A Perturbação por Uso de Substâncias como Comorbilidade em Doentes com Perturbação de Hiperatividade e Défice de Atenção

Maria Inês Ribeiro; Gustavo França

doi:10.20344/amp.21937

Autores

Maria Inês Ribeiro Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal.
Gustavo França Hospital de Magalhães Lemos. Unidade Local de Saúde Santo António. Porto. Portugal.

DOI:

https://doi.org/10.20344/amp.21937

Palavras-chave:

Comorbilidade, Diagnóstico Duplo, Perturbação de Hiperatividade e Défice de Atenção/complicações, Perturbação por Uso de Substâncias, Prevalência, Terapia Combinada

Resumo

A perturbação de hiperatividade e défice de atenção (PHDA) é uma perturbação do neurodesenvolvimento que se manifesta por desatenção e/ou hiperatividade e impulsividade. É uma perturbação com início na infância, mas que pode persistir na vida adulta. Está associada ao surgimento de várias comorbilidades, entre elas, muito frequentemente, o desenvolvimento de perturbação por uso de substâncias (PUS). Esta comorbilidade confere uma maior gravidade ao quadro clínico, e torna o tratamento mais complexo e desafiante. Apesar de serem patologias diferentes, apresentam algumas características etiológicas comuns. Esta revisão narrativa pretendeu estudar a associação entre a PHDA e a PUS, nomeadamente no que concerne à prevalência desta associação, etiologia e quais as melhores estratégias de diagnóstico e tratamento. Conclui-se que a PUS corresponde a uma das comorbilidades mais comuns entre os doentes com PHDA, com fatores genéticos, alterações neuroanatómicas e neurofisiológicas a correlacionarem ambas as patologias. Os doentes com PHDA, com PUS em comorbilidade, apresentam um início mais precoce da PUS, com um consumo mais intenso, e piores resultados terapêuticos. Assim, deve ser recomendada uma atenção especial a esta comorbilidade em doentes com PHDA, bem como uma pesquisa ativa de sintomas de PHDA em doentes com PUS. Esta pesquisa pode ser realizada primeiramente, através de escalas de screening de autopreenchimento. O tratamento adequado pode incluir uma combinação de tratamento farmacológico e não farmacológico, com estratégias dirigidas para ambas as patologias.

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Referências

American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais: DSM-5 - 5.a ed. Vila Franca de Xira: Climepsi Editores; 2024.

Kaye S, Ramos-Quiroga JA, van de Glind G, Levin FR, Faraone S V., Allsop S, et al. Persistence and subtype stability of ADHD among substance use disorder treatment seekers. J Atten Disord. 2019;23:1438-53.

Choi WS, Woo YS, Wang SM, Lim HK, Bahk WM. The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: a systematic literature review. PLoS ONE. 2022;17:e0277175.

Mariani JJ, Khantzian EJ, Levin FR. The self-medication hypothesis and psychostimulant treatment of cocaine dependence: An update. Am J Addict. 2014;23:189-93.

Manni C, Cipollone G, Pallucchini A, Maremmani AGI, Perugi G, Maremmani I. Remarkable reduction of cocaine use in dual disorder (adult attention deficit hyperactive disorder/cocaine use disorder) patients treated with medications for ADHD. Int J Environ Res Public Health. 2019;16:3911.

van Amsterdam J, van der Velde B, Schulte M, van den Brink W. Causal factors of increased smoking in ADHD: a systematic review. Subst Use Misuse. 2018;53:432-45.

Perugi G, Pallucchini A, Rizzato S, De Rossi P, Sani G, Maremmani AGI, et al. Pharmacotherapeutic strategies for the treatment of attention-deficit hyperactivity (ADHD) disorder with comorbid substance-use disorder (SUD). Expert Opin Pharmacother. 2019;20:343-55.

Luo SX, Levin FR. Towards precision addiction treatment: new findings in co-morbid substance use and attention-deficit hyperactivity disorders. Curr Psychiatry Rep. 2017;19:14.

Groenman AP, Greven CU, van Donkelaar MJ, Schellekens A, van Hulzen KJE, Rommelse N, et al. Dopamine and serotonin genetic risk scores predicting substance and nicotine use in attention deficit/hyperactivity disorder. Addict Biol. 2016;21:915-23.

Koutsoklenis A, Honkasilta J. ADHD in the DSM-5-TR: What has changed and what has not. Front Psychiatry. 2023;13:1064141.

Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach. BMC Psychiatry. 2017;17:302.

Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2024;10:11.

Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord. 2017;9:47-65.

