Abstract Most adults with attention-deficit/hyperactivity disorder (ADHD) are not recognized and remain untreated, although a large fraction of these individuals are diagnosed and treated for other ...comorbid mental disorders, such as major depressive disorder (MDD). The fact that MDD is one of the most commonly occurring mental disorders with high comorbidity with adult ADHD raises the question whether such comorbidity is associated with differences in the clinical picture of ADHD. Three hundred and twenty adult ADHD outpatients were evaluated. Diagnoses followed DSM-IV criteria. Interviews to evaluate ADHD and oppositional defiant disorder (ODD) were performed based on the Portuguese version of K-SADS-E. Psychiatric comorbidities were investigated using SCID-IV and MINI. Regression models were applied to test MDD association with clinical and demographic outcomes. Subjects presenting ADHD and MDD had a higher frequency of generalized anxiety disorder and social phobia and a lower frequency of substance dependence, grade repetition and school suspensions, when compared to subjects with ADHD without MDD. Furthermore, adults presenting ADHD and MDD reported higher demand for psychotherapy and pharmacological treatment prior to enrollment in the study when compared to ADHD subjects free of MDD. However, contrary to what could be expected based on these data, the presence of MDD was not associated with an earlier ADHD diagnosis. These results point to the need for research and medical education into an earlier and more efficient ADHD diagnosis in patients who search for mental health care.
Abstract Objective The prevalence of smoking is significantly increased among adults with Attention-Deficit/Hyperactivity Disorder (ADHD), and this association has a significant impact in both ...disorders, ascribed to either self-medication or behavioral disinhibition hypotheses. However, little is known about clinical variables associated with cigarette smoking among patients with ADHD. The present study evaluates comorbidity, demographic and personality profiles of patients with ADHD in relation to smoking status. Methods Patients ( n 422) were evaluated in the adult ADHD outpatient clinic of Hospital de Clínicas de Porto Alegre. Diagnoses were based on DSM-IV criteria and interviews were performed with Portuguese version of K-SADS-E for ADHD and Oppositional-Defiant Disorder. Axis I psychiatric comorbidities were evaluated with the SCID-I and smoking behavior with Fagerström Test for Nicotine Dependence (FTND). Personality was evaluated with Cloninger’s Temperament and Character Inventory (TCI). Results: The presence of smoking was strongly associated with externalizing characteristics as antisocial personality disorder (OR 4.2) and substance dependence (OR 6.5), but not with internalizing disorders. Moreover, smoking was associated with higher novelty seeking and lower harm avoidance scores. Conclusions Smoking initiation among patients with ADHD is consistent with a behavioral disinhibition profile beyond the possible role of self-medication in smoking persistence. Smoking in these patients is strongly associated with externalizing comorbid disorders.
Abstract Objective The requirement in classificatory systems that some impairment from attention-deficit/hyperactivity disorder (ADHD) symptoms starts before 7 years of age (age of onset of ...impairment criteria – AOC) has been harshly criticized. Although there is evidence that late-onset ADHD is a valid diagnosis, little is known about the role of age of onset of impairment on the clinical profile of adult patients. Methods The diagnoses of 349 adults with ADHD followed DSM-IV criteria. ADHD and oppositional defiant disorder (ODD) were evaluated with the K-SADS-E, and other comorbidities with the SCID-IV and the MINI. Subjects were divided in early and late-onset groups (age of onset of impairment between 7 and 12 years old). The effect of age of onset over clinical and demographic characteristics was tested by regression models. Results Late-onset subjects were diagnosed later ( P = 0.04), had a lower frequency of problems with authority and discipline ( P = 0.004), and lower scores in SNAP-IV ( P < 0.001) and in Barkley’s scale for problems in areas of life activities ( P = 0.03). On the other hand, late-onset patients presented a higher prevalence of comorbid general anxiety disorder (GAD) ( P = 0.01). Both groups had a similar profile in the remaining comorbidities and sociodemographic characteristics. Conclusions This study provides initial evidence that adults with late-onset ADHD have less severity, lower frequency of externalizing symptoms and increased comorbidity with GAD, but similar profile in other comorbidities. In addition, the data suggest that late-onset patients have a higher probability of delayed diagnosis despite the significant impairment of their condition.
