| 1. |
- Franke, Barbara, et al.
(författare)
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Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan
- 2018
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Ingår i: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 28:10, s. 1059-1088
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Forskningsöversikt (refereegranskat)abstract
- Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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| 2. |
- Giacobini, MaiBritt, et al.
(författare)
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Epidemiology, treatment patterns, comorbidities, and concomitant medication in patients with ADHD in Sweden : a registry-based study (2018–2021)
- 2023
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Ingår i: Journal of Attention Disorders. - : Sage Publications. - 1087-0547 .- 1557-1246. ; 27:12, s. 1309-1321
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate treatment patterns for ADHD in Sweden.Method: Observational retrospective study of patients with ADHD from the Swedish National Patient Register and Prescribed Drug Register, 2018 to 2021. Cross-sectional analyses included incidence, prevalence, and psychiatric comorbidities. Longitudinal analyses (newly diagnosed patients) included medication, treatment lines, duration, time-to-treatment initiation, and switching.Results: Of 243,790 patients, 84.5% received an ADHD medication. Psychiatric comorbidities were common, particularly autism among children, and depression in adults. Most frequent first-/second-line treatments were methylphenidate (MPH; 81.6%) and lisdexamfetamine dimesylate (LDX; 46.0%), respectively. In the second-line, LDX was most frequently prescribed (46.0%), followed by MPH (34.9%), then atomoxetine (7.7%). Median treatment duration was longest for LDX (10.4 months), followed by amphetamine (9.1 months).Conclusion: This nationwide registry study provides real-life insights into the current epidemiology of ADHD and the changing treatment landscape for patients in Sweden.
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| 3. |
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| 4. |
- Ginsberg, Ylva
(författare)
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Attention deficit hyperactivity disorder in prison inmates
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Attention deficit hyperactivity disorder (ADHD) is an inherited developmental disorder with early onset, chronically persisting in the vast majority of cases. ADHD is associated with pervasive cognitive, emotional and functional impairments, as well as an increased rate of coexisting disorders. ADHD in the presence of early disruptive behaviours increase the risk for later delinquency. ADHD is estimated to be present in about 25-45% of adult prison inmates, thus 10-times increased relative to the general population. Despite this, pharmacological treatment for ADHD has not previously been evaluated in prison inmates. Aims: The aims of the present thesis were to characterise symptoms and impairments of adult male long-term prison inmates with ADHD, and to evaluate the efficacy, safety and tolerability of osmotic release oral system methylphenidate (OROS-MPH) provided to adult male prison inmates with ADHD and coexisting disorders as compared to placebo. An additional aim was to evaluate the long-term effectiveness of OROS-MPH when delivered alongside regularly provided psychosocial interventions within a prison setting. Methods: Following an initial screening procedure at Norrtälje Prison, Sweden, extensive diagnostic evaluations were undertaken in 34 inmates indicating ADHD by the screening. Subsequently, 30 inmates out of 34 that confirmed ADHD and coexisting disorders were enrolled to a 5-week randomised, double-blind, placebo-controlled, fixed-dose trial of OROS-MPH followed by a 47-week open- label, flexible-dosing extension. Results: ADHD was estimated to be present in about 40% of adult male long-term inmates of Norrtälje Prison. Inmates with ADHD were severely symptomatic and functionally impaired when compared to psychiatric outpatients with ADHD and with controls. OROS-MPH was highly effective and overall safe, both in the short- term relative to placebo (Cohen’s d=2.17; Number needed to treat=1.1), and in the long-term when provided alongside psychosocial interventions. The placebo response was non-significant. By the primary end-point, 87% of participants receiving OROS-MPH had achieved ≥ 30% improvement in ADHD symptoms evaluated by the investigator-rated CAARS: O-SV scale, thus defined as treatment responders. On the other hand, 40% were defined to be in full remission by achieving normalisation of CAARS: O-SV scores when compared to a norm population without ADHD. Overall, symptomatic improvements translated into functional improvements. A few predictors of treatment response are suggested. Conclusions: ADHD is a prevalent, persistent and impairing disorder in adult male long-term prison inmates. Treatment with OROS-MPH appears to be associated with a robust positive response in this specific group of long-term prison inmates with ADHD and coexisting disorders.
