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Fazel S, Favril L. Prevalence of attention-deficit hyperactivity disorder in adult prisoners: An updated meta-analysis. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:339-346. [PMID: 38568877 DOI: 10.1002/cbm.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Previous meta-analyses may have overestimated the prevalence of attention-deficit hyperactivity disorder (ADHD) in prisoners by including data from selected samples. AIMS To estimate the prevalence of ADHD in unselected samples of adults in prison and examine potential sources of heterogeneity by meta-regression and subgroup analyses. METHODS We assessed all studies included in a 2018 systematic review for eligibility and updated the literature search to include studies published up to September 2023. RESULTS A total of 11 studies reporting robust diagnostic data on ADHD in 3919 unselected adults in prison were included. In meta-regression, ADHD prevalence did not differ between men and women but it was significantly higher in studies using a two-phase design. In random sampling studies, the pooled prevalence of ADHD was 8.3% (95% CI: 3.8-12.8) which was further halved after the removal of an outlier. CONCLUSION One in 12 adults in prison have been diagnosed with ADHD. Our findings highlight the importance of using clear and consistent inclusion criteria in meta-analyses of prevalence.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
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2
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Byrne C, Guenter D. Treatments for ADHD in adults in jails, prisons and correctional settings: a scoping review of the literature. HEALTH & JUSTICE 2023; 11:36. [PMID: 37676388 PMCID: PMC10486076 DOI: 10.1186/s40352-023-00234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Attention-Deficit / Hyperactivity Disorder (ADHD) is prevalent at a higher rate in correctional settings than in the general population. Treatment of ADHD in this environment is challenging as stimulants, the most common treatment for ADHD, require cautious prescribing in the context of frequent substance use disorders (SUD) and diversion in the institutional setting. In addition, both pharmacological and non-pharmacological treatment approaches require significant staff resources. The aim of this scoping review is to map and summarize all literature addressing treatment of ADHD specifically in correctional settings, synthesize the evidence supporting various approaches, and highlight areas for future research. Due to the limited number of primary research studies addressing this question directly, we chose a scoping review methodology that would allow us to explore what kinds of studies and literature exist and include all types of articles directly related to our question. RESULTS Five-hundred sixty-five relevant articles were screened. Thirty-two articles were included in the final review. Eleven of the articles reported primary research. Five of these articles were based on three randomized controlled trials. Among randomized controlled trials on the effect of stimulants, inclusion criteria, outcome measures and effectiveness varied widely. Non-male and non-white populations were under-represented. Among review articles and recommendations opinion was inconsistent, with some recommending stimulants as first-line treatment and others recommending they be avoided altogether. The effect of non-stimulant medications was examined in 2 small studies. The only non-pharmacological treatment examined was dialectical behavior therapy, and only feasibility was reported. Four articles provided practice recommendations from consensus or expert opinion. Two of these recommended stimulants as first-line treatment, and two recommended stimulants as treatment of last resort. CONCLUSIONS We found a diverse but shallow literature addressing our research question. Primary research in the corrections setting is limited and varies in inclusion criteria, outcomes studied, and effectiveness. Recommendations on treatment are inconsistent. Future research should address methods of diagnosis, the role of non-stimulants, non-pharmacological interventions, non-male and non-white people who are incarcerated (PWAI), and effects of treatment method on patients, staff and other PWAI. Better research and guidance on treating ADHD has potential to improve health of PWAI, the institutional environment, and resource utilization.
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Affiliation(s)
- Cory Byrne
- School of Interdisciplinary Science, Faculty of Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Dale Guenter
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.
