ADHD in children with ADHD in children with neurological ...
ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent...
Transcript of ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent...
![Page 1: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/1.jpg)
ADHD dall’infanzia all’età adulta:
evoluzione clinica e trattamento
Giulio Perugi, MD
Istituto di Scienze del Comportamento “G.De Lisio”, Pisa
Dipartimento di Medicina Clinica e Sperimentale, Sezione
di Psichiatria, Università di Pisa, Pisa
![Page 2: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/2.jpg)
ES
Un paziente che nonostante la diagnosi e le
terapie corrette continua ad avere problemi
Descrive la sua vita come difficile e diversa
Grande disorganizzazione ed incapacità di
concludere a casa e sul lavoro
Grande difficoltà a raggiungere gli obiettivi
Bassa autostima
Sono sempre stato così
Come è il paziente adulto con ADHD
che chiede aiuto allo psichiatra?
![Page 3: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/3.jpg)
Circa il 75% dei disturbi psichiatrici degli adulti è
preceduta da disturbi ad esordio prima dei 18 anni (50%
prima dei 15 anni).
La psicopatologia infantile è spesso diversa da quella
che ritroveremo nell’adulto (sviluppo eterotipico).
La definizione delle traiettorie evolutive dei più
importanti disturbi psichiatrici ha un importante valore
preventivo sulla salute mentale della popolazione.
Dall’infanzia all’età adulta:
la prospettiva evolutiva
![Page 4: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/4.jpg)
• L’ADHD passa sotto la soglia clinica in 1/3 degli
adolescenti e nel 50% degli adulti.
• Non necessariamente le comorbidità seguono lo
stesso destino, per cui i disturbi “favoriti” dall’ADHD
possono seguire un percorso autonomo, sia in
adolescenza sia in età adulta.
Percorsi evolutivi dell’ADHD
![Page 5: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/5.jpg)
I SINTOMI NUCLEARI DELL’ADHD
• Iperattività
• Impulsività
• Inattenzione/Disorganizzazione
• Disregolazione Emotiva (ciclotimia)
Sintomi aspecifici
Continuum normalità-patologia
“Comorbidità”
![Page 6: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/6.jpg)
DSM 5: cambiamenti nei criteri
diagnostici
Inizio dei sintomi prima di 12 anni
Non più sottotipi ma “presentazioni”
Criteri più sensibili per soggetti adolescenti
o adulti
Per adolescenti > 17 anni ed adulti, sono
richiesti 5 anziché 6 sintomi.
Autismo non più criterio di esclusione
![Page 7: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/7.jpg)
• Inattention
• Over-activity
• Impulsiveness
• Ceaseless mental activity (distracted mind)
• Mood lability / emotional dysregulation
• Low tolerance of frustration
• Low self-esteem
• Variable performance
DSM criteria (core symptoms)
Associated Symptoms
Symptoms of ADHD are non specific
1. Asherson. 1st European Network Adult ADHD Conference. London, 2011.
![Page 8: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/8.jpg)
ADHD: TRAIETTORIA EVOLUTIVA
La fenomenica nell’età adulta cambia
rispetto a infanzia e adolescenza.Biederman et al. AJP 2000
… per l’interazione di
molteplici fattori …
![Page 9: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/9.jpg)
• Disorganisation (“doesn’t plan ahead”)
• Forgetfulness (“misses appointments, loses things”)
• Procrastination (“starts projects but can’t complete”)
• Time management problems (“always late”)
• Premature shifting of activities (“starts something but then quickly distracted by something else”)
• Impulsive decisions (especially around spending, taking on projects, travelling, jobs or social plans)
• Criminal offences (speeding, illegal drugs)
• Unstable jobs and relationships
Clinical Presentation in Adults
1. Kooij & Francken. DIVA Foundation 2010.
![Page 10: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/10.jpg)
• Disorganisation (“doesn’t plan ahead”)
• Forgetfulness (“misses appointments, loses things”)
• Procrastination (“starts projects but can’t complete”)
• Time management problems (“always late”)
• Premature shifting of activities (“starts something but then quickly distracted by something else”)
• Impulsive decisions (especially around spending, taking on projects, travelling, jobs or social plans)
• Criminal offences (speeding, illegal drugs)
• Unstable jobs and relationships
Clinical Presentation in Adults
1. Kooij & Francken. DIVA Foundation 2010.
![Page 11: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/11.jpg)
Diverse tipologie di pazienti adulti
con ADHD
1. Predominanti sintomi di inattenzione e difficoltà di organizzazione
Lentezza sul piano cognitivo e pragmatico, difficolta prestazionali e di funzionamento
frequente la comorbidità con depressione e ansia
2. Impulsività marcata e iperattività ampia sovrapposizione con i disturbi dello spettro bipolare e di
personalità, spesso in comorbidità con uso di sostanze
Malingering e disturbi fittizi
Più complicati da gestire
![Page 12: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/12.jpg)
• Anxiety:1
– Ceaseless thoughts, avoidance behaviour
• Depression:1
– Unstable mood, impatience, irritability, initial insomnia, low self-esteem
• Personality disorder:1
– Antisocial, borderline, emotionally unstable, poor social interactions, impulsive, adulthood instability trait-like quality
• Hypomania, bipolar ll disorder, cyclothymia:2
– Differentiated by grandiosity, clear focus of thoughts, episodic, reduced need for sleep, psychosis
