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

(This is the second part of a 4-part series that ran in the Psychiatric Times. 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.)

by Jordan F. Karp, MD, and Jamie Manser

Jeffrey Newcorn, MDThe 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.

Dr Newcorn is professor of psychiatry and pediatrics, director of the Division of ADHD and Learning Disorders at Icahn School of Medicine at Mount Sinai, and director of pediatric psychopharmacology for the Mount Sinai Health System. He is also the immediate past president of the American Professional Society of ADHD and Related Disorders (APSARD). He is a highly regarded clinician—a researcher with special expertise in the field of ADHD across the lifespan, as well as child, adolescent, and adult psychopharmacology, whose academic work spans both clinical and translational topics.

Release Date: 
03/10/2022 - 10:30am
Original Story: