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Hernández M, Levin FR, Campbell ANC. ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions. CNS Drugs 2025; 39:457-472. [PMID: 39979544 DOI: 10.1007/s40263-025-01168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2025] [Indexed: 02/22/2025]
Abstract
Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.
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Affiliation(s)
- Mariely Hernández
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA.
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA.
- Department of Psychology, The City College of New York, New York, USA.
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA
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Ribeiro MI, França G. [Substance Use Disorder as a Comorbidity in Patients with Attention Deficit Hyperactivity Disorder]. ACTA MEDICA PORT 2025. [PMID: 40299888 DOI: 10.20344/amp.21937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 03/28/2025] [Indexed: 05/01/2025]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder manifested by inattention and/or hyperactivity and impulsivity. It is a disorder that begins in childhood but can persist into adulthood. It is associated with the emergence of various comorbidities, including, very often, the development of substance use disorders (SUD). When present simultaneously, they contribute to more severe presentations of both conditions and makes treatment more complex and challenging. Despite being different conditions, they have potentially common etiological pathways. The main aims of this article were to study the correlation between ADHD and SUD, particularly concerning the prevalence of this association, etiology and what are the best diagnostic and treatment strategies. We conclude that SUD is one of the most common comorbidities among ADHD patients, with genetic factors, neuroanatomical and neurophysiological impairments correlating both conditions. Patients with ADHD and SUD have an earlier onset of SUD, heavier abuse and worse outcomes. Special attention to this disorder is recommended in patients with ADHD. Furthermore, an active search for ADHD in patients with SUD is highly recommended, which can be carried out in the first place with self-reported scales. The appropriate treatment seems to involve a combination of pharmacological and non-pharmacological approaches, with strategies targeting both conditions.
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Affiliation(s)
- Maria Inês Ribeiro
- Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
| | - Gustavo França
- Hospital de Magalhães Lemos. Unidade Local de Saúde Santo António. Porto. Portugal
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Summit AG, Moseley MC, Chaku N, Elam KK, Jacobs W, Lederer AM, Vaughan EL, Quinn PD. Prevalence of pharmacotherapy for attention-deficit/hyperactivity disorder and prescription stimulant misuse: A national study of US college students. Addiction 2025; 120:721-731. [PMID: 39552232 DOI: 10.1111/add.16716] [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: 06/14/2024] [Accepted: 10/16/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND AND AIMS Increasing rates of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy may simultaneously benefit patients and increase the availability of stimulants for misuse. We measured the association between university-level prevalence of ADHD medication treatment and prevalence of prescription stimulant misuse (PSM) among college students. DESIGN, SETTING AND PARTICIPANTS This was an observational study using cross-sectional data from the American College Health Association-National College Health Assessment III. Data included 395 participating universities between Fall 2019 and Fall 2022. Our sample included 224 469 undergraduates aged 18-25 years (65.2% cisgender female; 58.7% White). MEASUREMENTS Students self-reported any life-time clinical ADHD diagnosis, past-year ADHD medication treatment and past-3-month PSM. We defined university-level ADHD medication prevalence as the proportion of included students endorsing past-year ADHD medication treatment. Secondary outcomes included life-time PSM and moderate- to high-risk alcohol and cannabis use. We also measured university-level depression medication prevalence as a negative control exposure. FINDINGS Among the included students, 9.6% reported a life-time clinical ADHD diagnosis, 5.1% reported past-year medication treatment and 2.4% reported past-3-month PSM. The prevalence of ADHD medication treatment varied among universities [mean = 5.3%, standard deviation (SD) = 2.8%]. In adjusted models, prevalence of PSM was 7% relatively greater for every 1% increase in university-level medication prevalence [adjusted prevalence ratio (aPR) = 1.07; 95% confidence interval (CI) = 1.04-1.09]. Further, individuals with non-medication-treated ADHD were 40% more likely to report PSM than those without ADHD (aPR = 1.40; 95% CI = 1.25-1.56). There was no statistically significant difference in PSM among individuals with ADHD who did or did not receive medication (aPR = 0.90; 95% CI = 0.78-1.04). Results for secondary outcomes and the negative control partially supported the specificity of the findings. CONCLUSIONS Among university students in the United States, there appears to be a positive association between attending universities with a greater prevalence of attention deficit/hyperactivity disorder (ADHD) medication treatment and risk of prescription stimulant misuse (PSM). This study provides further support for the possibility that ADHD medication treatment prevalence is a risk factor for PSM.
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Affiliation(s)
- Alynna G Summit
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Madison C Moseley
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Natasha Chaku
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Kit K Elam
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Wura Jacobs
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Alyssa M Lederer
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Ellen L Vaughan
- Department of Applied Psychology in Education and Research Methodology, Indiana University, Bloomington, IN, USA
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
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Yerys BE, Tao S, Shea L, Wallace GL. Attention-Deficit/Hyperactivity Disorder in Medicaid-Enrolled Autistic Adults. JAMA Netw Open 2025; 8:e2453402. [PMID: 39937481 PMCID: PMC11822541 DOI: 10.1001/jamanetworkopen.2024.53402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 10/12/2024] [Indexed: 02/13/2025] Open
Abstract
Importance Autistic adults experience suboptimal health outcomes. Likewise, attention-deficit/hyperactivity disorder (ADHD) is linked to poor health outcomes in the general population, yet little is known about co-occurring ADHD and its links with poor health outcomes among autistic adults. Objective To determine the prevalence of ADHD and ADHD medication prescriptions and to examine associations between health outcomes and both ADHD co-occurrence and ADHD medication prescriptions among autistic adults. Design, Setting, and Participants Population-based cohort study of US Medicaid-enrolled adults aged 18 years and older, including autistic adults with and without co-occurring intellectual disability (ID), adults with ID without autism, and adults from a random sample of Medicaid-enrolled individuals from 2008 to 2019. Analyses were completed September 2023 to September 2024. Exposures Autism, ADHD, and ID using validated algorithms from the Chronic Conditions Warehouse. Main Outcomes and Measures Prevalence rates of co-occurring ADHD, ADHD medication prescriptions, substance use, cardiovascular conditions, injury in autism without ID, ID without autism, autism with ID, and the general population. Results The study included 3 506 661 patients (mean [SD] age, 33.5 [15.6] years; 1 854 892 [52.9%] female; 702 694 [20.0%] Black, 587 048 [16.7%] Hispanic, and 1 786 703 [60.0%] White). Compared with the general Medicaid-enrolled population (1 846 102 patients), which had 49 523 patients (2.7%) with co-occurring ADHD diagnoses, this study found elevated rates of ADHD in autism without ID (280 195 patients [26.7%]; prevalence ratio [PR], 5.1; 95% CI, 4.4-5.9), autism with ID (261 061 patients [40.2%]; PR, 6.8; 95% CI, 6.0-7.7), and ID without autism (1 119 303 patients [19.0%]; PR, 4.4; 95% CI, 4.0-5.0). A total of 117 704 adults (26.6%) with ADHD received an ADHD medication prescription. The study identified that rates of substance use were higher among clinical groups with co-occurring ADHD. For example, 9886 of 74 675 autistic adults with ADHD (13.2%) had substance use disorder, compared with 11 782 of 205 520 autistic adults with no ADHD (5.7%). ADHD diagnoses were associated with higher rates of all health outcomes, regardless of group. Substance use was higher in both ID groups with ADHD diagnoses and ADHD medications, whereas injury and cardiovascular condition rates were lower in all ADHD groups who received ADHD medications. Conclusions and Relevance In this cohort study of Medicaid-enrolled adults, autistic adults experienced high rates of co-occurring ADHD and were more likely to receive ADHD medication prescriptions than adults in the general population. Negative health outcome rates are higher among autistic people with co-occurring ADHD, although ADHD medication prescriptions are associated with lower rates of negative health outcomes. Treating ADHD may improve health among autistic adults.
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Affiliation(s)
- Benjamin E. Yerys
- Center for Autism Research and Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sha Tao
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Gregory L. Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
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Alleyne K, Fogler J, Simon KM, Spinks-Franklin A, Spencer AE. Promoting Equitable Engagement in Attention-Deficit/Hyperactivity Disorder Care. Pediatr Ann 2025; 54:e12-e17. [PMID: 39760344 PMCID: PMC11829811 DOI: 10.3928/19382359-20241007-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a treatable pediatric condition, but children with racial-ethnic minority backgrounds often do not receive timely or consistent treatment. Understanding how systemic racism impacts care and learning from families of color about their experiences can provide critical insights for improving clinical practice and engaging patients equitably in ADHD care. We interweave a mother's experience navigating ADHD care for her son with commentary from an interprofessional team about what clinicians can do for families to reduce the impact of systemic racism on care. [Pediatr Ann. 2025;54(1):e12-e17.].
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Grassi G, Moradei C, Cecchelli C. Long-term changes on behavioral addictions symptoms among adults with attention deficit hyperactivity disorder treated with methylphenidate. J Behav Addict 2024; 13:904-912. [PMID: 39540888 PMCID: PMC11737418 DOI: 10.1556/2006.2024.00060] [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: 08/30/2023] [Revised: 01/19/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) and behavioral addictions (BAs) are highly comorbid but little is known about the effect of anti-ADHD medications on behavioral addiction symptoms. Thus, the aim of this naturalistic prospective study was to investigate the long-term changes on BAs symptoms among methylphenidate-treated adults with a primary diagnosis of ADHD. Methods 37 consecutive adult ADHD outpatients completed a baseline and follow-up assessment of ADHD, mood and BAs symptoms (internet, shopping, food, sex addictions and gambling disorder) after one year of methylphenidate (flexible dose) treatment. Results Internet addiction test scores pre-treatment were significantly higher than post-treatment scores (p < 0.001). The same trend was seen for the shopping addiction (p = 0.022), food addiction scores (p = 0.039) and sex addiction scores (p = 0.047). Gambling disorder scores did not differ pre and post treatment since none of the included patients reported significant gambling symptoms at baseline. The rate of ADHD patients with at least one comorbid BA was reduced after methylphenidate treatment (51.4% vs 35.1%). The correlation analyses showed a moderate positive correlation between the changes in sluggish cognitive tempo symptoms, cognitive impulsivity, mood and anxiety symptoms and changes in internet addiction symptoms. Conclusions This is the first study showing that after one-year of treatment with methylphenidate, adult ADHD patients show a significant reduction on internet, food, shopping and sex addiction symptoms. Further controlled studies with larger samples should replicate these preliminary results and elucidate the role of methylphenidate and other moderator factors (such as concomitant psychological treatments or lifestyle habits changes) on BAs improvements.
