Psychiatry for Primary Care: An Update on ADHD (Part 2)

(This is the second part of a 4-part series. The next 2 pieces will discuss addiction and suicide prevention as covered in the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference.—Ed.)

The late Paul H. Wender, MD, once wrote that “ADHD is probably the most common chronic undiagnosed psychiatric disorder in adults.”¹ The primary care providers (PCPs) on our planning committee for the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference unanimously favored covering this topic, and we are thrilled that Jeffrey Newcorn, MD, professor of psychiatry and pediatrics and director of the Division of ADHD and Learning Disorders at Icahn School of Medicine at Mount Sinai, will present a 30-minute lecture titled,“Diagnosis & Treatment of ADHD Across the Lifespan: A Primer for Primary Care Physicians.”

Newcorn shares with us that the main obstacle to the diagnosis and treatment of adults with attention-deficit/hyperactivity disorder (ADHD) is that most PCPs are not trained to consider it in the differential diagnosis.

“Very few physician training programs outside of psychiatry, pediatrics, and family medicine include ADHD in their curricula, yet ADHD is often present in ~4.5% of the adult population,” he said.

“Adults with ADHD underachieve at work and often have multiple changes in jobs. They earn less money than their non-ADHD peers—across all socioeconomic and social strata.² Further, ADHD complicates family relationships and is associated with high rates of divorce. Moreover, a missed diagnosis of ADHD is a very common contributor to treatment failure of other disorders. Unfortunately, the vast majority of adults with ADHD who are seen for medical checkups by their primary care providers never come to psychiatric care. So, identifying ADHD in medical settings is extremely important.”

For adults with undiagnosed ADHD, the consequences can have serious implications. The National Comorbidity Survey Replication study reported a significant degree of psychiatric comorbidity among adults with ADHD: 19% had major depressive disorder, compared with 8% of those without ADHD; 47% also had a coexisting anxiety disorder (vs 20%), 38% had a mood disorder (vs 11%), and 15% had a substance use disorder (vs 6%).³

Unfortunately, there are not current treatment guidelines for adult ADHD, so extrapolation from guidelines and best practices in treating adolescents is necessary. Treatments can include a combination of medication, environmental modifications, and psychosocial interventions. For medication treatment, whether to use simulants or approved nonstimulant medications, or to use them in combination, of course depends on many factors. Newcorn’s presentation will review ways to choose from among the various medications and nonmedication approaches to care.

We hope you join us and Dr Newcorn on Saturday, March 12, to learn more about how to treat your patients with ADHD. Find conference details, including the schedule, description of presenters, and registration at Psychiatry.arizona.edu/Psych4PCPs.

Dr Karp is professor and department chair of psychiatry at the University of Arizona College of Medicine. He is an expert in the fields of geriatric psychiatry, depression treatment, and suicide prevention. He is committed to educating health care providers about the principles of psychiatry and behavioral medicine. Ms Manser is the communication and marketing specialist for the University of Arizona College of Medicine Department of Psychiatry.

References

1. Wender PH. Attention-Deficit Hyperactivity Disorder in Adults. Oxford University Press; 1995.

2. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67(4):524-540.

3. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723.