title: Personality disorders in ADHD Part 2: The effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: Reid J
authors.initials: RJ
authors.lastname: Robison
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Reimherr
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Gale
authors.forename: Barrie K
authors.initials: BK
authors.lastname: Marchant
authors.forename: Erika D
authors.initials: ED
authors.lastname: Williams
authors.forename: Poonam
authors.initials: P
authors.lastname: Soni
authors.forename: Corinne
authors.initials: C
authors.lastname: Halls
authors.forename: Robert E
authors.initials: RE
authors.lastname: Strong
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D015897:Comorbidity; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D010552:Personality Assessment; D010554:Personality Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D011581:Psychological Tests; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
chemical_list: D000697:Central Nervous System Stimulants; D018765:Dopamine Uptake Inhibitors; D008774:Methylphenidate