Identifying ADHD in adults using the international personality disorder examination screening questionnaire.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is frequently diagnosed concurrently with a personality disorder (PD) in adulthood. Both are trait-like chronic disorders with substantial similarities. AIM: To measure the accuracy of the International Personality Disorder Examination screening questionnaire (IPDE-SQ) in identifying ADHD in adults from a psychiatric population. METHOD: Participants (n = 119) from mental health services completed an ADHD interview and the IPDE-SQ. MAIN RESULTS: Although many IPDE-SQ subscales demonstrated good sensitivity in identifying ADHD, a potential 11-item scale from IPDE-SQ components had excellent sensitivity (84%) and specificity (82%). CONCLUSIONS: An 11-item subscale from the IPDE-SQ shows potential as a screening instrument for ADHD in an adult psychiatric population.

Co-morbidity and cannabis use in a mental health trust in South East England.

AIM: The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England. DESIGN AND PARTICIPANTS: Cross-sectional prevalence survey of 1,808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study. RESULTS: The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively. CONCLUSIONS: Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.

Nurse prescribing in addiction services: client benefits.

Recent changes to prescribing regulations mean that nurse independent prescribers and supplementary prescribers are now able to prescribe any licensed medicine for conditions within their competence, including some controlled drugs. This article discusses the anticipated benefits of these prescribing changes for patients receiving treatment for substance misuse.

Is opiate detoxification unsafe in pregnancy?

Despite the widespread avoidance of detoxification in the second or third trimesters, there is no clear evidence to support the view that methadone withdrawal is harmful in pregnant opiate dependent women. We investigated the safety of methadone detoxification in pregnancy in a retrospective case series of 101 pregnant opiate dependent women who underwent a 21-day in-patient methadone withdrawal. One miscarriage occurred in the first trimester (n = 5; incidence rate ratio of 6.87 compared to population norms (95% CI = 0.16-47.3; p =.15)). No miscarriages were observed in the second trimester (n = 54; incidence rate ratio = 0 compared to population norms (95% CI = 0-3.69; p =.27). One premature delivery occurred in the third trimester (1 in 158 weeks at risk compared to 1 in 150 weeks in population norms; p =.16). Methadone detoxification treatment was not associated with any increased risk of miscarriage in the second trimester or premature delivery in the third trimester.

Impulsivity and response inhibition in alcohol dependence and problem gambling.

INTRODUCTION: Impulsivity is a central feature of drug addiction and may arise as a result of impaired inhibitory control. The extent to which inhibitory deficits arise as a consequence of drug exposure or relate to pre-existing addiction vulnerability is unknown. MATERIALS AND METHODS: This study compared measures of impulsivity in outpatients with alcohol dependence (n = 23) and problem gambling (n = 21), a putative behavioural addiction where direct effects of drug exposure may be minimal. Healthy controls (n = 27) were also tested, in a cross-sectional design. Subjects completed the stop-signal test as a neurocognitive probe of response inhibition, alongside self-report ratings of impulsivity, adult ADHD and OCD. RESULTS: On the stop-signal test, Go reaction time and stop-signal reaction time were significantly slower in the alcohol-dependent group, compared with healthy controls. Healthy controls slowed their responding after successful and failed stop trials. Slowing after failed stop trials was significantly attenuated in the alcohol-dependent subjects. Go reaction time and post-error slowing were correlated with chronicity and severity, respectively, in the alcohol-dependent subjects. Problem gamblers did not differ significantly from controls on the stop-signal test, despite trait elevations in impulsivity ratings. CONCLUSION: Inhibitory control is impaired in alcohol dependence but occurs in the context of psychomotor slowing. In addition, alcohol-dependent individuals failed to show behavioral adjustment following failed stops. These deficits may represent direct effects of chronic alcohol administration on fronto-striatal circuitry.

Validation of self-report instruments to assess attention deficit hyperactivity disorder symptoms in adults attending community drug and alcohol services.

