The experiences of receiving a diagnosis of attention deficit hyperactivity disorder during adulthood in Japan: a qualitative study.

BACKGROUND: Although the number of adults with attention deficit hyperactivity disorder (ADHD) has increased considerably in recent years, there are few qualitative investigations of the experiences of adults with adult-diagnosed ADHD in Japan. This study aimed to explore in depth the diagnosis-related experiences and needs of such adults. METHODS: Participants were 12 psychiatric outpatients aged 23-55 years diagnosed with ADHD during adulthood. Individual semi-structured interviews were conducted to examine participants' experiences of receiving, and subsequently coping with, an ADHD diagnosis. A thematic analysis of the interview data was performed. RESULTS: Six themes emerged: difficulties in accepting the diagnosis, interest in ADHD, feelings of relief, identity concerns, dealing with symptoms, and acceptance of ADHD. Despite initial negative reactions, participants were willing to learn about the disorder, spending time seeking ADHD-related information and sharing it with loved ones. Participants felt relieved after the diagnosis, as they realized why they had experienced long-term problems and incorrect labeling. However, participants also had identity concerns. They gradually began to accept their ADHD symptoms and deal with them better. CONCLUSIONS: The results suggest that, when treating individuals with adult-diagnosed ADHD, it is important to promote self-understanding and reduce negative attitudes toward ADHD; to provide appropriate, brief, evidence-based information about ADHD; and to give individuals sufficient time to think about their ADHD symptoms, how they have affected their daily lives, and how to cope with them in the future.

Seven-day shared decision making for outpatients with first episode of mood disorders among university students: A randomized controlled trial.

Providing appropriate treatment to patients with a first episode of mood disorders is crucial for recovery from the disorders. Although shared decision making (SDM) has been proposed as a promising model in psychiatric practice, an appropriate SDM approach has not yet been established. The aim of the current study was to evaluate the effects of an originally developed seven-day SDM program for outpatients with a first episode of mood disorders among university students. University students with a first episode of mood disorders were randomly allocated into two arms: SDM and control. The participants in the SDM arm received the seven-day SDM program, which included option presentation consultation, external deliberation with a decision aid booklet, decision coaching by a nurse, and decision-making consultation. The control arm received usual care. The primary outcome was patient-perceived involvement. We enrolled 88 participants. Compared with usual care, the SDM program significantly improved patient-perceived involvement in treatment decision making without taking up clinicians' time. The program did not lead to worse symptoms of mood disorders. In conclusion, sharing treatment decision making with university students with a first episode of mood disorders is feasible.

[A study on involutional melancholia].

In 1896 Kraepelin described (involutional) melancholia as a single clinical entity separate from manic-depressive psychosis. Because of the high incidence of depression in the involutional period, its symptomatic characteristics, and somewhat poor prognosis, this was recognized as valid at that time. Nowadays, the broadening concept of mood disorder denies involutional melancholia as a valid independent entity, and so it is included in mood disorders. A closer psychopathological inspection, however, still reveals several crucial differentiating points, which suggest that should be separated from the current mood disorder concept. Its cardinal symptoms are as follows: unveiled basic anxiety (Schneider K), specific autistic thinking (Kranz H), lack of insight, dissimulation, and severe suicidal thoughts. Patients fear that their innermost mind will be revealed, try to hide it, and even pretend to be healthy. Melancholic patients are believed to be at an extremely high risk of suicide. Difference between species and types of disease and the diagnostic hierarchial rule, which classifies all mental disorders into four different hierarchies (groups), are also referred to. The reevaluation of involutional melancholia is imperative for the present field of clinical psychiatry.