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Beslot A, Grall-Bronnec M, Balem M, Schreck B, Laforgue EJ, Victorri-Vigneau C, Guillou-Landreat M, Leboucher J, Challet-Bouju G, Cabelguen C. ADHD: prevalence and effect on opioid use disorder treatment outcome in a French sample of patients receiving medication for opioid use disorder-the influence of impulsivity as a mediating factor. Harm Reduct J 2024; 21:165. [PMID: 39252018 PMCID: PMC11382469 DOI: 10.1186/s12954-024-01079-7] [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: 02/02/2024] [Accepted: 08/17/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Opioid use disorder (OUD) poses a global health challenge, and despite medications for opioid use disorder (MOUD) and psychosocial interventions, relapse remains a significant concern. Comorbid psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), are one of the major factors associated with poor OUD treatment outcome. We aimed to estimate the frequency of probable ADHD (in childhood and in adulthood) in patients with OUD; to assess the factors associated with this comorbidity; and to explore the factors that mediate the relationship between ADHD and OUD treatment outcome. METHODS We conducted an observational study using a sample of 229 patients aged 18 years and older who were diagnosed with OUD and had received MOUD for at least six months. Participants were assessed through a structured interview and self-report questionnaires. Multivariate logistic regressions and a mediation analysis were performed. RESULTS Almost half of the participants reported probable ADHD in childhood, and ADHD persisted into adulthood among two-thirds of the patients. The factors associated with poor OUD treatment outcome included earlier onset of OUD, lower education, and greater impulsivity. There was no direct effect of probable ADHD in childhood on OUD treatment outcome, but there was an indirect effect through negative urgency, the tendency to respond impulsively to negatively connoted emotional experiences. CONCLUSIONS The findings suggest that ADHD symptoms, particularly impulsivity, may contribute to vulnerability in opioid use and play a crucial role in treatment outcomes for this population. TRIAL REGISTRATION ClinicalTrials identifier NCT01847729.
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Affiliation(s)
- Auxane Beslot
- Addiction Medicine and Psychiatry Department, Nantes Université, CHU Nantes, Nantes, 44000, France
| | - Marie Grall-Bronnec
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France.
- HUGOPSY Network, Rennes, France.
- Addiction Medicine and Psychiatry Department, Saint Jacques Hospital, 85, rue Saint Jacques, Nantes cedex 1, 44093, France.
| | - Marianne Balem
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France
| | - Benoit Schreck
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France
| | - Edouard-Jules Laforgue
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France
- Pharmacology Department, Nantes Université, CHU Nantes, Nantes, 44000, France
| | - Caroline Victorri-Vigneau
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France
- Pharmacology Department, Nantes Université, CHU Nantes, Nantes, 44000, France
| | - Morgane Guillou-Landreat
- Addiction Medicine Department, CHU Brest, Brest, France
- Université de Bretagne Occidentale, ERCR SPURBO, Brest, France
| | - Juliette Leboucher
- Addiction Medicine and Psychiatry Department, Nantes Université, CHU Nantes, Nantes, 44000, France
| | - Gaëlle Challet-Bouju
- Addiction Medicine and Psychiatry Department, Nantes Université, CHU Nantes, Nantes, 44000, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, 44000, France
| | - Clémence Cabelguen
- Addiction Medicine and Psychiatry Department, Nantes Université, CHU Nantes, Nantes, 44000, France
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McCabe VV, Veliz PT, Wilens TE, Schepis TS, Pasman E, Evans-Polce RJ, McCabe SE. Adolescents' Use of Medications for Attention-Deficit/Hyperactivity Disorder and Subsequent Risk of Nonmedical Stimulant Use. J Adolesc Health 2024; 75:188-191. [PMID: 38483378 PMCID: PMC11405061 DOI: 10.1016/j.jadohealth.2024.01.024] [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: 10/06/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE This national prospective multicohort study examined the relationship between US adolescents' use of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and subsequent risk of nonmedical stimulant use (i.e., nonmedical use of prescription stimulants and cocaine use) during young adulthood, relative to nonstimulant therapy and population controls. METHODS Nationally representative multicohort panels of 11,905 US 12th-grade students were surveyed via self-administered questionnaires at baseline (age 18) and followed prospectively over six years into young adulthood (ages 19‒24). RESULTS There were no statistically significant differences between adolescents who used stimulant therapy for ADHD compared to those who used only nonstimulant medications and population controls in their adjusted odds of nonmedical stimulant use incidence or prevalence during young adulthood, after adjusting for baseline covariates. DISCUSSION The findings offer preliminary support that adolescents who use prescription stimulant or nonstimulant medications for ADHD when clinically indicated are not at greater risk for nonmedical stimulant use during young adulthood.
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Affiliation(s)
- Vita V McCabe
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | - Philip T Veliz
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
| | - Emily Pasman
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Rebecca J Evans-Polce
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan
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McCabe SE, Schulenberg JE, Wilens TE, Schepis TS, Werner KS, McCabe VV, Veliz PT. Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood. Psychiatr Serv 2024; 75:622-629. [PMID: 38321920 PMCID: PMC11315353 DOI: 10.1176/appi.ps.20230418] [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: 02/08/2024]
Abstract
OBJECTIVE Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants). METHODS National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM. RESULTS Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood. CONCLUSIONS Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - John E Schulenberg
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Timothy E Wilens
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Kennedy S Werner
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Philip T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing (S. E. McCabe, Wilens, Schepis, Werner, V. V. McCabe, Veliz), Institute for Social Research (S. E. McCabe, Schulenberg, Veliz), Department of Psychology (Schulenberg), and Department of Psychiatry (Werner, V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
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Xu KY, Berkel TDM, Martin CE, Jones HE, Carter EB, Kelly JC, Mintz CM, Levin FR, Grucza RA. Prescription psychostimulant use, admissions and treatment initiation and retention in pregnant people with opioid use disorder. NATURE. MENTAL HEALTH 2024; 2:801-808. [PMID: 39726823 PMCID: PMC11671152 DOI: 10.1038/s44220-024-00270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/16/2024] [Indexed: 12/28/2024]
Abstract
While attention deficit hyperactivity disorder is common among people with addiction, the risks and benefits of attention deficit hyperactivity disorder medication in pregnant people with opioid use disorder are poorly understood. Here, using US multistate administrative data, we examined 3,247 pregnant people initiating opioid use disorder treatment, of whom 5% received psychostimulants. Compared to peers not receiving psychostimulants, the psychostimulant cohort had greater buprenorphine (adjusted relative risk 1.81 (1.50-2.18)) but lower methadone initiation (adjusted relative risk 0.39 (0.19-0.78)). Among psychostimulant recipients who initiated buprenorphine, we observed lower buprenorphine discontinuation associated with the psychostimulant cohort compared to nonrecipients (adjusted hazard ratio 0.77 (0.67-0.88)). In within-person case-crossover analyses, person-days defined by psychostimulant fills were associated with fewer substance use disorder-related admissions compared to days without fills (odds ratio 0.50 (0.33-0.76)). Overall, our data suggest that psychostimulant use in pregnancy may be associated with increased buprenorphine initiation, decreased methadone initiation and improved buprenorphine retention. Decreased substance use disorder-related admissions were associated with person-days of psychostimulant receipt, although other risks of psychostimulant use in pregnancy warrant further investigation.
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Affiliation(s)
- Kevin Y. Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- These authors contributed equally: Kevin Y. Xu, Tiffani D. M. Berkel
| | - Tiffani D. M. Berkel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- These authors contributed equally: Kevin Y. Xu, Tiffani D. M. Berkel
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Hendrée E. Jones
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeannie C. Kelly
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Frances R. Levin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Richard A. Grucza
- Department of Family/Community Medicine and Health and Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
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11
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Stutzman DL, Dopheide JA. Practice Pearls for Stimulant Treatment of Attention-Deficit/Hyperactivity Disorder in Youth. J Pediatr Pharmacol Ther 2024; 29:215-231. [PMID: 38863854 PMCID: PMC11163912 DOI: 10.5863/1551-6776-29.3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/04/2023] [Indexed: 06/13/2024]
Abstract
Over half of youth with attention-deficit/hyperactivity disorder (ADHD) have co-occurring psychiatric or medical conditions that present treatment challenges. Stimulants are the most effective pharmacologic treatment of ADHD for preschoolers to adults but questions about safety with co-occurring conditions frequently arise. In addition, stigma surrounding diagnosis and treatment can negatively impact care. This manuscript presents evidence-based practice pearls to guide treatment decisions for youth with ADHD and common coexisting psychiatric and medical conditions. Recommendations address specific stimulant adverse effects (i.e., anxiety, cardiac, growth, mania, psychosis) along with management strategies. Pearls were developed for the most common clinical questions, controversial topics, or therapeutic issues that may not be widely known. The goals of this manuscript are to: 1) provide a detailed resource for interprofessional teams regarding stimulant use in youth with ADHD, 2) improve therapeutic outcomes for youth with ADHD and co-occurring psychiatric and/or medical conditions through evidence-based recommendations, and 3) decrease stigma associated with stimulant use through education.
