Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen mit assoziierter Symptomatik und komorbiden psychiatrischen Erkrankungen: Diagnostik und medikamentöse Behandlung

Zusammenfassung

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) des Erwachsenenalters ist eine häufige psychiatrische Erkrankung mit Beginn im Kindesalter und wird durch die Kernsymptome Aufmerksamkeitsstörungen, Hyperaktivität und impulsives Verhalten gekennzeichnet. Neben der Kernsymptomatik liegen häufig weitere Symptome, insbesondere emotionale Labilität, Schlafstörungen und Selbstwertbeeinträchtigungen und/oder komorbide psychiatrische Erkrankungen, v. a. depressive Episoden, Suchterkrankungen und Angststörungen vor. Diagnostik und Behandlung der ADHS des Erwachsenenalters sollten daher auch assoziierte Symptomatik und komorbide psychiatrische Erkrankungen umfassen. Erfolgt eine Einordnung der assoziierten Symptomatik als ADHS-inhärent, sollte zunächst die ADHS spezifisch behandelt und die assoziierte Symptomatik im Verlauf beobachtet werden. Wird die zusätzlich vorliegende Symptomatik als eigenständige psychiatrische Störung eingeordnet, sollte die psychiatrische Erkrankung mit der größten Krankheitsschwere vorrangig und störungsspezifisch behandelt werden. Die vorliegende Übersicht stellt den aktuellen Wissensstand zur Differenzialdiagnostik und Behandlung der ADHS des Erwachsenenalters mit assoziierten Symptomen und komorbiden psychiatrischen Erkrankungen entsprechend den Empfehlungen internationaler Leitlinien, klinischer Studien und Expertenmeinungen vor.

Abstract

Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions.

Schlüsselwörter

ADHS des Erwachsenenalters - depressive Episode - Suchterkrankung - Angststörung - Schlafstörung

Key words

adult ADHD - depression - substance abuse disorder - anxiety disorder - sleep disorder