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May T, Birch E, Chaves K, Cranswick N, Culnane E, Delaney J, Derrick M, Eapen V, Edlington C, Efron D, Ewais T, Garner I, Gathercole M, Jagadheesan K, Jobson L, Kramer J, Mack M, Misso M, Murrup-Stewart C, Savage E, Sciberras E, Singh B, Testa R, Vale L, Weirman A, Petch E, Williams K, Bellgrove M. The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. Aust N Z J Psychiatry 2023; 57:1101-1116. [PMID: 37254562 PMCID: PMC10363932 DOI: 10.1177/00048674231166329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. METHODS Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. RESULTS The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/. CONCLUSIONS The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | | | | | - Noel Cranswick
- Clinical Pharmacology Unit, Department of Medicine and Melbourne Children’s Trials Centre, Royal Children’s Hospital, Parkville, Vic, Australia
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - Evelyn Culnane
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - Jane Delaney
- Speech Pathology Australia, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- South Western Sydney Local Health District and Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia
| | | | - Daryl Efron
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tatjana Ewais
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Ingrid Garner
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Michael Gathercole
- Youth Justice, Department of Community and Justice, Grafton, NSW, Australia
| | - Karuppiah Jagadheesan
- NWAMHS–North West Area Mental Health Services, Melbourne, VIC, Australia
- Bi-National ADHD Network Committee, RANZCP - Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
- Swinburne University, Melbourne, VIC, Australia
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - John Kramer
- ADHD, ASD and Neurodiversity Special Interest Group, Faculty of Special Interests, RACGP
- Rural Medical School, UNSW Medicine & Health, Coffs Harbour, NSW, Australia
| | - Martha Mack
- Applied Neuroscience Society of Australasia (ANSA)
| | - Marie Misso
- The Knowledge Synthesis Lab, Melbourne, VIC, Australia
| | - Cammi Murrup-Stewart
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | | | - Emma Sciberras
- Murdoch Children’s Research Institute, Parkville Vic, Australia
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Bruce Singh
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Renee Testa
- Department of Mental Health, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Psychology, Monash University, Melbourne, VIC, Australia
| | - Lisa Vale
- Occupational Therapy Australia, Splash Paediatric Therapy, Melbourne, VIC, Australia
| | - Alyssa Weirman
- ADHD Guideline Development Group, Melbourne, VIC, Australia
| | - Edward Petch
- Hakea Prison, Department of Justice, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Monash Children’s Hospital, Clayton, VIC, Australia
| | - Mark Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- AADPA Australian ADHD Professionals Association, Melbourne, VIC, Australia
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Friestad C, Haukvik UK, Johnsen B, Vatnar SK. Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review. Int J Prison Health 2023; ahead-of-print. [PMID: 37158168 DOI: 10.1108/ijph-12-2022-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE This study aims to provide an overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among sentenced female prisoners. DESIGN/METHODOLOGY/APPROACH A mixed-methods systematic literature review. FINDINGS A total of 4 reviews and 39 single studies met the inclusion criteria for the review. Mental disorders were the main area of investigation in the majority of single studies, with substance abuse, particularly drug abuse, as the most consistently gender biased disorder, with higher prevalence among women than men in prison. The review identified a lack of updated systematic evidence on the presence of multi-morbidity. ORIGINALITY/VALUE This study provides an up-to-date overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among female prisoners.
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Affiliation(s)
- Christine Friestad
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Unn Kristin Haukvik
- Faculty of Medicine, University of Oslo, Oslo, Norway and Department of Mental Health and Addiction, Oslo University Hospital, Asker, Norway
| | - Berit Johnsen
- University College of Norwegian Correctional Service, Lillestrøm, Norway
| | - Solveig Karin Vatnar
- Department of Mental Health and Addiction, Oslo University Hospital, Asker, Norway and Molde University College, Molde, Norway
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5
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Etterlid-Hägg V, Pauli M, Howner K. A Comparative Study of Prison Inmates With and Without ADHD: Which Neuropsychological and Self-Report Measures are Most Effective in Detecting ADHD Within Correctional Services? J Atten Disord 2023; 27:721-730. [PMID: 36927135 DOI: 10.1177/10870547231158764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE In this study we aimed to investigate the screening and diagnostic properties of various self-report instruments to identify measures which most effectively detect ADHD in a correctional sample. METHOD The sample consisted of 193 male high security prisoners in Sweden. We investigated if measures of ADHD symptoms, executive functioning, impulsivity, estimated IQ and working memory could differentiate participants with ADHD from those with ASPD or no diagnosis. RESULTS Participants with ADHD obtained significantly higher total scores on all included measures. Although we found that some of the measures were more efficient in differentiating ADHD, mean values were generally elevated in the sample. CONCLUSION Results demonstrate the importance of investigating psychometric properties in relevant samples to assure a measurement's usefulness in different contexts, in this case a correctional setting, where the high influence of unspecific behavioral indicators in these measurements might negatively affect their validity.
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Affiliation(s)
| | - Malin Pauli
- National Board of Forensic Medicine, Stockholm, Sweden.,Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Katarina Howner
- National Board of Forensic Medicine, Stockholm, Sweden.,Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: A systematic literature review. PLoS One 2022; 17:e0277175. [PMID: 36331985 PMCID: PMC9635752 DOI: 10.1371/journal.pone.0277175] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Comorbid psychiatric disorders in adults with ADHD are important because these comorbidities might complicate the diagnosis of ADHD and also worsen the prognosis. However, the prevalence of comorbid psychiatric disorders in adult ADHD varies according to the diagnostic tools used and the characteristics of target populations. The purpose of this review was to describe the prevalence of comorbid psychiatric disorders in adults with ADHD compared with adults without ADHD. Thirty-two studies published before August 2022 were identified and classified according to diagnosis of other psychiatric disorder in those with ADHD. The most frequent comorbid psychiatric disorder in the ADHD group was substance use disorder (SUD), followed by mood disorders, anxiety disorders, and personality disorders. The prevalence of these four disorders was higher in the ADHD group, whether or not subjects were diagnosed with other psychiatric disorders. In addition, the diversity of ADHD diagnostic tools was observed. This also might have affected the variability in prevalence of comorbidities. Standardization of ADHD diagnostic tools is necessary in the future.
