[Genetic advances in attention deficit hyperactivity disorder]. / Avances geneticos en el trastorno por deficit de atención/hiperactividad.

AIM: To update the knowledge currently available on the genetic foundations of attention deficit hyperactivity disorder (ADHD). The presentation will focus especially on recent data concerning adults. DEVELOPMENT AND CONCLUSIONS: ADHD is one of the most prevalent neuropsychiatric disorders among the general childhood population. In recent years it has been shown that it often progresses into adulthood. The results from studies of families, twins and adopted children display a high degree of familial aggregation. Molecular genetics studies have brought to light positive associations with different genetic polymorphisms in neurotransmitter systems involved in the pathophysiology of ADHD, mainly with the dopaminergic, serotoninergic and noradrenergic, and neurotrophins such as the brain-derived neurotrophic factor (BDNF). The causation of ADHD is still largely unknown but the different studies published to date dealing with the genetic foundations of the disorder suggest that genetics play an important role, its inheritance is complex and it is modulated by environmental factors. ADHD in adults can be a good model for studying the genetic foundations of ADHD.

Avances genéticos en el trastorno por déficit de atención/hiperactividad / Genetic advances in attention deficit hyperactivity disorder

Objetivo. Actualizar los conocimientos existentes sobre las bases genéticas del trastorno por déficit de atención/hiperactividad (TDAH). La presentación se centrará especialmente en los datos recientes sobre adultos. Desarrollo y conclusiones. El TDAH es uno de los trastornos neuropsiquiátricos de mayor prevalencia en la población general en la infancia. Durante los últimos años se ha puesto de manifiesto su frecuente progresión a la edad adulta. Los resultados de los estudios familiares, de gemelos y de niños adoptados demuestran un elevado grado de agregación familiar. Los trabajos en genética molecular han mostrado asociaciones positivas con diferentes polimorfismos genéticos de sistemas de neurotransmisión implicados en la fisiopatología del TDAH, principalmente con el dopaminérgico, serotoninérgico, noradrenérgico y neurotrofinas como el factor neurotrófico derivado del cerebro (BDNF). La etiología del TDAH es todavía poco conocida, pero los diferentes trabajos publicados en torno a las bases genéticas del trastorno indican que presenta una alta carga genética, de herencia compleja, y modulada por factores ambientales. El TDAH en adultos puede ser un buen modelo para el estudio de las bases genéticas del TDAH (AU)

Aim. To update the knowledge currently available on the genetic foundations of attention deficit hyperactivity disorder (ADHD). The presentation will focus especially on recent data concerning adults. Development and conclusions. ADHD is one of the most prevalent neuropsychiatric disorders among the general childhood population. In recent years it has been shown that it often progresses into adulthood. The results from studies of families, twins and adopted children display a high degree of familial aggregation. Molecular genetics studies have brought to light positive associations with different genetic polymorphisms in neurotransmitter systems involved in the pathophysiology of ADHD, mainly with the dopaminergic, serotoninergic and noradrenergic, and neurotrophins such as the brain-derived neurotrophic factor (BDNF). The causation of ADHD is still largely unknown but the different studies published to date dealing with the genetic foundations of the disorder suggest that genetics play an important role, its inheritance is complex and it is modulated by environmental factors. ADHD in adults can be a good model for studying the genetic foundations of ADHD (AU)

[Attention deficit hyperactivity disorder in adults: a clinical and therapeutic characterization]. / Trastorno por deficit de atencion con hiperactividad en adultos: caracterizacion clinica y terapeutica.

AIM: To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, with special interest given to aspects concerning epidemiology, diagnosis, progression and treatment. DEVELOPMENT: Acknowledging the fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few years evidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adult population is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. The symptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with the same symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familial repercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction, personality disorders and depression). CONCLUSIONS: A number of different psychometric instruments are available in Spanish for evaluating ADHD in adults. The use of structured interviews, together with a systemized evaluation of possible comorbid disorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially the same as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and results show methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has been most widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD.

Trastorno por déficit de atención con hiperactividad en adultos: caracterización clínica y terapéutica / Attention deficit hyperactivity disorder in adults: a clinical and therapeutic characterisation

Objetivo. Actualizar los conocimientos existentes sobreel trastorno por déficit de atención con hiperactividad (TDAH) enadultos, centrándose en aspectos relativos a la epidemiología, diagnóstico,evolución y tratamiento. Desarrollo. El reconocimiento dela persistencia del TDAH en la edad adulta es relativamente reciente.A pesar de ello, durante los últimos años se han aportadoevidencias que sustentan la validez del diagnóstico en adultos. Laprevalencia del TDAH en la población general adulta se estima entorno al 4%. Más del 50% de niños afectados continuarán presentandoel trastorno en la edad adulta. Los síntomas del TDAH puedenmanifestarse de diferente forma en los adultos, mostrandomenor hiperactividad y una leve disminución de la impulsividadpero manteniéndose los síntomas de inatención. El TDAH en laedad adulta se asocia a graves repercusiones económicas, laborales,académicas, familiares, así como a accidentes de tráfico y a lapresencia de otras patologías psiquiátricas (como drogodependencias,trastornos de personalidad y depresión). Conclusiones. Se disponede diferentes instrumentos psicométricos en español paraevaluar el TDAH en adultos. El empleo de entrevistas estructuradas,así como una evaluación sistematizada de los posibles trastornoscomórbidos, facilitarán el correcto diagnóstico diferencial. Eltratamiento farmacológico en adultos es esencialmente el mismoque en niños, pero adaptado al peso. Existen ensayos clínicos conpsicoestimulantes, destacando el metilfenidato por su eficacia y seguridad.Dentro del grupo de fármacos no estimulantes, la atomoxetinaes el mejor estudiado en adultos. Los tratamientos psicológicoscognitivoconductuales se han mostrado eficaces en adultoscon TDAH

Aim. To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, withspecial interest given to aspects concerning epidemiology, diagnosis, progression and treatment. Development. Acknowledgingthe fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few yearsevidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adultpopulation is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. Thesymptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with thesame symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familialrepercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction,personality disorders and depression). Conclusions. A number of different psychometric instruments are available in Spanishfor evaluating ADHD in adults. The use of structured interviews, together with a systemised evaluation of possible comorbiddisorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially thesame as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and resultsshow methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has beenmost widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD