No evidence of structural abnormality of the substantia nigra in adult attention-deficit/hyperactivity disorder: a pilot cross-sectional cohort study.

Background: Abnormal expansion of the echogenic substantia nigra (SN+) is a common observation in Parkinson's disease (PD) and considered a potential trait marker within this context. However, SN+ was also frequently detected in children diagnosed with attention-deficit/hyperactivity disorder (ADHD), where it has been discussed as a biomarker of maturational dopaminergic dysfunction. Interestingly, ADHD was recently linked to an elevated risk of PD in epidemiological studies, particularly among individuals treated with psychostimulants. Here, we investigated the potential of SN echogenicity as a disease biomarker in adults with ADHD and its relation to psychostimulant treatment. Methods: In an exploratory cross-sectional cohort study, we performed transcranial sonography of the SN in 30 adults (mean age 33.3 ± 7.6 years, 19 males/11 females) diagnosed with ADHD according to DSM-V criteria. Results and conclusions: In this pilot study, we observed no evidence of structural abnormalities of the SN among adults diagnosed with ADHD, thus questioning the potential of SN+ as a biomarker for ADHD in this population. Moreover, we found no evidence of treatment-related SN echogenicity changes that would link therapeutic psychostimulant use to alterations in the structural integrity of the SN.

Reduced dopamine transporter availability in drug-naive adult attention-deficit/hyperactivity disorder.

Aim: This study aimed to clarify the abnormalities in dopamine transporter (DAT) availability in drug-naive adult patients with attention-deficit/hyperactivity disorder (ADHD) and the relationship between ADHD symptoms and abnormalities in DAT availability. Methods: Single-photon emission tomography (SPECT) was performed using iodine-123-ß-carbomethoxy-3ß-(4-iodophenyltropane) (I-123 ß CIT) as a tracer to measure in vivo DAT availability in 20 drug-naive patients with ADHD [mean age ± standard deviation (SD)]: 25 ± 3.44 years; male:female = 11:9] and 20 age- and sex-matched healthy controls (HCs) (mean age ± SD: 23.9 ± 2.27 years). Comparisons of DAT availability between HCs and adult patients with ADHD and the association between symptom severity and DAT availability within the ADHD group were analyzed using Statistical Parametric Mapping 12. Results: Drug-naive adults with ADHD showed significantly reduced DAT availability in the bilateral nucleus accumbens compared with HCs. Correlation analyses revealed a negative correlation between the severity of inattentive symptoms in adult patients with ADHD and DAT availability in the bilateral heads of the caudate nucleus, indicating the association between severe inattentive symptoms and lower DAT availability in the caudate nucleus. Conclusion: In drug-naive adult patients with ADHD, DAT availability was reduced in the nucleus accumbens, an important part of the reward system. This finding indicates the importance of the DAT in the reward system in the pathogenesis of ADHD. Inattentiveness was associated with DAT availability in the caudate nucleus, suggesting involvement of the cortico-striato-thalamo-cortical circuit.

[Are the concepts of "chronic mania" in German-speaking psychiatry around 1900 early contributions to the disorder of the adult form of attention deficit hyperactivity disorder (ADHD)?] / Sind die Konzepte zur "chronischen Manie" der deutschsprachigen Psychiatrie um 1900 frühe Beiträge zum Störungsbild der adulten Form der Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung (ADHS)?

The adult form of attention deficit hyperactivity disorder (ADHD) has increasingly become a focus of adult psychiatry. Despite long-established diagnostic criteria and specific therapeutic approaches for the disorder, the common misconception that ADHD is a "fad" has persisted. Examining the history of psychiatry can make an educational contribution by showing that the adult form of ADHD is a continuously existing illness phenomenon. The present study examines the discussion of sometimes prominent authors about "chronic mania" in German-speaking psychiatry around 1900. The individual concepts were analyzed for their content and compared with each other and with modern diagnostic manuals for adult ADHD. The aim of this work is to question and discuss whether these "chronic-manic concepts" are part of the conceptual history of adult ADHD and whether a gap in the history of this disorder can be filled with their help. It is concluded that in the early twentieth century neurologists reported and discussed about patients who nowadays would almost certainly receive the diagnosis of ADHD. The psychiatrists had difficulty in classifying this disorder into their nosological schemes but their "chronic-manic concepts" show clear parallels to the current diagnostic criteria for adult ADHD and its symptoms.

Attention-deficit hyperactivity disorder in adults with epilepsy: An indirect relationship with suicide risk.

PURPOSE: Studies on attention-deficit hyperactivity disorder (ADHD) are scarce in adults with epilepsy. This study aimed to investigate the risk factors for ADHD and determine whether ADHD is directly associated with the risk of suicide in adults with epilepsy. METHODS: ADHD was assessed using the Structured Clinical Interview for the DSM-5 Disorders Clinical Version. The Mini International Neuropsychiatric Interview (MINI) Plus 5.0.0, Neurological Disorders Depression Inventory for Epilepsy (NDDIE), and Generalized Anxiety Disorder-7 (GAD-7) were also used. Suicide risk was defined as a MINI suicidality score of ≥ 1. Stepwise logistic regression and mediation analyses were conducted. RESULTS: Of the 157 adults with epilepsy, 19 (12.1 %) were diagnosed with ADHD, including inattentive (5.7 %), hyperactive (3.8 %), and combined (2.5 %) types. Thirty-two subjects (20.4 %) had a risk of suicide. ADHD was insignificantly associated with any epilepsy-related factors. The diagnosis of ADHD was not associated with suicide risk independent of NDDIE ≥ 14 and GAD-7 ≥ 7. Mediation effects of ADHD on suicidality using NDDIE ≥ 14 (odds ratio [OR] 2.850, 95 % confidence interval [CI] 1.398-5.811, p = 0.004) or GAD-7 ≥ 7 (OR 3.240, 95 % CI 1.537-6.828, p = 0.002) were statistically significant, with the proportion mediated being 84.5 % or 92.0 % of the total ADHD effect, respectively. These models were adjusted for age, sex, and composite epilepsy severity scores. CONCLUSIONS: ADHD was diagnosed in 12.1% of adults with epilepsy and was not associated with any epilepsy-related factors. ADHD was indirectly associated with the risk of suicide resulting from depression and anxiety in adults with epilepsy.

Cognitive Disengagement Syndrome in Mothers of Children With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To examine the cognitive disengagement syndrome (CDS) symptoms of mothers of children with attention-deficit/hyperactivity disorder (ADHD). METHOD: The participants consisted of 223 mothers of children with ADHD, and data were collected using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV), the Stroop Test (ST), the Barkley Adult SCT Scale (CDS), and the Adult ADHD Self-Report Scale (ASRS). RESULTS: The participants were divided into four groups based on psychopathology: the group without any psychiatric disorder, the group with only ADHD, the group with a psychiatric disorder other than ADHD, and the group with another psychiatric disorder along with ADHD. The group with any psychiatric disorder along with ADHD had the highest CDS scores, while the group without any psychopathology had the lowest CDS scores. CONCLUSION: CDS seems to be a construct associated with both ADHD and other internalizing disorders. Further studies are needed to shed more light on these relationships.

Association of bisphenol A with cognitive functions and functionality in adult attention deficit hyperactivity disorder.

BACKGROUND: Bisphenol A (BPA) has been linked to attention-deficit/hyperactivity disorder (ADHD) symptoms, but the effects on cognitive functions and functionality in adult ADHD have not been investigated. We investigated the associations between serum BPA with cognitive functions and functionality in adult ADHD patients. METHODS: The levels of BPA were measured in 45 adult ADHD patients and 45 well-matched healty controls. The relationship between plastic exposure and BPA was also evaluated. Stroop test and Wisconsin Card Sorting Test were applied for neurocognitive evaluation and participants were compared in basic cognitive functions including planning, organization, abstraction, problem solving, strategy development, set shifting, cognitive flexibility, variants of attention, information processing speed, the ability to change perceptual setup and response under interference. Sheehan disability scale was applied for functionality. The association of BPA with test scores was analyzed statistically. RESULTS: Serum BPA levels in adult ADHD patients were found to be significantly higher than in healthy controls. There was no relationship between plastic exposure and BPA levels. BPA levels showed a significant effect on functionality in terms of work field. There were significant differences between the groups in terms of cognitive functions. However, no significant correlation was found between BPA levels and cognitive functions. CONCLUSIONS: BPA is associated with ADHD and affects functionality in the field of work, but larger-scale further studies are needed for its effect on cognitive functions.

Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial.

INTRODUCTION: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD: A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS: Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.

Attention-deficit hyperactivity disorder in Egyptian medical students and how it relates to their academic performance.

BACKGROUND: The neurobehavioral disorder, known as attention-deficit hyperactivity disorder (ADHD), is characterized by impulsivity, hyperactivity, and a lack of focus. In addition, it is connected to poor academic performance. The purpose of this study was to determine the prevalence of ADHD and its effect on their academic performance among medical students. MATERIALS AND METHODS: This web-based cross-sectional study was conducted among medical students of four medical colleges during December 2021 and April 2022. Data was collected using a self-administered questionnaire comprising Wender Utah Rating Scale and adult ADHD Self-Report Scale [ASRS]. The link to Google Form survey was distributed to students through academic emails and WhatsApp. Data analyzed using SPSS; Chisquare test or Fisher's exact test as appropriate, were used to determine statistical significance. RESULTS: A total of 990 students filled online questionnaire; 54.7% were females.. The estimated prevalence of ADHD in Egyptian medical students was 11%. Students who had childhood ADHD were significantly linked with the present ADHD (r = 0.54, P < 0.001). There was a negative correlation between the ASRS score for ADHD and students' GPA (r = 0.2, P < 0.001). No statistically significant association was observed between ADHD and sex, type of university, and academic level. of the students. CONCLUSION: ADHD is prevalent among medical students. Since most of our students with adult ADHD also had preexisting childhood ADHD, it is crucial that the primary care services, especially school health services, have appropriate standards for the early identification and management of ADHD. Health authorities should conduct a comprehensive health education campaign to raise public awareness of ADHD and its risk factors, the clinical picture, and the burden.

Psychometric properties of the Hungarian childhood trauma questionnaire short form and its validity in patients with adult attention-deficit hyperactivity disorder or borderline personality disorder.

BACKGROUND: Compelling evidence supports the role of childhood traumatization in the etiology of psychiatric disorders, including adult attention-deficit hyperactivity disorder (aADHD) and borderline personality disorder (BPD). The aim of this study was to examine the psychometric properties of the Hungarian version of the Childhood Trauma Questionnaire Short Form (H-CTQ-SF) and to investigate the differences between patients diagnosed with aADHD and BPD in terms of early traumatization. METHODS: Altogether 765 (mean age = 32.8 years, 67.7% women) patients and control subjects were enrolled from different areas of Hungary. Principal component analysis and confirmatory factor analysis were carried out to explore the factor structure of H-CTQ-SF and test the validity of the five-factor structure. Discriminative validity was assessed by comparing clinical and non-clinical samples. Subsequently, aADHD and BPD subgroups were compared with healthy controls to test for the role of early trauma in aADHD without comorbid BPD. Convergent validity was explored by measuring correlations with subscales of the Personality Inventory for DSM-5 (PID-5). RESULTS: The five scales of the H-CTQ-SF demonstrated adequate internal consistency and reliability values. The five-factor model fitted the Hungarian version well after exclusion of one item from the physical neglect scale because of its cross-loading onto the emotional neglect subscale. The H-CTQ-SF effectively differentiated between the clinical and non-clinical samples. The BPD, but not the aADHD group showed significant differences in each CTQ domain compared with the healthy control group. All CTQ domains, except for physical abuse, demonstrated medium to high correlations with PID-5 emotional lability, anxiousness, separation insecurity, withdrawal, intimacy avoidance, anhedonia, depressivity, suspiciousness, and hostility subscales. CONCLUSIONS: Our study confirmed the psychometric properties of the H-CTQ-SF, an easy-to-administer, non-invasive, ethically sound questionnaire. In aADHD patients without comorbid BPD, low levels of traumatization in every CTQ domain were comparable to those of healthy control individuals. Thus, the increased level of traumatization found in previous studies of aADHD might be associated with the presence of comorbid BPD. Our findings also support the role of emotional neglect, emotional abuse and sexual abuse in the development of BPD.

