Nicholas R. Morrison

An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults

Adults with attention-deficit/hyperactivity disorder (ADHD) are more frequently presenting for diagnosis and treatment. Medication is considered to be appropriate among available treatments for ADHD; however, the evidence supporting the use of pharmacotherapeutics for adults with ADHD remains less established. In this article, the effectiveness and dosing parameters of the various agents investigated for adult ADHD are reviewed. In adults with ADHD, short-term improvements in symptomatology have been documented through the use of stimulants and antidepressants. Studies suggest that methylphenidate and amphetamine maintained an immediate onset of action, whereas the ADHD response to the nonstimulants appeared to be delayed. At a group level, there appears to be some, albeit not entirely consistent, dose-dependent responses to amphetamine and methylphenidate. Generally speaking, variability in diagnostic criteria, dosing parameters and response rates between the various studies was considerable, and most studies were of a relatively short duration. The aggregate literature shows that the stimulants and catecholaminergic nonstimulants investigated had a clinically significant beneficial effect on treating ADHD in adults.

The intersection of attention-deficit/hyperactivity disorder and substance abuse.

Purpose of review The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) continues to be an area of great interest. In this report more recent work exploring the developmental relationship between ADHD and SUDs and associated concurrent disorders is discussed. Recent findings Recent work highlights the role of treatment of ADHD in children on subsequent cigarette smoking and SUDs in adolescence and adulthood. Contemporary data suggest that ADHD may be underdiagnosed in SUD populations. Studies in patients with ADHD and SUDs suggest that SUDs treatment needs to be sequenced initially with ADHD treatment quickly thereafter. Recent studies also highlight concerns associated with the misuse and diversion of prescription stimulants in ADHD adolescents and young adults and indicate that extended-release stimulants may reduce the likelihood for abuse. Summary Practitioners are increasingly recognizing the overlap between ADHD and SUDs, and treatment modalities including cognitive behavioral therapy and pharmacotherapy demonstrate mixed results in the treatment of these comorbid disorders. Areas in need of further investigation include the mechanism(s) by which ADHD leads to SUDs, diagnostic criteria associated with ADHD in SUD individuals, and prevention and treatment strategies for these populations.

Nonmedical Stimulant Use in College Students: Association With Attention-Deficit/Hyperactivity Disorder and Other Disorders

Objective The nonmedical use of stimulants (misuse) in the college setting remains of utmost public health and clinical concern. The objective of this study was to evaluate comprehensively the characteristics of college students who misused stimulants, attending to rates of attention-deficit/hyperactivity disorder (ADHD), other psychopathology, and substance use disorders. Methods The data presented are from a cross-sectional study of college students who misused prescription stimulant medications (not including cocaine or methamphetamine) and controls (college students without stimulant misuse). Between May 2010 and May 2013, college students were assessed blindly for psychopathology and substance use disorder by way of Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P) and completion of self-report questionnaires. Results The analysis included 198 controls (mean ± SD age = 20.7 ± 2.6 years) and 100 stimulant misusers (20.7 ± 1.7 years). Misusers, when compared to controls, were more likely to endorse alcohol, drug, alcohol + drug, and any substance use disorder (all P values < .01). When a subset of stimulant misusers (n = 58) was examined, 67% had a full or subthreshold prescription stimulant use disorder. Misusers also had higher rates of conduct disorder (10% vs 3%; P = .02) and ADHD (including subthreshold cases; 27% vs 16%; P = .02) in addition to lower Global Assessment of Functioning score (P < .01). Higher rates of misuse of immediate-release—relative to extended-release—stimulants were reported. Conclusions Our data suggest that, compared to controls, college students who misuse stimulant medications are more likely to have ADHD, conduct disorder, stimulant and other substance use disorder, and overall dysfunction.

Are obstetrical, perinatal, and infantile difficulties associated with pediatric bipolar disorder?

Martelon MK, Wilens TE, Anderson JP, Morrison NR, Wozniak J. Are obstetrical, perinatal, and infantile difficulties associated with pediatric bipolar disorder? Bipolar Disord 2012: 14: 507–514.

Exploring therapeutic alliance training in clinical and counseling psychology graduate programs.

The therapeutic alliance is widely regarded as an empirically-based element of successful psychotherapy. However, the degree to which training programs incorporate alliance-centered components into their curricula and clinical practica remains unclear. The aims of this study were to explore (a) training programs’ awareness of research that establishes the alliance as a component of evidence-based practice; (b) the extent to which programs incorporate formal, evidence-based alliance training into their pedagogy; (c) what training programs would consider ideal alliance-training practices; and (d) whether there are differences in evidence-based alliance-training practices or perspectives between programs with different terminal degrees. Data derived from a quantitative survey of directors (or their designates; N = 84) of American Psychological Association-accredited clinical (Doctor of Philosophy or Doctor of Psychology) and counseling (Doctor of Philosophy) programs in the United States and Canada. Generally, respondents indicated that their programs were aware of alliance research trends. However, respondents also largely indicated that they do not incorporate systematic, evidence-based alliance training into their programs, despite believing that such systematic elements would contribute to ideal alliance-training practices. There were no statistically significant differences between program degree type in terms of awareness of alliance research, current alliance-training practices, or views on ideal alliance-training practices. We discuss the implications of the present results for training and future research directions.