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Update ADHS - Empirischer Teil

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Die vorliegende Untersuchung gibt eine vergleichende Beschreibung der ADHS-diagnostizierten Patientinnen und Patienten, die am Stichtag 31.8.2008 in den vier Poli-kliniken der ARUD Zürich wegen einer Substanzstörung (SUD) in Behandlung waren. Wir untersuchten die zwei Behandlungssettings "niederschwellige, substitutionsge-stützte Behandlung von Opioidabhängigkeit" (SGB) und "Behandlung von Substanzstörungen ohne Substitution" (BOS). Es zeigte sich, dass insgesamt in 8% der Fälle die kli-nische Diagnose einer Aufmerksamkeitsdefizit/Hyperak-tivitätsstörung (ADHS) gestellt wurde. In BOS war eine ADHS-Diagnose häufiger (12%) als in SGB (7%). Am häufigsten wurde ADHS diagnostiziert bei Personen mit einer Substanzstörung durch Kokain oder Stimulan-tien, nicht kombiniert mit einer Störung durch Opioide (16%). ADHS diagnostizierte Personen zeigten im Vergleich mit den übrigen SUD-Patientinnen und -Patienten tendenziell mehr komorbide Substanz-und psychische Störungen, eine schlechtere berufliche Integration und mehr aktuel-len Substanzkonsum. Die präferierten Substanzen unterschieden sich je nach Behandlungssetting: In SGB konsumierten die ADHS dia-gnostizierten Personen signifikant mehr Kokain und Ben-zodiazepine, in BOS hingegen mehr Cannabis. Eine Behandlung der ADHS mit Methylphenidat erfolgte, abhängig vom Behandlungssetting, in der Hälfte bis drei Viertel der Fälle. Die Dosierung von Methylphenidat zeigte eine grosse interindividuelle Variabilität. Unsere Befunde zur Patientencharakteristik von Personen mit ADHS stimmen weitgehend mit der Literatur überein. - The present study provides a comparative description of ADHD-diagnosed patients undergoing treatment for a substance use disorder (SUD) at the four polyclinics of ARUD Zurich on the cut-off date of August 31, 2008. We examined the two treatment settings "low-threshold, substitution-assisted treatment for opioid dependence" (SGB) and "treatment of substance disorders without substitution" (BOS). It was found that in total, 8% of the cases had a clinical diagnosis of attention deficit/hyperactivity disorder (ADHD). In BOS, an ADHD diagnosis was more common (12%) than in SGB (7%). ADHD was most frequently diagnosed in individuals with a substance use disorder due to cocaine or stimulants, not combined with an opioid use disorder (16%). ADHD-diagnosed individuals tended to have more comorbid substance and mental health disorders, poorer vocational integration, and more current substance use compared with other SUD patients. Preferred substances differed by treatment setting: in SGB, ADHD diagnosed individuals used significantly more cocaine and benzodiazepines, whereas in BOS they used more cannabis. Treatment of ADHD with methylphenidate occurred in half to three-quarters of cases, depending on the treatment setting. The dosage of methylphenidate showed large inter-individual variability. Our findings on patient characteristics of individuals with ADHD are largely consistent with the literature.
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