A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters.

BACKGROUND: Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter's mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) - including Burn Units- with other MSSA admitted to other medical and surgical units. METHODS: The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais' definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance. RESULTS: Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts. CONCLUSIONS: MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective.

A Potential Role for the STXBP5-AS1 Gene in Adult ADHD Symptoms.

We aimed to detect Attention-deficit/hyperactivity (ADHD) risk-conferring genes in adults. In children, ADHD is characterized by age-inappropriate levels of inattention and/or hyperactivity-impulsivity and may persists into adulthood. Childhood and adulthood ADHD are heritable, and are thought to represent the clinical extreme of a continuous distribution of ADHD symptoms in the general population. We aimed to leverage the power of studies of quantitative ADHD symptoms in adults who were genotyped. Within the SAGA (Study of ADHD trait genetics in adults) consortium, we estimated the single nucleotide polymorphism (SNP)-based heritability of quantitative self-reported ADHD symptoms and carried out a genome-wide association meta-analysis in nine adult population-based and case-only cohorts of adults. A total of n = 14,689 individuals were included. In two of the SAGA cohorts we found a significant SNP-based heritability for self-rated ADHD symptom scores of respectively 15% (n = 3656) and 30% (n = 1841). The top hit of the genome-wide meta-analysis (SNP rs12661753; p-value = 3.02 × 10-7) was present in the long non-coding RNA gene STXBP5-AS1. This association was also observed in a meta-analysis of childhood ADHD symptom scores in eight population-based pediatric cohorts from the Early Genetics and Lifecourse Epidemiology (EAGLE) ADHD consortium (n = 14,776). Genome-wide meta-analysis of the SAGA and EAGLE data (n = 29,465) increased the strength of the association with the SNP rs12661753. In human HEK293 cells, expression of STXBP5-AS1 enhanced the expression of a reporter construct of STXBP5, a gene known to be involved in "SNAP" (Soluble NSF attachment protein) Receptor" (SNARE) complex formation. In mouse strains featuring different levels of impulsivity, transcript levels in the prefrontal cortex of the mouse ortholog Gm28905 strongly correlated negatively with motor impulsivity as measured in the five choice serial reaction time task (r2 = - 0.61; p = 0.004). Our results are consistent with an effect of the STXBP5-AS1 gene on ADHD symptom scores distribution and point to a possible biological mechanism, other than antisense RNA inhibition, involved in ADHD-related impulsivity levels.

Pharmacogenetics of methylphenidate response and tolerability in attention-deficit/hyperactivity disorder.

Methylphenidate (MPH) is the most frequently used pharmacological treatment in children with attention-deficit/hyperactivity disorder. However, a considerable interindividual variability exists in clinical outcome, which may reflect underlying genetic influences. We analyzed 57 single-nucleotide polymorphisms in 9 dopamine-related candidate genes (TH, DBH, COMT, DAT1 and DRD1-5) as potential predictors of MPH efficacy and tolerability, and we considered prenatal and perinatal risk factors as environmental hazards that may influence treatment effects in a gene-by-environment analysis. Our results provide evidence for the contribution of DRD3 (P=0.041; odds ratio (OR)=4.00), DBH (P=0.032; OR=2.85), TH (P=5.5e-03; OR=4.34) and prenatal smoking (P=1.7e-03; OR=5.10) to the clinical efficacy of MPH, with a higher risk for treatment failure in genetically susceptible subjects whose mother smoked during pregnancy. Adverse events after MPH treatment were significantly associated with variation in DBH (P=6.4e-03; OR=0.28) and DRD2 (P=0.047; OR=3.76). This study suggests that the dopaminergic system together with prenatal smoking exposure may moderate MPH treatment effects.

Psychopathology and traffic violations in subjects who have lost their driving license.