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7
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Newbury-Birch D, Ferguson J, Connor N, Divers A, Waller G. A Rapid Systematic Review of Worldwide Alcohol Use Disorders and Brief Alcohol Interventions in the Criminal Justice System. Front Psychiatry 2022; 13:900186. [PMID: 35873244 PMCID: PMC9301009 DOI: 10.3389/fpsyt.2022.900186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Although the relationship is complex, there is an association between alcohol use and offending behavior with an interplay between the amount drank, the pattern of drinking and individual and contextual factors. Alcohol brief interventions have been shown to be effective in primary healthcare, however there is currently a lack of compelling evidence in the criminal justice system. We carried out a rapid systematic review of the literature, which updated our review conducted in 2016. Following systematic searches, we included 36 papers on prevalence and 13 papers on effectiveness. Between 26 and 88% of individuals in the policy custody setting scored positive for an alcohol use disorder. In the magistrates court this was 95%; 31-86% in the probation setting and between 19 and 86% in the prison system. In relation to probable dependence, between 21 and 38% of individuals were shown to have probable alcohol dependence in the police custody suite setting; 39 per cent in the magistrate court system; 17-36% in the probation setting and between 18 and 48% in the prison system. This compares to 6% in the general population. We included 13 studies of effectiveness with differing outcome measures and outcomes. We conclude more studies are needed in the field to develop the current evidence base.
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Affiliation(s)
- Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
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8
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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van de Baan FC, Montanari L, Royuela L, Lemmens PHHM. Prevalence of illicit drug use before imprisonment in Europe: results from a comprehensive literature review. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2021.1879022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Frank C. van de Baan
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Linda Montanari
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Luis Royuela
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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10
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Young S, Cocallis K. ADHD and offending. J Neural Transm (Vienna) 2021; 128:1009-1019. [PMID: 33538909 DOI: 10.1007/s00702-021-02308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES International studies have reported disproportionately higher rates of Attention Deficit Hyperactivity Disorder (ADHD) among youth and adult offenders across police custody, prison, probation and forensic mental health settings, estimated to fall at around 25%. This review aimed to investigate the presentation and vulnerabilities of this subpopulation of people with ADHD compared to those with ADHD in the general population and consider how this may impact on the approach to assessment and treatment in this population. METHODOLOGY A selective review of the extant literature was conducted to investigate how offenders with ADHD may present differently from their non-ADHD peers in their clinical presentation, criminogenic behaviour and psychological vulnerabilities. RESULTS Nearly all (around 96%) offenders with ADHD have additional comorbid problems, including mood, anxiety, conduct, substance use and personality disorders. Compared with offenders without ADHD, they become involved in the criminal justice system (CJS) at a younger age, have higher rates of recidivism, are more likely to make a false confession, engage in behavioural disturbances in custody, have health risk behaviours and a lower quality of life. Assessing and treating ADHD in this subpopulation may be more complex due to their presentation. CONCLUSIONS Offenders with ADHD are disadvantaged within the system by their ADHD symptoms being unrecognised and/or misunderstood; their diagnosis of ADHD may be missed or misdiagnosed. This is at cost to the individual, from both a health and rehabilitative perspective, as well as more broadly to society.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, PO 1735, Croydon, C9 7AE, UK. .,Department of Psychology, Reykjavik University, Reykjavík, Iceland.
| | - Kelly Cocallis
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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11
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Machado A, Rafaela D, Silva T, Veigas T, Cerejeira J. ADHD Among Offenders: Prevalence and Relationship With Psychopathic Traits. J Atten Disord 2020; 24:2021-2029. [PMID: 29199502 DOI: 10.1177/1087054717744880] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Longitudinal studies have shown a strong association between ADHD and criminal behavior. The aims of this study were to examine the prevalence of adult ADHD in a high-security facility and to investigate the relationship between ADHD symptoms and psychopathic traits in criminal offenders. Material and Methods: Participants were recruited between October 2015 and January 2016 among the inmates from a high-security all-male correctional facility in Portugal. Self-report scales were used to measure ADHD symptoms, current psychopathology, and psychopathic traits. An interview was conducted to collect sociodemographic data, along with information about adverse childhood experiences, substance use, and criminal record. The statistical analysis was conducted using STATA 13 with the significance level set at .05. Results: From the final sample of 101 male prisoners, 17 participants (16.8%) screened positive for ADHD. Participants positive for ADHD had higher levels of general psychopathology and psychopathic traits. Psychopathic traits remained significantly higher in ADHD offenders after controlling for age, substance abuse, and early childhood adversities (OR = 1.07, p = .002) and this was explained by differences in the Meanness subscale (OR = 1.11, p = .013). Discussion/conclusions: The present study shows that ADHD symptoms are highly prevalent among offenders and might have a modulating effect on the course of delinquent behavior. The cross-sectional association between ADHD symptoms and psychopathic traits reinforces the previously documented correlation between these disorders and can lead to a better understanding of the prevalent criminal behavior in ADHD patients.
