-20.49%; 9482 per 50 897 cases). Young women aged 13 to 20 years had a 2.6-fold increase in new diagnoses during the pandemic, from 577 per 100 000 in 2020 to 1488 per 100 000 in 2022, and women aged 21 to 30 years had a 3.0-fold increase, from 361 per 100 000 to 1100 per 100 000. New diagnoses increased by 2.9-fold among those older than 55 years (from 5 per 100 000 to 13 per 100 000 in women and from 5 per 100 000 to 14 per 100 000 in men). Boys younger than 13 years had the highest absolute rate of new ADHD diagnoses in 2022 (1745 per 100 000), but boys and young men younger than 21 years did not show a significant incremental increase in new diagnoses. Lifetime prevalence of ADHD medication purchases was 0.57% (95% CI, 0.56%-0.58%) in 2015 (31 771 [55.62%] of those with ADHD diagnosis), 1.15% (95% CI, 1.14%-1.16%) in 2020 (64 034 [63.83%]), and 1.69% (95% CI 1.68%-1.70%) in 2022 (92 557 [61.43%]), respectively. Conclusions and Relevance In this nationwide cohort study, new ADHD diagnoses and ADHD prevalence showed significant increase in Finland during the pandemic. ADHD medication use did not increase in relation to ADHD diagnoses. These results highlight potential adverse outcomes of pandemic-associated changes in living conditions.
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Affiliation(s)
- Kirsi Auro
- Division of Adolescent Psychiatry, Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Clinicum, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Ida Holopainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Markus Perola
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Aki S. Havulinna
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
- Institute for Molecular Medicine Finland, FIMM-HiLIFE, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Division of Adolescent Psychiatry, Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Clinicum, Helsinki, Finland
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Banaschewski T, Häge A, Hohmann S, Mechler K. Perspectives on ADHD in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use. Front Psychiatry 2024; 14:1289157. [PMID: 38250274 PMCID: PMC10796544 DOI: 10.3389/fpsyt.2023.1289157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
The diagnosis of attention-deficit hyperactivity disorder (ADHD) is based on the presence of pervasive, persistent symptoms of inattention and/or hyperactivity/impulsivity typically emerging early in life and resulting in significant functional impairment. In contrast to a worldwide epidemiological prevalence of approximately 5% in children and 2-3% in adults, there are significant variations in the prevalence of administrative ADHD diagnoses and medication use. We assert that in order to explore the underlying dynamics of this phenomenon, a thorough understanding of the construct ADHD is necessary. We contend that ADHD is not a natural entity that unfolds within an individual and can be understood independent from societal and environmental factors, but rather that ADHD as a diagnosis can better be conceptualized as a valid and pragmatically useful social construct. Decisions to diagnose and treat ADHD should follow a person-centered approach and be focused on functional impairment within a socially constructed, context-dependent and environmentally contingent model.
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Affiliation(s)
- Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konstantin Mechler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Beaugrand M, Jaramillo V, Markovic A, Huber R, Kohler M, Schoch SF, Kurth S. Lack of association between behavioral development and simplified topographical markers of the sleep EEG in infancy. Neurobiol Sleep Circadian Rhythms 2023; 15:100098. [PMID: 37424705 PMCID: PMC10329166 DOI: 10.1016/j.nbscr.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
The sleep EEG mirrors neuronal connectivity, especially during development when the brain undergoes substantial rewiring. As children grow, the slow-wave activity (SWA; 0.75-4.25 Hz) spatial distribution in their sleep EEG changes along a posterior-to-anterior gradient. Topographical SWA markers have been linked to critical neurobehavioral functions, such as motor skills, in school-aged children. However, the relationship between topographical markers in infancy and later behavioral outcomes is still unclear. This study aims to explore reliable indicators of neurodevelopment in infants by analyzing their sleep EEG patterns. Thirty-one 6-month-old infants (15 female) underwent high-density EEG recordings during nighttime sleep. We defined markers based on the topographical distribution of SWA and theta activity, including central/occipital and frontal/occipital ratios and an index derived from local EEG power variability. Linear models were applied to test whether markers relate to concurrent, later, or retrospective behavioral scores, assessed by the parent-reported Ages & Stages Questionnaire at ages 3, 6, 12, and 24 months. Results indicate that the topographical markers of the sleep EEG power in infants were not significantly linked to behavioral development at any age. Further research, such as longitudinal sleep EEG in newborns, is needed to better understand the relationship between these markers and behavioral development and assess their predictive value for individual differences.
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Affiliation(s)
| | - Valeria Jaramillo
- University of Surrey, School of Psychology, Guildford, United Kingdom
| | - Andjela Markovic
- University of Fribourg, Department of Psychology, Fribourg, Switzerland
- University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland
| | - Reto Huber
- Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, Switzerland
| | - Malcolm Kohler
- University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland
- Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Sarah F. Schoch
- University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Salome Kurth
- University of Fribourg, Department of Psychology, Fribourg, Switzerland
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Waltereit R, Ehrlich S, Roessner V. First-time diagnosis of ADHD in adults: challenge to retrospectively assess childhood symptoms of ADHD from long-term memory. Eur Child Adolesc Psychiatry 2023; 32:1333-1335. [PMID: 37286879 PMCID: PMC10326145 DOI: 10.1007/s00787-023-02244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Robert Waltereit
- Department of Child and Adolescent Psychiatry, LWL-Klinikum Marsberg, Bredelarer Str. 33, 34431, Marsberg, Germany
- Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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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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Scarpellini F, Bonati M. Transition care for adolescents and young adults with attention-deficit hyperactivity disorder (ADHD): A descriptive summary of qualitative evidence. Child Care Health Dev 2022; 49:431-443. [PMID: 36223008 DOI: 10.1111/cch.13070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022]
Abstract
The review presents a summary of available evidence about transition care of ADHD patients from all service users' perspectives. Common barriers, and suggestions for improvement ADHD of transition care, were extrapolated from qualitative research, including case notes studies, and were exposed. A comprehensive search of the PubMed, Embase, PsychInfo and Web of Science databases for articles published up to October 2021 was conducted to summarize recent evidence on the experiences of all stakeholders involved in the transition process. Reviews, other chronic conditions and different meaning of transition were excluded. Authors extracted data and assessed study quality independently. Findings were discussed taking into consideration barriers and suggestions from all service users' perspectives. Findings from 23 studies with different context and methods were collected and summarized. Most of the studies were conducted in UK, using interviews and questionnaires, and addressed to the physicians. The lack of information about ADHD as a condition and about transition process were the barriers most reported, while joint working and sharing transition protocols were the suggestions pointed out by all stakeholders. Despite different perspectives, all stakeholders exposed similar needs. The review reveals an evident need for defining and evaluating the effectiveness of transition programmes from child to adult ADHD services.
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Affiliation(s)
- Francesca Scarpellini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Fechner ME, Mazheika Y, Fehr F, Jung R, Borusiak P. Is it all about knowledge? A survey of attitudes toward ADHD among German pediatricians. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-9. [PMID: 36188445 PMCID: PMC9510220 DOI: 10.1007/s10389-022-01758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022]
Abstract
Aim Sometimes treatment is not necessarily according to guidelines, which is partly due to attitudes rather than lack of knowledge. In Germany, regional differences concerning prevalence rates of ADHD exist without valid explanation. We contribute with our data to the question of attitudes toward ADHD among pediatricians in Germany. Method A specially designed questionnaire based on the Knowledge of Attention Deficit Disorders Scale and previous surveys was sent to pediatricians. In addition to descriptive statistics, we performed factor analysis and multiple linear regression analysis. Results The vast majority (85.5%) of 581 respondents have a positive attitude toward ADHD, i.e., ADHD exists and should be treated appropriately. Physicians with positive attitudes were older and more often had a neuropediatric specialization. Conclusion Most of the pediatricians surveyed in Germany assess ADHD and treatment in line with medical guidelines and treat as part of multimodal therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01758-4.
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Affiliation(s)
| | - Yuliya Mazheika
- Wagener-Foundation for Social Pediatrics, Emsdetten, Germany
| | | | | | - Peter Borusiak
- Witten/Herdecke University, Witten, Germany
- Wagener-Foundation for Social Pediatrics, Emsdetten, Germany
- Kinderneurologisches Zentrum KiNZ, LVR-Klinik, Waldenburger Ring 46, D-53119 Bonn, Germany
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A Review of Canadian Diagnosed ADHD Prevalence and Incidence Estimates Published in the Past Decade. Brain Sci 2022; 12:brainsci12081051. [PMID: 36009114 PMCID: PMC9406225 DOI: 10.3390/brainsci12081051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined.
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Ballmann C, Kölle MA, Bekavac-Günther I, Wolf F, Pargent F, Barzel A, Philipsen A, Gensichen J. Evaluation of the German Version of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 as a Screening Tool for Adult Attention-Deficit/Hyperactivity Disorder in Primary Care. Front Psychol 2022; 13:858147. [PMID: 35529560 PMCID: PMC9075696 DOI: 10.3389/fpsyg.2022.858147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Adult attention-deficit/hyperactivity disorder (ADHD) is common, but often undiagnosed. A valid and time-efficient screening tool for primary care is needed. Objective of this study is to evaluate the German version of the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5) and its feasibility, acceptability, and reliability as a screening tool for adult ADHD in primary care. A multi-centered prospective, diagnostic study was performed. We recruited 262 patients in primary care practices and at an ADHD Outpatient Service of a department of psychiatry in Germany. Patients from 18 to 65 years with suspected or diagnosed ADHD were included by medical doctors, as well as non-ADHD patients as "negative controls." Participants filled in the ASRS-5 and a sociodemographic questionnaire. The Integrated Diagnosis of Adult ADHD, revised version (IDA-R) performed by trained interviewers was used for validation. Feasibility, acceptability, and credibility in primary care practices were examined through a semi-structured interview. The German version of the ASRS-5 showed comparable psychometric properties to the English original version (sensitivity 95.6% and specificity 72.3%). For factor structure, a parallel analysis suggested one latent dimension. Performing confirmatory factor analysis, the best fit was achieved for a general factor with one correlated error. Internal consistency results in Raykovs Omega = 0.86 and Cronbach's α = 0.88. The ASRS-5 was assessed positively in terms of feasibility, acceptability, and credibility by interviewed general practitioners. Potential problems were raised for "treatment options," "stigmatization," and "knowledge gaps." In conclusion, the German version of the ASRS-5 offers a promising tool to improve adult ADHD patients' diagnosis and healthcare.