BACKGROUND: : Symptoms of attention deficit disorder of predominantly inattentive, predominantly hyperactive-impulsive subtype, or combined (hereafter referred to as ADHD), may persist into adulthood, although the diagnosis in adults remains controversial. The study aimed to validate self-report instruments for assessment of adult ADHD in a sample of treatment-seeking adults attending community drug and alcohol teams. METHODS: : Adult patients attending 3 National Health Service (NHS) community drug and alcohol teams in England completed several self-report instruments for assessment of adult ADHD symptoms, and a diagnosis of adult ADHD was determined using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria with an interview with both the patient and an informant. RESULTS: : One hundred seven subjects completed the project. Thirty-nine percent of subjects had an undisputed diagnosis of adult ADHD. The most accurate self-report instrument for diagnosis of adult ADHD was the Connors Adult ADHD Rating Scale Self-report Long version-a cutoff of 91 of 198 gave a sensitivity of 97% and specificity of 83%. Analysis of the WHO Adult ADHD Self-report Screener confirmed the optimal recommended cutoff as 12 of 13 giving 89% sensitivity and 83% specificity for adult ADHD against diagnostic interview. Although the Wender Utah adult ADHD scale is designed to retrospectively assess symptoms of ADHD in childhood it gave a sensitivity of 88% and specificity of 70% for diagnosis of ADHD in adults. CONCLUSION: : The symptoms of ADHD in adults can be reliably assessed by self-report instruments.

Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals.

AIMS: Problem gambling has been proposed to represent a 'behavioural addiction' that may provide key insights into vulnerability mechanisms underlying addiction in brains that are not affected by the damaging effects of drugs. Our aim was to investigate the neurocognitive profile of problem gambling in comparison with alcohol dependence. We reasoned that shared deficits across the two conditions may reflect underlying vulnerability mechanisms, whereas impairments specific to alcohol dependence may reflect cumulative effects of alcohol consumption. DESIGN: Cross-sectional study. SETTING: Out-patient addiction treatment centres and university behavioural testing facilities. PARTICIPANTS: A naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants. MEASUREMENTS: Neurocognitive battery assessing decision-making, impulsivity and working memory. FINDINGS: The problem gamblers and alcohol-dependent groups displayed impairments in risky decision-making and cognitive impulsivity relative to controls. Working memory deficits and slowed deliberation times were specific to the alcohol-dependent group. CONCLUSIONS: Gambling and alcohol-dependent groups shared deficits in tasks linked to ventral prefrontal cortical dysfunction. Tasks loading on dorsolateral prefrontal cortex were selectively impaired in the alcohol-dependent group, presumably as a consequence of long-term alcohol use.

Specialised alcohol treatment services are a luxury the NHS cannot afford.

Is alcoholism an illness or merely a self-inflicted indulgence? Can we afford specialist alcohol treatment services? Do they even work? Should the tax payer foot the bill? Is the lack of such services 'perverse'? In this lively debate Drs. Carnwath and Luty weigh up the pros and cons of controlling the effects of 'our favourite drug'.

Satisfaction with life and opioid dependence.

BACKGROUND: Serious substance misuse and dependence is widely seen as damaging to an individual and to society in general. Whereas the medical and society effects of substance misuse are widely described, some commentators suggest substance misuse may be an "alternative lifestyle". AIM: To assess general life satisfaction amongst treatment-seeking people with substance dependence. METHODS: The Satisfaction With Life Scale (SWLS) was administered to a sample of opioid-dependent people receiving substitute medication. RESULTS: 105 subjects and 105 age-sex matched subjects in a comparison group completed the questionnaire. The mean SWLS score was 7.12 (SD = 10.6; median = 6) for patients compared to 22.6 (SD = 6.8) in the comparison group. (Two sided p < 0.0001; Median difference = -13.5; Wilcoxon signed rank test.) CONCLUSION: The study used a validated instrument and objective reports to confirm significantly higher rates of dissatisfaction with life among opioid dependent people in treatment when compared to members of the general population.

A retrospective sibling study of childhood adjustment in adults with substance use disorders.

PURPOSE: : Research has suggested that people who develop serious substance use disorders have delinquent traits as children before using any illicit drugs. This study was designed to retrospectively identify differences in antisocial and delinquent behavior between siblings discordant for serious substance use disorders. METHODS: : A retrospective survey was conducted of 50 pairs of adult siblings who were discordant for serious substance use disorders. The self-report early delinquency scale (SRED) was used to retrospectively assess delinquent traits in childhood and adolescence. RESULTS: : The mean SRED 29 (illegal item) score in treatment seeking opiate-dependent people (mean age = 33.5 years) was 19.6 (standard error [SE] = 0.9) compared with 4.8 (SE = 0.6) in same-sex, nonsubstance-dependent siblings (P < 0.0001; paired Wilcoxon test). The mean SRED 58 (norm violation) score in treatment seeking opiate-dependent people was 36.8 (SE = 1.7) compared with 10.5 (SE = 1.4) in same-sex siblings (P < 0.0001; paired Wilcoxon test). Forty percent of patients were expelled from school compared with 12% of siblings (Yates-corrected χ = 8.78; P = 0.003). Ninety-six percent of patients reported problems with the police as adolescence compared with 48% of controls (Yates-corrected χ = 26.24; P < 0.0001). Police problems in substance users predated first use of illicit substances by 5.5 years. CONCLUSIONS: : The study used a validated instrument and objective reports to confirm significantly higher rates of delinquent behavior and social dysfunction in childhood for substance users compared with nonsubstance-dependent siblings. The delinquent behaviors usually predated serious substance misuse.

