ADHD: a hidden comorbidity in adult psychiatric patients

Adult attention-deficit/hyperactivity disorder (aADHD) has recently been better recognized and treated in many European countries. In spite of this development, aADHD still features as a "hidden" comorbidity, often not diagnosed even in patients under psychiatric treatment for other psychiatric disorders. The aim of this study was to establish the prevalence rates of unrecognized aADHD in academic centers providing regular psychiatric services in the Czech Republic and Hungary. In a population of psychiatric in-and outpatients, Adult ADHD Self-Report Scale was administered. All positively and about half of the negatively screened subjects were clinically interviewed and the DSM diagnosis of ADHD was determined based on the symptom list and Conners' Adult ADHD Rating Scale. The estimated point prevalence rate of unrecognized comorbid aADHD among psychiatric in-and out patients was 6.99% (95% lower CI: 5.11, 95% upper CI 8.86) according to the DSM-IV-TR criteria and 9.27% (95% lower CI: 7.13, 95% upper CI 11.40) according to the DSM-5 criteria. Current suicide risk was significantly associated with the presence of undiagnosed aADHD; however, life time suicide attempts, depression, dysthymia, alcohol and substance dependence, anxiety and stress related disorders were not. Further educational efforts are needed to improve the recognition and treatment of aADHD in adults

R E V I E W A R T I C L E Off-Label Use of Second Generation Antipsychotics in Anxiety Disorders and Obsessive Compulsive Disorder

Abstract There is a paucity of data to support "next-step" treatments for the many patients with anxiety disorders who remain symptomatic after initial pharmacotherapy. Because of their somewhat improved safety profile, second generation antipsychotics (SGAs) are increasingly used for the treatment of nonpsychotic anxiety. The published literature describing the efficacy of SGAs in patients with anxiety disorders is briefly reviewed, and the efficacy and safety of second generation antipsychotics in these patients is discussed. The literature reviewed was primarily comprised of small open-label trials, thus making it difficult to draw definitive conclusions. There is moderately strong controlled evidence supporting the use of some SGAs, either as adjunctive treatment or monotherapy, in the treatment of anxiety disorders. Despite the limitations of the trials reviewed, atypical antipsychotics represent a promising treatment modality when considering their improved side effect profile compared to conventional agents. The facts to date does not warrant the use of SGAs as first-line monotherapy or as first -adjunctive therapy in the treatment of anxiety disorders. Nevertheless, some patients with highly refractory anxiety disorders may benefit from the judicious and carefully monitored use of adjunctive SGAs. A careful risk-benefit assessment, on a case-by-case basis, must be undertaken by the physician