Is there a correlation between ADHD symptom expression between parents and children?

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders in childhood; symptoms persist into adulthood in a majority of patients. It is among the most heritable of psychiatric disorders with a high risk for familial aggregation and has been linked in adulthood with impairment across a variety of domains, including parenting. Parental gender, ADHD status and symptom expression could be related to the severity of ADHD symptoms in the child. METHODS: We used prospective, observational study of clinical group of 30 children with diagnosed ADHD and control group of 37 healthy subjects. Only children with both biological parents available were included. Data on ADHD symptomatology for all subjects was gathered by a set of clinical tools (CBCL1991, TRF1991, WURS, self-report scale modified from DSM IV). Under the assumption that ADHD is a dimensional disorder, raw scores from questionnaires were used as they display the complete range of values. RESULTS: Clinical group showed higher values in all areas of children symptomatology, the same was observed for parental ADHD symptomatology. Significant correlation was found between children and paternal current ADHD symptomatology in the clinical group. This was not confirmed for mothers. CONCLUSION: Our study stresses an importance of screening for ADHD symptoms in parents of clinically referred children with ADHD as the correlation between severity of paternal and child's ADHD symptoms was confirmed. Our results stress the importance of including the father into the clinical assessment.

TPH2 polymorphisms and alcohol-related suicide.

Substantial evidence from family, twin, and adoption studies corroborates implication of genetic and environmental factors, as well as their interactions, on suicidal behavior and alcoholism risk. Serotonergic disfunction seems to be involved in the pathophysiology of substance abuse, and has also an important role in suicidal behavior. Recent studies of the tryptophan hydroxylase 2 showed mild or no association with suicide and alcohol-related suicide. We performed SNP and alcohol analysis on 388 suicide victims and 227 controls. The results showed association between suicide (Pχ²=0.043) and alcohol-related suicide (Pχ²=0.021) for SNP Rs1843809. A tendency for association was determined also for polymorphism Rs1386493 (Pχ²=0.055) and alcohol-related suicide. Data acquired from psychological autopsies in a subsample of suicide victims (n=79) determined more impulsive behavior (Pχ²=0.016) and verbal aggressive behavior (Pχ²=0.025) in the subgroup with alcohol misuse or dependency. In conclusion, our results suggest implication of polymorphisms in suicide and alcohol-related suicide, but further studies are needed to clarify the interplay among serotonergic system disfunction, suicide, alcohol dependence, impulsivity and the role of TPH2 enzyme.

The association between brain-derived neurotrophic factor polymorphism (BDNF Val66Met) and suicide.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) mediates neural plasticity, mood, different behaviours, and stress response. A functional BDNF polymorphism (BDNF Val66Met) was reported to influence the effects of stressful life events or childhood adversity on depression and suicidal behaviour in various psychopathologies. The study evaluated the association between BDNF Val66Met variants and suicide, committed with violent or non-violent methods, in victims with or without stressful childhood experience. METHODS: BDNF Val66Met polymorphism was genotyped on 560DNA samples from 359 suicide victims and 201 control subjects collected on autopsy from unrelated Caucasian subjects and subdivided according to gender, method of suicide, and influence of childhood adversity. RESULTS: A similar frequency of BDNF Val66Met variants was found between all included suicide victims and the control groups, and also between the male groups. The frequency of the combined Met/Met and Met/Val genotypes and the homozygous Val/Val genotype was significantly different between the female suicide victims and female controls, between the female suicide victims who used violent suicide methods and female controls, and between all included suicide victims with or without stressful life events. The combined Met/Met and Met/Val genotypes contributed to this significance. LIMITATION: A small group of suicide victims with available data on childhood adversity was studied. CONCLUSIONS: The combined Met/Met and Met/Val genotypes of the BDNF Val66Met variant could be the risk factor for violent suicide in female subjects and for suicide in victims exposed to childhood trauma. These results confirm a major role of BDNF in increased vulnerability to suicide.

No association between polymorphisms in four serotonin receptor genes, serotonin transporter gene and alcohol-related suicide.

