Differential relationships of PTSD and childhood trauma with the course of substance use disorders.

A large body of research documents the link between Posttraumatic Stress Disorder (PTSD) and the course of Substance Use Disorders (SUD). Similar relationships have been reported between Childhood Trauma (CT) and the course of illness in patients with SUD even in the absence of PTSD, but few studies have examined differential effects of PTSD and CT (independent of PTSD) in this population. We used the International Diagnostic Checklist (IDCL) and the Posttraumatic Diagnostic Scale (PDS) to diagnose PTSD in a sample of patients with SUD (N = 459). The Childhood Trauma Questionnaire (CTQ) and the European Addiction Severity Index (EuropASI) were administered to assess childhood trauma and addiction related problems including comorbid psychopathological symptoms. The sample was divided into three groups: patients with experiences of CT and PTSD (CT-PTSD), experiences of CT without PTSD (CT-only), and neither experiences of CT nor PTSD (No trauma) to examine their differential associations with the course and severity of SUD. Patients of both the CT-PTSD (n = 95) and the CT-only group (n = 134) reported significantly higher levels of anxiety and depression as well as more suicidal thoughts and suicide attempts during their lifetime than the No trauma group (n = 209). Regarding most variables a graded association became apparent, with the highest level of symptoms in the CT-PTSD group, an intermediate level in the CT-only group and the lowest level in the No trauma group. The CT-PTSD group also differed in almost all substance use variables significantly from the No trauma group, including a younger age at first use of alcohol and cannabis, more cannabis use in the last month, and more lifetime drug overdoses. Our results confirm the relationships of both CT and PTSD with psychiatric symptoms in patients with SUD. Thus, it seems important to include both domains into the routine assessment of SUD patients. Specific treatments for comorbid PTSD but also for other consequences of childhood trauma should be integrated into SUD treatment programs.

Comorbidity of Internet use disorder and attention deficit hyperactivity disorder: Two adult case-control studies.

Objectives There is good scientific evidence that attention deficit hyperactivity disorder (ADHD) is both a predictor and a comorbidity of addictive disorders in adulthood. These associations not only focus on substance-related addictions but also on behavioral addictions like gambling disorder and Internet use disorder (IUD). For IUD, systematic reviews have identified ADHD as one of the most prevalent comorbidities besides depressive and anxiety disorders. Yet, there is a need to further understand the connections between both disorders to derive implications for specific treatment and prevention. This is especially the case in adult clinical populations where little is known about these relations so far. This study was meant to further investigate this issue in more detail based on the general hypothesis that there is a decisive intersection of psychopathology and etiology between IUD and ADHD. Methods Two case-control samples were examined at a university hospital. Adult ADHD and IUD patients ran through a comprehensive clinical and psychometrical workup. Results We found support for the hypothesis that ADHD and IUD share psychopathological features. Among patients of each group, we found substantial prevalence rates of a comorbid ADHD in IUD and vice versa. Furthermore, ADHD symptoms were positively associated with media use times and symptoms of Internet addiction in both samples. Discussion Clinical practitioners should be aware of the close relationships between the two disorders both diagnostically and therapeutically. When it comes to regain control over one's Internet use throughout treatment and rehabilitation, a potential shift of addiction must be kept in mind on side of practitioners and patients.

Relationships between a Dissociative Subtype of PTSD and Clinical Characteristics in Patients with Substance Use Disorders.

The increasing support for a dissociative subtype of post-traumatic stress disorder (PTSD-D) has led to its inclusion in DSM-5. We examined relationships between PTSD-D and relevant variables in patients with substance use disorders (SUD). The sample comprised N = 459 patients with SUD. The International Diagnostic Checklist and the Posttraumatic Diagnostic Scale were used to diagnose PTSD. In addition, participants completed the Childhood Trauma Questionnaire and the Dissociative Experiences Scale. The course of SUD was assessed by means of the European Addiction Severity Index. One-fourth of participants fulfilled a diagnosis of PTSD (25.3%). Patients with PTSD-D (N = 32, 27.6% of all patients with PTSD) reported significantly more current depressive symptoms, more current suicidal thoughts, more lifetime anxiety/tension, and more suicide attempts. The PTSD-D group also showed a significantly higher need for treatment due to drug problems, higher current use of opiates/analgesics, and a higher number of lifetime drug overdoses. In a regression model, symptoms of depression in the last month and lifetime suicide attempts significantly predicted PTSD-D. These findings suggest that PTSD-D is related to additional psychopathology and to a more severe course of substance-related problems in patients with SUD, indicating that this group also has additional treatment needs.