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| 5. |
- Ginsberg, Ylva, et al.
(författare)
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Long-Term Treatment Outcome in Adult Male Prisoners With Attention-Deficit/Hyperactivity Disorder : Three-Year Naturalistic Follow-Up of a 52-Week Methylphenidate Trial
- 2015
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Ingår i: Journal of Clinical Psychopharmacology. - : Lippincott Williams & Wilkins. - 0271-0749 .- 1533-712X. ; 35:5, s. 535-543
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Tidskriftsartikel (refereegranskat)abstract
- Despite high rates of attention-deficit/hyperactivity disorder (ADHD) among adult lawbreakers, particularly the long-term effects of ADHD pharmacotherapy remain unclear, not the least because of ethical challenges with preventing control subjects in randomized controlled trials from receiving medication over prolonged time. We followed up adult male prisoners with ADHD who completed a 5-week randomized, double-blind, placebo-controlled trial followed by a 47-week open-label extension of osmotic-release oral system methylphenidate in a Swedish high-security prison from 2007 to 2010 (ClinicalTrials.gov: NCT00482313). Twenty-five trial completers were prospectively followed up clinically 1 year (24/25, 96% participated fully or in part) and 3 years (20/25, 80% participation) after trial regarding ADHD symptoms (observer and self-reports), psychosocial functioning, substance misuse, and criminal reoffending. Methylphenidate-related improvements in ADHD symptoms and psychosocial functioning obtained during the 52-week trial were maintained at 1- and 3-year follow-ups. Specifically, after 3 years, 75% (15/20) of the respondents had been released from prison, and 67% of these (10/15) had employment, usually full time. In contrast, nonmedicated respondents at the 3-year follow-up (5/20) reported more ADHD symptoms, functional impairment, and substance misuse compared with currently medicated respondents (15/20). Further, 40% of the respondents self-reported reoffending, indicating a substantially lower relapse rate than expected (70%-80%).In summary, although these observations need validation from new and larger samples, positive effects were maintained after 4 years of methylphenidate treatment. Most study completers were employed and had no relapse in substance misuse or criminality. These results suggest that motivational support and continued medication are important for improved outcome in adult criminal offenders with ADHD.
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| 6. |
- Ginsberg, Ylva, et al.
(författare)
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Maternal infection requiring hospitalization during pregnancy and attention-deficit hyperactivity disorder in offspring : a quasi-experimental family-based study
- 2019
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Ingår i: Journal of Child Psychology and Psychiatry. - : Blackwell Publishing. - 0021-9630 .- 1469-7610. ; 60:2, s. 160-168
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal infection during pregnancy (IDP) has been associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, infection is associated with social adversity, poor living conditions and other background familial factors. As such, there is a need to rule out whether the observed association between maternal IDP and ADHD might be attributed to such confounding.METHODS: This nationwide population-based cohort study using a family-based, quasi-experimental design included 1,066,956 individuals born in Sweden between 1992 and 2002. Data on maternal IDP (bacterial or viral) requiring hospitalization and ADHD diagnosis in offspring were gathered from Swedish National Registers, with individuals followed up through the end of 2009. Ordinary and stratified Cox regression models were used for estimation of hazard ratios (HRs) and several measured covariates were considered. Cousin- and sibling-comparisons accounted for unmeasured genetic and environmental factors shared by cousins and siblings.RESULTS: In the entire population, maternal IDP was associated with ADHD in offspring (HR = 2.31, 95% CI = 2.04-2.61). This association was attenuated when accounting for measured covariates (HR = 1.86, 95% CI = 1.65-2.10). The association was further attenuated when adjusting for unmeasured factors shared between cousins (HR = 1.52, 95% CI = 1.12-2.07). Finally, the association was fully attenuated in sibling comparisons (HR = 1.03, 95% CI = 0.76-1.41).CONCLUSIONS: This study suggests that the association between maternal IDP and offspring ADHD is largely due to unmeasured familial confounding. Our results underscore the importance of adjusting for unobserved familial risk factors when exploring risk factors for ADHD.
