物质使用障碍合并注意缺陷/多动障碍患者的治疗方法和治疗预测因素：ADHD与SUD国际自然队列研究（INCAS）的初步结果

Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder: First Results From the International Naturalistic Cohort Study of ADHD and SUD (INCAS).

作者信息

Brynte Christoffer, Schellekens Arnt, Barta Csaba, Begeman Alex H A, Crunelle Cleo L, Daigre Costanza, Demetrovics Zsolt, Dom Geert, Grau-López Lara, Hernandez Mariely, Icick Romain, Johnson Brian, Kapitány-Fövény Máté, van Kernebeek Michiel, Konstenius Maija, Levin Frances R, Luderer Mathias, Matthys Frieda, Moggi Franz, Ramos-Quiroga J Antoni, Schleussner Laura, Therribout Norman, Thomas Anil, Vorspan Florence, van den Brink Wim, Franck Johan

机构信息

Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.

Corresponding Author: Christoffer Brynte, MD, Dalagatan 86H, 122 43, Stockholm, Sweden (

出版信息

J Clin Psychiatry. 2024 Dec 23;86(1):24m15494. doi: 10.4088/JCP.24m15494.

DOI:10.4088/JCP.24m15494

PMID:39724095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11992959/

Abstract

Treatment of attention-deficit/ hyperactivity disorder (ADHD) in patients with a substance use disorder (SUD) and comorbid ADHD (SUD +ADHD) may have positive effects on the outcome of both conditions, but controversy exists regarding the preferred ADHD treatment in these patients. Little is known about the treatments that are provided for these patients in routine addiction care practice and the factors that are associated with treatment provision. To describe the treatments provided in everyday clinical practice and to explore factors associated with ADHD treatment provision in patients with SUD +ADHD. An international multicenter observational prospective cohort design was employed. Patients with moderate to severe SUD and comorbid ADHD according to were invited to participate at the start of a new SUD treatment episode between June 2017 and May 2021. Clinical and sociodemographic data were collected at 12 study sites in 9 countries through patient interviews, interviews with treatment providers, and patient files. Treatment variation across studies was described, and mixed-effect logistic regression was used to identify factors associated with ADHD treatment provision. A total of 578 treatment-seeking patients with SUD +ADHD (274 inpatients, 303 outpatients, and 1 unknown) were recruited. About two thirds received some kind of ADHD treatment (62.8%), with 54.0% receiving pharmacologic, 34.0% receiving psychological treatment, and 25.1% receiving combined pharmacologic and psychological treatment. The treatment site explained more of the variation in ADHD treatment provision than individual patient factors. In addition, higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. These findings suggest that treatment of SUD +ADHD patients is suboptimal even in specialized centers with substantial practice variation. Further research is needed to better understand the barriers to implement treatment guidelines for ADHD + SUD and, thus, to improve quality of care. ISRCTN: 15998989 20/12/2019 (https://doi.org/10.1186/ISRCTN15998989).

摘要

对患有物质使用障碍（SUD）且合并注意力缺陷多动障碍（ADHD）（SUD + ADHD）的患者进行ADHD治疗，可能对两种病症的治疗结果均产生积极影响，但对于这些患者首选的ADHD治疗方法仍存在争议。对于在常规成瘾护理实践中为这些患者提供的治疗方法以及与治疗提供相关的因素，人们知之甚少。描述日常临床实践中提供的治疗方法，并探索与SUD + ADHD患者的ADHD治疗提供相关的因素。采用国际多中心观察性前瞻性队列设计。根据[具体标准，原文未提及]，患有中度至重度SUD且合并ADHD的患者在2017年6月至2021年5月期间新的SUD治疗疗程开始时被邀请参与研究。通过患者访谈、与治疗提供者的访谈以及患者档案，在9个国家的12个研究地点收集临床和社会人口统计学数据。描述了不同研究中的治疗差异，并使用混合效应逻辑回归来确定与ADHD治疗提供相关的因素。共招募了578名寻求治疗的SUD + ADHD患者（274名住院患者、303名门诊患者和1名情况不明者）。约三分之二的患者接受了某种形式的ADHD治疗（62.8%），其中54.0%接受药物治疗，34.0%接受心理治疗，25.1%接受药物和心理联合治疗。治疗地点对ADHD治疗提供差异的解释比个体患者因素更多。此外，更高的ADHD症状严重程度和入院时的清醒状态与接受ADHD治疗相关。这些发现表明，即使在专门的中心，SUD + ADHD患者的治疗也并不理想，且存在大量的实践差异。需要进一步研究以更好地理解实施ADHD + SUD治疗指南的障碍，从而提高护理质量。国际标准随机对照试验编号：15998989 2019年12月20日（https://doi.org/10.1186/ISRCTN15998989）。