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Affiliation(s)
- Cora Ballmann
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | | | - Anne Barzel
- Institute of General Medicine, Ulm University, Ulm, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
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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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12
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Rocco I, Corso B, Bonati M, Minicuci N. Time of onset and/or diagnosis of ADHD in European children: a systematic review. BMC Psychiatry 2021; 21:575. [PMID: 34784913 PMCID: PMC8594188 DOI: 10.1186/s12888-021-03547-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children's daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes. The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries. METHODS A systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review. RESULTS The lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years. CONCLUSIONS Our findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found. TRIAL REGISTRATION PROSPERO registration: CRD42017070631 .
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Affiliation(s)
- Ilaria Rocco
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy.
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Nadia Minicuci
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
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13
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[Psychoanalytic Treatments without Medication and Behavioral Therapy Treatments with and without Medication in Children with the Diagnosis of ADHD and/or Conduct Disorder]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:499-519. [PMID: 34519617 DOI: 10.13109/prkk.2021.70.6.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The controlled, prospective intervention study without randomization with a non-inferiority study design investigates the effectiveness of psychoanalytic treatments without medication in comparison to behavioral therapy treatments with and without medication in children aged 6 to 11 years with a diagnosis of ADHD and/or conduct disorder. 73 children (58 boys and 15 girls) were included in the study. Diagnostics before treatment, at end of treatment and at follow-up after 38 months included a standardized clinical interview (DISYPS-KJ), questionnaires for parents, teachers and children (DISYPS-KJ, CBCL, TRF, CPRS, CTRS, ILK), intelligence test and behavioral observation of the child. Primary outcome criterion was disorder-specific symptom reduction at end of treatment and follow-up. Both treatment groups showed significant symptom reductions at end of treatment and at follow-up. There were no significant differences between treatment groups. Parent and teacher ratings showed significant improvements in both groups at end of treatment and at follow-up on the ADHD index, oppositional behavior, and hyperactivity/impulsivity scales, as well as on the externalizing and internalizing behavior problems scales. Quality of life improved for children in both treatment groups.
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14
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Akmatov MK, Holstiege J, Bätzing J. Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. BMC Psychiatry 2021; 21:405. [PMID: 34391396 PMCID: PMC8364007 DOI: 10.1186/s12888-021-03409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The study aim was to examine the secular trends and regional variations in pharmacotherapy of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in Germany. METHODS We used nationwide drug prescription data of outpatient care (2009 to 2016). The study population comprised patients aged between 5 and 14 years with the diagnoses "hyperkinetic disorders" (ICD-10 code F90) (e.g. n = 262,766 in 2016). The examined drugs were methylphenidate, amphetamines, atomoxetine and guanfacine. RESULTS Overall, the proportion of patients received any prescription showed a decreasing trend over years (2010, 51%; 2016, 44%). The proportion of methylphenidate prescription was higher in Western than Eastern federal states. However, atomoxetine was more often prescribed in Eastern than Western federal states. The proportion of methylphenidate prescriptions issued by pediatric psychiatrists increased from 28% (2009) to 41% (2016). CONCLUSION A decreasing trend in use of pharmacotherapy may be explained by prescription restrictions issued by the Federal Joint Committee in recent years.
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Affiliation(s)
- Manas K. Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany, Salzufer 8, 10587 Berlin, Germany
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15
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Jaite C, Hoffmann F, Seidel A, Mattejat F, Bachmann C. [Outpatient Psychological Therapies in Children and Adolescents in Germany: Status Quo and Time Trends, 2009-2018]. PSYCHIATRISCHE PRAXIS 2021; 49:304-312. [PMID: 34352894 DOI: 10.1055/a-1540-4958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the prevalence of outpatient psychological therapies (PT) in youths with statutory health insurance in Germany. METHODS Based on statutory health insurance funds data for 2009-2018, the prevalence of outpatient PT was assessed, stratified by sex, age, and federal state. Psychotherapeutic specialty, coded psychiatric diagnoses, and type of PT were also analysed. RESULTS In 2018, 7.3 % received any form of PT (2009: 7.1 %). Of these, 18.4 % (2009: 12.8 %) received therapy according to the directives for psychotherapy (dPT), with CBT (since 2012) being most frequently used. PT prevalence was highest in 15- to 19-year olds, and only marginally differed by sex. Child psychiatrists delivered the majority of PTs. Main diagnoses were anxiety/emotional disorders, ADHD, and adjustment disorders. CONCLUSION During the studied period, PT prevalence has not changed markedly. Yet, the share of dPT has increased, with CBT ranking top.
