Vol 8, No 1 Diagnosis and Management of Schizophrenic Disorders
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ttention deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood. In recent years there has been growing evidence that in many patients the disorder persists into adulthood. Meanwhile, adult ADHD has been recognized in the literature as a valid clinical entity, affecting as many as 2% to 4% of adults.1 Symptomatology and diagnosis The core symptoms of ADHD are inattention, hyperac- tivity, and impulsivity.2 In most descriptions of ADHD in the 1980s and the early 1990s, it seemed that hyperactiv- ity had to be present in every case as a striking symptom, but with growing knowledge of ADHD it became evi- dent  that  not  all  patients–in  particular  girls–present hyperactivity. Since 1994, with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV)3 three types of ADHD have been differenti- ated: • Combined type (6 or more symptoms of hyperactiv- ity/impulsivity as well as of inattention); • Inattentive type (6 or more symptoms of inattention); • Hyperactive/impulsive type (6 or more symptoms of hyperactivity/impulsivity). A change in symptoms with increasing age is character- istic  of  ADHD. After  puberty, hyperactivity  often 2 9 C l i n i c a l  r e s e a r c h A Copyright © 2006 LLS SAS.  All rights reserved www.dialogues-cns.org ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine Johanna Krause, MD; Klaus-Henning Krause, MD; Stefan H. Dresel, MD; Christian la Fougere, MD; Manfred Ackenheil, MD Keywords: attention deficit hyperactivity disorder; adolescence; adulthood; brain imaging techniques; single photon emission computed tomography;
dopamine transporter; nicotine; diagnosis; therapy; methylphenidate Author  affiliations: Outpatient  Clinic  for  Psychiatry  and  Psychotherapy, Ottobrunn, Germany (Johanna Krause, MD); Friedrich-Baur-Institute, Ludwig- Maximilians-University,  Munich,  Germany  (Klaus-Henning  Krause,  MD); Department of Nuclear Medicine (Stefan H. Dresel, MD; Christian la Fougere, MD); and Department of Neurochemistry (Manfred Ackenheil, MD); Ludwig- Maximilians-University, D-80336 Munich, Germany Address  for  correspondence: Johanna  Krause,  MD, Schillerstr. 11a,  
D-85521 Ottobrunn. (e-mail: drjkrause@yahoo.com) The persistence of attention deficit hyperactivity disor- der (ADHD) into adolescence and adulthood has now been accepted as a clinical entity. The rate of prevalence among adults is assumed to be from 2% to 4%. With increasing age, a symptom change has to be considered; disturbance  of  attention  becomes  more  prominent, whereas hyperactivity often diminishes or changes to inactivity. Neuroimaging studies show a high striatal dopamine transporter (DAT) availability in most adults with ADHD; this can be reduced by stimulants. Nicotine seems to have a stimulant-like action on the DAT. In most adults with ADHD, therapy has to be multimodal, com- bining psychotherapy and medication. Methylphenidate is the first-line drug in adult ADHD; further options are amphetamine and noradrenaline reuptake inhibitors. Nonresponders to methylphenidate seem to have no ele- vated DAT availability prior to therapy. Combination with  other  psychiatric  disorders  occurs  frequently  in adults with ADHD; in these patients additional pharma- cological treatment with special regard to the comorbid disease is recommended.   © 2006, LLS SAS Dialogues Clin Neurosci. 2006;8:39-36.