Aim. To evaluate the prevalence rate and the diagnostic and therapeutic pathways of care of ADHD patients in the Lombardy Region. Methods. Data on patients evaluated by the 18 ADHD Regional Reference Centres in the 2012-2013 period were analysed in order to describe the diagnostic and therapeutic characteristics of the sample. Results. In all, 753 of 1150 (65%) suspected patients received a diagnosis of ADHD (M:F=6:1; median age 9yr; range: 5-17yr). In 24% of cases there was a family history of ADHD. A total of 483 (65%) patients had at least one psychopathological disorder, the most frequent of which were learning disorders (35%), sleep disturbances (14%), and oppositional defiant disorder (13%), while 69 (9%) had other chronic medical conditions, most of which were neurological diseases (n=28). In all, 85% of patients received a prescription for a psychological type of intervention, involving mostly parent training (428 patients, 82%), child training (308, 59%), and teacher training (173, 33%), while 2% received prescriptions for drugs alone, and 13% a combination of both. Of the 115 patients receiving drug therapy, 95 (83%) were treated with methylphenidate (5-40 mg/day), 5 of whom in combination with other psychotropic drugs, 7% (n=8) with atomoxetine (10-75 mg/day), and the remaining 10% (n=12) with another drug, especially risperidone. Compared to subjects treated with psychological interventions alone, patients with drug prescriptions more commonly presented values of CGI-S of 5 or higher (p<0.0001), lower cognitive levels (p=0.0019), and the presence of associated disorders, such as oppositional defiant disorder (p<0.0001) and sleep disturbances (p=0.0007). Conclusions. The registry represents an essential tool for continuous, systematic monitoring and has permitted the planning and appropriate use of resources based on actual needs, leading to significant, progressive improvements in clinical practice and ensuring an efficient and homogeneous quality of care.

Obiettivo. Definire la prevalenza e descrivere i percorsi diagnostico-terapeutici dei pazienti ADHD in Regione Lombardia. Metodi. I dati relativi ai nuovi pazienti valutati dai 18 Centri di Riferimento Lombardi nel periodo 2012-2013 sono stati estrapolati dal database del Registro regionale ADHD e analizzati, per descrivere le caratteristiche clinico-diagnostiche e prescrittive del campione. Risultati. 753 dei 1150 casi sospetti (65%) hanno ricevuto una diagnosi di ADHD (M:F=6:1; età mediana: 9aa; range: 5-17aa), nel 24% dei casi era presente familiarità per ADHD. 483 (65%) pazienti presentavano almeno un altro disturbo psicopatologico, più frequentemente disturbi dell’apprendimento (35%), disturbi del sonno (14%) e disturbo oppositivo-provocatorio (13%); mentre 69 (9%) avevano in associazione altra condizione medica cronica, per lo più di tipo neurologico (n=28). L’85% dei pazienti ha ricevuto una prescrizione di tipo psicologico, più comunemente parent training (n=428, 82%), seguito da child training (n=308, 59%) e teacher training (n=173, 33%); il 2% solo farmacologica, il 13% entrambe. Dei 115 pazienti con terapia farmacologica, 95 (83%) sono stati trattati con metilfenidato (5-40 mg/die), 5 dei quali in associazione con un altro psicofarmaco, il 7% (n=8) con atomoxetina (10-75 mg/die) e il restante 10% (n=12) con un altro farmaco, in particolare risperidone. Rispetto ai soggetti cui è stato prescritto solo l’intervento psicologico, i pazienti con prescrizione farmacologica presentavano più frequentemente valori di CGI-S di 5 o superiore (P<0,0001), livello cognitivo inferiore (P=0,0019), la presenza di disturbi associati, quali il disturbo oppositivo-provocatorio (P<0,0001) e i disturbi del sonno (P=0,0007). Conclusioni. Il Registro ha rappresentato un essenziale strumento di monitoraggio continuo e sistematico che ha permesso di programmare e usare in modo appropriato le risorse sulla base dei bisogni (grado e tipo di domanda), attivando progressivi e significativi miglioramenti nella pratica clinica e garantendo un’efficiente e omogenea qualità delle cure.

Reale, L., Bonati, M., Zanetti, M., Cartabia, M., Fortinguerra, F. (2015). Due anni di attività del Progetto ADHD della Regione Lombardia: analisi dei percorsi di cura diagnostici e terapeutici. [Two-years of activity of the Lombardy Region’s ADHD Project: an analysis of the diagnostic and therapeutic pathways of care]. GIORNALE DI NEUROPSICHIATRIA DELL'ETÀ EVOLUTIVA, 35, 117-126.

Due anni di attività del Progetto ADHD della Regione Lombardia: analisi dei percorsi di cura diagnostici e terapeutici. [Two-years of activity of the Lombardy Region’s ADHD Project: an analysis of the diagnostic and therapeutic pathways of care]

Reale, L
;
Bonati, M;
2015

Abstract

Aim. To evaluate the prevalence rate and the diagnostic and therapeutic pathways of care of ADHD patients in the Lombardy Region. Methods. Data on patients evaluated by the 18 ADHD Regional Reference Centres in the 2012-2013 period were analysed in order to describe the diagnostic and therapeutic characteristics of the sample. Results. In all, 753 of 1150 (65%) suspected patients received a diagnosis of ADHD (M:F=6:1; median age 9yr; range: 5-17yr). In 24% of cases there was a family history of ADHD. A total of 483 (65%) patients had at least one psychopathological disorder, the most frequent of which were learning disorders (35%), sleep disturbances (14%), and oppositional defiant disorder (13%), while 69 (9%) had other chronic medical conditions, most of which were neurological diseases (n=28). In all, 85% of patients received a prescription for a psychological type of intervention, involving mostly parent training (428 patients, 82%), child training (308, 59%), and teacher training (173, 33%), while 2% received prescriptions for drugs alone, and 13% a combination of both. Of the 115 patients receiving drug therapy, 95 (83%) were treated with methylphenidate (5-40 mg/day), 5 of whom in combination with other psychotropic drugs, 7% (n=8) with atomoxetine (10-75 mg/day), and the remaining 10% (n=12) with another drug, especially risperidone. Compared to subjects treated with psychological interventions alone, patients with drug prescriptions more commonly presented values of CGI-S of 5 or higher (p<0.0001), lower cognitive levels (p=0.0019), and the presence of associated disorders, such as oppositional defiant disorder (p<0.0001) and sleep disturbances (p=0.0007). Conclusions. The registry represents an essential tool for continuous, systematic monitoring and has permitted the planning and appropriate use of resources based on actual needs, leading to significant, progressive improvements in clinical practice and ensuring an efficient and homogeneous quality of care.
Articolo in rivista - Articolo scientifico
Attention deficit disorder, Prevalence, Disease registry, Treatment planning, Child, Adolescents, Epidemiology
ADHD, prevalenza, registro, trattamento, bambini, adolescenti, epidemiologia
English
Italian
2015
35
117
126
none
Reale, L., Bonati, M., Zanetti, M., Cartabia, M., Fortinguerra, F. (2015). Due anni di attività del Progetto ADHD della Regione Lombardia: analisi dei percorsi di cura diagnostici e terapeutici. [Two-years of activity of the Lombardy Region’s ADHD Project: an analysis of the diagnostic and therapeutic pathways of care]. GIORNALE DI NEUROPSICHIATRIA DELL'ETÀ EVOLUTIVA, 35, 117-126.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/185873
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