Abstract Body

Attention deficit hyperactivity disorder (ADHD), which is characterized by the core symptoms inattention, impulsivity and hyperactivity, is a chronic neurodevelopmental disorder with childhood onset and persists into adulthood in many patients. A cross-national study conducted across Europe, the Americas, and Asia estimated a prevalence in adults of 3.4% according to DSM-IV-criteria. With release of DSM-5, specific diagnostic criteria for classification of adults are available. Comparing DSM-IV to DSM-5, for the clinician one of the most important changes is the requirement that some symptoms must be present before age 12 instead before age 7 and that the symptom threshold has been reduced from six to five symptoms. As diagnostic prevalence in psychiatric clinical samples and insurance records surveys is still far below the population based prevalence rate, next years will show, if these changes will help to improve patient care and recognition of adult ADHD. The focus of this lecture is nosology of ADHD including symptoms, functional impairment and to update diagnostic tools availables to diagnose ADHD in adults.

Abstract Body

NTRODUCTION:

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, which presents a high comorbidity with anxiety and affective signs and symptoms. It has repercussions on the functioning of those suffering from it, who also have low therapy compliance and generate a significant cost both at a personal level and for society. Mindfulness is a psychological treatment that has proved to be effective for ADHD. Virtual reality is widely used as treatment in cases of phobias and other pathologies, with positive results.

AIMS:

To develop the first treatment for ADHD in adults based on virtual reality and mindfulness, while also resulting in increased treatment adherence and reduced costs.

PATIENTS AND METHODS:

We conducted a pilot study with 25 patients treated by means of virtual reality, in four 30-minute sessions, and 25 treated with psychostimulants. Measures will be taken pre-treatment, post-treatment, to evaluate both ADHD and also depression, anxiety, functionality and quality of life. Data will be later analysed with the SPSS v. 20 statistical program. An ANOVA of independent groups will be performed to see the differences between treatments and also a test-retest to detect whether the changes will be maintained.

RESULTS AND CONCLUSIONS:

It is necessary to use treatments that are effective, reduce costs and increase therapy adherence. Treatment with virtual reality is an interesting alternative to the classical treatments, and is shorter and more attractive for patients.

Abstract Body

Across all available guidelines and the European consensus statement, a multimodal treatment approach is recommended that addresses adult ADHD and associated co-morbid disorders in the treatment plan if symptoms are clinically impairing and involve the patients’ partners and, family members. The multimodal treatment approach should include psycho-education, pharmacotherapy, and disorder-oriented psychotherapy for ADHD and family or couple therapy if needed.

Pharmacotherapy for adults with ADHD has shown to be highly effective and is recommended as first-line treatment for adult ADHD in the NICE guidelines. The first-line drugs for adults with ADHD are the stimulants (methylphenidate or lisdexamphetamine). The effect size for stimulants in adults is also quite high (around 1.0).

Several stimulants are available with methylphenidate (MPH) being the most extensively studied. MPH is available in different formulations including immediate-release (IR) tablets, extended-release (ER) tablets and the OROS MPH formulation. Other stimulant treatment options for adult ADHD include mixed amphetamine salts ER, dexmethylphenidate IR and ER, and lisdexamfetamine dimesylate. Stimulants have proven to be effective in adults with ADHD: around 70% of patients respond to the first stimulant prescribed to them, while around 90% respond to either the first or second stimulant prescribed. The treatment with stimulants are quite well tolerated in adults, but it is necessary to carry out a clinical examination prebious to prescription (blood tension, family history of sudden dead). Treatment with stimulants in adults with ADHD is associated with reductions in criminality, car accidents, suicide, depression and substance use disorder.