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1. International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Author

Ozgen, H, Spijkerman, R, Noack, M, Holtmann, M, Schellekens, ASA, van de Glind, G, Banaschewski, T, Barta, C, Begeman, A, Casas, M, Crunelle, CL, Daigre Blanco, C, Dalsgaard, S, Demetrovics, Z, den Boer, J, Dom, G, Eapen, V, Faraone, SV, Franck, J, Gonzalez, RA, Grau-Lopez, L, Groenman, AP, Hemphala, M, Icick, R, Johnson, B, Kaess, M, Kapitany-Foveny, M, Kasinathan, JG, Kaye, SS, Kiefer, F, Konstenius, M, Levin, FR, Luderer, M, Martinotti, G, Matthys, FIA, Meszaros, G, Moggi, F, Munasur-Naidoo, AP, Post, M, Rabinovitz, S, Ramos-Quiroga, JA, Sala, R, Shafi, A, Slobodin, O, Staal, WG, Thomasius, R, Truter, I, van Kernebeek, MW, Velez-Pastrana, MC, Vollstadt-Klein, S, Vorspan, F, Young, JT, Yule, A, van den Brink, W, Hendriks, V, Ozgen, H, Spijkerman, R, Noack, M, Holtmann, M, Schellekens, ASA, van de Glind, G, Banaschewski, T, Barta, C, Begeman, A, Casas, M, Crunelle, CL, Daigre Blanco, C, Dalsgaard, S, Demetrovics, Z, den Boer, J, Dom, G, Eapen, V, Faraone, SV, Franck, J, Gonzalez, RA, Grau-Lopez, L, Groenman, AP, Hemphala, M, Icick, R, Johnson, B, Kaess, M, Kapitany-Foveny, M, Kasinathan, JG, Kaye, SS, Kiefer, F, Konstenius, M, Levin, FR, Luderer, M, Martinotti, G, Matthys, FIA, Meszaros, G, Moggi, F, Munasur-Naidoo, AP, Post, M, Rabinovitz, S, Ramos-Quiroga, JA, Sala, R, Shafi, A, Slobodin, O, Staal, WG, Thomasius, R, Truter, I, van Kernebeek, MW, Velez-Pastrana, MC, Vollstadt-Klein, S, Vorspan, F, Young, JT, Yule, A, van den Brink, W, and Hendriks, V

Abstract

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should pr

Published
2022

2. Jongeren met een stoornis in het gebruik van middelen en ADHD : internationale consensus

Author

Spijkerman, R., Crunelle, C. L., Özgen, M. H., Begeman, A. H.A., Dom, G., van de Glind, G., Groenman, A. P., van Kernebeek, M. W., Matthys, F., Post, M., Schellekens, A., Staal, W., Van Den Brink, W., Hendriks, V. M., Psychiatrie, Faculteit van de Geneeskunde en Farmacie, Observerende Klinische wetenschappen, Neuroprotectie & Neuromodulatie, Onderzoeksgroep Geestelijke Gezondheid en Welbevinden, and Vriendenkring VUB

Subjects
Psychiatry and Mental health, mental disorders, Psychology, Human medicine, behavioral disciplines and activities, health care economics and organizations
Abstract

BACKGROUND: Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure. AIM: To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD. METHOD: In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations. RESULTS: Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consistof psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment. CONCLUSION: Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

Published
2021

3. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

Author

Faraone, S, Banaschewski, T, Coghill, D, Zheng, Y, Biederman, J, Bellgrove, MA, Newcorn, JH, Gignac, M, Al Saud, NM, Manor, I, Rohde, LA, Yang, L, Cortese, S, Almagor, D, Stein, MA, Albatti, TH, Aljoudi, HF, Alqahtani, MMJ, Asherson, P, Atwoli, L, Bolte, S, Buitelaar, JK, Crunelle, CL, Daley, D, Dalsgaard, S, Doepfner, M, Espinet, S, Fitzgerald, M, Franke, B, Gerlach, M, Haavik, J, Hartman, CA, Hartung, CM, Hinshaw, SP, Hoekstra, PJ, Hollis, C, Kollins, SH, Kooij, JJS, Kuntsi, J, Larsson, H, Li, T, Liu, J, Merzon, E, Mattingly, G, Mattos, P, McCarthy, S, Mikami, AY, Molina, BSG, Nigg, JT, Purper-Ouakil, D, Omigbodun, OO, Polanczyk, G, Pollak, Y, Poulton, AS, Rajkumar, RP, Reding, A, Reif, A, Rubia, K, Rucklidge, J, Romanos, M, Ramos-Quiroga, JA, Schellekens, A, Scheres, A, Schoeman, R, Schweitzer, JB, Shah, H, Solanto, M, Sonuga-Barke, E, Soutullo, C, Steinhausen, H-C, Swanson, JM, Thapar, A, Tripp, G, van de Glind, G, van den Brink, W, Van der Oord, S, Venter, A, Vitiello, B, Walitza, S, Wang, Y, Faraone, S, Banaschewski, T, Coghill, D, Zheng, Y, Biederman, J, Bellgrove, MA, Newcorn, JH, Gignac, M, Al Saud, NM, Manor, I, Rohde, LA, Yang, L, Cortese, S, Almagor, D, Stein, MA, Albatti, TH, Aljoudi, HF, Alqahtani, MMJ, Asherson, P, Atwoli, L, Bolte, S, Buitelaar, JK, Crunelle, CL, Daley, D, Dalsgaard, S, Doepfner, M, Espinet, S, Fitzgerald, M, Franke, B, Gerlach, M, Haavik, J, Hartman, CA, Hartung, CM, Hinshaw, SP, Hoekstra, PJ, Hollis, C, Kollins, SH, Kooij, JJS, Kuntsi, J, Larsson, H, Li, T, Liu, J, Merzon, E, Mattingly, G, Mattos, P, McCarthy, S, Mikami, AY, Molina, BSG, Nigg, JT, Purper-Ouakil, D, Omigbodun, OO, Polanczyk, G, Pollak, Y, Poulton, AS, Rajkumar, RP, Reding, A, Reif, A, Rubia, K, Rucklidge, J, Romanos, M, Ramos-Quiroga, JA, Schellekens, A, Scheres, A, Schoeman, R, Schweitzer, JB, Shah, H, Solanto, M, Sonuga-Barke, E, Soutullo, C, Steinhausen, H-C, Swanson, JM, Thapar, A, Tripp, G, van de Glind, G, van den Brink, W, Van der Oord, S, Venter, A, Vitiello, B, Walitza, S, and Wang, Y

