Bariatric Surgery Is Highly Effective and Underutilized in Patients with ADHD: A 5-Year Retrospective Cohort Study.

INTRODUCTION: Obesity and ADHD have become increasingly common diagnoses. In the last decade, research has found that there is a high prevalence of obesity in patients with ADHD. The mainstays of management in the general population include lifestyle modifications, pharmacotherapies, and/or bariatric surgery. However, there is a lack of understanding of appropriate management of patients with both ADHD and obesity. METHODS: We identified those with obesity for at least five consecutive years (BMI > 30) in the TriNetX database before separating into two groups based on the presence or absence of ADHD. We assessed both the distribution of treatment modalities and the change in average BMI over time in each of our four groups across 5 years. RESULTS: Average BMI decreased over time in all groups, with the smallest change seen in the ADHD Pharmacology cohort (- 0.366 kg/m2) and the largest in the ADHD Surgery group (- 8.532 kg/m2). Average BMIs at the 5-year mark were significantly different. CONCLUSION: Our research found that pharmacological management of individuals with ADHD was only half as effective for individuals with ADHD than our control. Though surgical management of patients with ADHD is roughly 20 times more effective in managing obesity, it was not used as frequently in comparison to medication for management of weight.

Researching Eyesight Trends IN ADHD (RETINA).

BACKGROUND: There has been limited exploration of the relationship between ADHD and vision impairment, especially in relation to ADHD medication regimens and age. This study aims to examine trends in visual disorders in young patients with ADHD. METHODS: We analyzed deidentified patient records from TriNetX database. Patients under 22 years old were divided into cohorts based on ADHD status and medication regimen. We compared prevalence of vision disorders between cohorts. RESULTS: We studied over 1 million patients. The ADHD cohort had higher rates of all visual disorders than their non-ADHD peers. Medication usage was found to have a slight impact, with non-stimulants associating with higher rates for all outcomes. DISCUSSION: Our findings suggest that the higher occurrence of visual disorders in ADHD is not primarily due to misdiagnosis or medication effects. There is a need for regular eye care in ADHD patients and further investigation into the role of ADHD medications in eye health.

The heart of it all: Body dysmorphic disorder in cosmetic surgery.

BACKGROUND: Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE: This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS: We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS: Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS: These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

Patient Outcomes following Septoplasty in Patients with Attention-deficit/Hyperactivity Disorder.

Recent research has indicated that daytime manifestations of sleep-disordered breathing, frequently caused by deviated septum, can mimic many characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD) and could indicate intermittent hypoxia or hypercarbia as factors in the development of ADHD. To investigate the differences in outcomes following septoplasty between patients with ADHD and deviated septum, we used a retrospective cohort design to compare outcomes in patients diagnosed with deviated septa between June 1, 2002 and June 1, 2022. We then separated these patients into four total groups based on the presence or absence of ADHD diagnosis and the presence or absence of septoplasty. After matching cohorts to create insignificant differences in age, sex, and race, we analyzed various outcomes associated with ADHD, such as conduct disorders, anxiety disorders, fractures, and substance abuse disorders. Septoplasty reduces the risk for nearly all outcomes in patients with deviated septum, with statistically significant results present in 11 of 15 outcomes in both ADHD and non-ADHD groups. The effect of septoplasty was up to 10 times greater for the ADHD cohort. Patients with ADHD who receive septoplasty display a plethora of beneficial effects, with significantly reduced risk of common sequelae such as depression, obsessive-compulsive disorder, anxiety, and addictive disorders. The difference in outcomes indicates future prospective studies into outcomes of septoplasty in patients with ADHD.

Delirium Following Anticholinergic Use in Hospitalized Patients With Dementia.