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| 7. |
- Johansson Capusan, Andrea, MD PhD, 1970-, et al.
(författare)
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Den mörka sidan – ADHD vanligt vid substansbruk och kriminalitet : [The dark side of ADHD - comorbidity with substance use disorder and criminality - an overview]
- 2022
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Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 119
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Forskningsöversikt (refereegranskat)abstract
- ADHD frequently co-occurs with substance use disorder (SUD) and is also common in prison populations. Screening and structured diagnosis should therefore be made available to treatment seeking SUD patients as well as to prison inmates. Multimodal, integrated treatment, including appropriate pharmacological and psychosocial therapies, is recommended for both ADHD and SUD. Long-acting stimulants with lower misuse potential are first line treatment for ADHD, with research indicating that somewhat higher stimulant doses could be necessary in this population. Increased frequency of underlying cardiovascular conditions, as well as increased risks for medication misuse in SUD populations, warrant careful treatment monitoring. There is no evidence suggesting that stimulant treatment increases risk for SUD. Given its high prevalence in prison settings, diagnosis of and integrated pharmacological and psychosocial treatment for ADHD may decrease SUD relapse and criminality in those incarcerated.
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| 8. |
- Kittel-Schneider, Sarah, et al.
(författare)
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Non-mental diseases associated with ADHD across the lifespan : Fidgety Philipp and Pippi Longstocking at risk of multimorbidity?
- 2022
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Ingår i: Neuroscience and Biobehavioral Reviews. - : Pergamon Press. - 0149-7634 .- 1873-7528. ; 132, s. 1157-1180
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Forskningsöversikt (refereegranskat)abstract
- Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms and genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.
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| 9. |
- Kooij, Sandra J. J., et al.
(författare)
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European consensus statement on diagnosis and treatment of adult ADHD : The European Network Adult ADHD
- 2010
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Ingår i: BMC Psychiatry. - London, United Kingdom : BioMed Central. - 1471-244X. ; 10
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Forskningsöversikt (refereegranskat)abstract
- Background: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe.Methods: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated.Results: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated?Conclusions: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.
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| 10. |
- Midhage, Robin, et al.
(författare)
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Psychometric evaluation of the Swedish self-rated 36-item version of WHODAS 2.0 for use in psychiatric populations - using classical test theory.
- 2021
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 75:7, s. 494-501
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to evaluate the reliability and validity of the Swedish version of the self-rated 36-item WHODAS 2.0 in patients from Swedish psychiatric outpatient settings, using classical test theory.Methods The 36-item WHODAS 2.0, together with the Sheehan Disability Scale (SDS), was filled in by a sample of 780 participating psychiatric patients: 512 (65.6%) women, 263 (33.7%) men, and 5 (0.6%) who did not report any sex.Results The internal consistency, measured by Cronbach’s alpha, for the different domains of functioning were between 0.70 and 0.94, and interpreted as good. The confirmatory factor analysis (CFA) revealed two levels: the first level consisted of a general disability factor, while the second level consisted of the six domains of the scale, respectively. The model had borderline fit. There was a significant correlation between WHODAS 2.0 36-item and SDS (n = 395). The WHODAS 2.0 differed significantly between diagnostic groups.Conclusion The present study demonstrates that the Swedish self-rated 36-item version of WHODAS 2.0, within a psychiatric outpatient population, showed good reliability and convergent validity. We conclude that the self-rated 36-item Swedish version of WHODAS 2.0 can be used for valid interpretations of disability in patients with psychiatric health conditions.
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