Pallucchini Alessandro, Carli Marco, Maremmani Angelo G I, Scarselli Marco, Perugi Giulio, Maremmani Icro
PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy.
Department of Clinical and Experimental Medicine, School of Clinical Pharmacology, University of Pisa, 56100 Pisa, Italy.
J Clin Med. 2021 May 5;10(9):1984. doi: 10.3390/jcm10091984.
Attention-Deficit/Hyperactivity Disorder (ADHD) is the most widespread neurodevelopmental disorder, and it still persists into adulthood in 2-6% of the population. Psychiatric comorbidities are very common in adult ADHD (A-ADHD) patients; in particular, Substance Use Disorder (SUD) is found in 40% of these patients. Co-occurrence of ADHD and SUD is described as detrimental to clinical outcome by many authors, while only a few studies describe good clinical results in A-ADHD-SUD patients when they were treated for ADHD, both for the efficacy and the compliance of patients. In this study we tested to determine whether SUD can influence the treatment outcome of A-ADHD patients by correlating lifetime, past and current substance use in A-ADHD patients with their outcome (retention rate) during a 5-year follow-up of patients treated with stimulant and non-stimulant medications, using Kaplan-Meier survival analysis with overall and pairwise comparison. The association between demographic, symptomatological and clinical aspects with retention in treatment, adjusting for potential confounding factors, was summarized using Cox regression. After 5 years of observation, the cumulative treatment retention was 49.0%, 64.3% and 41.8% for A-ADHD patients without lifetime SUD (NSUD/A-ADHD), A-ADHD with past SUD (PSUD/A-ADHD) and A-ADHD with current SUD (CSUD/A-ADHD), respectively. Overall comparisons were not significant (Wilcoxon Rank-Sum (statistical) Test = 1.48; df = 2; = 0.477). The lack of differences was confirmed by a Cox regression demonstrating that the ADHD diagnosis according to DIVA, gender, education, civil status, presence of psychiatric comorbidity, and psychiatric and ADHD familiarity; severity of symptomatological scales as evaluated by WHODAS, BPRS, BARRAT, DERS, HSRS, and ASRS did not influence treatment drop-out (χ2 22.30; df = 20 = 0.324). Our A-ADHD-SUD patients have the same treatment retention rate as A-ADHD patients without SUD, so it seems that substance use comorbidity does not influence this clinical parameter.
注意力缺陷/多动障碍（ADHD）是最常见的神经发育障碍，在2%至6%的人群中会持续到成年期。精神共病在成年ADHD（A-ADHD）患者中非常普遍；特别是，40%的此类患者存在物质使用障碍（SUD）。许多作者认为ADHD和SUD同时出现对临床结果不利，而只有少数研究描述了A-ADHD-SUD患者在接受ADHD治疗时，无论是疗效还是患者依从性方面都有良好的临床结果。在本研究中，我们进行测试以确定SUD是否会影响A-ADHD患者的治疗结果，方法是将A-ADHD患者的终身、过去和当前物质使用情况与他们在接受兴奋剂和非兴奋剂药物治疗的5年随访期间的结果（保留率）进行关联分析，采用Kaplan-Meier生存分析及总体和两两比较。使用Cox回归总结了人口统计学、症状学和临床方面与治疗保留率之间的关联，并对潜在的混杂因素进行了调整。经过5年的观察，无终身SUD的A-ADHD患者（NSUD/A-ADHD）、有过去SUD的A-ADHD患者（PSUD/A-ADHD）和有当前SUD的A-ADHD患者（CSUD/A-ADHD）的累积治疗保留率分别为49.0%、64.3%和41.8%。总体比较无显著差异（Wilcoxon秩和检验=1.48；自由度=2；P=0.477）。Cox回归证实了无差异，表明根据DIVA诊断的ADHD、性别、教育程度、婚姻状况、精神共病的存在、精神疾病和ADHD家族史；由WHODAS、BPRS、BARRAT、DERS、HSRS和ASRS评估的症状学量表严重程度均不影响治疗退出率（χ2=22.30；自由度=2 =0.324）。我们的A-ADHD-SUD患者与无SUD的A-ADHD患者具有相同的治疗保留率，因此物质使用共病似乎不会影响这一临床参数。