Abstract

BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Published
2021

4. Childhood trauma exposure in substance use disorder patients with and without ADHD

Author

Kinstenius, M., Leifman, A., van Emmerik-van Oortmerssen, K., van de Glind, G., Franck, J., Moggi, F., Ramos-Quiroga, J., Levin, F., Carpentier, P., Skuttle, A., Bu, E., Kaye, S., Demetrovics, Z., Barta, C., Auriecomb, M., Fatséas, M., Johnson, B., Faraone, S., Allsop, Steve, Carruthers, Susan, Schoevers, R., Verspreet, S., Dom, G., Koeter, M., van den Brink, W., Kinstenius, M., Leifman, A., van Emmerik-van Oortmerssen, K., van de Glind, G., Franck, J., Moggi, F., Ramos-Quiroga, J., Levin, F., Carpentier, P., Skuttle, A., Bu, E., Kaye, S., Demetrovics, Z., Barta, C., Auriecomb, M., Fatséas, M., Johnson, B., Faraone, S., Allsop, Steve, Carruthers, Susan, Schoevers, R., Verspreet, S., Dom, G., Koeter, M., and van den Brink, W.

Abstract

Background: Childhood trauma exposure (CTE) is frequently reported by those with substance use disorders (SUDs). SUDs also frequently co-occur with attention deficit hyperactivity disorder (ADHD). Objective: To investigate the role of childhood trauma exposure (CTE) in the presence and the persistence of ADHD in treatment seeking SUD patients. Method: Data was derived from the International ADHD in Substance Use Disorder Prevalence (IASP) study. A structured interview was administered to 1274 treatment-seeking SUD patients aged 18 to 65. Results: CTE was present in 53.5% of the patients and comorbid adult ADHD in 14.1%. CTE was significantly associated with ADHD: the prevalence of adult ADHD with and without CTE was 19.4% and 8.5% (OR adjusted for age, gender, main substance of abuse, BPD, and ASPD 1.91 [95% CI 1.29–2.81]). CTE was not associated with the severity of adult ADHD or with the persistence of childhood ADHD into adulthood. Conclusions: CTE is common in SUD patients and associated with adult ADHD but not with the persistence of childhood ADHD into adulthood. These findings suggest that the increased rate of adult ADHD in SUD patients with CTE is not the consequence of a negative effect of CTE on the persistence of childhood ADHD into adulthood, but a direct expression of the high rate of childhood ADHD in SUD patients with CTE.

Published
2017

5. Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men

Author

Vogel, T., Dom, G., van de Glind, G., Studer, J., Gmel, G., Strik, W., Moggi, F., and Other departments

Subjects
Research Report, Male, Motivation, conduct disorder, Adolescent, Substance-Related Disorders, longitudinal study, substance use, Attention Deficit Disorder with Hyperactivity/epidemiology, Attention Deficit Disorder with Hyperactivity/psychology, Diagnosis, Dual (Psychiatry), Humans, Longitudinal Studies, Socioeconomic Factors, Substance-Related Disorders/epidemiology, Substance-Related Disorders/psychology, Switzerland/epidemiology, Young Adult, ADHD, substance use disorders, young men, Research Reports, 610 Medicine & health, Attention Deficit Disorder with Hyperactivity, mental disorders, Human medicine, Switzerland
Abstract

Background and Aims Young adults with attention deficit/hyperactivity disorder (ADHD) show higher substance use disorder (SUD) prevalence relative to non‐ADHD controls; few longitudinal studies have examined the course of substance use with reference to conduct disorder (CD). We compared initiation and escalation of substance use at 15‐month follow‐up in men screened positive or negative for ADHD (ADHD+ versus ADHD–), controlling for CD presence in early adolescence. Design Participants were recruited during August 2010 and November 2011 from the census of all young men who have to pass mandatory army conscription from three of six Swiss Army recruitment centres. A two‐wave data collection was performed via questionnaires at baseline and 15‐month follow‐up as a part of the longitudinal Cohort Study on Substance Use Risk Factors. Setting Recruitment centres in Lausanne, Windisch and Mels, responsible for 21 cantons in German‐ and French‐speaking areas of Switzerland. Participants Consecutive sample of 5103 male Swiss Army conscripts who provided informed consent and responded to questionnaires at baseline and 15‐month follow‐up. Their mean age was 20.0 (standard deviation = 1.21) years at baseline. Measurements ADHD and CD were assessed using the adult ADHD Self‐Report Scale and the MINI International Neuropsychiatric Interview Plus, respectively, at baseline, and substance use was measured via self‐administered substance use questionnaires at baseline and follow‐up. Findings Compared with the ADHD– group, the ADHD+ group (n = 215, 4.2%) showed heavier baseline substance use and increased likelihood of alcohol (χ2 = 53.96; P

Published
2016
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6. Persistence and Subtype Stability of ADHD Among Substance Use Disorder Treatment Seekers.