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Affiliation(s)
- Charlotte Jaite
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Falk Hoffmann
- Carl von Ossietzky Universität Oldenburg, Abteilung Ambulante Versorgung und Pharmakoepidemiologie
| | - Anja Seidel
- Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Fachbereich Versorgungsforschung, Systemanalyse und Data Science
| | | | - Christian Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
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16
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Sasaki Y, Tsujii N, Sasaki S, Sunakawa H, Toguchi Y, Tanase S, Saito K, Shinohara R, Kurokouchi T, Sugimoto K, Itagaki K, Yoshida Y, Namekata S, Takahashi M, Harada I, Hakosima Y, Inazaki K, Yoshimura Y, Mizumoto Y, Okada T, Usami M. Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan. PLoS One 2021; 16:e0252420. [PMID: 34081716 PMCID: PMC8174687 DOI: 10.1371/journal.pone.0252420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background/aim Patients with attention-deficit hyperactivity disorder (ADHD) manifest symptoms of hyperactivity, impulsivity, and/or inattention. ADHD medications available in Japan are limited compared with those in Western countries. Prescribing status has not been sufficiently evaluated in clinical settings in Japan. This study investigated the current use of ADHD medications and characteristics of patients who received multiple ADHD medications in a clinical setting in Japan. Methods Study participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital between April 2015 and March 2020. We investigated patients who received osmotic-controlled release oral delivery system methylphenidate, atomoxetine, or guanfacine. A retrospective case–control design was used to evaluate the characteristics of patients who received multiple ADHD medications. Patients who were given three ADHD medications were defined as the case group. Randomly sampled sex- and age-matched patients diagnosed with ADHD were defined as the control group. We compared data for child-to-parent violence, antisocial behavior, suicide attempt or self-harm, abuse history, refusal to attend school, and two psychological rating scales (the ADHD-Rating Scale and Tokyo Autistic Behavior Scale). Results Among the 878 patients who were prescribed any ADHD medications, 43 (4.9%) received three ADHD medications. Logistic regression revealed that children with severe ADHD symptoms, autistic characteristics, or tendency of child-to-parent violence were more likely to have been prescribed three medications during their treatment. Conclusions Our findings suggest the approach to prevent the use of multiple ADHD medications. A prospective study to investigate the causality between prescribing status and clinical characteristics is warranted.
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Affiliation(s)
- Yoshinori Sasaki
- Department of Psychiatry and Behavioral Science, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Noa Tsujii
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shouko Sasaki
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Hikaru Sunakawa
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yusuke Toguchi
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Syuuichi Tanase
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Kiyoshi Saito
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Rena Shinohara
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Toshinari Kurokouchi
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Kaori Sugimoto
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Kotoe Itagaki
- Department of Clinical Psychology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yukino Yoshida
- Clinical Center of Children’s Mental Health, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Saori Namekata
- Department of Clinical Psychology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Momoka Takahashi
- Clinical Center of Children’s Mental Health, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Ikuhiro Harada
- Department of Social Worker, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yuuki Hakosima
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Kumi Inazaki
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yuta Yoshimura
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yuki Mizumoto
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Takayuki Okada
- Department of Psychiatry and Behavioral Science, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
- Department of Clinical Psychology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
- Clinical Center of Children’s Mental Health, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
- * E-mail: , ,
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17
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Speerforck S, Hertel J, Stolzenburg S, Grabe HJ, Carta MG, Angermeyer MC, Schomerus G. Attention Deficit Hyperactivity Disorder in Children and Adults: A Population Survey on Public Beliefs. J Atten Disord 2021; 25:783-793. [PMID: 31271090 PMCID: PMC7897776 DOI: 10.1177/1087054719855691] [Citation(s) in RCA: 9] [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: 01/03/2023]
Abstract
Objective: To investigate beliefs and attitudes of the public toward attention deficit hyperactivity disorder (ADHD) in children and adults. Method: In a representative population survey in Germany (N = 1,008) using computer-assisted telephone interviews, we asked participants about causal beliefs, illness recognition, treatment recommendations, and beliefs about ADHD, presenting an unlabelled vignette of a child or an adult with ADHD. Results: The most frequently endorsed causal beliefs for the depicted child with ADHD were "TV or Internet," "lack of parental affection," and "broken home." In comparison with the child vignette, biological causal beliefs were endorsed more often after the adult vignette. In the child vignette, 66% advised against a treatment with stimulant medication. About 90% of respondents had heard of ADHD. Of those, 20% said they believed ADHD to be not a real disease. Conclusion: Beliefs of the German public partly contradict evidence and should be considered in therapeutical and public contexts.
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Affiliation(s)
- Sven Speerforck
- University Medicine Greifswald, Germany,Sven Speerforck, Department of Psychiatry, University of Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany.
| | | | | | | | - Mauro G. Carta
- Center for Public Mental Health, Gösing am Wagram, Austria
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18
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Ishizuya A, Enomoto M, Tachimori H, Takahashi H, Sugihara G, Kitamura S, Mishima K. Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder. Sci Rep 2021; 11:1707. [PMID: 33462331 PMCID: PMC7814069 DOI: 10.1038/s41598-021-81416-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Poor adherence is a major concern in the treatment of attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to evaluate factors linked to early interruption of and low adherence to treatment with osmotic-release oral system methylphenidate hydrochloride (OROS-MPH) in pediatric patients with ADHD. A total of 1353 young people (age 6–17 years) with a diagnosis of ADHD who newly started OROS-MPH were extracted from the pharmacoepidemiological data of 3 million people in Japan. The cohort was retrospectively surveyed every month for 12 months. Ten possible risk factors were extracted from the data and analyzed by multivariable logistic regression. Sensitivity analysis was conducted to ensure the robustness of the analysis. The results revealed that treatment adherence was generally poor, with a tendency for discontinuation in the early stage. Multivariable logistic regression results showed that adherence is reduced by female sex, lower starting dose, and concomitant atomoxetine or hypnotics. These findings may help clinicians to predict the risk of poor adherence in the early stage of treatment and improve not only patients’ symptoms, but also their quality of life.
