Exploring nonverbal synchrony in borderline personality disorder: A double-blind placebo-controlled study using oxytocin.

OBJECTIVES: Interpersonal dysfunction is a central feature of borderline personality disorder (BPD), and the neuropeptide oxytocin (OT) has been shown to impact patients' behaviour in numerous ways. Nonverbal signals such as the coordination of body movement (nonverbal synchrony) are associated with the success of interpersonal exchanges and could thus be influenced by features of BPD and by the administration of OT. DESIGN: We explored the effect of intranasal OT (inOT) on nonverbal synchrony in sixteen patients with BPD and fifteen healthy controls (CTL) randomly assigned to two double-blind clinical interviews under inOT and placebo (PL). METHODS: Nonverbal synchrony was assessed by automated video-analyses of subject's and interviewer's body movement. Lagged cross-correlations were used to objectively quantify coordination in dyads. RESULTS: Synchrony was higher than pseudosynchrony (= synchrony expected by chance), and there was a differential effect of inOT between groups: While healthy controls displayed increased synchrony under inOT, patients with BPD showed low levels of synchrony under inOT. Additionally, patient's synchrony was negatively associated with self-reported childhood trauma. CONCLUSIONS: Nonverbal synchrony in clinical interviews is influenced by inOT, and this effect depends on subject's diagnosis. In line with previous research implying positive associations between nonverbal synchrony and relationship quality, inOT led to an increase of synchrony in healthy controls, but not in patients with BPD. Low levels of synchrony under inOT in patients and its association with childhood trauma suggest that additional mechanisms such as rejection sensitivity might mediate BPD patients' nonverbal behaviour. PRACTITIONER POINTS: Intranasal oxytocin (inOT) attenuated nonverbal synchrony - a proxy for relationship quality - in patients with borderline personality disorder (BPD), while it increased nonverbal synchrony in healthy controls (CTL). Available models (rejection sensitivity; social salience) suggest that inOT may alter the way patients with BPD assess social situations, and this alteration is expressed by changes in nonverbal coordination. Patients with BPD display low levels of synchrony which are even below expected pseudosynchrony based on chance. The association between self-reported childhood trauma and lower synchrony in BPD was most evident for patient's imitative behaviour: Under inOT, patients with high scores of childhood trauma refrained from imitating their interview partners. Study limitations include small sample sizes and limited data on the psychological impact of the clinical interviews.

Endogenous oxytocin is associated with the experience of compassion and recalled upbringing in Borderline Personality Disorder.

BACKGROUND/OBJECTIVE: The role of the neuropeptide oxytocin (OT) in Borderline Personality Disorder (BPD) is poorly understood. It is particularly unknown how early experiences with caregivers moderate the action of OT in BPD. Here, we examined the association of plasma OT levels in BPD patients with the experience of compassion and recalled parental behavior during childhood. METHODS: Fifty-seven BPD patients and 43 healthy controls participated in the study. OT plasma levels were analyzed by radioimmunoassay. Subjects additionally completed questionnaires focusing on fears of compassion (FOC) and recalled upbringing ("Questionnaire of Recalled Parental Rearing Behavior/Fragebogen zum erinnerten elterlichen Erziehungsverhalten," FEE). RESULTS: BPD patients had significantly lower OT plasma levels than healthy controls and differed significantly on all FOC and FEE scales; BPD patients had higher FOC scores (indicating more aversion of being compassionate to themselves and others and receiving compassion from others). They also differed in recalled parenting. In the BPD group, scores of the FOC scale "fear of compassion from others" were significantly negatively correlated with OT levels. Moreover, recalled "emotional warmth" of their parents during childhood was positively correlated with OT plasma levels of BPD subjects. No such correlations were found in the control group. CONCLUSION: Our results corroborate findings from previous studies reporting lower OT levels in patients with BPD. Moreover, peripheral OT seems to be linked with the tolerance of compassionate feelings and early experiences with caregivers. This is consistent with other findings that OT is an important mediator of the experience of emotional warmth from others.

Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder - A pilot study.