BACKGROUND: The persistence of risky behaviors while driving and traffic accidents despite campaigns to increase awareness suggest that there may be underlying causes that maintain proneness to traffic violations. The aim of the current study was to assess: a) the prevalence of psychopathology in a sample of people who have lost their driving license due to former traffic violations and b) the discriminatory capacity of each psychopathological disorder to differentiate among people with high and low proneness to perform risky behaviors while driving. METHODS: 383 participants in a course to recover their driving license after its loss due to previous traffic violations were included. The International Neuropsychiatric Interview (M.I.N.I.) according to DSM-IV was used to assess psychopathology. RESULTS: Between 67% and 76.2% of the participants had been affected by a lifetime psychopathological disorder until the moment of assessment. The most prevalent diagnoses were substance abuse including alcohol (52.5-62.7%), ADHD (19.7-28.5%), depression (7.9-14.4%) and anxiety (3.6-12.4%). Substance abuse and ADHD also showed the strongest set of associations with specific risk behaviors, but ADHD emerged as the most discriminant disorder to distinguish between those people at high and low risk of while driving. CONCLUSIONS: The results of the current study suggest that addressing psychopathology explicitly to prevent risky behaviors and recidivism while driving would provide benefits in this area.

Bipolar disorder with comorbid attention-deficit and hyperactivity disorder. Main clinical features and clues for an accurate diagnosis.

OBJECTIVE: To study the prevalence of attention-deficit and hyperactivity disorder (ADHD) in adult patients with bipolar disorder (BD) and identify differential clinical features for a better diagnosis. METHOD: A total of 163 euthymic bipolar out-patients were screened for ADHD with the ASRS.V1 and the WURS at a BD Unit. Patients with a positive screening were assessed with the CAADID, at an ADHD unit. Sociodemographic and clinical features of the groups with and without ADHD were compared. RESULTS: Lifetime prevalence of comorbid ADHD was 17.9% (10.5% for adult ADHD and 7.4% for childhood ADHD). The BD + ADHD group showed more suicidal behaviour although less severe. Comorbidity was also more common, especially regarding substance use disorders. Nevertheless, these patients did not show more affective episodes or hospitalizations and suffered more atypical but less melancholic depression. However, they required more treatment with psychotherapy and valproate. One-third of positive screenings at the ASRS were false; a severe course of BD was the hallmark of this subgroup. CONCLUSION: Adult patients with BD and ADHD show differential clinical features, but not a more severe course of BD. Comorbidity with substance abuse is a big issue, deserving special clinical attention. Better screening tools are necessary to avoid overdiagnosis of comorbid ADHD in BD.

Early-age clinical and developmental features associated to Substance Use Disorders in Attention-Deficit/Hyperactivity Disorder in Adults.

OBJECTIVE: The main objective was to explore early-age conditions associated to Substance Use Disorders (SUD) in adults with Attention Deficit/Hyperactivity Disorder (ADHD); secondly, to determine which of those conditions are specific to ADHD subjects; and finally, to compare ADHD and non-ADHD subjects in terms of SUD lifetime prevalence and professional, social and personal adjustment. METHOD: Comparison between ADHD adults with (n=236) and without lifetime SUD (n=309) regarding clinical characteristics of ADHD, externalization disorders, temperamental traits, environmental factors, academic history and family psychiatric history; secondly, ADHD subjects were compared to a non-ADHD group (n=177) concerning those variables. RESULTS: The following variables were found to be positively associated to SUD in ADHD subjects: ADHD severity, CD and ODD comorbidities, temperamental characteristics ("fearful", "accident prone" and "frequent temper tantrums"), "sexual abuse", "be suspended from school", family history of SUD and ADHD, and male gender; ADHD inattentive subtype and "fearful" were inversely associated to SUD. From those variables, "frequent temper tantrums" was also associated to SUD in non-ADHD subjects. ADHD subjects had higher prevalence of lifetime SUD and greater professional, social and personal impairment than non-ADHD subjects. CONCLUSION: Findings suggest a significant association between ADHD, SUD and early-age conditions, such as CD and ODD comorbidity; other variables from childhood, namely, ADHD subtype, temper characteristics ("fearful", "accident prone"), "sexual abuse", "be suspended from school" and family history of ADHD are associated to SUD in ADHD subjects, but not in non-ADHD subjects. Moreover, this study confirms both the higher prevalence of lifetime SUD and greater professional, social and personal impairment in ADHD subjects than in non-ADHD subjects.

