ORIGINAL CONTRIBUTION
Severity But Not Comorbidities Predicts Response to Methylphenidate in Adults With Attention-Deficit/Hyperactivity Disorder Results From a Naturalistic Study Marcelo M. Victor, MD, PhD,* Diego L. Rovaris, MSc,Þ Carlos A.I. Salgado, MD,* Katiane L. Silva, PhD,* Rafael G. Karam, MD, PhD,* Eduardo S. Vitola, MD,* Felipe A. Picon, MD,* Veroˆnica Contini, PhD,þ Paula O. Guimara˜es-da-Silva, MSc,* Paula Blaya-Rocha,* Paulo S. Belmonte-de-Abreu, MD, PhD,§ Luis A. Rohde, MD, PhD,§|| Eugenio H. Grevet, MD, PhD,*§ and Claiton H.D. Bau, MD, PhDÞ
Abstract: Although the identification of reliable predictors of methylphenidate response in adults with attention-deficit/hyperactivity disorder (ADHD) is necessary to guide treatment decisions, very few data exist on this issue. Here, we assessed the predictors of clinical response to immediate-release methylphenidate hydrochloride (IR-MPH) in a naturalistic setting by analyzing the influence of demographic factors, severity, and a wide range of comorbid psychiatric disorders. Two hundred fifty adult patients with ADHD were evaluated and completed a short-term treatment with IR-MPH. Mental health diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria through the use of standard structured interviews. The Swanson, Nolan, and Pelham Rating Scale, version 4, adapted to adults was used to assess the severity of ADHD. In the linear regression model, only higher severity of ADHD was associated to a better IRMPH response (b = 0.770; P G 0.001). Treatment of comorbidities in a subsample (n = 62) did not modify this pattern. Our findings suggest that in clinical settings, patients with more severe ADHD symptoms have a good response to treatment independently from the presence of mild or stabilized comorbidities and their treatments. For adults with ADHD, differently from other common psychiatric disorders such as depression and anxiety, higher severity is associated with better treatment response. Key Words: ADHD, adult, comorbidities, treatment, methylphenidate (J Clin Psychopharmacol 2014;34: 212Y217)
A
ttention-deficit/hyperactivity disorder (ADHD) is a frequent psychiatric disorder affecting approximately 2.5% of adults in community-based studies1 and around 20% of individuals in general adult psychiatric outpatient samples.2 A substantial
From the *ADHD Outpatient Clinic, Hospital de Clı´nicas de Porto Alegre, and †Department of Genetics, Instituto de Biocieˆncias, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul; ‡Postgraduate Program in Biotechnology, Centro Universita´rio UNIVATES, Lajeado; §Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul; and ||National Institute of Development Psychiatry for Children and Adolescents, Sa˜o Paulo, Brazil. Received March 19, 2013; accepted after revision October 18, 2013. Reprints: Claiton H.D. Bau, MD, PhD, Departamento de Gene´tica, Federal University of Rio Grande do Sul, Campus do Vale, Av Bento Gonc¸alves, 9500, 91501-970, Porto Alegre, Rio Grande do Sul, Brazil (e
Severity But Not Comorbidities Predicts Response to Methylphenidate in Adults With Attention-Deficit/Hyperactivity Disorder Results From a Naturalistic Study Marcelo M. Victor, MD, PhD,* Diego L. Rovaris, MSc,Þ Carlos A.I. Salgado, MD,* Katiane L. Silva, PhD,* Rafael G. Karam, MD, PhD,* Eduardo S. Vitola, MD,* Felipe A. Picon, MD,* Veroˆnica Contini, PhD,þ Paula O. Guimara˜es-da-Silva, MSc,* Paula Blaya-Rocha,* Paulo S. Belmonte-de-Abreu, MD, PhD,§ Luis A. Rohde, MD, PhD,§|| Eugenio H. Grevet, MD, PhD,*§ and Claiton H.D. Bau, MD, PhDÞ
Abstract: Although the identification of reliable predictors of methylphenidate response in adults with attention-deficit/hyperactivity disorder (ADHD) is necessary to guide treatment decisions, very few data exist on this issue. Here, we assessed the predictors of clinical response to immediate-release methylphenidate hydrochloride (IR-MPH) in a naturalistic setting by analyzing the influence of demographic factors, severity, and a wide range of comorbid psychiatric disorders. Two hundred fifty adult patients with ADHD were evaluated and completed a short-term treatment with IR-MPH. Mental health diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria through the use of standard structured interviews. The Swanson, Nolan, and Pelham Rating Scale, version 4, adapted to adults was used to assess the severity of ADHD. In the linear regression model, only higher severity of ADHD was associated to a better IRMPH response (b = 0.770; P G 0.001). Treatment of comorbidities in a subsample (n = 62) did not modify this pattern. Our findings suggest that in clinical settings, patients with more severe ADHD symptoms have a good response to treatment independently from the presence of mild or stabilized comorbidities and their treatments. For adults with ADHD, differently from other common psychiatric disorders such as depression and anxiety, higher severity is associated with better treatment response. Key Words: ADHD, adult, comorbidities, treatment, methylphenidate (J Clin Psychopharmacol 2014;34: 212Y217)
A
ttention-deficit/hyperactivity disorder (ADHD) is a frequent psychiatric disorder affecting approximately 2.5% of adults in community-based studies1 and around 20% of individuals in general adult psychiatric outpatient samples.2 A substantial
From the *ADHD Outpatient Clinic, Hospital de Clı´nicas de Porto Alegre, and †Department of Genetics, Instituto de Biocieˆncias, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul; ‡Postgraduate Program in Biotechnology, Centro Universita´rio UNIVATES, Lajeado; §Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul; and ||National Institute of Development Psychiatry for Children and Adolescents, Sa˜o Paulo, Brazil. Received March 19, 2013; accepted after revision October 18, 2013. Reprints: Claiton H.D. Bau, MD, PhD, Departamento de Gene´tica, Federal University of Rio Grande do Sul, Campus do Vale, Av Bento Gonc¸alves, 9500, 91501-970, Porto Alegre, Rio Grande do Sul, Brazil (e
