Karsten Peters’s scientific contributions

Objetivos: El trastorno por déficit de atención con hiperactividad (TDAH) tiene una gran importancia clínica no sólo por su elevada prevalencia sino también por su frecuente comorbilidad con enfermedades que están relacionadas con este trastorno. Diversos estudios han sido capaces de demostrar que el TDAH constituye un importante factor de riesgo para la exacerbación de enfermedades que producen dependencia, es decir adicciones. Métodos: Nosotros realizamos un estudio de 152 pacientes adultos con dependencia del alcohol (n=91) o adicción a múltiples drogas (n=61) para determinar si estos pacientes estaban afectados por el TDAH o no. Para la valoración retrospectiva del TDAH en la infancia, se empleó elWURS-k así como la lista de síntomas del DSM-IV para el TDAH. Para evaluar los síntomas de TDAH persistentes en los adultos se utilizó el CAARS. Resultados: Un 20,9% (WURS-k) o 23,1% (criterio diagnóstico del DSM-IV) de los pacientes alcohol dependientes mostraron evidencias retrospectivas de haber padecido TDAH en la infancia. Con ayuda del CAARS, se demostró que el TDAH persistía en un 33,3% de los pacientes adultos. En el grupo de los pacientes adictos a drogas, un 50,8% (WURS-k) y un 54,1% (DSM-IV) presentaban criterios diagnósticos para TDAH en la infancia y un 65% (CAARS) mostraron evidencias de persistencia del TDAH en la edad adulta. Conclusiones: Estos resultados revelan que las enfermedades que ocasionan adicción pueden asociarse, con una elevada comorbilidad, con TDAH, expresada en la forma de abuso de alcohol y también en el consumo de drogas ilegales. Estos resultados enfatizan la gran importancia de diagnósticos y terapias precoces y precisas del TDAH para la prevención de enfermedades que ocasionan adicción.

Attention-deficit/hyperactivity disorder (ADHD) is of great clinical importance not only because of its high prevalence but also due to the frequent comorbid illnesses that are connected with this disorder. Several studies were able to demonstrate that ADHD constitutes a significant risk factor for the exacerbation of habit-forming illnesses, i.e. addictions. We conducted a study on 152 adult patients with alcohol dependence (n = 91) or multiple substance addiction (n = 61) to determine whether or not these patients were affected by ADHD. For retrospective assessment of childhood ADHD, the WURS-k was used as well as the DSM-IV symptom checklist for ADHD. The CAARS was used to assess the persisting symptoms of ADHD in adults. 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the alcohol-dependent patients showed evidence of retrospective ADHD affliction in childhood. With the help of CAARS, ADHD was proved to be persistent in 33.3% of the adult patients. In the group of substance-addicted patients 50.8% (WURS-k) and 54.1% (DSM-IV) presented with diagnostic criteria for ADHD in childhood and 65.5% (CAARS) showed evidence of ADHD persisting in adulthood. These results reveal that habit-forming illnesses can be associated with a high comorbidity with ADHD, expressed in the form of alcohol abuse and also in consumption of illegal drugs. The results underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illnesses.