Long-term efficacy of a new 6-session cognitive behavioral therapy for adults with attention-deficit/hyperactivity disorder: A randomized, controlled clinical trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 2.8 % of the adult population. Cognitive behavioral therapy (CBT) has been demonstrated to be the most effective psychological intervention for ADHD. The aim of this study was to explore the efficacy of a new 6-session CBT program in comparison with a 12-session CBT program for adults with ADHD at short- and long-term. METHODS: 81 adults with ADHD (58 % males; mean age = 41.27±9.26 years old) were randomly assigned to each treatment condition (6- or 12-session CBT). Validated instruments were used to assess ADHD symptoms, comorbidities (anxiety and depression), and functional impairments at post treatment, and at 3- and 6-month follow-up. RESULTS: A significant improvement in ADHD severity, comorbidities (anxiety and depression) and functional impairments were found in both CBT programs after treatment. Furthermore, this improvement was also reported at 3- and 6-month follow-up. CONCLUSION: The current study highlights that a 6-session CBT program is as effective as a 12-session CBT program for ADHD improvement at post treatment and follow-up. The newly developed 6-session CBT program can be used to treat a larger number of patients, reducing the financial cost.

[Autism spectrum disorder: the impact of an online training strategy on the knowledge of the healthcare staff of a tertiary care hospital]. / Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.

INTRODUCTION: Autism spectrum disorder (ASD) often presents related medical disorders that require specialised healthcare. Professionals in the health sector therefore face difficulties that require specific training in the healthcare needs of this population. AIM: The aim of this study is to quantify paediatric healthcare professionals' knowledge about ASD and to assess the impact of online training. SUBJECTS AND METHODS: It is a quasi-experimental, longitudinal, prospective before-and-after study; study subjects: health professionals; independent variable: online training in ASD; dependent variable: knowledge about ASD. An online training course was held for paediatric professionals to address the core characteristics of diagnosis, as well as the needs they present in the hospital context and the adaptations it is recommended that should be carried out. Fifty-eight healthcare professionals took part. RESULTS: An increase in knowledge about ASD was observed at the end of the intervention (from 73.9% to 85% according to the ASD background knowledge questionnaire), which showed that more than 90% of the participants had the highest level of knowledge about ASD. CONCLUSIONS: Online training courses are a useful and effective way to increase knowledge about ASD and the adaptations that are recommended in the hospital setting. More training in ASD should be made available in these settings.

TITLE: Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.Introducción. El trastorno del espectro autista (TEA) frecuentemente presenta trastornos médicos relacionados que requieren una atención sanitaria especializada. En este sentido, los profesionales del ámbito sanitario se enfrentan a dificultades que precisan una formación específica en las necesidades sanitarias que presenta esta población. Objetivo. Cuantificar los conocimientos sobre el TEA de los profesionales sanitarios del área pediátrica y valorar el impacto de una formación en línea. Sujetos y métodos. Estudio cuasi experimental del antes y después, longitudinal y prospectivo; sujetos a estudio: profesionales sanitarios; variable independiente: formación en línea en TEA; variable dependiente: conocimiento sobre el TEA. Se llevó a cabo una formación en línea para profesionales del área de pediatría en la que se abordaron las características nucleares del diagnóstico, así como las necesidades que presentan en el contexto hospitalario y las adaptaciones que se recomiendan llevar a cabo. Participaron 58 profesionales sanitarios. Resultados. Se observó un aumento en el conocimiento sobre el TEA al finalizar la intervención (del 73,9 al 85% según el cuestionario de conocimientos previos del TEA), que mostró que más del 90% de los participantes tenía el grado máximo de conocimiento sobre el TEA. Conclusiones. Las formaciones en línea son un método para ampliar conocimiento útil y eficaz para aumentar el conocimiento sobre el TEA y las adaptaciones que se recomiendan en el ámbito hospitalario. Se recomienda aumentar la disponibilidad de formación sobre TEA en estos entornos.

The genetics of attention deficit/hyperactivity disorder in adults, a review.