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Affiliation(s)
- Ana Machado
- Centro Hospitalar e Universitário de Coimbra, Portugal.,Universidade de Coimbra Faculdade de Medicina, Portugal
| | - Diana Rafaela
- Centro Hospitalar e Universitário de Coimbra, Portugal.,Universidade de Coimbra Faculdade de Medicina, Portugal
| | - Tânia Silva
- Centro Hospitalar e Universitário de Coimbra, Portugal.,Universidade de Coimbra Faculdade de Medicina, Portugal
| | - Tânia Veigas
- Universidade de Coimbra Faculdade de Medicina, Portugal
| | - Joaquim Cerejeira
- Centro Hospitalar e Universitário de Coimbra, Portugal.,Universidade de Coimbra Faculdade de Medicina, Portugal
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Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan. Neurosci Biobehav Rev 2020; 120:236-248. [PMID: 33271164 DOI: 10.1016/j.neubiorev.2020.11.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.
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Abstract
PURPOSE OF REVIEW To examine recent advances in the understanding of attention deficit hyperactivity disorder (ADHD) among the prison population. RECENT FINDINGS Efforts have been made to develop useful tools for assessing ADHD among prisoners. Prisoners with ADHD demonstrate incremental vulnerability due to comorbid psychiatric disorders, neurodevelopmental disorders and traumatic brain injury. Compared with prisoners without ADHD, prisoners with ADHD become involved in the criminal justice system at a younger age and have higher rates of recidivism in adulthood. Recent studies demonstrate the effectiveness of extended release stimulant medication and psychological interventions. Early identification and treatment of prisoners with ADHD have the potential to demonstrate health economic benefits. Our understanding of ADHD among prisoners continues to develop. However, further research is needed, particularly among neglected groups such as females. Much more attention is needed by the prison service to engender better outcomes for this at-risk population.
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14
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Mehta D, Czamara D. GWAS of Behavioral Traits. Curr Top Behav Neurosci 2019; 42:1-34. [PMID: 31407241 DOI: 10.1007/7854_2019_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the past decade, genome-wide association studies (GWAS) have evolved into a powerful tool to investigate genetic risk factors for human diseases via a hypothesis-free scan of the genome. The success of GWAS for psychiatric disorders and behavioral traits have been somewhat mixed, partly owing to the complexity and heterogeneity of these traits. Significant progress has been made in the last few years in the development and implementation of complex statistical methods and algorithms incorporating GWAS. Such advanced statistical methods applied to GWAS hits in combination with incorporation of different layers of genomics data have catapulted the search for novel genes for behavioral traits and improved our understanding of the complex polygenic architecture of these traits.This chapter will give a brief overview on GWAS and statistical methods currently used in GWAS. The chapter will focus on reviewing the current literature and highlight some of the most important GWAS on psychiatric and other behavioral traits and will conclude with a discussion on future directions.
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Affiliation(s)
- Divya Mehta
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - Darina Czamara
- Department of Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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15
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Young S, Gudjonsson G, Chitsabesan P, Colley B, Farrag E, Forrester A, Hollingdale J, Kim K, Lewis A, Maginn S, Mason P, Ryan S, Smith J, Woodhouse E, Asherson P. Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus. BMC Psychiatry 2018; 18:281. [PMID: 30180832 PMCID: PMC6122636 DOI: 10.1186/s12888-018-1858-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Around 25% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Because ADHD is associated with increased recidivism and other functional and behavioural problems, appropriate diagnosis and treatment can be a critical intervention to improve outcomes. While ADHD is a treatable condition, best managed by a combination of medication and psychological treatments, among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed and consequently inadequately treated. We aimed to identify barriers within the prison system that prevent appropriate intervention, and provide a practical approach to identify and treat incarcerated offenders with ADHD. METHODS The United Kingdom ADHD Partnership hosted a consensus meeting to discuss practical interventions for youth (< 18 years) and adult (≥18 years) offenders with ADHD. Experts at the meeting addressed prisoners' needs for effective identification, treatment, and multiagency liaison, and considered the requirement of different approaches based on age or gender. RESULTS The authors developed a consensus statement that offers practical advice to anyone working with prison populations. We identified specific barriers within the prison and criminal justice system such as the lack of adequate: staff and offender awareness of ADHD symptoms and treatments; trained mental health staff; use of appropriate screening and diagnostic tools; appropriate multimodal interventions; care management; supportive services; multiagency liaison; and preparation for prison release. Through discussion, a consensus was reached regarding prisoners' needs, effective identification, treatment and multiagency liaison and considered how this may differ for age and gender. CONCLUSIONS This practical approach based upon expert consensus will inform effective identification and treatment of offenders with ADHD. Appropriate intervention is expected to have a positive impact on the offender and society and lead to increased productivity, decreased resource utilization, and most importantly reduced rates of re-offending. Research is still needed, however, to identify optimal clinical operating models and to monitor their implementation and measure their success. Furthermore, government support will likely be required to effect change in criminal justice and mental health service policies.