OBJECTIVES: Borderline personality disorder (BPD) is characterized by emotional instability, interpersonal dysfunction, and other features that typically develop before a background of insecure attachment and traumatic experiences. Dialectical behaviour therapy (DBT) has proven highly effective in reducing self-harm and improving emotion regulation, whereby problems concerning social cognition, which are also characteristic of BPD, may need additional approaches such as mentalization-based treatment (MBT). METHODS: Here, we examined, in a pilot study, the effectiveness of MBT given adjunct to DBT, compared to DBT alone, in an inpatient sample with BPD, whereby mentalization was measured using a novel cartoon-based task. RESULTS: Both treatments were highly effective in reducing symptom severity. The combination of DBT and MBT was superior in reducing fearful attachment and in improving affective mentalizing. CONCLUSIONS: Mentalization-based treatment in combination with DBT may improve certain aspects of social cognitive skills and attachment security, as compared to DBT alone, although the exact mechanisms that led to these changes need to be studied further. PRACTITIONER POINTS: Clinical implications Dialectical behaviour therapy (DBT) can usefully be combined with mentalization-based treatment (MBT). The combination of DBT and MBT reduces self-harm more than DBT alone. DBT plus MBT may lead to a reduction in fearful attachment and improvement of affective mentalizing. Short-term combinations of evidence-based borderline treatments may enrich psychiatric inpatient care. Therefore, such approaches deserve further research. Limitations The treatment condition was therapeutically more intense than the control condition. The study lacked a follow-up assessment. The impact of comorbid conditions on treatment response was not taken into account. Adherence to the manualized approach was not measured.

Antidepressive response of inpatients with major depression to adjuvant occupational therapy: a case-control study.

BACKGROUND: Despite marked costs and limited evidence regarding effectiveness, occupational therapy (OT) is widely applied in psychiatric settings and financed by health insurance companies in European countries. This pilot study investigated the antidepressive effects of adjuvant OT for patients with major depression in a 6-week inpatient setting, stratified for females and males. METHODS: A total of 114 inpatients with major depression were assigned to either a standard OT group (using basic handcraft) or an active control group that played board games (2 h daily, 5 days a week). HAMD-21 scores were assessed as the primary outcome parameter after 3-6 weeks. RESULTS: The OT intervention was not superior to "board game" (BG) activities in reducing depressive symptoms. However, significant interaction effects were found in favor of the OT group regarding anxiety measures and other variables. Male participants displayed more significant interaction effects than female participants. CONCLUSIONS: OT as an adjuvant short-term treatment for inpatients with major depression may be more efficacious than game interventions in terms of reducing anxiety and other symptoms, particularly in males. Trial registration The study was registered in the EU Clinical Trials Register as a multicenter trial (EudraCT Number 2009-016463-10; https://www.clinicaltrialsregister.eu/ctr-search/trial/2009-016463-10/DE#A) However, because of the elaborate setting requirements, the original study design with four centers was transformed into a solution with those two centers facilitating the pertinent resources. Furthermore, "mono-therapy with mirtazapine" was changed into "preferably mono-therapy with any antidepressant drug".

Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task.

Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task.

Nonverbal communication of patients with borderline personality disorder during clinical interviews: a double-blind placebo-controlled study using intranasal oxytocin.

Interpersonal dysfunction is central to borderline personality disorder (BPD). Recent research has focused on the role of oxytocin (OT) in BPD, with mixed results regarding the processing of social information. Fifteen BPD patients and 15 controls participated in two clinical interviews, one under OT and one under placebo, which were randomly conducted 1 week apart in a double-blind fashion. Nonverbal behavior was evaluated using the Ethological Coding System for Interviews. Childhood trauma was examined using the Childhood Trauma Questionnaire. The patients with BPD showed less affiliative behavior than the controls. Notably, the controls, but not the patients, displayed more affiliation when OT was given at T1 compared with OT given at T2. OT was also associated with less flight behavior in both groups when given at T1 compared with placebo. OT responses were unrelated to the patients' history of childhood trauma. The present findings are informative with respect to patients' nonverbal prosocial behavior in clinical settings.

Attachment, recalled parental rearing, and ADHD symptoms predict emotion processing and alexithymia in adults with ADHD.

