scholarly journals The diagnosis and management of adult ADHD in HMP Elmley, a Category B remand prison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S90-S90
Author(s):  
Kathleen McCurdy ◽  
Nosa Igbinomwanhia
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Physical Health ◽  
Attention Deficit ◽  
Prison Population ◽  
Waiting Times ◽  
Adhd Medication ◽  
Diagnosis And Management ◽  
Hyperactivity Disorder ◽  
Initial Appointment

AimsAttention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder in young adult prisoners. This audit aimed to identify how many residents are prescribed medication treatment for ADHD in HMP Elmley and whether those seen by the prison psychiatrists have been managed in line with NICE guidelines. We also audited waiting times and time to follow-up appointments. This was done with the overall aim to identify potential areas for development.MethodWe performed a spot audit of all residents in HMP Elmley who were prescribed ADHD medication on 4th November 2019, using their electronic patient records. Appointments with the psychiatrists were then subdivided into initial assessments and follow-up appointments for the purpose of analysis. Performance was measured against NICE Guideline [NG87]: Attention deficit hyperactivity disorder: diagnosis and management. We also calculated the waiting times for initial appointment and follow-up appointment.ResultWe found that 33 of residents were on ADHD medication at the time of the audit, approximately 3% of the prison population. 64% of those had a pre-existing diagnosis and 36% had been given a new diagnosis at HMP Elmley. Of those newly diagnosed 100% had undergone a Diagnostic Interview for Adults in ADHD (DIVA) assessment for diagnosis.Baseline physical health checks had been performed in 68% of patients prior to starting medication and a cardiovascular examination had occurred in 9%. At follow-up 100% of patients had their physical observations and weight checked and their symptoms reviewed.91% of patients were started on methylphenidate or lisdexamfetamine as first line treatment, with the rest started on atomoxetine and the reason for this documented.100% patients were offered general psychological support.There was a mean 22 day wait for an initial appointment (range 0-65) and a mean 20 day wait from starting medication to a psychiatric follow-up appointment (range 8-37)ConclusionThe number of residents treated for ADHD in HMP Elmley is relatively low (3%) compared to the estimated prevalence in prison population.The key areas for improvement are in baseline cardiovascular examinations and physical health evaluations. The waiting time between initial psychiatric appointment and follow-up is another area where improvement is needed and this will form the basis of a quality improvement project.Future steps include setting up a specific ADHD clinic with an allocated nurse practitioner to support, producing a template for ADHD assessments and follow-ups, producing a local policy on ADHD and developing specific resources for ADHD psychoeducation.

scholarly journals Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Viktoria Johansson ◽  
Sven Sandin ◽  
Zheng Chang ◽  
Mark J. Taylor ◽  
Paul Lichtenstein ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Clinical Studies ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Prescribing Patterns ◽  
Adhd Medication ◽  
Hyperactivity Disorder ◽  
Drug Register

Abstract Background Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. Methods Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. Results Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. Conclusions The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

scholarly journals Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based longitudinal study

2014 ◽  
Vol 205 (4) ◽  
pp. 291-297 ◽  
Author(s):  
Cédric Galéra ◽  
Jean-Baptiste Pingault ◽  
Grégory Michel ◽  
Manuel-Pierre Bouvard ◽  
Maria Melchior ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Psychiatric Comorbidity ◽  
Medication Use ◽  
Population Based ◽  
Social Characteristics ◽  
Adhd Medication ◽  
Social Variables ◽  
Hyperactivity Disorder ◽  
The Impact

BackgroundThe impact of longitudinal psychiatric comorbidity, parenting and social characteristics on attention-deficit hyperactivity disorder (ADHD) medication use is still poorly understood.AimsTo assess the baseline and longitudinal influences of behavioural and environmental factors on ADHD medication use.MethodSurvival regressions with time-dependent covariates were used to model data from a population-based longitudinal birth cohort. The sample (n = 1920) was assessed from age 5 months to 10 years. Measures of children's psychiatric symptoms, parenting practices and social characteristics available at baseline and during follow-up were used to identify individual and family-level features associated with subsequent use of ADHD medication.ResultsUse of ADHD medication ranged from 0.2 to 8.6% between ages 3.5 to 10 years. Hyperactivity–inattention was the strongest predictor of medication use (hazard ratio (HR) = 2.75, 95% CI 2.35–3.22). Among all social variables examined, low maternal education increased the likelihood of medication use (HR = 2.09, 95% CI 1.38–3.18) whereas immigrant status lowered this likelihood (HR = 0.40, 95% CI 0.17–0.92).ConclusionsBeyond ADHD symptoms, the likelihood of receiving ADHD medication is predicted by social variables and not by psychiatric comorbidity or by parenting. This emphasises the need to improve global interventions by offering the same therapeutic opportunities (including medication) as those received by the rest of the population to some subgroups (i.e. immigrants) and by diminishing possible unnecessary prescriptions.

