PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy.
School of Clinical Pharmacology, University of Pisa, 56100 Pisa, Italy.
Int J Environ Res Public Health. 2020 May 17;17(10):3509. doi: 10.3390/ijerph17103509.
While a large amount of medical literature has explored the association between Attention Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUDs), less attention has been dedicated to the typologies of SUD and their relationships with ADHD-specific symptomatology and general psychopathology in dual disorder patients.
We selected 72 patients (aged 18-65) with a concomitant SUD out of 120 adults with ADHD (A-ADHD). Assessment instruments included the Diagnostic Interview for ADHD in adults (DIVA 2.0), Conner's Adult ADHD Rating Scales-Observer (CAARS-O:S): Short Version, the Structured Clinical Interview for Axis I and II Disorders (SCID-I), the Barratt Impulsiveness Scale (BIS-11), the Brief Psychiatric rating scale (BPRS), the Reactivity Intensity Polarity Stability Questionnaire (RIPoSt-40), the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Morningness-Eveningness Questionnaire (MEQ). A factorial analysis was performed to group our patients by clusters in different typologies of substance use and correlations between SUDs, as made evident by their typological and diagnostic features; in addition, specific ADHD symptoms, severity of general psychopathology and patients' functionality were assessed.
Two patterns of substance use were identified: the first (type 1) characterized by stimulants/alcohol and the second (type 2) by the use of cannabinoids (THC). Type 1 users were significantly younger and had more legal problems. The two patterns were similar in terms of ADHD-specific symptomatology and its severity at treatment entry. No differences were found regarding the other scales assessed, except for lower scores at MEQ in type 1 users.
At treatment entry, the presence of different comorbid SUD clusters do not affect ADHD-specific symptomatology or severity.
虽然大量医学文献探讨了注意力缺陷/多动障碍（ADHD）与物质使用障碍（SUD）之间的关联，但对于 SUD 的类型及其与双相障碍患者的 ADHD 特异性症状和一般精神病理学的关系，关注较少。
我们从 120 名成人 ADHD（A-ADHD）患者中选择了 72 名伴有并发 SUD 的患者。评估工具包括成人 ADHD 诊断访谈（DIVA 2.0）、Conner's 成人 ADHD 评定量表-观察者（CAARS-O：短版）、轴 I 和 II 障碍的结构临床访谈（SCID-I）、Barratt 冲动量表（BIS-11）、简明精神病评定量表（BPRS）、反应强度极性稳定性问卷（RIPoSt-40）、世界卫生组织残疾评估量表（WHODAS 2.0）和晨型/晚型问卷（MEQ）。通过因子分析，根据物质使用的不同类型对我们的患者进行分组，并根据其类型和诊断特征对 SUD 进行相关性分析；此外，还评估了特定的 ADHD 症状、一般精神病理学的严重程度和患者的功能。
确定了两种物质使用模式：第一种（类型 1）以兴奋剂/酒精为特征，第二种（类型 2）以大麻素（THC）为特征。类型 1 使用者明显更年轻，且有更多的法律问题。在治疗开始时，两种模式在 ADHD 特异性症状及其严重程度方面相似。在评估的其他量表中没有发现差异，除了类型 1 使用者的 MEQ 得分较低。
在治疗开始时，不同共患 SUD 簇的存在不会影响 ADHD 特异性症状或严重程度。