Gender Biases Toward People With Difficulty in Balancing Work and Family Due to ADHD: Two Case Vignette Randomized Studies Featuring Japanese Laypersons and Psychiatrists.

Objective The gender gap in labor force participation is likely larger in adults with attention deficit hyperactivity disorder (ADHD) than that in the general population. Thus, we investigated whether gender affected the perception toward persons displaying ADHD symptoms and experiencing difficulty in balancing work and family. Methods Both Japanese laypersons and psychiatrists were recruited for web-based surveys in March and October 2020 via an online survey company, Cross Marketing Inc., and the secretariat of the Japanese Society of Psychiatry and Neurology, respectively. The participants were randomly assigned to read either a male or female case vignette. The vignettes were identical, except for the gender of the patient in the case. The primary and secondary outcomes were the respondents' opinions on the seriousness of the case and the degree to which the case's wish should be maintained, using sliding scales of 0-100. Results We included 560 laypersons and 585 psychiatrists. Neither cohort differed in most outcomes between the groups assigned to the male and female case vignettes. Among laypersons, the average score of seriousness was 58.8 in the female-vignette group and 58.6 in the male-vignette group (mean difference, 0.15; 95% confidence interval, -4.9 to 5.2). Among psychiatrists, the average score of seriousness was 53.9 in the female-vignette group and 53.7 in the male-vignette group (mean difference, 0.18; 95% confidence interval, -3.1 to 3.4). Similarly, between-group differences in the opinions on the degree to which the case's wish should be maintained were 1.2 in laypersons and 0.63 in psychiatrists. We found no significant interaction between the gender of the case and the respondent's gender in any of the outcomes. Conclusion Our results did not support the hypothesis that women were more likely to be pressured to prioritize family over work than men were when there was difficulty balancing work and family due to ADHD symptoms.

Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?

Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88-6.26 and OR = 3.42, 95% CI = 1.30-8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.

Linguistic Equivalence, Validity and Reliability Study of the Mind Excessively Wandering Scale.

Introduction: The main objective was to study the linguistic equivalence, validity and reliability of the transliterated Turkish version of Mind Excessively Wandering Scale (MEWS) developed by Prof. Philip Asherson in England (2016). Mind excessively wandering defines uncontrolled mental phenomena, which is proposed as the psychological counterpart of Default Mode Network in literature. Method: Mind Excessively Wandering Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, Barratt Impulsiveness Scale, Difficulties in Emotion Regulation Scale have been used. The sample group consists of 64 patients previously diagnosed as adult Attention Deficit Hyperactivity Disorder for validity, 60 students for transliteral equivalence, and 80 healthy controls for test re-test reliability. Results: Transliteral equivalence study demonstrates that Turkish version of MEWS is highly correlated with the English version and is statistically significant. The sixth item in the scale was removed in order to ensure the consistency model established by LISREL in the validity study according to the confirmatory factor analysis. When the sixth item was excluded, it was concluded that the structure of the scale was compatible. In the reliability study of the MEWS, the Cronbach's alpha value (α) of the scale was found to be 0.826. It is seen that the item with the highest distinctiveness feature is Item-10 (0.618) and the item with the lowest distinctiveness feature is Item-5 (0.318). In the linguistic equivalence study, no statistical difference was found between the English form and the Turkish versions of the scale. Conclusion: As a result of the practical and statistical evaluations, our study demonstrated that the Turkish version of the MEWS is a valid and reliable measurement tool.

Marital Adjustment and Marital Conflict in Individuals Diagnosed with ADHD and Their Spouses.