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Affiliation(s)
- Danielle L. Stutzman
- Pediatric Mental Health Institute (DLS), Children’s Hospital Colorado, Aurora, CO
- Department of Clinical Pharmacy (DLS), University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO
- Department of Child and Adolescent Psychiatry (DLS), University of Colorado School of Medicine, Aurora, CO
| | - Julie A. Dopheide
- University of Southern California Mann School of Pharmacy and Pharmaceutical Sciences and Keck School of Medicine (JAD), LAC+USC Medical Center, Los Angeles, CA
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12
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Adams SM, Riley T, Quinn PD, Meraz R, Karna V, Rickert M, D'Onofrio BM. Racial-Ethnic Differences in ADHD Diagnosis and Treatment During Adolescence and Early Adulthood. Psychiatr Serv 2024; 75:521-527. [PMID: 38239182 DOI: 10.1176/appi.ps.20230113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
OBJECTIVE This study examined racial-ethnic differences in attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment during adolescence and early adulthood. METHODS A national health care claims database was used to identify a cohort of 4,216,757 commercially insured youths with at least 1 year of coverage during 2014-2019. Racial-ethnic differences in the prevalence of visits with a recorded ADHD diagnosis (identified through ICD-9-CM and ICD-10-CM codes) and of ADHD treatment (identified through medical claims for psychosocial treatments and pharmacy claims for ADHD medications) were examined. Period prevalence rates were determined within five age categories, stratified by race-ethnicity. Poisson regression with a natural log link was used within each age category to estimate prevalence ratios (PRs) comparing prevalence in each racially and ethnically minoritized group with prevalence in the White group. RESULTS The overall prevalence of ADHD diagnosis was 9.1% at ages 12-14 and 5.3% at ages 24-25. In each age category, Asian, Black, and Hispanic youths had lower prevalence of ADHD diagnosis than did White youths (PR=0.29-0.77). Among youths with an ADHD diagnosis, relative racial-ethnic differences in treatment were small (PR=0.92-1.03). CONCLUSIONS Throughout adolescence and early adulthood, racially and ethnically minoritized youths were less likely than White youths to have health care visits with recorded ADHD diagnoses and, among those with diagnoses, were also slightly less likely to receive treatment. More research is needed to understand the processes underlying these differences and their potential health consequences among racially and ethnically minoritized youths.
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Affiliation(s)
- Sydney M Adams
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Tennisha Riley
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Patrick D Quinn
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Richard Meraz
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Vivek Karna
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Martin Rickert
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, College of Arts and Sciences (Adams, Meraz, Karna, Rickert, D'Onofrio), Department of Counseling and Educational Psychology, School of Education (Riley), and Department of Applied Health Science, School of Public Health (Quinn), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (D'Onofrio)
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Faraone SV, Newcorn JH, Wozniak J, Joshi G, Coffey B, Uchida M, Wilens T, Surman C, Spencer TJ. In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry. J Atten Disord 2024; 28:550-582. [PMID: 39315575 PMCID: PMC10947509 DOI: 10.1177/10870547231225818] [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: 02/10/2024]
Abstract
OBJECTIVE To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. METHOD Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. RESULTS Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. CONCLUSION The world is a better place because Joe Biederman was here.
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Affiliation(s)
- Stephen V Faraone
- State University of New York Upstate Medical University, Syracuse, USA
| | | | - Janet Wozniak
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Gagan Joshi
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Mai Uchida
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Timothy Wilens
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Craig Surman
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas J Spencer
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Beaudin SA, Gorman S, Schilpp N, Woodfin D, Strupp BJ, Smith DR. Sensorimotor dysfunction due to developmental manganese exposure is less severe in adult female than male rats and partially improved by acute methylphenidate treatment. Neurotoxicol Teratol 2024; 102:107330. [PMID: 38307398 DOI: 10.1016/j.ntt.2024.107330] [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: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Epidemiological studies have reported associations between elevated manganese (Mn) exposure and poorer psychomotor performance in children. Our studies in adult male rats have established that this relationship is causal and that prolonged methylphenidate (MPH) treatment is efficacious in treating this area of dysfunction. However, it is unclear if sensitivity to these Mn deficits differs between females and males, and whether existing pharmacological therapies are efficacious in improving sensorimotor dysfunction in females. To address these questions, we used our rat model of childhood environmental Mn exposure and the Montoya staircase test to determine whether 1) there are sex differences in the lasting sensorimotor dysfunction caused by developmental Mn exposure, and 2) MPH treatment is efficacious in ameliorating the sensorimotor deficits in females. Female and male neonates were treated orally with Mn (50 mg Mn/kg/d) from postnatal day 1 to 21 and evaluated for skilled forelimb sensorimotor performance as adults. Subsequently, the efficacy of acute oral MPH treatment (doses of 0, 0.5, and 3.0 mg MPH/kg/d) was assessed in females using a within-subject MPH treatment design. Developmental postnatal Mn exposure produced lasting sensorimotor reaching and grasping deficits that were milder in females than in males. Acute MPH treatment of Mn-exposed females with the 0.5 mg/kg/d dose attenuated the reaching dysfunction without alleviating grasping dysfunction. These findings show sex-based variations in sensitivity to the sensorimotor impairment caused by developmental Mn exposure, and they are consistent with prior studies showing less vulnerability of females to Mn-induced dysfunction in other functional domains, possibly due to the protective effects of estrogen. Given our previous work showing the efficacy of MPH treatment to alleviate Mn-induced inattention, impulsiveness, and sensorimotor dysfunctions in adult male rats, they also highlight the need for further research into sex-based differences in cognitive and behavioral areas of brain function, and the efficacy of therapeutics in treating behavioral dysfunction in females. Supported by NIEHS R01ES028369.
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Affiliation(s)
- Stephane A Beaudin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Samantha Gorman
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Naomi Schilpp
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - David Woodfin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Barbara J Strupp
- Division of Nutritional Sciences, and Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Donald R Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA.
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15
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Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
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16
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Zafari Z, Park JE, Shah CH, dosReis S, Gorman EF, Hua W, Ma Y, Tian F. The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies. Am J Epidemiol 2024; 193:426-453. [PMID: 37851862 PMCID: PMC11484649 DOI: 10.1093/aje/kwad201] [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: 12/16/2022] [Revised: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Uses of real-world data in drug safety and effectiveness studies are often challenged by various sources of bias. We undertook a systematic search of the published literature through September 2020 to evaluate the state of use and utility of negative controls to address bias in pharmacoepidemiologic studies. Two reviewers independently evaluated study eligibility and abstracted data. Our search identified 184 eligible studies for inclusion. Cohort studies (115, 63%) and administrative data (114, 62%) were, respectively, the most common study design and data type used. Most studies used negative control outcomes (91, 50%), and for most studies the target source of bias was unmeasured confounding (93, 51%). We identified 4 utility domains of negative controls: 1) bias detection (149, 81%), 2) bias correction (16, 9%), 3) P-value calibration (8, 4%), and 4) performance assessment of different methods used in drug safety studies (31, 17%). The most popular methodologies used were the 95% confidence interval and P-value calibration. In addition, we identified 2 reference sets with structured steps to check the causality assumption of the negative control. While negative controls are powerful tools in bias detection, we found many studies lacked checking the underlying assumptions. This article is part of a Special Collection on Pharmacoepidemiology.
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Affiliation(s)
- Zafar Zafari
- Correspondence to Dr. Zafar Zafari, 220 N. Arch Street, Baltimore, Maryland, 21201 (e-mail: )
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Way N, Mikl J, Cataldo M, Erensen JG, Martin A, Li V, Pliszka SR. Drivers and Barriers to Tolerable and Effective Treatment for ADHD: The Importance of Treatment Perseverance and Duration of Effect. J Atten Disord 2024; 28:310-320. [PMID: 38243741 DOI: 10.1177/10870547231217088] [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: 01/21/2024]
Abstract
OBJECTIVE To examine treatment outcomes for classes of ADHD drugs in conjunction with physicians' prescribing rationales and the utility of treatment perseverance in treatment effectiveness. METHODS A retrospective non-interventional study using physician-provided chart data for treated adolescent and adult ADHD patients in the United States (April-June 2019). Multivariable analyses compared the effectiveness and tolerability of drug classes. RESULTS Among the 1,232 ADHD patients included in this study, 37.7% experienced one, 11.8% two, and 6.7% three treatment changes post their first prescribed regimen. These changes were mostly attributed to lack of rapid onset and duration of effect. Achieving best response correlated with the number of previous treatments for adolescents, but not adults. Maintaining full response correlated with the length of current treatment for adolescents and adults. CONCLUSION Physicians' prescribing rationales targeted duration of effect and tolerability. ER monotherapy demonstrated potential advantages over other regimens. Treatment perseverance is integral to effective ADHD management.
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Affiliation(s)
- Nate Way
- Real World Evidence, Cerner Enviza, Malvern, PA, USA
| | | | | | | | - Ashley Martin
- Real World Evidence, Cerner Enviza, Malvern, PA, USA
| | - Vicky Li
- Real World Evidence, Cerner Enviza, Malvern, PA, USA
| | - Steven R Pliszka
- The University of Texas Health Science Center at San Antonio, USA
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18
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Houmann TB, Kaalund-Brok K, Clemmensen L, Petersen MA, Plessen KJ, Bilenberg N, Verhulst F, Jeppesen P. Early treatment response as predictor of long-term outcome in a clinical cohort of children with ADHD. Eur Child Adolesc Psychiatry 2024; 33:357-367. [PMID: 36795232 PMCID: PMC10869385 DOI: 10.1007/s00787-023-02158-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: 06/03/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
This study investigates early onset of treatment response as predictor of symptomatic and functional outcome 3 years after initiation of methylphenidate (MPH) administration in a naturalistic, clinical cohort of children and adolescents with ADHD. Children were followed across an initial 12-week MPH treatment trial and after 3 years, with ratings of symptoms and impairment. Associations between a clinically significant MPH treatment response in week 3 (defined as ≥ 20% reduction in clinician-rated symptoms) and in week 12 (defined as ≥ 40% reduction), and 3-year outcome were tested in multivariate linear regression models, adjusting for sex, age, comorbidity, IQ, maternal education, parental psychiatric disorder, and baseline symptoms and function. We did not have information on treatment adherence or the nature of treatments beyond 12 weeks. 148 children, mean age 12.4 years (range 10-16 years), 77% males, participated in the follow-up. We found a significant decrease in symptom score from baseline [M = 41.9 (SD = 13.2)] to 3-year follow-up [M = 27.5 (SD = 12.7), p < 0.001, and in impairment score from baseline (M = 41.6 (SD = 19.4)] to 3-year follow-up [M = 35.6 (SD = 20.2), p = 0.005]. Treatment responses in week 3 and week 12 were significant predictors of the long-term outcome of symptoms, but not of impairment at 3-year follow-up, when adjusting for other well-known predictors. Early treatment response predicts long-term outcome over and above other well-known predictors. Clinicians should follow-up patients carefully, during the first months of treatment, and detect non-responders, since there might be a window of opportunity to alter the outcome, by changing the treatment strategy.Clinical trial registration: ClinicalTrials.gov, registration number NCT04366609, April 28, 2020 retrospectively registered.