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Affiliation(s)
- Asami Ishizuya
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.,Department of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita-city, Akita, 010-8543, Japan.,Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan
| | - Minori Enomoto
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita-city, Akita, 010-8543, Japan. .,Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan. .,International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Japan.
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19
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Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives. Neural Plast 2021; 2021:8823383. [PMID: 33519929 PMCID: PMC7817276 DOI: 10.1155/2021/8823383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.
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20
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Cheung K, El Marroun H, Dierckx B, Visser LE, Stricker BH. Maternal Sociodemographic Factors Are Associated with Methylphenidate Initiation in Children in the Netherlands: A Population-Based Study. Child Psychiatry Hum Dev 2021; 52:332-342. [PMID: 32566998 PMCID: PMC7973638 DOI: 10.1007/s10578-020-01016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Multiple factors may contribute to the decision to initiate methylphenidate treatment in children such as maternal sociodemographic factors of which relatively little is known. The objective was to investigate the association between these factors and methylphenidate initiation. The study population included 4243 children from the Generation R Study in the Netherlands. Maternal sociodemographic characteristics were tested as determinants of methylphenidate initiation through a time-dependent Cox regression analysis. Subsequently, we stratified by mother-reported ADHD symptoms (present in 4.2% of the study population). When ADHD symptoms were absent, we found that girls (adjusted HR 0.25, 95%CI 0.16-0.39) and children born to a mother with a non-western ethnicity (compared to Dutch-Caucasian) (adjusted HR 0.42, 95%CI 015-0.68) were less likely to receive methylphenidate. They were more likely to receive methylphenidate when their mother completed a low (adjusted HR 2.29, 95%CI 1.10-4.77) or secondary (adjusted HR 1.71, 95%CI 1.16-2.54) education. In conclusion, boys and children born to a mother of Dutch-Caucasian ethnicity were more likely to receive methylphenidate, irrespective of the presence of ADHD symptoms.
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Affiliation(s)
- K Cheung
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Health and Youth Care Inspectorate, Utrecht, The Netherlands.
| | - H El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, University Medical Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - B Dierckx
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L E Visser
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Haga Teaching Hospital, The Hague, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Health and Youth Care Inspectorate, Utrecht, The Netherlands
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21
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Scholle O, Kollhorst B, Riedel O, Bachmann CJ. First-Time Users of ADHD Medication Among Children and Adolescents in Germany: An Evaluation of Adherence to Prescribing Guidelines Based on Claims Data. Front Psychiatry 2021; 12:653093. [PMID: 33935837 PMCID: PMC8081976 DOI: 10.3389/fpsyt.2021.653093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Drug utilization studies based on real-world data are vital for the identification of potentially needed improvements to rational prescribing. This is particularly important for the pharmacological treatment of children and adolescents with attention-deficit hyperactivity disorder (ADHD) due to the associated potential side effects and the frequent use. Whereas prevalent use is well-characterized, studies on first-time use of ADHD medication are scarce. This study aimed to evaluate off-label prescribing in first-time users of ADHD medication among children and adolescents in Germany based on three criteria: (i) lack of a documented ADHD diagnosis; (ii) first-time pharmacological treatment with a second-line drug; and (iii) patient age below 6 years. Methods: Based on German claims data, we included children and adolescents aged 0-17 years with a first-time dispensation of any ADHD medication in the period 2015-2017. These first-time users were characterized with regard to sex, age, specialty of the prescribing physician, documentation of an ADHD diagnosis, psychiatric hospitalization, psychiatric comorbidities, and history of other psychopharmacological drugs at first-time use. Results: The study population comprised 18,703 pediatric first-time users of ADHD medication. Of these, 9.8% had no documented ADHD diagnosis. Most of the ADHD drug users received first-line ADHD pharmacotherapy (methylphenidate, atomoxetine), whereas 2.6% were prescribed second-line ADHD medication (lisdexamfetamine, guanfacine, dexamfetamine, multiple ADHD drugs) as first drug. Overall, 1.2% of first-time users were aged below 6 years. A total of 12.7% of the study population met any off-label criterion. Conclusions: About 13% of pediatric first-time users of ADHD medication in Germany received an off-label pharmacotherapy at first-time use. Prescribing ADHD medication without a confirmed ADHD diagnosis was the most common of the three assessed off-label criteria. Off-label prescribing regarding drug choice and age of patients only occurred in a small percentage of initial pharmacological ADHD treatment. Our results suggest the need for improvement in rational prescribing, especially with regard to diagnostic requirements.