Introduction: Attention deficit and hyperactivity disorder (ADHD) can cause many problems in adulthood, particularly in close interpersonal relationships and marriage. The aim of this study was to investigate the differences in patterns of the marital relationship between healthy couples and couples with one member previously diagnosed with ADHD. Methods: The sample of the study included the ADHD group consisting of 28 couples one of whom was diagnosed with ADHD; and the comparison group consisting of 28 healthy couples who were reached through snowball sampling. All couples had been married for at least one year and their ages range from 22 to 61. Wender Utah Rating Scale, Adults ADHD Self-Report Scale, Marital Conflict Questionnaire, Marital Adjustment Scale, Conflict Resolution Styles Scale in Romantic Relationship, and The Birtchnell Partner Evaluation Scale were used as data collection tools. Results: Analysis results showed that adults diagnosed with ADHD and their spouses had more unfavorable patterns in their marriages with regard to the level of conflict, marital adjustment, conflict resolution styles, and reciprocal evaluations when compared to the comparison group. Conclusion: ADHD can lead to the termination of marriages when it is not recognized and not treated properly. In consideration of this fact, it is thought that this study will provide information about the recognition of ADHD in adults who apply with especially marital problems and directing them to appropriate treatment.

Validity of the Czech Translation of the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale (ASRS).

Objective: The study aim was to assess the psychometric properties of the ASRS in the Czech Republic. Although this screening tool is now frequently used, its validity has not been assessed among the general Czech population. Methods: The ASRS and WURS were administered online to the general Czech population (N = 1,518). We performed confirmatory and exploratory factor analyses. Results: For the ASRS, confirmatory factor analysis showed good fit for the screening part (SRMR = 0.03, RMSEA = 0.06, CFI = 0.98). For the symptom list, the fit was good according to the SRMR, acceptable according to the RMSEA, and slightly below acceptable according to the CFI. For the WURS, the results showed SRMR = 0.06, RMSEA = 0.07, and CFI = 0.92. Conclusion: The Czech translation of the ASRS is appropriate and has acceptable psychometric properties. However, we strongly recommend only using this tool together with clinical judgment.

Depressive Symptoms Account for Loss of Positive Attention Bias in ADHD Patients: An Eye-Tracking Study.

OBJECTIVES: Depression and ADHD often co-occur and are both characterized by altered attentional processing. Differences and overlap in the profile of attention to emotional information may help explain the co-occurence. We examined negative attention bias in ADHD as neurocognitive marker for comorbid depression. METHODS: Patients with depression (n = 63), ADHD (n = 43), ADHD and depression (n = 25), and non-psychiatric controls (n = 68) were compared on attention allocation toward emotional faces. The following eye-tracking indices were used: gaze duration, number of revisits, and location and duration of first fixation. RESULTS: Controls revisited the happy faces more than the other facial expressions. Both the depression and the comorbid group showed significantly less revisits of the happy faces compared to the ADHD and the control group. Interestingly, after controlling for depressive symptoms, the groups no longer differed on the number of revisits. CONCLUSION: ADHD patients show a relative positive attention bias, while negative attention bias in ADHD likely indicates (sub)clinical comorbid depression.

Cognitive Developmental Trajectories in Adult ADHD Patients and Controls: A Comparative Study.

OBJECTIVE: There is an updated conceptualization of whole-lifespan attention-deficit hyperactivity disorder (ADHD), promoted by awareness of probable persistence of impairment into adulthood. We investigated cognition trajectories from adolescence to mid-adulthood in ADHD. METHOD: Data of 240 patients with ADHD and 244 healthy controls (HCs) were obtained; clinical symptoms and neuropsychological functions were assessed using the various tests. RESULTS: Compared to HCs, patients with ADHD except 35 to 44 age interval showed lower full scale intelligence quotient. They showed decreased verbal comprehensive scores except in the 35 to 44 age interval and working memory scores in all intervals. In the Comprehensive Attention Test, patients with ADHD showed increased working memory error frequencies except in the 15 to 17 age interval and divided attention omission error in all intervals. CONCLUSION: Adults with ADHD showed deficits not in simple attention but in complex attention, including divided attention and working memory.