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Affiliation(s)
- Tine Bodil Houmann
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristine Kaalund-Brok
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Clemmensen
- Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, 2900, Hellerup, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Smedegade 16, 4000, Roskilde, Denmark
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Abstract
OBJECTIVES To examine how the concept of prevention is applicable to adolescent ADHD, which preventive interventions may be feasible, and which methods can be used to evaluate effectiveness. METHOD Following a literature search for prevention clinical trials relevant to adolescent ADHD, selected studies are critically reviewed to identify suitable targets and promising interventions. RESULTS There is some evidence from controlled studies that interventions delivered to prepubertal children at high risk for ADHD or diagnosed with ADHD may decrease the incidence or persistence of ADHD in adolescence. Uncontrolled follow-up of clinical samples and population studies suggest that treatment of adolescents with ADHD can decrease the risk for several negative functional outcomes in youth. A controlled trial found a specific cognitive training intervention to decrease risky driving. CONCLUSIONS Prevention of ADHD and associated negative outcomes is possible and of high clinical relevance. Assessing prevention effects is methodologically challenging, but feasible.
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Affiliation(s)
- Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Mental Health, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Germany
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Merino M, Maravilla-Herrera P, Lorenzo TM, Arance JA, Bobes J, Corrales M, Guzmán F, Morales M, Mur C. The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:82-93. [PMID: 38601072 PMCID: PMC11005448 DOI: 10.33393/grhta.2024.2697] [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: 10/25/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults highly interfere with function in multiple dimensions, increasing the economic burden associated with ADHD. The aim of this study was to explore the impact of ADHD in Spanish adults and estimate the associated economic burden within the healthcare, social, economic, and legal domains. Methods An economic model was developed from a social perspective using a bottom-up approach, based on the scientific literature and a multidisciplinary expert group. Results The cost incurred per diagnosed adult patient with ADHD included an annual cost of €15,652 and a one-time cost of €7,893 (3,035 M€ and 1,531 M€ for Spain, respectively). Regarding the annual cost, 50% was attributed to costs within the economic domain, of which 53% were work-absenteeism-related. Moreover, 28% was attributed to costs within the social domain, of which 74% were substance-abuse-related. Regarding the one-time cost, 52% was attributed to costs within the healthcare domain, of which approximately 50% were hospitalization-related costs. Moreover, 42% was attributed to costs within the legal domain, of which 62% were imprisonment-related costs. Conclusions This is the first report on the socioeconomic burden of ADHD in Spanish adults, shedding light on the large burden that adult ADHD poses on the healthcare system and society at large, as symptoms have been shown to impact almost every aspect of life. This is particularly important for undiagnosed/untreated patients with ADHD in Spain, as appropriate treatments have shown positive results in these areas and may reduce its associated socioeconomic burden.
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Affiliation(s)
| | | | | | | | - Julio Bobes
- Department of Medicine, Oviedo University, Oviedo - Spain
- Network Biomedical Research Centre on Mental Health—CIBERSAM, Oviedo - Spain
| | - Montse Corrales
- Department of Psychiatry, Vall d’Hebron University Hospital, Barcelona - Spain
| | | | - María Morales
- Department of Psychiatry, Puerta de Hierro University Hospital, Majadahonda - Spain
| | - Carlos Mur
- Department of Psychiatry, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany - Andorra
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Lee WC, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Healthcare utilization and comorbidity shortly before suicide mortality in patients with attention-deficit/hyperactivity disorder: a nested case-control study. Eur Child Adolesc Psychiatry 2023; 32:2009-2019. [PMID: 35780447 DOI: 10.1007/s00787-022-02038-y] [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: 02/12/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Few studies have analyzed healthcare utilization before suicide among individuals with attention-deficit/hyperactivity disorder (ADHD). This study examined the pattern of healthcare utilization and comorbidities shortly before death among patients with ADHD who died by suicide and compared these data with those of living controls. This study used Taiwan's National Health Insurance Research Database to identify patients with ADHD (N = 379,440) between January 1, 2001, and December 31, 2016. Subsequently, the researchers identified 159 suicide decedents by linking each patient with the National Mortality Database. By conducting a nested case-control study with risk-set sampling from the ADHD cohort, the researchers selected 20 age- and sex-matched controls (n = 3180) for each patient who died by suicide (cases). The researchers then applied conditional logistic regression to investigate differences in healthcare utilization as well as psychiatric and physical comorbidities between case patients and controls. Case patients had higher healthcare utilization within 3 months before suicide, particularly in the psychiatry, emergency, internal medicine, neurosurgery, and plastic surgery departments. These patients also had higher risks of psychiatric comorbidities, including schizophrenia, bipolar disorder, depressive disorder, and sleep disorder, as well as physical comorbidities such as hypertension and other forms of heart disease. Among patients with ADHD, suicide decedents had increased healthcare utilization and higher risks of specific psychiatric and physical comorbidities than living controls. Thus, for suicide prevention among individuals with ADHD, suicide risk must be detected early and comorbidities should be adequately managed.
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Affiliation(s)
- Wan-Chen Lee
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Sung-Te Road, 110, Taipei, Taiwan
| | - Chun-Hung Pan
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Sung-Te Road, 110, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Siang Su
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Sung-Te Road, 110, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, 309 Sung-Te Road, 110, Taipei, Taiwan.
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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22
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Molina BSG, Kennedy TM, Howard AL, Swanson JM, Arnold LE, Mitchell JT, Stehli A, Kennedy EH, Epstein JN, Hechtman LT, Hinshaw SP, Vitiello B. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry 2023; 80:933-941. [PMID: 37405756 PMCID: PMC10323757 DOI: 10.1001/jamapsychiatry.2023.2157] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 07/06/2023]
Abstract
Importance Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, -0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, -0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, -0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, -0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, -0.25 [0.33] to -0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use.
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Affiliation(s)
- Brooke S. G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea L. Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - James M. Swanson
- Department of Pediatrics, University of California, Irvine, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University, Columbus
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Annamarie Stehli
- Department of Pediatrics, University of California, Irvine, Irvine
| | - Edward H. Kennedy
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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23
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Ramey OL, Bonny AE, Silva Almodóvar A, Nahata MC. Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review. Ann Pharmacother 2023; 57:978-990. [PMID: 36510631 DOI: 10.1177/10600280221141065] [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: 12/15/2022] Open
Abstract
OBJECTIVES To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). DATA SOURCES Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. STUDY SELECTION AND DATA EXTRACTION Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. DATA SYNTHESIS This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. CONCLUSIONS Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.
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Affiliation(s)
- Olivia L Ramey
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
- College of Medicine, The Ohio State University, Columbus, OH, USA
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24
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Ryst E, Childress A. An updated safety review of the current drugs for managing ADHD in children. Expert Opin Drug Saf 2023; 22:1025-1040. [PMID: 37843488 DOI: 10.1080/14740338.2023.2271392] [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: 02/27/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers. AREAS COVERED This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described. EXPERT OPINION Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.
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Affiliation(s)
- Erika Ryst
- College of Education and Human Development, University of Nevada, Reno, USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA
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25
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Tardelli V, Xu KY, Bisaga A, Levin FR, Fidalgo TM, Grucza RA. Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk. BMJ MENTAL HEALTH 2023; 26:e300728. [PMID: 37500184 PMCID: PMC10387656 DOI: 10.1136/bmjment-2023-300728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (OUD) treatment with buprenorphine. OBJECTIVES To assess the effect of PAs on OUD buprenorphine treatment retention and/or SUD-related emergency admission or drug-related poisonings. METHODS We used a retrospective cohort design with a secondary analysis of data from Merative MarketScan Commercial and Multi-State Medicaid Databases from 1 January 2006 to 31 December 2016. Individuals included were aged 12-64 years, had an OUD diagnosis and were prescribed buprenorphine. Our analysis used multivariable Cox regression to evaluate the relationship between PA receipt and time to buprenorphine discontinuation. The second part focused on subsamples of buprenorphine initiators who had either (1) any SUD-related emergency admissions or (2) drug-related poisoning. These outcomes were modelled as a function of PA exposure using conditional logistic regression models as part of a within-person, case-crossover design. FINDINGS Our sample had 90 269 patients with OUD (mean age 34.2 years (SD=11.3)) who initiated buprenorphine. Being prescribed a PA was associated with improved buprenorphine retention among individuals both with (adjusted HR (aHR) 0.91 (95% CI 0.86 to 0.97)) and without a concurrent psychostimulant use disorder (PSUD) (aHR 0.92 (95% CI 0.90 to 0.93)). CONCLUSIONS PA use was associated with improved buprenorphine retention in people with OUD with and without co-occurring PSUD. The risks of acute SUD-related events and drug-related poisonings associated with PA use did not differ when comparing PA-using days with days without PA use. CLINICAL IMPLICATIONS Patients with OUD on buprenorphine should receive treatment with a PA when indicated.
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Affiliation(s)
- Vitor Tardelli
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Translational Addictions Research Lab, Centre for Addiction and Mental Health, Department of Psychiatr, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adam Bisaga
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York City, New York, USA
| | - Frances R Levin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Richard A Grucza
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
- Department of Health and Outcomes Research, Saint Louis University, St. Louis, Missouri, USA
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26
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Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord 2023; 27:669-697. [PMID: 36876491 PMCID: PMC10173356 DOI: 10.1177/10870547231158572] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. METHOD Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. RESULTS We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. CONCLUSION This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.