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Affiliation(s)
- Oliver Scholle
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Christian J Bachmann
- Department of Child & Adolescent Psychiatry, University Hospital Ulm, Ulm, Germany
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22
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Libutzki B, May M, Gleitz M, Karus M, Neukirch B, Hartman CA, Reif A. Disease burden and direct medical costs of incident adult ADHD: A retrospective longitudinal analysis based on German statutory health insurance claims data. Eur Psychiatry 2020; 63:e86. [PMID: 32998793 PMCID: PMC7576526 DOI: 10.1192/j.eurpsy.2020.84] [Citation(s) in RCA: 5] [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] [Indexed: 01/08/2023] Open
Abstract
Background. Adult attention-deficit/hyperactivity disorder (aADHD) is still a largely unrecognized psychiatric condition despite its strong impact on individuals’ well-being. Here, we describe the healthcare situation of individuals with incident aADHD over 4 years before and 4 years after initial administrative diagnosis. Methods. A retrospective, longitudinal cohort analysis was conducted using German claims data. The InGef database contained approximately 5 million member-records from over 60 nationwide statutory health insurances (SHI). Individuals were indexed upon initial diagnosis of aADHD. Results. Average age at diagnosis of aADHD was 35 years, and 60% of individuals were male. Comorbidities, resource use, and healthcare costs were substantial before initial diagnosis and decreased within the 4 years thereafter. Only 32% of individuals received initial ADHD medication and adherence was low. The majority received psychotherapy. Individuals with initial ADHD medication showed the highest share in comorbidities, physician visits, medication use for comorbidities, psychotherapy, and costs. Overall, healthcare costs were at over €4,000 per individual within the year of aADHD diagnosis. Conclusions. We conclude that earlier recognition of aADHD could prevent the development and aggravation of comorbid mental illnesses. At the same time, comorbid conditions may have masked (“over-shadowed”) aADHD and delayed diagnosis. The burden of disease in aADHD is high, which was noticeable especially among individuals who received initial ADHD-medication, suggesting that psychopharmacological treatment was mainly considered for the most severely ill. We conclude that measures to facilitate access of aADHD patients to clinical experts are required to improve reality of care in the outpatient setting.
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Affiliation(s)
- Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,HGC Healthcare Consultants GmbH, Düsseldorf, Germany
| | - Melanie May
- HGC Healthcare Consultants GmbH, Düsseldorf, Germany
| | - Markus Gleitz
- MEDICE Arzneimittel Pütter GmbH & Co KG, Iserlohn, Germany
| | - Michael Karus
- MEDICE Arzneimittel Pütter GmbH & Co KG, Iserlohn, Germany
| | - Benno Neukirch
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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23
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Drechsler R, Brem S, Brandeis D, Grünblatt E, Berger G, Walitza S. ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics 2020; 51:315-335. [PMID: 32559806 PMCID: PMC7508636 DOI: 10.1055/s-0040-1701658] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.
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Affiliation(s)
- Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Silvia Brem
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Methylphenidate treatment of adult ADHD patients improves the degree of ADHD severity under routine conditions. J Neural Transm (Vienna) 2020; 127:1427-1434. [PMID: 32880706 PMCID: PMC7497302 DOI: 10.1007/s00702-020-02226-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is associated with substantial personal and social impairments. Besides psychosocial interventions, current guidelines recommend a therapy with methylphenidate (MPH). This prospective, non-interventional study aims to investigate the efficacy and tolerability of MPH treatment of adult ADHD patients in a real-world setting. 468 adult patients with newly diagnosed ADHD were observed for 12–14 weeks. Primary efficacy endpoint was the clinical global impression (CGI) by the physician. Secondary endpoints comprise patient evaluation (Wender–Reimherr self-report, WR-SR), safety, tolerability, and dosage of MPH. With a mean daily dose of 35.8 (±17.0) mg MPH, the population of patients being severely/most extremely ill or markedly ill decreased by 64% and 61%, respectively. According to physicians’ assessment (CGI), 74.5% of patients were identified as treatment responders. The total score of patient-based assessment (WR-SR) improved by 23.5% (50.1 ± 40.3 points) with the most profound improvement in attention deficit (−30.0%), disorganization (−26.6%), and hyperactivity / unrest (−23.3%). Self-evaluation revealed a responder rate of 35.4%. In summary, MPH treatment improves the degree of ADHD severity under routine conditions. In addition, activities of daily living were facilitated when taking MPH. The rather poor responder rates determined by patient assessment as well as the comparatively low applied mean daily dose of 35.8 mg (median 40 mg) indicate sub-optimal dosing under routine conditions, not exploiting the full beneficial therapeutic potential of MPH.