Beyond childhood: psychiatric comorbidities and social background of adults with Asperger syndrome.

BACKGROUND: Over the past few years, our knowledge about Asperger syndrome (AS) has increased enormously. Although it used to be a syndrome mainly encountered in childhood and adolescent psychiatry, it is now increasingly recognized in adult psychiatry. Nevertheless, little is known about psychiatric comorbidities and life course of adults with AS. The current study aimed to gain an insight into comorbidities and the development of the social situation of adults with AS. SUBJECTS AND METHODS: We investigated psychiatric comorbidities, psychiatric history, professional background, partnerships, and children in 50 adults with AS (34 men and 16 women) over a broad age range (20-62 years). RESULTS: Seventy percent of adults with AS had at least one psychiatric comorbiditiy. Most frequent comorbidities were depression and anxiety disorders. Obsessive-compulsive disorder and alcohol abuse/dependence were also observed. Many adults had previously been treated with psychopharmacological or psychotherapeutic interventions. Although most adults had a high-level school leaving certificate and had gone on to complete training/university studies, less than half were currently in employment. Fourteen adults were living in a partnership and 10 had children. CONCLUSIONS: Adults with AS often have psychiatric comorbidities, indicating lower levels of mental health. Additionally, they seem to have severe limitations concerning professional success, despite having a good school education. Their family situation is also impaired with regard to starting a family. These considerable limitations in the life of adults with AS may help to understand their specific problems, and emphasize the importance of developing specific treatments for improving their mental health and social integration.

Asperger Syndrome: a frequent comorbidity in first diagnosed adult ADHD patients?

BACKGROUND: Because adult ADHD is often accompanied by psychiatric comorbidities, the diagnostic process should include a thorough investigation for comorbid disorders. Asperger-Syndrome is rarely reported in adult ADHD and commonly little attention is paid to this possible comorbidity. SUBJECTS AND METHODS: We investigated 53 adult ADHD-patients which visited our out patient clinic for first ADHD-diagnosis (17 females, 36 males; range of age: 18-56 years) for the frequency of a comorbid Asperger-Syndrome. Diagnosis of this autism-spectrum disorder was confirmed by applying the appropriate DSM-IV-criteria. Additionally we tested the power of the two screening-instruments "Autism-spectrum quotient" (AQ) and "Empathy quotient" (EQ) by Baron-Cohen for screening Asperger-Syndrome in adult ADHD. RESULTS: Eight ADHD-patients were diagnosed with a comorbid Asperger-Syndrome (15.1%). The difference in AQ- and EQ-scores between pure ADHD-patients and comorbid patients was analysed, showing significantly higher scores in AQ and significant lower scores in EQ in comorbid patients. CONCLUSIONS: Results show that the frequency of Asperger-Syndrome seems to be substantially increased in adult ADHD (versus the prevalence of 0.06% in the general population), indicating that investigators of adult ADHD should also be attentive to autism-spectrum disorders. Especially the AQ seems to be a potential screening instrument for Asperger-Syndrome in adult ADHD-patients.

Alcohol and drug dependence in adults with attention-deficit/hyperactivity disorder: data from Germany

Background and Objectives: The objective of the present study was to obtain information about the prevalence of addiction disorders in ADHD patients in a German study population, to compare the prevalence of addiction disorders in ADHD patients to that in the normal population according to the German Epidemiological Addiction Survey, and to determine which drugs are consumed most by ADHD patients. Participants: The sample consisted of 61 patients (average age 35.11 +/- 9.33 years) from our ADHD consultation who were consecutively included in our study over a periodof 12 months. Measurements: We diagnosed ADHD according to DSM-IV-R and by assessing the WURS-k, CAARS and BROWN ADD scales. For diagnosing addiction we conducted the EuropASI, the IDCL, the QOD and the FTNA. For differential diagnosis we assessed the SCL-K. Results: About half of our study population of ADHD patients were diagnosed with a dependence disorder (50.8%, n = 31). Twenty one dot three percent (n = 13) were suffering froman alcohol dependence, 13.1% (n = 8) from a substance use disorder (SUD) and 18% (n = 11) from a combination of both addictions. The drug consumed most commonly by ADHD patients was cannabis. Alcohol and substance abuse commenced significantly earlier in patients with ADHD than in patients with addiction disorders without comorbid ADHD. Conclusions: Our data show that the risk of developing a dependence disorder is elevatedin ADHD patients. Clinicians should bear in mind that the characteristics of a dependencein ADHD patients are clinically more pronounced and that an addiction in ADHD patients starts earlier than usually expected (AU)