We sought to explore rates of delirium amongst hospitalized patients with dementia following orders for anticholinergic medications. We hypothesized that patients receiving anticholinergic medications would have higher rates of delirium than similar, unexposed patients. We performed a retrospective chart review of 23 031 hospitalized individuals with Alzheimer's disease, vascular dementia, or unspecified dementia from 2011-2018. Rates of delirium diagnosis and haloperidol orders following anticholinergic administration were compared to patients with dementia without anticholinergic orders. Significant differences in rates of delirium and orders for haloperidol were observed between exposed and unexposed groups, with delirium having a relative risk of 2.3 and orders for haloperidol having a relative risk of 10.4. The number needed to harm for anticholinergic exposure was 5.45 for delirium and 7.09 for haloperidol. The identified difference suggests that inpatient use of anticholinergic medications may increase the risk of delirium in hospitalized patients with dementia. Despite this risk, our review suggests that anticholinergic administration is common during hospital stays among patients with dementia. Anticholinergic use may be a modifiable risk factor for delirium prevention, which could improve inpatient management of patients with dementia.

Fracture rates by medication type in attention-deficit/hyperactive disorder.

Background: ADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times. Objectives: To analyze the incidences of fractures in patients with ADHD on various medication regimens. Methods: Using the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity. Results: The comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the "phenidate" cohort had an insignificant difference in risk of lower limb fractures. Patients in the "any medication," "-etamine," "stimulant," and "not ADHD" groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities. Conclusions: As patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.

Suicide in Deep Brain Stimulation for Parkinson's Disease: A Retrospective Case-Control Study.

Deep brain stimulation (DBS), a treatment of Parkinson's disease (PD), has been associated with suicidality. We conducted a case-control study comparing suicide in four pairs of cohorts: PD patients with DBS or not, epilepsy patients with resection surgery or not, subjects with BMI≥30 with bariatric surgery or not, and patients with chronic kidney disease with transplantation or not. PD patients with DBS demonstrated a lower risk of suicide relative to PD patients without DBS. Findings from other elective surgeries indicate that patients receiving operative treatments do not possess predictable differences in suicide rates relative to their medically managed counterparts.

Supporting the future of medicine: Student mental health services in medical school.

Background: Mental health issues are common among United States medical students, and the AAMC has established recommendations for student mental health services provided by medical schools. Few studies directly compare mental health services at medical schools across the United States and, to our knowledge, none analyze how well schools adhere to the established AAMC recommendations. Objective: To determine whether mental health services at United States medical schools adhere to established guidelines. Methods: From October 2021 to March 2022, we obtained student handbooks and policy manuals from 77% of the accredited LCME United States medical schools. The AAMC guidelines were operationalized and placed into a rubric format. Each set of handbooks was independently scored against this rubric. A total of 120 handbooks were scored and the results were compiled. Results: Rates of comprehensive adherence were very low, with only 13.3% of schools displaying adherence to the full set of AAMC guidelines. Partial adherence was higher, with 46.7% of schools meeting at least one of three guidelines. Portions of guidelines whose requirements reflected a standard for LCME accreditation displayed a higher rate of adherence. Conclusion: The low rates of adherence across medical schools, as measured by handbooks and Policies & Procedures manuals, represents an opportunity to improve the mental health services within United States allopathic schools. An increase in adherence could be a step towards improving the mental health of United States medical students.

Under-Documented or Under-Recognized? Comorbid ADHD in Emergency Department Patients With Addictive Disorders.

OBJECTIVES: We sought to examine rates of comorbid ADHD and SUD/AUD using a nationally representative dataset, and to compare this data with established estimates. We hoped to increase available research on ADHD within patients with SUD/AUD. METHODS: This study is a retrospective secondary analysis of cross-sectional data collected in the National Hospital Ambulatory Medical Care Survey (NHAMCS). RESULTS: The data showed less than 1% of comorbid ADHD in either AUD or SUD, and prevalence of 0.6% in patients with both. Our estimated prevalence of ADHD among SUD/AUD patients is more than 30-fold smaller than the 25% consensus. CONCLUSION: The stark difference between our data and prior research indicates a need for further examination of the prevalence of ADHD within acute care. This finding of a large reservoir of ADHD that is unrecognized or undocumented indicates a substantive need for ADHD-focused education with opportunity for improvement in patient treatment.

Obstetric complications in mothers with ADHD.

