A multi-center, multi-country, cross-sectional study on the prevalence of ADHD in non-psychotic adult psychiatric care (ADPSYC)

For Europe very few community-based estimates of the total care of attention
deficit hyperactivity disorder (ADHD) in adults are available and data of the
prevalence of adult ADHD in outpatient psychiatric clinics are sparse. In this
study, the prevalence of ADHD in nonpsychotic adult outpatient psychiatric care
in several European countries will be estimated and patients who screen
positive for ADHD will further be examined. Also prevalence of comorbidities in
patients with ADHD, as well as the prevalence of comorbid ADHD in patients
diagnosed with other psychiatric disorders will be estimated. Resource
utilization and subjective well-being will be assessed for the entire sample.
Thus, this study will contribute to a better understanding of the presence and
implications of ADHD in adult mental health care. This knowledge can be the
basis for a better allocation of appropriate diagnostic and treatment
resources, a reduction of primary and secondary costs, and a better outcome for
patients with ADHD.

The goal of the study is to estimate the prevalence of patients with ADHD in
adult outpatient care. About 2300 patients in 8 European countries will
participate to this trial. This data will improve the knowledge about the
presence and the importance of ADHD in adults in the mental health care.

Study B4Z-EW-B020 is a multi-center, multi-country, cross-sectional,
observational study
to estimate the prevalence of ADHD in non-psychotic adults in psychiatric
outpatient care as assessed by the DIVA instrument.

At each study site, all eligible patients known, as well as new patients,
regardless of their existing diagnosis (including ADHD), will be invited to
participate in the study. Before the start of the study, a predefined maximum
number of patients that the site will manage to enter per week will be agreed
upon. The sites will be asked to approach all patients during their normal
clinic days during pre-specified periods and varying times of the day until
their predefined maximum number of entered patients per week is reached.

Patients will be screened for ADHD using the ASRS Symptom Checklist (Part A and
the ADHD questions of the PDI-4 as derived from ASRS). All patients screened
positive on one of these tools and those with a previous or suspected diagnosis
of ADHD will be assessed by the DIVA.
Moreover,in all patients other psychiatric diagnoses will be recorded according
to the clinical judgment of the investigator as guided by DSM or International
Classification of Disease(s) (ICD) criteria. Clinical status parameters,
information on the patients* functioning, quality of life, and resource
utilization will be collected by the use of several instruments as well as
questions to the patients.

In case the patient and/or physician are not able to perform all needed
procedures on the same day, additional sessions can be agreed on during
naturally occurring visits. Procedures should be started ideally within 2
weeks, and completed within a maximum of 6 weeks.

There will not be any specific study visits: the investigator will collect the
study data during the normal consultations: after signing the informed consent,
the procedures will be done, if possible, on the same day. If not possible, one
or multiple sessions can be agreed upon, during the normal patient consults.
There is only data that will be collected, there will not be any physical
examination, blood sampling, etc.

The following patient information is collected:
1/ Age and gender, weight, height, chronic medical non-psychiatric comorbidities

2/ Presence of an ADHD diagnosis (before entering the study); age of diagnosis;
specific ADHD treatment (medication and/or psychotherapy) in childhood,
adolescence, and/or adulthood

3/ The ASRS (Kessler et al. 2005) will be used to screen for ADHD.

4/ Exploratory screening question for presence of ADHD symptoms since childhood
*Have you always had these problems?*

5/ The CGI-S (Clinical Global Impressions of Severity) scale (Guy 1976) will be
used to rate the severity of overall mental illness and illnesses at the time
of study entry. The score ranges from 1 (normal, not at all ill) to 7 (among
the most extremely ill patients).

6/Clinical status parameters and medical history will be collected by the use
of questions to the patient that will be documented by check boxes
- Tobacco consumption
- Presence of clinical relevant neurological symptoms/diagnoses by
clinicaljudgment and patient history.
- Assessment of the patients* family history

7/Information on functioning will be collected by the use of several
instruments as well as questions to the patient that will be documented by
check boxes:
- The SDS (Sheehan Disability Scale) (Sheehan 1983) is used to assess
changes in the patients* personal work schedule, social life/leisure
activities, and family life/home responsibilities.
- Education and degrees
- Actual work status and the frequency (or how often) the patient changed
his/her employment in the last 3 years
- Parenthood
- Living arrangement
- Possession of a driving license, if it has been revoked (if applicable),
the number of times and if the patient has received a traffic fine in the last
3 years
- How frequently does the patient go overdrawn on his/her banking account or
debts with family/friends
- Contacts with justice system: has the patient been prosecuted since
adulthood?

8/ Information on the patients* quality of life (QoL) and resource utilization
will be collected by the use of several screening instruments as well as
questions to the patient that will be assessed by simple check boxes:
- The EQ-5D (EuroQol - 5 Dimensions) questionnaire is a brief,
self-administered questionnaire that assesses a patient*s current, perceived,
health-related quality of life
- Psychiatric medication in the last 6 months
- Information about if the patient has had any visit in the last 6 months
to the following:Primary health care. Number of visits; Psychiatrist. Number
of visits; Psychologist/psychotherapist. Number of visits; Other mental health
worker (including nurses). Number of visits; Other specialist
- Has the patient had any visits to the emergency room in the last 6
months? Number of visits due to accidents/injuries?; Number of visits due to
mental health?
- Number of hospital admissions in the last 6 months for other than
psychiatric reason. Total length of stay
- Number of hospital admissions in the last 6 months relating to mental
health. Total length of stay


Short overview of the questionnaires used in this trial:
- The ASRS (Kessler et al. 2005) will be used for the ADHD screening (patient
to complete this himself)
- CGI-S scale
- SDS (Sheehan Disability Scale) (patient to complete this himself)
- EQ-5D (patient to complete this himself)
-DIVA ( in case of ADHD diagnosis)