Cognitive and emotional impairments in adults with attention-deficit/hyperactivity disorder and cocaine use

Michael D Wunderli; Matthias Vonmoos; Stefania M Niedecker; Lea M Hulka; Katrin H Preller; Markus R Baumgartner; Thomas Kraemer; Erich Seifritz; Michael P Schaub; Dominique Eich-Höchli; Boris B Quednow

doi:10.1016/j.drugalcdep.2016.03.026

Cognitive and emotional impairments in adults with attention-deficit/hyperactivity disorder and cocaine use

Drug Alcohol Depend. 2016 Jun 1:163:92-9. doi: 10.1016/j.drugalcdep.2016.03.026. Epub 2016 Apr 7.

Affiliations

¹ Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
² Center of Forensic Hairanalytics, Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006 Zurich, Switzerland.
³ Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
⁴ Swiss Research Institute for Public Health and Addiction, Associated Institute at the University of Zurich and WHO Collaborating Centre, Konradstrasse 32, 8031 Zurich, Switzerland.
⁵ Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland. Electronic address: quednow@bli.uzh.ch.

PMID: 27085500
DOI: 10.1016/j.drugalcdep.2016.03.026

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is an important modulator of cognitive and social functioning in cocaine addiction but it is unclear whether ADHD symptoms and cocaine use display mutually aggravating interaction effects on cognition, social functioning, and depressive symptoms. Therefore, we investigated the interaction of cocaine use and adult ADHD on social and non-social cognition and depressive symptoms.

Methods: Twenty-four cocaine users with (CU+ADHD) and 30 without ADHD (CU-ADHD), 29 cocaine-naïve ADHD patients, and 40 cocaine-naïve healthy controls underwent comprehensive neuropsychological testing including assessment of social cognition (cognitive/emotional empathy and Theory-of-Mind). Additionally, depressive symptoms were measured with the Beck Depression Inventory.

Results: The effect size of global cognitive impairment was largest in CU+ADHD (d=1.22 vs. controls) followed by CU-ADHD (d=0.74), and cocaine-naïve ADHD patients (d=0.33). A similar pattern appeared regarding depressive symptoms (CU+ADHD: d=1.47; CU-ADHD: d=0.49, ADHD: d=0.34). In the measures of Theory-of-Mind (CU+ADHD: d=0.76; CU-ADHD: d=0.06, ADHD: d=0.01) and cognitive empathy (CU+ADHD: d=0.80; CU-ADHD: d=0.39, ADHD: d=-0.11) only CU+ADHD showed moderate to large impairments. Moreover, two-way analyses of covariance revealed a significant interaction effect of the factors ADHD and cocaine use on depressive symptoms (p<0.05) and Theory-of-Mind (p<0.05) but not on global cognitive performance (p=0.64).

Conclusions: When occurring together, cognitive impairments associated with both ADHD and cocaine use are largely additive, whereas both factors seem to mutually potentiate one another with respect to mood and mental perspective-taking disturbances. Given the high comorbidity between ADHD and cocaine use, longitudinal studies are needed to investigate the origin of these potentiated impairments.

Keywords: Affective disorder; Chronic use; Depression; Emotion recognition; Mentalizing; Stimulants.

MeSH terms

Adult
Affective Symptoms / etiology*
Affective Symptoms / psychology*
Attention Deficit Disorder with Hyperactivity / complications*
Attention Deficit Disorder with Hyperactivity / psychology*
Cocaine-Related Disorders / complications*
Cocaine-Related Disorders / psychology*
Cognition Disorders / etiology*
Cognition Disorders / psychology*
Depression / etiology
Depression / psychology
Female
Humans
Male
Neuropsychological Tests
Psychiatric Status Rating Scales
Recognition, Psychology
Social Behavior
Young Adult