Hartman CA, Larsson H, Vos M, Bellato A, Libutzki B, Solberg BS, et al. Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: a substantive and methodological overview. Neurosci Biobehav Rev. 2023;151:105209.

Zulauf CA, Sprich SE, Safren SA, Wilens TE. The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders topical collection on child and adolescent disorders. Curr Psychiatry Rep. 2014;16:436.

Sibley MH, Rohde LA, Swanson JM, Hechtman LT, Molina BSG, Mitchell JT, et al. Late-onset ADHD reconsidered with comprehensive repeated assessments between ages 10 and 25. Am J Psychiatry. 2018;175:140-9.

López-Toro E, Wolf CJ, González RA, van den Brink W, Schellekens A, Vélez-Pastrana MC. Network analysis of DSM symptoms of substance use disorders and frequently co-occurring mental disorders in patients with substance use disorder who seek treatment. J Clin Med. 2022;11:2883.

Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H. Comorbidity of adult ADHD and its subtypes with substance use disorder in a large populationbased epidemiological study. J Atten Disord. 2019;23:1416-26.

Molina BS, Howard AL, Swanson JM, Stehli A, Mitchell JT, Kennedy TM, et al. Substance use through adolescence into early adulthood after childhooddiagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry. 2018;59:692-702.

Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. Sumário executivo - a situação do país em matéria de drogas e toxicodependências 2022. 2022. [consultado 2024 dez 29]. Disponível em: https://www.icad.pt/DocumentList/GetFile?id=603&languageId=1.

Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. Sumário executivo - a situação do país em matéria de álcool 2022. 2022. [consultado 2024 dez 29]. Disponível em: https://sicad.pt/PT/Publicacoes/Paginas/detalhe.aspx?itemId=193&lista=SICAD_PUBLICACOES&bkUrl=BK/Publicacoes/

Solberg BS, Halmøy A, Engeland A, Igland J, Haavik J, Klungsøyr K. Gender differences in psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatr Scand. 2018;137:176-86.

Chen Q, Hartman CA, Haavik J, Harro J, Klungsøyr K, Hegvik TA, et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: a population-based cross-sectional study. PLoS One. 2018;13:e0204516.

Icick R, Moggi F, Slobodin O, Dom G, Mathys F, Van Den Brink W, et al. Attention deficit/hyperactivity disorder and global severity profiles in treatmentseeking patients with substance use disorders. Eur Addict Res. 2020;26:201-10.

Palma-Álvarez RF, Barta C, Carpentier PJ, Carruthers S, Crunelle CL, Demetrovics Z, et al. Validity of the ADHD module of the mini international neuropsychiatric interview plus for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus. Span J Psychiatry Ment Health. 2023;16:11-5.

Luderer M, Kaplan-Wickel N, Richter A, Reinhard I, Kiefer F, Weber T. Screening for adult attention-deficit/hyperactivity disorder in alcohol dependent patients: underreporting of ADHD symptoms in self-report scales. Drug Alcohol Depend. 2019;195:52-8.

Van De Glind G, Brynte C, Skutle A, Kaye S, Konstenius M, Levin F, et al. The international collaboration on ADHD and substance abuse (ICASA): mission, results, and future activities. Eur Addict Res. 2020;26:173-8.

Young S, Sedgwick O. Attention deficit hyperactivity disorder and substance misuse: an evaluation of causal hypotheses and treatment considerations. Expert Rev Neurother. 2015;15:1005-14.

van de Glind G, Konstenius M, Koeter MWJ, van Emmerik-van Oortmerssen K, Carpentier PJ, Kaye S, et al. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug Alcohol Depend. 2014;134:158-66.

Wimberley T, Agerbo E, Horsdal HT, Ottosen C, Brikell I, Als TD, et al. Genetic liability to ADHD and substance use disorders in individuals with ADHD. Addiction. 2020;115:1368-77.

Derks EM, Vink JM, Willemsen G, Van Den Brink W, Boomsma DI. Genetic and environmental influences on the relationship between adult ADHD symptoms and self-reported problem drinking in 6024 Dutch twins. Psychol Med. 2014;44:2673-83.

van Wingen GA, van den Brink W, Veltman DJ, Schmaal L, Dom G, Booij J, et al. Reduced striatal brain volumes in non-medicated adult ADHD patients with comorbid cocaine dependence. Drug Alcohol Depend. 2013;131:198-203.

Slobodin O. The utility of the CPT in the diagnosis of ADHD in individuals with substance abuse: a systematic review. Eur Addict Res. 2020;26:283-94.

