Emotional dysregulation in adult ADHD and response to atomoxetine.
BACKGROUND
Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as "associated features" in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms.


METHODS
The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting "emotional dysregulation." Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS.


RESULTS
Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis.


CONCLUSIONS
Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.
Reimherr
Frederick W
FW
Mood Disorders Clinic, Department of Psychiatry, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. fred.reimherr@hsc.utah.edu
Marchant
Barrie K
BK
Strong
Robert E
RE
Hedges
Dawson W
DW
Adler
Lenard
L
Spencer
Thomas J
TJ
West
Scott A
SA
Soni
Poonam
P
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000342:Affective Symptoms / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000150:complications / Q000188:drug therapy; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D009638:Norepinephrine / Q000378:metabolism; D011437:Propylamines / Q000627:therapeutic use*
D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride; D009638:Norepinephrine