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Affiliation(s)
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK
| | - Prathiba Chitsabesan
- Offender Health Research Network, Division of Psychology and Mental Health and Division of Medicine and Health, University of Manchester, Manchester, UK
| | | | - Emad Farrag
- Sussex Partnership NHS Foundation Trust, Children & Young People’s Service, Tunbridge Wells Kent, UK
| | - Andrew Forrester
- Forensic Psychiatry and Offender Health Research Network, Division of Psychology and Mental Health and Division of Medicine and Health, University of Manchester, Manchester, UK
| | - Jack Hollingdale
- Division of Psychology and Language Science, University College London, London, UK
| | - Keira Kim
- Independent Medical Writer, San Diego, California USA
| | - Alexandra Lewis
- Barnet Enfield & Haringey Mental Health NHS Trust, HMP/YOI Feltham, Feltham, UK
- Health & Justice Central Team, NHS, London, UK
| | - Sarah Maginn
- Kent Prisons, Oxleas NHS Foundation Trust, Dartford, UK
| | - Peter Mason
- Cheshire & Wirral Partnership NHS Foundation Trust, The Stein Centre, St Catherine’s Hospital, Birkenhead, UK
| | - Sarah Ryan
- Tees, Esk & Wear Valley NHS Foundation Trust, HMP Frankland, Durham, UK
| | - Jade Smith
- Humber NHS Foundation Trust, East Yorkshire, London, UK
| | - Emma Woodhouse
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, London, UK
- South London & Maudsley NHS Foundation Trust, National Adult Outpatient Neurodevelopmental Clinic, and National Autism Unit, London, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
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16
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Dark C, Homman-Ludiye J, Bryson-Richardson RJ. The role of ADHD associated genes in neurodevelopment. Dev Biol 2018; 438:69-83. [DOI: 10.1016/j.ydbio.2018.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/04/2018] [Accepted: 03/27/2018] [Indexed: 12/19/2022]
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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18
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Dwyer R, Fraser S. Engendering drug problems: Materialising gender in the DUDIT and other screening and diagnostic ‘apparatuses’. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017. [DOI: 10.1016/j.drugpo.2017.05.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Bejerholm U, Larsson ME, Johanson S. Supported employment adapted for people with affective disorders-A randomized controlled trial. J Affect Disord 2017; 207:212-220. [PMID: 27723546 DOI: 10.1016/j.jad.2016.08.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/18/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND While effective vocational methods for gaining employment exist for people with schizophrenia and similar conditions, no evidence exists with regard to people with affective disorders. We aimed to study the effectiveness of a newly developed Individual Enabling and Support (IES) model adapted for the target group and compared to traditional vocational rehabilitation (TVR). METHODS An assessor-blinded randomized controlled trial (RCT) with a parallel design was performed. Sixty-one participants received IES or TVR. The primary outcome was employment rate at 12-month follow-up. Secondary vocational outcomes, depression severity, and quality of life were also studied. Trial register number is ISRCTN93470551. RESULTS IES was more effective for employment compared to TVR (42.4% vs. 4%; difference 38%, 95% CI 0.12-0.55). Significant group differences were present in secondary vocational outcomes (hours and weeks employed, time to employment), and depression severity. The IES-group had significantly lowering in depression scores and increased quality of life scores during the intervention period. LIMITATIONS This RCT was limited by the small sample size due to restriction of recruitment to middle-sized cities within geographically diverse sites in southern Sweden. Larger trials are needed, also in primary health care and employment services settings. CONCLUSIONS IES is more effective than TVR for attaining employment and improving depressive symptoms. On a societal level, IES closes the time and service gap between treatment and employment, and thus lowers sick-leave costs.
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Affiliation(s)
- Ulrika Bejerholm
- Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University, Lund, Sweden.