Word recognition memory in adults with attention-deficit/hyperactivity disorder as reflected by event-related potentials.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is increasingly diagnosed in adults. In this study we address the question whether there are impairments in recognition memory. METHODS: In the present study 13 adults diagnosed with ADHD according to DSM-IV and 13 healthy controls were examined with respect to event-related potentials (ERPs) in a visual continuous word recognition paradigm to gain information about recognition memory effects in these patients. RESULTS: The amplitude of one attention-related ERP component, the N1, was significantly increased for the ADHD adults compared with the healthy controls in the occipital electrodes. The ERPs for the second presentation were significantly more positive than the ERPs for the first presentation. This effect did not significantly differ between groups. CONCLUSION: Neuronal activity related to an early attentional mechanism appears to be enhanced in ADHD patients. Concerning the early or the late part of the old/new effect ADHD patients show no difference which suggests that there are no differences with respect to recollection and familiarity-based recognition processes.

Swallowing foreign bodies as an example of impulse control disorder in a patient with intellectual disabilities: a case report.

Objective. Foreign body ingestion can be a challenge to multiprofessional approaches involving medical, surgical, neurological, and psychiatric teams.Case presentation. A 41-year-old male patient with intellectual disabilities presented after having swallowed approximately 20 sharp objects. While admitted to a psychiatric ward, surgeons removed a glove from his stomach endoscopically and pharmacologically facilitated the objects' complication-free bowel passage. The patient explained the swallowing as a means to release himself from tension induced by stress. His aberrant behavior also seemed to serve as a means to exert pressure on psychosocial workers. Other deviations included the pushing of sharp objects under the skin and multiple paraphiliae. As a child, the patient suffered from early psychological and physical traumatization. Both parents were allegedly physically abusive alcoholics.Conclusion. Apart from possible alcohol embryopathy and traumatic brain damage, meningitis, which the patient had at the age of three, is discussed as the most likely reason for his oligophrenia, associated with left-sided, temporo-parietal atrophy and epilepsy.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

Pathological Internet use and psychiatric disorders: Across-sectional study on psychiatric phenomenology and clinical relevance of Internet dependency

Background and Objectives: With the Cyberspace’s exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions. Methods: Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls. Results: The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbidanxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES). Conclusions: PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself in aspectrum of behavioural and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology (AU)

Neuronal correlates of ADHD in adults with evidence for compensation strategies--a functional MRI study with a Go/No-Go paradigm.

OBJECTIVE: Response inhibition impairment is one of the most characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD). Thus functional magnetic resonance imaging (fMRI) during a Go/No-Go task seems to be an ideal tool for examining neuronal correlates of inhibitory control deficits in ADHD. Prior studies have shown frontostriatal abnormalities in children and adolescents. The aim of our study was to investigate whether adults with ADHD would still show abnormal brain activation in prefrontal brain regions during motor response inhibition tasks. METHODS: fMRI was used to compare brain activation in 15 untreated adult patients with ADHD and 15 healthy reference volunteers during performance of a Go/No-Go task. RESULTS: In contrast to various other studies with children and adolescents with ADHD, we found no significant difference in the activity of anterior cingulate cortex (ACC) or other frontostriatal structures between ADHD and healthy adults. Significantly enhanced activity was found in the parietal cortex, which is known to play an important role in building up attention. CONCLUSION: We hypothesize that the enhanced activity is due to the ability of adult ADHD patients to compensate their deficits for a short time, which is demonstrated in our study by equal task performance in both groups.

Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study.

BACKGROUND: The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse. METHODS: Of the 459 participants (59.7% male) 182 (39.7%) were alcohol-dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD. RESULTS: Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9+/-8.8; group D: 12.9+/-11.7; group AD: 15.1+/-11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders. CONCLUSIONS: It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma.

Asperger's syndrome in adulthood.

