Assessment of personality disorder in adult ADHD using data from a clinical trial of OROS Methylphenidate (OROS MPH)

Background: Studies have reported high comorbidity of personality disorder and adult ADHD. However, assessment of personality disorder is problematic and none have rigorously confirmed this observation with measures of concurrent validity. Methods: 47 patients entered a double-blind trial of OROS MPH after administration of the Wisconsin Personality Inventory (WISPI-IV) and the SCID-II. At discharge, all information was reviewed to produce a final consensus personality diagnosis. Patients were separated into three post hoc categories: PDnegative (no personality disorder), PDpositive (subjects meeting diagnostic criteria for one disorder), and PDplus (subjects meeting diagnostic criteria for ?2 disorders). Results: 45% of subjects had a personality disorder on the final assessment versus 62% (SCID-II) and 33% (WISPI-IV): 11% cluster A, 17% cluster B and 30% cluster C. Compared to the final assessment, the WISPI-IV identified PDnegative subjects with sensitivity = .92 and specificity = .67 and PDplus subjects with sensitivity = .40 and specificity = 1.00. The SCID-II identified PDnegative subjects with sensitivity = .64 and specificity = .90 and PDplus subjects with sensitivity = .90 and specificity = .84. There was a significant correlation between the number of SCID-II items endorsed by each subject and their WISPI-IV average z-score (r=.67, df=46, p<.001). Conclusions: All three systems detected personality disorder in a large proportion of patients. The WISPI tended to under-estimate personality disorders while the SCID-II over-estimated them. The self-administered WISPI-IV would be more practical in a multicenter clinical trial to provide an estimate of personality disorder. Light therapy has been demonstrated useful in treating SAD.  The seminal article by Rosenthal et al (1984) hypothesized about the depressogenic effects of melatonin and described preliminary findings about the effects of artificial light therapy.  Since that time, research has supported this observation and expanded to conditions other than SAD such as problems with jet-lag and shift work. A particular area of interest is the relationship between SAD and other affective disorders.  It is probable that even within SAD studies, subjects do not all suffer from pure SAD, but most studies do not indicate the degree of overlap in their samples.  For example, patients with major depressive disorder often have seasonal variations with winter being the season with the greatest risk for depression (Kasper et al 1990). Photosensitive retinal ganglion cells that project from the retina to the suprachiasmatic nucleus, intergeniculate leaflet and olivary pretectal nucleus (Gooley et al 2003) are probably responsible for the melatonin suppression associated with light therapy.  It appears that these cells respond most strongly to wavelengths of ~480nm.  This understanding has led to the development of blue light therapy for SAD. While blue light treatment of SAD has proven effective in prior trials, the present study was an improvement in three ways:  1)  The use of bright red light as placebo rather than the commonly used dim red light.  2) The impact of incomplete summer remission on treatment outcome was assessed.  3) An open-label, follow-up period was included.