Author

Kaye, S., Ramos-Quiroga, J., van de Glind, G., Levin, F., Faraone, S., Allsop, Steve, Degenhardt, L., Moggi, F., Barta, C., Konstenius, M., Franck, J., Skutle, A., Bu, E., Koeter, M., Demetrovics, Z., Kapitány-Fövény, M., Schoevers, R., van Emmerik-van Oortmerssen, K., Carpentier, P., Dom, G., Verspreet, S., Crunelle, C., Young, Jesse, Carruthers, Susan, Cassar, J., Fatséas, M., Auriacombe, M., Johnson, B., Dunn, M., Slobodin, O., van den Brink, W., Kaye, S., Ramos-Quiroga, J., van de Glind, G., Levin, F., Faraone, S., Allsop, Steve, Degenhardt, L., Moggi, F., Barta, C., Konstenius, M., Franck, J., Skutle, A., Bu, E., Koeter, M., Demetrovics, Z., Kapitány-Fövény, M., Schoevers, R., van Emmerik-van Oortmerssen, K., Carpentier, P., Dom, G., Verspreet, S., Crunelle, C., Young, Jesse, Carruthers, Susan, Cassar, J., Fatséas, M., Auriacombe, M., Johnson, B., Dunn, M., Slobodin, O., and van den Brink, W.

Abstract

Objective: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

Published
2016

7. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults

Author

Young, JT, Carruthers, S, Kaye, S, Allsop, S, Gilsenan, J, Degenhardt, L, van de Glind, G, van den Brink, W, Preen, D, Young, JT, Carruthers, S, Kaye, S, Allsop, S, Gilsenan, J, Degenhardt, L, van de Glind, G, van den Brink, W, and Preen, D

Abstract

INTRODUCTION AND AIMS: Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. DESIGN AND METHODS: A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. RESULTS: Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19-2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21-3.45) and amphetamine (OR = 1.96; 95% CI: 1.26-3.06) as well as significantly increased risk of moderate (3-4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. DISCUSSION AND CONCLUSIONS: The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.

Published
2015

8. Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study

Author

Wapp, M, van de Glind, G, van Emmerik-van Oortmerssen, K, Dom, G, Verspreet, S, Carpentier, PJ, Ramos-Quiroga, JA, Skutle, A, Bu, E-T, Franck, J, Konstenius, M, Kaye, S, Demetrovics, Z, Barta, C, Fatseas, M, Auriacombe, M, Johnson, B, Faraone, SV, Levin, FR, Allsop, S, Carruthers, S, Schoevers, RA, Koeter, MWJ, van den Brink, W, Moggi, F, Wapp, M, van de Glind, G, van Emmerik-van Oortmerssen, K, Dom, G, Verspreet, S, Carpentier, PJ, Ramos-Quiroga, JA, Skutle, A, Bu, E-T, Franck, J, Konstenius, M, Kaye, S, Demetrovics, Z, Barta, C, Fatseas, M, Auriacombe, M, Johnson, B, Faraone, SV, Levin, FR, Allsop, S, Carruthers, S, Schoevers, RA, Koeter, MWJ, van den Brink, W, and Moggi, F

Abstract

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

Published
2015

9. Risk factors for borderline personality disorder in treatment seeking patients with a substance use disorder: An international multicenter study

Author

Wapp, M., Van De Glind, G., Van Emmerik-Van Oortmerssen, K., Dom, G., Verspreet, S., Carpentier, P., Ramos-Quiroga, J., Skutle, A., Bu, E., Franck, J., Konstenius, M., Kaye, S., Demetrovics, Z., Barta, C., Fatséas, M., Auriacombe, M., Johnson, B., Faraone, S., Levin, F., Allsop, Steve, Carruthers, Susan, Schoevers, R., Koeter, M., Van Den Brink, W., Moggi, F., Wapp, M., Van De Glind, G., Van Emmerik-Van Oortmerssen, K., Dom, G., Verspreet, S., Carpentier, P., Ramos-Quiroga, J., Skutle, A., Bu, E., Franck, J., Konstenius, M., Kaye, S., Demetrovics, Z., Barta, C., Fatséas, M., Auriacombe, M., Johnson, B., Faraone, S., Levin, F., Allsop, Steve, Carruthers, Susan, Schoevers, R., Koeter, M., Van Den Brink, W., and Moggi, F.

Abstract

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

Published
2015

10. Early developmental, temperamental and educational problems in 'substance use disorder' patients with and without ADHD: Does ADHD make a difference?

Author

Skutle, A., Bu, E., Jellestad, F., van Emmerik-van Oortmerssen, K., Dom, G., Verspreet, S., Carpentier, P., Ramos-Quiroga, J., Franck, J., Konstenius, M., Kaye, S., Demetrovics, Z., Barta, C., Fatséas, M., Auriacombe, M., Johnson, B., Faraone, S., Levin, F., Allsop, Steve, Carruthers, S., Schoevers, R., Koeter, M., van den Brink, W., Moggi, F., Møller, M., van de Glind, G., Skutle, A., Bu, E., Jellestad, F., van Emmerik-van Oortmerssen, K., Dom, G., Verspreet, S., Carpentier, P., Ramos-Quiroga, J., Franck, J., Konstenius, M., Kaye, S., Demetrovics, Z., Barta, C., Fatséas, M., Auriacombe, M., Johnson, B., Faraone, S., Levin, F., Allsop, Steve, Carruthers, S., Schoevers, R., Koeter, M., van den Brink, W., Moggi, F., Møller, M., and van de Glind, G.