Association of the serotonin transporter gene, neuroticism and smoking behaviours.

Cigarette consumption and smoking cessation are influenced in part by genes. Personality traits have also been implicated in the aetiology of smoking. Neuroticism, a personality trait with a heritable component, correlates well with anxiety and depression, increasing the risk of being a smoker and decreasing the chance of smoking cessation. Several prior studies in non-British populations have given conflicting results as to whether some genetic polymorphisms affect the relationship between smoking and neuroticism. This study investigated the influence of serotonin transporter (5HTTLPR) genotypes on a composite measure of neuroticism and cigarette consumption/smoking cessation in a British population. Although neuroticism was significantly associated with cigarette consumption and smoking cessation, genotype did not affect this relationship. Our results do not support initial interest in utilising 5HTTLPR genotypes in combination with neuroticism ratings for predicting outcome in smoking cessation clinical settings.

Prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults.

Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were "likely" and 49 were "highly likely" to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.

Validation of the 13-Item Beck Depression Inventory in alcohol-dependent people.

Aims. To validate a self-administered questionnaire (the 13-item Beck Depression Inventory) as an instrument for assessing depressive symptoms in alcohol-dependent people. Design, setting and participants. One hundred and eight treatment-seeking alcohol-dependent patients were recruited from a teaching hospital substance misuse facility. Measures. The Beck Depression Inventory, Montgomery Asberg Depression Rating Scale and Hamilton Rating Scale for Depression were administered. Scores from each instrument were compared using correlation coefficients. Findings. Correlation between the Beck Depression Inventory and Montgomery Asberg Depression Rating Scale was 0.763. The Beck Depression Inventory achieved a high degree of consistency/reliability (Cronbach's α=0.8847). Receiver operated curve analysis gave an optimal cut-off on the 13-item Beck Depression Inventory of 18/19 out of 39 as a screening tool to identify cases with moderate or severe depression. This cut-off gave a sensitivity of 79% and a specificity of 79% compared to the Montgomery Asberg Depression Rating Scale. The diagnostic efficient was 82% for moderate to severe depression compared to the Montgomery Asberg Depression Rating and 85% compared to Hamilton Depression Rating Scale. Conclusions. The self-administered Beck Depression Inventory is a feasible, valid and reliable alternative to the interview for detecting change in depressive symptoms in alcohol-dependent people. This would be particularly useful in services with very limited staffing time such as primary care.

Understanding of the term "schizophrenia"by the British public.

A postal survey of a representative sample of UK adults was conducted. Subjects were asked "What do you understand by the term 'schizophrenia'?".Four hundred four completed questionnaires were received (81% response rate). Forty-two percent of respondents mentionedat least one first rank symptom of schizophrenia or gave a description that reasonably approximated to any diagnostic feature as stated inICD-10. Forty percent mentioned "split" or "multiple" personality. Thirty-eight percent described auditory hallucinations or "hearing voices".Fifteen percent mentioned "delusions" or described passivity experiences. Only 6% of subjects mentioned violence in their descriptions.

Social problems, psychological well-being, and childhood parenting experiences in a community sample of heroin addicts in central London.

Well-validated instruments were used to compare the social adjustment, psychological well-being, and childhood parenting experiences of 105 heroin-dependent people and a matched sample of 103 unemployed people recruited from April to November 2001 via newspaper advertisements and word of mouth in central London. The groups were not homogenous. Both groups had more social and psychological problems than population norms. The unemployed group reported significantly more social and interpersonal problems than the heroin users although they had significantly fewer psychological problems. Childhood parenting experiences were comparable between both groups suggesting this is not a specific cause of heroin dependence.