The adult form of attention deficit/hyperactivity disorder (aADHD) has a prevalence of up to 5% and is the most severe long-term outcome of this common neurodevelopmental disorder. Family studies in clinical samples suggest an increased familial liability for aADHD compared with childhood ADHD (cADHD), whereas twin studies based on self-rated symptoms in adult population samples show moderate heritability estimates of 30-40%. However, using multiple sources of information, the heritability of clinically diagnosed aADHD and cADHD is very similar. Results of candidate gene as well as genome-wide molecular genetic studies in aADHD samples implicate some of the same genes involved in ADHD in children, although in some cases different alleles and different genes may be responsible for adult versus childhood ADHD. Linkage studies have been successful in identifying loci for aADHD and led to the identification of LPHN3 and CDH13 as novel genes associated with ADHD across the lifespan. In addition, studies of rare genetic variants have identified probable causative mutations for aADHD. Use of endophenotypes based on neuropsychology and neuroimaging, as well as next-generation genome analysis and improved statistical and bioinformatic analysis methods hold the promise of identifying additional genetic variants involved in disease etiology. Large, international collaborations have paved the way for well-powered studies. Progress in identifying aADHD risk genes may provide us with tools for the prediction of disease progression in the clinic and better treatment, and ultimately may help to prevent persistence of ADHD into adulthood.

Genetic architecture of ADHD and overlap with other psychiatric disorders and cognition-related phenotypes.

Attention-deficit/hyperactivity disorder (ADHD) co-occurs with many other psychiatric disorders and traits. In this review, we summarize and interpret the existing literature on the genetic architecture of these comorbidities based on hypothesis-generating approaches. Quantitative genetic studies indicate that genetic factors play a substantial role in the observed co-occurrence of ADHD with many different disorders and traits. Molecular genetic correlations derived from genome-wide association studies and results of studies based on polygenic risk scores confirm the general pattern but provide effect estimates that are smaller than those from twin studies. The identification of the specific genetic variants and biological pathways underlying co-occurrence using genome-wide approaches is still in its infancy. The first analyses of causal inference using genetic data support causal relationships between ADHD and comorbid disorders, although bidirectional effects identified in some instances point to complex relationships. While several issues in the methodology and inferences from the results are still to be overcome, this review shows that the co-occurrence of ADHD with many psychiatric disorders and traits is genetically interpretable.

Corrigendum: Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females.

[This corrects the article DOI: 10.3389/fpsyt.2022.982583.].

Functional improvement and correlations with symptomatic improvement in adults with attention deficit hyperactivity disorder receiving long-acting methylphenidate.

BACKGROUND: Data on the relationship between core symptoms and daily functioning in adults with attention deficit hyperactivity disorder (ADHD) are limited. Daily functioning was assessed as part of an open-label extension, and associations with symptom scores were evaluated. METHOD: After a 5-week double-blind study with adults with ADHD receiving osmotic-controlled release oral delivery system (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo, participants were eligible for a 7-week open-label extension in which all patients received OROS MPH. Data for the Conners' Adult ADHD Rating Scale - Observer: Screening Version (CAARS-O:SV) (primary endpoint) have been presented previously. Secondary endpoints included the observer self-reported short version of the CAARS (CAARS-S:S) and the Clinical Global Impressions - Severity Scale (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) respectively. In post-hoc analyses, changes in CAARS-O:SV were evaluated in subgroups. Relationships between symptom and functional outcomes were evaluated in a multivariate regression analysis. RESULTS: A total of 370 patients entered the open-label extension. Significant improvements from baseline in CAARS-O:SV were similar regardless of sex, ADHD subtype, prior treatment or psychiatric co-morbidity. Significant improvements from double-blind baseline were also seen for the CAARS-S:S, CGI-S, SDS and Q-LES-Q. Improvements in the CAARS-O:SV Hyperactivity/Impulsivity subscale were associated with improvements in SDS total and subscale scores, and in the Q-LES-Q score at open-label endpoint. Improvements in CAARS-O:SV Inattention subscale and CGI-S scores were not significantly associated with functional changes. CONCLUSIONS: Improvements in ADHD symptoms relating to hyperactivity and impulsivity in adults receiving OROS MPH are associated with improvements in daily functioning and quality of life.

The impact of insomnia disorder on adult attention-deficit/hyperactivity disorder severity: A six-month follow-up study.