Several studies have shown that attention-deficit/hyperactivity disorder (ADHD) represents a significant risk factor for the onset and development of an addiction. Thirty-five per cent of adult ADHD patients are known to be addicted to alcohol. Many ADHD patients also have an increased nicotine consumption, which typically, leads to an improvement of attention, ability to concentrate and control of impulses. There may be pathophysiological connections here. On the other hand, it can also be assumed that there is a high prevalence of addicted patients with undiagnosed ADHD. Ninety-one adult alcohol-dependent patients were examined for ADHD in this study, using the Wender Utah Rating Scale (WURS-k), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom check-list for ADHD and the Conners' Adult ADHD Rating Scales (CAARS, Long Version). The patients were divided into diagnostic sub-groups according to DSM-IV (inattentive type, impulsive type, combined type). Nicotine consumption was investigated using the Fagerström Test of Nicotine Dependence (FTND) and then graded as 'minimal', 'average' or 'high' nicotine dependence. There were 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the patients addicted to alcohol, who showed evidence of ADHD in childhood. With the help of CAARS, it could be demonstrated that 33.3% of the patients who fulfilled the diagnostic criteria of ADHD, according to DSM-IV, had persisting ADHD in adulthood. The FTND showed a statistically significant difference in nicotine dependence between alcohol-dependent patients with and without ADHD in childhood. Patients numbering 76.2% with ADHD, demonstrated an 'average to high' level of nicotine dependence compared to 45.7% of those patients without ADHD. Furthermore, the number of patients not addicted to nicotine (19%) was significantly lower than among those without ADHD (36.6%) (P = 0.029). The results of this investigation reveal that a large number of ADHD patients suffer from alcohol dependence, and an even greater number from excessive nicotine dependence. The outcome indicates that there are most likely pathophysiological connections with alcohol and nicotine dependence, and that this substance abuse is probably a form of 'self-medication'. The results clearly underline the great importance of early and adequate diagnosis and therapy of ADHD, in order to prevent exacerbation of addictive illness.

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) hat aufgrund der hohen Prävalenz, aber auch im Hinblick auf die häufig bestehenden komorbiden Erkrankungen eine große klinische Bedeutung. So konnten verschiedene Studien zeigen, dass die ADHS auch ein bedeutender Risikofaktor für die Entwicklung einer Suchterkrankung ist. In einer eigenen Studie wurden 152 erwachsene Patienten mit einer Alkoholabhängigkeit (n = 91) bzw. einer multiplen Substanzabhängigkeit (n = 61) auf das Vorliegen einer ADHS untersucht. Bei 20,9 % (WURS) bzw. 23,1 % (DSM-IV Diagnosekriterien) der alkoholabhängigen Patienten ergaben sich retrospektiv Hinweise auf das Vorliegen einer ADHS in der Kindheit. Bei 26,3 % der Patienten ließ sich mit Hilfe der CAARS ein Persistieren der Diagnose im Erwachsenenalter feststellen. In der Gruppe der Substanzabhängigen erfüllten 50,8 % (WURS) bzw. 54,1 % (DSM-IV) der Patienten die diagnostischen Kriterien für das Vorliegen einer ADHS in der Kindheit, bei 65,5 % (CAARS) persistierte die Erkrankung im Erwachsenenalter. Die Untersuchungsergebnisse zeigen, dass bei Suchterkrankungen von einer hohen Komorbidität mit ADHS auszugehen ist, die sowohl in Form eines Alkoholmissbrauchs als auch durch den Konsum illegaler Drogen zum Ausdruck kommen kann. Die Ergebnisse unterstreichen die große Bedeutung einer frühzeitigen und adäquaten Diagnostik und Therapie der ADHS zur Prävention von Suchterkrankungen. Summary Attention deficit/hyperactivity disorder (ADHD) is of great clinical importance not only because of its high prevalence but also due to the frequent comorbid illnesses that are connected with this disorder. Several studies were able to demonstrate that ADHD constitutes a significant risk factor for the exacerbation of habit-forming illnesses, i.e. addictions. We conducted a study with 152 adult patients with alcohol dependence (n = 91), respectively, multiple substance addiction (n = 61) to determine whether or not these patients were affected by ADHD. 20,9 % (WURS), respectively, 23,1 % (DSM-IV criteria) of the alcohol-dependent patients showed evidence of retrospective ADHS affliction in childhood. With the help of CAARS ADHD was proved persistent in 26,3 % of the adult patients. In the group of substance-addicted patients 50,8 % (WURS), respectively, 54,1 % (DSM-IV) presented with diagnostic criteria for ADHS in childhood and 65,5 % (CAARS) showed evidence of ADHD persisting in adult age. These results reveal that habit-forming illnesses can be associated with a high comorbidity with ADHD, expressed in the form of alcohol abuse and also in the consumption of illegal drugs. The results underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illnesses.