Quality of life in substance use disorder patients with and without attention deficit hyperactivity disorder 12 months after treatment: a naturalistic follow-up study.

There is sparse research on quality of life (QoL) as an outcome measure in patients with substance use disorders (SUD), with or without attention deficit hyperactivity disorder (ADHD). We aimed to investigate whether SUD patients with and without ADHD (SUD + ADHD vs. SUD - ADHD) differed in QoL at baseline and at a 12-month follow-up after SUD treatment. The groups were additionally compared with data from a national population sample (NPS). From a sample of 16 SUD + ADHD and 87 SUD - ADHD patients originally recruited between 2010 and 2012, eight SUD + ADHD (50.0%) and 28 SUD - ADHD (32.2%) patients were reached at follow-up. QoL was measured with the short version of the World Health Organization QoL instrument (WHOQOL-BREF). Cross-sectional data on QoL from NPS was utilized. Compared to NPS, SUD patients reported significantly lower QoL at baseline and follow-up. Furthermore, QoL was similar at baseline in SUD + ADHD and SUD - ADHD patients. At a 12-month follow-up after SUD treatment, SUD + ADHD patients 'QoL had improved, however, not significantly differing from SUD - ADHD patients or the NPS. SUD - ADHD patients' QoL remained significantly lower. At follow-up, SUD + ADHD patients' QoL improved nominally compared to SUD - ADHD patients, but not the NPS. The clinical and functional relevance of these findings should be investigated further.

Optimal management of ADHD in older adults.

BACKGROUND: The manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed. METHOD: A systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years. RESULTS: ADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered. CONCLUSION: It is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk-benefit ratio when pharmacotherapy is considered to be a possible treatment.

Psychopharmacological treatment of ADHD in adults aged 50+: an empirical study.

OBJECTIVE: To study pharmacotherapy in adults aged 50+ with ADHD. METHOD: A survey was administered to adults with ADHD (≥ 50 years old). Participants on medication for ADHD were compared with those not on medications. RESULTS: Mean age of participants was 55.8 years, and mean age when diagnosed with ADHD was 50.3 years. Ninety-five participants (63.8%) reported current psychopharmacological treatment for ADHD, 36 (24.2%) had stopped psychopharmacological treatment, and 18 (12.0%) were psychopharmacological treatment naive for ADHD. Those currently being treated psychopharmacologically for ADHD reported significantly improved attention relative to the two nonmedicated groups (p < .01). Among examined sample characteristics (including current psychopharmacological treatment for ADHD), employment was associated with a better outcome (odds ratio = 3.3, p = .006). CONCLUSION: The majority of adults aged 50+ with ADHD reported regular pharmacotherapy for ADHD. Participants currently receiving psychopharmacological treatment for ADHD reported better attention than those not receiving pharmacotherapy. Employment was associated with more favorable outcomes.

Quality of life in adults aged 50+ with ADHD.

OBJECTIVE: To study the quality of life in adults aged 50+ with ADHD. METHOD: An anonymous questionnaire survey was performed on 148 adults aged 50+ with ADHD. Quality of life was assessed with EuroQol and the Satisfaction With Life Scale. Age-matched Norwegian and Danish population samples served as reference groups. RESULTS: Mean age of participants was 55.7 years, and mean age when diagnosed with ADHD was 50.2 years, while mean Adult ADHD Self-Report Scale Screener score was 15.2. Adults with ADHD reported significantly reduced health-related quality of life and reduced satisfaction with life compared with population norms. Nonemployment and severe ADHD were associated with poor quality of life. CONCLUSION: Adults aged 50+ with ADHD diagnosed in late adulthood reported significantly reduced quality of life when compared with population norms. The negative impact of ADHD persists into late adulthood.

Adults with ADHD: use and misuse of stimulant medication as reported by patients and their primary care physicians.

This study investigated the agreement on treatment for attention-deficit/hyperactivity disorder (ADHD) between adults with ADHD and the primary care physicians responsible for their treatment. Adults with ADHD and the primary care physicians responsible for their ADHD treatment completed a survey. The κ-statistic assessed physician-patient agreement on ADHD treatment variables. The eligible sample consisted of 274 patients with confirmed current or previous psychopharmacological treatment for ADHD and the physicians responsible for their treatment. We received 159 questionnaires (58.0 %) with sufficient information from both sources. There were no significant differences between participants and nonparticipants (N = 115) on ADHD sample characteristics. Participants' mean age was 37.6 years, and 75 (47.2 %) were females. There was high agreement for current pharmacological treatment for ADHD, current and last ADHD drug prescription, treatment for substance use, and misuse of stimulant medication. Agreement for nonpharmacological treatment for ADHD and treatment termination because of the side effects was low. A minority of participants from both sources reported misuse of stimulant medication. There was a moderate correlation between the physicians' clinical judgment and patients' self-report on current functioning. The study showed that primary care physicians and their patients agreed on the pharmacological but not the nonpharmacological, treatments given. They also agreed on patients' current functioning. Physicians and patients reported low levels of misuse of stimulant medication. The results show that pharmacological treatment for adults with ADHD can be safely undertaken by primary care physicians.

Four-year outcome in psychopharmacologically treated adults with attention-deficit/hyperactivity disorder: a questionnaire survey.

OBJECTIVE: In adults with attention-deficit/hyperactivity disorder (ADHD), pharmacotherapy is a recommended treatment option. However, research on long-term outcome with such treatment has been scarce. METHOD: A questionnaire survey was completed by adults with ADHD, diagnosed according to ICD-10/DSM-IV criteria and approved for pharmacotherapy during 2003 to 2005, living in southeastern Norway. The questionnaire was conducted from November 2008 to April 2009. Of an eligible number of 1,096 subjects, 1,080 remained at follow-up; 371 subjects (34.4%) agreed to participate, and 368 of these reported having ever been treated with ADHD medication. Baseline characteristics and self-reported outcome were studied by time on psychopharmacologic treatment. Primary outcome measures were the Adult ADHD Self-Report Scale version 1.1 (ASRS) Screener and the Mental Health Index-5 (MHI-5). Based on cutoff scores for these instruments, 2 groups (favorable outcome vs others) were created to study possible predictors of outcome status. RESULTS: Self-reported baseline ADHD symptoms and impairment did not differ between participants and nonparticipants. Mean observation time was 4.5 years (range, 3.5-6.0 years). At follow-up, mean age was 36.5 years. Altogether, 270 patients (73.4%) had been treated for more than 24 months. They reported better outcome on all measures compared to those treated for 24 months or less (mean values: ASRS Screener score: 12.8 vs 15.3; MHI-5 score: 63.7 vs 57. 7). The favorable outcome group consisted of 79 participants (21.5%). Comorbidity at baseline predicted poorer outcome than did no comorbid illness. CONCLUSIONS: In adults with ADHD, pharmacologic treatment for more than 2 years was associated with better functioning than treatment for 2 years or less. Comorbidity at baseline predicted poorer outcome.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.