Comment: As close as possible to reality
Nikos Myttas
pp 3-3
The diagnostic concept of
attention deficit hyperactivity
disorder (ADHD) has come of age. An increasing number of clinicians are recognising, accepting and treating
ADHD effectively, notwithstanding its complexity and the frequent diagnostic
dilemmas it presents.
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Managing ADHD across Europe: the views from France and Spain
Samuele Cortese and Diane Purper-Ouakil, Isabel Hernández Otero
pp 4-7
ADHD in practice is exploring how attention deficit hyperactivity disorder (ADHD) is managed in different European countries. The two countries featuring in this issue are France and Spain.
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ADHD, schizophrenia and methylphenidate
Peter Mason
pp 8-10
The use of methylphenidate (MPH) to treat attention deficit hyperactivity disorder
(ADHD) in patients with comorbid psychosis is controversial, with much evidence to suggest
that stimulants can increase psychosis levels in 50–70% of patients with schizophrenia. This is not surprising when one considers the mode of action of stimulant drugs and
the dopamine hypothesis of schizophrenia.
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Prescription stimulant abuse: vigilance is needed
Nigel Humphrey
pp 11-13
The use of stimulants to treat attention deficit
hyperactivity disorder (ADHD) is widely
accepted as safe and effective, provided that
prescriptions are made in accordance with
medical guidelines. There is a clear body of
evidence showing that treating ADHD with
stimulants actually reduces the risk of ADHD
patients developing a substance-use disorder
later in life. However, there have been increasing numbers of reports saying that
stimulants prescribed to the general population are being diverted.
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The reality of living with ADHD
Andrea Bilbow
pp 14-16
Over the years, the UK Attention Deficit Disorder Information and Support Service
(ADDISS) has undertaken several family surveys that give a clear picture of what it is like to live with attention deficit hyperactivity
disorder (ADHD). We believe this information is invaluable for anyone drafting guidelines
for assessment and treatment. Unfortunately, the National Institute for Health and Clinical Excellence did not include this kind of research in its 2008 clinical guideline on ADHD, but only considered what was already published or what it had itself commissioned. We believe that our role is to bring the reality of the condition to the foreground, and would therefore like to share some of the results of our research in this article.
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Does ADHD increase the risk of developing addiction?
Jacques Bouchez, Hervé Caci and Franck Bayle
pp 17-17
The relationship between attention deficit hyperactivity disorder (ADHD) and addiction represents a major field of interest for clinicians. Numerous studies have found that ADHD sufferers are over-represented among
alcohol abusers or addicts (35–70%) and among drug abusers or addicts (15–25%).
Furthermore, it has been found that 17–45% of ADHD patients are alcohol addicts and 9–30% are illicit drug addicts. In adults with ADHD, substance use disorder (SUD) is often
more severe and has an earlier onset than in the general adult population. Even though the epidemiological data for most European countries
are patchy, the issue of SUD in ADHD sufferers remains a valid one.
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The general adult psychiatrist and ADHD
Trevor Turner
pp 18-21
Over the last ten years, there has been a change in the assessments and treatments
required of general adult psychiatrists, generated
in part by the new specialist teams of the NHS plan and in part by the ‘new ways of
working’ policy. There have also been pressures to integrate more closely with primary care, which is not unreasonable given that
about 90% of mental health assessments take place in the GP surgery. Instead of being
‘asylum doctors’ relocated into community mental health teams (CMHTs) and looking
after people with chronic severe psychoses, general adult psychiatrists now have to take on board the remit and concerns of GPs.
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Nurse prescribing: the need to act in a concordant way
Noreen Ryan
pp 22-23
Nurses have historically been involved with medication management, mainly dispensing
and administration, particularly in hospitals.
Recently, they have taken on a more active role by embracing new ways of working, including
nurse prescribing. There has been a great shift towards patients being more involved in their own healthcare, particularly in the case of
chronic health problems. However, there is much debate about the validity and safety of nurse prescribing, especially in mental health
nursing. There is increasing concern, in the UK, that many prescribed medicines are either
returned to pharmacies without being taken, not taken per the stated regimen, or not taken
by the person to whom they were prescribed.
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