ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015.

Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments.

Children and adolescents with ADHD followed up to adulthood: a systematic review of long-term outcomes.

The objective is to highlight the clinical and social outcomes among adults who suffered from Attention-Deficit Hyperactivity Disorder (ADHD) in their childhood/adolescence. PubMed, PsycINFO, and Scopus databases were searched for prospective studies published during the last 5 years addressing patients with ADHD in childhood/adolescence followed-up to adulthood. We also included studies published before 2015 reported in other reviews with similar outcomes. Thousand four-hundred and eighty-five studies were identified, but only 39 were included for qualitative analysis and 27 for quantitative analysis. Overall, we found that ADHD persisted into adulthood with a mean rate of 43% and was mainly associated with both substance/alcohol use disorders and antisocial behavior and, less frequently, with anxiety and depressive disorders. The prevalence of persistent ADHD in adulthood reported by studies published after 2011 (55%) was higher than that reported by studies published previously from 1985 to 2011 (34%), suggesting a greater focus on ADHD in recent years. Our results highlight that ADHD can be considered not only a neurodevelopmental disorder, but also a persistent and complex condition, with detrimental consequences for quality of life in adulthood.

Computed Tomography in Acute Severe Central Nervous System Complications in Children Treated for Cancer: Still a Useful Diagnostic Tool in the Emergency Setting.

We retrospectively checked patients who underwent chemotherapy and/or hematopoietic stem cell transplantation from 2007 to 2016, in order to evaluate whether early computed tomography is useful in children treated for cancer with acute central nervous system complications. Out of a total sample of 443 patients, 52 children (11.7%) presented these complications. In the end, 31 patients were included, with a total of 33 events of central nervous system complications. The computed tomography was abnormal in 22 events (67%) and diagnostic for a specific complication in 20 events (61%), whereas it directly influenced the treatment in 16 events (48%). Computed tomography should be still considered a relevant diagnostic tool in the management of acute central nervous system complications in the emergency setting.

Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory.

INTRODUCTION: Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term. PURPOSES: The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors. METHODS: The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed. RESULTS: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach's alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach's alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach's alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach's alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy. DISCUSSION: Among the selected variables, "monotherapy" and "total number of hospitalizations" were negatively correlated to the final score of DAI-30, whereas being "married" was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.

Stability of Psychiatric Diagnoses in Candidates to Liver Transplantation Referred to a Consultation-Liaison Psychiatry Service.

OBJECTIVE: To investigate the stability over time of the psychiatric diagnoses among candidates to liver transplantation referred to a consultation-liaison psychiatric service. METHOD: Descriptive study, carried out at the Consultation-Liaison Psychiatry Service (CLPS) placed at the Modena (Italy) General University Hospital. All patients waiting for liver transplantation and repeatedly referred to the CLPS were enrolled. The observation period was from 1 January 2008 to 31 December 2013. Pearson's coefficients were calculated to measure diagnostic stability (index referral vs. last referral). RESULTS: One hundred patients were assessed (males 67%; mean age 53 ± 7 years old). The mean number of referrals for patients was 3 ± 2. The stability rate of psychiatric diagnosis was 64%. The following diagnoses or conditions were all significantly stable (i.e., all featured by r > 0.5 and p < 0.05): Adjustment disorder, depressive disorder, comorbid anxiety/depressive disorder, substance use disorder (including alcohol), absence of any disorder, and presence of any disorder. CONCLUSIONS: The good level of diagnostic stability displayed in the sample may be a function of the clinical and organizational "style" of the CLPS, namely the focus on identifying the prevailing personality traits, defensive mechanisms, and relational patterns.