The course of attention-deficit/hyperactivity disorder through midlife.

The course of ADHD from childhood up to young adulthood has been characterized in several studies. However, little is known about the course of symptoms into middle age and beyond. This study aims to evaluate predictors of ADHD trajectories in midlife based on three assessments. The follow-up sample comprised 323 adults with ADHD, evaluated at baseline and seven and thirteen years later, from the average ages of 34 up to 47 years old. ADHD status at reassessments was used to characterize trajectories. Demographics, ADHD features, comorbidities, and polygenic scores for ADHD and genetically correlated psychiatric disorders were evaluated to predict ADHD trajectories. Study retention rate was 67% at T2 (n = 216) and 62% at T3 (n = 199). Data from patients evaluated three times showed that 68.8% coursed stable, 25.5% unstable, and 5.7% remission trajectory of ADHD. Women, individuals with more severe syndromes, higher frequency of comorbidities at reassessments, and genetic liability to depression present a higher probability of a stable trajectory. Our findings shed light on midlife ADHD trajectories and their gender, genomic and clinical correlates.

Does collateral retrospective information about childhood attention-deficit/hyperactivity disorder symptoms assist in the diagnosis of attention-deficit/hyperactivity disorder in adults? Findings from a large clinical sample.

OBJECTIVES: In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder. METHODS: Adult patients with attention-deficit/hyperactivity disorder (n = 449) and non-attention-deficit/hyperactivity disorder subjects (n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement (n = 277) and disagreement (n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms. RESULTS: Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p < 0.001) and impairments than controls. Disagreement between self- and collateral reports on childhood attention-deficit/hyperactivity disorder symptoms occurred in 38% of patients. Overall, attention-deficit/hyperactivity disorder disagreement and agreement groups had similar profiles in response to treatment and comorbidity, and the few differences detected in impairment measures were of small magnitude (Eta(2) < 0.05). CONCLUSION: Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings.

Methylphenidate Alters Functional Connectivity of Default Mode Network in Drug-Naive Male Adults With ADHD.

Objective: This study evaluated the hypothesis that methylphenidate immediate release (MPH-IR) treatment would improve Default Mode Network (DMN) within-connectivity. Method: Resting-state functional connectivity of the main nodes of DMN was evaluated in a highly homogeneous sample of 18 drug-naive male adult participants with ADHD. Results: Comparing resting-state functional connectivity functional magnetic resonance imaging (R-fMRI) scans before and after MPH treatment focusing exclusively on within-DMN connectivity, we evidenced the strengthening of functional connectivity between two nodes of the DMN: posterior cingulate cortex (PCC) and left lateral parietal cortex (LLP). Conclusion: Our results contribute to the further understanding on how MPH affects functional connectivity within DMN of male adults with ADHD and corroborate the hypothesis of ADHD being a delayed neurodevelopmental disorder.

[Internet and videogame addiction: a review]. / Dependência de Internet e de jogos eletrônicos: uma revisão.

OBJECTIVE: With the introduction of the new technologies to our daily lives, the Internet and electronic games have become widely and unrestrictedly used tools and one of the major global phenomena in the last decade. Several investigations have attested the benefits from such resources; however, their healthy, adaptive use progressively gave place to their abuse and the lack of control, which have severely impacted on the daily life of millions of users. The objective of this study was to systematically review the articles looking into Internet and electronic games addiction in the general population. We intend, therefore, to evaluate the progression of these concepts in the course of the last decade, as well as contributing to better understand this condition and its comorbidities. METHOD: A systematic literature review was conducted by means of MedLine, Lilacs, SciELO, and Cochrane using the following terms as a parameter: "Internet addiction", "pathological internet use", "internet abuse", "videogame" , "computer games" and "electronic games". The electronic search was done up to December 2007. DISCUSSION: Studies conducted in distinct countries still indicate very different prevalence rates; this is probably due to the absence of consensus and the use of diverse names, which brings about the adoption of distinct diagnostic criteria. Many patients reporting abusive use and dependence show significant consequences to their professional, academic (school), social and family lives. CONCLUSIONS: Further investigations are needed to determine whether this abusive Internet and electronic game use should be understood as one of the newest psychiatric classifications of the 21st century or just substrates of other disorders.

Replicated association of Synaptotagmin (SYT1) with ADHD and its broader influence in externalizing behaviors.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common psychiatric disorder, affecting both children and adults. The Soluble N-ethylmaleimide sensitive factor Attachment REceptors (SNARE) complex has been implicated in ADHD pathophysiology since it is a key component of neurotransmitter release events and neurodevelopment processes, and SNPs in this complex have been associated with ADHD. Here we aim to analyze the effects of SNARE complex variants on ADHD susceptibility and its clinical heterogeneity in affected adults. We tested the association between ADHD and polymorphisms on the SNARE genes STX1A (rs2228607), SYT1 (rs1880867 and rs2251214), VAMP2 (26bp Ins/Del) and SNAP25 (rs6108461 and rs8636) on a sample comprised of 548 adults with ADHD and 644 non-affected controls. Regarding clinical heterogeneity, we further investigated the effects of associated SNPs on age at onset of impairment due to ADHD and on relevant externalizing behaviors (i.e. school suspensions/expulsions and problems with law/authority) and comorbidities (i.e. Substance Use Disorder, Oppositional Defiant Disorder, Conduct Disorder and Antisocial Personality Disorder). We replicated a previously reported association between SYT1-rs2251214 and ADHD in adulthood. This SNP was also associated with age at onset of impairment due to ADHD symptoms and with a range of externalizing phenotypes. These findings involving SYT1 suggest that variation in neurotransmitter exocytosis mechanisms may represent an underlying genetic factor shared by a spectrum of externalizing behaviors and disorders, including - but not restricted to - ADHD.