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Affiliation(s)
| | - Oren Mason
- Attention MD, Grand Rapids, MI, USA and
Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine,
Midland, TX, USA
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27
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Muhammad N, Murugesan BG, Singal P, Antai A, Jain L. Diagnostic Dilemma of Differentiating Attention-Deficit/Hyperactivity Disorder (ADHD) From Mood Disorders and Other Common Psychiatric Illnesses in Substance Use Patient Population. Cureus 2023; 15:e37372. [PMID: 37041853 PMCID: PMC10084797 DOI: 10.7759/cureus.37372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 04/13/2023] Open
Abstract
To raise awareness of attention-deficit/hyperactivity disorder (ADHD) as an underdiagnosed, undertreated disorder in adult patients with comorbid substance use disorder (SUD) who are misdiagnosed with other common psychiatric illnesses and to reduce fear and hesitancy in prescribing stimulants as treatment in such a patient population. ADHD diagnosis is easier in the child and adolescent population than the adults due to comorbidities of other psychiatric illnesses and SUD. However, diagnosing ADHD appropriately in an increasing number of adult patients presents challenges. Even if they get diagnosed appropriately, the stigma of substance use disorder holds the providers prescribing stimulant medications for such patient populations due to the high comorbidity of ADHD with SUD. Accurate diagnosis of ADHD in adults is a worthwhile endeavor as this diagnosis is comorbidly present in many mood and substance use disorders patients. Treating ADHD in this population can improve clinical symptoms and overall quality of life.
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Affiliation(s)
- Nazar Muhammad
- Psychiatry, Cornerstone Family Healthcare, New York, USA
| | - Bhavani G Murugesan
- Psychiatry and Behavioral Sciences, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Prakamya Singal
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Angelica Antai
- Radiology, University of Uyo Teaching Hospital, Uyo, NGA
| | - Lakshit Jain
- Psychiatry, University of Connecticut, Hartford, USA
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28
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Quinn PD, Chang Z, Pujol TA, Bair MJ, Gibbons RD, Kroenke K, D’Onofrio BM. Association between prescribed opioid dose and risk of motor vehicle crashes. Pain 2023; 164:e228-e236. [PMID: 36155384 PMCID: PMC11104685 DOI: 10.1097/j.pain.0000000000002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/12/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Opioid-involved motor vehicle traffic fatalities have increased over the past 2 decades. However, the extent to which prescribed opioids increase the risk of motor vehicle crashes remains uncertain. This study used real-world healthcare claims data to examine the association between prescription opioid dose and motor vehicle crash risk. Using nationwide US commercial insurance claims data for 2010 to 2018, we identified 772,404 adults who received incident, noncancer opioid therapy. We examined associations between daily prescription opioid dose, calculated in morphine milligram equivalents (MME) from filled prescription claims, and risk of motor vehicle crashes, assessed as diagnoses of motor vehicle injuries in claims for emergency visits, inpatient hospitalizations, and ambulance transportation. We estimated associations using a within-individual design, which ruled out all time-stable confounding. We complemented the design with time-varying statistical adjustment for other pharmacotherapies and a negative control pain pharmacotherapy analysis (with incident cyclic antidepressant prescriptions). During 2,150,009 person-years of follow-up, there were 12,123 motor vehicle crashes (5.64 crashes per 1000 person-years). In within-individual comparisons, crash risk was greater during opioid prescription periods involving doses ≤60 MME/day (odds ratio [OR], 3.86; 95% confidence interval [CI], 3.54, 4.21), >60 to 120 MME/day (OR, 5.46; 95% CI, 4.44, 6.73), and >120 MME/day (OR, 3.45; 95% CI, 2.31, 5.15) than during off-treatment periods. The negative control analysis supported the specificity of the results to opioids rather than to other processes associated with pharmacologic pain management. These findings suggest that the receipt of prescription opioids, even at doses ≤60 MME/day, is associated with an increased risk of motor vehicle crashes.
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Affiliation(s)
- Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Robert D. Gibbons
- Center for Health Statistics, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
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29
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Schepis TS, Werner KS, Figueroa O, McCabe VV, Schulenberg JE, Veliz PT, Wilens TE, McCabe SE. Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine 2023; 58:101902. [PMID: 36969344 PMCID: PMC10036501 DOI: 10.1016/j.eclinm.2023.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stimulant and non-stimulant pharmacotherapy improve adolescent ADHD, but their associations with prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear. Using 2005-2020 US Monitoring the Future data, we investigated relationships between ADHD pharmacotherapy history and PSM, cocaine, or methamphetamine use. Methods Secondary students (13-19 years) provided data on pharmacotherapy history (N = 199,560; 86.3% of total sample) between January 1, 2005 and May 31, 2020 in a cross-sectional multi-cohort study; weights assured a nationally representative sample. Participants were grouped by ADHD pharmacotherapy history: none (88.7%; principally non-ADHD controls); stimulant-only (5.8%); non-stimulant-only (3.3%); both stimulant and non-stimulant (2.1%). Outcomes were past-year PSM, cocaine, and methamphetamine use. Logistic regressions examined relationships between pharmacotherapy history and outcomes, controlling for sociodemographics, recent substance use, and stimulant treatment cessation. Findings Past-year outcome rates were lowest in adolescents with no pharmacotherapy history: 4.7% for PSM [8310/174,561], 1.6% for cocaine [2858/174,688], and 0.7% for methamphetamine [1036/148,378]. A history of both stimulant and non-stimulant treatment was associated with the highest rates: 22.3% for PSM [940/4098], 10.4% for cocaine [450/4110], and 7.8% for methamphetamine [275/3427]. Adolescents who received monotherapy (stimulant- or non-stimulant-only) had intermediate rates, with no differences between monotherapy groups. Interpretation While elevated PSM and illicit stimulant use rates are likely influenced by ADHD, our findings suggested adolescents with a history of both stimulant and non-stimulant pharmacotherapy are at highest risk for these stimulant outcomes. Adolescents receiving ADHD pharmacotherapy should be monitored for PSM and illicit stimulant use. Funding National Institute on Drug Abuse/National Institutes of Health (USA) and Food and Drug Administration (USA).
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kennedy S. Werner
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Olivia Figueroa
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Vita V. McCabe
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - John E. Schulenberg
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Phil T. Veliz
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Timothy E. Wilens
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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30
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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31
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Dernbach MR, Gray KM, Borich A, Seery E, Russo SB, Lewis ET, Gwynette MF. Prescribing Stimulants for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder and Co-occurring Cannabis Use: Considerations for Managing a Clinical Dilemma. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)00055-2. [PMID: 36773700 DOI: 10.1016/j.jaac.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/02/2022] [Accepted: 11/02/2022] [Indexed: 02/11/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in the pediatric population, with 11% of children and adolescents having ever been diagnosed with the disorder.1 The management of ADHD in the setting of co-occurring cannabis use, which is more prevalent in adolescents with ADHD than in the general population, is an increasingly common dilemma facing clinicians, in part due to recent changes in social acceptability, access, usage, and state-level legal status of cannabis.2 Clinicians face several considerations, including the following: the confounding effects of cannabis use on assessment and management of ADHD symptoms; the potential reduction in risk of substance use when ADHD symptoms are well managed; and the increased risk of misuse and diversion of stimulants in patients with ongoing cannabis use.2.
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Affiliation(s)
| | - Kevin M Gray
- Medical University of South Carolina, Charleston
| | - Abbey Borich
- Medical University of South Carolina, Charleston
| | - Erin Seery
- Medical University of South Carolina, Charleston
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32
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Weiss F, Tidona S, Carli M, Perugi G, Scarselli M. Triple Diagnosis of Attention-Deficit/Hyperactivity Disorder with Coexisting Bipolar and Alcohol Use Disorders: Clinical Aspects and Pharmacological Treatments. Curr Neuropharmacol 2023; 21:1467-1476. [PMID: 36306451 PMCID: PMC10472804 DOI: 10.2174/1570159x20666220830154002] [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: 05/13/2022] [Revised: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD), Bipolar Disorder (BD) and Alcohol Use Disorder (AUD) are common medical conditions often coexisting and exerting mutual influence on disease course and pharmacological treatment response. Each disorder, when considered separately, relies on different therapeutic approaches, making it crucial to detect the plausible association between them. Treating solely the emerging condition (e.g., alcoholism) and disregarding the patient's whole psychopathological ground often leads to treatment failure and relapse. Clinical experience and scientific evidence rather show that tailoring treatments for these three conditions considering their co-occurrence as a sole complex disorder yields more fulfilling and durable clinical outcomes. In light of the above considerations, the purpose of the present review is to critically discuss the pharmacological strategies in the personalized treatment of complex conditions defined by ADHD-bipolarityalcoholism coexistence.
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Affiliation(s)
- Francesco Weiss
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Tidona
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56126, Italy
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33
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Lorenzi CH, Teixeira Leffa D, Bressan R, Belangero S, Gadelha A, Santoro ML, Salum GA, Rohde LA, Caye A. Replication of a predictive model for youth ADHD in an independent sample from a developing country. J Child Psychol Psychiatry 2023; 64:167-174. [PMID: 35959538 DOI: 10.1111/jcpp.13682] [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] [Accepted: 06/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Very few predictive models in Psychiatry had their performance validated in independent external samples. A previously developed multivariable demographic model for attention-deficit/hyperactivity disorder (ADHD) accurately predicted young adulthood ADHD using clinical and demographical information collected in childhood in three samples from developed countries, but failed to replicate its performance in a sample from a developing country. Furthermore, consolidated risk factors for ADHD were not included among its predictors. METHODS Participants were 1905 children and adolescents from a community-based sample and followed from ages 6 to 14 years at baseline to ages 14 to 23 years (mean age 18) at follow-up. We applied the intercept and weights of the original model to the data, calculating the predicted probability of each participant according to the set of predictors collected in childhood, and compared the estimates with the actual outcome (ADHD) collected during adolescence and young adulthood. We explored the performance of the original model, and of models including novel predictors (prematurity, family history of ADHD, and polygenic risk score for ADHD). RESULTS The observed area under the curve of the original model was .76 (95% Confidence Interval .70 to .82). The multivariable demographical model outperformed single variable models using only prematurity, family history, or the ADHD PRS. Adding either of these variables, or all at once, did not improve the performance of the original demographical model. CONCLUSIONS Our findings suggest that the originally developed ADHD predictive model is suitable for use in different settings for clinical and research purposes.
