| 3 :
Can Fam Physician. 2005 Jan;51:53-9. |
|
Attention deficit disorder in adults. Management in primary care.
Kates N.
Department of Psychiatry and Behavioural Neurosciences, McMaster University,
Hamilton, Ont.
OBJECTIVE: To review the ways attention deficit disorder (ADD) presents in
adults in primary care and to suggest treatment approaches. SOURCES OF
INFORMATION: PsycINFO, PubMed, and Academic Search Elite databases were
searched. Level I evidence supports the effectiveness of stimulants for
treating ADD in adults, and mixed evidence (levels I and II) supports the
effectiveness of antidepressants. MAIN MESSAGE: Attention deficit disorder is
a prevalent but often unrecognized disorder in adults. The diagnosis, which
must include onset of symptoms before age 7, is often missed. This could be
because family physicians are not always familiar with the presentation in
adults, because it frequently presents with comorbid problems, or because
specific questions are not asked to elicit the diagnosis. Diagnosis is based
on clinical assessment often assisted by self-rating scales. Management
includes support and education, helping patients develop additional structure
in their lives and make necessary behavioural changes, enhancing self-esteem,
supporting and educating families, and prescribing medication. Medication
choices include stimulants and antidepressants; medication can benefit up to
60% of people with ADD. CONCLUSION: It is crucial for primary care physicians
to identify ADD in adults and to initiate treatment or referral. Several
simple interventions can be employed.
PMID: 15732222 [PubMed - indexed for MEDLINE]
Comment in:
Can Fam Physician. 2005 Jan;51:16, 20-1.
4- Entrevue Medscape, mai 2004
Treatment for Adult ADHD: A Newsmaker Interview With
Timothy Wilens, M. par Martin Korn, MD
|
5: J Clin Psychiatry 2004; 65 (suppl 3:27-37) |
|
A Guide to The Treatment of Adults With ADHD
Margaret D. Weiss, M.D., Ph.d., and Jacqueline R.
Weiss, M. D.
While child and adolescent physicians are
familiar with the treatment of attention-deficit/hyperactivity disorder (ADHD),
many adult physicians have little experience with the disorder. It is difficult
to develop clinical skills in the management of residual adult manifestations of
developmental disorders without clinical experience
with their presentation in childhood. Adult patients
are increasingly seeking treatment for the symptoms of ADHD, and physicians need
practice guidelines. Adult ADHD often presents differently from childhood
ADHD. Because adult ADHD can be comorbid with other disorders and has symptoms
similar to those of other disorders, it is important to understand differential
diagnoses. Physicians should work with patients to provide feedback about their
symptoms, to educate them about ADHD, anb to set treatment goals.
Treatment for
ADHD in adults should include a medication trial, restructuring of patient's
environment to make it more compatible with the sypmtoms of ADHD, and ongoing
supportive management to address any residual impairment and to facilitate
functional and developmental improvements.
| 6:
CMAJ • March 18, 2003; 168 (6) |
|
|
Assessment and management of
attention-deficit hyperactivity disorder in adults
Margaret
Weiss
and Candice Murray
(Dr.
Weiss
is with the Division of Child Psychiatry and Ms. Murray is with the Department
of Psychology, University of British Columbia, Vancouver, BC.)
Correspondence to:
Dr. Margaret
Weiss,
Rm. B430, Children's and Women's Health Centre of British Columbia, 4500 Oak
St., Vancouver BC V6H 3N1; fax 604 875-2468;
mweiss@cw.bc.ca
Attention-deficit hyperactivity disorder (ADHD) is estimated
to
affect 2%–6% of adults. The symptoms in adults with ADHD mirror those
in children with the disorder and are associated with significant
educational, occupational and interpersonal difficulties.
Double-blind, placebo-controlled trials have established that adult
ADHD is responsive to stimulant medication treatment. New medications
and psychotherapeutic approaches are being developed in an effort to
achieve optimal treatment effects in this population. We review the
available literature and provide an approach to the assessment and
management of ADHD in adults.
© 2003
Canadian Medical Association
or its licensors
|
7: Biol Psychiatry. 2004 Apr 1;55(7):692-700.
|
|
Gender effects on Attention-Deficit/Hyperactivity disorder in adults, revisited
Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E.
Pediatric Psychopharmacology Unit of the Psychiatry Department (JB, SVF, MCM,
MB, EC), Massachusetts General Hospital, Boston, Massachusetts, USA.
BACKGROUND: This study reexamined gender differences in a large sample of adults
with attention-deficit/hyperactivity disorder (ADHD). METHODS: We assessed the
effects of ADHD, gender, and their interaction on rates of psychiatric
comorbidity and cognitive functioning in 219 adults with ADHD who were referred
to an outpatient psychiatric clinic over the last 7 years compared with 215
control subjects group-matched to control subjects on age and gender, and
ascertained from ongoing family genetic case control adults with ADHD. RESULTS:
There was no evidence that gender moderated the association between ADHD and
other psychiatric disorders. Attention-deficit/hyperactivity disorder was
associated with cognitive deficits and higher rates of major depression, anxiety,
substance use disorders, and antisocial personality disorder.
