Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Similarity of biotin-binding activity and immunoreactivity in chicken oviduct and non-oviduct avidin.

Biotin-binding and immunological methods were employed to demonstrate the similarity of oviduct and non-oviduct avidin in the chicken. Oviduct avidin was induced after oestrogen pretreatment by progesterone and non-oviduct avidin by intestinal tissue injury or by intraperitoneal actinomycin D administration. Avidin in the intestine, lung, bursa of Fabricius, plasma, pectoral muscle and liver after injury had biotin-binding activity similar to that of progesterone-induced oviduct avidin: (1) a temperature of 79-83 degree C was required for 50% of the maximum [14C]biotin uptake, (2) maximal exchange occurred only at 90 or 100 degree C and (3) denaturation of protein, i.e., loss of biotin-binding activity, was not yet observed at 100 degree C. Avidin in the intestine, lung, bursa of Fabricius, plasma and pectoral muscle also showed an identical cross-reaction with oviduct avidin. Furthermore, the increase in avidin-like biotin binding in the oviduct and most non-oviduct tissues was significantly correlated with the increase in avidin-like antigen in the tissue. This indicates that avidin induced in chicken non-oviduct tissues by injury or inflammation caused by actinomycin D administration is similar to progesterone-dependent oviduct avidin.

Development of progestin-specific response in the chicken oviduct.

Avidin is a host acute defense protein induced by progestins and by inflammation caused by injurious factors such as microbes, viruses, toxic factors or tissue trauma. In the reproductive tract of egg-laying vertebrates avidin has evolved into a progestin-dependent secretory protein involved in anti-microbial action through its biotin avidity. For "progestin-dependent avidin" production, cellular differentiation by estrogen is necessary. In contrast, the expression of "progestin-independent or inflammation-induced avidin" does not require differentiation. Many cell types such as macrophages, heterophils and fibroblasts can produce avidin after non-specific cellular injuries. The wide distribution of avidin in avian, reptilian and amphibian species could be explained on the basis of its vital functions such as antimicrobial or antifungal, metabolic and immunomodulatory actions. The ontogeny of the progestin-dependent avidin synthesis is a complex event involving oviductal differentiation by steroid hormones leading to a specific gene expression. The first phase in oviductal differentiation by estrogens is characterized by a new chromatin organization and by an infiltration of progesterone receptor (PR)-containing mesenchymal cells into the subepithelial mucosa leading to epithelial cell differentiation ("mesenchymal and epithelial cell interaction"). The second phase in the differentiation of progestin-induced response is dependent on the presence of PR in the secretory cells. Two kinds of PR expression occur in the oviduct. The first is a "constitutive PR" and is found in the epithelial, submucosal and peritoneal cells of the immature chick oviduct without steroid treatment, and the second is an "inducible PR" found especially in the mucosal mesenchymal and smooth muscle cells. Avidin production requires PR in the target cells, but not all PR-containing cells can produce avidin. Therefore, in addition to PR, other transcription factors are needed to define the target cell specificity of the response to progestins. Earlier biochemical studies suggested that cytosolic and/or nuclear unoccupied PR was complexed as an 8 S form with the heat shock protein 90 (hsp90). Our immunohistochemical results, however, indicate that PR in vivo is not bound to hsp90, which is located entirely in the cytoplasm, whereas PR is an entirely nuclear protein in both ligand-occupied and unoccupied forms. Therefore, we assume that PR is a monomeric (4S) or homodimeric (5S) (chromatin?) protein associated to DNA. Ligand binding to PR appears to lead to a conformational change, dimer formation, tighter binding to PRE (progesterone responsive element) and to transcription factors, phosphorylation and proteolysis of PR as well as a chromatin change.(ABSTRACT TRUNCATED AT 400 WORDS)

Avidin induction by theophylline in vivo and in vitro.