Comorbidity and symptoms of ADHD
1. Asherson. 1st European Network Adult ADHD Conference. London, 2011.
2. Babcock and Ornstein. Postgraduate Medicine. 2009;121(3):73-82.
![Page 13: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/13.jpg)
ADHD as a Risk Factor for Development
of Co-occurring Conditions Later in Life
Environmental and genetic risks:
(maltreatment / COMT* genotype)
Risk Model
Adult with ADHD
• Antisocial behavior• Addiction• Depression/low self-esteem• Anxiety
*Catechol-O-methyl transferase
1. Asherson. 1st European Network Adult ADHD Conference. London, 2011.
![Page 14: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/14.jpg)
• Dyslexia (overlapping genetic risk factors)1
• Specific and general learning difficulties (overlapping genetic risk factors, inattention)1
• Pervasive developmental disorder1
• Dyspraxia1
• Tic disorders/Tourette's disorder1
• Speech problems2
• Autism spectrum disorder1
Overlapping Neurodevelopmental Disorders
1. Kooij et al. BMC Psychiatry 2010;10:67
2. Tannock et al J Abnl Child Psychol, 2000; 28(3):237–252
![Page 15: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/15.jpg)
aPrevalence estimates of ADHD in the subsamples with the comorbid disordersbPrevalence estimates of the comorbid disorders in the subsample with ADHD
Conditional Prevalence Estimates, %(SE)1
OR (95% CI)ADHD in other
disorderaOther disorder in
ADHDb
Classes of co-occurring disorders
Mood 11 (1.2) 25 (2.6) 3.9 (3.0–5.1)
Anxiety 10 (1.0) 38 (3.1) 4.0 (3.0–5.2)
Substance use 12.5 (2.3) 11 (2.0) 4.0 (2.8–5.8)
Comorbidities in ADHD
1. Fayyad et al. Br J Psychiatry 2007;190:402–9.
![Page 16: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/16.jpg)
• Reason for the relationship:
– High stimulus seeking behaviour:
• Inherent component of ADHD (e.g. novelty seeking)
• Shared genetic risk
– Impaired social/academic/work function:
• Secondary consequence of psychosocial
impairments
– Relief from symptoms:
• Self-treatment of symptoms (e.g. cannabis, alcohol,
cocaine)
ADHD and Substance Misuse
1. Arias et al. Addictive Behaviors 2008;33(9):1199–207.
2. Asherson. 1st European Network Adult ADHD Conference. London, 2011.
![Page 17: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/17.jpg)
• Lifetime prevalence 9.5% (14.7% males, 5.8%
Females
• Early onset of BD (5 years before)
• Comorbid anxiety, alcohol and substance use
disorders
![Page 18: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/18.jpg)
• Increased rates• ADHD in relatives of BD-I probands
• BD-I in relatives of ADHD probands
• Not accounted for by misdiagnosis
• Comorbidity as a distinct familial subtype ?
![Page 19: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/19.jpg)
Prevalence: 17/96-19.1%
Early onset
Comorbidity (ICD, SUD, GAD)
Problems with antidepressants
![Page 20: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/20.jpg)
Treatment
• Children’s Guidelines for Treatment
• Adults = ???
• Overview
– Symptom reduction/minimize
– Education
– Psychotherapy
– Pharmacological
![Page 21: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/21.jpg)
ADHD is an heterogeneuos disorder
DSM-IV Clinical subtypes
• Inattentive
• Hyperactive/Impulsive
• Combined
Neuropsychology Models
• Executive Dysfunction
• Motivational Dysfunction
• Delay Adversion
• Response Variability
• Speed in Cognition & Arausal
DSM-IV ADHD vs
ICD-10 Hyperkinetic Dis.
Comorbidities
• Disruptive behaviours (ODD, CD, Antis P)
• Neurodevelopmental (i.e.dyslexia, ASD)
• Tics & Tourette Syndrome
• Severe Mood Disregulation (bipolar ?)
• Anxiety and Depression
• Bipolar Disorder
• Drug and alcohol abuse
![Page 22: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/22.jpg)
A TRIPLE PATHWAY HYPOTHESIS
CORTICO-DORSAL
STRIATAL LOOP
DISTURBANCE
INHIBITORY
DEFICITS
EXECUTIVE
DEFICITS
CORTICO-VENTRAL
STRIATAL LOOP
DISTURBANCE
IMPAIRED SIGNAL
DELAYED REWARD
DELAY AVERSION
ADHD subtypes
CORTICO-
CEREBELLAR LOOP
DISTURBANCE
TEMPORO-SENSORY-
MOTOR INTEGRATION
DEFICITS
MOTOR
ASYNCHRONY
![Page 23: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/23.jpg)
Psychosocial Intervention
– CBT
– Self-Mgmt Skills Training
– Environmental Restructuring
– Psycho-education
– Individual Psychotherapy
– Family Therapy
– Marital/Couple Therapy
– Vocational Counseling
– ADHD Coaching
![Page 24: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/24.jpg)
DRUGS
– Well established in children with ADHD
• Stimulants (first line drugs)
• Atomoxetine (Strattera)
• Children (70-80% respond)
• Adults (25-78% respond) (30% don’t!!!!)