Abstract

Introduction: The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants? Method: An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40. years and 27% of the sample was female. All participants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV. Results: SUD patients with ADHD (n = 196; 16.3% of the total sample) had a significantly slower infant development than SUD patients without ADHD (n = 1,009; 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD. Conclusion: The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Published
2015

11. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults

Author

Young, Jesse, Carruthers, Susan, Kaye, S., Allsop, Steve, Gilsenan, J., Degenhardt, L., van de Glind, G., van den Brink, W., Preen, D., Young, Jesse, Carruthers, Susan, Kaye, S., Allsop, Steve, Gilsenan, J., Degenhardt, L., van de Glind, G., van den Brink, W., and Preen, D.

Abstract

Introduction and Aims - Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. Design and Methods - A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. Results - Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19–2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21–3.45) and amphetamine (OR = 1.96; 95% CI: 1.26–3.06) as well as significantly increased risk of moderate (3–4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. Discussion and Conclusions - The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.

Published
2015

12. Acute Cardiac Failure due to Intra-Atrial Mass Caused by Zygomycetes in an Immunocompromised Paediatric Patient

Author

van de Glind, G. J., Gidding, C. E. M., Verlaat, C. M. W., Duthoi, K., Backx, A. P. C., Verweij, P. E., and Warris, A.

Subjects
Article Subject
Abstract

Cardiac zygomycosis can be a critical condition with sudden onset of severe congestive heart failure followed by severe hemodynamic deterioration. We report a fatal course of disseminated fungal infection with a massive intra-atrial thrombosis caused by a zygomycete, in a five year old boy treated for acute lymphoblastic leukaemia. In addition, we discuss the literature concerning infections caused by zygomycetes involving the heart. Prognosis is poor. A high index of suspicion and an aggressive diagnostic and therapeutic approach with the prompt start of preemptive antifungal therapy are key factors to improve outcome.

Published
2010
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13. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: Results from an international multi-center study exploring DSM-IV and DSM-5 criteria

Author

van de Glind, G, Konstenius, M, Koeter, MWJ, van Emmerik-van Oortmerssen, K, Carpentier, P-J, Kaye, S, Degenhardt, L, Skutle, A, Franck, J, Bu, E-T, Moggi, F, Dom, G, Verspreet, S, Demetrovics, Z, Kapitany-Foveny, M, Fatseas, M, Auriacombe, M, Schillinger, A, Moller, M, Johnson, B, Farone, SV, Antoni Ramos-Quiroga, J, Casas, M, Allsop, S, Carruthers, S, Schoevers, RA, Wallhed, S, Barta, C, Alleman, P, Levin, FR, van den Brink, W, van de Glind, G, Konstenius, M, Koeter, MWJ, van Emmerik-van Oortmerssen, K, Carpentier, P-J, Kaye, S, Degenhardt, L, Skutle, A, Franck, J, Bu, E-T, Moggi, F, Dom, G, Verspreet, S, Demetrovics, Z, Kapitany-Foveny, M, Fatseas, M, Auriacombe, M, Schillinger, A, Moller, M, Johnson, B, Farone, SV, Antoni Ramos-Quiroga, J, Casas, M, Allsop, S, Carruthers, S, Schoevers, RA, Wallhed, S, Barta, C, Alleman, P, Levin, FR, and van den Brink, W

Abstract

BACKGROUND: Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed. METHODS: A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview. RESULTS: Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4-8.3) for Hungary to 31.3% (CI 95%:25.2-37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1-11.1) for Hungary to 32.6% (CI 95%: 26.4-38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2-83%→5.4-31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV. CONCLUSIONS: Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD.

Published
2014

14. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: Results from an international multi-center study exploring DSM-IV and DSM-5 criteria

Author

Van de Glind, G., Konstenius, Maija, Koeter, Maarten, Van Emmerik-Van Oortmerssen, Katelijne, Carpentier, Pieter, Kaye, Sharlene, Degenhardt, Louisa, Skutle, Arvid, Franck, Johan, Bu, Eli-torild, Moggi, Franz, Dom, Geert, Verspreet, Sofie, Demetrovics, Zolt, Kapitány-Fövény, Máté, Fatséas, Mélina, Auriacombe, Marc, Schillinger, Arild, Moller, Merete, Johnson, Brian, Faraone, Stephen, Ramos-Quiroga, J, Allsop, Steven, Carruthers, Susan, Casas, Miguel, Wallhed, Sara, Barta, Csaba, Schoevers, Robert, Levin, Frances, Van Den Brink, Wim, Alleman, Peter, Van de Glind, G., Konstenius, Maija, Koeter, Maarten, Van Emmerik-Van Oortmerssen, Katelijne, Carpentier, Pieter, Kaye, Sharlene, Degenhardt, Louisa, Skutle, Arvid, Franck, Johan, Bu, Eli-torild, Moggi, Franz, Dom, Geert, Verspreet, Sofie, Demetrovics, Zolt, Kapitány-Fövény, Máté, Fatséas, Mélina, Auriacombe, Marc, Schillinger, Arild, Moller, Merete, Johnson, Brian, Faraone, Stephen, Ramos-Quiroga, J, Allsop, Steven, Carruthers, Susan, Casas, Miguel, Wallhed, Sara, Barta, Csaba, Schoevers, Robert, Levin, Frances, Van Den Brink, Wim, and Alleman, Peter

Abstract

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs).This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine their liability and validity of the Adult ADHD Self-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner’s Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti-social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders.

