Comparison of clinical and cognitive characteristics of a Mexican adult clinical population with and without ADHD / Comparación de las características clínicas y cognitivas de una población clínica adulta mexicana con y sin TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of the world population, with symptoms that may persist into adulthood. Despite the findings on the clinical course of this disorder, information regarding comorbidity patterns, psychosocial and executive functioning in adult life in those with and without ADHD in Latin American samples is scarce. Objective The aim of this study is to compare the comorbidity pattern, psychosocial, and executive functioning of adults with and without ADHD from a clinical sample. Method One hundred and fifty-one patients between 20 and 45 years, with screened positively on ASRS-V1.1, were invited to continue an evaluation process as part of clinical research program (PROMETEO): 1) K-SADS-PL Mx interview, 2) MINI-Plus interview, ASRS-V1-1 18 item version, BRIEF self-reported questionnaire, SCQA-ADHD, and 3) Individual case review by clinical expert in ADHD. Results Individuals in the ADHD group had a higher average of comorbid disorders (2.5 SD 1.1 vs. 1.3 SD 1.0 respectively, F = .439; t = -6.621; df = 149; p < .001), more likelihood of procrastinating (OR = 6.5; 95% CI[2.6, 16.2]; z = 4.0) and were more likely to present difficulties in both the behavior regulation index (OR = 104.9; 95% CI[31.8, 345.7]; z = 7.65) and the metacognitive index (OR = 94.79; 95% CI[29.10, 308.76]; z = 7.56) compared to the non-ADHD group, regardless of gender. Discussion and conclusions Our results indicate that the ADHD adult group presented with more comorbidity, and worse psychosocial and executive functioning than non-ADHD adults.

Resumen Introducción El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo que afecta aproximadamente al 5% de la población mundial, persistiendo hasta la adultez. A pesar de los hallazgos acerca del curso clínico de este trastorno, la información es escasa con respecto a los patrones de comorbilidad, funcionamiento psicosocial y ejecutivo en la vida adulta entre aquellos con y sin TDAH en muestras latinoamericanas. Objetivo Comparar el patrón de comorbilidad, el funcionamiento psicosocial y ejecutivo de adultos con y sin TDAH de una muestra clínica. Método Ciento cincuenta y un pacientes entre 20 y 45 años, quienes inicialmente presentaron un tamizaje positivo del ASRS-V1.1, fueron evaluados dentro de un programa de investigación clínica (PROMETEO) con los siguientes instrumentos: 1) la entrevista K-SADS-PL-Mx, 2) la entrevista MINI-Plus, la version de 18 items del ASRS-V1-1, y los cuestionarios autoaplicados BRIEF y SCQA-ADHD y 3) Revisión de cada caso por un clínico experto en el diagnóstico de TDAH. Resultados El grupo de TDAH comparado con aquel sin TDAH presentó un mayor promedio de trastornos comórbidos (2.5 DE 1.1 vs 1.3 DE 1.0 respectivamente, F = .439; t = -6.621; gl = 149; p < .001), mayor probabilidad de procrastinar (OR = 6.5; 95% IC[2.6, 16.2]; z = 4.0), y mayor probabilidad de presentar dificultades tanto en el índice de regulación de la conducta (OR = 104.9; 95% IC[31.8, 345.7]; z = 7.65) como en el índice metacognitivo (OR = 94.79; 95% IC[29.10, 308.76]; z = 7.56) independientemente del sexo. Discusión y conclusión Nuestros resultados señalan que los adultos con TDAH presentan mayor comorbilidad y peor funcionamiento psicosocial y ejecutivo que los adultos sin TDAH.

Relapse and recovery: five to ten year follow-up study of chemically dependent physicians--the Georgia experience.

Of 100 physicians who entered into a continuing care contract during a five-year period with the Impaired Physicians Program of the Medical Association of Georgia, seventy-seven have maintained documentable abstinence from all mood-altering substances. One physician was lost to follow-up. Twenty-two relapsed, eighteen of whom have undergone another treatment for chemical dependence. Only one physician in the relapse group has been involved in a pattern of chronic relapsing behavior.

The effect of physician impairment on the family.

There are few studies on the effect of physician impairment on the marriage and the family. There is a need for research on both the functional and non-functional medical marriage, and treatment needs to be devised to focus on the special needs of the medical family.

Combined Alcoholics Anonymous and professional care for addicted physicians.

The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process.

t-butyl-4-hydroxyanisole as an inhibitor of tumor cell respiration.

The effect of t-butyl-4-hydroxyanisole (BHA), a widely used food antioxidant additive, on the culture growth, oxygen consumption, and redox state of some electron carriers of intact TA3 and 786A ascites tumor cells has been studied. BHA inhibited culture growth and respiration of these two tumor cell lines, by inhibiting the electron flow through the respiratory chain. Experiments to determine its site of action showed that BHA did not inhibit noticeably the electron flow through cytochrome oxidase, due to the ability of N,N,N',N'-tetramethyl-p-phenylenediamine to bypass the BHA inhibition of the respiration. Electron flow through the ubiquinone-cytochrome b-c1 complex also was unaffected by BHA; in fact, BHA failed to inhibit the oxidation of duroquinol. Spectrophotometric experiments are in accordance with studies carried out using synthetic electron donors. The redox state of NAD(P)+, determined in steady-state conditions, changed to a more reduced level, and the redox states of ubiquinone, cytochrome b, cytochromes c + c1 and cytochromes a + a3 changed to a more oxidized level. These observations suggest that the electron transport in the tumor mitochondria was inhibited by BHA at the NADH-dehydrogenase-ubiquinone level (energy-conserving site 1). These findings could explain, in part, the cytotoxic effect of BHA.

Addiction in anesthesiologists: drug access and patterns of substance abuse.

Impaired anesthesiologists (IAs) seen by the Medical Association of Georgia Impaired Physicians Program were compared to all other impaired physicians seen by the program. Anesthesiologists were the specialists most overrepresented in the program. When each IA was matched to a control with respect to age, sex, race, professional activity status, and year of admission to the program, the IAs were found to be more likely to abuse drugs than alcohol, to abuse narcotics, and to abuse drugs intravenously. The authors recommend tighter control of narcotics and surveillance of all anesthesia personnel in order to reduce the risks to patients associated with chemical dependence.

The Medical Association of Georgia's Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty.

Risk factors for the disease of chemical dependence, or addiction to alcohol and/or drugs, for physicians have not been clearly defined. Yet chemical dependence is believed to be a leading occupational hazard for physicians. This study compares the specialties of a population of physicians assessed for the presence of impairment (study group, N = 1000) with the distribution of specialties for all US physicians. Only 21 of the total were found to be free of impairment from chemical dependence or psychiatric disease, while 920 physicians (92.0%) had a primary diagnosis of chemical dependence, and 59 (5.9%) had a major psychiatric illness. Anesthesia and family and general practice were found to be overrepresented in the population under study, as compared with all US physicians. There were significant differences between the study group and all US physicians with respect to age, sex, and practice activity status. The authors urge these apparent high-risk specialties, as well as the medical profession itself, to develop control or prevention strategies that will reduce risk for chemical dependence through education, early identification, intervention, and treatment of those individuals with the disease.

Clinical and microbial features of prosthetic joint infection.

A one-year experience with prosthetic joint infection, in which 63 cases were identified, is reviewed. Thirty cases (48 percent) were early infections, in the first postoperative year, and 33 cases (52 percent) were late, occurring more than one year after implantation. Pain was the predominant symptom, but clinical clues suggesting infection were frequently absent, with fever in 43 percent and leukocytosis in only 10 percent. The radiographic appearance was more frequently abnormal in late infections (67 versus 37 percent, p less than 0.02). Staphylococci were predominant organisms, constituting 59 percent of prosthetic joint infections, and S. epidermidis was the predominant species in both early and later infections. Of the hematogenous infections, 11 of 13 occurred in the group with late infections; these were mostly nonstaphylococcal . Antigenic proteins of S. epidermidis were characterized by gel electrophoresis, but no infection-specific antigens could be identified when patient serum was compared with normal samples. Precipitating antibodies to the extracellular proteins of S. epidermidis were present in 50 percent of patients with S. epidermidis prosthetic joint infections, 27 percent of patients with nonstaphylococcal infections, 20 percent of patients with S. aureus infections, and 11 percent of normal subjects. In view of the increasing importance of prosthetic joint infection, further study of the pathogenesis of the infection and the host immune response is warranted.