BACKGROUND: Serotonin (5-HT) is an important neurotransmitter with wide-ranging functions. Its disfunction in the central nervous system seems to play an important role in many psychiatric disorders and suicidal behavior. The objective of this study was to examine the association between polymorphisms in different serotonin receptor genes (HTR): HTR1A (polymorphism -1019C>G), HTR1B (polymorphisms 861G>C and -161A>T), HTR1F (polymorphism -78C>T) and HTR2A (polymorphism -1420C>T), and serotonin transporter gene (5-HTT) (polymorphism LPR in promoter and VNTR in the second intron), and completed alcohol-related suicide, as well as between alcohol-dependent suicide victims. SUBJECTS AND METHODS: The study subjects were 373 Slovenian suicide victims (mean age ± SD: 48.8 ± 17.7 years) autopsied in the years 2002 through 2005. During autopsy venous blood was drawn, and afterwards DNA extraction and alcoholimetric analysis were performed. Relatives of 79 suicide victims were interviewed using a semi-structured questionnaire designed according to Slovenian cultural and economic conditions. They provided information about the alcohol abuse of the suicide victims. Amongst the suicide victims were 25 alcohol misusers and 54 non-misusers. RESULTS: Association between polymorphisms in the selected serotonin receptor genes, transporter gene and completed alcohol-related suicide, as well as between alcohol-dependent suicide victims was not established. CONCLUSIONS: Present results suggest that selected polymorphisms of the 5-HT receptor genes and transporter gene are not involved in genetic susceptibility to completed suicide under acute influence of alcohol or among alcohol-dependent individuals, but further studies in a larger sample are needed.

Effect of management of patients with Anorexia and Bulimia nervosa on symptoms and impulsive behavior.

The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns.

Lifetime prevalence of suicidal and self-injurious behaviors in a representative cohort of Slovenian adolescents with type 1 diabetes.

OBJECTIVE: To determine lifetime prevalence of suicidal and self-injurious behaviors in Slovenian adolescents with type 1 diabetes compared with healthy controls. RESEARCH DESIGN AND METHODS: Adolescents (14-19 yr) with type 1 diabetes were compared with a normative control group of healthy secondary school students by means of a self-reported questionnaire (according to Kienhorst) containing questions on demographic and family characteristics, suicidal ideation, intended suicide, attempted suicide, possible future suicide, and self-injurious behavior. Patients received the questionnaires at regular outpatient visits to the pediatric diabetes clinic, completed them in private, and returned them by mail. Questionnaires for control subjects were administered in classrooms. RESULTS: The responses of 126 eligible patients and 499 controls were analyzed. The control group trended toward higher lifetime prevalence of all suicidal behaviors and self-injurious behavior. The lowest prevalence of all suicidal behaviors and self-injurious behavior was reported by males with diabetes. Compared with male controls, the differences were statistically significant for suicidal ideation (p < 0.05) and intended suicide (p < 0.05). Compared with females with diabetes, the differences were statistically significant for suicidal ideation (p < 0.001), intended suicide (p < 0.01), attempted suicide (p < 0.05), and self-injurious behavior (p < 0.05). Females with diabetes reported highest prevalence of all suicidal but not self-injurious behaviors. More patients than controls reported receiving counseling the year preceding the study (p < 0.001). CONCLUSIONS: In the study, type 1 diabetes showed a protective effect for suicidal behavior in adolescent males but not in adolescent females. Professionals working with adolescents with type 1 diabetes should be alert to possible suicidality, especially among females.

Suicide, stress and serotonin receptor 1A promoter polymorphism -1019C>G in Slovenian suicide victims.

Implication of serotonergic system in suicide and suicide attempts has been discussed for several years. One of the most abundant serotonin receptors in the mammalian brain is the receptor 1A (5-HT1A); studies of its polymorphisms and suicide have provided very inconsistent results so far. The suggestion that the G allele depresses HTR1A autoreceptor expression, and therefore reduces serotonergic neurotransmission that might predispose to depression and suicide, made the promoter polymorphism -1019C>G a very promising candidate gene. In our study we analyzed promoter polymorphism -1019C>G on 323 suicide victims and 190 controls (all of Slovenian origin), taking into account sex, suicide method, and in case of suicide victims also stressful life events. Differences in the distributions of genotype and allele frequencies were not statistically significant between suicide victims and control group, and the same was found for distributions according to sex and suicide method. For 62 suicide victims information about stressful life events in the month prior to the suicide and in childhood was provided. For analysis we combined CG/GG genotypes and compared them to the CC genotype. More stressful life events in the month prior to the suicide were reported for the subgroup with CC genotype (mean number of events = 2.53; SD = 1.50) in comparison to subgroup with CG/GG genotypes (mean number of events = 1.58; SD = 1.32; P < 0.05). However, subgroups of suicide victims with CC or CG/GG genotypes did not differ regarding numbers of reported stressful life events in childhood (P > 0.05). Our study provides no evidence for the implication of HTR1A promoter polymorphism in suicide in general, but it suggests further studies that would take into account the interconnected network of suicide completion, genetic background and stress, beside other risk factors.

