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Árangur ADHD-lyfjameðferðar fullorðinna hjá ADHD-teymi Landspítala 2015-2017

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Authors
Sólveig Bjarnadóttir
Halldóra Ólafsdóttir
Árni Johnsen
Magnús Haraldsson
Engilbert Sigurðsson
Sigurlín Hrund Kjartansdóttir
Issue Date
2020-03

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Other Titles
Effectiveness of medical treatment in the adult ADHD unit of Landspitali 2015-2017
Citation
Sólveig Bjarnadóttir, Halldóra Ólafsdóttir, Árni Johnsen et al. Árangur ADHD-lyfjameðferðar fullorðinna hjá ADHD-teymi Landspítala 2015-2017. Læknablaðið. 2020; 106(3): 131-138.
Abstract
INNGANGUR Athyglisbrestur með ofvirkni (ADHD) er algengasta taugaþroskaröskunin sem greind er hjá börnum en einkenni geta varað fram á fullorðinsár. Á Landspítala starfar þverfaglegt teymi sem sér um greiningu og meðferð ADHD hjá fullorðnum. Markmið þessarar rannsóknar er að meta árangur lyfjameðferðar sem veitt er af teyminu og áhrif fylgiraskana. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og náði til allra 18 ára og eldri sem komu í fyrsta viðtal til læknis hjá ADHD-teymi Landspítala 2015- 2017 og þáðu lyfjameðferð. Einstaklingar sem höfðu áður fengið meðferð hjá teyminu eða voru þegar á lyfjameðferð voru undanskildir. Upplýsingar um einkenni og líðan fyrir og eftir meðferð fengust úr spurningalistunum ADHD-hegðunarmatskvarði, DASS og QOLS. NIÐURSTÖÐUR Af 211 sjúklingum sem uppfylltu skilyrði rannsóknarinnar voru 144 (68%) sem luku meðferð hjá ADHD-teyminu á að meðaltali 143 dögum. Hvatvísi/ofvirkni reyndist forspárþáttur fyrir að falla úr meðferð með OR=0,96 (p=0,015). Marktækur munur var á öllum breytum fyrir og eftir lyfjameðferð (p<0,001). Fyrir ADHD-einkenni var hrifstærð Cohens d=3,18 fyrir athyglisbrest og 1,40 fyrir hvatvísi/ofvirkni. Hrifstærð fyrir lífsgæði var 1,00 en af DASS-undirkvörðum var hrifstærðin hæst 1,43 fyrir streitu. Fylgni var milli aukinna lífsgæða og minnkandi einkenna. Hjá einstaklingum með fleiri geðgreiningar en ADHD var meðferðarárangur marktækt meiri fyrir DASS en ekki var marktækur munur fyrir athyglisbrest, hvatvísi/ ofvirkni og lífsgæði. Ekki var marktækur munur á meðferðarárangri eftir kyni. ÁLYKTUN Einstaklingar sem ljúka meðferð í ADHD-teymi ná miklum árangri sem felst í minnkun einkenna og betri lífsgæðum. Brottfall úr meðferð er hins vegar mikið vandamál.
Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder among children but symptoms may persist into adulthood. At Landspitali - the National University Hospital an interdisciplinary unit is responsible for ADHD-diagnosis and for commencing treatment of adult ADHD. The aim of this study is to evaluate the effectiveness of pharmaceutical treatment provided by the unit and the effects of psychiatric comorbidities. Methods: The study is retrospective and includes all individuals ≥18 years of age who received pharmaceutical treatment in the adult ADHD unit at Landspitali 2015-2017. Individuals who had previously received treatment by the unit or were already on medication for ADHD were excluded. Information on symptoms and wellbeing before and after treatment were obtained from three questionnaires, an ADHD rating scale, DASS and QOLS. Results: Of 211 patients who met inclusion criteria 144 (68%) completed the treatment provided by the unit on average 143 days. Impulsivity/hyperactivity predicted treatment failure with OR=0.96 (p=0.015). There was a statistically significant difference in all key response variables before and after pharmaceutical treatment (p<0.001). The Cohen‘s d effect size for ADHD variables were 3.18 for attention-deficit and 1.40 for impulsivity/hyperactivity. The effect size for quality of life was 1.00 and among the DASS subscales the maximum effect size was 1.43 for stress. Increased quality of life correlated with decreased symptoms as rated by DASS and the ADHD rating scale. Treatment success rates were significantly higher for DASS but not for attention-deficit, impulsivity/ hyperactivity and quality of life among individuals with psychiatric comorbidities alongside ADHD. Gender did not affect treatment effectiveness. Conclusions: Those who complete treatment within the ADHD unit achieve good results with decreased psychiatric symptoms and improved quality of life. Treatment discontinuation is a challenge.
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https://www.laeknabladid.is/tolublod/2020/03/nr/7277
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Icelandic Journal Articles (Peer Reviewed)

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