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Suicide risk is doubled for inmates who have ADHD.

SEATTLE--Inmates who have attention-deficit/hyperactivity disorder have twice the risk of suicide as other inmates, a study has shown.

Previous research has identified associations between ADHD and criminal behavior, according to lead author Dr. Patricia Westmoreland, a psychiatrist with the Iowa Department of Corrections in Oakdale. For example, ADHD in childhood strongly predicts disruptive behavior, arrests, jail stays, and felony convictions in adulthood.

In the current study, Dr. Westmoreland and her colleagues randomly selected offenders newly admitted to the Iowa Medical and Classification Center who were not violent or acutely unstable, had not violated probation, did not have a maximum security designation, and were not in protective custody.

Mental health disorders, suicide risk, and physical and mental functioning were assessed with the Mini-International Neuropsychiatric Interview Plus (MINI-Plus) and the Short Form-36 Health Survey (SF-36), she reported at the annual meeting of the American Academy of Psychiatry and the Law.

Overall, 21% of the 319 inmates (14% of women and 23% of men) had ADHD, said Dr. Westmoreland. Ninety-one percent of this group had at least four symptoms of the disorder; the most common were impulsivity with money (93%), general impulsivity (91%), distractibility (90%), and being "in a fog" (90%).

"The most striking thing we found was that ADHD was highly correlated with potential suicidality," she said in an interview. Compared with inmates who did not have ADHD, those who did had a twofold higher risk of suicide as assessed from risk scores.

"We speculate, as have others in the past in noncorrectional populations, that that [elevated risk] is due to their very often having other comorbid mental illnesses," she commented. "But it may also be due in part to their impulsivity."

Indeed, offenders with ADHD were more likely than their counterparts without it to have antisocial personality disorder (54% vs. 30%), borderline personality disorder (52% vs. 23%), and several other mental health conditions (mood or anxiety disorders, psychotic disorders, body dysmorphic disorder, and somatoform disorders).

Taken together, the findings indicate that ADHD is common among offenders and often accompanied by other psychological comorbidity, according to Dr. Westmoreland.

Psychiatrists should be aware of ADHD in prison populations. "A lot of the so-called acting out in inmates may be due to attention deficit," she said. "You have got to look for other symptoms of the disorder and be prepared to treat it."

Although stimulants are effective for treating ADHD, using them in the prison population is problematic because of the potential for abuse, she observed. "You have to find ways of dealing with the disorder using non-stimulants, such as psychotherapy tools, or if you use stimulants, use them in the liquid form," she recommended.

Several offenders identified as having ADHD at her center have done well with appropriate treatment, Dr. Westmoreland said. "So I think it's important to recognize the disorder and not just attribute their behavior to bad behavior," she concluded.

Dr. Westmoreland reported that she had no conflicts of interest related to the study.

BY SUSAN LONDON

Contributing Writer
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Title Annotation:FORENSIC PSYCHIATRY
Author:London, Susan
Publication:Clinical Psychiatry News
Date:Jan 1, 2009
Words:499
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