BACKGROUND AND OBJECTIVES: The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up. METHODS: Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5 ± 11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia. RESULTS: Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission. CONCLUSION: The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity.

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: Differences between males and females.

Background: Deficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset. Materials and methods: The initial sample comprised 588 individuals. However, only adults with non-affective FEP (n = 247, 161 males and 86 females) and healthy controls (n = 224, 142 males and 82 females) were included. A comprehensive assessment including functional, neuropsychological, and clinical scales was performed at baseline and at 2-year follow-up. A linear regression model was used to determine the predictors of functioning at 2-year follow-up. Results: FEP improved their functionality at follow-up (67.4% of both males and females). In males, longer duration of untreated psychosis (ß = 0.328, p = 0.003) and worse premorbid adjustment (ß = 0.256, p = 0.023) were associated with impaired functioning at 2-year follow-up, while in females processing speed (ß = 0.403, p = 0.003), executive function (ß = 0.299, p = 0.020) and CR (ß = -0.307, p = 0.012) were significantly associated with functioning. Conclusion: Our data indicate that predictors of functioning at 2-year follow-up in the FEP group differ according to sex. Therefore, treatment and preventative efforts may be adjusted taking sex into account. Males may benefit from functional remediation at early stages. Conversely, in females, early interventions centered on CR enhancement and cognitive rehabilitation may be recommended.

A common variant of the latrophilin 3 gene, LPHN3, confers susceptibility to ADHD and predicts effectiveness of stimulant medication.

Attention-Deficit/Hyperactivity Disorder (ADHD) has a very high heritability (0.8), suggesting that about 80% of phenotypic variance is due to genetic factors. We used the integration of statistical and functional approaches to discover a novel gene that contributes to ADHD. For our statistical approach, we started with a linkage study based on large multigenerational families in a population isolate, followed by fine mapping of targeted regions using a family-based design. Family- and population-based association studies in five samples from disparate regions of the world were used for replication. Brain imaging studies were performed to evaluate gene function. The linkage study discovered a genome region harbored in the Latrophilin 3 gene (LPHN3). In the world-wide samples (total n=6360, with 2627 ADHD cases and 2531 controls) statistical association of LPHN3 and ADHD was confirmed. Functional studies revealed that LPHN3 variants are expressed in key brain regions related to attention and activity, affect metabolism in neural circuits implicated in ADHD, and are associated with response to stimulant medication. Linkage and replicated association of ADHD with a novel non-candidate gene (LPHN3) provide new insights into the genetics, neurobiology, and treatment of ADHD.

[Psychological interventions on fetal alcohol spectrum disorder across the life span]. / Intervenciones psicológicas del trastorno del espectro alcohólico fetal a lo largo del ciclo vital.

INTRODUCTION: Fetal alcohol spectrum disorder (FASD) is the leading known and preventable cause of intellectual disability in the western world, affecting up to 1-5% of the population. It is considered an underdiagnosed and undertreated disorder, with few psychological interventions with empirical evidence. AIM: To review all the studies published to date on the psychological treatment of FASD throughout life. A bibliographic search was carried out using the MEDLINE, PsychINFO, PubMed and Cochrane Library databases using the terms 'fetal alcohol syndrome disorder' AND 'cognitive behavioral intervention' OR 'psychological intervention' OR 'psychological treatment' OR 'therapy' OR 'psychotherapy'. The review included published works which evaluate the efficacy of psychological treatments for these patients. DEVELOPMENT: Twenty published studies met the inclusion criteria. The treatments were classified according to the type of intervention: emotional and behavioral regulation, social skills training and family interventions for patients with FASD. CONCLUSIONS: The results indicate that psychological treatments focused on emotional and behavioral regulation, social skills training and family interventions are the most evidenced treatments for these patients. These treatments are based on cognitive-behavioral principles and include school-age children. However, more research is needed on psychological interventions for adults with FASD. Despite the progress in psychological interventions for FASD, the research still reflects highlighted limitations.