Avidin induction in chick tissues in vivo and in vitro was studied by a phosphodiesterase inhibitor, theophylline, and compared to progesterone-dependent induction. Theophylline (100 mg/kg, ip) caused a significant increase in avidin content only in the oviduct of diethylstilbestrol-treated chicks, but not in the lung, muscle, intestine, plasma, or in the bursa of Fabricius. Diethylstilbestrol priming was necessary for oviductal avidin induction in vivo by theophylline. In the oviduct culture, theophylline at a concentration between 100 and 500 micrograms/ml caused a dose-dependent increase in avidin production. Effects of theophylline and progesterone on avidin synthesis in oviduct culture were synergistic. Avidin production was dependent on protein and RNA synthesis, since induction was inhibited by cycloheximide and actinomycin D. Avidin induction by theophylline resembled progesterone-dependent induction, beginning 9 h after the injection in vivo and 12 h after administration of these drugs in vitro. Avidin induced by theophylline showed heat-induced biotin exchange identical to that of progesterone-induced avidin, indicating close similarity of these proteins. The results suggest that theophylline can mimic the action of progesterone on avidin production, and that cyclic nucleotides may have a role in the regulation of avidin synthesis.

Effects of oestradiol-17 beta and diethylstilboestrol on progesterone-induced protein (avidin) production in chick oviduct: evidence for differences in the actions of steroidal and non-steroidal oestrogens.

The effects of diethylstilboestrol (DES) and oestradiol-17 beta on the production of a progesterone-induced protein (avidin) in the chick oviduct were studied. Chicks were pretreated with DES or oestradiol-17 beta daily for 3-28 days and progesterone (10 or 20 mg/kg) was administered 24 h after the last oestrogen injection. Diethylstilboestrol (2-20 mg/kg) administered with progesterone to chicks pretreated with DES increased avidin production after 16 h compared with that induced by progesterone alone. The potentiation of avidin production appeared even when DES was administered between 6 h before and 13 h after progesterone injection. The length of DES pretreatment did not affect the potentiation. The amount of avidin induced by progesterone in the chicks pretreated with oestradiol-17 beta was similar to that in the chicks pretreated with DES. Oestradiol-17 beta (2-20 mg/kg) administered with progesterone, however, did not affect avidin production. The results suggest that DES may have some non-oestrogenic effects on the production of progesterone-induced proteins.

Progesterone-binding properties of the microsomal fraction from chick oviduct.

Progesterone binds to specific high-affinity and limited-capacity binding sites of chick-oviduct microsomes of estrogen-primed chicks. The dissociation constant is 2 x 10(-9) M (range 1.6--3.0) and the number of binding sites 500 femtomoles/mg microsomal protein (range 464--551). Treatment of the estrogen-primed chicks by progesterone had no apparent effect on the progesterone-binding capacity or affinity. Competition studies showed that testosterone, R-5020, Org-2058, D-norgestrel, 5 alpha-dihydrotestosterone and R-2323 were effective competitors of progesterone, in that order, whereas cortisol, estradiol and estrone exhibited only minimal displacement. No displacement of microsome-bound [3H]progesterone was found with fenoterol or prostaglandin F2 alpha. No high-affinity progesterone-binding sites were found in the microsomal fractions of liver, muscle, intestine or brain. On the basis of steroid-binding affinity and steroid-specificity determinations, the microsomal progesterone-binding components seem to be different from the progesterone receptor previously described in chick oviduct cytosol.

p53 immunohistochemical positivity as a prognostic marker in intracranial tumours.

