Copenhagen HealthTeam
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1 Copenhagen HealthTeam - ADHD among homeless KØBENHAVNS KOMMUNE Forvaltning Afdeling / kontor
2 Case C.C. 20 years old man Homeless, living as squatter Abuse of alcohol every day and stimulant-drugs in weekends No contact to family. Dismissed from several schools. Good exam from secondary school. Lots of conflict. Lots of violence. Lots of party
3 School (Barkley et al., 2008) Expelled from education 13% ADHD vs. 5% control Special education (High School) 44% ADHD vs. 10% control Graduated High School 68% ADHD vs. 100% control Started at College 22% ADHD vs. 77% control Graduated from College 5-10% ADHD vs. 35% control Department of Psychiatry, University of Pennsylvania School of Medicine
4 Jobs (Barkley, 2002) Dismissed ADHD 3x > control group Change of job (10 years period) ADHD 2-3 x more Disciplinary talks with employer More problems with lower performance
5 Subjects (%) More traffic accidents involving adults with ADHD P=0.004 ADHD n=25 Control n=23 P= P=0.07 P= Traffic violations Speeding violations Drunk driving License suspended Driver-caused accidents Barkley RA, et al. Pediatrics. 1996;98:
6 Current smokers More smokers with ADHD 50% Adult patients with ADHD; n= % 40% 40.8% 30% 20% 25.8% 29% ADHD General population *P< % 0% *Smokers Quit ratio Pomerleau, et al. J Subst Abuse. 1995;7: Department of Psychiatry, University of Pennsylvania School of Medicine
7 Lifetime rate of substance abuse in referred ADHD adults More abusers 60 ADHD (n=239) 55% Control (n=268) P< % Biederman, et al. Biol Psychiatry. 1998;44: Department of Psychiatry, University of Pennsylvania School of Medicine
8 Risk of developing drug abuse
9 Number of substance abusers who develop an addiction
10 % of study population Medical treatments reduce abuse in adults with ADHD Effect of pharmacotherapy P< Biederman J, et al. Pediatrics. 1999;104:e20-e Unmedicated ADHD (N=19) Medicated ADHD (N=56) Control (N=137)
11 Survey among homeless in Copenhagen All new patients in 2010 are asked to participate The nurse calculates an ADHD-score based on ASRS questionnaire (Adult ADHD Self Report Scale) Evaluation of psychosis The patient completes the ASRS questionnaire Questions about being in prison
12 Those who score positive on the ASRS Further examination by the doctor Symptoms and difficulties History of childhood, family and school Previous history and eventual result of treatment Previous medical/psychiatric history
13 Treatment Medicine administrated by the nurse Close contact Contact to the social system Contact to abuse-treatment system
14 Preliminary data from the survey 92 new patients in first 9 months of evaluated by nurse(41 male, m.age 42, 9 female m.age 38) 38 made ASRS part I (33 both self- & nurse evaluation) 22 made ASRS part II
15 Preliminary data from the survey Data for 33 persons evaluated by nurse and self 1 female evaluated as clearly psychotic 3 males evaluated as possible psychotic or psychotic some of the time
16 Preliminary data from the survey 25 Total ASRS-score by nurse and patient Nurse Patient
17 Preliminary data from the survey Of the 33 cases where both nurse and patient have scored ASRS part I Similar score in 23 cases (patient-score13 neg. 10 pos.) Different score in 10 cases (patient-score: 5 neg. 5 pos.)
18 Preliminary data from the survey Of the 10 cases with different score The nurse scores pos. and patient neg. in 3 cases The nurse scores neg. and patient pos. in 7 cases
19 (Very preliminary) Conclusions The nurse does not find patients by clinical sense alone there are more negative evaluations in comparison to ASRS outcome The use of systematic screening is of importance in finding cases for further examination But there is agreement in 2 out of 3
20 Preliminary data from the survey Imprisonment and ADHD No. % of all ASRS pos. (N=15) % of all ASRS neg. (N=18) Positive ASRS and been to prison 8 53 Negative ASRS and been to prison 5 27
21 (Very preliminary) Conclusions Imprisonment is occuring twice as often among ADHD - patients Of those who has been imprisoned the average score on general function in prison compared to outside is 2,9 = better functioning inside prison. (5 point scale) One third indicates much better functioning inside prison
22 What happened to C.C. 6 month in prison for violence and shop-lifting Started en education as car mechanic Dismissed after 1 month due to alcohol abuse Diagnosed with ADHD and starting treatment Living in a youth-shelter and waiting for his own apartment soon Trying to reduce alcohol. Has been abstinent for several weeks Waiting to start an education as a web-designer as soon as he get his apartment. Got in contact with his brother
23 For more information KØBENHAVNS KOMMUNE Forvaltning Afdeling / kontor
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