BMC Psychiatry最新文献

Background: Attention Deficit Hyperactivity Disorder (ADHD) in adults is characterized by cognitive, behavioral and affective symptoms. Emotion dysregulation (ED), psychiatric comorbidities, and disturbances in sleep and circadian rhythms frequently co-occur with ADHD, yet their relationships have rarely been investigated using objective measures and are overlooked in therapeutic approaches. This study aimed to compare sleep and rest-activity rhythm parameters between adults with ADHD and control subjects and to examine their associations with cognitive and emotional symptoms in adults with ADHD.

Methods: Fifty-four adults with ADHD completed self-report questionnaires assessing inattention, hyperactivity/impulsivity, and emotional symptoms of ADHD, along with a neuropsychological evaluation of attentional and executive functions. Sleep patterns and rest-activity rhythm were monitored using actigraphy over a 10-days period and compared to data from 47 control participants without psychiatric or neurodevelopmental disorders, adjusting for age and sex. Relationships between ADHD symptoms, neuropsychological test results, sleep and rest-activity rhythm parameters were examined using correlation analyses.

Results: Adults with ADHD exhibited a more unstable and delayed rhythm compared to controls. Sleep and rest-activity rhythm disturbances were significantly associated with cognitive and behavioral symptoms, particularly hyperactivity. Longer sleep latency was associated with poorer selective attention, while shorter total sleep time was linked to deficits in inhibitory control. However, no significant associations were found between sleep, circadian rhythms, and ED symptoms and the majority of observed correlations were no longer significant after correction for multiple comparisons.

Conclusions: These findings highlight the intricate interplay between sleep and circadian rhythm disturbances and the core symptoms of ADHD, emphasizing the need to consider sleep and circadian rhythms interventions in the management of core ADHD symptoms in adults.

Trial registration: The study involving adults with ADHD, Emotional Dysregulation and Cyclothymia in Adult Patients With ADHD (EMO-TDA), was registered at ClinicalTrials.gov (Identifier: NCT03494478) on April 11, 2018. The study involving control participants, Influence of Light on Sleep, Awakening, Electroencephalogram (EEG) and Cognitive Performances, and Medical Technology Assessment for Registration and Long-term EEG Analysis (CHRONOSOMNO), was registered at ClinicalTrials.gov (Identifier: NCT02858765) on August 8, 2016.

Background: The aim of this study was to examine stimulant access difficulties among school-aged children with attention-deficit/hyperactivity disorder (ADHD) in Turkey, family strategies to obtain medications, and access-related medication changes, and to evaluate their associations with irritability, emotional, behavioral, social, academic, and sleep difficulties by psychiatric comorbidity.

Methods: A cross-sectional study was conducted with 149 children aged 6-16 years diagnosed with ADHD and treated with methylphenidate-based stimulants, the only stimulant medications available for pediatric ADHD in Turkey, for at least three months. Data were collected using a sociodemographic form, the Medication Shortage Experience Assessment Form, and standardized parent-report scales, including the DSM-5 Level 2 Irritability Scale, Strengths and Difficulties Questionnaire (SDQ), and Sleep Disturbance Scale for Children (SDSC). Group comparisons were performed according to medication change and comorbidity status, followed by multivariable Generalized Linear Models (GZLM) to evaluate interaction effects between these variables.

Results: Nearly all parents (97.3%) reported difficulties, and 55.7% required medication switching due to shortages. Medication changes were associated with significantly greater perceived impacts on physical and mental health (77.1% vs. 42.4%, p < .001) and on academic and social functioning (69.9% vs. 51.5%, p = .022). In children who underwent medication changes, those with psychiatric comorbidities showed significantly higher irritability, emotional symptoms, conduct problems, peer relationship issues, and total SDQ difficulty scores compared with non-comorbid peers. GZLM interaction analyses formally confirmed these findings, showing that the combination of medication change and psychiatric comorbidity significantly predicted higher irritability (B = 2.65, p = .017), sleep arousal disorders (B = 1.12, p = .028), and total sleep disturbances (B = 9.56, p = .043). Notably, interaction coefficients were positive across nearly all psychometric scales, indicating a synergistic worsening of symptoms, except for prosocial behavior, which showed an expected negative coefficient.

Conclusions: Stimulant shortage is highly prevalent and disrupt treatment continuity in children with ADHD in Turkey. Those with psychiatric comorbidities appear particularly sensitive to medication changes, with our findings formally demonstrating a synergistic interaction that amplifies clinical vulnerability. These results highlight the need for coordinated supply systems and targeted psychosocial support to mitigate the emotional and functional consequences of stimulant unavailability.