The frequency and scale of positive p53 immunohistochemistry in 107 intracranial tumours of different types was studied as a possible prognostic marker using a polyclonal antibody CM-1 which detects both the wild-type and mutated p53 proteins. Fifty of the tumours (46.7%) showed nuclear p53 positivity with different percentages of positive nuclei. The positivity was concentrated in glial tumours of which 52.8% were positive. Forty-two of seventy-four astrocytomas (56.8%), 4 of 12 oligodendrogliomas (33.3%), and 1 of 3 ependymomas (33.3%) showed p53-positive nuclei. Cytoplasmic positivity, found in 25 astrocytomas, was always associated with nuclear positivity. Some p53-positive nuclei were seen in 16.7% of the non-gliomatous tumours, but in all cases p53 positivity was seen in less than 1% of the nuclei. The patients with astrocytomas containing more than 5% p53-positive nuclei were younger (mean 27.3 years) (p = 0.016) and their tumours larger in diameter (mean 4.4 cm) (p = 0.05) than those with p53-negative astrocytomas (mean 41.0 years and mean 3.3 cm, respectively). In p53-positive (> or = 1% of nuclei) grade IV astrocytomas, survival time was significantly shorter (mean 7.2 months) than in p53-negative grade IV astrocytomas (mean 15.5 months (p = 0.024). The results indicate frequent p53 expression in intracranial tumours, especially in gliomas. The association of p53 positivity with young age, larger tumour size, and poor prognosis in high-grade astrocytomas suggests that p53 may be involved in the development of more aggressive types of intracranial tumours. According to these results, p53 immunohistochemical positivity may serve as a prognostic marker in high-grade astrocytomas.

Inducibility of the avidin gene by progesterone is suppressed during estrogen-induced cytodifferentiation.

We have studied epithelial differentiation of the chick oviduct as induced by diethylstilbestrol (DES) and 17 beta-estradiol (E2). The proportion of goblet cells in the oviduct was slightly higher after E2 than after DES treatment. Also avidin induction by progesterone was stronger following DES than E2 priming. In the estrogen pretreated oviduct epithelium, avidin expression was induced by progesterone in the surface epithelial cells, protodifferentiated gland cells and tubular gland cells, but not in goblet cells. During prolonged estrogen treatment, however, the inducibility of avidin by progesterone ceased in tubular gland cells but not in surface epithelial cells. The estrogen action on the expression of avidin could be explained by estrogen-induced terminal differentiation of the epithelial gland cells or by a direct effect of estrogen on the progesterone action, for instance interaction of estrogen receptor and progesterone receptor in the regulation of transcription.

Effect of oestriol succinate on serum lipids.

The series comprises 70 women with climacteric symptoms; 14 of them were oophorectomized. The first group of patients received 4 mg of oestriol succinate per day or a placebo in a double-blind experiment. In the second part of the study oophorectomized women were given 8 mg of oestriol succinate per day or 16 mg/day divided into two doses. Serum total cholesterol, HDL-cholesterol and serum triglycerides were estimated before drug treatment and after drug administration for three and six months. Administration of 4-16 mg/day of oestriol succinate was without effect on serum total cholesterol. A significant increase of 25-30% in HDL-cholesterol was observed following administration of oestriol succinate (8 mg divided into two doses) with a rising tendency in total triglyceride value.

Effects of 4 mg estradiol valerianate on serum lipids in newly oophorectomized women.

The material consisted of 32 patients, 12 of whom were selected for control. All were cases approaching the menopause and had been subject to oophorectomia bilateralis and hysterectomia for myomas. All 20 investigation patients received estradiol valerianate orally 4 mg/day of 6 mth. During the course the serum estradiol level increased 5--6-fold from the postmenopausal levels. No significant changes occurred in the serum triglycerides and total cholesterol, whereas in the control group the triglycerides decreased. The proportional concentration of beta-lipoproteins decreased. There was also a slight decrease in the pre-beta-lipoproteins. The proportional concentration of beta-lipoproteins increased, as also serum high density lipoprotein (HDL) cholesterol. In the liver enzymes no changes occurred. Blood pressure increased in one patient. There were no other complications.

Regulation of avidin accumulation by prostaglandins in chick oviduct culture.