BACKGROUND: The aim of the aricle is to study the relationship between attachment, parental rearing behavior, and (infant and current) ADHD symptoms with emotion processing and alexithymia in adults with ADHD. METHODS: Attachment, parental behavior, and ADHD variables were tested for predictive value regarding emotion processing and alexithymia in the total sample, the pooled ADHD groups (with inattentive type and combined type, each with n = 26) and a control group (n = 26). Comparisons were performed between the pooled ADHD groups and the control group, and between the ADHD subtype groups regarding all emotion processing and alexithymia, and attachment-related measures. RESULTS: Emotion processing/alexithymia parameters were mainly predicted by early or current attachment-related features, and, to a lesser extent, by childhood or current ADHD symptoms, primarily in the ADHD groups. CONCLUSIONS: The findings suggest partly specific and possibly causal relationships between attachment-related features and current emotion processing/alexithymia in adults with ADHD. The results confirm the necessity for further study of the multiple interactions between infant and parental ADHD symptoms, aversive parenting, and attachment with respect to emotional functioning in adult ADHD.

Validation and psychometric properties of the German Capability for Suicide Questionnaire.

OBJECTIVE: Our study aimed at the validation of the newly developed German Capability for Suicide Questionnaire, the GCSQ. It is supposed to assess both fearlessness of death and pain tolerance, both facets of the acquired capability to commit suicide as postulated by the interpersonal theory of suicide. METHODS: This cross-sectional study was conducted on two clinical (n=424) and an online sample (n=532). Factor structure, convergent and discriminant validity, predictive validity as well as test-retest reliability were investigated. RESULTS: Two factors-"Fearlessness of Death" and "Pain Tolerance"-were derived. One item, the "perceived capability" item, assesses the subject's self-perception of acquired capability. Both subscales and the "perceived capability"-item demonstrate good construct validity and a high test-retest reliability. Fearlessness of death proves to be predictive for the occurrence of suicidal behaviors, whereas the importance of pain tolerance for suicidal behaviors was not confirmed. The subject's perception of his own capability is of high predictive value for both attempt status and suicidal behaviors. CONCLUSION: The GCSQ seems to be a useful measure of pain tolerance, fearlessness of death and the self-perception of acquired capability of suicide.

Methylphenidate in mania project (MEMAP): study protocol of an international randomised double-blind placebo-controlled study on the initial treatment of acute mania with methylphenidate.

BACKGROUND: Treatment of patients with acute mania remains a considerable medical challenge since onset of action of antimanic medication is delayed for several days. Psychostimulants could have an earlier onset of action. This assumption is based on the 'vigilance regulation model of mania' which postulates that vigilance is unstable in manic patients. Accordingly, vigilance-stabilising psychostimulants could be more useful than conventional treatment in acute mania. We present here the study protocol of a trial intended to study the efficacy and safety of methylphenidate in the initial treatment of acute mania. METHODS/DESIGN: A multi-centre, randomised, double-blind, placebo-controlled clinical trial will be conducted in 88 bipolar inpatients with acute mania. Male and female patients older than 18 years will be randomised to treatment with either methylphenidate (20 to 40 mg/day) or placebo for 2.5 days, given once or twice daily. The main outcome measure is the reduction in the Young Mania Rating Scale (YMRS) after 2.5 days of treatment. Other outcome measures include the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) the Clinical Global Impression-Bipolar Scale (CGI-BP), the Screen for Cognitive Impairment in Psychiatry (SCIP), actigraphy and the EEG-'Vigilance Algorithm Leipzig' (VIGALL). DISCUSSION: A positive study outcome of the proposed study could substantially impact our understanding of the etiopathogenesis of mania and open new treatment perspectives.

Oxytocin influences avoidant reactions to social threat in adults with borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is characterized by interpersonal dysfunction, emotional instability, impulsivity, and risk-taking behavior. Recent research has focused on the role of oxytocin in BPD, with mixed results as regards the processing of social stimuli. METHODS: In a double-blind randomized placebo-controlled study, 13 BPD patients and 13 controls performed a dot probe task to examine attentional biases to happy and angry faces after intranasal application of oxytocin or placebo. Childhood trauma was examined using the childhood trauma questionnaire. RESULTS: In the placebo condition, patients with BPD (but not controls) showed an avoidant reaction to angry faces (but not happy faces). The strength of the avoidant reaction correlated with the severity of childhood trauma. This behavioral response (as well as the correlation) was abolished in the oxytocin condition. CONCLUSIONS: Adult patients with BPD show an avoidant response to social threat, a reaction that is linked with traumatic experiences during childhood. This response pattern is altered by oxytocin, possibly by reducing stress and inhibiting social withdrawal from distressing social stimuli.