Background: There is currently limited research on the intersection of pregnancy and ADHD and the unique pregnancy risk factors for mothers with an ADHD diagnosis. With an increased population of patients with ADHD in the recent decades and an increase in ADHD medication use during pregnancy it is important to consider what unique risks mothers with ADHD face during the perinatal period. Objective: Investigate a variety of outcomes in maternal ADHD. Methods: We identified female patients with a diagnosis of pregnancy and ADHD diagnosis. We also further separated the ADHD cohort for separate sub-analyses based on medication type. Odds ratios and relative risk were calculated from outcome incidence within each cohort. Cohorts were balanced on age, sex, and race. Results: We identified 45,737 pregnant females with ADHD. We matched these patients to pregnant females without ADHD, for a total of 42,916 pairs. Compared to the group without ADHD, mothers with ADHD had higher rates of every outcome except for HPV infection, which was statistically insignificant (P = 0.768). The odds ratios ranged from 1.08 for anemia complicating pregnancy to 2.63 for depressive episodes. Most outcomes were between 1.2 and 1.8 times more likely to occur in the cohort with ADHD. Conclusion: This study presents substantial advancements in our knowledge of pregnancy-related ADHD care. Armed with an increased awareness of these potential complications and their relationship with ADHD, obstetricians, psychiatrists, and providers of all specialties may be able to reduce the rate of complications within this specific patient population.

Patient Characteristics in Oral Cancer Staging.

Background: Oral cancer is a largely preventable malignancy with many modifiable risk factors, such as tobacco use and proper oral hygiene. Early detection of oral cancer is an important goal for oral healthcare providers, as survival rates for oral cancers diagnosed at an advanced stage are less than half the rates for cancers diagnosed in early stages. As many patients are asymptomatic in early stages, it is crucial for oral healthcare providers to have a high index of suspicion while treating patients at risk for late diagnosis. Objectives: To identify characteristics associated with early vs. late stage diagnosis of oral cancer. Methods: We performed a retrospective chart review using the TriNetX database. We identified two cohorts of interest: patients with an initial diagnosis of stage 1 oral cancer, and patients with an initial diagnosis of stage 3 or 4 oral cancer. Statistical comparison of cohort characteristics was completed through the TriNetX statistical software platform. Results: We identified 386 patients diagnosed at stage 1 and 869 patients diagnosed at stage 3 or 4. We identified several characteristics not previously reported in the literature. Race, BMI between 20 and 29, malnurition, anemia were all associated with late stage diagnosis. Certain medications were also associated with late stage diagnosis, such as heparin derivatives and diclofenac. Our findings also reinforced prior research for characteristics such as nicotine use and ethnicity. Conclusion: Our findings offer new characteristics that may aid oral healthcare providers in detecting oral cancer at an early stage. Increasing provider awareness of factors that they may not have considered previously could increase the rates of early stage cancer detection, improving overall patient mortality and curative outcomes.

Baseball injuries in adolescent athletes with ADHD.

At the intersection of injury-prone sports such as baseball and conditions like ADHD that affect all aspects of life, there is a lack of research. This limits the availability of preventive care programs designed to target potential risks and promote a safe experience. In this retrospective cohort study, we assess the frequency of injury in youth baseball players with and without ADHD, along with further investigation into how treatment with stimulant medication may modify risk factors. The data for this study were obtained in deidentified, aggregate format from the TriNetX research database. We identified all patients under 25 years of age with a designation of baseball activity. Within this population, we separated patients by presence or absence of ADHD diagnosis, and then by stimulant usage. The studied outcomes were injuries commonly occurring in baseball, including fractures, sprains, and specific injury patterns. We identified 17,710 patients under 25 years old with designated baseball activity, 1,183 of which had a diagnosis of ADHD. Of these, 511 had a history of stimulant medication and 470 had no history of stimulant use. For most events (i.e., injuries), there were no statistical differences between cohorts. The overall ADHD cohort significantly differed from the Not ADHD cohort in 3 events: "thorax, abdomen, pelvis injuries," "ankle sprain," and "concussion." When athletes with ADHD received treatment, this trend reversed for select injuries: "any fracture", "head or neck injuries", "upper limb injuries", and "lower limb injuries" were less likely in ADHD athletes on stimulants. Given the ongoing debate around stimulant use in athletics, our study is relevant to many patients, providers, and the baseball community.