Subjective experience and suicidal ideation in schizophrenia.

Suicidal ideation and behavior are a frequent complication of schizophrenia. Although a number of risk factors have been identified, specific features of suicidality in schizophrenia remain poorly understood. In this study, 19 patients with schizophrenia were interviewed in depth on their suicidal ideation and intentions, followed by a qualitative phenomenological analysis of the material. Solitude with inability to participate in human interactions and feelings of inferiority were found to be the main sources of suicidal ideation. These experiences seem to resemble ordinary depressive reactions, yet we found them to be reflective of a more basic self-alienation and incapacity for immersion in the shared world. Ignoring this experiential level of patients' disturbances may lead to trivialization (and misjudgment) of the experiences at the root of suicidality in schizophrenia.

Two generations of Slovenian suicidal adolescent inpatients.

BACKGROUND: The political and socio-economic situation in Slovenia, a former Yugoslav republic, a country in transition and a country with a high suicide rate, which joined the European Union in 2004, has changed steadily since the beginning of the 1970s. Literature shows constancy in suicide statistics in Slovenia during these times. AIM: The present study examines whether the suicidal adolescent inpatient population in Slovenia reflects recent social changes and upheavals. METHOD: Data on two groups of patients admitted to a specialized adolescent psychiatry department after attempting suicide were collected. The first group (n = 74) were patients admitted from 1975 to 1977, the second group (n = 73) from 2002 to 2004. They were compared on general characteristics, family and living circumstances, risk behaviors, suicide attempts and diagnoses. RESULTS: The comparison revealed statistically significant differences between groups on educational level, number of siblings, frequency of smoking and psychoactive medication misuse as well as number of previous suicide attempts. No differences were found in other family and living circumstances, methods used in the index suicide attempt, other risk behaviors or diagnoses. CONCLUSIONS: The post-independence suicidal inpatient population in Slovenia shows a tendency towards higher morbidity, but has changed less than expected considering the vast changes in the society. These results suggest a certain constancy in adolescent suicidal behavior.

Trait aggression and hostility in recovered alcoholics.

There is a long-recognized association between alcohol consumption and aggressive behavior. This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics (RA). The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in RA. A group of male RA (n = 64), who did not meet the DSM-IV criteria for any psychiatric or personality disorder, were recruited to the study from aftercare groups. According to data from their group therapists, they were reliably abstinent for at least 3 years and socially well adapted. The study participants representing the control group (n = 69), diagnosed as being 'reliable nonalcoholics' (NA) by the Munich Alcoholism Test, were recruited from general practice. Data were derived from an in-house questionnaire on general characteristics of both groups, and aggressive and hostility traits were assessed using the Buss-Durkee Hostility Inventory (BDHI). The univariate and multivariate between-groups design was used for data analysis. Taking into account the BDHI dimensions of aggression and hostility, the difference between RA and NA groups was statistically significant [Wilks' lambda (8, 125) = 0.769; p = 0.00004]. There were statistically significant differences in the BDHI scales for indirect aggression, irritability, negativism, suspicion, resentment, and guilt. Both RA and Na groups did not differ significantly in variables that assessed physical and verbal aggression. After a 3-year abstinence, subjects from the RA group displayed signs of hostility and covert aggression.

Serotonin transporter gene promoter (5-HTTLPR) and intron 2 (VNTR) polymorphisms: a study on Slovenian population of suicide victims.

Several studies have been carried out to investigate how genetic variants of gene encoding for the serotonin transporter (5-HTT) may confer susceptibility to suicide. It was demonstrated that polymorphisms in the promoter region (5-HTTLPR) and in the second intron (VNTR) have functional consequences and are for this reason of particular interest in relation to various psychiatric disorders. In our study, we analyzed 5-HTTLPR and VNTR polymorphisms in 235 suicide victims and 233 controls in a Slovenian population to find a possible association of the polymorphisms and suicidal behavior. No statistically important differences between genotypes of controls and suicide group (5-HTTLPR: Pearson's chi2=1.597, df=2, P=0.455; VNTR: Pearson's chi=1.961, df=4, P=0.744), as well as no differences in allele distribution (5-HTTLPR: Pearson's chi2=0.598, df=1, P=0.467; VNTR: Pearson's chi2=0.837, df=2, P=0.654) were found, although a slightly higher frequency of LL genotype and of L allele was observed in the suicide group. Haplotype frequency analysis showed no excess of particular haplotypes between the two groups. Our study showed no association of serotonin transporter polymorphisms and suicide. The study, however, was performed on a population with a very high suicide rate (27.1 victims/100,000 citizens) and the role of 5-HTTLPR polymorphisms may be different in other populations.