Targeting working memory to modify emotional reactivity in adult attention deficit hyperactivity disorder: a functional magnetic resonance imaging study.

Understanding the neural mechanisms of emotional reactivity in Attention-Deficit/Hyperactivity Disorder (ADHD) may help develop more effective treatments that target emotion dysregulation. In adult ADHD, emotion regulation problems cover a range of dimensions, including emotional reactivity (ER). One important process that could underlie an impaired ER in ADHD might be impaired working memory (WM) processing. We recently demonstrated that taxing WM prior to the exposure of emotionally salient stimuli reduced physiological and subjective reactivity to such cues in heavy drinkers, suggesting lasting effects of WM activation on ER. Here, we investigated neural mechanisms that could underlie the interaction between WM and ER in adult ADHD participants. We included 30 male ADHD participants and 30 matched controls. Participants performed a novel functional magnetic resonance imaging paradigm in which active WM-blocks were alternated with passive blocks of negative and neutral images. We demonstrated group-independent significant main effects of negative emotional images on amygdala activation, and WM-load on paracingulate gyrus and dorsolateral prefrontal cortex activation. Contrary to earlier reports in adolescent ADHD, no impairments were found in neural correlates of WM or ER. Moreover, taxing WM did not alter the neural correlates of ER in either ADHD or control participants. While we did find effects on the amygdala, paCG, and dlPFC activation, we did not find interactions between WM and ER, possibly due to the relatively unimpaired ADHD population and a well-matched control group. Whether targeting WM might be effective in participants with ADHD with severe ER impairments remains to be investigated.

[Adult attention deficit hyperactivity disorder (ADHD) in the clinical descriptions and classificatory reflections of Gustav Specht (1905) and Hermann Paul Nitsche (1910)]. / Die Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung (ADHS) bei Erwachsenen in den klinischen Beschreibungen und klassifikatorischen Reflexionen von Gustav Specht (1905) und Hermann Paul Nitsche (1910).

The notion that the adult form of attention deficit hyperactivity disorder (ADHD) is not a construct of modern psychiatry is increasingly prevailing. Looking into the history of psychiatry can make an enlightening contribution here. Guided by this aim and specifically following literature referred to by Emil Kraepelin (1856-1926), we analyzed the content of one study each by Gustav Specht (1860-1940) and the later Nazi psychiatrist Hermann Paul Nitsche (1876-1948) from 1905 and 1910, respectively, on the topic of chronic mania. Our investigation concluded that in their case studies both authors described people who would today be diagnosed as suffering from adult ADHD as the clinical descriptions reveal core symptoms of this entity as defined by modern classifications. They also mentioned currently discussed research questions. Both authors expressed their dissatisfaction with the classificatory situation of these patients at the time. Specht even postulated a "completely independent mental illness" that he called "chronic mania", under which he classified all the patients suffering from today's adult ADHD. He also pointed out that this diagnosis was not widely recognized at the time by psychiatrists as a full-fledged form of illness but used more as a diagnosis to avoid the embarrassment of not having one. Nitsche saw the "chronic manic states" as he called them as a "clinical peculiarity" but assigned them to the large group of "manic depressive insanity", which could only be more finely differentiated in the future.

Adult attention-deficit Hyperactivity disorder: From clinical reality toward conceptual clarity.

There is ambiguity about the clinical picture and concept of attention-deficit hyperactivity disorder (ADHD) in adults. Relevant literature was extracted from various search engines, analyzed, and interpreted. Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning. Inattentiveness was more commonly present than hyperactivity-impulsivity. Frequent comorbidities with other psychiatric disorders like anxiety disorders and substance use disorders were noted. Pharmacological management and psychotherapy have been found effective in its management. ADHD is a disorder across the lifespan and fairly prevalent among adults. Greater awareness and more research are required for a better understanding of Adult ADHD and its effective management.