Yetişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Komorbidite ve Tedavide Güncel Yaklaşımlar
Özet
Yetişkin Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB), çocuklukta başlayıp sıklıkla yetişkinlikte de devam eden ve hastaların %60-80'inde depresyon, anksiyete ve madde kullanımı gibi en az bir ek psikiyatrik bozuklukla seyreden nörogelişimsel bir durumdur. Tanı süreci, eşlik eden hastalıkların semptomlarıyla örtüşmesi nedeniyle karmaşık bir yapı sergilemekte; tedavide ise öncelikle işlevselliği en çok bozan durumun hedeflenmesi önerilmektedir. Farmakolojik yaklaşımların yanı sıra bilişsel davranışçı terapilerin de dahil olduğu bütüncül bir tedavi planı, hastaların yaşam kalitesini artırırken ileride oluşabilecek ek ruhsal sorunların önlenmesinde kritik rol oynamaktadır.
Adult Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that begins in childhood and often persists into adulthood, frequently co-occurring with at least one additional psychiatric disorder such as depression, anxiety, or substance use in 60-80% of patients. The diagnostic process is complex due to overlapping symptoms with comorbid conditions, and guidelines recommend prioritizing the treatment of the most functionally impairing disorder. A holistic treatment plan, incorporating both pharmacological approaches and cognitive-behavioral therapies, plays a critical role in enhancing patients' quality of life and preventing the development of future psychiatric complications.
Referanslar
Köroğlu E. Amerikan Psikiyatri Birliği, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru Elkitabı’ndan Çev. Ankara: Hekimler Yayın Birliği; 2013. 15-42 p.
Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biological psychiatry. 2005;57(11):1215-20.
Karamustafalıoğlu O. Temel ve Klinik Psikiyatri. Ankara Güneş Tıp Kitabevleri; 2018. 552-5 p.
Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biological psychiatry. 2005;57(11):1313-23.
Karamustafalıoğlu O. Temel ve Klinik Psikiyatri. Ankara: Güneş Tıp Kitabevleri; 2018. 551-2 p.
Mukaddes NM. Yaşam Boyu Dikkat Eksikliği Hiperaktivite Bozukluğu ve Eşlik Eden Durumlar. İstanbul: Nobel Tıp Kitabevleri; 2015. 1-7 p.
Sadock BJ, Sadock VA, Ruiz P. Kaplan&Sadock Psikiyatri Davranış Bilimleri/Klinik Psikiyatri. 11 ed. Ankara: Güneş Tıp kitabevleri; 2016. 1169-80 p.
Ercan ES. Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu. İstanbul: Dönence Basım ve Yayın Hizmetleri; 2010. 9-15 p.
Karamustafalıoğlu O. Temel ve Klinik Psikiyatri. Ankara Güneş Tıp Kitabevleri; 2018. 559-64 p.
Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017 Aug 22;17(1):302.
CADDRA - Canadian ADHD Resource Alliance: Canadian ADHD Practice Guidelines, 4.1 Edition, Toronto ON; CADDRA, 2020.
Mukaddes NM. Yaşam Boyu Dikkat Eksikliği Hiperaktivite Bozukluğu ve Eşlik Eden Durumlar. İstanbul: Nobel Tıp Kitabevleri; 2015. 71-131 p.
Tuğlu C, Şahin ÖÖ. Erişkin dikkat eksikliği hiperaktivite bozukluğu: Nörobiyoloji, tanı sorunları ve klinik özellikler. Psikiyatride güncel yaklaşımlar. 2010;2(1):75-116.
Barkley RA, Brown TE. Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS spectrums. 2008;13(11):977-84.
Tuğlu C. Dikkat Eksikliği ve Hiperaktivite Bozukluğu. Psikiyatride Güncel. 2016;6(4):296-320.
Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child and adolescent psychiatric clinics of North America. 2000;9(3):525-40.
Newcorn JH. Managing ADHD and comorbidities in adults. The Journal of clinical psychiatry. 2009;70(2):e40-e.
Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of psychiatry. 2006;163(4):716-23.
Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological psychiatry. 2004;55(7):692-700.
McGough JJ, Smalley SL, McCracken JT, Yang M, Del’Homme M, Lynn DE, et al. Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. American Journal of Psychiatry. 2005;162(9):1621-7.
Lundervold AJ, Hinshaw SP, Sørensen L, Posserud M-B. Co-occurring symptoms of attention deficit hyperactivity disorder (ADHD) in a population-based sample of adolescents screened for depression. BMC psychiatry. 2016;16(1):46.
Goodman D. Adult ADHD and comorbid depressive disorders: diagnostic challenges and treatment options. CNS spectrums. 2009;14(S6):5-7.
Brown, T.E., ADHD comorbidities: Handbook for ADHD complications in children and adults. 2009, Washington, DC: American Psychiatric Pub.
Weiss, L., Attention Deficit Disorder in Adults. 1992, Dallas, TX: Taylor Publishing Co.
Sobanski E. Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). European archives of psychiatry and clinical neuroscience. 2006;256(1):i26-i31.
Nierenberg AA, Miyahara S, Spencer T, Wisniewski SR, Otto MW, Simon N, et al. Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biological psychiatry. 2005;57(11):1467-73.
