Leiden University Student Repository

houwen, roseline van der (2023)

Atypical treatment response to first-choice medication in adults with ADHD: a role of stress?

Master thesis | Psychology (MSc)

This retrospective cohort study aimed to investigate the influence of stress on atypical symptom amelioration to first-choice psychostimulant medication in individuals with attention deficit hyperactivity disorder (ADHD). Understanding the impact of stress on the effectiveness of psychostimulant medications is crucial, given the high prevalence of stress-related psychiatric comorbidity in ADHD and the potential stress effects on psychostimulant effectivity. It was hypothesized that cardiovascular stress and stress-related psychiatric comorbidity are related to atypical symptom amelioration and that these two characteristics are interrelated. Additionally, the effect of medication and time will be explored. A unique subset from the SOPHISTICATE cohort was analysed, comprising of 460 patients diagnosed with ADHD who exhibited atypical treatment response following first-choice medication registration and were switched to a second-choice medication within 3 weeks. The adult version of...Show moreThis retrospective cohort study aimed to investigate the influence of stress on atypical symptom amelioration to first-choice psychostimulant medication in individuals with attention deficit hyperactivity disorder (ADHD). Understanding the impact of stress on the effectiveness of psychostimulant medications is crucial, given the high prevalence of stress-related psychiatric comorbidity in ADHD and the potential stress effects on psychostimulant effectivity. It was hypothesized that cardiovascular stress and stress-related psychiatric comorbidity are related to atypical symptom amelioration and that these two characteristics are interrelated. Additionally, the effect of medication and time will be explored. A unique subset from the SOPHISTICATE cohort was analysed, comprising of 460 patients diagnosed with ADHD who exhibited atypical treatment response following first-choice medication registration and were switched to a second-choice medication within 3 weeks. The adult version of the Quantified Behavioral Test (QbTest), a computerized tool that quantifies the core symptoms of ADHD was used to determine baseline symptom severity and treatment response, i.e. QbActivity (QbAct); QbImpulsivity (QbImp); and QbInattention (QbIna). Patients were divided into groups based on stresscharacteristics, and linear mixed models were employed to examine the impact of stresscharacteristics, first-choice medication and time on symptom amelioration (i.e. QbTest score after first- or second-choice medication – QbTest score at baseline; ∆). The results reveal that stress-characteristics were not related to atypical symptom amelioration after first-choice medication. However, patients with stress related psychiatric comorbidity show more inattentive symptom amelioration after second-choice medication registration β=.21, SE=.10, 95% CI [.02, .41], p=.031. Importantly, the effect of time was significant for all three symptom domainssuggesting a role of time to enable a typical response, i.e. ∆QbAct (F(1,462) = 387.818, p < .001), ∆QbImp (F(1, 462) = 235.224, p < .001) and on ∆QbIna (F(1, 463) = 319.655, p = .242). Additionally it was found that baseline symptom severity confounds the medication effect for ∆QbImp and for ∆QbAct. In conclusion, the results indicate that stress characteristics nor medication is related to an atypical response pattern to first-choice medication. The current study did reveal an important role of time to enable a ‘typical’ response. Limitations of the study included the lack of a reference group, the possibility of random effects, and quality of the cardiovascular data. In conclusion, while the impact of stress on treatment response could not be definitively determined based on the available data, future research should explore the complex interplay between stress, psychiatric comorbidity, and medication types to optimize treatment strategies and improve outcomes for patientsShow less

ADHD

Stress

Dexamphetamine

Methylphenidate

Author

houwen, roseline van der

Faculty

Faculty of Social & Behavioural Sciences

Specialisation

clinical neuro psychology

Supervisors

Anne Cuperus

ECTS Credits

20

Language

nl