Recognizing ADHD in Adults with Comorbid Mood Disorders: Implications for Identification and Management
ABSTRACT The objective of this study was to assist those in psychiatric clinical practice in the identification and management of attention-deficit/hyperactivity disorder (ADHD) in adults, with an emphasis on ADHD in the presence of comorbid mood disorders in adults. PubMed was searched to identify relevant studies and critical reviews published in English between 1988 and 2008 on the prevalence, persistence, and consequences of ADHD in adults. Additionally, relevant studies and critical reviews pertaining to the treatment of adults with ADHD and the relationships between ADHD and mood disorders with regard to overlapping symptom profiles, comorbidity, and treatment options were identified. The symptoms of ADHD persist into adulthood for a high proportion of children with this disorder. Among adults, the estimated prevalence of clinician-assessed ADHD in the general population is 4% to 5%. Untreated ADHD can adversely affect school and work achievements, diminish self-esteem, damage interpersonal relationships, and significantly reduce quality of life for adults. A significant proportion of adults with mood disorders have comorbid ADHD, and a significant proportion of adults with ADHD have comorbid mood disorders. Few reports have described the outcome of treatment of individuals with ADHD and concurrent mood disorders and no controlled trials were identified. Attention-deficit/hyperactivity disorder in adults can be identified despite resembling, or coexisting with, other psychiatric disorders. The complexities of comorbid psychiatric conditions require careful diagnostic prioritization when developing a comprehensive sequential treatment plan. The current research literature offers little clinical guidance for constructing treatment algorithms.
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ABSTRACT: Neurofeedback has been applied effectively in various areas, especially in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This study protocol is designed to investigate the effect of slow cortical potential (SCP) feedback and a new form of neurofeedback using near-infrared spectroscopy (NIRS) on symptomatology and neurophysiological parameters in an adult ADHD population. A comparison of SCP and NIRS feedback therapy methods has not been previously conducted and may yield valuable findings about alternative treatments for adult ADHD. The outcome of both neurofeedback techniques will be assessed over 30 treatment sessions and after a 6-month follow-up period, and then will be compared to a nonspecific biofeedback treatment. Furthermore, to investigate if treatment effects in this proof-of-principle study can be predicted by specific neurophysiological baseline parameters, regression models will be applied. Finally, a comparison with healthy controls will be conducted to evaluate deviant pretraining neurophysiological parameters, stability of assessment measures, and treatment outcome. To date, an investigation and comparison of SCP and NIRS feedback training to an active control has not been conducted; therefore, we hope to gain valuable insights in effects and differences of these types of treatment for ADHD in adults. This study is registered with the German Registry of Clinical Trials: DRKS00006767 , date of registration: 8 October 2014.Trials 04/2015; 16(1):174. DOI:10.1186/s13063-015-0683-4 · 2.12 Impact Factor
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ABSTRACT: For many years, a deficiency of monoamines including serotonin has been the prevailing hypothesis on depression, yet research has failed to confirm consistent relations between brain serotonin and depression. High degrees of overlapping comorbidities and common drug efficacies suggest that depression is one of a family of related conditions sometimes referred to as the "affective spectrum disorders", and variably including migraine, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia and generalized anxiety disorder, among many others. Herein, we present data from many different experimental modalities that strongly suggest components of mitochondrial dysfunction and inflammation in the pathogenesis of depression and other affective spectrum disorders. The three concepts of monoamines, energy metabolism and inflammatory pathways are inter-related in many complex manners. For example, the major categories of drugs used to treat depression have been demonstrated to exert effects on mitochondria and inflammation, as well as on monoamines. Furthermore, commonly-used mitochondrial-targeted treatments exert effects on mitochondria and inflammation, and are increasingly being shown to demonstrate efficacy in the affective spectrum disorders. We propose that interactions among monoamines, mitochondrial dysfunction and inflammation can inspire explanatory, rather than mere descriptive, models of these disorders.Progress in Neuro-Psychopharmacology and Biological Psychiatry 04/2011; 35(3):730-43. DOI:10.1016/j.pnpbp.2010.07.030 · 4.03 Impact Factor
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ABSTRACT: The links between attention deficit hyperactivity disorder (ADHD) and substance use disorders have been the subject of numerous papers. Few studies, however, have focused specifically on the relationship between ADHD and behavioural addictions. The aim of this study was to (i) examine the frequency of pathological and at-risk gamblers having a previous history of ADHD; (ii) give details of the characteristics of this association, and (iii) identify risk factors for a history of ADHD. 84 pathological and at-risk gamblers were assessed about socio-demographic, gambling and clinical characteristics. Over 25% of the subjects had a history of ADHD. They were characterized as having more severe gambling problems and a higher level of gambling-related cognitions, a higher frequency of psychiatric comorbidities and an elevated risk of suicide. Finally, they differed in their level and type of impulsivity. Among pathological and at-risk gamblers, a high level of impulsivity, or a history of anxiety disorders, constitute risk factors for a comorbidity with ADHD. The association 'ADHD-problem gambling' therefore appears to be not only frequent, but also linked to factors that are known to worsen the prognosis. Researching this relationship is therefore important to adapt strategies for effective future therapy.European Addiction Research 06/2011; 17(5):231-40. DOI:10.1159/000328628 · 2.07 Impact Factor