ADHD: a hidden comorbidity in adult psychiatric patients

István Bitter,Brigitta Kakuszi,Attila Pulay,Daniela Zmeškalová-Jelenová,Pavla Stopková,Klára Látalová,Pál Czobor,Lívia Balogh,Pavel Mohr

doi:10.1007/s12402-019-00285-9

Abstract

Adult attention-deficit/hyperactivity disorder (aADHD) has recently been better recognized and treated in many European countries. In spite of this development, aADHD still features as a “hidden” comorbidity, often not diagnosed even in patients under psychiatric treatment for other psychiatric disorders. The aim of this study was to establish the prevalence rates of unrecognized aADHD in academic centers providing regular psychiatric services in the Czech Republic and Hungary. In a population of psychiatric in-and outpatients, Adult ADHD Self-Report Scale was administered. All positively and about half of the negatively screened subjects were clinically interviewed and the DSM diagnosis of ADHD was determined based on the symptom list and Conners’ Adult ADHD Rating Scale. The estimated point prevalence rate of unrecognized comorbid aADHD among psychiatric in-and out patients was 6.99% (95% lower CI: 5.11, 95% upper CI 8.86) according to the DSM-IV-TR criteria and 9.27% (95% lower CI: 7.13, 95% upper CI 11.40) according to the DSM-5 criteria. Current suicide risk was significantly associated with the presence of undiagnosed aADHD; however, life time suicide attempts, depression, dysthymia, alcohol and substance dependence, anxiety and stress related disorders were not. Further educational efforts are needed to improve the recognition and treatment of aADHD in adults

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, characterized with persistent and developmentally inappropriate level of inattention and/or hyperactivity and impulsivity, resulting in functional impairment (Buitelaar et al 2011)
Two-thirds of individuals diagnosed with ADHD early in their lives suffer from symptoms in adult age, as well; 15% of them meet full
The European study reported row rates “applying DSM-IV-TR-TR or DSM-5 criteria, 15.8% (95% confidence interval [CI] 14.2–17.4%) or 17.4% of patients were diagnosed with ADHD, respectively”, while we report adjusted prevalence estimations for the DSM-IV-TR group 6.99% (95% confidence interval [CI] 5.11%–8.86%) and for the DSM-5 group 9.27% (95% confidence interval [CI] 7.13%–11.40%)

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, characterized with persistent and developmentally inappropriate level of inattention and/or hyperactivity and impulsivity, resulting in functional impairment (Buitelaar et al 2011). Two-thirds of individuals diagnosed with ADHD early in their lives suffer from symptoms in adult age, as well; 15% of them meet full. DSM-IV-TR (American Psychiatric Association 2000) diagnostic criteria and the rest is regarded as ‘ADHD in partial remission’ (Ramos-Quiroga et al 2013). The most frequent subtype of adult ADHD (aADHD) is predominantly inattentive type, with associated disorganization, emotional dysregulation (Kooij et al 2010). A meta-analysis reported a 2.5% prevalence of aADHD based on pooled data of population-based studies (Simon et al 2009). Similar number (current DSM-IV-TR aADHD prevalence of 2.8%) has been recently reported in a representative WHO World Mental Health Survey across 20 countries (Fayyad et al 2017)

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