| | - Maria E Larsson
- Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Suzanne Johanson
- Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University, Lund, Sweden
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20
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Corbisiero S, Hartmann-Schorro RM, Riecher-Rössler A, Stieglitz RD. Screening for Adult Attention-Deficit/Hyperactivity Disorder in a Psychiatric Outpatient Population with Specific Focus on Sex Differences. Front Psychiatry 2017; 8:115. [PMID: 28713294 PMCID: PMC5491936 DOI: 10.3389/fpsyt.2017.00115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/15/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/AIMS Attention-deficit/hyperactivity disorder (ADHD) is often overlooked in adults; moreover, the problem seems to be even more critical in women. In the present, observational screening study, a clinical, particularly adult outpatient population was examined regarding frequency and severity of a likely ADHD, whereby sex differences were of particular interest. METHODS 224 participants, 146 men and 78 women, were included. Based on data recorded with the self-rating WHO screening instrument Adult ADHD Self-Report Scale (ASRS-v1.1), it was examined how many participants were conspicuous for adult ADHD by exceeding a predefined cutoff value (COV) (COV ≥ 4 for ASRS-6, and ≥12 for ASRS-18). To examine frequency distributions, χ2 tests were conducted. For the inferential statistical comparison of means, t-tests for independent samples or Mann-Whitney U tests were calculated. RESULTS 34.4% of the sample was screened positive in the ASRS-v1.1 screener short version, ASRS-6, while 17.4% were conspicuous in the symptom checklist, ASRS-18. There were indeed more men screened positive, but the difference in the frequency between the sexes was not statistically significant, indicating a balanced sex ratio. Further, severity of ADHD core symptoms inattention and hyperactivity/impulsivity was examined by comparing ASRS-18 symptom subscale scores. In concordance with the hypothesis, men and women did not differ in severity of symptoms. CONCLUSION Results indicate that women might be affected by ADHD in a comparable manner as men; this emphasizes the importance for the awareness of ADHD in both sexes in clinical practice.
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Affiliation(s)
- Salvatore Corbisiero
- University of Basel Psychiatric Hospital, Clinical Psychology and Psychiatry, Basel, Switzerland
| | - Raffaela M Hartmann-Schorro
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- University of Basel Psychiatric Hospital, Clinical Psychology and Psychiatry, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
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21
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Moore E, Sunjic S, Kaye S, Archer V, Indig D. Adult ADHD Among NSW Prisoners: Prevalence and Psychiatric Comorbidity. J Atten Disord 2016; 20:958-967. [PMID: 24134874 DOI: 10.1177/1087054713506263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Given the paucity of research among prisoners, this study aimed to examine the prevalence and psychiatric comorbidity associated with adult ADHD. METHOD The study was conducted at four NSW correctional facilities (2 male; 2 female). RESULTS Thirty-five percent of the sample screened positive for adult ADHD, and 17% of the sample met criteria for a full diagnosis. After adjustment, benzodiazepine dependence, borderline personality disorder, social phobia, antisocial personality disorder, and a number of lifetime psychological disorders remained significantly and independently associated with the diagnosis of adult ADHD. Lowering the threshold on the ADHD Self-Rating Scale to ≥3 (vs. ≥4) increased the sensitivity (80%-93%), but lowered the specificity (55%-47%). CONCLUSION Adult ADHD among NSW prisoners is elevated, with substance use disorders and psychiatric comorbidity common. A greater acceptance of this disorder among prisoners, and appropriate treatment, is warranted.
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Affiliation(s)
- Elizabeth Moore
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
| | - Sandra Sunjic
- Justice and Forensic Mental Health Network, Ermington, Australia
| | | | - Vicki Archer
- Justice and Forensic Mental Health Network, Pagewood, Australia
| | - Devon Indig
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
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22
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Johanson S, Bejerholm U. The role of empowerment and quality of life in depression severity among unemployed people with affective disorders receiving mental healthcare. Disabil Rehabil 2016; 39:1807-1813. [PMID: 27684543 DOI: 10.1080/09638288.2016.1211758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Sick leave and unemployment are highly prevalent among people with affective disorders. Their depression severity is disabling and inversely related to having employment. No evidence-based vocational rehabilitation exists for this target group. Knowledge is therefore needed to understand the psychosocial factors that affect depression severity in order to develop new rehabilitation interventions. This study examined relationships between depression severity and empowerment, working life aspirations, occupational engagement, and quality of life in unemployed people with affective disorders receiving mental healthcare. METHOD In this cross-sectional study of 61 participants, instruments on psychosocial factors and questions on descriptive sociodemographic and clinical characteristics were administered. Descriptive, correlation, and regression statistics were applied. RESULTS Correlation and regression analyses showed significant inverse relations between depression severity and empowerment and quality of life. The odds for more severe depression decreased with higher empowerment and quality of life. However, neither extent of engagement in daily life nor working life aspiration was related to depression severity. CONCLUSIONS An empowerment approach and strategies, which support the quality of life, are needed in development of vocational rehabilitation interventions, and bridging of mental healthcare and vocational services. Implications for Rehabilitation Enhancing empowerment and quality life in the return to work process can decrease depression severity in unemployed people with affective disorder. There is a need to address work issues in addition to symptom reduction in primary and mental healthcare. Bridging the service and time gap between vocational rehabilitation and healthcare is recommended for mitigating long-term unemployment for people with affective disorders who want to work.
