Presentation
Diagnosis and treatment of attention deficit hyperactivity disorder in adults
Diagnóstico y tratamiento del trastorno por déficit de atención/hiperactividad en adultos
J.A.
Ramos-Quiroga
1,2,3,*
,
P.J.
Chalita
1
,
R.
Vidal
1
,
R.
Bosch
1,2,3
,
G.
Palomar
1
,
L.
Prats
1
,
M.
Casas
1,2,3
Show Less
Affiliation
1
Servicio de Psiquiatría; Programa Integral del Déficit de Atención en Adultos; Hospital Universitari Vall d’Hebron
, España
2
Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM
, España
3
Departamento de Psiquiatría y Medicina Legal; Facultad de Medicina; Universitat Autònoma de Barcelona
, España
*Correspondencia:Dr. Josep Antoni Ramos-Quiroga.Servicio de Psiquiatría. Hospital Universitari Vall d’Hebron. Edificio Antigua Escuela de Enfermería,5.ª planta. Pg. Vall d’Hebron,119-129. E-08035 Barcelona.
Rev Neurol 2012
, 54(Suplemento 1),
105–115;
https://doi.org/10.33588/rn.54S01.2012009
Abstract
AIM To review the latest data available concerning the diagnosis and treatment of adults with attention deficit hyperactivity disorder (ADHD). DEVELOPMENT AND
CONCLUSIONS A number of different instruments for evaluating ADHD have been adapted to the adult patient and allow a reliable diagnosis of the disorder to be reached. Semi-structured interviews, like the Diagnostisch Interview Voor ADHD 2.0 (DIVA), simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD. Quick screening instruments that allow better detection of ADHD in adults, such as the Adult Self-Report Scale 1.1 (ASRS), have been validated. In recent years, there has been a notable increase in the number of studies focused on ADHD in adults and that research has provided solid data regarding the safety and effectiveness of different treatments. According to the recommendations of the European Consensus statement by the European Network Adult ADHD, the treatment ought to be multimodal, which means combining pharmacological interventions with psychological and psychosocial ones. Methylphenidate displays a high degree of effectiveness and safety in the treatment of adults at doses of around 1 mg/kg/day. Amphetamines, such as lisdexamphetamine, have also proved to be effective in the treatment of adults with ADHD. Among non-stimulant treatments, atomoxetine has proved to be effective and safe in adults in doses of about 80-100 mg/day. Excellent studies have been conducted on the cognitive-behavioural treatment of adults with ADHD, the results of which highlight its effectiveness in both the short and the long term.
CONCLUSIONS A number of different instruments for evaluating ADHD have been adapted to the adult patient and allow a reliable diagnosis of the disorder to be reached. Semi-structured interviews, like the Diagnostisch Interview Voor ADHD 2.0 (DIVA), simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD. Quick screening instruments that allow better detection of ADHD in adults, such as the Adult Self-Report Scale 1.1 (ASRS), have been validated. In recent years, there has been a notable increase in the number of studies focused on ADHD in adults and that research has provided solid data regarding the safety and effectiveness of different treatments. According to the recommendations of the European Consensus statement by the European Network Adult ADHD, the treatment ought to be multimodal, which means combining pharmacological interventions with psychological and psychosocial ones. Methylphenidate displays a high degree of effectiveness and safety in the treatment of adults at doses of around 1 mg/kg/day. Amphetamines, such as lisdexamphetamine, have also proved to be effective in the treatment of adults with ADHD. Among non-stimulant treatments, atomoxetine has proved to be effective and safe in adults in doses of about 80-100 mg/day. Excellent studies have been conducted on the cognitive-behavioural treatment of adults with ADHD, the results of which highlight its effectiveness in both the short and the long term.
Resumen
Objetivo Revisar los últimos datos existentes sobre el diagnóstico y el tratamiento de los adultos con trastorno por déficit de atención/hiperactividad (TDAH). Desarrollo y conclusiones. Existen diferentes instrumentos de evaluación del TDAH adaptados a la edad adulta que permiten un diagnóstico fiable del trastorno. Las entrevistas semiestructuradas, como la Diagnostisch Interview Voor ADHD 2.0 (DIVA), facilitan una evaluación rigurosa de los síntomas del trastorno en la edad adulta, así como de las disfunciones generadas por el TDAH. Se han validado instrumentos de cribado rápido, como la escala Adult Self-Report Scale 1.1 (ASRS), que permiten una mejor detección del TDAH en adultos. Durante los últimos años se ha incrementado de forma notable la investigación centrada en el TDAH en adultos, y se han aportado datos sólidos respecto la seguridad y eficacia de diferentes tratamientos. Según las recomendaciones del Consenso Europeo de la European Network Adult ADHD, se considera que el tratamiento debe ser multimodal, de modo que se combinen las intervenciones farmacológicas con las psicológicas y las psicosociales. El metilfenidato evidencia una elevada eficacia y seguridad en el tratamiento de adultos en dosis en torno a 1 mg/kg/día. Las anfetaminas, como la lisdexanfetamina, también han mostrado ser fármacos eficaces en el tratamiento de los adultos con TDAH. Dentro de los tratamientos no estimulantes, la atomoxetina ha demostrado ser eficaz y segura en adultos en dosis de unos 80-100 mg/día. Se han realizado excelentes estudios sobre el tratamiento cognitivo-conductual en adultos con TDAH, que ponen de manifiesto su eficacia a corto y largo plazo.
Keywords
ADHD
Adults
Atomoxetine
Attention deficit
Diagnosis
Hyperactivity
Lisdexamphetamine
Methylphenidate
Review
Stimulants
Treatment
Palabras Claves
Adultos
Atomoxetina
Déficit de atención
Diagnóstico
Estimulantes
Hiperactividad
Lisdexanfetamina
Metilfenidato
Revisión
TDAH
Tratamiento