ADHD in Substance Use Disorders Prevalence and Pharmacotherapy

Transkript

1 ADHD in Substance Use Disorders Prevalence and Pharmacotherapy Maija Konstenius, PhD, Licensed psychologist Karolinska Institutet Department of Clinical Neuroscience Handledare: Prof. Johan Franck, Nitya Jayaram-Lindström, Björn Philips

2 Attention Deficit/Hyperactivity Disorder ADHD DSM-IV diagnostic criteria A. Six out of nine age inappropriate symptoms of inattention and/or hyperactivity/impulsivity B. Symptoms lead to functional impairment in C. several settings D. Symptoms started in childhood before age of 7 - ADHD NOS and DSM5; before age of 12 E. The symptoms are not better explained by any other disorder (APA, 1996)

3 Studier Studie I - Prevalence of DSM-IV and DSM-5 ADHD in Treatment Seeking Substance Users; Results from an International Multi- Center Study Studie II - An Epidemiological Study of ADHD, Substance Use, and Comorbid Problems in Incarcerated Women in Sweden Studie III - Sustained Release Methylphenidate for the Treatment of ADHD in Amphetamine Abusers: a Pilot Study Studie IV - Methylphenidate in Adults with ADHD and Substance Dependence: A 24-week Randomized Placebo-controlled Trial

4 Prevalens Namn Efternamn

5 Studie I Prevalence of DSM-IV and DSM-5 ADHD in Treatment Seeking Substance Users; Results from an International Multi-Center Study Geurt Van de Glind*, Maija Konstenius*, Frances R Levin, Maarten W J Koeter, Katelijne van Emmerik-van Oortmerssen, Pieter-Jan Carpentier, Sharlene Kaye, Louisa Degenhardt, Arvid Skutle, Johan Franck, Eli-Torild Bu, Franz Moggi, Geert Dom, Sofie Verspreet, Zsolt Demetrovics, Máté Kapitány-Fövény, Melina Fatseas, Marc Auriacombe, Arild Schillinger, Brian Johnson, Stephen V Faraone, J Antoni Ramos-Quiroga, Miguel Casas, Steve Allsop, Susan Carruthers, Robert A Schoevers, Sara Wallhed, Csaba Barta, Peter Allemann, IASP research group, Wim van den Brink Drug and alcohol dependence, 2013 accepted

6 Prevalence of ADHD in Substance Use Disorders IASP Study Ett nätverk med kliniska forskare från 10 länder Australien, Belgien, Frankrike, Nederländerna, Norge, Schweiz, Spanien, Sverige, Ungern, USA

7 All patients referred to participating site Selection Random sample, related to patient flow and availability of staff Stage 1: Screening Demographics, ASRS, Substance use quesonnaire Selection All subjects from stage 1 were asked to parcipate in Stage 2. Stage 2: Full assessment ADHD screen: ASRS SUD diagnosis: MINI-plus ADHD diagnosis: CAADID/ MINI plus MD/BD/ASP/: MINI plus BPD: SCID II module Stage 2: Full assessment - dropout group, control for biases

8 IASP population - Fas 2 (n=1276) Ålder M 40 years (SD 10; range 37 to 43) Kvinnor 27% (range 18 to 34) Primär substans - alkohol 55% - CS 15.1% - cannabis 10.8% - opiater 10.8% - andra droger 8.6% Skillnader mellan länderna - slutenvård/öppenvård - primär substans - demografi

9 Huvuddrog France (n=157) Hungary (n=226) Netherlands (n=129) Norway (n=220) Spain (n=222) Sweden (n=168) Switzerland (n=154) Total (N=1276) % % % % % % % % - Alcohol Stimulants - Opiates - Cannabis - Other drugs (191) 10.8 (137) 10.8 (137) 8.6 (109)

10 ADH D Frankrike n=157 Ungern n=226 Nederländerna n=129 Norge n=220 Spanien n=222 Sverige n=168 Schweizn =154 Adult DSM-IV 11.2 ( ) 5.4 ( ) 10.1 ( ) 31.3 ( ) 9.2 (4-13.0) 19.7 ( ) 6.1 ( ) Adult DSM ( ) 7.6 ( ) 11.8 ( ) 32.6 ( ) 10.6 ( ) 22.4 ( ) 7.7 ( ) Adult DSM-IV ADHD- NOS 16.9 ( ) 8.9 ( ) 12.3 ( ) 34.5 ( ) 10.6 ( ) 22.4 ( ) 8.2 ( ) ADHD prevalens i olika länder

11 ADHD prevalens varierar Beroende på - Land - Substans - alkohol/illegala droger - Vårdform - sluten/öppenvård - Ålder

12 A relationship between the prevalence of ADHD and solar intensity (SI) (kilowatt hours/square meters/day) Specific for ADHD Arns et al. Biol. Psychiatry, 2013

13 Psykiatrisk komorbiditet hos personer med SUD och ADHD Aktuell depression Aktuell (hypo)mani EJ ADHD (n=1098) ADHD (n=168) n (%) n (%) OR (95% CI) 191 (18.4) 49 (29.2) 1.82 ( ) ** 42 (4.1) 25 (14.9) 3.96 ( ) *** Antisocial 176 (17.0) 87 (51.8) 5.25 ( ) *** Borderline 121 (11.7) 51 (30.4) 3.30 ( ) *** Van Emmerik - van Oortmerssen et al. Addiction 2013 (accepted)

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15 ASRS fungerar bra som screening Sensitivitet 0.84 Specificitet 0.66 NPV 0.97

16 STUDIE II - Prevalens 29% - ASRS sensitivitet 1.0, specificitet 0.66, NPV 1.0, PPV 0.57

17 Farmakoterapi

18 STUDIE III RCT 72 mg Concerta/placebo 12 veckor N= 24 Amfetaminberoende+ADHD Primärt utfallsmått - förändring av ADHDsymptom Resultat ingen skillnad mellan grupperna CAARS score PL MPH Week in treatment

19 STUDIE IV Primärt utfallsmått negativa urinprover alla droger (ITT) RCT mg Concerta/placebo 24 veckor N=54 Amfetaminberoende+ADHD Rekryterades från anstalt * Konstenius et al. Addicition 2013(accepted)

20 Sekundärt utfallsmått negativa urinprover för amfetamin (ITT) ** Konstenius et al. Addicition 2013(accepted)

21 Methylfenidat förbättrade ADHD Symptomen (ITT) ** Konstenius et al. Addicition 2013 (accepted)

22 Studierna finansierades av Socialstyrelsen Kriminalvårdsverket Stockholms läns landsting Vetenskapsrådet Psykiatrifonden Milan Valverius Studie I: läkemedel donerades av Jansen Cilag