CONCLUSIONS: Attention-deficit/hyperactivity disorder in adults is associated with
psychiatric and cognitive impairment in both genders. These results bear
striking similarities to findings reported in pediatric samples, supporting the
validity of ADHD and stressing the importance of identifying and treating the
disorder in adulthood.
PMID: 15038997 [PubMed - in process]
| 8: JAMA. 2004 Aug 4;292(5):619-23. |
|
Attention-deficit/hyperactivity disorder in adults.
Wilens TE, Faraone SV, Biederman J.
Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General
Hospital and Harvard Medical School, Boston, Mass 02114-3139, USA. twilens@partners.org
PMID: 15292088 [PubMed - in process
commentaire:
article excellent et disponible sur
9
: Am J Psychiatry. 2004 Nov;161(11):1948-56.
Diagnostic controversies in adult attention deficit hyperactivity disorder.
McGough JJ, Barkley RA.
Suite 1414, 300 UCLA Medical Plaza, Los Angeles, CA 90095. jmcgough@mednet.ucla.edu.
OBJECTIVE: While it is increasingly recognized that attention deficit
hyperactivity disorder (ADHD) persists into adulthood, there is no consensus
on diagnostic criteria for adult ADHD. In this article the authors describe
and contrast competing approaches for diagnosis of adult ADHD used in
clinical and research practice. METHOD: The authors review the Wender Utah
criteria, DSM criteria, and laboratory assessment strategies for adult ADHD.
Advantages and disadvantages of each approach are described, and
recommendations are made as a basis for clinical assessment and future
research. RESULTS: Both the Wender Utah criteria and DSM-based approaches
identify significantly impaired ADHD adults with neurocognitive, biological,
and treatment response patterns similar to pediatric ADHD patients. The
Wender Utah criteria established the need for retrospective childhood
diagnosis and recognize developmental differences in adult symptom
expression. The Wender Utah criteria fail to identify patients with
predominately inattentive symptoms, exclude some patients with significant
comorbid psychopathology, and diverge significantly from the DSM conception
of ADHD. The DSM criteria have never been validated in adults, do not
include developmentally appropriate symptoms and thresholds for adults, and
fail to identify some significantly impaired adults who are likely to
benefit from treatment. There are insufficient scientific data to justify
use of laboratory assessment measures, including neuropsychological tests
and brain imaging, in diagnosing adult ADHD.
CONCLUSIONS: Adult ADHD remains
a clinical diagnosis. Clinicians should be flexible in application of the
current ADHD criteria to adults. Additional research is required to validate
adult diagnostic criteria.
PMID: 15514392 [PubMed - in process]
| 10: MMW
Fortschr Med. 2004 Aug 19;146(33-34):31-4. |
|
[Adult attention deficit/hyperactivity disorder][Article in German]
Laufkotter R, Eichhammer P, Hajak G.
Klinik und Poliklinik fur Psychiatrie und Psychotherapie der Universitat
Regensburg. rainer.laufkoetter@medbo.de
ADHD (attention deficit/hyperactivity disorder) in adults is a more complex
pathological condition than ADHD seen in children and adolescents. The number of
reports of impaired self-regulation are on the increase. Psychiatric comorbities
are being found ever more frequently, and negative life experiences are coloring
the clinical presentation to an ever greater extent. Therapeutic strategies
involving the use of stimulants and antidepressants are often needed to pave the
way for individual and group psychotherapy.
Despite the fact that it is
currently considered to be "fashionable", the diagnosis of ADHD is a clinically
relevant and persisting psychological disorder.
PMID: 15526623 [PubMed - in process]
-
| 11: Psychol Med.
2005 Jun;35(6):807-16. |
|
Stopping and changing in adults with ADHD.
Bekker EM,
Overtoom CC,
Kenemans JL,
Kooij JJ,
De Noord I,
Buitelaar JK,
Verbaten MN.
Department of Psychopharmacology, Utrecht University, The Netherlands. E.M.Bekker@pharm.uu.nl
BACKGROUND: A lack of inhibitory control has been suggested to be the core
deficit in children with attention deficit hyperactivity disorder (ADHD). This
means that a primary deficit in behavioral inhibition mediates a cascade of
secondary deficits in other executive functions, such as arousal regulation.
Clinical observations have revealed that with increasing age symptoms of
hyperactivity and impulsivity decline at a higher rate than those of
inattention. This might imply that a deficit in attention rather than a lack of
inhibitory control is the major feature in adult ADHD. METHOD: To study whether
an attentional or inhibitory deficit predominates, the stop-signal task and the
stop-change task were presented to 24 adults with ADHD combined subtype and 24
controls. RESULTS: Relative to controls, the stop-signal reaction time (SSRT)
was significantly more prolonged than the go-stimulus reaction time (RT) in
patients with ADHD. This disproportionate elongation of the SSRT was comparable
across tasks, even though the stop-change task exerted more complex (or at least
different) demands on the inhibitory system than the stop-signal task. ADHD
patients had a higher proportion of choice errors, possibly reflecting more
premature responses. Specifically in the stop-change task, patients had more
variable choice responses and made more inappropriate change responses, which
may also reflect enhanced impulsivity. CONCLUSIONS: The results support a core
deficit in behavioral inhibition in adults with ADHD. We further suggest that
there is more evidence for a critical role of deficient inhibitory control in
adults than in children with ADHD.
PMID: 15997601 [PubMed - in process]