Black Mirror: considerações psicanalíticas sobre o uso destrutivo da tecnologia / Black Mirror: psychoanalytic considerations on the destructive use of technology

A série inglesa Black Mirror desnuda o humano a partir da sua complexa relação com a tecnologia de uma forma que impacta e provoca o telespectador. Algo inquietante sobre nós é revelado através do espelho da série, que convida a refletir sobre um uso destrutivo das novas ferramentas e suas possíveis consequências. O autor aceita o convite e examina a partir das principais temáticas da série, o que em nosso funcionamento psíquico pode levar a um uso mortífero da tecnologia. Na busca desse objetivo, este trabalho propõe um diálogo entre as narrativas de Black Mirror e conceitos psicanalíticos de Freud, Meltzer, Bion e Green.(AU)

The English series Black Mirror exposes the human from its complex relationship with technology in a way that impacts and stirs the viewer. Something uncanny about us is revealed through series mirror, which invites us to reflect on the destructive use of new tools and their possible consequences.The author accepts the invitation and examines it from the main themes of the series, which in our psychic functioning can lead to a deadly use of technology. In the pursuit of this objective, this work proposes a dialogue between Black Mirror narratives and psychoanalytic concepts of Freud, Meltzer, Bion and Green.(AU)

La serie inglesa Black Mirror despoja al ser humano en su compleja relación con la tecnología de una manera que impacta y provoca al espectador. Algo inquietante acerca de nosotros se revela a través del espejo de la serie, que nos invita a reflexionar sobre el uso destructivo de nuevas herramientas y sus posibles consecuencias. El autor acepta la invitación y la examina a partir de los principales temas de la serie, que en nuestro funcionamiento psíquico pueden derivar en un uso letal de la tecnología. En la búsqueda de este objetivo, este trabajo propone un diálogo entre las narrativas de Black Mirror y los conceptos psicoanalíticos de Freud, Meltzer, Bion y Green.(AU)

Dependência de Internet e de jogos eletrônicos: uma revisão / Internet and videogame addiction: a review

OBJETIVO: Com a inclusão das novas tecnologias contemporâneas, a Internet e os jogos eletrônicos tornaram-se ferramentas de uso amplo e irrestrito, transformando-se em um dos maiores fenômenos mundiais da última década. Diversas pesquisas atestam os benefícios desses recursos, mas seu uso sadio e adaptativo progressivamente deu lugar ao abuso e à falta de controle ao criar severos impactos na vida cotidiana de milhões de usuários. O objetivo deste estudo foi revisar de forma sistemática os artigos que examinam a dependência de Internet e jogos eletrônicos na população geral. Almejamos, portanto, avaliar a evolução destes conceitos no decorrer da última década, assim como contribuir para a melhor compreensão do quadro e suas comorbidades. MÉTODO: Foi feita uma revisão sistemática da literatura através do MedLine, Lilacs, SciELO e Cochrane usando-se como parâmetro os termos: "Internet addiction", pathological "Internet use", "problematic Internet use", "Internet abuse", "videogame", "computer games" e "electronic games". A busca eletrônica foi feita até dezembro de 2007. DISCUSSÃO: Estudos realizados em diferentes países apontam para prevalências ainda muito diversas, o que provavelmente se deve à falta de consenso e ao uso de diferentes denominações, dando margem à adoção de distintos critérios diagnósticos. Muitos pacientes que relatam o uso abusivo e dependência passam a apresentar prejuízos significativos na vida profissional, acadêmica (escolar), social e familiar. CONCLUSÕES: São necessárias novas investigações para determinar se esse uso abusivo de Internet e de jogos eletrônicos pode ser compreendido como uma das mais novas classificações psiquiátricas do século XXI ou apenas substratos de outros transtornos.

OBJECTIVE: With the introduction of the new technologies to our daily lives, the Internet and electronic games have become widely and unrestrictedly used tools and one of the major global phenomena in the last decade. Several investigations have attested the benefits from such resources; however, their healthy, adaptive use progressively gave place to their abuse and the lack of control, which have severely impacted on the daily life of millions of users. The objective of this study was to systematically review the articles looking into Internet and electronic games addiction in the general population. We intend, therefore, to evaluate the progression of these concepts in the course of the last decade, as well as contributing to better understand this condition and its comorbidities. METHOD: A systematic literature review was conducted by means of MedLine, Lilacs, SciELO, and Cochrane using the following terms as a parameter: "Internet addiction", "pathological internet use", "internet abuse", "videogame" , "computer games" and "electronic games". The electronic search was done up to December 2007. DISCUSSION: Studies conducted in distinct countries still indicate very different prevalence rates; this is probably due to the absence of consensus and the use of diverse names, which brings about the adoption of distinct diagnostic criteria. Many patients reporting abusive use and dependence show significant consequences to their professional, academic (school), social and family lives. CONCLUSIONS: Further investigations are needed to determine whether this abusive Internet and electronic game use should be understood as one of the newest psychiatric classifications of the 21st century or just substrates of other disorders.