Erişkin DEHB olan ve olmayan madde bağımlılarında klinik özellikler, eş tanı ve işlevselliğin karşılaştırılması

Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB) ve madde kullanım bozuklukları (MKB) arasındaki karşılıklıilişki nedeniyle klinisyenler, erişkin madde bağımlılarını değerlendirirken DEHB eş tanısını, değerlendirme ve tedaviaşamasında dikkate almalıdır. Bu araştırmada DEHB eş tanısı olan (DEHB+) ve olmayan (DEHB-) erişkin maddebağımlılarının klinik özellikleri, psikiyatrik eş tanıları ve işlevsellik düzeyi bakımından karşılaştırılması amaçlan-mıştır. Yöntem: Çalışmaya 226 madde bağımlısı erkek hasta alındı (DEHB-=140, DEHB+=86). SCID-I ile tanısalgörüşme yapıldı. Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Ölçeği, Wender Utah Derecelendirme Ölçeği,Barratt İmpulsivite Ölçeği-11, Bireysel ve Sosyal Performans Ölçeği uygulandı. DEHB+ ve DEHB- gruplar maddebağımlılığının klinik özellikleri, psikiyatrik eş tanıları ve ölçek sonuçları açısından karşılaştırıldı. Sonuçlar: DEHB+olan grup maddeye daha erken yaşta başlıyordu. DEHB- gruba göre çoğul madde kullanımı, madde kullanılan günsayısı, maddeyle ilişkili yasal sorunlar daha yüksekti. DEHB+ grupta stimülan ve opiat bağımlılığı daha fazlaydı.Özkıyım düşüncesi ve girişimi, psikiyatrik eş tanı oranı DEHB+ grupta daha fazlaydı. DEHB+ grubun bireysel vesosyal işlevselliği daha kötüydü. Tartışma: DEHB+ grup maddeyle ilişkili klinik özellikleri açısından DEHB- grubagöre farklılık göstermektedir. Erişkinlerde DEHB’nin MKB üzerine etkisini araştıran, her iki cinsiyeti de kapsayan,randomize, uzunlamasına izlem çalışmalarına gerek vardır. (Anadolu Psikiyatri Derg 2019; 20(3):296-304)

Comparison of clinical features, comorbidity and functioning in substance dependents with and without adult ADHD

Objective: Because of the interrelation between attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD), clinicians should consider ADHD comorbidity in assessment and treatment phase when evaluating adult substance dependence. It was aimed to compare the adult substance dependent patients with comorbid ADHD (ADHD+) and without comorbid ADHD (ADHD-) in terms of clinical features, psychiatric comorbidity and de- gree of functioning. Methods: 226 patients with substance dependence were included in the study (ADHD-=140, ADHD+=86). Diagnostic interview with SCID-I was performed. Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale, Wender Utah Rating Scale, Barratt Impulsivity Scale-11, Personal and Social Perfor- mance Scale were applied. ADHD+ and ADHD- groups were compared in terms of clinical features of substance dependence, psychiatric comorbidity and scale outcomes. Results: The group of ADHD+ was starting using sub- stance at an earlier age. Polysubstance use, number of days of substance use, and legal issues related to the sub- stance were higher than the ADHD- group. ADHD+ group had more stimulant, opiate dependency. Rates of suicidal ideation and attempts, psychiatric comorbidity were higher in ADHD+ group. Personal and social functioning of ADHD+ group was worse. Discussion: ADHD+ group differs from the ADHD- group in terms of the clinical char- acteristics associated with the substance. In adults, there is a need for randomized, longitudinal follow-up studies involving both genders, investigating the effect of ADHD on SUD. (Anatolian Journal of Psychiatry 2019; 20(3):296-304)