TITLE: Intervenciones psicológicas del trastorno del espectro alcohólico fetal a lo largo del ciclo vital.Introducción. El trastorno del espectro alcohólico fetal (TEAF) es la principal causa conocida y prevenible de discapacidad intelectual en el mundo occidental y afecta hasta al 1-5% de la población. Se considera un trastorno infradiagnosticado e infratratado, y las intervenciones psicológicas con evidencia empírica son escasas. Objetivo. Revisar los estudios publicados hasta el momento sobre tratamiento psicológico del TEAF a lo largo de la vida. Se realizó una búsqueda bibliográfica mediante las bases de datos de Medline, PsychINFO, PubMed y Cochrane Library usando los términos 'fetal alcohol syndrome disorder' AND 'cognitive behavioral intervention' OR 'psychological intervention' OR 'psychological treatment' OR 'therapy' OR 'psychotherapy'. Se incluyeron los trabajos publicados que evaluaran la eficacia de tratamientos psicológicos para estos pacientes. Desarrollo. Cumplieron los criterios de inclusión 20 estudios publicados. Los tratamientos se clasificaron en función del tipo de intervención: la regulación emocional y conductual, el entrenamiento en habilidades sociales y las intervenciones familiares. Conclusiones. Los resultados indican que los tratamientos psicológicos dirigidos a trabajar la regulación emocional y conductual, el entrenamiento en habilidades sociales y las intervenciones familiares son los que tienen mayor evidencia en el tratamiento para el TEAF. La mayoría se basa en principios cognitivo-conductuales y a niños de edad escolar, y son escasas todavía las investigaciones de tratamientos para adultos con TEAF. A pesar del progreso en las intervenciones psicológicas para el TEAF, la investigación aún refleja marcadas limitaciones.

Prematurity and ADHD in Childhood: An Observational Register-Based Study in Catalonia.

Objective: To evaluate the association between prematurity (by the gestational week [gw]) and ADHD during childhood. Method: Observational, matched cohort study using data from children born in a tertiary-level hospital (Hospital Universitari Vall d'Hebron, Catalonia, Spain) during 1995-2007 and data from the Information System for the Development of Research in Primary Health Care (SIDIAP database, Catalonia, Spain). Results: Prevalence of ADHD increases as gestational age decreases, 12.7% for those born ≤28 gw, compared to 3.2% for those born after the 37 gw. The risk of developing ADHD in the non-premature children tends to increase as the gw decreases (35-36 gw, hazard ratio [HR] = 1.70, 95% confidence interval [CI] [1.19, 2.44]; 33-34 gw, HR = 3.38, 95% CI [2.08, 5.50]; 29-32 gw, HR = 2.37, 95% CI [1.54, 3.63]; and ≤28 gw, HR = 5.57, 95% CI [2.49, 12.46]) Conclusion: Being born preterm is associated with a risk of developing ADHD, also in late preterm children (35-36 gw). Attention when taking care of these infants regarding their mental health must be made.

[Drug-induced mania and hypomania: analysis of a case of lamotrigine-induced mania]. / Manía e hipomanía inducida por fármacos: análisis de un caso de manía inducida por lamotrigina.

INTRODUCTION: Lamotrigine is an antiepileptic medication approved as a mood stabilizer for the prevention of depressive episodes in bipolar disorder. Among its adverse reactions, it may present maniac symptoms, despite being an idiosyncratic adverse effect and low incidence. CASE REPORT: We present the case of a 58-year-old patient, diagnosed with bipolar disorder since her youth and who has required multiple therapeutic schemes. After a pharmacological change from lithium to lamotrigine in progressive ascending doses, she presented a mania decompensation, temporally consistent with the initiation of lamotrigine, and that was accentuated with increasing dose. The symptoms disappear when lamotrigine is withdrawn and a pharmacological approach is carried out. When evaluating the case according to the causality criteria of Naranjo et al, we found a possible result. CONCLUSION: Although lamotrigine-induced manifest symptoms have been previously documented, it is important to take this adverse effect into account, given the affective and behavioral repercussions. Further studies are needed to understand the bilateral relationship of this effect from a clinical and neurobiological point of view.

