May 2010  << Back  

Personality disorders in ADHDPart 2: The effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD

Reid J. Robison, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Frederick W. Reimherr, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Phillip D. Gale, DO

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Barrie K. Marchant, MS

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Erika D. Williams, MSW

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Poonam Soni, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Corinne Halls, MS

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Robert E. Strong, DO

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

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.

KEYWORDS: ADHD, adult, personality disorder, outcome

ANNALS OF CLINICAL PSYCHIATRY 2010;22(2):94–102

CORRESPONDENCE: Fred W. Reimherr, MD, Mood Disorders Clinic, Department of Psychiatry, 30 N 1900 E Rm 5R218, University of Utah Health Sciences Center, Salt Lake City, UT 84132 USA E-MAIL: fred.reimherr@hsc.utah.edu

 
Read full article