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Background: Persistent attention deficit hyperactivity disorder (ADHD) and a history of conduct disorder (CD) are highly prevalent among patients with substance use disorders (SUD). We examined the influence of both diagnoses on problem severity, psychiatric comorbidity, and quality of life in methadone-maintained patients. Methods: 193 patients in long-term methadone maintenance treatment (MMT) were assessed for ADHD through a semi-structured interview. Psychiatric disorders and SUD were assessed with the MINI, the CIDI-SAM, and the SIDP-IV. Results: Childhood ADHD was diagnosed in 68 (35.2%) patients; 48 (24.9%) had persisting ADHD; a CD history was present in 116 (60.1%). Patients with adult ADHD had significantly higher problem severity scores, lower quality of life scores, more comorbid SUD and more psychiatric comorbidity. Although both ADHD and CD contributed to problem severity, addictive pathology and psychopathology, ADHD was found to substantially increase the risk of psychiatric comorbidity, independent of CD. Conclusion: ADHD in MMT patients is characterised by greater addiction severity and more comorbid psychopathology, only partly explained by the influence of a coexisting CD. The presence of ADHD in a substantial minority of patients accentuates the need for early detection and treatment of this complicating disorder.

There is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD. A multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined. In MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = -3.44 (-5.75, -1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩾30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up. MBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.

Objectives ADHD has a considerable economic impact. The aim of this study is to conduct a trial-based economic evaluation of mindfulness-based cognitive therapy (MBCT) added to treatment as usual (TAU) versus TAU in adults with ADHD. Methods A Dutch economic evaluation with a time horizon of 9 months was conducted from the societal perspective in the intention-to-treat (ITT) sample. Costs were assessed with a self-report questionnaire. Outcomes were expressed in quality adjusted life years (QALYs) and response rate. Bootstrap simulations were performed to estimate mean costs, QALYs, response rate, incremental cost-effectiveness ratios (ICERs), and associated uncertainty. Additional sensitivity analyses were done with imputed data, without extreme cost outliers, using the per protocol sample, and from a health care perspective. Results In the ITT sample, societal costs were €3572 for MBCT + TAU ( n  = 47; 95% CI 2416 to 4995) and €3389 for TAU ( n  = 49; 2327 to 4763). Average QALYs were 0.542 (0.522 to 0.563) per patient for MBCT + TAU and 0.534 (0.511 to 0.556) for TAU. In MBCT + TAU, more patients responded than in TAU (31% versus 6%; M bootstrapped difference 25%, 12 to 40%). ICERs were €21,963 per QALY gained and €389 per responder. At a threshold of €30,000 per QALY, the probability of MBCT being cost-effective was 51%. All sensitivity analyses showed more favorable results for MBCT + TAU. Conclusions In most analyses, MBCT was found to be more costly and effective, particularly in terms of disease-specific outcome, than TAU. If the threshold exceeds €30,000 per QALY and €1000 per responder, MBCT seemed cost-effective in treating adult ADHD.

The treatment of hormone resistant prostate cancer) with epirubicin 25 mg/m(2)(Epi25) on a weekly intravenous regimen may be better in terms of health related quality of life (HRQOL) than with 100 mg/m(2)(Epi100) on a 4-weekly regimen. A total of 79 patients who filled out the EORTC-QLQ-C30 questionnaire for the assessment of HRQOL could be evaluated. Compared with the baseline, no changes in HRQOL function scales or significant changes in the following HRQOL symptom scales were found. The Epi25 group reported less pain during the first 3 months and the Epi100 group more dyspnoea after 4 weeks and less pain and less insomnia but more loss of appetite after 8 weeks. In both groups, toxicity was comparable, except for World Health Organisation grade II-III alopecia occurring in 82% in the Epi100 versus 31% in the Epi25 group. There were no significant differences between groups in response rates and survival. In this study, HRQOL was not improved which is in line with other studies using only epirubicine. Epirubicin as single agent therapy should not be used in future treatment of patients with HRPC.