RESUMEN
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Consenso , Guías de Práctica Clínica como Asunto/normas , Adulto , Trastorno por Déficit de Atención con Hiperactividad/terapia , Estimulantes del Sistema Nervioso Central/uso terapéutico , Europa (Continente) , Femenino , Accesibilidad a los Servicios de Salud/normas , Humanos , Masculino , Prevalencia , Psicoterapia/métodosRESUMEN
The role of the forebrain commissures and the septal area in the interhemispheric transfer of hippocampal afterdischarges (ADs) was investigated in the rat under halothane anesthesia. Electrical seizures were elicited from the dorsal hippocampus before and after commissurotomy. The degree of relatedness between EEG signals recorded from homologous sites of both hippocampi was quantified using two approaches: (i) a time domain analysis considering an AD as a succession of discrete bursts; the onset times of such bursts were measured and used to estimate interhemispheric onset delays; (ii) using signal analysis the linear (r2) and non-linear (h2) regression coefficients between pairs of EEG signals were computed as a function of time shift between the two signals. In this way the values of association (linear and non-linear) and the corresponding time delays were measured. In general a tetanus applied unilaterally to the dorsal CA3 field resulted in bilaterally synchronous ADs. The estimated interhemispheric time delay was in most cases zero. This bilateral synchrony disappeared after section of a specific part of the ventral hippocampal commissure (VHC), the dorso-caudal third, but was not affected by section of other commissural fibers or by a lesion of the septal area. This study also allowed evaluation of different methods of quantification of the association between EEG signals, namely the linear (r2) and the non-linear (h2) regression coefficients. The latter was shown to be a more robust measure than the former and to yield values of association even in cases in which r2 was at noise level. The experimental findings allow the conclusion that ADs elicited from an epileptogenic focus spread to homologous sites in the contralateral hemisphere following commissural systems that may be strong enough to ensure the forming of one bilateral oscillating system.