• Literatur

• 1 World Health Organisation. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation; 1992
• 2 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (4th ed., text revision) Washington, DC: Author; 2000
• 3 Simon V, Czobor P, Balint S et al. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 2009; 194: 204-211
• 4 De Zwaan M, Gruß B, Müller A et al. The estimated prevalence and correlates of adult ADHD. Eur Arch Psychiatry Clin Neurosci 2012; 262: 79-86
• 5 Sobanski E, Brüggemann D, Alm B et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention deficit/ hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2007; 257: 371-377
• 6 Barkley RA, Brown TE. Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr  2008; 13: 977-984
• 7 Kooij SJ, Bejerot S, Blackwell A et al. European consensus statement of adult ADHD: The European Network adult ADHD. BMC Psychiatry 2012; 10: 67
• 8 Nutt DJ, Fone K, Asherson P et al. British Association for Psychopharmacology. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2007; 21: 10-41
• 9 National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. 2008 (full guideline: www.nice.org.uk/CG072)
• 10 Ebert D, Krause J, Roth-Sackenheim C. ADHD in adulthood – guidelines based on expert consensus with DGPPN support. Nervenarzt 2003; 74: 939-946
• 11 Moss SB, Nair R, Vallarino A et al. Attention deficit/hyperactivity disorder in adults. Prim Care 2007; 34: 445-473
• 12 Alpert JE, Maddocks A, Nierenberg AA et al. Attention deficit hyperactivity disorder in childhood among adults with major depression. Psychiatry Res 1996; 62: 213-219
• 13 Sobanski E, Krumm B, Alm B. Methylphenidatbehandlung bei Erwachsenen mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS): Bedeutung von Störungssubtyp und Komorbidität. Nervenarzt 2007; 78: 328-337
• 14 Spencer TJ, Faraone SV, Michelson D et al. Atomoxetine and adult attention-deficit/hyperactivity disorder: The effects of comorbidity. J Clin Psychiatry 2006; 67: 415-420
• 15 Schatzberg AF, Kelsey DK, Williams DW. Addition of atomoxetine for depression incompletely responsive to sertraline: A randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007; 68: 582-587
• 16 Weintraub D, Mavandadi S, Mamikonyan E et al. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology 2010; 75: 444-455
• 17 Bangs ME, Emslie GJ, Spencer TJ et al. Efficacy and safety of atomoxetine in adolescents with attention-deficit/hyperactivity disorder and major depression. J Child Adolesc Psychopharmacol 2007; 17: 407-420
• 18 Hornig-Rohan M, Amsterdam JD. Venlafaxine versus stimulant therapy in patients with dual diagnosis ADD and depression. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 585-589
• 19 Rösler M, Retz W, Fischer R et al. Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. World J Biol Psychiatry 2010; 11: 709-718
• 20 Reimherr FW, Marchant BK, Strong RE et al. Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry 2005; 58: 125-131
• 21 Reimherr FW, Williams ED, Strong RE et al. A double-blind crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry 2007; 68: 93-101
• 22 Sobanski E, Sabljic D, Alm B et al. A Randomized, Waiting List-Controlled 12-Week Trial of Atomoxetine in Adults with ADHD. Pharmacopsychiatry 2011; 45: 100-107
• 23 Fallgatter AJ, Jacob CP. Comorbidity of substance use disorders and attention-deficit hyperactivity disorders: Pathogenesis and therapy. Nervenarzt 2009; 80: 1015-1021
• 24 Wilens TE. Attention deficit hyperactivity disorder and substance use disorders. Am J Psychiatry 2006; 163: 2059-2063
• 25 van Emmerik-van OortmerssenK, van de Glind G, van den Brink W et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend 2012; 122: 11-19
• 26 Faraone SV, Biederman J, Jetton JG et al. Attention deficit disorder and conduct disorder: longitudinal evidence for a familial subtype. Psychol Med 1997; 27: 291-300
• 27 Barkley RA, Fischer M, Smallish L. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 2004; 45: 195-211
• 28 Levin FR, Evans SM, Brooks DJ et al. Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend 2006; 81: 137-148
• 29 Schubiner H, Tzelepis A, Isaacson JH. The dual diagnosis of attention-deficit/hyperactivity disorder and substance abuse: case reports and literature review. J Clin Psychiatry 1995; 56: 146-150
• 30 Somoza EC, Winhusen TM, Bridge TP et al. An open-label pilot study of methylphenidate in the treatment of cocaine dependent patients with adult attention deficit/hyperactivity disorder. J Addict Dis 2004; 23: 77-92
• 31 Carpentier PJ, de Jong CA, Dijkstra BA et al. A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction 2005; 100: 1868-1874
• 32 Levin FR, Evans SM, Brooks DJ et al. Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Drug Alcohol Depend 2007; 87: 20-29
• 33 Schubiner H, Saules KK, Arfken CL et al. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol 2002; 10: 286-294
• 34 Spencer T, Biederman J, Wilens TDR et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 2005; 57: 456-463
• 35 Upadhyaya HP. Managing attention-deficit/hyperactivity disorder in the presence of substance use disorder. J Clin Psychiatry 2007; 68 (Suppl. 11) 23-30
• 36 Koesters M, Becker T, Kilian R et al. Limits of meta-analysis: methylphenidate in the treatment of adult attention-deficit hyperactivity disorder. J Psychopharmacol 2009; 23: 733-744
• 37 Paslakis G, Kiefer F, Diehl A et al. Methylphenidate. Therapy option for adults with ADHD and comorbid substance use disorder?. Nervenarzt 2010; 81: 277-288
• 38 Klassen LJ, Bilkey TS, Katzman M et al. Comorbid Attention Deficit/Hyperactivity Disorder and Substance Use Disorder: Treatment Considerations. Curr Drug Abuse Rev 2012; May 8 [Epub ahead of print]
• 39 Gibson AP, Bettinger TL, Patel NC et al. Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder. Ann Pharmacother 2006; 40: 1134-1142
• 40 Wilens TE, Haight BR, Horrigan JP et al. Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled study. Biol Psychiatry 2005; 57: 793-801
• 41 Wilson JJ, Levin FR. Attention-deficit/hyperactivity disorder and early-onset substance use disorders. J Child Adolesc Psychopharmacol 2005; 15: 751-763
• 42 Volkow ND, Ding YS, Fowler JS et al. Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain. Arch Gen Psychiatry 1995; 52: 456-463
• 43 Volkow ND. Stimulant medications: how to minimize their reinforcing effects?. Am J Psychiatry 2006; 163: 359-361
• 44 Kollins SH. Comparing the abuse potential of methylphenidate versus other stimulants: A review of available evidence and relevance to the ADHD patient. J ClinPsychiatry 2003; 64 (Suppl. 11) 14-18
• 45 Arria AM, Caldeira KM, O'Grady KE et al. Nonmedical use of prescription stimulants among college students: associations with attention-deficit-hyperactivity disorder and polydrug use. Pharmacotherapy 2008; 28: 156-169
• 46 Bogle KE, Smith BH. Illicit methylphenidate use: a review of prevalence, availability, pharmacology, and consequences. Curr Drug Abuse Rev 2009; 2: 157-176
• 47 Franke AG, Bonertz C, Christmann M et al. Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany. Pharmacopsychiatry 2011; 44: 60-66
• 48 Kessler RC, Adler L, Barkley R et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163: 716-723
• 49 Van Ameringen M, Mancini C, Simpson W et al. Adult attention deficit hyperactivity disorder in an anxiety disorder population. CNS Neurosci Ther 2010; 17: 221-226
• 50 Adler A, Liebowitz M, Kronenberger W et al. Atomoxetin treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. Depression and Anxiety 2006; 26: 212-221
• 51 Surman C, Adamson J, Petty C et al. Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: Evidence from a large controlled study. J Clin Psychiatry 2009; 70: 1523-1529
• 52 Philipsen A, Feige B, Hesslinger B et al. Sleep in adults with attention-deficit/hyperactivity disorder: a controlled polysomnographic study including spectral analysis of the sleep EEG. Sleep 2005; 28: 738-745
• 53 Schredl M, Alm B, Sobanski E. Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Europ Arch Psychiatry Clin Neurosc 2007; 57: 164-168
• 54 Konofal E, Lecendreux M, Cortese S. Sleep and ADHD. Sleep Medicine 2010; 11: 652-658
• 55 Buysse D, Reynolds III C, Monk T et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213
• 56 Johns M. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540-545
• 57 Naseem S, Chaudhary B, Collop N. Attention deficit hyperactivity disorder in adults and obstructive sleep apnea. Chest 2011; 119: 294-296
• 58 Sobanski E, Schredl M, Kettler N et al. Sleep in adults with Attention Deficit Hyperactivity Disorder (ADHD) before and during treatment with methylphenidate: A controlled polysomnographic study. Sleep 2008; 31: 375-381
• 59 Kooij J, Middelkoop H, van Gils K et al. The effect of stimulants on nocturnal motor activity and sleep quality in adults with ADHD: An open-label case-control study. J Clin Psychiatry 2001; 62: 952-956
• 60 Morin CM. Psychological and behavioral treatments for insomnia I: Approaches and efficacy. In: Kryger MH, Roth T, Dement WC, (eds.) Principles and practice of sleep medicine. St. Louis, Mo: Saunders; 2011: 866-883