PDF

___

Klein RG, Mannuzza S, Olazagasti MAR, Roizen E, Hutchison JA, Lashua EC, et al. Clinical and functional outcome of childhood attention-deficit/ hyperactivity disorder 33 years later. Arch Gen Psychiatry 2012; 69(Suppl.12):1295.
Biederman J. Attention-deficit/hyperactivity disorder: A selective overview. Biol Psychiatry 2005; 57(Suppl.11):1215-1220.
Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, et al. Attention-deficit/ hyper- activity disorder in adults: An overview. Biol Psychiatry 2000; 48(Suppl.1):9-20.
Wilson JJ, Levin FR. Attention-deficit/hyperactivity disorder and early-onset substance use disorders. J Child Adolesc Psychopharmacol 2005; 15:751- 763.
Satterfield JH, Faller KJ, Crinella FM, Schell AM, Swanson JM, Homer LD. A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality. J Am Acad Child Adolesc Psychiatry 2007; 46:601-610.
Wilens TE. Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. Psychiatr Clin North Am 2004; 27(Suppl.2):283-301.
Levin FR, Evans SM, Kleber HD. Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend 1998; 52(Suppl.1):15-25.
van Emmerik-van Oortmerssen K, van de Glind G, Koeter MWJ, Allsop S, Auriacombe M, Barta C, et al. Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study. Addiction 2014; 109(Suppl.2):262-272.
Arias AJ, Gelernter J, Chan G, Weiss RD, Brady KT, Farrer L, et al. Correlates of co-occurring ADHD in drug-dependent subjects: Prevalence and features of substance dependence and psychiatric disorders. Addict Behav 2008; 33(Suppl.9):1199-1207.
Wilens TE, Martelon M, Joshi G, Bateman C, Fried R, Petty C, et al. Does ADHD predict sub-stance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry 2011; 50(Suppl.6):543-553.
Chang Z, Lichtenstein P, Larsson H. The effects of childhood ADHD symptoms on early-onset sub-stance use: A Swedish twin study. J Abnorm Child Psychol 2012; 40(Suppl.3):425-435.
Yule AM, Martleon M, Faraone S, Carrellas N, Wilens T E, Biederman J. Examining the associa-tion between attention deficit hyperactivity disor-der and substance use disorders: a familial risk analysis. J Psychiatr Res 2017; (85):49-55).
McCabe SE, Dickinson K, West, B T, Wilens TE. Age of onset, duration, and type of medication therapy for attention-deficit/hyperactivity disorder and substance use during adolescence: a multi-cohort national study. J Am Acad Child Adolesc Psychiatry 2016; 55(Suppl.6):479-486.
Uchida M, Spencer TJ, Stephen V. Faraone SV, Biederman J. Adult outcome of ADHD: An over-view of results from the MGH longitudinal family studies of pediatrically and psychiatrically referred youth with and without ADHD of both sexes. J Atten Disord 2018; 22 (Suppl.6): 523-534.
Biederman J, Petty CR, Hammerness P, Batchel-der H, Faraone SV. Cigarette smoking as a riskfactor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder. Br J Psychiatry 2012; 201:207-214.
Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and sub-stance use and abuse/dependence: a metaana-lytic review. Clin Psychol Rev 2011; 31:328-341.
Önal A, Ögel K, Eke C. Dikkat eksikliği ve hiperak-tivite belirtileri bulunan ergenlerde madde kullanı-mı ve aile özellikleri üstüne kesitsel bir çalışma. Klin Psikofarmakol Bul 2011; 21(Suppl.3):225-231.
Cakir U, Kavur Inan E, Temeloglu Sen E, Kara-bulut U, Tekes AS, Tanriverdi A. Prevalence of adult attention and hyperactivity disorders symp-toms among those have history of substance abuse. Abant Med J 2014; 3(1):62-66.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). 1997.
Ozkürkçügil A. DSM-IV eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe’ye uyar-lanması ve güvenilirlik çalışması. İlaç ve Tedavi Derg 1999; 12:233-236.
Turgay A. DSM-IV’e Dayalı Erişkin Hiperaktivite Değerlendirme Ölçeği (Yayınlanmamış Ölçek). Toronto, 1995.
Günay Ş, Savran C, Aksoy UM. Erişkin Dikkat Eksikliği Hiperaktivite Ölçeğinin (Adult ADD/ ADHD DSM IV- Based Diagnostic Screening and Rating Scale) dilsel eşdeğerlilik, geçerlik güvenir-lik ve norm çalışması. Türkiye’de Psikiyatri 2006; 8:98-107.
Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperac-tivity disorder. Am J Psychiatry 1993;150(6):885-890.
Oncü B, Olmez S, Sentürk V. Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. Turk Psikiyatri Derg 2005; 16(Suppl.4):252-259.
Patton JH, Stanford MS, Barratt ES. Factor struc-ture of the Barratt impulsiveness scale. J Clin Psychol 1995; 51(Suppl.6):768-774.