Several lines of evidence suggest a relevant role for the dopamine transporter (DAT1) gene not only as a susceptibility factor for attention-deficit hyperactivity disorder (ADHD), but also as a ...predictor of individual methylphenidate (MPH) response. Pharmacogenetic studies of MPH response in ADHD have mainly focused on the 40-bp variable number of tandem repeats (VNTR) in the 3′ untranslated region (3′-UTR) of DAT1. Most studies were performed in samples of children and conflicting findings were obtained. Only two studies have assessed 3′-VNTR in samples of adults—one with positive and the other with negative findings. In the present study, we investigate three potentially relevant polymorphisms in DAT1 gene (−839 C > T; Int8 VNTR and 3′-VNTR), and their possible role in therapeutic response to MPH treatment in a sample of 171 Brazilian adults with ADHD. The diagnostic procedures followed the DSM-IV criteria and the outcome measures were the scales Swanson, Nolan, and Pelham Rating scale version IV and the Clinical Global Impression-Severity Scale, applied at the beginning and after the 30th day of treatment. Drug response was assessed by both categorical and dimensional approaches. There was no effect of any DAT1 polymorphisms or haplotypes on MPH response. This is the second report demonstrating absence of differences in MPH response according to DAT1 genotypes in adults with ADHD. Although DAT protein is crucial for the effect of MPH, genetic variations in DAT1 gene probably do not have a significant clinical role in this sample of adults with ADHD.
Previous studies have suggested that individuals with ADHD have high scores in novelty seeking and harm avoidance. However, it is not known whether personality is associated with specific subtypes ...and dimensions of the disorder. The aim of this study is to test for associations between scores in the temperament and character inventory of C.R. Cloninger with adult ADHD subtypes and severity.
The diagnostic interviews of 296 adult ADHD patients followed the DSM-IV criteria. ADHD dimensions were evaluated with the SNAP-IV scores, and personality dimensions were assessed using the Temperament and Character Inventory.
The combined subtype (n=168) was associated with higher scores in novelty seeking (p<0.001) and lower scores in cooperativeness (p=0.006) than the inattentive subtype (n=128). Higher inattention scores were associated with decreased self-directedness (p<0.001) and increased harm avoidance (p=0.02), whereas higher hyperactivity/impulsivity scores correlated positively with novelty seeking (p<0.001) and persistence (p=0.03).
These findings suggest that personality dimensions are strongly correlated with ADHD subtypes and severity dimensions, pointing to the need for studies evaluating the mechanisms behind this association.
Adults with attention-deficit/hyperactivity disorder (ADHD) are predisposed to smoking, but the neuropsychological correlates of this association have not been elucidated so far. The present study ...evaluates possible associations between cognitive performance and smoking and other comorbidities in adults with ADHD. Two hundred and sixty-four (264) patients were evaluated in the adult ADHD outpatient clinic of the Hospital de Clínicas de Porto Alegre. The diagnoses were based on the DSM-IV criteria and interviews were performed with the Portuguese version of K-SADS-E for ADHD and oppositional-defiant disorder. Axis I psychiatric comorbidities were evaluated with the SCID-IV and the cognitive performance with the Vocabulary and Block Design subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The evaluation of the influence of the WAIS-R scores on each dependent variable was performed with logistic regression analyses. Lower scores in the Block Design subtest of WAIS-R were associated with smoking and the presence of anxiety disorder. These results suggest that a subgroup of ADHD patients with lower Block Design subtest scores may be at increased risk of smoking as a cognitive enhancement. Our findings also confirmed the previously suggested association between anxiety and lower Block Design scores.
The aim of the present study is to verify if gender modifies the clinical, adaptative and psychological outcomes of adult attention-deficit/hyperactivity disorder (ADHD) subtypes. We evaluated 219 ...clinically referred adult patients. The interviews followed the DSM-IV criteria,using the K-SADS-E for ADHD and oppositional defiant disorder and SCID-IV for comorbidities. Regression models were used to analyze gender and subtype main effects and interactions in psychiatric outcomes. In the initial sample, 117 patients (53.5%) were of the combined subtype, 88 (40%) were inattentives and 14 (6.5%) hyperactives. There were no significant interactions between gender and subtype in any variable assessed. Men and women did not differ in the relative frequency of each subtype. Patients of the combined subtype in both genders presented a higher severity and increased rates of conduct and ODD disorders than inattentives. The main effects of gender and subtype in this sample are similar to those previously reported in other countries, suggesting the cross-cultural equivalence of the phenotype. The absence of significant interactions between gender and subtype suggests that, at least in clinical-based samples, DSM-IV adult ADHD subtypes present cross-gender validity.