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The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol 2020; 77:107-115. [PMID: 32803292 PMCID: PMC7782395 DOI: 10.1007/s00228-020-02948-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/26/2020] [Indexed: 01/14/2023]
Abstract
Purpose The aim of this study was to analyse whether the global trend in drug prescriptions for attention-deficit hyperactivity disorders (ADHD), as observed during the last years and often criticized as medicalization, have remained stable or shifted. Methods This observational study was based on a secondary analysis of data from a large German database including patients with an ADHD diagnosis between 2008 and 2018. Prescription data comprised all important ADHD drugs. Results A total of 620 practices delivered data from a total of 77,504 patients (31% of them females) with a diagnosis of AHDH. Nearly 38% (29,396/77,504) of all patients received, at least, one prescription for an ADHS medicine between 2008 and 2018. The number of patients receiving a drug steadily increased annually until 2012 and then slowly fell, but unevenly distributed across the age groups. While the number of younger patients ( ≤ 16 years) receiving a prescription fell by 24% and the defined daily doses (DDDs) remained stable, the number of patients between 17 and 24 years receiving a prescription increased by 113% and the DDDs by 150%. Respectively, the number of older adults (≥ 25 years) with a prescription increased by 355% and the DDDs by 515%. Nearly one-third of older adults received an ADHD medicine only once. Conclusion The ever-increasing prescription of ADHD medicines stopped some years ago for children. ADHS and its pharmacological management are increasingly observed among older adolescents and adults, with a different pattern of drug persistence compared with children. Electronic supplementary material The online version of this article (10.1007/s00228-020-02948-3) contains supplementary material, which is available to authorized users.
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Russell AE, Ford T, Russell G. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1555-1564. [PMID: 31073627 PMCID: PMC6858474 DOI: 10.1007/s00127-019-01720-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/25/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Little is known about sociodemographic and clinical factors that predict and act as barriers to ADHD medication independently of symptom severity. We examined the proportion of children using medication for ADHD, age of initiation of medication, and predictors of medication use in a population-representative cohort. METHODS Data from the Millennium Cohort Study on child ADHD, medication use for ADHD at age 14 (in 2014-2015) and child, parent and sociodemographic variables were collated. Logistic regression models were used to identify factors that predict medication use for ADHD (the main outcome measure), adjusting for symptom severity at age seven. RESULTS The weighted prevalence of ADHD was 3.97% (N = 11,708). 45.57% of children with ADHD (N = 305) were taking medication. The median age at initiation was 9 years (range 3-14). Male gender (AOR 3.66, 95% CI 1.75, 7.66) and conduct problems at age seven (AOR 1.24 95% CI 1.04, 1.47) and 14 predicted medication use at age 14 after adjusting for symptom severity. CONCLUSIONS Our study is the first to assess predictors of medication whist adjusting for ADHD symptom severity. Girls with ADHD were less likely to be prescribed medication, even when they displayed similar ADHD symptom levels to boys. Conduct problems also predicted medication independently of ADHD symptoms. ADHD may be more often medicated in boys because clinicians may think a prototypical ADHD child is male, and perhaps conduct problems make boys more disruptive in the classroom, leading to boys being more often treated.
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Affiliation(s)
- A E Russell
- Centre for Academic Mental Health, University of Bristol Medical School, Oakfield House, Bristol, BS8 2BN, UK.
| | - T Ford
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - G Russell
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
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Schubert M, Hegewald J, Freiberg A, Starke KR, Augustin F, Riedel-Heller SG, Zeeb H, Seidler A. Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183336. [PMID: 31510007 PMCID: PMC6765874 DOI: 10.3390/ijerph16183336] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023]
Abstract
Children and adolescents may be particularly vulnerable to environmental influences such as noise which can affect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Difficulties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9–10 years and 15–17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total difficulties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04–1.19), respectively 9% (95% CI 1.02–1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total difficulties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Franziska Augustin
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany.
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28344 Bremen, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
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Greydanus DE, Cates KW, Sadigh N. Adverse effects of stimulant medications in children and adolescents: focus on drug abuse. Int J Adolesc Med Health 2019; 31:ijamh-2019-0175. [PMID: 31483757 DOI: 10.1515/ijamh-2019-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Kevin W Cates
- Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Nina Sadigh
- Western Michigan University, Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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Accident patterns in trauma surgery patients with and without self-reported ADHD. J Neural Transm (Vienna) 2019; 126:1163-1173. [PMID: 31076914 DOI: 10.1007/s00702-019-02011-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) has been associated with a higher risk for accidents and injuries, leading to increased mortality. The objective of this study was to identify the types and mechanisms of accidents in a group of adult trauma victims with self-reported ADHD compared to a control group, based on Adult ADHD Self-Report Scale Version 1.1 (ASRSv1.1). A semi-open/qualitative accident questionnaire was conducted with 116 recruited patients from three trauma surgery units. The adult ADHD (aADHD) group differed significantly from the control group in self-reported psychiatric co-morbidities (p = 0.012), regular psychotropic medication use (p = 0.005), other accidents in the past year (p = 0.002), substance use before the accident (p = 0.007), and overconfidence in relation to the accident (p = 0.033). Most interestingly, we found significantly greater subjective ratings for stress (p = 0.002) and stressful/pressurising events before the accident (p = 0.026) in the adult ADHD group, as well as for self-reported stress at the time when conducting the interview (p = 0.016). The data demonstrate that special attention should be paid to interventions in stress reduction and sufficient treatment of ADHD in terms of preventing accidents and injuries in aADHD. Therefore, we suggest, in addition to pharmaceutical therapy, the integration of stress-management and coping strategies into aADHD management.