Gulec H, Tamam L, Gulec MY, Turhan M, Karakuş G, Zengin M, et al. Psychometric properties of Turkish version of BIS-11. Bull Clin Psychopharm 2008;18(Suppl.4):251-258.
Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occu-pational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000; 101(Suppl.4):323-329.
Aydemir Ö, Üçok A, Danacı A, Canpolat T, Kara-dayı G, Emiroğlıu B, ve ark. Bireysel ve sosyal performans ölçeği’nin Türkçe sürümünün geçerli-lik ve güvenilirlik çalışması. Klin Psikofarmakol Bülteni 2009; 19(Suppl.2):93-100.
van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M, et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. Drug Alcohol Depend 2012; 122(1-2):11-19.
Bácskai E, Czobor P, Gerevich J. Trait aggression, depression and suicidal behavior in drug depen-dent patients with and without ADHD symptoms. Psychiatry Res 2012; 200(2-3):719-723.
Kaye S, Ramos-Quiroga JA, van de Glind G, Levin FR; Faraone SV, Allsop S, et al. Persistence and subtype stability of ADHD among substance use disorder treatment seekers. J Atten Disord 2016; (1):1-16.
Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comor-bidity and functional impairment in a clinically re-ferred sample of adults with attention-deficit/ hyperactivity disorder (ADHD). Eur Arch Psychi-atry Clin Neurosci 2007; 257(Suppl.7):371-377.
Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent sub-stance use and abuse. Arch Gen Psychiatry 2007; 64(Suppl.10):1145-1152.
Biederman J, Wilens T, Mick E, Milberger S, Spencer TJ, Faraone SV. Psychoactive sub-stance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. Am J Psychiatry 1995; 152:1652-1658.
Faraone SV, Antshel KM. Diagnosing and treating attention-deficit/hyperactivity disorder in adults. World Psychiatry 2008; 7(Suppl.3):131-136.
Cho SC, Kim JW, Choi HJ, Kim BN, Shin MS, Lee JH, et al. Associations between symptoms of attention deficit hyperactivity disorder, depres-sion, and suicide in Korean female adolescents. Depress Anxiety 2008; 25(Suppl.11):142-146.
Umar MU, Salihu AS, Owolabi SD. Prevalence and correlates of ADHD in individuals with sub-stance use disorder in Nigeria. Atten Defic Hyperact Disord 2017; 9(Suppl.3):189-198.
Verdejo-García A, Lawrence AJ, Clark L. Impulsi-vity as a vulnerability marker for substance use disorders: review of findings from high-risk re-search, problem gamblers and genetic associa-tion studies. Neurosci Biobehav Rev 2008; 32(Suppl.4):777-810.
Biederman J, Petty CR, Woodworth KY, Lomedico A, Hyder LL, Faraone SV. Adult outcome of atten-tion-deficit/hyperactivity disorder: A controlled 16-year follow-up study. J Clin Psychiatry 2012; 73:941-950.
Ernst M, Luckenbaugh DA, Moolchan ET, Leff MK, Allen R, Eshel N, et al. Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder. Pediatrics 2006; 117(Suppl.6):2030-2039.
Biederman J. Impact of comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2004; 65(Suppl 3):3-7.
Wilens TE, Gignac M, Swezey A, Monuteaux MC, Biederman J. Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. J Am Acad Child Adolesc Psychiatry 2006; 45(Suppl.4):408-414.
Wilens TE, Fusillo S. When ADHD and substance use disorders intersect: Relationship and treat-ment implications. Curr Psychiatry Rep 2007; 9(Suppl.4):408-414.
Carroll KM, Rounsaville BJ. History and signifi-cance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Compr Psychiatry 1993; 34(Suppl.2):75-82.
Loflin M, Earleywine M, De Leo J, Hobkirk A. Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use. Subst Use Misuse 2014; 49(Suppl.4):427-434.
Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H. Comorbidity of adult ADHD and its subtypes with substance use disorder in a large population-based epidemiological Study. J Atten Disord 2016; 20(2):1-16.
Wilens TE, Kwon A, Tanguay S,Chase R, Moore H, Faraone SV, et al. Characteristics of adults with attention deficit hyperactivity disorder plus sub-stance use disorder: the role of psychiatric comor-bidity. Am J Addict 2005; 14(Suppl.4):319-327.
Kessler RC, Adler L, Barkley R, Biederman J, Conners K, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163:716-723.
Yoshimasu K, Barbaresi WJ, Colligan RC, Voight RG, Killian JM, Weaver AL, et al. Adults with persistent ADHD: Gender and psychiatric comor-bidities–a population-based longitudinal study. Eur Psychiatry 2016; 33:136-137.
Mao AR, Findling RL. Comorbidities in adult attention-deficit/hyperactivity disorder: A Practical Guide to Diagnosis in Primary Care. Postgrad Med 2014; 126(Suppl.5):42-51.