INTRODUCTION: Asperger's syndrome is one of the autism spectrum disorders. Affected individuals display considerably impaired capacity for social interaction, unusual special interests, and a tendency towards ritualized behavior. METHODS: The etiology, symptoms, diagnosis, and treatment of Asperger's syndrome in adulthood are outlined on the basis of a selective literature review via Medline and information in relevant reference books. Furthermore, the authors report their personal experience at a special clinic for adults. RESULTS: Asperger's syndrome in adulthood can be diagnosed by thorough anamnesis, heteroanamnesis-with emphasis on childhood-and painstaking clinical examination. The considerable psychosocial impairments affect the patients' professional, social, and private lives. The precise etiology is still unknown, but a multifactorial origin with genetic, neurobiological, and psychosocial components appears probable. Although no specific, empirically tested treatment concepts have yet been established, psychotherapeutic elements (structuring and directive interventions) seem to be helpful, together with pharmacotherapy-if indicated-in the presence of comorbidity. CONCLUSIONS: Asperger's syndrome should be included in the differential diagnosis of adults who display the corresponding symptoms. The etiopathogenesis and treatment of Asperger's syndrome in adulthood should be further investigated.

Effective methylphenidate treatment of an adult Aspergers Syndrome and a comorbid ADHD: a clinical investigation with fMRI.

OBJECTIVE: Aspergers Syndrome can present as comorbid with attention-deficit/hyperactivity disorder (ADHD). Very few cases of the assessment and treatment of this comorbidity in adulthood are described in the research literature. METHOD: A 26-year-old patient as suffering from ADHD in combination with Aspergers Syndrome is diagnosed. Treatment is started with methylphenidate (MPH), and the patient's clinical response is observed, psychological tests concerning attention are analyzed, and a functional magnetic resonance imaging (fMRI) examination is performed during an attention-task. RESULTS: On the functional magnetic resonance imaging, a reduction of cerebral activity bilaterally in the parietal lobe under the influence of MPH is detected. CONCLUSION: Besides the neurophysiological findings, this case reports the complex impairment caused by the combination of AD/HD with Aspergers Syndrome and the broad social and behavioral benefits of treatment with MPH for this comorbidity.

Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD).

AIMS: Attention-deficit/hyperactivity disorder (ADHD) is of great clinical importance not only because of its high prevalence but also due to the frequent comorbid illnesses that are connected with this disorder. Several studies were able to demonstrate that ADHD constitutes a significant risk factor for the exacerbation of habit-forming illnesses, i.e. addictions. METHODS: We conducted a study on 152 adult patients with alcohol dependence (n = 91) or multiple substance addiction (n = 61) to determine whether or not these patients were affected by ADHD. For retrospective assessment of childhood ADHD, the WURS-k was used as well as the DSM-IV symptom checklist for ADHD. The CAARS was used to assess the persisting symptoms of ADHD in adults. RESULTS: 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the alcohol-dependent patients showed evidence of retrospective ADHD affliction in childhood. With the help of CAARS, ADHD was proved to be persistent in 33.3% of the adult patients. In the group of substance-addicted patients 50.8% (WURS-k) and 54.1% (DSM-IV) presented with diagnostic criteria for ADHD in childhood and 65.5% (CAARS) showed evidence of ADHD persisting in adulthood. CONCLUSIONS: These results reveal that habit-forming illnesses can be associated with a high comorbidity with ADHD, expressed in the form of alcohol abuse and also in consumption of illegal drugs. The results underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illnesses.

Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study.

BACKGROUND: We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD. METHODS: In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics. RESULTS: 25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects. CONCLUSIONS: The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.

[Scurvy--a wrongly forgotten avitaminosis]. / Skorbut--eine zu Unrecht vergessene Hypovitaminose.

We treated a chronic alcoholic patient who showed all the symptoms of scurvy (petechiae, greyish skin colour, areas of thinning hair on the head, gingivitis, elevated liver enzyme levels, hyponatraemia, hypalbuminaemia and hypothyroidism) at admission. Even today, alcoholics and chronically ill people in particular can develop symptoms of diet-related vitamin C deficiency.

