Personality disorders in ADHD Part 2: The effect of symptoms of personality
disorder on response to treatment with OROS methylphenidate in adults with ADHD.
Author(s): Robison RJ, Reimherr FW, Gale PD, Marchant BK, Williams ED, Soni P, Halls C,
Strong RE.
Affiliation(s): Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake
City, UT 84132, USA.
Publication date & source: 2010, Ann Clin Psychiatry. , 22(2):94-102
BACKGROUND: This study explored the relationship between personality disorder
(PD) and treatment response in a randomized, double-blind, clinical trial of
osmotic release oral system (OROS) methylphenidate (MPH).
METHODS: Forty-seven patients entered a crossover trial using the Wender-Reimherr
Adult Attention Deficit Disorder Scale (WRAADDS) to assess outcome. A final
personality diagnosis was made using staff consensus and information from the
Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical
Interview for DSM-IV Axis II Personality Disorders (SCID-II). Three post hoc
categories were created: PD-negative (no PD; n = 26), PD-positive (patients with
1 PD; n = 11), and PD-plus (patients with 2 or more PDs; n = 10). Improvement in
attention-deficit/hyperactivity disorder (ADHD) symptoms was assessed using a
mixed-model analysis with treatment and personality categories as fixed
variables. Average z scores on the WISPI-IV and items endorsed on SCID-II
provided dimensional measures of PD severity.
RESULTS: Different treatment effects were observed for the PD subgroups (P <
.001). PD-negative patients improved 40% on OROS MPH vs 7% on placebo, and
PD-positive patients improved 66% on OROS MPH vs 9% on placebo. In contrast,
PD-plus patients improved 26% on OROS MPH vs 23% on placebo.
CONCLUSION: Most patients experienced significantly reduced ADHD symptoms on OROS
MPH; however, patients with 2 or more PDs did not. The 2 alternate measures of PD
supported this observation in this small exploratory study.
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