ADHD hos vuxna (hyperaktivitetsstörning)
Senast uppdaterad: Senast reviderad:
Sakkunnig:Ylva GinsbergDefinition:
Tillstånd präglat av störningar i koncentrations-/uppmärksamhetsförmågan och/eller motorisk hyperaktivitet och impulsivitet. Tillståndet måste föreligga i minst sex månader. Symtomen ska ha noterats före tolv års ålder och ha en direkt negativ inverkan på sociala aktiviteter och aktiviteter inom studier/arbete.
Förekomst:
Prevalensen av ADHD bland vuxna är 2,5 %.
Symtom:
ADHD karakteriseras av bristande reglering av koncentration, uppmärksamhet, impulser och motorisk aktivitet, vilket medför funktionsnedsättningar inom minst två olika vardagsområden som studier, arbete, sociala relationer, fritid och hemmiljö.
Kliniska fynd:
Samtalet med en patient med ADHD kan störas av ouppmärksamhet och rastlöshet.
Diagnostik:
Diagnostiken baseras på anamnes och status.
Behandling:
Behandlingen är en kombination av individanpassad farmakologisk och icke-farmakologisk behandling.
- Verkuijl N, Perkins M, Fazel M. Childhood attention-deficit/hyperactivity disorder. BMJ. 2015 May 20;350:h2168. doi: 10.1136/bmj.h2168. PMID: 25994532 PubMed
- American Psychiatric Association. MINI-D 5. Diagnostiska kriterier enligt DSM-5. Stockholm: Pilgrim Press AB, 2015.
- Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016. pmid:26386541 PubMed
- Simon V, Czobor P, Balint S, Meszaros A, Bitter I. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 2009; 194(3): 204-11. PMID: 19252145 PubMed
- Ginsberg Y, Quintero J, Anand E et al. Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature. Prim Care Companion CNS Disord 2014. pmid:25317367 PubMed
- Biederman J, Fried R, Petty CR, et al. Cognitive development in adults with attention- deficit/hyperactivity disorder: a controlled study in medication-naïve adults across the adult life cycle. J Clin Psychiatry 2011;72:11-6. PubMed
- NEPI, Nätverk för läkemedelsepidemiologi (2013-01-21): ADHD-läkemedel 2012 - mer än halva kostnaden för vuxna nepi.net
- Läkemedel vid adhd - behandlingsrekommendation: Information från Läkemedelsverket 2016;27(2):13–23. lakemedelsverket.se
- Kooij JJS, Bijlenga D, Salerno L et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2018; 56: 14-34. pmid:30453134 PubMed
- Faraone SV, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 2005;57:1313-23. PubMed
- Faraone SV, Asherson P, Banaschewski T et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; Aug 6;1: 15020. pmid:2718926512. Arnsten AF, Rubia K. Neurobiological Circuits Regulating Attention, Cognitive Control, Motivation, J Am Acad Child Adolesc Psychiatry. 2012;51(4):356-67. PMID: 22449642. 13. Volkow ND, Swanson JM. Clinical practice: Adult attention deficit-hyperactivity disorder. N Engl J Med. 2013 Nov 14;369(20):1935-44. 29. Hoogman M, Bralten J, Hibar DP et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry , 2017 [url]http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30049-4/fulltext[/url] PMID: 27189265 PubMed
- Arnsten AF, Rubia K. Neurobiological Circuits Regulating Attention, Cognitive Control, Motivation, J Am Acad Child Adolesc Psychiatry. 2012;51(4):356-67. PMID: 22449642. PubMed
- Volkow ND, Swanson JM. Clinical practice: Adult attention deficit-hyperactivity disorder. N Engl J Med. 2013 Nov 14;369(20):1935-44. PubMed
- Hoogman M, Bralten J, Hibar DP et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, Feb 2017. www.thelancet.com
- Gillberg C, Gillberg IC, Rasmussen P, et al. Co-existing disorders in ADHD - implication for diagnosis and intervention. Eur Child Adolesc Psychiatry 2004;13 (Suppl 1): 80-92. PMID: 15322959. PubMed
- Psykiatriprogram om ADHD, Psykiatristöd SLL. www1.psykiatristod.se
- ADHD – Diagnostik och behandling, vårdens organisation och patientens delaktighet. En systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2013. SBU-rapport nr 217. www.sbu.se
- Boesen K, Saiz LC, Erviti J, et al. The Cochrane Collaboration withdraws a review on methylphenidate for adults with attention deficit hyperactivity disorder . Evid Based Med 2017. doi:10.1136/ebmed-2017-110716 DOI
- National Institute for Health and Clinical Excellence (NICE). Attention Deficit Hyperactivity Disorder - diagnosis and management of ADHD in children, young people and adults. NICE Clinical Guideline 72. The British Psychological Society and The Royal College of Psychiatrists, UK; 2008. [url]http://www.nice.org.uk/nicemedia/pdf/ADHDFullGuideline.pdf[/url] PMID: 19899506 PubMed
- Konstenius M et al. Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction. 2014 Mar;109(3):440-9. PubMed
- Cunill R, Castells X, Tobias A, Capellà D. Atomoxetine for attention deficit hyperactivity disorder in the adulthood: a meta-analysis and meta-regression. Pharmacoepidemiol Drug Saf. 2013 Sep;22(9):961-9. PMID: 23813665 PubMed
- Nörby U, Winbladh B, Källén K. Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics. 2017 Dec;140(6). pii: e20170747. PMID: 29127207. PubMed
- Young S, Amarasinghe M. Practitioner review: Non-pharmacological treatments for ADHD: a lifespan approach. J Child Psychol Psych 2010;51(2):116-133. PubMed
- Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine. 2006;36(2):159-65. PubMed
- Young S, Thome J. ADHD and offenders. World J Biol Psychiatr. 2011;12 (Suppl. 1):124-8. PMID: 21906010. PubMed
- Halmoy A et al. 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 Sep;13(2):175-87. PubMed
- Chang Z, et al. Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry. 2013 E-pub 2013 Oct 25. DOI: 10.1111/jcpp.12164. PMID: 25158998 PubMed
- Lichtenstein P, et al. Medication for Attention Deficit–Hyperactivity Disorder and Criminality. N. Engl. J. Med. 2012;367(21):2006-2014. PubMed
- Chang Z, et al. Serious Transport Accidents in Adults with Attention-Deficit/Hyperactivity Disorder and the Effect of Medication: A Population-Based Study. JAMA Psychiatry. 2014 Jan 29. PMID: 24477798. PubMed
- Ylva Ginsberg, med dr och överläkare, Norra Stockholms psykiatri, Region Stockholm
- Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet