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.

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.

Pharmacological Treatment of Insomnia Symptoms in Individuals with Substance Use Disorders in Spain: A Quasi-Experimental Study.

INTRODUCTION: Pharmacological treatment of insomnia in patients with addictions has been hardly investigated and there are few researches about it in an inpatient detoxification. The aim of this study was to describe the outcomes of the pharmacological treatment of insomnia in SUD patients admitted to a detoxification unit in Spain, with a focus on the primary substance of abuse and co-occurring mental disorders. METHODS: A quasi-experimental study was conducted in 481 addicted in patients, who were admitted for substances detoxification in Vall d´Hebron University Hospital, Barcelona, Spain, from 2010 to 2015. The patients underwent systematic evaluation of axes I and II psychiatric disorders (SCID-I, SCID-II, and CAADID). Insomnia was evaluated using a night time sleep log. Substance-dependent patients, who had insomnia during hospital detoxification, received a psychotropic medication with hypnotic effect, keeping the regular clinical practice without randomization. RESULTS: At discharge, insomnia was considered to have been alleviated in 63.8% (n = 204) of patients while 36.2% (n = 116) of patients remained with insomnia disturbances. Comparing hypnotic treatments it was observed that mirtazapine and clotiapine were the treatment that corrected the insomnia more frequently. DISCUSSION: Since insomnia is not corrected in all patients, it should be further investigated in medications with hypnotic purpose. Based on the results of this work, randomized clinical trials might be proposed.

Higher severity of cocaine addiction is associated with tactile and somatic hallucinations.

BACKGROUND: The aim of this study is to describe the features of cocaine-dependent patients who have had cocaine-induced tactile/somatic hallucinations (CITSH), and to analyze the association with addiction-related variables and psychiatric comorbidity, comparing patients with CITSH, patients with cocaine psychotic symptoms (CIP) and no CITSH, and patients without any psychotic symptom. METHOD: A cross-sectional study was conducted in 767 cocaine-dependent patients in an outpatient treatment center for addictions. The following data were obtained: sociodemographic characteristics, CIP information, addiction-related variables and psychiatric comorbidity. A bivariate and multivariate analysis was performed. RESULTS: Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom. According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine. In general, in all variables studied, patients with CITSH presented worse clinical features (addiction variables and psychiatric comorbidity) than patients with CIP without CITSH and non-CIP group. CONCLUSION: CITSH are usually associated with other psychotic symptoms induced by cocaine. The patients who experienced CITSH are more severe cases compared both with patients with CIP without CITSH and patients without CIP. Increased risk of overdose is an important issue in this type of patients.

Transcriptomic and genetic studies identify NFAT5 as a candidate gene for cocaine dependence.

Cocaine reward and reinforcing effects are mediated mainly by dopaminergic neurotransmission. In this study, we aimed at evaluating gene expression changes induced by acute cocaine exposure on SH-SY5Y-differentiated cells, which have been widely used as a dopaminergic neuronal model. Expression changes and a concomitant increase in neuronal activity were observed after a 5 µM cocaine exposure, whereas no changes in gene expression or in neuronal activity took place at 1 µM cocaine. Changes in gene expression were identified in a total of 756 genes, mainly related to regulation of transcription and gene expression, cell cycle, adhesion and cell projection, as well as mitogen-activeated protein kinase (MAPK), CREB, neurotrophin and neuregulin signaling pathways. Some genes displaying altered expression were subsequently targeted with predicted functional single-nucleotide polymorphisms (SNPs) in a case-control association study in a sample of 806 cocaine-dependent patients and 817 controls. This study highlighted associations between cocaine dependence and five SNPs predicted to alter microRNA binding at the 3'-untranslated region of the NFAT5 gene. The association of SNP rs1437134 with cocaine dependence survived the Bonferroni correction for multiple testing. A functional effect was confirmed for this variant by a luciferase reporter assay, with lower expression observed for the rs1437134G allele, which was more pronounced in the presence of hsa-miR-509. However, brain volumes in regions of relevance to addiction, as assessed with magnetic resonance imaging, did not correlate with NFAT5 variation. These results suggest that the NFAT5 gene, which is upregulated a few hours after cocaine exposure, may be involved in the genetic predisposition to cocaine dependence.

