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BACKGROUND: Previous studies have suggested that individuals with ADHD have high scores in novelty seeking and harm avoidance. However, it is not known whether personality is associated with specific subtypes and dimensions of the disorder. The aim of this study is to test for associations between scores in the temperament and character inventory of C.R. Cloninger with adult ADHD subtypes and severity. SAMPLING AND METHODS: The diagnostic interviews of 296 adult ADHD patients followed the DSM-IV criteria. ADHD dimensions were evaluated with the SNAP-IV scores, and personality dimensions were assessed using the Temperament and Character Inventory. RESULTS: The combined subtype (n=168) was associated with higher scores in novelty seeking (p<0.001) and lower scores in cooperativeness (p=0.006) than the inattentive subtype (n=128). Higher inattention scores were associated with decreased self-directedness (p<0.001) and increased harm avoidance (p=0.02), whereas higher hyperactivity/impulsivity scores correlated positively with novelty seeking (p<0.001) and persistence (p=0.03). CONCLUSIONS: These findings suggest that personality dimensions are strongly correlated with ADHD subtypes and severity dimensions, pointing to the need for studies evaluating the mechanisms behind this association.

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OBJECTIVE: The requirement in classificatory systems that some impairment from attention-deficit/hyperactivity disorder (ADHD) symptoms starts before 7 years of age (age of onset of impairment criteria - AOC) has been harshly criticized. Although there is evidence that late-onset ADHD is a valid diagnosis, little is known about the role of age of onset of impairment on the clinical profile of adult patients. METHODS: The diagnoses of 349 adults with ADHD followed DSM-IV criteria. ADHD and oppositional defiant disorder (ODD) were evaluated with the K-SADS-E, and other comorbidities with the SCID-IV and the MINI. Subjects were divided in early and late-onset groups (age of onset of impairment between 7 and 12 years old). The effect of age of onset over clinical and demographic characteristics was tested by regression models. RESULTS: Late-onset subjects were diagnosed later (P=0.04), had a lower frequency of problems with authority and discipline (P=0.004), and lower scores in SNAP-IV (P<0.001) and in Barkley's scale for problems in areas of life activities (P=0.03). On the other hand, late-onset patients presented a higher prevalence of comorbid general anxiety disorder (GAD) (P=0.01). Both groups had a similar profile in the remaining comorbidities and sociodemographic characteristics. CONCLUSIONS: This study provides initial evidence that adults with late-onset ADHD have less severity, lower frequency of externalizing symptoms and increased comorbidity with GAD, but similar profile in other comorbidities. In addition, the data suggest that late-onset patients have a higher probability of delayed diagnosis despite the significant impairment of their condition.

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Adults with attention-deficit/hyperactivity disorder (ADHD) are predisposed to smoking, but the neuropsychological correlates of this association have not been elucidated so far. The present study evaluates possible associations between cognitive performance and smoking and other comorbidities in adults with ADHD. Two hundred and sixty-four (264) patients were evaluated in the adult ADHD outpatient clinic of the Hospital de Clínicas de Porto Alegre. The diagnoses were based on the DSM-IV criteria and interviews were performed with the Portuguese version of K-SADS-E for ADHD and oppositional-defiant disorder. Axis I psychiatric comorbidities were evaluated with the SCID-IV and the cognitive performance with the Vocabulary and Block Design subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The evaluation of the influence of the WAIS-R scores on each dependent variable was performed with logistic regression analyses. Lower scores in the Block Design subtest of WAIS-R were associated with smoking and the presence of anxiety disorder. These results suggest that a subgroup of ADHD patients with lower Block Design subtest scores may be at increased risk of smoking as a cognitive enhancement. Our findings also confirmed the previously suggested association between anxiety and lower Block Design scores.

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Most adults with attention-deficit/hyperactivity disorder (ADHD) are not recognized and remain untreated, although a large fraction of these individuals are diagnosed and treated for other comorbid mental disorders, such as major depressive disorder (MDD). The fact that MDD is one of the most commonly occurring mental disorders with high comorbidity with adult ADHD raises the question whether such comorbidity is associated with differences in the clinical picture of ADHD. Three hundred and twenty adult ADHD outpatients were evaluated. Diagnoses followed DSM-IV criteria. Interviews to evaluate ADHD and oppositional defiant disorder (ODD) were performed based on the Portuguese version of K-SADS-E. Psychiatric comorbidities were investigated using SCID-IV and MINI. Regression models were applied to test MDD association with clinical and demographic outcomes. Subjects presenting ADHD and MDD had a higher frequency of generalized anxiety disorder and social phobia and a lower frequency of substance dependence, grade repetition and school suspensions, when compared to subjects with ADHD without MDD. Furthermore, adults presenting ADHD and MDD reported higher demand for psychotherapy and pharmacological treatment prior to enrollment in the study when compared to ADHD subjects free of MDD. However, contrary to what could be expected based on these data, the presence of MDD was not associated with an earlier ADHD diagnosis. These results point to the need for research and medical education into an earlier and more efficient ADHD diagnosis in patients who search for mental health care.

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O presente trabalho propõe uma reflexão sobre o setting analítico abordando a importância da inscrição do setting na mente do analista a partir do desenvolvimento de uma postura ética e do diálogo com a técnica contrapondo uma visão normativa. Desenvolve o pensamento de que essa construção passa pela transferência do analista com a psicanálise e da sua atitude no manejo do inconsciente, apontando a necessidade de constante auto-análise e questionamento da sua prática abrindo caminho para possibilidades de trabalho individualizadas onde analista e paciente possam criar o lugar possível para a análise.(AU)

The present study proposes a reflection on the analytical setting addressing the importance of the inscription of the setting on the analyst’s mind from the development of an ethical position and from the dialogue with the technique opposing a normative vision. It develops the thought that this construction is related to the transference of the analyst with psychoanalysis and his attitude on handling the unconscious, pointing out the necessity of constant self-analysis and questioning of his practice making way to individualized working possibilities where analyst and patient may create the possible room for the analysis.(AU)

El presente trabajo propone una reflexión sobre el setting analítico abordando la importancia de la inscripción del setting en la mente del psicoanalista a partir del desarrollo de una posición ética y del diálogo con la técnica en contraposición a una visión normativa. Desarrolla el pensamiento de que esa construcción pasa por la transferencia del psicoanalista con el psicoanálisis y de su actitud en el manejo del inconsciente, apuntando la necesidad de constante auto análisis y cuestionamiento de su practica abriendo camino para posibilidades de trabajo individualizadas donde el psicoanalista y el paciente puedan crear un lugar posible para el análisis.(AU)

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The aim of the present study is to verify if gender modifies the clinical, adaptative and psychological outcomes of adult attention-deficit/hyperactivity disorder (ADHD) subtypes. We evaluated 219 clinically referred adult patients. The interviews followed the DSM-IV criteria,using the K-SADS-E for ADHD and oppositional defiant disorder and SCID-IV for comorbidities. Regression models were used to analyze gender and subtype main effects and interactions in psychiatric outcomes. In the initial sample, 117 patients (53.5%) were of the combined subtype, 88 (40%) were inattentives and 14 (6.5%) hyperactives. There were no significant interactions between gender and subtype in any variable assessed. Men and women did not differ in the relative frequency of each subtype. Patients of the combined subtype in both genders presented a higher severity and increased rates of conduct and ODD disorders than inattentives. The main effects of gender and subtype in this sample are similar to those previously reported in other countries, suggesting the cross-cultural equivalence of the phenotype. The absence of significant interactions between gender and subtype suggests that, at least in clinical-based samples, DSM-IV adult ADHD subtypes present cross-gender validity.

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Este artigo apresenta uma prática de intervenção psicossocial realizada no estágio curricular de Psicologia do Trabalho, para que, no contexto de formação acadêmica, se possa discutir o papel do psicólogo neste campo de atuação, considerando seu compromisso social frente aos novos desafios que lhe são impostos, resultando numa atuação efetiva a ser desenvolvida não só nas organizações formais, mas alcançando os espaços mais diversos voltados ao trabalho no seu sentido amplo (AU)

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Este artigo apresenta uma prática de intervenção psicossocial realizada no estágio curricular de Psicologia do Trabalho, para que, no contexto de formação acadêmica, se possa discutir o papel do psicólogo neste campo de atuação, considerando seu compromisso social frente aos novos desafios que lhe são impostos, resultando numa atuação efetiva a ser desenvolvida não só nas organizações formais, mas alcançando os espaços mais diversos voltados ao trabalho no seu sentido amplo

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