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Affiliation(s)
- Cezar H Lorenzi
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas Teixeira Leffa
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Rodrigo Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil
| | - Sintia Belangero
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil.,Genetics Division, Department of Morphology and Genetics, UNIFESP, São Paulo, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil
| | - Marcos L Santoro
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil.,Genetics Division, Department of Morphology and Genetics, UNIFESP, São Paulo, Brazil
| | - Giovanni A Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Arthur Caye
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
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34
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Pai MS, Yang SN, Chu CM, Lan TY. Risk of injuries requiring hospitalization in attention deficit hyperactivity disorder and the preventive effects of medication. Psychiatry Clin Neurosci 2022; 76:652-658. [PMID: 36066073 DOI: 10.1111/pcn.13471] [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: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
AIMS Patients with attention deficit hyperactivity disorder (ADHD) are prone to injury and frequently require treatment with hospital admission. This study aimed to evaluate the risk of injuries requiring hospitalization among children and adolescents with and without ADHD and assess the effects of medication on the risk reduction in patients with ADHD. METHODS This is a retrospective population-based cohort study by using data from the Taiwan National Health Insurance Research Database. We compared 4658 6-18 year-old ADHD patients with 18 632 sex-, age-, and index day-matched non-ADHD controls between 2005 and 2012. Both groups were followed until the end of 2013 to compare the risk of injuries requiring hospitalization. Cox regression analysis was performed to determine the hazard ratio (HR) with 95% confidence intervals (CI) after adjusting for confounders. RESULTS Children and adolescents with ADHD had a significantly higher risk of injuries requiring hospitalization than the non-ADHD controls (HR = 1.39, 95% CI = 1.12-1.72), and a higher risk was especially observed in the male and adolescent subgroups. In ADHD patients, long-term users of ADHD medication were associated with a lower risk of injuries requiring hospitalization than nonusers (HR = 0.51, 95% CI = 0.30-0.85). CONCLUSION Healthcare providers should be aware of the potential risk of injury in patients with ADHD and highlight the importance of the duration and compliance with medication treatment.
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Affiliation(s)
- Ming-Shang Pai
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Szu-Nian Yang
- Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.,Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Ming Chu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Big Data Research Center, Fu-Jen Catholic University, New Taipei City, Taiwan.,Division of Biostatistics and Medical Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Public Health, School of Public Health, China Medical University, Taichung, Taiwan.,Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzuo-Yun Lan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
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35
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Ding J, Ding Y, Wu J, Deng J, Yu Q, Wang J. "Jing-Ning Granules" Can Alleviate Attention Deficit Hyperactivity Disorder in Rats by Modulating Dopaminergic D2/D1-Like Receptor-Mediated Signaling Pathways. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:9139841. [PMID: 36337583 PMCID: PMC9635972 DOI: 10.1155/2022/9139841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulsivity. Jing-Ning Granules (JNG) is a traditional Chinese medicine (TCM) that can alleviate ADHD. Although JNG is commonly used for the effective treatment of ADHD and has obtained the national invention patent, the exact mechanism of action remains unclear. Objective In this study, we examined the effect and mechanism of JNG in spontaneously hypertensive rats (SHRs). We hypothesized that JNG affects dopaminergic D2/D1-like receptors and related pathways. Materials and Methods Six rat groups were used in the experiment: Wistar-Kyoto rats (WKY, control group) and five SHR groups, including a model group; atomoxetine (ATX, positive control) group; and low, medium, and high-dose JNG groups. The corresponding treatments were daily administered to each group for 6 weeks. A behavioral test, including a step-down test and open field test (OFT), was carried out at the end of treatment. After the behavioral test, all animals were sacrificed, and the brain tissue was collected and analyzed ex vivo; histopathological analysis was performed to assess the pathological changes of the hippocampus; expression of D1-like and D2-like receptors, sensor protein calmodulin (CaM), protein kinase A (PKA), and calcium/calmodulin-dependent serine/threonine protein kinase (CaMKII) in the striatum and hippocampus was measured by western blot and real-time quantitative PCR (RT-PCR); cyclic adenosine monophosphate (cAMP) levels in the striatum were analyzed using an enzyme-linked immunosorbent assay (ELISA), while the level of Ca2+ in the striatum was analyzed by a calcium kit. Results Our results showed that ATX or JNG could ameliorate the hyperactive/impulsive behavior and cognitive function of ADHD by promoting neuroprotection. Mechanistically, ATX or JNG could prompt the expressions of Dl-like and D2-like receptors and improve the mRNA and protein levels of cAMP/PKA and Ca2+/CAM/CAMKII signaling pathways. Conclusion These results indicate that JNG can produce therapeutic effects by regulating the balance of D2/D1-like receptor-mediated cAMP/PKA and Ca2+/CaM/CaMKII signaling pathways.
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Affiliation(s)
- Jie Ding
- Department of Pediatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yiyun Ding
- Department of Pediatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
- School of Psychology, Capital Normal University, Beijing 100048, China
| | - Jingjing Wu
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Jialin Deng
- Department of Pediatrics, Beijing Huaxin Hospital, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China
| | - Qingyang Yu
- Department of TCM, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Junhong Wang
- Department of Pediatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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36
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2022; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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37
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Tuan WJ, Babinski DE, Rabago DP, Zgierska AE. Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD. Brain Res Bull 2022; 187:155-161. [PMID: 35839903 PMCID: PMC9279163 DOI: 10.1016/j.brainresbull.2022.07.005] [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: 04/08/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022]
Abstract
Adults with attention deficit hyperactivity disorder (ADHD) have shown higher infection rates and worse outcomes from COVID-19. Stimulant medications are prescribed as the first-line treatment for ADHD in adults and mitigate risk of negative ADHD-related health outcomes, but little is known about the association between stimulant medications and COVID-19 outcomes. The objective of this study was to assess the risks of severe COVID-19 outcomes among people with ADHD who were prescribed stimulant medications versus those who were not. This retrospective cohort study used electronic health records in the TriNetX research database. We assessed records of adults with ADHD diagnosed with COVID-19 between January 1, 2020 and June 30, 2021. The stimulant cohort consisted of 28,011 people with at least one stimulant prescription; the unmedicated cohort comprised 42,258 people without prescribed stimulants within 12 months prior to their COVID infection. Multiple logistic regression modeling was utilized to assess the presence of critical care services or death within 30 days after the onset of COVID diagnoses, controlling for patient demographics, and comorbid medical and mental health conditions. The stimulant cohort was less likely to utilize emergency department, hospital, and intensive care services than the unmedicated cohort, and had significantly lower 30-day mortality. Further research, including prospective studies, is needed to confirm and refine these findings.
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Affiliation(s)
- Wen-Jan Tuan
- Penn State College of Medicine, Departments of Family and Community Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA.
| | - Dara E Babinski
- Penn State College of Medicine, Department of Psychiatry and Behavioral Health, 700 HMC Crescent Rd, Hershey, PA 17033, USA
| | - David P Rabago
- Penn State College of Medicine, Departments of Family and Community Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA; Penn State College of Medicine, Department of Psychiatry and Behavioral Health, 700 HMC Crescent Rd, Hershey, PA 17033, USA; Penn State College of Medicine, Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, 700 HMC Crescent Rd, Hershey, PA 17033, USA
| | - Aleksandra E Zgierska
- Penn State College of Medicine, Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, 700 HMC Crescent Rd, Hershey, PA 17033, USA
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38
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Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD. Medicina (B Aires) 2022; 58:medicina58070962. [PMID: 35888680 PMCID: PMC9323800 DOI: 10.3390/medicina58070962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.
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39
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Taubin D, Wilson JC, Wilens TE. ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy. Child Adolesc Psychiatr Clin N Am 2022; 31:515-530. [PMID: 35697399 DOI: 10.1016/j.chc.2022.01.005] [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: 11/03/2022]
Abstract
Co-occurring ADHD and substance use disorder (SUD) is a common clinical presentation associated with significant impairment requiring careful evaluation, diagnosis, and treatment. Treatment with medication, along with cognitive behavioral therapy, is generally regarded as effective in addressing symptoms and impairments associated with both disorders. Options for pharmacotherapy include stimulant and nonstimulant therapies administered with careful monitoring of dosage and compliance to optimize efficacy. In high-risk groups such as college students and/or those with SUD, prescribers should address risks of stimulant misuse and diversion through patient and family education, medication monitoring, and other risk-reducing practices.
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Affiliation(s)
- Daria Taubin
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Julia C Wilson
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Warren Building 628B, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Child Psychiatry Service, Massachusetts General Hospital, 55 Fruit Street, YAW 6A, Boston, MA 02114, USA; Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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40
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Kildal E, Hassel B, Bjørnebekk A. ADHD symptoms and use of anabolic androgenic steroids among male weightlifters. Sci Rep 2022; 12:9479. [PMID: 35676515 PMCID: PMC9178025 DOI: 10.1038/s41598-022-12977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Use of anabolic androgenic steroids (AAS) is associated with adverse health effects. The factors that predispose to AAS use among athletes are poorly understood, but attention deficit/hyperactivity disorder (ADHD), which is known to occur among athletes more often than in the general population, is associated with risk behaviors, including substance abuse. We aimed to see if AAS use in male weightlifters was associated with ADHD symptoms, and test the link between ADHD symptoms and cognitive performance. Hundred and forty male weightlifters, 72 AAS users and 68 weightlifting controls (WLC), completed the Achenbach system of empirically based assessment (ASEBA) for ADHD symptoms and underwent cognitive examination. Self-reported ADHD symptom scores were significantly higher among AAS users compared to WLC, and scores in the range indicating clinically important ADHD was significantly more common in the AAS-using group. Age of onset of AAS use correlated inversely with ADHD scale score (r = - 0.35; p = 0.003). ADHD score correlated inversely with cognitive scores for working memory (r = - 0.25, p < 0.001), processing speed (r = - 0.24, p < 0.001), verbal learning and memory (r = - 0.19, p = 0.03), and problem solving (r = - 0.20, p = 0.02). AAS use among weightlifters is associated with ADHD symptoms and corresponding lower cognitive performance. Recognising a relationship between ADHD symptoms and AAS use may guide drug prevention strategies in sports.
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Affiliation(s)
- Emilie Kildal
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørnar Hassel
- Department of Neurohabilitation, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Bjørnebekk
- The Anabolic Androgenic Steroid Research Group, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
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41
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Mintz CM, Xu KY, Presnall NJ, Hartz SM, Levin FR, Scherrer JF, Bierut LJ, Grucza RA. Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder. JAMA Netw Open 2022; 5:e2211634. [PMID: 35544135 PMCID: PMC9096599 DOI: 10.1001/jamanetworkopen.2022.11634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Stimulant medication use is common among individuals receiving buprenorphine for opioid use disorder (OUD). Associations between prescription stimulant use and treatment outcomes in this population have been understudied. OBJECTIVES To investigate whether use of prescription stimulants was associated with (1) drug-related poisoning and (2) buprenorphine treatment retention. DESIGN, SETTING, AND PARTICIPANTS This retrospective, recurrent-event cohort study with a case-crossover design used a secondary analysis of administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Primary analyses were conducted from March 1 through August 31, 2021. Individuals aged 12 to 64 years with an OUD diagnosis and prescribed buprenorphine who experienced at least 1 drug-related poisoning were included in the analysis. Unit of observation was the person-day. EXPOSURES Days of active stimulant prescriptions. MAIN OUTCOMES AND MEASURES Primary outcomes were drug-related poisoning and buprenorphine treatment retention. Drug-related poisonings were defined using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes; treatment retention was defined by continuous treatment claims until a 45-day gap was observed. RESULTS There were 13 778 567 person-days of observation time among 22 946 individuals (mean [SD] age, 32.8 [11.8] years; 50.3% men) who experienced a drug-related poisoning. Stimulant treatment days were associated with 19% increased odds of drug-related poisoning (odds ratio [OR], 1.19 [95% CI, 1.06-1.34]) compared with nontreatment days; buprenorphine treatment days were associated with 38% decreased odds of poisoning (OR, 0.62 [95% CI, 0.59-0.65]). There were no significant interaction effects between use of stimulants and buprenorphine. Stimulant treatment days were associated with decreased odds of attrition from buprenorphine treatment (OR, 0.64 [95% CI, 0.59-0.70]), indicating that stimulants were associated with 36% longer mean exposure to buprenorphine and its concomitant protection. CONCLUSIONS AND RELEVANCE Among persons with OUD, use of prescription stimulants was associated with a modest increase in per-day risk of drug-related poisoning, but this risk was offset by the association between stimulant use and improved retention to buprenorphine treatment, which is associated with protection against overdose.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Kevin Y. Xu
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Ned J. Presnall
- Department of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Sarah M. Hartz
- Department of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Frances R. Levin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, St Louis University, St. Louis, Missouri
- Department of Health and Outcomes Research, St. Louis University, St Louis, Missouri
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Richard A. Grucza
- Department of Family and Community Medicine, St Louis University, St. Louis, Missouri
- Department of Health and Outcomes Research, St. Louis University, St Louis, Missouri
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42
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Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Brain Sci 2022; 12:brainsci12050590. [PMID: 35624977 PMCID: PMC9139081 DOI: 10.3390/brainsci12050590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Sex differences are poorly studied within the field of mental health, even though there is evidence of disparities (with respect to brain anatomy, activation patterns, and neurochemistry, etc.) that can significantly influence the etiology and course of mental disorders. The objective of this work was to review sex differences in adolescents (aged 13–18 years) diagnosed with ADHD (according to the DSM-IV, DSM-IV-TR and DSM-5 criteria) in terms of substance use disorder (SUD), prevalence, pharmacological therapy and mental health. We searched three academic databases (PubMed, Web of Science, and Scopus) and performed a narrative review of a total of 21 articles. The main conclusions of this research were (1) girls with ADHD are more at risk of substance use than boys, although there was no consensus on the prevalence of dual disorders; (2) girls are less frequently treated because of underdiagnosis and because they are more often inattentive and thereby show less disruptive behavior; (3) together with increased impairment in cognitive and executive functioning in girls, the aforementioned could be related to greater substance use and poorer functioning, especially in terms of more self-injurious behavior; and (4) early diagnosis and treatment of ADHD, especially in adolescent girls, is essential to prevent early substance use, the development of SUD, and suicidal behavior.
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Wilens TE, Woodward DW, Ko JD, Berger AF, Burke C, Yule AM. The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders. J Child Adolesc Psychopharmacol 2022; 32:200-214. [PMID: 35587209 PMCID: PMC9145257 DOI: 10.1089/cap.2022.0016] [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: 11/13/2022]
Abstract
Background and Objective: Child- and adolescent-onset psychopathology is known to increase the risk for developing substance use and substance use disorders (SUDs). While pharmacotherapy is effective in treating pediatric psychiatric disorders, the impact of medication on the ultimate risk to develop SUDs in these youth remains unclear. Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of peer-reviewed literature published on PubMed through November 2021, examining pharmacological treatments of psychiatric disorders in adolescents and young adults and their effect on substance use, misuse, and use disorder development. Results: Our search terms yielded 21 studies examining the impact of pharmacotherapy and later SUD in attention-deficit/hyperactivity disorder (ADHD), two studies on Major Depressive Disorder, and three studies on psychotic disorders. The majority of these studies reported reductions in SUD (N = 14 sides) followed by no effects (N = 10) and enhanced rates of SUD (N = 2). Studies in ADHD also reported that earlier-onset and longer-duration treatment was associated with the largest risk reduction for later SUD. Conclusions: Overall, pharmacological treatments for psychiatric disorders appear to mitigate the development of SUD, especially when treatment is initiated early and for longer durations. More studies on the development of SUD linked to the effects of psychotherapy alone and in combination with medication, medication initiation and duration, adequacy of treatment, non-ADHD disorders, and psychiatric comorbidity are necessary.
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Affiliation(s)
- Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Timothy Wilens, MD, Department of Psychiatry, YAW6A, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Diana W. Woodward
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Je Deuk Ko
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colin Burke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
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Bhattacharyya N, Singh S, Banerjee A, Ghosh R, Sinha O, Das N, Gayen R, Pal SS, Ganguly S, Dasgupta T, Dasgupta T, Mondal P, Adhikari A, Sarkar S, Bhattacharyya D, Mallick AK, Singh OP, Pal SK. Integration of electroencephalogram (EEG) and motion tracking sensors for objective measure of attention-deficit hyperactivity disorder (MAHD) in pre-schoolers. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2022; 93:054101. [PMID: 35649790 DOI: 10.1063/5.0088044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
We developed an integrated device composed of a single-probe Electroencephalogram (EEG) and Charge Coupled Device (CCD) based motion sensors for objective measurement of Attention-deficit Hyperactivity Disorder (ADHD). While the measurement of attention-deficit hyperactivity disorder (MAHD) relies on the EEG signal for the assessment of attention during a given structured task, the CCD sensor depicts the movement pattern of the subjects engaged in a continuous performance task. A statistical analysis of attention and movement patterns was performed, and the accuracy of completed tasks was analyzed using indigenously developed software. The device with the embedded software is intended to improve certainty with criterion E. We used the EEG signal from a single-channel dry sensor placed on the frontal lobe of the head of the subjects (3-5 year old pre-schoolers). During the performance of the task power for delta and beta, EEG waves from the subjects are found to be correlated with relaxation and attention/cognitive load conditions. While the relaxation condition of the subject hints at hyperactivity, a more direct CCD-based motion sensor is used to track the physical movement of the subject engaged in a continuous performance task. We used our indigenously developed software for statistical analysis to derive a scale for the objective assessment of ADHD. We also compared our scale with clinical ADHD evaluations and found a significant correlation between the objective assessment of the ADHD subjects and the clinician's conventional evaluation. MAHD, the integrated device, is supposed to be an auxiliary tool to improve the accuracy of ADHD diagnosis by supporting greater criterion E certainty.
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Affiliation(s)
- Neha Bhattacharyya
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd., Machuabazar, Kolkata 700009, India
| | - Soumendra Singh
- Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal 700106, India
| | - Amrita Banerjee
- Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal 700106, India
| | - Ria Ghosh
- Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal 700106, India
| | - Oindrila Sinha
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Nairit Das
- Department of Electrical and Computer Engineering, North Carolina State University, 890 Oval Drive 3114 Engineering Building II, Raleigh, North Carolina 27606, USA
| | - Rajkumar Gayen
- Department of Paediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata 700014, India
| | - Somya Shubhra Pal
- California State University Los Angeles, 5151 State University Drive, Los Angeles, California 90032, USA
| | - Sahely Ganguly
- Department of Clinical Psychologist, AMRI Hospital Dhakuria, Block-A, Scheme-L11, P-4&5, Gariahat Rd., Dhakuria, Ward Number 90, Kolkata, West Bengal 700029, India
| | - Tanmoy Dasgupta
- Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata 700106, India
| | - Tanusree Dasgupta
- Department of Chemical, Biological and Macromolecular Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata 700106, India
| | - Pulak Mondal
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd., Machuabazar, Kolkata 700009, India
| | - Aniruddha Adhikari
- Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering, University of California, Los Angeles, California 90095, USA
| | - Sharmila Sarkar
- Department of Psychiatry, Calcutta National Medical College, 32, Gorachand Rd., Beniapukur, Kolkata, West Bengal 700014, India
| | - Debasish Bhattacharyya
- Department of Gynecology and Obstetrics, Nil Ratan Sircar Medical College and Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata 700014, India
| | - Asim Kumar Mallick
- Department of Paediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata 700014, India
| | - Om Prakash Singh
- West Bengal Medical Education Services Government of West Bengal, Swasthya Bhawan, GN-29, Sector-V, Salt Lake, Kolkata 700 091, India
| | - Samir Kumar Pal
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd., Machuabazar, Kolkata 700009, India
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45
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Quinn PD, Chang Z, Bair MJ, Rickert ME, Gibbons RD, Kroenke K, D’Onofrio BM. Associations of opioid prescription dose and discontinuation with risk of substance-related morbidity in long-term opioid therapy. Pain 2022; 163:e588-e595. [PMID: 34326295 PMCID: PMC8795234 DOI: 10.1097/j.pain.0000000000002415] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Efforts to reduce opioid-related harms have decreased opioid prescription but have provoked concerns about unintended consequences, particularly for long-term opioid therapy (LtOT) recipients. Research is needed to address the knowledge gap regarding how risk of substance-related morbidity changes across LtOT and its discontinuation. This study used nationwide commercial insurance claims data and a within-individual design to examine associations of LtOT dose and discontinuation with substance-related morbidity. We identified 194,839 adolescents and adults who initiated opioid prescription in 2010 to 2018 and subsequently received LtOT. The cohort was followed for a median of 965 days (interquartile range, 525-1550), of which a median of 176 days (119-332) were covered by opioid prescription. During follow-up, there were 17,582 acute substance-related morbidity events, defined as claims for emergency visits, inpatient hospitalizations, and ambulance transportation with substance use disorder or overdose diagnoses. Relative to initial treatment, risk was greater within individual during subsequent periods of >60 to 120 (adjusted odds ratio [OR], 1.29; 95% CI, 1.12 to 1.49) and >120 (OR, 1.48; 95% CI, 1.24-1.76) daily morphine milligram equivalents. Risk was also greater during days 1 to 30 after discontinuations than during initial treatment (OR, 1.19; 95% CI, 1.05-1.35). However, it was no greater than during the 30 days before discontinuations, indicating that the risk may not be wholly attributable to discontinuation itself. Results were supported by a negative control pharmacotherapy analysis and additional sensitivity analyses. They suggest that LtOT recipients may experience increased substance-related morbidity risk during treatment subsequent to initial opioid prescription, particularly in periods involving higher doses.