Bostezos como efecto secundario dependiente de la dosis del tratamiento con escitalopram / Yawning as a dose-dependent side effect of treatment with escitalopram

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Risk factors for cocaine-induced psychosis in cocaine-dependent patients.

Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. This is the first European study on the relationship between CIP, consumption pattern variables and personality disorders. We evaluated 173 cocaine-dependent patients over 18 years; mostly males, whose average age was 33.6 years (SD=7.8). Patients attending an outpatient addictions department were enrolled in the study and subsequently systematically evaluated using SCID I and SCID II interviews for comorbid disorders, a clinical interview for psychotic symptoms and EuropASI for severity of addiction. A high proportion of cocaine dependent patients reported psychotic symptoms under the influence of cocaine (53.8%), the most frequently reported being paranoid beliefs and suspiciousness (43.9%). A logistic regression analysis was performed, finding that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder and cannabis dependence history had 66.2% sensitivity 75.8% specificity predicting the presence of CIP. In our conclusions, we discuss the relevance of evaluating CIP in all cocaine dependent-patients, and particularly in those fulfilling the clinical profile derived from our results. These findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.

Cuestionario autoinformado de cribado de TDAH ASRS-v. 1.1 en adultos en tratamiento por trastorno por uso de sustancias / Adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist in patients with substance use disorders

Objetivo. Diagnosticar el trastorno por déficit de atención con hiperactividad (TDAH) en pacientes con trastorno por uso de sustancias (TUS) es un proceso complejo, en el cual un instrumento de cribado puede ser de granutilidad. Se ha analizado la validez del cuestionario autoinformado de cribado de TDAH en adultos ASRS-v1.1 en pacientes con TUS, considerando la gravedad de la adicción y la comorbilidad con los trastornos depresivo, antisocial y límite de la personalidad. Método. Se evaluaron 80 pacientes en tratamiento ambulatorio por dependencia de sustancias mediante los siguientes instrumentos: ASRS-v1.1, CAADID-II, Europ ASI, SCID-I, SCID-II. Se realizó un análisis factorial con rotación varimax para determinar la estructura de las intercorrelaciones entre los ítems y se analizó la exactitud delASRS-v1.1.Resultados. La entrevista diagnóstica CAADID utilizada como patrón de oro, indica que el 20% (intervalo de confianza [IC] del 95%: 11-29) cumple criterios para TDAH. La estructura factorial del ASRS-v1.1 está marcada por dos factores referentes a inatención e hiperactividad/impulsividad que explican el 67,7% de la varianza. ElASRS-v1.1 con punto de corte 4, presenta una sensibilidad del 87,5% y una especificidad del 68,8%. Conclusiones. El ASRS-v1.1 es un instrumento de cribado sencillo, útil y de aceptable validez para identificar TDAH entre pacientes con TUS (AU)

Aim. Diagnosing attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD) is a complicated process in which a screening tool may be useful. We analyzed the ASRS-v1.1 validity in patients with SUD, considering the addiction severity and comorbidity with depressive disorders, antisocial and borderline personality. Methods. Eighty outpatients with SUD were evaluated with the following instruments: ASRS-v1.1, CAAD-II, Europ ASI, SCID-I, SCID-II. A factor analysis was performed with Varimax rotation to determine the structure of the intercorrelations among the items. Accuracy of ASRS-v1.1 was also analyzed. Results. The diagnostic interview CAADID used as a gold standard indicated that 20% (95% confidence interval [CI]: 11-29) meet the criteria for ADHD. The ASRS v1.1factor structure is marked by two factors related to inattention and hyperactivity / impulsivity that account for 67.7% of the variance. ASRS-v1.1, with a 4 cut-off, showed an 87.5% sensitivity and 68.6% specificity. Conclusions. ASRS-v1.1 is a simple screening tool that is useful and has acceptable validity for the identification of ADHD among addicted patients (AU)