– Atomoxetine (Strattera)
– Methylphenidate (Ritalin)
– Amphetamine compounds (Adderall)
– Dextroamphetamine (Dexedrine)
![Page 25: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/25.jpg)
![Page 26: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/26.jpg)
Stimulant administration • Metilphenidate
– Short-acting,low dose = titrate up
• Ritalin = 3 – 4 hours
– Move towards longer acting stimulants
• Equasym = 6-12 hours
• Medikinet = 8-16 hours
![Page 27: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/27.jpg)
Stimulants: Pros & Cons• Pros:
– Highly effective
– Long history of use
• Cons:
– Limited duration of action
– Side effects [e.g., Nausea, headache, insomnia,
decreased appetite, tics (up to 65% w/MPH),
anxiety, HTN/tachycardia, psychosis]
– Contraindications [HTN, symptomatic
cardiovascular disease, glaucoma,
hyperthyroidism, tics/Tourette’s (relative), drug
abuse (relative), psychosis (relative)]
![Page 28: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/28.jpg)
Stimulants, Abuse,
and ADHD Patients
• CNS stimulants are rarely abused by children and
adolescents with ADHD
• Used properly, they decrease the likelihood of
later substance abuse in these patients
• In adults long-term stimulants may be associated
with misuse
• In adults with comorbid substance abuse,
malingering and stimulant misuse is frequent
![Page 29: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/29.jpg)
Anti-depressants
– Atomoxetine (Strattera)**
– Tri-cyclics (Desipramine-Norpramin)
– MAOI (tranilcipromine)
– Bupropion (Wellbutrin)-atypical
– Venlafaxine (Effexor)-atypical
**= Strattera, indicated for ADHD
![Page 30: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/30.jpg)
• Bipolar-ADHD
• Severity
• Substance abuse
• Malingering-diversion
• Stimulants very effective in ADHD
• Mood instability
• Atomoxetine
• Substance abuse
• Malingering-diversion
![Page 31: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/31.jpg)
TEST IMPLEMENTATION
Saliva Sample
DNA Analysis & Interpretation
User-friendly Pharmacogenetic Report
Stable at room temperature
![Page 32: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/32.jpg)
CLINICAL CASE 2
• Demographics: Male 19 y/o
• Condition: ADHD, DSA, Long-lasting mood instability, impulsivity, severe functional disability
• Treatment:
1. Fluoxetine: Poor tolerability
2. Citalopram, quetiapine, olanzapine: Very poor tolerability
3. Valproate: no effect
![Page 33: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/33.jpg)
![Page 34: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/34.jpg)
Conclusioni
• L’ADHD nell’adulto è poco diagnosticato
– Scarsa familiarità con I disturbi del neurosviluppo
– Elevata comorbidità con disturbi dell’umore, d’ansia, da uso di
sostanze, di personalità.
• ADHD può essere considerato un fattore di rischio per lo
sviluppo di altri disturbi mentali
• La co-occorrenza di ADHD, Disturbo Bipolare e uso di
sostanze sembra delineare un fenotipo specifico
• Richiede un trattamento specifico anche nell’adulto
• Atomoxetina approvata nell’adulto
• Gli stimolanti richiedono procedura off-label
![Page 35: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/35.jpg)
Domande e Commenti ?
“La mente umana deve
costruire le forme,
indipendentemente, prima
di poterle trovare nelle
cose.”
Albert Eisnstein, 1927
![Page 36: ADHD dall’infanzia all’età adulta€¦ · –High stimulus seeking behaviour: •Inherent component of ADHD (e.g. novelty seeking) •Shared genetic risk –Impaired social/academic/work](https://reader033.fdocuments.net/reader033/viewer/2022060322/5f0d8c667e708231d43ae821/html5/thumbnails/36.jpg)
CORSO PRATICO DI FARMACOTERAPIA
PSICHIATRICAAdulto, età evolutiva, anziano, doppia diagnosi
ROMA, 7-10 OTTOBRE e 16-19 DICEMBRE 2015
OLY HOTEL - Via Santuario Regina degli Apostoli, 36
www.iscdelisio.org
Faculty
Albert U.Brugnoli R.De Bartolomeis A.Di Sciascio G. Girardi P.Koukopoulos A.Maina G.Maremmani I.
Masi G.Mazzarini L.Mecocci P.Medda P.Perugi G.Pompili M.Sani G.Tondo L.Toni C.Vampini C.Zuddas A.