Effectiveness and cost of atypical versus typical antipsychotic treatment in a nationwide cohort of patients with schizophrenia in Germany.

This study investigates the effectiveness and cost of typical versus atypical antipsychotics in a nationwide German cohort of patients with schizophrenia. The study sample consisted of patients insured with 4 sickness funds (n = 8,610) who were followed up for 12 months after hospital discharge with a diagnosis of schizophrenia in 2003. Multivariate regression models were fitted to assess the relationship between outcome variables (rehospitalization, bed-days, prescriptions against adverse effects, cost) and medication type, sex, age, and severity. Severity was assessed by prior bed-days due to schizophrenia during 2000 to 2002. Risk of rehospitalization did not differ between groups but within each group severity (P = 0.0003). Males (P = 0.0016) and patients younger than 35 years (P < 0.0001) had a higher risk of rehospitalization. Number of bed-days was lower for treatment with typicals compared with atypicals (P < 0.0001); furthermore, bed-days depended on severity of disease (P < 0.0001). Prescriptions of drugs against extrapyramidal symptoms, anxiety, and agitation were higher for patients treated with typicals (P < 0.0001 for each). Mean predicted treatment cost per year was € 6442 for atypicals versus € 4443 for typicals (P < 0.0001). This study does not support unconditional superiority of atypicals over typicals, neither in terms of effectiveness nor in terms of cost.

Interaction of recalled parental ADHD symptoms and rearing behavior with current attachment and emotional dysfunction in adult offspring with ADHD.

Research into attachment and emotion regulation has shown that children with ADHD are at risk of developing attachment disorders and emotion regulation disturbances, which in part may be due to the rearing style of their parents. No such data exists for adults with persistent ADHD. We hypothesized that current attachment style and emotion processing of adult patients with ADHD may be influenced by the presence of parental ADHD symptoms when the now adult patients were children, assuming that ADHD symptoms of parents have an impact on their parenting style. We examined recalled parental ADHD symptoms and rearing style as well as current attachment and emotion regulation abilities in a sample of 73 adults with ADHD using several self-rating instruments. Recalled prevalence of ADHD symptoms in the mother, and less so in the father, of adult patients with ADHD was significantly associated with partly adverse parental rearing styles, current attachment problems in romantic partnerships and emotion regulation disturbances compared with adult ADHD patients without possibly affected parent. ADHD symptoms in parents of children with ADHD may present a risk factor for attachment problems and poor emotion regulation when ADHD children are grown.

[Operationalized psychodynamic diagnostics (OPD) in patients in a prodromal state of schizophrenia--an explorative study]. / Operationalisierte Psychodynamische Diagnostik (OPD) bei Patienten im schizophrenen Prodromalstadium--Eine explorative Studie.

OBJECTIVES: To obtain data and hypotheses regarding the amelioration of risk estimation and preventive psychotherapy in patients in a prodromal state of schizophrenia by using OPD. METHODS: 20 participants with a prodromal condition--6 subjects far from psychosis and 14 close to psychosis--along with 10 patients with paranoid schizophrenia as reference group were examined using the first four OPD axes. RESULTS: Both groups differed considerably in all four axes. Compared to the schizophrenic participants, prodromal probands appear to have more favourable preconditions for therapy. Moreover, they experienced the interaction partners, including the investigator, as less aversive and induced less distanced behaviour in the investigator. Conflicts of self-esteem were prominent in both prodromal subgroups. However, patients farther from psychosis showed less conflicts of autonomy versus dependence and displayed a higher integration in structures such as "defence" and "attachment" when compared to participants closer to psychosis. CONCLUSIONS: Particularly the differences between the prodromal subgroups suggest that application of the OPD may positively complement previous approaches of early detection, prevention,and psychotherapy for prodromal conditions. The hypotheses obtained should be tested in longitudinal studies with larger sample sizes.

Configural processing of emotional bodies and faces in patients with attention deficit hyperactivity disorder.

