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Tesi etd-06242020-104336

Thesis type
Tesi di laurea magistrale LM6
Treatment of adult Attention-Deficit/Hyperactivity Disorder: outcome and predictors of response
Corso di studi
relatore Prof. Perugi, Giulio
Parole chiave
  • ADHD
  • adulthood
  • adult
Data inizio appello
Secretata d'ufficio
Data di rilascio
Riassunto analitico
Background: Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Although better known and recognized in childhood, ADHD may still influence adulthood in a heterogeneous variety of manifestations; in fact, representing a development issue, it will always be part of the subject, even though not always in a pathological way. Adult ADHD is, indeed, different from its respective in children; unlike attention-deficit and executive dysfunction typically observed in children, Adult ADHD is characterized by emotional impulsiveness and reactivity and difficulty in managing negative emotions; in short “Emotional Dysregulation (ED)”. This explains why adult ADHD often happens to be firstly diagnosticated only after the manifestation of a common comorbidity, such as Bipolar Disorder or Substance Use Disorder. Furthermore, adult ADHD can sometimes have a major impact on adult life, leading to difficulties in social relations, school education and employment.
Although it is essential to treat its complex symptomatology, little evidence regarding stimulant and non-stimulant drugs specifically used for adult ADHD, is available today. Thus, the aim of this study, is to evaluate specific adult ADHD treatment effectiveness and its consequences when comorbidities co-occur. Through this naturalistic observational study, structured into data collecting during baseline, 2- and 4 months follow-up, we also pointed out the possible role of some variables as predictors of response to stimulant and non-stimulant drugs.
Methods: 76 subjects diagnosed with adult ADHD were included in the study. All patients were assessed using Conners Adult ADHD Rating Scales CAARS-Observer: Screening Version (CAARS–O:S), Diagnostic Interview for ADHD in Adults (DIVA 2.0), Brief Psychiatric Rating Scale (BPRS), Difficulties in Emotion Regulation Scale (DERS),
Hypomania Check List-32 (HCL-32), Temperament Evaluation of Memphis, Pisa, Paris and San Diego–M (brief TEMPS-M), Reactivity Intensity Polarity Stability Questionnaire (RIPoSt), Barratt Impulsiveness Scale (BIS-11) and World Health Organization Disability assessment schedule 2.0 (WHODAS 2.0).
Positive treatment response of ADHD symptoms was defined as an improvement of the CAARS index total score ≥ 20%, whereas increment of CAARS total score was considered as a clinical worsening. In addition, we evaluated improvement of emotional dysregulation by DERS and RIPoSt total scores decrease from baseline to endpoint. Repeated measures ANOVA for baseline, 2- and 4 months variations, parametric and non-parametric comparison tests between subgroups differing for demographic and clinical features and logistic regression analyses were utilized.
Results: Our sample showed a significant improvement of CAARS, RIPoSt and DERS total score at 2- and 4 months follow-up. The presence of comorbid Anxiety Disorders and high level of psychopathology (high BPRS score) seemed to be positive predictors of treatment response in patients with CAARS score decrease ≥ 20 %, differently than Substance Use Disorders (SUD). The logistic regression model indicated that Bipolar Disorder (BD) and anxious temperament were positive predictors of response to pharmacological treatment in RIPoSt ED scores, whereas Feeding and Eating Disorders (FED) were negative predictors. As for DERS scale, regression analysis showed that both female gender and intellectual disability were negative predictors of response, whereas Barrat non-planning 2nd order was a positive predictor of response to treatment (Wald: 7.157; p=0.007; OR (95% CI): 1.223 (1.055-1.418)). Comparing BPRS total scores over time in these patients treated for ADHD, the two groups (improvement and absent response) differed in previous psychiatric treatments, which were more present in BPRS improvement group (p=0.010); Methylphenidate (MPH) was associated to BPRS score
decrease (69.60%; p=0.05) unlike atomoxetine (ATX). ADHD patients co-occurring with SUD showed higher improvement in the BPRS score than patients without SUD.
Conclusions: We found a statistically significant improvement over time in all clinical scales measuring ADHD and ED severity and global psychopathology. Specific ADHD treatment did not appear to destabilize BD symptoms in patients previously stabilized. Anxiety, emotional impulsivity and hyperarousal demonstrated to be core symptoms of ADHD and stimulant and non-stimulant drugs may improve these aspects as well. In our sample, co-occurring SUD did not seem to affect the severity and the outcome of ADHD, whereas FED was associated to an increased severity in terms of ED. Furthermore, ADHD women showed severe ED more often than men and that was also associated with absence of response. To conclude, treatment with MPH resulted in better effectiveness than ATX (as shown by BPRS total scores) and this positive result was particularly observed in patients with ADHD+SUD then in those with ADHD only.