Published
2014

15. Risk behaviours among substance use disorder treatment seekers with and without adult ADHD symptoms

Author

Kaye, S., Gilsenan, J., Young, J., Carruthers, Susan, Allsop, Steve, Degenhardt, L., van de Glind, G., van den Brink, W., Kaye, S., Gilsenan, J., Young, J., Carruthers, Susan, Allsop, Steve, Degenhardt, L., van de Glind, G., and van den Brink, W.

Abstract

Background: Impulsivity and consequent risk-taking are features of both Attention Deficit Hyperactivity Disorder (ADHD) and substance use disorder (SUD). To date there are no data on the impact of comorbid ADHD on the likelihood and frequency of risk-taking behaviour among individuals with SUD. The current study aimed to examine drug-related, sexual and driving-related risk behaviours in people seeking treatment for SUD with co-occurring symptoms of Attention Deficit Hyperactivity Disorder (ADHD), taking into account potential confounders. Methods: 489 Australian adult SUD treatment seekers were administered a structured interview assessing demographics, drug use and SUD treatment history, psychiatric history, self-reported adult ADHD symptoms and self-reported drug-related, sexual and driving-related risk behaviours. Results: Almost a third (32%) screened positive for adult ADHD symptoms with onset prior to age 12. Those screening positive were more likely to report early onset (<15 years) nicotine and illicit drug use and to have a prior diagnosis of childhood ADHD, anxiety, depression and personality disorder. ADHD symptom status was not independently associated with injecting drug use-related or sexual risk-taking in the preceding month, but was an independent predictor of a greater overall number of driving offences, a higher frequency of driving without a seatbelt, a greater likelihood of having driven without a valid licence, more at-fault accidents and having one's licence disqualified at the time of interview. Conclusions: These findings suggest that the risk-taking behaviour that is common among people with SUD is further increased among those with comorbid ADHD symptoms, particularly with respect to dangerous driving practices.

Published
2014

16. Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

Author

Van Emmerik-Van Oortmerssen, K., Van de Glind, G., Koeter, M., Allsop, Steve, Auriacombe, M., Barta, C., Bu, E., Burren, Y., Carpentier, P., Carruthers, Susan, Casas, M., Demetrovics, Z., Dom, G., Faraone, S., Fatséas, M., Franck, J., Johnson, B., Kapitány-Fövény, M., Kaye, S., Konstenius, M., Levin, F., Moggi, F., Møller, M., Ramos-Quiroga, J., Schillinger, A., Skutle, A., Verspreet, S., Van Den Brink, W., Schoevers, R., Van Emmerik-Van Oortmerssen, K., Van de Glind, G., Koeter, M., Allsop, Steve, Auriacombe, M., Barta, C., Bu, E., Burren, Y., Carpentier, P., Carruthers, Susan, Casas, M., Demetrovics, Z., Dom, G., Faraone, S., Fatséas, M., Franck, J., Johnson, B., Kapitány-Fövény, M., Kaye, S., Konstenius, M., Levin, F., Moggi, F., Møller, M., Ramos-Quiroga, J., Schillinger, A., Skutle, A., Verspreet, S., Van Den Brink, W., and Schoevers, R.

Abstract

Aims To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8–4.2], BPD (OR = 7.0, 95% CI = 3.1–15.6 for alcohol; OR = 3.4, 95% CI = 1.8–6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1–7.8) andHME(OR = 4.3, 95% CI = 2.1–8.7)were all more prevalent in ADHD+ compared with ADHD- patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional co

Published
2014

17. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population

Author

Van de Glind, G., Van Emmerik-Van Oortmerssen, K., Carpentier, P., Levin, F., Koeter, M., Barta, C., Kaye, S., Skutle, A., Franck, J., Konstenius, M., Bu, E., Moggi, F., Dom, G., Demetrovics, Z., Fatséas, M., Schillinger, A., Kapitány-Fövény, M., Verspreet, S., Seitz, A., Johnson, B., Faraone, S., Ramos-Quiroga, J., Allsop, Steve, Carruthers, Susan, Schoevers, R., Van Den Brink, W., Van de Glind, G., Van Emmerik-Van Oortmerssen, K., Carpentier, P., Levin, F., Koeter, M., Barta, C., Kaye, S., Skutle, A., Franck, J., Konstenius, M., Bu, E., Moggi, F., Dom, G., Demetrovics, Z., Fatséas, M., Schillinger, A., Kapitány-Fövény, M., Verspreet, S., Seitz, A., Johnson, B., Faraone, S., Ramos-Quiroga, J., Allsop, Steve, Carruthers, Susan, Schoevers, R., and Van Den Brink, W.

Abstract

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHDSelf-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner’s Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders. Copyright © 2013 John Wiley & Sons, Ltd.

Published
2013

18. Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients

Author

Van de Glind, G., Van Den Brink, W., Koeter, M., Carpentier, P., Van Emmerik-Van Oortmerssen, K., Kaye, S., Skutle, A., Bu, E., Franck, J., Konstenius, M., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitány-Fövény, M., Fatséas, M., Auriacombe, M., Schillinger, A., Seitz, A., Johnson, B., Faraone, S., Ramos-Quiroga, J., Casas, M., Allsop, Steve, Carruthers, Susan, Barta, C., Schoevers, R., Levin, F., Van de Glind, G., Van Den Brink, W., Koeter, M., Carpentier, P., Van Emmerik-Van Oortmerssen, K., Kaye, S., Skutle, A., Bu, E., Franck, J., Konstenius, M., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitány-Fövény, M., Fatséas, M., Auriacombe, M., Schillinger, A., Seitz, A., Johnson, B., Faraone, S., Ramos-Quiroga, J., Casas, M., Allsop, Steve, Carruthers, Susan, Barta, C., Schoevers, R., and Levin, F.