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Piper BJ, Ogden CL, Simoyan OM, Chung DY, Caggiano JF, Nichols SD, McCall KL. Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PLoS One 2018; 13:e0206100. [PMID: 30485268 PMCID: PMC6261411 DOI: 10.1371/journal.pone.0206100] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Stimulants are considered the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD) in the US and they are used in other indications. Stimulants are also diverted for non-medical purposes. Ethnic and regional differences in ADHD diagnosis and in stimulant use have been identified in earlier research. The objectives of this report were to examine the pharmacoepidemiological pattern of these controlled substances over the past decade and to conduct a regional analysis. METHODS Data (drug weights) reported to the US Drug Enforcement Administration's Automation of Reports and Consolidated Orders System for four stimulants (amphetamine, methylphenidate, lisdexamfetamine, and methamphetamine) were obtained from 2006 to 2016 for Unites States/Territories. Correlations between state level use (mg/person) and Hispanic population were completed. RESULTS Amphetamine use increased 2.5 fold from 2006 to 2016 (7.9 to 20.0 tons). Methylphenidate use, at 16.5 tons in 2006, peaked in 2012 (19.4 tons) and subsequently showed a modest decline (18.6 tons in 2016). The consumption per municipality significantly increased 7.6% for amphetamine and 5.5% for lisdexamfetamine but decreased 2.7% for methylphenidate (all p < .0005) from 2015 to 2016. Pronounced regional differences were also observed. Lisdexamfetamine use in 2016 was over thirty-fold higher in the Southern US (43.8 mg/person) versus the Territories (1.4 mg/person). Amphetamine use was about one-third lower in the West (48.1 mg/person) relative to the Northeastern (75.4 mg/person, p < .05) or the Midwestern (69.9 mg/person, p ≤ .005) states. States with larger Hispanic populations had significantly lower methylphenidate (r(49) = -0.63), lisdexamfetamine (B, r(49) = -0.49), and amphetamine (r(49) = -0.43) use. CONCLUSIONS Total stimulant usage doubled in the last decade. There were dynamic changes but also regional disparities in the use of stimulant medications. Future research is needed to better understand the reasons for the sizable regional and ethnic variations in use of these controlled substances.
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Affiliation(s)
- Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Christy L. Ogden
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Olapeju M. Simoyan
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
- Department of Addiction Medicine, Geisinger Marworth Alcohol and Chemical Dependency Treatment Center, Waverly, Pennsylvania, United States of America
| | - Daniel Y. Chung
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - James F. Caggiano
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States of America
| | - Stephanie D. Nichols
- Department of Pharmacy Practice, Husson University School of Pharmacy, Bangor, Maine, United States of America
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Kenneth L. McCall
- Department of Pharmacy Practice, University of New England College of Pharmacy, Portland, Maine, United States of America
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Akmatov MK, Steffen A, Holstiege J, Hering R, Schulz M, Bätzing J. Trends and regional variations in the administrative prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Germany. Sci Rep 2018; 8:17029. [PMID: 30451896 PMCID: PMC6242899 DOI: 10.1038/s41598-018-35048-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
There is a controversy regarding temporal trends in prevalence of attention-deficit/hyperactivity disorder (ADHD). Using nationwide claims data containing data for approximately six million statutory health insured children we aimed to examine a) trends of ADHD administrative prevalence during 2009-2016; b) regional variations in prevalence, and c) factors associated with an increased chance of ADHD diagnosis. The ICD-10 code 'F90-hyperkinetic disorder' was used to define an ADHD case. Global and Local Moran's I tests were used to examine the spatial autocorrelation and k-means-cluster analysis to examine the course of ADHD prevalence in administrative districts over years. Two-level logistic regression was applied to examine individual- and district-level factors associated with ADHD diagnosis. The administrative prevalence of ADHD was 4.33% (95% CI: 4.31-4.34%). We observed pronounced small-area differences on the district level with prevalences ranging between 1.6% and 9.7%. There was evidence of strong spatial autocorrelation (Global Moran's I: 0.46, p < 0.0001). The k-means-method identified six clusters of different size; all with a stagnating trend in the prevalence over the observation period of eight years. On the district level, a lower proportion of foreign citizens, and a higher density of paediatric psychiatrists and paediatricians were positively associated with ADHD with a more pronounced effect in urban districts.
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Affiliation(s)
- M K Akmatov
- Department of Regional Health Care Analysis and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany.
| | - A Steffen
- Department of Regional Health Care Analysis and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - J Holstiege
- Department of Regional Health Care Analysis and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - R Hering
- Department of Health Services Research and Risk Structure, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - M Schulz
- Department of Health Services Research and Risk Structure, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - J Bätzing
- Department of Regional Health Care Analysis and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
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J. Bachmann C, Philipsen A, Hoffmann F. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:428-429. [PMID: 28683858 PMCID: PMC5508066 DOI: 10.3238/arztebl.2017.0428b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Alexandra Philipsen
- **Medizinischer Campus Universität Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Universitätsklinik für Psychiatrie und Psychotherapie, Karl-Jaspers-Klinik, Bad Zwischenahn
| | - Falk Hoffmann
- ***Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg
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Schlander M, Schwarz O, Trott GE. Unanswered Questions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:428. [PMID: 28683857 PMCID: PMC5508065 DOI: 10.3238/arztebl.2017.0428a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Michael Schlander
- *Universität Heidelberg Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
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