RESUMO Objetivo: Mapear a inclusão de políticas afirmativas nos cursos de pós-graduação em Enfermagem no Brasil. Método: Trata-se de um estudo descritivo e de base documental, realizado com ...informações coletadas na Plataforma Sucupira, via Coordenação de Aperfeiçoamento de Pessoal de Nível Superior que é vinculada ao Ministério da Educação. Após a coleta de dados, feita entre outubro de 2021 e março de 2022, deu-se a leitura integral de cada edital para a extração dos seguintes elementos: nome do programa; código do programa; nome da Instituição de Ensino Superior; sigla; Unidade Federativa; quantitativos de vagas para cursos de mestrado. Resultados: Identificou-se 79 instituições do país, com amostra final de 67 programas avaliados, os quais foram classificadas em nove tipos a partir do uso dos princípios das políticas afirmativas em mestrados acadêmicos e profissionais. Conclusão: Os cursos de pós-graduação em Enfermagem apresentam desequilíbrio quanto à implementação de políticas afirmativas em suas ofertas de vagas regulares, bem como nas questões de equidade no acesso regional e de diversidade nos grupos sociais contemplados.
ABSTRACT Objective: To map the inclusion of affirmative policies in Postgraduate Nursing courses in Brazil. Method: This is a descriptive, document-based study, carried out with information collected on the Sucupira Platform, via the Coordination for the Improvement of Higher Education Personnel, linked to the Ministry of Education. After data collection, carried out between October 2021 and March 2022, each public notice was read in full, in order to extract the following elements: name of the program; program code; name of the Higher Education Institution; acronym; Federative unit; and number of vacancies for master’s courses. Results: 79 institutions in the country were identified, with a final sample of 67 evaluated programs, which were classified into nine types, based on the use of affirmative policy principles in academic and professional master’s degrees. Conclusion: Postgraduate Nursing courses present an imbalance regarding the implementation of affirmative policies in their offers of regular vacancies, as well as in issues of equity in regional access and diversity in the social groups contemplated.
RESUMEN Objetivo: Mapear la inclusión de políticas afirmativas en los cursos de Postgrado en Enfermería de Brasil. Método: Se trata de un estudio descriptivo, de base documental, realizado con informaciones recogidas en la Plataforma Sucupira, a través de la Coordinación de Perfeccionamiento del Personal de Enseñanza Superior, vinculada al Ministerio de Educación. Después de la recolección de datos, realizada entre octubre de 2021 y marzo de 2022, cada convocatoria fue leída en su totalidad para extraer los siguientes elementos: nombre del programa; código del programa; nombre de la Institución de Educación Superior; sigla; Unidad Federativa; y número de vacantes para maestrías. Resultados: Se identificaron 79 instituciones en el país, con una muestra final de 67 programas evaluados y clasificados en nueve tipos, a partir del uso de principios de políticas afirmativas en maestrías académicas y profesionales. Conclusión: Los cursos de postgrado en Enfermería presentan un desequilibrio en la implementación de políticas afirmativas en sus ofertas regulares de vacantes, así como en las cuestiones de equidad para el acceso regional y diversidad de los grupos sociales contemplados.
The diagnosis of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in adults lacks adequate assessment instruments. The aim of this investigation is to evaluate ...the interrater reliability of the sections of K-SADS-E adapted for the diagnosis of these disorders among adults. The adaptations were limited to asking questions directly to the patient, investigation of a later onset of symptoms, and asking for adult specific symptoms. Six trained raters scored 16 recorded interviews. Kappa coefficients were 1.00 for ADHD diagnosis in the past, 0.91 for subtype in the past, 1.00 for ADHD diagnosis in the present, 0.95 for subtype in the present, 1.00 and 0.89 for ODD diagnosis in the past and present, respectively (all with p < 0.001). These results reveal excellent agreement for the ADHD and ODD diagnosis in adults using the adapted form of the Portuguese version of K-SADS-E.
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