[Pharmacotherapy of ADHD in adults with comorbid depression]. / Pharmakotherapie der ADHS im Erwachsenenalter bei komorbider Depression.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is a common disorder with a high prevalence of 2-6% in adults. The often distinctive clinical symptomatology has a great practical relevance and the diagnostic demarcation of other psychiatric illnesses can be difficult which underlines the necessity of a differential and careful diagnosis. ADHD is a risk factor for comorbid disorders like anxiety, personality disorders and addiction. Comorbid depression is also frequent and has an important meaning in the differential diagnostic process. METHODS: A review was made about diagnostics and pharmacotherapy of ADHD with comorbid depression. RESULTS AND CONCLUSIONS: For the combination treatment of ADHD with comorbid depression there are good pharmacological procedures of treatment. Here in particular modern antidepressants with noradrenergic or noradrenergic-serotonergic active principles play an important role. Very important is an exact diagnosis and differentiated treatment of ADHD, i.e. a "multimodal therapy" using pharmacological and psychotherapeutic concepts.

[Internet dependency as a symptom of depressive mood disorders]. / Internetabhängigkeit als ein Symptom depressiver Störungen.

OBJECTIVE: In psychiatric contexts, the quick distribution of virtual techniques in private and professional everyday life gives rise to the question, if these can evoke a psychological addiction. Yet, the diagnostic assessment of internet or computer game dependency remains problematic. METHODS: Within a study with 23 internet-dependent patients with significant psychological strain, 18 (77.8%) were diagnosed with a depressive mood disorder by thorough clinical examination and structured interviews. The presented work compares psychometric test results of the depressed subpopulation with healthy controls matched for age, sex and school education. RESULTS: In the Barrat Impulsiveness Scale patients with internet dependency scored significantly higher than the control group (p < or = 0.05), while there was no significant correlation to the Internet Addiction Scale. Becks Depression Inventory and the Symptom-Checklist subscale for depression revealed significantly higher scores within the patient group as compared to controls (p < or = 0.001). And in the Dissociative Experience Scale, the Sense of Coherence Scale and the Inventory for Interpersonal Problems the internet dependent subjects showed significantly more pathological scores than the healthy subjects (p < or = 0.05). CONCLUSIONS: Since internet dependency can be understood as a novel psychopathology of well known psychiatric conditions, every psychiatrist should be able to detect and treat it adequately, as long as there is a willingness to deal with the contents and impacts of cyberspace. Especially with depressed patients, it seems to be crucial to include questions about media usage in psychiatric examination taking.

Nicotine and alcohol dependence in patients with comorbid attention-deficit/hyperactivity disorder (ADHD).

AIMS: Several studies have shown that attention-deficit/hyperactivity disorder (ADHD) represents a significant risk factor for the onset and development of an addiction. Thirty-five per cent of adult ADHD patients are known to be addicted to alcohol. Many ADHD patients also have an increased nicotine consumption, which typically, leads to an improvement of attention, ability to concentrate and control of impulses. There may be pathophysiological connections here. On the other hand, it can also be assumed that there is a high prevalence of addicted patients with undiagnosed ADHD. METHODS: Ninety-one adult alcohol-dependent patients were examined for ADHD in this study, using the Wender Utah Rating Scale (WURS-k), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom check-list for ADHD and the Conners' Adult ADHD Rating Scales (CAARS, Long Version). The patients were divided into diagnostic sub-groups according to DSM-IV (inattentive type, impulsive type, combined type). Nicotine consumption was investigated using the Fagerström Test of Nicotine Dependence (FTND) and then graded as 'minimal', 'average' or 'high' nicotine dependence. RESULTS: There were 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the patients addicted to alcohol, who showed evidence of ADHD in childhood. With the help of CAARS, it could be demonstrated that 33.3% of the patients who fulfilled the diagnostic criteria of ADHD, according to DSM-IV, had persisting ADHD in adulthood. The FTND showed a statistically significant difference in nicotine dependence between alcohol-dependent patients with and without ADHD in childhood. Patients numbering 76.2% with ADHD, demonstrated an 'average to high' level of nicotine dependence compared to 45.7% of those patients without ADHD. Furthermore, the number of patients not addicted to nicotine (19%) was significantly lower than among those without ADHD (36.6%) (P = 0.029). CONCLUSIONS: The results of this investigation reveal that a large number of ADHD patients suffer from alcohol dependence, and an even greater number from excessive nicotine dependence. The outcome indicates that there are most likely pathophysiological connections with alcohol and nicotine dependence, and that this substance abuse is probably a form of 'self-medication'. The results clearly underline the great importance of early and adequate diagnosis and therapy of ADHD, in order to prevent exacerbation of addictive illness.