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Affiliation(s)
- Suzanne Johanson
- a Medical Faculty, Department of Health Sciences, Work and Mental Health , Lund University , Lund , Sweden
| | - Ulrika Bejerholm
- a Medical Faculty, Department of Health Sciences, Work and Mental Health , Lund University , Lund , Sweden
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23
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Young S, González RA, Mutch L, Mallet-Lambert I, O'Rourke L, Hickey N, Asherson P, Gudjonsson GH. Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates. Psychol Med 2016; 46:1449-1458. [PMID: 26867860 DOI: 10.1017/s0033291716000039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties. METHOD A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). RESULTS A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale. CONCLUSIONS The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.
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Affiliation(s)
- S Young
- Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK
| | - R A González
- Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK
| | - L Mutch
- Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - I Mallet-Lambert
- Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - L O'Rourke
- Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - N Hickey
- Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK
| | - P Asherson
- Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
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24
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Liebrenz M, Gamma A, Ivanov I, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use - a clinical study. F1000Res 2015; 4:407. [PMID: 27853503 PMCID: PMC5089146 DOI: 10.12688/f1000research.6780.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.
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Affiliation(s)
- Michael Liebrenz
- Institute of Forensic Medicine, Department of Forensic Psychiatry, University of Bern, Bern, 3012, Switzerland
| | - Alex Gamma
- Institute of Forensic Medicine, Department of Forensic Psychiatry, University of Bern, Bern, 3012, Switzerland
| | - Iliyan Ivanov
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, 10029, USA
| | - Anna Buadze
- Psychiatric University Hospital, Research Group on ADHD, Zurich, 8032, Switzerland
| | - Dominique Eich
- Psychiatric University Hospital, Research Group on ADHD, Zurich, 8032, Switzerland
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25
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Young S, Sedgwick O, Fridman M, Gudjonsson G, Hodgkins P, Lantigua M, González RA. Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis. Psychol Med 2015; 45:2499-2510. [PMID: 25857258 PMCID: PMC4531473 DOI: 10.1017/s0033291715000598] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples. METHOD Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals. RESULTS Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09-3.28). CONCLUSIONS This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.
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Affiliation(s)
- S. Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- Broadmoor Hospital, West London Mental Health Trust, London, UK
| | - O. Sedgwick
- Broadmoor Hospital, West London Mental Health Trust, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M. Fridman
- AMF Consulting Inc., Los Angeles, CA, USA
| | - G. Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P. Hodgkins
- Global Health Economics & Outcomes Research, Vertex Pharmaceuticals, Boston, MA, USA
| | - M. Lantigua
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Puerto Rico
| | - R. A. González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Puerto Rico
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26
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Hawi Z, Cummins TDR, Tong J, Johnson B, Lau R, Samarrai W, Bellgrove MA. The molecular genetic architecture of attention deficit hyperactivity disorder. Mol Psychiatry 2015; 20:289-97. [PMID: 25600112 DOI: 10.1038/mp.2014.183] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 11/14/2014] [Accepted: 11/19/2014] [Indexed: 12/27/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioral condition which affects 2-10% of school age children worldwide. Although the underlying molecular mechanism for the disorder is poorly understood, familial, twin and adoption studies suggest a strong genetic component. Here we provide a state-of-the-art review of the molecular genetics of ADHD incorporating evidence from candidate gene and linkage designs, as well as genome-wide association (GWA) studies of common single-nucleotide polymorphisms (SNPs) and rare copy number variations (CNVs). Bioinformatic methods such as functional enrichment analysis and protein-protein network analysis are used to highlight biological processes of likely relevance to the aetiology of ADHD. Candidate gene associations of minor effect size have been replicated across a number of genes including SLC6A3, DRD5, DRD4, SLC6A4, LPHN3, SNAP-25, HTR1B, NOS1 and GIT1. Although case-control SNP-GWAS have had limited success in identifying common genetic variants for ADHD that surpass critical significance thresholds, quantitative trait designs suggest promising associations with Cadherin13 and glucose-fructose oxidoreductase domain 1 genes. Further, CNVs mapped to glutamate receptor genes (GRM1, GRM5, GRM7 and GRM8) have been implicated in the aetiology of the disorder and overlap with bioinformatic predictions based on ADHD GWAS SNP data regarding enriched pathways. Although increases in sample size across multi-center cohorts will likely yield important new results, we advocate that this must occur in parallel with a shift away from categorical case-control approaches that view ADHD as a unitary construct, towards dimensional approaches that incorporate endophenotypes and statistical classification methods.