Introduction: Attention Deficit Disorder (ADHD) is associated with interpersonal problems and difficulties in inferring other peoples' emotions. Previous research has focused on face processing, mostly in children. Our study investigated configural processing of emotional bodies and faces in adults with ADHD in comparison with healthy controls, analyzing P100, N170 and P250 event-related potentials (ERPs) and relating them to (socio)cognitive functioning. Method: Nineteen patients with ADHD and 25 healthy controls were presented upright and inverted bodies and faces which had to be categorized as neutral, happy or angry while ERPs were recorded. Additionally, sociocognitive and executive functioning was assessed. Results: In ADHD patients relative to controls, recognition of emotions depicted by bodies but not by faces was impaired and P100 amplitudes were enhanced for angry bodies. Furthermore, patients showed enhanced P250 amplitudes in response to both bodies and faces, specifically for happy and neutral emotions. Larger N170 amplitudes to bodies and faces correlated with lower alexithymia scores only in controls, while enhanced P250 amplitudes to both categories were associated with poorer inhibition only in patients. Conclusion: Adults with ADHD show potentially compensatory enhanced semantic processing of emotional bodies and faces, as reflected by increased P250 amplitudes, associated with poorer executive functioning and subtle alterations of emotional and configural processing, as reflected by ERPs.

Social problem solving in adult patients with attention deficit hyperactivity disorder.

Patients with Attention Deficit Hyperactivity Disorder (ADHD) experience interpersonal difficulties potentially linked to impaired social cognition. We aimed to investigate social problem solving strategies in adults with ADHD. Nineteen patients with ADHD and 20 healthy controls were assessed with a scenario-based battery gauging the ability to understand other people's mental states, to recognize interpersonal conflicts and to generate and identify optimal (i.e. both socially sensitive and practically effective) solutions to these conflicts. Furthermore, measures of socioemotional and executive functioning were administered. Patients and controls performed on a similar level with respect to theory of mind, the generation of the "best" solution to problematic social situations and the selection of the optimal solution out of alternatives. However, in a fluency task, patients generated fewer optimal solutions, while the number of only socially sensitive, only practically effective or irrelevant solutions was comparable in both groups. The overall ability to freely generate problem solutions was not linked to executive functioning or trait empathy, but better generation abilities were related to lower social interaction anxiety in the patients only. This suggests impaired generation fluency of optimal interpersonal conflict solutions in patients with ADHD which might contribute to higher levels of anxiety in social interactions.

Trauma exposure and post-traumatic stress disorder in bipolar disorder.

INTRODUCTION: There is a lack of data about post-traumatic stress disorder (PTSD) in European bipolar patients compared to the US-population. This study was conducted to ascertain the rates and types of traumatic events and PTSD in bipolar-I disorder. METHODS: Euthymic bipolar patients were screened for lifetime diagnosis of PTSD using the Post-Traumatic Stress Diagnostic Scale and the Clinician Administered Post-traumatic Stress Disorder Scale. RESULTS: A total of 74 patients (m = 30, f = 44) with diagnosis of bipolar-I disorder were assessed. 37 patients (50%) reported no trauma, 22 patients (29.7%) experienced traumatic events without diagnosis of PTSD and 15 patients (20.3%) had comorbid PTSD. Bipolar PTSD patients were at higher risk to be exposed to physical violence, parental disregard, alcohol dependence of parents, sexual assault by a family member or acquaintance. The number of siblings was higher and they had higher scores on the Hamilton Depression Rating Scale and the Global Assessment of Functioning Scale. CONCLUSIONS: Bipolar patients are more likely to experience traumatic events and PTSD is a relevant comorbid disorder. PTSD is associated with an increased illness severity of bipolar disorder.

Prospective memory (partially) mediates the link between ADHD symptoms and procrastination.

Individuals with attention deficit hyperactivity disorder (ADHD) often show poor planning and poor organization of tasks and activities which has been related to reduced memory for delayed intentions (prospective memory) and procrastination-in addition to other cognitive or motivational factors. This study set out to bring the fields of prospective memory and procrastination research together and to explore possible relations between the two constructs in ADHD. Twenty-nine adults with ADHD and 24 healthy controls performed several laboratory-based and real-life prospective memory tasks and filled in questionnaires measuring their symptom severity and procrastination behaviour. Overall, individuals' with ADHD showed clear deficits in everyday prospective memory performance. Individuals with ADHD recalled and executed less of their own real-life intentions. Moreover, there were clear links between everyday prospective memory performance and reported procrastination behaviour, and everyday prospective memory performance mediated the link between ADHD symptoms and procrastination behaviour.