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Affiliation(s)
- Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Martin E. Rickert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Robert D. Gibbons
- Center for Health Statistics, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
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46
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Simonoff EA. Editorial: The Long-term Impact of Attention-Deficit/Hyperactivity Disorder: Lessons From the Past and Directions for the Future. J Am Acad Child Adolesc Psychiatry 2022; 61:357-359. [PMID: 34971731 DOI: 10.1016/j.jaac.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
In this issue of the Journal, Cherkasova et al.1 provide a unique synthesis of 7 prospective longitudinal cohorts of children with attention-deficit/hyperactivity disorder (ADHD), all followed into adult life. The authors focus on a diverse range of outcome domains: educational performance, occupational/economic functioning, mental health, physical health, substance use, antisocial behavior, and driving. These not only are important for the quality of life and well-being of people with ADHD, but also have implications for health service use and the wider economic impact on society. Each cohort on its own has already provided significant insights into the course of ADHD and played a key role in our current understanding of the condition. All cohorts have a long follow-up period-in the New York cohort, 33 years after initial evaluation and well into mid-adulthood. The retention rates are impressive, ranging from 60% to 94%. All cohorts employ a comparison group, which is essential in interpreting the reported outcomes. In bringing together the 7 cohorts, the authors present a clear consensus that people with ADHD are at high risk of adverse outcomes in all functional domains. ADHD is considered by some experts to be one of the mental health conditions most responsive to intervention, and, as such, these findings challenge our management of the condition and mandate future research to improve outcomes.
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Affiliation(s)
- Emily A Simonoff
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
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47
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Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA, Biederman J, Uchida M, Hinshaw SP, Owens EB, Hechtman L. Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood. J Am Acad Child Adolesc Psychiatry 2022; 61:378-391. [PMID: 34116167 DOI: 10.1016/j.jaac.2021.05.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA). METHOD All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes. RESULTS The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders. CONCLUSION Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.
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Affiliation(s)
| | | | | | | | - Gabrielle Weiss
- McGill University, Montreal, and the University of British Columbia, Vancouver, Canada
| | | | | | - Mai Uchida
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephen P Hinshaw
- University of California Berkeley and the University of California San Francisco, California
| | | | - Lily Hechtman
- McGill University Health Center, Montreal, Quebec, Canada; Division of Child Psychiatry, McGill University, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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48
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Chen VCH, Kao KL, Chen YL, Wu SI, Lee MJ, Gossop M. Methylphenidate Use and Infectious Diseases in Children With Attention Deficit and Hyperactivity Disorder: A Population-Based Study. Front Med (Lausanne) 2022; 8:787745. [PMID: 35211484 PMCID: PMC8861374 DOI: 10.3389/fmed.2021.787745] [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: 10/01/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Children with attention deficit hyperactivity disorder (ADHD) have more visits to the emergency department (ED) due to injuries than those without ADHD. However, no study has investigated whether children with ADHD have more ED visits or hospitalizations due to infectious diseases (IDs) and whether methylphenidate (MPH) treatment may reduce the risk. Method The incidence of ID-related ED visits or hospitalizations was defined as the main outcome. The Cox regression and conditional Poisson regression models were calculated to estimate hazard ratios (HRs) in the population level and relative risks for the self-controlled case series design, respectively. Results Children with ADHD had higher rates of emergency visits (HR = 1.25, 95% CI: 1.23~1.27) and hospitalizations (HR = 1.28, 95% CI: 1.26~1.31) due to IDs than those without ADHD. In the ADHD subgroup, those who received MPH treatment have a reduced risk of emergency visits (HR = 0.10, 95% CI: 0.09~0.10) and hospitalizations (HR = 0.73, 95% CI: 0.71~0.75), compared to those without treatment. The risk of ID-related emergency visits decreased to 0.21 (95% CI: 0.21~0.22); and hospitalizations decreased to 0.71 (95% CI: 0.69~0.73). Within self-controlled analysis, it is demonstrated that compared with non-MPH exposed period, children with ADHD had significantly decreased risks for infection-related emergency visits (RR = 0.73, 95% CI: 0.68~0.78) or hospitalizations (RR = 0.19, 95% CI: 0.17~0.21) during MPH-exposed periods. Conclusions and Relevance This is the first study that reported an increased risk of ID-related healthcare utilizations in children with ADHD compared to those without, and that such risks may be significantly reduced in ADHD children that received MPH treatment.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Liang Kao
- Division of Infectious Diseases, Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, United Kingdom
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Virtanen S, Lagerberg T, Khemiri L, Suvisaari J, Larsson H, Lichtenstein P, Chang Z, Latvala A. Association of selective serotonin re-uptake inhibitor (SSRI) treatment with acute substance misuse outcomes. Addiction 2022; 117:234-242. [PMID: 34185347 DOI: 10.1111/add.15625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/19/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed medications for patients with anxiety/depression. These patients often have problems with substance use, but it remains unclear whether the risk of substance misuse is influenced by SSRI treatment. We aimed to determine whether SSRI treatment is associated with a decreased risk of acute substance misuse-related outcomes. DESIGN Cohort study following individuals through Swedish nation-wide registers between July 2005 and December 2013 and comparing the risk of substance misuse outcomes during periods on- versus off-treatment within the same individual. SETTING Swedish general population. PARTICIPANTS Individuals with a newly dispensed prescription of SSRIs between July 2006 and December 2013 and an ICD-10 diagnosis of anxiety/depressive disorder before the first treatment initiation. The cohort included 146 114 individuals (60.7% women). MEASUREMENTS Substance misuse outcomes included ICD-10 diagnoses of acute intoxications (F10.0-F19.0), accidental poisonings by alcohol or drugs (X41-X42, X45-X46) and substance-related criminal offenses. FINDINGS The absolute rate of substance misuse increased sharply before the onset of SSRI treatment and decreased after treatment initiation. Stratified Cox regression models showed an elevated risk [hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 1.62-1.78] of substance misuse outcomes during a 1-month period preceding treatment initiation, compared with the reference period of more than 1 month before treatment start. The on-treatment estimates (1-30 days, HR = 1.29, 95% CI = 1.23-1.37; 31-120 days, HR = 1.30, 95% CI = 1.24-1.35; and > 120 days, HR = 1.24, 95% CI = 1.18-1.30 after treatment initiation] were consistently lower than the 1-month pre-treatment estimate, but still elevated compared with the reference period. CONCLUSIONS For people with anxiety/depression, the risk of substance misuse appears to be particularly elevated immediately before initiating selective serotonin reuptake inhibitor (SSRI) treatment, which may reflect the emergence or worsening of substance use problems concurrently with anxiety/depression. SSRI treatment appears to be associated with a lower risk of substance misuse compared with the 1-month period preceding treatment initiation, but causality remains uncertain.
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Affiliation(s)
- Suvi Virtanen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lotfi Khemiri
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, County Council, Stockholm, Stockholm, Sweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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50
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Köck P, Meyer M, Elsner J, Dürsteler KM, Vogel M, Walter M. Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders - A Narrative Review. Front Psychiatry 2022; 13:827658. [PMID: 35280170 PMCID: PMC8907594 DOI: 10.3389/fpsyt.2022.827658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct disorders, and first-episodes psychosis frequently appear in early life stages. This review aims to provide a broad overview of transitional-aged youth's most common psychiatric comorbidities with substance use disorders. A literature search was conducted in Embase and Pubmed, and the main findings are described narratively. We present main findings for the following comorbidities: attention-deficit/hyperactivity disorder, conduct disorder, personality disorders, affective disorders, psychotic disorders, and the phenomena of overdose and suicidality. In conclusion, co-occurring mental health disorders are common and appear to facilitate the development of substance use disorders and exacerbate their overall course. Substance use also affects the severity and course of comorbid psychiatric disorders. Overall, data on transition-age youth with substance use disorders are highly inconsistent. Universal screening and treatment guidelines do not yet exist but should be aimed for in the future.
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Affiliation(s)
- Patrick Köck
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Julie Elsner
- University Psychiatric Clinics Basel, Clinic for Children and Adolescents, University of Basel, Basel, Switzerland
| | - Kenneth M Dürsteler
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Division of Substance Use Disorders, Psychiatric Clinic, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland
| | - Marc Walter
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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