Consensus of the Czech neuropsychopharmacological society on the diagnosis and treatment of adult ADHD
Abstract
Attention deficit and/or hyperactivity disorder (ADHD) is a neurodevelopmental, highly heritable disorder. In contrast to the previous views that ADHD is solely an illness of childhood, it has been shown that high rates of its symptoms persist into adulthood in up to two thirds of patients.
This paper summarizes data on adult ADHD and represents a consensus of the Czech Neuropsychopharmacological Society on its diagnosis and treatment. Diagnosis of ADHD should be considered even if not diagnosed earlier during childhood; persistence of symptoms and functional impairment are essential.
In the clinical manifestation of adult patients, attention problems, desorganization, emotional dysregulation, and executive dysfunction are more prominent than hyperactivity. ADHD is associated with a high rate of comorbidity (mood and anxiety disorders, personality disorders, sleep problems, substance abuse), poor quality of life, and negative impact on psychosocial functioning and socioeconomic status.
For screening purposes, self-administered questionnaires and inventories can be used; the definite diagnosis is based on structured interviews and diagnostic tools. Most drugs effective in treatment of ADHD affect dopaminergic or norepinephric neurotransmission.
Stimulants and atomoxetine are the drugs with the strongest evidence of efficacy in therapy of adult ADHD. Atomoxetine is the only drug approved for treatment of adult ADHD in the Czech Republic.
It can be beneficial especially in patients at risk of substance abuse and comorbid anxiety. If stimulants are used, slow-release formulas are preferred.
Administration of other psychotropic drugs (bupropion, modafinil, guanfacine, desipramine) can be considered in the next step. Psychological non-pharmacological interventions (CBT, education, coaching) are part of the complex therapeutic approach.