A multi-centre, randomised, double-blind, placebo-controlled clinical trial of methylphenidate in the initial treatment of acute mania (MEMAP study).

Based on many clinical and preclinical findings the 'vigilance regulation model of mania' postulates that an unstable regulation of wakefulness is a pathogenetic factor in both mania and Attention Deficit Hyperactivity Disorder (ADHD) and induces hyperactivity and sensation seeking as an autoregulatory attempt to stabilize wakefulness. Accordingly, stimulant medications with their vigilance stabilizing properties could have rapid antimanic effects similar to their beneficial effects in ADHD. The MEMAP study - a multi-center, double-blind, placebo-controlled and randomized clinical trial (RCT) - assessed the antimanic efficacy and safety of a 2.5-day treatment with methylphenidate (20-40mg/day). Of 157 screened patients with acute mania, 42 were randomly assigned to receive 20-40mg per day of methylphenidate in one or two applications, or placebo. The primary outcome was the change in Young Mania Rating Scale (YMRS) sum scores from baseline to day 2.5 in the methylphenidate group compared to the placebo group. A group sequential design was chosen to justify early RCT termination based on efficacy or futility at an interim analysis after inclusion of 40 patients. In the interim analysis, the change from baseline in the YMRS total score at day 2.5 was not significantly different between both groups (F(1,37)=0.23; p=0.64). Thus, futility was declared for methylphenidate and the RCT was stopped. In summary, although methylphenidate was well tolerated and safe in the full analysis set, it failed to show efficacy in the treatment of acute mania. TRIAL REGISTRATION: clinicaltrials.gov (URL: http://www.clinicaltrials.gov; registration number: NCT01541605).

A Comparison of Mindfulness-Based Group Training and Skills Group Training in Adults With ADHD.

OBJECTIVE: To compare a novel "third wave" mindfulness-based training program with an established skills training derived from dialectical behavior therapy, to reduce ADHD symptoms and improve mindfulness and self-efficacy. METHOD: Ninety-one adults with ADHD (combined and inattentive type, mainly medicated) were non-randomly assigned to and treated within a mindfulness-based training group (MBTG, n = 39) or a skills training group (STG, n = 52), each performed in 13 weekly 2-hr sessions. RESULTS: General linear models with repeated measures revealed that both programs resulted in a similar reduction of ADHD symptoms, and improvement of mindfulness and self-efficacy. However, the effect sizes were in the small-to-medium range. A decrease in ADHD symptoms ≥30% was observed in 30.8% of the MBTG participants and 11.5% of the STG participants. CONCLUSION: The comparatively weak results may be due to limitations such as the absence of randomization, the lack of a control group without intervention, and the lack of matching groups for borderline, depression, and anxiety status. Moreover, audio instructions for home exercises and more stringent monitoring of participants' progress and eventual absence from sessions might have improved the outcome.

Probabilistic reward learning in adults with Attention Deficit Hyperactivity Disorder--an electrophysiological study.

Attention Deficit Hyperactivity Disorder (ADHD) is hypothesized to be characterized by altered reinforcement sensitivity. The main aim of the present study was to assess alterations in the electrophysiological correlates of monetary reward processing in adult patients with ADHD of the combined subtype. Fourteen adults with ADHD of the combined subtype and 14 healthy control participants performed an active and an observational probabilistic reward-based learning task while an electroencephalogramm (EEG) was recorded. Regardless of feedback valence, there was a general feedback-related negativity (FRN) enhancement in combination with reduced learning performance during both active and observational reward learning in patients with ADHD relative to healthy controls. Other feedback-locked potentials such as the P200 and P300 and response-locked potentials were unaltered in the patients. There were no significant correlations between learning performance, FRN amplitudes and clinical symptoms, neither in the overall group involving all participants, nor in patients or controls considered separately. This pattern of findings might reflect generally impaired reward prediction in adults with ADHD of the combined subtype. We demonstrated for the first time that patients with ADHD of the combined subtype show not only deficient active reward learning but are also impaired when learning by observing other people׳s outcomes.