Validación al español de la escala de cribado del trastorno por déficit de atención/hiperactividad en adultos (ASRS v. 1.1): una nueva estrategia de puntuación / Validation of the Spanish version of the attention deficit hyperactivity disorder adult screening scale (ASRV v. 1.1): A novel scoring strategy

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno neuropsiquiátrico frecuente en la edad adulta. Su diagnóstico supone un proceso complejo en el que la aplicación de un instrumento de cribado puede ser de gran utilidad. Objetivo. Analizar la validez del cuestionario autoinformado de cribado del TDAH en adultos ASRS v. 1.1 de seis ítems, en un contexto clínico ambulatorio. Sujetos y métodos. Se realizó un estudio de casos y controles en el cual participaron 90 pacientes con TDAH y 90 controles sin él. Fueron seleccionados en las consultas ambulatorias hospitalarias de un programa especializado de adultos con TDAH. El diagnóstico clínico del trastorno fue realizado mediante la entrevista semiestructurada CAADID. Se analizó la exactitud de la prueba para diferentes formas de puntuación y puntos de corte. Resultados. Se encuentran óptimas características psicométricas considerando los ítems del ASRS v. 1.1 de manera cuantitativa, con un rango de puntuación entre 0 y 24, estableciendo como punto de corte 12 puntos. Se observaron una sensibilidad del 96,7%, una especificidad del 91,1%, un valor predictivo positivo del 91,6%, un valor predictivo negativo del 96,5%, un índice kappa de 0,78 y un área bajo la curva de 0,94 (odds ratio = 297,3; intervalo de confianza del 95% = 76,2- 1.159). Conclusión. El ASRS es un instrumento válido y útil para la detección de pacientes adultos con TDAH en el contexto clínico ambulatorio (AU)

Introduction. Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in the adulthood. It’s diagnosis is a complex process in which a screening tool can be useful. Aim. To analyze the six-question Adult ADHD Self-Report Scale (ASRS v. 1.1) validity in an outpatient clinical context. Subjects and methods. We performed a casecontrol study, involving 90 patients with ADHD and 90 controls without ADHD. They were outpatient treated in a program for adults ADHD in a hospital. The clinical disorder diagnosis was measured by the Conners Adult ADHD Diagnostic Interview. We analyzed the test accuracy for different ways to score and cut-offs. Results. We found the best psychometric characteristics of ASRS v. 1.1 using a quantitative ranking between 0 and 24 points, setting as cut-off 12 points. We observed a sensitivity of 96.7%, specificity 91.1%, positive predictive value 91.6% negative predictive value 96.5%, kappa index 0.88 and area under the curve 0.94 (odds ratio = 297.3; 95% confidence interval = 76.2-1,159). Conclusion. The ASRS is a valid and useful tool for the adult ADHD screening in the clinical context (AU)

[Validation of the Spanish version of the attention deficit hyperactivity disorder adult screening scale (ASRS v. 1.1): a novel scoring strategy]. / Validacion al espanol de la escala de cribado del trastorno por deficit de atencion/hiperactividad en adultos (ASRS v. 1.1): una nueva estrategia de puntuacion.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in the adulthood. It's diagnosis is a complex process in which a screening tool can be useful. AIM: To analyze the six-question Adult ADHD Self-Report Scale (ASRS v. 1.1) validity in an outpatient clinical context. SUBJECTS AND METHODS: We performed a case-control study, involving 90 patients with ADHD and 90 controls without ADHD. They were outpatient treated in a program for adults ADHD in a hospital. The clinical disorder diagnosis was measured by the Conners Adult ADHD Diagnostic Interview. We analyzed the test accuracy for different ways to score and cut-offs. RESULTS: We found the best psychometric characteristics of ASRS v. 1.1 using a quantitative ranking between 0 and 24 points, setting as cut-off 12 points. We observed a sensitivity of 96.7%, specificity 91.1%, positive predictive value 91.6% negative predictive value 96.5%, kappa index 0.88 and area under the curve 0.94 (odds ratio = 297.3; 95% confidence interval = 76.2-1,159). CONCLUSION: The ASRS is a valid and useful tool for the adult ADHD screening in the clinical context.