Regulation of avidin accumulation by prostaglandins (PGs) and their inhibitors was studied in chick oviduct organ culture. Avidin was induced neither by progesterone nor PGF2 alpha in the oviduct of immature chicks. By progesterone and PGs, a high avidin synthesis was induced when the chicks received diethylstilbestrol (DES) for 7 days. Enhanced avidin production was observed by PGF2 alpha, PGE1 and PGE2, whereas PGA2 and PGB2 had a slight inhibitory effect and PGA1 and PGB1 had no effect on avidin production. PGF2 alpha was most effective at a concentration of 10-20 micrograms/ml. The effects of progesterone and PGF2 alpha were not additive. Mefenamic acid, at concentrations of 40 and 60 micrograms/ml, inhibited 50 and 85%, respectively, of the avidin synthesis induced by progesterone, whereas the inhibition of the total protein synthesis was only 20%, and this only by the higher concentration of the drug. Tolfenamic and meclofenamic acid were also inhibitory in the case of progestin-induced avidin synthesis. These studies indicate that the PGs (F2 alpha, E1 and E2) might be involved in the avidin induction in the chick differentiated oviduct. The specific inhibition of the progesterone-dependent avidin synthesis by the PG inhibitors suggests that PGs may be connected with the progesterone action in the oviduct. We propose that the avidin synthesis by the chick oviduct might be considered as a model system for studying PG effects on the synthesis of a specific protein.

Immunological similarities between microsomal, cytosolic and nuclear progesterone receptors in the chick oviduct.

Progesterone receptor of microsomal, cytosolic and nuclear fractions of the chick oviduct was studied by using biochemical, immunochemical and immunohistochemical analyses. In the oviducts of estrogen-treated immature chicks cytosolic, microsomal and nuclear PR were 90, 9.6 and 0.4% of the total binding, respectively, whereas the corresponding values 1 h after progesterone administration were 33, 6 and 61%, respectively. Progesterone decreased the cytosolic and microsomal PR 90 and 88%, respectively. All the receptor forms were similarly recognized by anti-PR-IgG raised against B-subunit of the PR. By using a sensitive immunoelectron microscopy in most cells of the oviduct only nuclear PR antigen was detected both in estrogen-treated and estrogen-progesterone-treated chick oviductal cells. In most cells no PR was found in the cytoplasm nor in the microsomes. Occasionally in very few cells small amounts of PR were found, associated with rough endoplasmic reticulum close to the nucleus containing a high concentration of the PR. This is probably due to a nascent synthesis of the PR. It is concluded that the major part of the cytosolic as well as microsomal PR is due to a homogenization artefact caused by a redistribution of the unoccupied PR located in the nuclei in situ.

Evidence for a dissimilarity of chicken oviducts differentiated by diethylstilboestrol and oestradiol-17 beta: a study of progesterone-induced egg-white protein (avidin) synthesis.

The growth and differentiation of chick oviducts were caused by daily diethylstilboestrol (DES) or oestradiol-17 beta (E2) injections, and the effects of these oestrogens on the progesterone-induced production of a biotin-binding egg-white protein (avidin) were studied. In the DES primed oviducts, but not in the E2 primed ones, both DES and E2 administered with progesterone potentiated avidin production 2 to 3-fold, even after 10-day oestrogen withdrawal. The results suggest that DES and E2 prime the avian reproductive target tissue differently.

Is breastfeeding beneficial and maternal smoking harmful to the cognitive development of children?

The effects of breastfeeding on cognitive, visuomotor and language development were examined in healthy children born at full term, after they had reached 56 months of age. Three hundred and sixty-three children were breastfed for less than 5 months, and 363 for 5 months or more. The groups were matched pairwise having regard to maternal education and sex of the child. Significant differences were found in relation to scores reflecting general cognitive capacity, and the results of the visuomotor integration test between children breastfed for less than 5 months and those breastfed for 5 months or more, and between children of mothers who had smoked during pregnancy and non-smoking mothers. In multiple linear regression analysis prolonged breastfeeding was significantly related to scores reflecting general cognitive capacity and results of the visuomotor integration test. However, smoking by mothers during pregnancy was not significantly related to scores in cognitive tests. Biological factors, and factors such as lifestyle and social background, may be more important determinants of a child's development than breastfeeding.

Effect of brain tumour laterality on patients' perceived quality of life.

OBJECTIVES: There is little reliable quantitative information on preoperative quality of life of patients with brain tumours. The aim of this study was to clarify the effect of the volume, location, and histological grade of brain tumours on the preoperative quality of life of patients. METHODS: The study population consisted of 101 successive patients with brain tumour at Oulu Clinic for Neurosurgery studied with CT or MRI for preoperative determination of tumour location and size. The Nottingham health profile (NHP) and Sintonen's 15D scale were used at that time to measure quality of life. RESULTS: Tumour size did not correlate linearly with impairment of quality of life. Large tumours (>25 ml) were associated with poorer quality of life than small tumours (< or =25 ml). The patients with a tumour located on the right side or in the anterior region reported a poorer quality of life than those with a tumour on the left side or posteriorly. Quality of life assessments made by doctors using the Karnofsky performance scale showed no differences between the two hemispheres. Patients with the most malignant gliomas (grades III-IV) displayed the poorest quality of life. CONCLUSIONS: Large tumours apparently damage several parts of the brain and/or raise intracranial pressure to a level that exceeds the brain's compensatory capacity. Contrary to earlier understanding, tumours in the right hemisphere seemed to be related to poorer quality of life. This effect was especially clear in the patients' subjective evaluation of their quality of life. As the location of the brain tumour thus affects perceived quality of life, any measurements of the quality of life of patients with brain tumours should take into account the location and laterality of the tumour.

The effect of brain tumour laterality on anxiety levels among neurosurgical patients.

OBJECTIVES: The aim of this study was to investigate the level of anxiety in patients with a primary brain tumour and to analyse the effect of tumour laterality and histology on the level of anxiety. Recurrent measurements were assessed preoperatively, three months, and one year after operation. METHODS: The study population consisted of 101 patients with a primary brain tumour from unselected and homogeneous population in northern Finland. The patients were studied preoperatively with CT or MRI to determine the location of the tumour. The histology of the tumour was defined according to WHO classification. The level of anxiety was obtained by Crown-Crisp Experiential Index (CCEI) scale. RESULTS: The patients with a tumour in the right hemisphere had statistically significantly higher mean anxiety scores compared to the patients with a tumour in the left hemisphere before surgery of the tumour. By three months and by one year after surgical resection of the tumour, the level of anxiety declined in patients with a tumour in the right hemisphere. A corresponding decline was not found in patients with a tumour in the left hemisphere. According to laterality by tumour histology, the level of anxiety decreased significantly in male and female patients with a glioma in the right hemisphere, but a corresponding decline was not significant in the female patients with a meningioma in the right hemisphere. Decreased level of anxiety was not found in patients with gliomas or meningiomas in the left hemisphere by follow up measurements. CONCLUSIONS: Primary brain tumour in right hemisphere is associated with anxiety symptoms. The laterality of anxiety seems to reflect the differentiation of the two hemispheres. The level of anxiety declined after operation of right tumour, approaching that of the general population. The effect of right hemisphere gliomas on anxiety symptoms deserves special attention in future research.

Lactoferrin in human amniotic fluid.

The concentration of human lactoferrin (LF) was measured by radioimmunoassay or non-competitive avidin--biotin assay in amniotic fluid, cord blood and in the decidua, trophoblast, fetal membranes and umbilical cord. Amniotic fluid was obtained by amniocentesis, and cord blood and tissue samples were taken after delivery or elective Caesarean section. No detectable concentration of LF was found in amniotic fluid before week 20 of pregnancy. A significant increase in the LF concentration was observed around week 30 and it remained high until term. In cord blood, an undetectable or low concentration of LF was measured. In tissue specimens the amount of LF was highest in the decidua (9-95 micrograms/g), a moderate concentration was assayed in the amniotic (2-37 micrograms/) and chorion (2-26 micrograms/g) membrane and in the trophoblast (5-35 micrograms/g). In the umbilical cord, the concentration was less than 1 microgram/g. These results suggest a decidual origin of LF. The role of LF during pregnancy is discussed.