Prevalence of adult attention deficit hyperactivity disorder and comorbid axis-I disorders among first time applied cases of a general psychiatry outpatient clinic and a private psychotherapy centre

OBJECTIVES: The primary objective of this study was to identify the prevalence of adult attention deficit hyperactivity disorder (ADHD) among first time applied consecutive cases of a university hospital general psychiatry outpatient clinic (OC) and a private psychotherapy centre (PPC). The secondary aim of this study was to define the causes of application to these centres and prevalence of comorbid axis-I disorders in adult ADHD cases.

METHODS: This study was a descriptive epidemiological study conducted in OC of Ege University Faculty of Medicine and Private Psikoaktif Psychotherapy Center. At each center, all the first time applied consecutive cases were approached. Adult ADHD Self-Report Scale (ASRS-v1.1) and Turgay’s Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale were used as screening tests and Wender Utah Rating Scale (WURS) was used to evaluate childhood ADHD symptoms. Diagnostic Interview for ADHD in Adults (DIVA 2.0) was applied to positively screened cases and DSM-5 criteria were taken into consideration in diagnostic interviews. Patients who were diagnosed with adult ADHD via DIVA 2.0 were evaluated by Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I).

RESULTS: The prevalence of adult ADHD according to DSM-5 criteria in OC including 210 individuals was 14.3% (n = 30). The prevalence of adult ADHD in PPC including 133 individuals was 9.8% (n = 13). The most common type of comorbid psychiatric disorders among ADHD diagnosed patients of OC and PPC were depressive disorders (40.0% vs 46.1%). 80.0% of ADHD patients in OC were diagnosed with at least one additional psychiatric disorder and 46.7% were diagnosed with more than one additional psychiatric disorder; it was 84.6% and 30.8% for PPC, respectively. Only 30.0% of patients with ADHD in OC and only 15.4% of patients with ADHD in PPC were applied suspecting they had an ADHD. When we look at their causes of applications, it is seen that patients with ADHD in PPC reported more marriage/relationship problems (84.6% vs 49.5%) (p = 0.037), personal problems (53.8% vs 14.7%) (p = 0.003), and educational problems (46.2% vs 9.5%) (p = 0.003) than patients without ADHD. In OC, there was no statistically significant difference between ADHD and non-ADHD patients in terms of causes of application.

CONCLUSIONS: In this study, we found the prevalence of adult ADHD in OC and PPC much higher than estimates for the general adult population. Almost all adult ADHD patients of both centres had at least one additional psychiatric disorder. Adult ADHD patients who have marriage/relationship, personal, and educational problems preferred applying to a PPC expecting a treatment method other than pharmacotherapy. To our knowledge, this is the first study to evaluate the prevalence of adult ADHD, their clinical presentation, and causes of application in a group expecting treatment method other than pharmacotherapy. However, further studies in other mental health centres with larger sample sizes are needed to improve the knowledge and experience in this field.