Adult and Adolescent Patient Evaluations of Electroconvulsive Therapy in Comparison to Other Therapeutic Modalities.

OBJECTIVES: There is an increasing awareness of the importance of patients' subjective evaluations of therapy. Regarding electroconvulsive therapy (ECT), the results are conflicting. We hypothesized that making a comparison between patients' satisfaction with ECT and other forms of psychiatric therapies would capture personal experience as opposed to opinion about the treatment modalities. We compared adult responses to adolescent responses. METHODS: Four unmatched patient groups were recruited (N = 98) and were divided as follows: (a) patients treated with ECT as adolescents (n = 13), (b) patients treated with ECT as adults (n = 25), (c) patients hospitalized as adolescents but not treated with ECT (n = 30), and (d) patients hospitalized as adults but not treated with ECT (n = 30). All patients were interviewed using similar questions related to their satisfaction regarding the treatment modalities they experienced, including psychotherapy, pharmacotherapy, hospitalization and ECT, and years after being treated. RESULTS: Adults and adolescents viewed ECT as a legitimate and effective form of treatment (70%). Patients who were treated with ECT had a more positive attitude toward this treatment compared with patients who had not been treated with ECT. In comparison to other treatment modalities, ECT was considered by both adolescents and adults as the least effective form of therapy. Psychotherapy was considered the most effective, specifically among adolescents. CONCLUSIONS: Comparing patients' satisfaction in regard to different therapeutic modalities can potentially help clarify discrepancies in patient reports on satisfaction with ECT. Patients' satisfaction with ECT, just like their clinical response to ECT, is more dichotomous than with other forms of therapy.

High-gamma oscillations as neurocorrelates of ADHD: A MEG crossover placebo-controlled study.

Attention Deficit Hyperactive Disorder (ADHD) is a common neurobehavioral disorder with a significant and pervasive impact on patients' lives. Identifying neurophysiological correlates of ADHD is important for understanding its underlying mechanisms, as well as for improving clinical accuracy beyond cognitive and emotional factors. The present study focuses on finding a diagnostic stable neural correlate based on evaluating MEG resting state frequency bands. Twenty-two ADHD patients and 23 controls adults were blindly randomized to two methylphenidate/placebo evaluation days. On each evaluation day state anxiety was assessed, a 2N-back executive function task was performed, and resting state MEG brain activity was recorded at three timepoints. A frequency-based cluster analysis yielded higher high-gamma power for ADHD over posterior sensors and lower high-gamma power for ADHD over frontal-central sensors. These results were shown to be stable over three measurements, unaffected by methylphenidate treatment, and linked to cognitive accuracy and state anxiety. Furthermore, the differential high-gamma activity evidenced substantial ADHD diagnostic efficacy, comparable to the cognitive and emotional factors. These results indicate that resting state high-gamma activity is a promising, stable, valid and diagnostically-relevant neurocorrelate of ADHD. Due to the evolving understanding both in the cellular and network level of high-gamma oscillations, focusing future studies on this frequency band bears the potential for a better understanding of ADHD, thus advancing the specificity of the evaluation of the disorder and developing new tools for therapy.

Effect of Methylphenidate on State Anxiety in Children With ADHD-A Single Dose, Placebo Controlled, Crossover Study.

Introduction: Non-adherence to efficacious pharmacotherapy is a major obstacle in the treatment of children suffering from attention deficit hyperactive disorder (ADHD). Some hold the position that pharmacotherapy induces anxiety, and that this is one of the reasons for this non-adherence. Previous studies have pointed to the opposite, a moderating effect of methylphenidate (MPH) on state anxiety in patients with ADHD. This has been shown in continuous treatment in children, but not on a single dose. We hypothesized that a single dose might have a different effect. Method: Twenty children with ADHD were given single doses of MPH in a randomized, controlled, crossover, double blind study. State anxiety using The Spielberger State-Trait Anxiety Inventory (STAI) and a continuous performance test were assessed. Results: As a group, no change was detected in state anxiety with MPH or placebo. However, children who were given MPH during the first session as opposed to those who received placebo first, demonstrated deterioration in baseline state anxiety in the second session [t (2.485), p < 0.05]. Conclusion: Our findings show a possible delayed anxiety-provoking effect of a single dose of MPH. This may be relevant to the understanding of difficulties in adherence with MPH treatment in children with ADHD. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01798459.

Randomised sham-controlled study of high-frequency bilateral deep transcranial magnetic stimulation (dTMS) to treat adult attention hyperactive disorder (ADHD): Negative results.

OBJECTIVES: Recent studies support the possible effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a treatment for attention deficit hyperactivity disorder (ADHD). The objective of this study was to evaluate the safety and possible efficacy of bilateral prefrontal deep rTMS for the treatment of adult ADHD. METHODS: Twenty-six adult ADHD patients were randomised blindly to sham or actual deep TMS (dTMS). Twenty daily sessions were conducted using the bilateral H5 dTMS coil (Brainsway, IL) in order to stimulate the prefrontal cortex at 120% of the motor threshold at high frequency. For assessment, Conners' Adult ADHD Rating Scale questionnaire and a computerised continuous performance test, Test of Variables of Attention, were used. RESULTS: No differences in clinical outcomes were detected between the actual dTMS and sham groups. CONCLUSIONS: The presented evidence does not support the utility of bilateral prefrontal stimulation to treat adult ADHD. Due to the small sample size, caution must be exercised in interpreting our preliminary findings.