| 1. |
- Konstenius, Maija
(författare)
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ADHD in substance use disorders : prevalence and pharmacotherapy
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Substance use disorders (SUD) and Attention deficit /hyperactivity disorder (ADHD) are persistent and prevailing disorders that conjointly are associated with negative lifeevents and mental distress. The overall aim of this thesis was to examine the rate of ADHD in substance using populations and to investigate the feasibility and efficacy of methylphenidate pharmacotherapy for treatment of co-existing ADHD and SUD. The prevalence of ADHD was investigated in Studies I and II, which were cross-sectional investigations including two stages: screening and assessment. Study I included seven countries; France, Hungary, the Netherlands, Norway, Spain, Sweden, and Switzerland. Study II comprised incarcerated women in Swedish prisons. An initial screening was completed with WHO’s Adult ADHD Self-Rating Scale (ASRS). The assessment included Conners’ Adult ADHD interview for DSM-IV (CAADID) as a ‘gold standard’ for ADHD diagnosis. For differential diagnostics, the MINI Plus interview was used for mood disorders, antisocial personality disorder (ASP) and SUD, and SCID-II was used to assess borderline personality disorder (BPD). The results show that compared to the general population, the rate of ADHD is higher both in treatment-seeking substance users and in female prisoners (Study I and II). Studies III and IV were randomized, double-blind, placebo-controlled trials with parallel groups design investigating the safety and efficacy of methylphenidate (MPH) for treatment of ADHD in amphetamine dependent patients. Study III was a 12-week trial investigating 18-72mg/day MPH in treatment-seeking outpatients (men and women) with change in ADHD symptoms as the primary outcome measure. Study IV was a 24-week trial investigating 18-180 mg/day MPH in men recruited from medium security prisons. The participants started treatment within two weeks before release from prison and continued treatment in an outpatient clinic. The primary outcome measure in Study IV was relapse to illicit drug use. Results from Study III show that both treatment groups significantly improved their ADHD symptoms, but there were no significant differences between the groups in either ADHD or substance use outcome measures. In study IV, compared to placebo treatment, MPH treatment resulted in significantly more negative urine samples, improvement in ADHD symptoms, and better retention in treatment. Collectively, the findings from the epidemiological studies suggest that a significant number of individuals with SUD are also afflicted with ADHD. It is important that more attention is given to adult ADHD in addiction treatment centres and in criminal justice systems in order to address the clinical needs of this population. The results from the present clinical trials suggest that MPH given in structured settings may be safe to use in currently abstinent amphetamine dependent individuals with ADHD. A flexible dose range with a higher maximum dose improved ADHD symptoms, clinical condition and retention in treatment, and reduced the risk for relapse to illicit drug use in long-term drug dependent individuals.
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| 2. |
- Konstenius, Maija, et al.
(författare)
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An epidemiological study of ADHD, substance use, and comorbid problems in incarcerated women in Sweden
- 2015
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Ingår i: Journal of Attention Disorders. - : Sage Publications. - 1087-0547 .- 1557-1246. ; 19:1, s. 44-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to examine the prevalence of ADHD and psychiatric comorbidity, including substance use in incarcerated women.METHOD: This was a cross-sectional study, consisting of two parts: (a) screening using the ADHD Self-Rating Scale (ASRS) and (b) diagnostic assessment using a structured interview.RESULTS: A sample of 96 incarcerated women was screened and 56 underwent the diagnostic assessment. Twenty-nine percent of the women met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic criteria for adult ADHD in the diagnostic assessment. Forty-four of the women had misuse of alcohol, and 83% had misuse of narcotics the year prior to the incarceration. The ASRS showed sensitivity of 1.0 and specificity of 0.66.CONCLUSION: The prevalence rate of ADHD in incarcerated women was high and comparable to that in male offenders. Illicit stimulant use and antisocial personality disorder were significantly more common in women with ADHD. ASRS is useful as a screener in this population.
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| 3. |
- Konstenius, Maija, et al.
(författare)
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Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence : a 24-week randomized placebo-controlled trial.
- 2014
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Ingår i: Addiction. - : Wiley-Blackwell. - 0965-2140 .- 1360-0443. ; 109:3, s. 440-449
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co-diagnosis of ADHD and amphetamine dependence.DESIGN: Randomized placebo-controlled 24-week double-blind trial with parallel groups design.SETTING: Participants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out-patient care with twice-weekly visits, including once-weekly cognitive behavioural therapy.PARTICIPANTS: Fifty-four men with a mean age of 42 years, currently incarcerated, meeting DSM-IV criteria for ADHD and amphetamine dependence.MEASUREMENTS: Change in self-reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse.FINDINGS: The MPH-treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug-negative urines compared with the placebo group (P = 0.047), including more amphetamine-negative urines (P = 0.019) and better retention to treatment (P = 0.032).CONCLUSIONS: Methylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.
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| 4. |
- Skoglund, Charlotte, et al.
(författare)
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Factors Associated With Adherence to Methylphenidate Treatment in Adult Patients With Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders
- 2016
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Ingår i: Journal of Clinical Psychopharmacology. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0271-0749 .- 1533-712X. ; 36:3, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about factors associated with treatment adherence in individuals affected with comorbid attention-deficit/hyperactivity disorder and substance use disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician's (sub)specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD subtype, and psychiatric comorbidity, were associated with adherence to MPH treatment. Swedish national registers were used to identify adult individuals with prescriptions of MPH and medications specifically used in the treatment of SUD or a diagnosis of SUD and/or coexisting psychiatric diagnoses. Primary outcome measure was days in active MPH treatment in stratified dose groups (≤36 mg, ≥37 mg to ≤54 mg, ≥55 mg to ≤72 mg, ≥73 mg to ≤90 mg, ≥91 mg to ≤108 mg, and ≥109 mg). Lower MPH doses (ie, ≤36 mg day 100) were associated with treatment discontinuation between days 101 and 830 (HR≤36 mg, 1.67; HR37-54mg, 1.37; HR55-72mg, 1.36; HR73-90mg, 1.19; HR≥108mg, 1.09). The results showed a linear trend (P < 0.0001) toward decreased risk of treatment discontinuation along with increase of MPH doses. In conclusion, this study shows that higher MPH doses were associated with long-term treatment adherence in individuals with attention-deficit/hyperactivity disorder and SUD.
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