Visual attention in adults with attention-deficit/hyperactivity disorder before and after stimulant treatment

2018 ◽  
Vol 49 (15) ◽  
pp. 2617-2625 ◽  
Author(s):  
Ann-Marie Low ◽  
Signe Vangkilde ◽  
Julijana le Sommer ◽  
Birgitte Fagerlund ◽  
Birte Glenthøj ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Visual Attention ◽  
Attention Deficit ◽  
Processing Speed ◽  
Visual Processing ◽  
Stimulant Medication ◽  
Hyperactivity Disorder ◽  
Visual Processing Speed ◽  
Adhd Symptomatology

AbstractBackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder which frequently persists into adulthood. The primary goal of the current study was to (a) investigate attentional functions of stimulant medication-naïve adults with ADHD, and (b) investigate the effects of 6 weeks of methylphenidate treatment on these functions.MethodsThe study was a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 stimulant medication-naïve adult patients with ADHD, and 42 age and parental education-matched healthy controls. Assessments included measures of visual attention, based on Bundesen's Theory of Visual Attention (TVA), which yields five precise measures of aspects of visual attention; general psychopathology; ADHD symptoms; dyslexia screening; and estimates of IQ.ResultsAt baseline, significant differences were found between patients and controls on three attentional parameters: visual short-term memory capacity, threshold of conscious perception, and to a lesser extent visual processing speed. Secondary analyses revealed no significant correlations between TVA parameter estimates and severity of ADHD symptomatology. At follow-up, significant improvements were found specifically for visual processing speed; this improvement had a large effect size, and remained when controlling for re-test effects, IQ, and dyslexia screen performance. There were no significant correlations between changes in visual processing speed and changes in ADHD symptomatology.ConclusionsADHD in adults may be associated with deficits in three distinct aspects of visual attention. Improvements after 6 weeks of medication are seen specifically in visual processing speed, which could represent an improvement in alertness. Clinical symptoms and visual attentional deficits may represent separate aspects of ADHD in adults.

scholarly journals Diagnostic Support System for the Detection of Attention Deficit Hyperactivity Disorder Using EOG Signals

2021 ◽  
Author(s):  
Esra Demirci ◽  
Mustafa Yasin Esas ◽  
Çiğdem Gülüzar Altıntop ◽  
Neslihan Taştepe ◽  
Fatma Latifoğlu
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Support System ◽  
Attention Deficit ◽  
Diagnostic Methods ◽  
Healthy Individuals ◽  
Subjective Effect ◽  
Hyperactivity Disorder ◽  
Diagnostic Support

Abstract Although Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disease, objective diagnostic methods are insufficient still. Current diagnostic methods include the subjective influence of the evaluator. In this context, in our study, we aimed to minimize the subjective effect of the evaluator with the objective diagnosis support system for ADHD.In our study, a visual stimulus follow-up test developed by us was applied to the patient with ADHD and healthy individuals, and electrooculogram (EOG) signals were recorded simultaneously. With the features extracted from EOG signals, Artificial Neural Networks (ANN) were used for the classification study of patients and healthy individuals, and it was determined that the classification of ADHD and healthy group could be distinguished by 81.76% performance. Thus, the outcomes that will contribute to the objective diagnosis of ADHD have been presented. The results are remarkable and important findings have been obtained that will contribute to the literature.

scholarly journals Correlates of nicotine dependence in men with childhood attention-deficit/hyperactivity disorder: a 33-year follow-up

2018 ◽  
Vol 11 (2) ◽  
pp. 183-189
Author(s):  
Lourdes García Murillo ◽  
María A. Ramos-Olazagasti ◽  
Rachel G. Klein ◽  
Salvatore Mannuzza ◽  
Francisco Xavier Castellanos
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Nicotine Dependence ◽  
Attention Deficit ◽  
Hyperactivity Disorder
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