Abstract

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHDSelf-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner’s Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders. Copyright © 2013 John Wiley & Sons, Ltd.

Published
2013

19. Targeted delivery of TLR ligands to human and mouse dendritic cells strongly enhances adjuvanticity

Author

Tacken, P.J., Zeelenberg, I.S., Cruz, L.J., Hout-Kuijer, M.A., van de Glind, G., Fokkink, R.G., Lambeck, A.J.A., Figdor, C.G., Tacken, P.J., Zeelenberg, I.S., Cruz, L.J., Hout-Kuijer, M.A., van de Glind, G., Fokkink, R.G., Lambeck, A.J.A., and Figdor, C.G.

Abstract

Effective vaccines consist of 2 components: immunodominant antigens and effective adjuvants. Whereas it has been demonstrated that targeted delivery of antigens to dendritic cells (DCs) improves vaccine efficacy, we report here that co-targeting of TLR ligands (TLRLs) to DCs strongly enhances adjuvanticity and immunity. We encapsulated ligands for intracellular TLRs within biodegradable nanoparticles coated with Abs recognizing DC-specific receptors. Targeted delivery of TLRLs to human DCs enhanced the maturation and production of immune stimulatory cytokines and the Ag-specific activation of naive CD8(+) T cells. In vivo studies demonstrated that nanoparticles carrying Ag induced cytotoxic T-lymphocyte responses at 100-fold lower adjuvant dose when TLRLs were co-encapsulated instead of administered in soluble form. Moreover, the efficacy of these targeted TLRLs reduced the serum cytokine storm and related toxicity that is associated with administration of soluble TLRLs. We conclude that the targeted delivery of adjuvants may improve the efficacy and safety of DC-based vaccines. (Blood.2011;118(26):6836-6844)

Published
2011

20. Defining the concept of mental dysregulation in patients requiring ambulance and/or emergency department care: protocol for a Delphi consensus study.

Author

Van de Glind G, Crilly J, Galenkamp N, Schut B, Werner L, Chan E, Hilton E, Schoonhoven L, Scheepers FE, Muir R, Baden D, van Veen M, and Ham WHW

Subjects
Humans, Delphi Technique, Emergency Treatment, Emergency Service, Hospital, Review Literature as Topic, Ambulances, Emergency Medical Services
Abstract

Introduction: From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings., Methods and Analysis: A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics)., Ethics and Dissemination: This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023&#95;Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders., Competing Interests: Competing interests: EC declared to have received payment from Boehringer Ingelheim in October 2022 for acting as member of the suicide advisory board., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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21. Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review.

Author

Van de Glind G, Galenkamp N, Bleijenberg N, Schoonhoven L, Scheepers FE, Crilly J, van Veen M, and Ham WHW

Subjects
Humans, Systematic Reviews as Topic, Meta-Analysis as Topic, Emergency Service, Hospital, Review Literature as Topic, Ambulances, Attitude of Health Personnel
Abstract

Introduction: Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context., Methods and Analysis: The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results., Ethics and Dissemination: No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences., Prospero Registration Number: CRD42023390664 (https://www.crd.york.ac.uk/prospero/)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Published
2023
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22. The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study.

Author

Brynte C, Aeschlimann M, Barta C, Begeman AHA, Bäcker A, Crunelle CL, Daigre C, De Fuentes-Merillas L, Demetrovics Z, Dom G, López LG, Icick R, Johnson B, Joostens P, Kapitány-Fövény M, Karsinti E, Kiefer F, Konstenius M, Levin FR, Luderer M, Markus W, Matthys F, Moggi F, Palma-Alvarez RF, Paraskevopoulou M, Ramos-Quiroga JA, Schellekens A, Soravia LM, Therribout N, Thomas A, van de Glind G, van Kernebeek MW, Vollstädt-Klein S, Vorspan F, van den Brink W, and Franck J

Subjects
Adult, Analgesics, Opioid therapeutic use, Cohort Studies, Comorbidity, Female, Humans, Male, Multicenter Studies as Topic, Observational Studies as Topic, Prospective Studies, Attention Deficit Disorder with Hyperactivity complications, Attention Deficit Disorder with Hyperactivity drug therapy, Attention Deficit Disorder with Hyperactivity epidemiology, Substance-Related Disorders complications, Substance-Related Disorders drug therapy, Substance-Related Disorders epidemiology
Abstract

Background: Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD., Aims: This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months., Results: A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%., Conclusions: The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes., Trial Registration: ISRCTN15998989 20/12/2019., (© 2022. The Author(s).)

Published
2022
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23. [Adolescents with concurrent ADHD and substance use disorder; international consensus].

Author

Spijkerman R, Crunelle CL, Özgen MH, Begeman AHA, Dom G, van de Glind G, Groenman AP, van Kernebeek MW, Matthys F, Post M, Schellekens A, Staal W, van den Brink W, and Hendriks VM

Subjects
Adolescent, Comorbidity, Consensus, Humans, Attention Deficit Disorder with Hyperactivity diagnosis, Attention Deficit Disorder with Hyperactivity epidemiology, Attention Deficit Disorder with Hyperactivity therapy, Central Nervous System Stimulants therapeutic use, Substance-Related Disorders diagnosis, Substance-Related Disorders epidemiology, Substance-Related Disorders therapy
Abstract

Background: Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure., Aim: To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD., Method: In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations., Results: Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment., Conclusion: Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

Published
2021

24. [International consensus for the screening, diagnosis and treatment of adult patients with substance use disorder and ADHD].