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Affiliation(s)
- Z Hawi
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - T D R Cummins
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - J Tong
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - B Johnson
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - R Lau
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - W Samarrai
- New York City College of Technology, City University of New York, New York, NY, USA
| | - M A Bellgrove
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med 2015; 45:247-58. [PMID: 25066071 PMCID: PMC4301200 DOI: 10.1017/s0033291714000762] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Studies report the variable prevalence of attention deficit hyperactivity disorder (ADHD) in incarcerated populations. The aim of this meta-analysis was to determine the prevalence of ADHD in these populations. METHOD Primary research studies reporting the prevalence (lifetime/current) of ADHD in incarcerated populations were identified. The meta-analysis used a mixed log-binomial model, including fixed effects for each covariate and a random study effect, to estimate the significance of various risk factors. RESULTS Forty-two studies were included in the analysis. ADHD prevalence was higher with screening diagnoses versus diagnostic interview (and with retrospective youth diagnoses versus current diagnoses). Using diagnostic interview data, the estimated prevalence was 25.5% and there were no significant differences for gender and age. Significant country differences were noted. CONCLUSIONS Compared with published general population prevalence, there is a fivefold increase in prevalence of ADHD in youth prison populations (30.1%) and a 10-fold increase in adult prison populations (26.2%).
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Affiliation(s)
- S. Young
- Centre for Mental Health, Division of Brain
Sciences, Department of Medicine, Imperial College
London, UK
- Broadmoor Hospital, West
London Mental Health Trust, London,
UK
| | | | - O. Sedgwick
- Department of Psychology, Institute of
Psychiatry, King's College London,
UK
| | - M. Fridman
- AMF Consulting, Inc., Los
Angeles, CA, USA
| | - P. Hodgkins
- Global HEOR, Vertex
Pharmaceuticals, Boston, MA, USA
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28
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Hollingdale J, Woodhouse E, Asherson P, Gudjonsson GH, Young S. A Pilot Study Examining ADHD and Behavioural Disturbance in Female Mentally Disordered Offenders. AIMS Public Health 2014; 1:100-108. [PMID: 29546079 PMCID: PMC5689798 DOI: 10.3934/publichealth.2014.2.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/05/2014] [Indexed: 11/18/2022] Open
Abstract
Compared with general population rates, prevalence rates of ADHD have been consistently reported to be higher in both male and female offender populations, the latter estimated to range between 10-29%. Research in forensic institutional settings has reported that aggressive behaviour is a particularly prominent source of impairment among men with ADHD. However there is a paucity of research investigating the type of behavioural incidents that may arise in female offenders with ADHD. This pilot study therefore aimed to further our understanding of ADHD within a cohort of female mentally disordered offenders by ascertaining estimated rates of ADHD and associated functional disturbance presenting in this population. Fifty female offenders completed the Barkley ADHD rating scales. Data on aggressive and self-harming behaviours were obtained from patients' clinical records. Almost one-third of patients (28%) screened positive for ADHD, most commonly hyperactive/impulsive and combined subtypes. They were significantly younger than their peers and there were no significant differences in behavioural disturbance records between groups. When controlling for age, hyperactive/impulsive symptoms and combined symptoms were significantly and positively correlated with measures of behavioural disturbance. ADHD symptoms correlated more strongly with self-harm than outward aggression, which is a novel finding. This pilot study has contributed to the knowledge base about the rate and functional problems of female offenders with ADHD. Future research should replicate the study using a larger sample and explore the effect of treatment (pharmacological and psychological) on the reduction of ADHD symptoms, behavioural disturbance, length of stay and quality of life.
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Affiliation(s)
- Jack Hollingdale
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Emma Woodhouse
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gisli H. Gudjonsson
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
- Broadmoor Hospital, Crowthorne, West London Mental Health Trust, UK
| | - Susan Young
- Broadmoor Hospital, Crowthorne, West London Mental Health Trust, UK
- Centre for Mental Health, Imperial College London, London, UK
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Konstenius M, Jayaram-Lindström N, Guterstam J, Beck O, Philips B, Franck J. Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction 2014; 109:440-9. [PMID: 24118269 PMCID: PMC4226329 DOI: 10.1111/add.12369] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/26/2013] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
Abstract
AIM To test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co-diagnosis of ADHD and amphetamine dependence. DESIGN Randomized placebo-controlled 24-week double-blind trial with parallel groups design. SETTING Participants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out-patient care with twice-weekly visits, including once-weekly cognitive behavioural therapy. PARTICIPANTS Fifty-four men with a mean age of 42 years, currently incarcerated, meeting DSM-IV criteria for ADHD and amphetamine dependence. MEASUREMENTS Change in self-reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse. FINDINGS The MPH-treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug-negative urines compared with the placebo group (P = 0.047), including more amphetamine-negative urines (P = 0.019) and better retention to treatment (P=0.032). CONCLUSIONS Methylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.
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Affiliation(s)
- Maija Konstenius
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden,Correspondence to: Maija Konstenius, Kaolinska Solna R5:01, 17176 Stockholm, Sweden. E-mail:
| | - Nitya Jayaram-Lindström
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden
| | - Joar Guterstam
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden
| | - Olof Beck
- Division of Clinical Pharmacology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
| | - Björn Philips
- Department of Psychology, Linköping UniversityLinköping, Sweden
| | - Johan Franck
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden
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