Donfrancesco R, Di Trani M, Andriola E, Leone D, Torrioli MG, Passarelli F, et al. Bipolar disorder in children with ADHD: a clinical sample study. Journal of attention disorders. 2017;21(9):715-20.
Brus MJ, Solanto MV, Goldberg JF. Adult ADHD vs. bipolar disorder in the DSM-5 era: a challenging differentiation for clinicians. Journal of Psychiatric Practice®. 2014;20(6):428-37.
Masi G, Perugi G, Millepiedi S, Mucci M, Pfanner C, Berloffa S, et al. Pharmacological response in juvenile bipolar disorder subtypes: a naturalistic retrospective examination. Psychiatry research. 2010;177(1-2):192-8.
Lan W-H, Bai Y-M, Hsu J-W, Huang K-L, Su T-P, Li C-T, et al. Comorbidity of ADHD and suicide attempts among adolescents and young adults with bipolar disorder: a nationwide longitudinal study. Journal of affective disorders. 2015;176:171-5.
Semerci B, Aksoy UM. Erişkinlerde Dikkat Eksikliği ve Hiperaktivite Bozukluğu Tanı ve Tedavi Kılavuzu. Ankara: Miki Matbaacılık; 2018. 143-227 p.
Simon V, Czobor P, Bitter I. Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders? European Psychiatry. 2013;28(5):308-14.
Sevinç E, ŞENGÜL C, Çakaloz B, Herken H. Psikiyatri Polikliniğinde Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Tanısı Konan Hastalarda Eştanı. Archives of Neuropsychiatry/Noropsikiatri Arsivi. 2010;47(2).
Ekinci S, Öncü B, Canat S. Adult attention deficit hyperactivity disorder: comorbidity and functioning. Anatolian Journal of Psychiatry. 2011;12(3):185-91.
Coffey, B.J. and J. Rapoport, Obsessive-compulsive disorder and Tourette's disorder: where are we now? J Child Adolesc Psychopharmacol, 2010. 20(4): p. 235-6.
Miller CJ, Flory JD, Scott RM, Harty SC, Newcorn JH, Halperin JM. Childhood ADHD and the emergence of personality disorders in adolescence: A prospective follow-up study. The Journal of clinical psychiatry. 2008;69(9):1477.
Cumyn L, French L, Hechtman L. Comorbidity in adults with attention-deficit hyperactivity disorder. The Canadian Journal of Psychiatry. 2009;54(10):673-83.
Köroğlu E. Amerikan Psikiyatri Birliği, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru Elkitabı’ndan Çev. Ankara: Hekimler Yayın Birliği; 2013. 327-339 p.
Wilens TE, Martelon M, Joshi G, Bateman C, Fried R, Petty C, et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(6):543-53.
Evren C. Alkol ve madde kullanım bozukluğunda yaklaşım ve tedavi. psikiyatride güncel. 2014;4(2):140-2.
Ptacek R, Stefano GB, Weissenberger S, Akotia D, Raboch J, Papezova H, et al. Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced. Neuropsychiatric disease and treatment. 2016;12:571.
Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. Journal of Developmental & Behavioral Pediatrics. 2007;28(4):302-7.
Altfas JR. Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC psychiatry. 2002;2(1):9.
Bond DJ, Hadjipavlou G, Lam RW, McIntyre RS, Beaulieu S, Schaffer A, et al. The Canadian network for mood and anxiety treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry. 2012;24(1):23–37.
Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA): Canadian ADHD Practice Guidelines. 3rd Ed. Toronto ON: CADDRA; 2011.
Rösler M, Ginsberg Y, Arngrim T, Adamou M, Niemelä A, Dejonkheere J, et al. Correlation of symptomatic improvements with functional improvements and patient-reported outcomes in adults with attention-deficit/hyperactivity disorder treated with OROS methylphenidate. World J Biol Psychiatry. 2013;14(4):282–290.
Adler LA, Liebowitz M, Kronenberger W, Qiao M, Rubin R, Hollandbeck M, et al. Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. Depress Anxiety. 2009;26(3):212–221.
Spencer TJ, Faraone SV, Michelson D, Adler LA, Reimherr FW, Glatt SJ, et al. Atomoxetine and adult attention-deficit/hyperactivity disorder: the effects of comorbidity. J Clin Psychiatry. 2006;67(3):415–420.
Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics. 2009;124(1):71–78.
Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, et al. Effect of prior treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents. Arch Pediatr Adolesc Med. 2008;162(10):916–921.
Halmøy A, Fasmer OB, Gillberg C, Haavik J. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord. 2009;13(2):175–187.
Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M, Gentschow L, et al. Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72(12):1199–1210.
Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–880.
Knouse LE, Zvorsky I, Safren SA. Depression in adults with attention-deficit/hyperactivity disorder (ADHD): the mediating role of cognitive-behavioral factors. Cognit Ther Res. 2013;37(6):1220–1232.
McIntosh D, Kutcher S, Binder C, Levitt A, Fallu A, Rosenbluth M. Adult ADHD and comorbid depression: a consensus-derived diagnostic algorithm for ADHD. Neuropsychiatr Dis Treat. 2009;5:137–150.
Klassen LJ, Katzman MA, Chokka P. Adult ADHD and its comorbidities, with a focus on bipolar disorder. J Affect Disord. 2010;124(1–2):1–8.
