الفهرس 
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Abstract
SUMMARY AND CONCLUSION
A
DHD in the adult population is frequently associated with comorbid psychiatric diseases that complicate its recognition, diagnosis, and management.
The prevalence of ADHD in the general adult population is 2.5% to 5% and it is associated with substantial personal and individual burden. The most frequent comorbid psychopathologies include mood and anxiety disorders, SUD, and personality disorders. There are strong familial links and neurobiological similarities between ADHD and the various associated psychiatric comorbidities. The overlapping symptoms between ADHD and comorbid psychopathologies represent challenges for diagnosis and treatment. Guidelines recommend that when ADHD coexists with other psychopathologies in adults, the most impairing condition should generally be treated first.
This study investigates the possibility of a missed adult ADHD diagnosis among patients with non-psychotic affective mood disorders. As early recognition and treatment of ADHD and its comorbidities has the potential to change the trajectory of psychiatric morbidity later in life. The use of validated assessment scales and high-yield clinical questions can help identify adults with ADHD who could potentially benefit from evidence-based management strategies.
The aim of this study is:
1- To detect the rate of adult ADHD among patients with non-psychotic mood disorders.
2- To investigate the relationship between ADHD symptoms and clinical correlates of patients with non-psychotic mood disorders.
3- To detect whether ADHD plays any role in the prognosis of mood disorders cases.
Prognosis includes (timing of the diagnosis “whether early or late detection of mood disorder”- numbers of attacks- severity & hospitalization- compliance& adherence to treatment – single or poly pharmacies – level of functionality- accidents & risky situations involvement - forensic & legal history – substance abuse history).
This study is a Cross sectional observational study and was conducted Outpatient clinics and inpatient ward of Institute of Psychiatry Ain Shams University (El Demerdash hospital). It serves urban and rural areas, providing health services to different social classes.
Patients were Recruited according to their complaints and history in their medical recorders, also they had to free from any psychotic symptoms at time of interviewing, the age were between 18 to 60 years older than 60 or younger than 18 were excluded, both sexes male and female were invited to participate in this study. The study conducted in the duration begun from Jan 2020 until Aug 2020.
Patient included to this study were subjected to examination of their medical records, their socio demographic data, also they underwent Clinical Interview for Diagnostic and statistical manual of mental Disorder IV (DSM IV) (SCID I) scale: to diagnose Axis I psychiatric disorders and underwent CAARS to assess the presence and severity of ADHD symptoms in its Arabic version (Abdel Daiem et al., 2011) and finally designed Questionnaire to detect different relevant clinical correlates.
At the end of interview, the doctor calculated the Inconsistency Index (if the Inconsistency Index total 8 or greater the result may be some Inconsistency to the response and the subjects were excluded from study).
According to this index 19 patients were excluded due to Inconsistency Index were equal to 8 or more.
Subjects in this study after exclusion due to Inconsistency Index were 101 Subjects divided in two groups according to Conner’s Adult ADHD Rating Scale by each of its subgroups according to t-score equal or above 56 were ADHD Proven group and t-score less than 56 were Non-ADHD group, the sub-scale were:
Inattentive Symptoms: high scorers have tendencies associated with the inattentive sub-type of ADHD described in the DSM-IV.
Hyperactive/Impulsive: high scorers have tendencies associated with the hyperactive/impulsive sub-type of ADHD described in the DSM-IV.
Total ADHD Symptoms: high scorers meet the criteria for ADHD as described in the DSM-IV.
ADHD Index: High scores were useful for differentiating clinical from non-clinical individuals.
The relevant medical correlates used for comparison between two groups were:
• Seeking medical Advice
• Compliance
• Functionality
• Hospitalization
• ECT
• Accidents & Risks
• Legal Problems
The results were analyzed into descriptive, bivariate and correlation analysis of the given data by keeping the sample with 101 patients which were furtherly subdivided into 2 groups ADHD group and non- ADHD group according to the total ADHD symptoms subscale of conner’s compared as regards (Seeking medical advice, Response to treatment of mood symptoms, Compliance, Functionality, Hospitalization, ECT, Accidents & risks and legal problems as defined by operational definitions mentioned previously in the methodology section).
In our study mean age equals 35 years and the minimum age is 18 years, and the maximum age is 60 years, the disruption of gender is 54 males and 47 females.
ADHD symptoms subscale of conner’s compared as regards the Seeking medical advice of mood symptoms results shows most of the patients are late advised (67.74%) in the ADHD group. in comparison to the Non-ADHD group with (46.15%) of late advised, the effect of management of mood symptom result show insufficient treatment outcomes with percentage (77.42%) in the ADHD group and Non-ADHD group insufficient treatment percentage (43.59%) and effect Sufficient percentage (51.28%). the Compliance results show patients with No Complaint with percentage (70.97%) in ADHD group and in Non-ADHD group Complaint percentage (48.72%) and Not Complaint percentage (51.28%).
In the case of Functionality in the ADHD group the percentage are 85.48% is not functioning and this are significant data. in comparison to Non-ADHD group percentage of not functioning (43.59%) and (56.41%) are Functioning. Management of (ADHD group) did not include Hospitalization in the Majority of cases (77.42%) In the minority of cases that underwent Hospitalization show no improvement, the result of ECT therapy did not include in the Majority with percentage of (75.81%) In the minority of cases that underwent ECT show no improvement. The results also show Greater Risk Prone to Accidents and dangerous situations (85.48%) in ADHD in comparison to the Non-ADHD group (66.66%), the legal Problems in ADHD group patients Involved in Legal Problems percentage are (16.13%) in comparison to the Non-ADHD group (7.69%).
Conclusion
Given the breadth and overlap of symptoms with other disorders, as well as differences in presentation by age and gender, adult ADHD may be a difficult disorder to detect and effectively manage for the untrained professional. Kooij and colleagues (2010). Increasing awareness of this condition and introducing standardized clinical management guidelines will help to limit the development of chronicity in adult ADHD and comorbidity (Kooij et al., 2010). Just as behavioral and medical treatment are effective with childhood ADHD, they can be just as effective in adults given accurate diagnosis of ADHD and comorbid conditions in this life phase. Clinicians can improve health outcomes in their patients with a comprehensive understanding of the complex profile of ADHD in adulthood, and ultimately, society may benefit from less health care costs, increased work performance, and fewer days of sick leave in treated patients.