TITLE: Manía e hipomanía inducida por fármacos: análisis de un caso de manía inducida por lamotrigina.Introducción. La lamotrigina es un antiepiléptico aprobado como estabilizador del ánimo para la prevención de episodios depresivos en el trastorno bipolar. Entre sus reacciones adversas puede presentar sintomatología maniforme inducida, a pesar de ser un efecto adverso de carácter idiosincrático y baja incidencia. Caso clínico. Presentamos el caso de una paciente de 58 años, con diagnóstico de trastorno bipolar desde su juventud y que, a lo largo de la evolución de su patología, ha precisado múltiples esquemas terapéuticos. Tras un cambio farmacológico de litio a lamotrigina en dosis ascendentes progresivas, presenta descompensación maniforme, concordante temporalmente con el inicio de la lamotrigina y que se acentúa con el aumento de la dosis. La sintomatología desaparece al retirar la lamotrigina y realizar un abordaje farmacológico. Al evaluar el caso según los criterios de causalidad de Naranjo et al, encontramos un resultado posible. Conclusión. Aunque se ha documentado previamente sintomatología maniforme inducida por lamotrigina, es importante tener en cuenta este efecto adverso, dada la repercusión a nivel afectivo y conductual. Son necesarios más estudios para entender la relación bilateral de este efecto desde un punto de vista clínico y neurobiológico.

Exploration of 19 serotoninergic candidate genes in adults and children with attention-deficit/hyperactivity disorder identifies association for 5HT2A, DDC and MAOB.

Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in which different genetic and environmental susceptibility factors are involved. Several lines of evidence support the view that at least 30% of ADHD patients diagnosed in childhood continue to suffer the disorder during adulthood and that genetic risk factors may play an essential role in the persistence of the disorder throughout lifespan. Genetic, biochemical and pharmacological studies support the idea that the serotonin system participates in the etiology of ADHD. Based on these data, we aimed to analyze single nucleotide polymorphisms across 19 genes involved in the serotoninergic neurotransmission in a clinical sample of 451 ADHD patients (188 adults and 263 children) and 400 controls using a population-based association study. Several significant associations were found after correcting for multiple testing: (1) the DDC gene was strongly associated with both adulthood (P=0.00053; odds ratio (OR)=2.17) and childhood ADHD (P=0.0017; OR=1.90); (2) the MAOB gene was found specifically associated in the adult ADHD sample (P=0.0029; OR=1.90) and (3) the 5HT2A gene showed evidence of association only with the combined ADHD subtype both in adults (P=0.0036; OR=1.63) and children (P=0.0084; OR=1.49). Our data support the contribution of the serotoninergic system in the genetic predisposition to ADHD, identifying common childhood and adulthood ADHD susceptibility factors, associations that are specific to ADHD subtypes and one variant potentially involved in the continuity of the disorder throughout lifespan.

Meta-analysis of brain-derived neurotrophic factor p.Val66Met in adult ADHD in four European populations.

Attention-deficit hyperactivity disorder (ADHD) is a multifactorial, neurodevelopmental disorder that often persists into adolescence and adulthood and is characterized by inattention, hyperactivity and impulsiveness. Before the advent of the first genome-wide association studies in ADHD, genetic research had mainly focused on candidate genes related to the dopaminergic and serotoninergic systems, although several other genes had also been assessed. Pharmacological data, analysis of animal models and association studies suggest that Brain-Derived Neurotrophic Factor (BDNF) is also a strong candidate gene for ADHD. Several polymorphisms in BDNF have been reported and studied in psychiatric disorders but the most frequent is the p.Val66Met (rs6265G > A) single nucleotide polymorphism (SNP), with functional effects on the intracellular trafficking and secretion of the protein. To deal with the inconsistency raised among different case-control and family-based association studies regarding the p.Val66Met contribution to ADHD, we performed a meta-analysis of published as well as unpublished data from four different centers that are part of the International Multicentre Persistent ADHD CollaboraTion (IMpACT). A total of 1,445 adulthood ADHD patients and 2,247 sex-matched controls were available for the study. No association between the p.Val66Met polymorphism and ADHD was found in any of the four populations or in the pooled sample. The meta-analysis also showed that the overall gene effect for ADHD was not statistically significant when gender or comorbidity with mood disorders were considered. Despite the potential role of BDNF in ADHD, our data do not support the involvement of p.Val66Met in the pathogenesis of this neuropsychiatric disorder.