National Comorbidity Survey. Adult ADHD self-report scale (ASRS-v1). [consultado 2023 dez 29]. Disponível em: http://www.hcp.med.harvard.edu/ncs/asrs.php.

Crunelle CL, Van Den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, et al. International consensus statement on screening, diagnosis and treatment of substance use disorder patients with comorbid attention deficit/hyperactivity disorder. Eur Addict Res. 2018;24:43-51.

McClernon FJ, Kollins SH, Lutz AM, Fitzgerald DP, Murray DW, Redman C, et al. Effects of smoking abstinence on adult smokers with and without attention deficit hyperactivity disorder: Results of a preliminary study. Psychopharmacology. 2008;197:95-105.

Rigbi A, Yakir A, Sarner-Kanyas K, Pollak Y, Lerer B. Why do young women smoke VI. A controlled study of nicotine effects on attention: pharmacogenetic interactions. Pharmacogenomics J. 2011;11:45-52.

Ginsberg Y, Hirvikoski T, Lindefors N. Attention deficit hyperactivity disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry. 2010;10:112.

Kollins SH, English JS, Roley ME, O’Brien B, Blair J, Lane SD, et al. Effects of smoking abstinence on smoking-reinforced responding, withdrawal, and cognition in adults with and without attention deficit hyperactivity disorder. Psychopharmacology. 2013;227:19-30.

Miguel CS, Martins PA, Moleda N, Klein M, Chaim-Avancini T, Gobbo MA, et al. Cognition and impulsivity in adults with attention deficit hyperactivity disorder with and without cocaine and/or crack dependence. Drug Alcohol Depend. 2016;160:97-104.

Slobodin O, Blankers M, Kapitány-Fövény M, Kaye S, Berger I, Johnson B, et al. Differential diagnosis in patients with substance use disorder and/or attention-deficit/hyperactivity disorder using continuous performance test. Eur Addict Res. 2020;26:151-62.

Levin ED, Conners CK, Sparrow C, Hinton ES, Erhardt H, Meck JE, et al. Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology. 1996;123:55-63.

Wallace AL, Wade NE, Hatcher KF, Lisdahl KM. Effects of cannabis use and subclinical ADHD symptomology on attention based tasks in adolescents and young adults. Arch Clin Neuropsychol. 2019;34:700-5.

van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Koeter MW, Schoevers RA, van den Brink W. Diagnosing ADHD during active substance use: feasible or flawed? Drug Alcohol Depend. 2017;180:371-5.

Mao AR, Findling RL. Comorbidities in adult attention-deficit/ hyperactivity disorder: a practical guide to diagnosis in primary care. Postgrad Med. 2014;126:42-51.

Chang Z, Lichtenstein P, Halldner L, D’Onofrio B, Serlachius E, Fazel S, et al. Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry. 2014;55:878-85.

Groenman AP, Oosterlaan J, Rommelse NN, Franke B, Greven CU, Hoekstra PJ, et al. Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. Brit J Psychiatry. 2013;203:112-9.

McCabe SE, Veliz P, Boyd CJ. Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts. Drug Alcohol Depend. 2016;163:55-63.

Coetzee C, Schellekens AF, Truter I, Meyer A. Effect of past pharmacotherapy for attention-deficit/hyperactivity disorder on substance use disorder. Eur Addict Res. 2023;29:9-18.

Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, et al. ADHD medication and substance-related problems. Am J Psychiatry. 2017;174:877-85.

Konstenius M, Jayaram-Lindström N, Guterstam J, Beck O, Philips B, Franck J. Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction. 2014;109:440-9.

Skoglund C, Brandt L, D’Onofrio B, Larsson H, Franck J. Methylphenidate doses in attention deficit/hyperactivity disorder and comorbid substance use disorders. European Neuropsychopharmacology. 2017;27:1144-52.

Skoglund C, Brandt L, Almqvist C, D’Onofrio BM, Konstenius M, Franck J, et al. Factors associated with adherence to methylphenidate treatment in adult patients with attention-deficit/hyperactivity disorder and substance use disorders. J Clin Psychopharmacol. 2016;36:222-8.

van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Blankers M, Dekker JJ, van den Brink W, et al. Integrated cognitive behavioral therapy for ADHD in adult substance use disorder patients: results of a randomized clinical trial. Drug Alcohol Depend. 2019;197:28-36.

Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens AS, Van De Glind G, et al. International consensus statement for the screening, diagnosis, and treatment of adolescents with concurrent attention-deficit/hyperactivity disorder and substance use disorder. Eur Addict Res. 2020;26:223-32.