Author

Crunelle CL, van den Brink W, Schellekens A, van de Glind G, Icasa Consortium B, and Matthys F

Subjects
Attention Deficit Disorder with Hyperactivity epidemiology, Comorbidity, Consensus, Humans, Mass Screening, Substance-Related Disorders epidemiology, Attention Deficit Disorder with Hyperactivity diagnosis, Attention Deficit Disorder with Hyperactivity therapy, Substance-Related Disorders diagnosis, Substance-Related Disorders therapy
Abstract

Background: Substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur in adults. Together, they complicate diagnosis and can negatively influence treatment outcome.
AIM: To develop a practical guide to assist professionals with the screening, diagnosis and treatment of adult patients with SUD and ADHD.
METHOD: A literature search and a consensus procedure between several international scientific and clinical experts. This manuscript is an adapted and summarized Dutch version of the International consensus statement on screening, diagnosis and treatment of patients with SUD and comorbid ADHD.
RESULTS: The routine use of adequate screening tools enables ADHD to be detected earlier in adults with SUD. The diagnostic process for ADHD should be initiated as soon as possible in patients with SUD. Integrated treatment, involving a combination of pharmacotherapy and psychotherapy, is preferred. Long-acting stimulants with up-titration to higher dosages may be considered.
CONCLUSION: Early detection of ADHD in patients with SUD is essential for adequate diagnosis and more effective treatment and follow-up for these patients.

Published
2019

25. Fractionation of a tumor-initiating UV dose introduces DNA damage-retaining cells in hairless mouse skin and renders subsequent TPA-promoted tumors non-regressing.

Author

van de Glind G, Rebel H, van Kempen M, Tensen K, and de Gruijl F

Subjects
Animals, Carcinogens toxicity, Carcinoma, Squamous Cell etiology, Carcinoma, Squamous Cell metabolism, Cell Transformation, Neoplastic metabolism, Cell Transformation, Neoplastic radiation effects, DNA Damage drug effects, Epidermis metabolism, Epidermis radiation effects, Female, Hyperplasia etiology, Hyperplasia metabolism, Hyperplasia pathology, Immunoenzyme Techniques, Male, Mice, Mice, Hairless, Mutation genetics, Real-Time Polymerase Chain Reaction, Skin Neoplasms etiology, Skin Neoplasms metabolism, Tumor Suppressor Protein p53 genetics, Carcinoma, Squamous Cell pathology, Cell Transformation, Neoplastic pathology, DNA Damage radiation effects, Epidermis pathology, Skin Neoplasms pathology, Tetradecanoylphorbol Acetate toxicity, Ultraviolet Rays adverse effects
Abstract

Sunburns and especially sub-sunburn chronic UV exposure are associated with increased risk of squamous cell carcinomas (SCCs). Here we focus on a possible difference in tumor initiation from a single severe-sunburn dose (on day 1, 21 hairless mice) and from an equal dose fractionated into very low sub-sunburn doses not causing any (growth-promoting) epidermal hyperplasia (40 days daily exposure, n=20). From day 47 all mice received 12-O-Tetradecanoylphorbol-13-acetate (TPA) applications (2x/wk) for 20 weeks to promote tumor development within the lifetime of the animals. After the sub-sunburn regimen sparse DNA damage-retaining basal cells (quiescent stem cells, QSCs) remained in the non-hyperplastic epidermis. These cells were forced to divide by TPA. After discontinuation of TPA tumors regressed and disappeared in the 'sunburn group' but persisted and grew in the 'sub-sunburn group' (0.06 vs 2.50 SCCs and precursors ≥4 mm/mouse after 280 days, p=0.03). As the tumors carried no mutations in p53, H/K/N-Ras and Notch1/2, these 'usual suspects' were not involved in the UV-driven tumor initiation. Although we could not selectively eliminate QSCs (unknown phenotype) to establish causality, our data suggest that forcing specifically DNA damage-retaining QSCs to divide--with high mutagenic risk--gives rise to persisting (mainly 'in situ') skin carcinomas.

Published
2016
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26. Early developmental, temperamental and educational problems in 'substance use disorder' patients with and without ADHD. Does ADHD make a difference?

Author

Skutle A, Bu ETH, Jellestad FK, van Emmerik-van Oortmerssen K, Dom G, Verspreet S, Carpentier PJ, Ramos-Quiroga JA, Franck J, Konstenius M, Kaye S, Demetrovics Z, Barta C, Fatséas M, Auriacombe M, Johnson B, Faraone SV, Levin FR, Allsop S, Carruthers S, Schoevers RA, Koeter MWJ, van den Brink W, Moggi F, Møller M, and van de Glind G

Abstract

Introduction: The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants?, Method: An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40 years and 27% of the sample was female. All participants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV., Results: SUD patients with ADHD ( n  = 196; 16.3% of the total sample) had a significantly slower infant development than SUD patients without ADHD ( n  = 1,009; 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD., Conclusion: The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Published
2015
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27. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population.

Author

van de Glind G, Van Emmerik-van Oortmerssen K, Carpentier PJ, Levin FR, Koeter MW, Barta C, Kaye S, Skutle A, Franck J, Konstenius M, Bu ET, Moggi F, Dom G, Demetrovics Z, Fatséas M, Schillinger A, Kapitány-Fövény M, Verspreet S, Seitz A, Johnson B, Faraone SV, Ramos-Quiroga JA, Allsop S, Carruthers S, Schoevers RA, and van den Brink W

Subjects
Adult, Attention Deficit Disorder with Hyperactivity rehabilitation, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Mass Screening methods, Middle Aged, Protective Factors, Psychometrics statistics & numerical data, Reproducibility of Results, Research Design, Risk Factors, Substance-Related Disorders rehabilitation, Surveys and Questionnaires, Young Adult, Attention Deficit Disorder with Hyperactivity epidemiology, Substance-Related Disorders epidemiology
Abstract

Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHD Self-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders., (Copyright © 2013 John Wiley & Sons, Ltd.)

Published
2013
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28. UV-induced ablation of the epidermal basal layer including p53-mutant clones resets UV carcinogenesis showing squamous cell carcinomas to originate from interfollicular epidermis.

Author

Rebel HG, Bodmann CA, van de Glind GC, and de Gruijl FR

Subjects
Animals, Apoptosis, Carcinoma, Squamous Cell genetics, Caspase 3 genetics, Caspase 3 metabolism, Cell Transformation, Neoplastic, DNA Damage, Epidermis metabolism, Epidermis pathology, Female, Male, Mice, Mice, Hairless, Skin Neoplasms genetics, Sunburn pathology, Tumor Suppressor Protein p53 genetics, Carcinoma, Squamous Cell pathology, Epidermis radiation effects, Genes, p53, Neoplasms, Radiation-Induced pathology, Skin Neoplasms pathology, Tumor Suppressor Protein p53 metabolism, Ultraviolet Rays adverse effects
Abstract

Chronic ultraviolet (UV) exposure induces clones of cells overexpressing mutant p53 in the interfollicular (IF) epidermis and subsequently squamous cell carcinomas (SCCs) with similar p53 mutations. Mutated p53 may give cells growth advantage over neighbouring cells by impaired apoptosis. We tested this by UV overexposure of skin laden with p53-mutant clones and assessed the impact on subsequent tumour development. P53-mutant clones were induced in two groups of hairless SKH1 mice by daily exposures (500 J/m(2) UV from TL12 lamps) for 28 days. On day 29, one group was overexposed (to 10 kJ/m(2) UV), whereas the control group received the regular daily dose. After 1 week of recovery, the daily exposures were resumed in both groups to induce SCCs. UV overexposure forced the entire IF basal layer into caspase-3-driven apoptosis while leaving overlying layers with sunburn cells intact. No apparent regions were spared from apoptosis. Pulse-chase BrdU labelling showed the IF epidermis to be repopulated from the hair follicles (remaining p63 positive). One week after overexposure, the p53-mutant clones had virtually disappeared (0.6, 95% confidence interval 0.5-0.8 per mouse versus 102, 59-179, without overexposure). Tumour development was significantly delayed after UV overexposure (P < 0.0001) by an average of 27 days (standard error of the mean 3); a period matching that of daily exposures preceding the overexposure. Thus, we found that UV-induced ablation of the IF epidermal basal layer eliminates p53-mutant clones and resets UV carcinogenesis. Furthermore, and in contrast with earlier reports, our data show that UV-induced p53-mutant clones and SCCs originate from the IF epidermis.

Published
2012
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29. Targeted delivery of TLR ligands to human and mouse dendritic cells strongly enhances adjuvanticity.

Author

Tacken PJ, Zeelenberg IS, Cruz LJ, van Hout-Kuijer MA, van de Glind G, Fokkink RG, Lambeck AJ, and Figdor CG

Subjects
Adjuvants, Immunologic administration & dosage, Animals, CD8-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes metabolism, Cells, Cultured, Cytokines blood, Cytokines immunology, Cytokines metabolism, Cytotoxicity, Immunologic immunology, Dendritic Cells metabolism, Drug Delivery Systems methods, Female, Flow Cytometry, Humans, Lymphocyte Activation immunology, Male, Mice, Mice, Inbred C57BL, Microscopy, Confocal, Monocytes immunology, Monocytes metabolism, Nanoparticles administration & dosage, T-Lymphocytes, Cytotoxic immunology, T-Lymphocytes, Cytotoxic metabolism, Time Factors, Toll-Like Receptors metabolism, Vaccines administration & dosage, Dendritic Cells immunology, Ligands, Toll-Like Receptors immunology, Vaccines immunology
Abstract

Effective vaccines consist of 2 components: immunodominant antigens and effective adjuvants. Whereas it has been demonstrated that targeted delivery of antigens to dendritic cells (DCs) improves vaccine efficacy, we report here that co-targeting of TLR ligands (TLRLs) to DCs strongly enhances adjuvanticity and immunity. We encapsulated ligands for intracellular TLRs within biodegradable nanoparticles coated with Abs recognizing DC-specific receptors. Targeted delivery of TLRLs to human DCs enhanced the maturation and production of immune stimulatory cytokines and the Ag-specific activation of naive CD8(+) T cells. In vivo studies demonstrated that nanoparticles carrying Ag induced cytotoxic T-lymphocyte responses at 100-fold lower adjuvant dose when TLRLs were co-encapsulated instead of administered in soluble form. Moreover, the efficacy of these targeted TLRLs reduced the serum cytokine storm and related toxicity that is associated with administration of soluble TLRLs. We conclude that the targeted delivery of adjuvants may improve the efficacy and safety of DC-based vaccines.

Published
2011
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