Association study of seven polymorphisms in four serotonin receptor genes on suicide victims.

A number of molecular genetic studies have investigated if serotonin (5-HT) receptor subtypes are involved in the pathogenesis of depression, suicidal behavior, aggression, and impulsive behavior. Existence of many receptor subtypes for a single transmitter permits a great diversity of signaling raising the possibility that they may serve as genetic markers for suicidal behavior. Most previous studies of suicide have analyzed polymorphisms of the receptors 5-HT1A, 5-HT1B, 5-HT2A, fewer have examined 5-HT1F. We report a study of possible association between the polymorphisms in the 5-HT receptor genes (1A, 1B, 1F, and 2A) and suicidal behavior on a sample of 226 suicide victims and 225 healthy control subjects. No significant differences in genotype frequency distributions between the suicide victims and healthy control subjects were observed for four polymorphisms; three were not polymorphic. A single polymorphism, C-1420T in gene 5-HT2A, showed a slight association with suicide (chi2= 4.94, df = 2, P = 0.067), but the correlation was not statistically significant. None of the tested genetic variants of serotonin receptors appears to be associated with suicidal behavior in the Slovenian population which has a relatively high suicide rate.

Event-related potentials elicited by distractors in an auditory oddball paradigm in schizophrenia.

Patients with schizophrenia are affected more adversely than healthy controls by distracting conditions, due to their inability to adequately apportion attentional resources to targets or distractors. We attempted to re-evaluate the effects of distractors in 25 patients with chronic schizophrenia and in 12 controls. They performed an auditory target-detection task with 1500 Hz tone distractors and an additional control condition where a 1500-Hz tone was used as the target. The rate of target misses for patients with schizophrenia was 3.79% in non-distractor conditions and 14.79% in distractor conditions. Significantly reduced N100 responses to distractors and distractor condition targets were found. P300 responses to all target stimulus categories were reduced, but P300 responses to distractors were equal to those in the control group. There was a reduction of P300 amplitudes to distractors in both groups; however, only the control group showed significant enlargement of P300 amplitude when the distractors became the target stimuli. There is evidence that patients with schizophrenia tend to be less able to allocate their attentional resources adequately to target vs. distractor stimuli. When the distractors became the target stimuli, their responses remained unchanged, which suggests their inability to appropriately integrate stimulus information with contextual information.

Association of BDNF with restricting anorexia nervosa and minimum body mass index: a family-based association study of eight European populations.

Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric disorders where different genetic and environmental factors are involved. Several lines of evidence support that brain-derived neurotrophic factor (BDNF) plays an essential role in eating behaviour and that alterations on this neurotrophic system participates in the susceptibility to both AN and BN. Accordingly, intraventricular administration of BDNF in rats determines food starvation and body weight loss, while BDNF or its specific receptor NTRK2 knockout mice develop obesity and hyperphagia. Case-control studies also suggest a BDNF contribution in the aetiology of ED: we have previously reported a strong association between the Met66 variant within the BDNF gene, restricting AN (ANR) and minimum body mass index (minBMI) in a Spanish sample, and a positive association between the Val66Met and -270C/T BDNF SNPs and ED in six different European populations. To replicate these results, avoiding population stratification effects, we recruited 453 ED trios from eight European centres and performed a family-based association study. Both haplotype relative risk (HRR) and haplotype-based haplotype relative risk (HHRR) methods showed a positive association between the Met66 allele and ANR. Consistently, we also observed an effect of the Met66 variant on low minBMI and a preferential transmission of the -270C/Met66 haplotype to the affected ANR offspring. These results support the involvement of BDNF in eating behaviour and further suggest its participation in the genetic susceptibility to ED, mainly ANR and low minBMI.

Suicidal ideation in adolescence--an indicator of actual risk?

BACKGROUND: The aim of the study was to assess both the frequency of suicidal ideation and also its link to other risk factors for suicidal behavior in the community population of adolescents. METHOD: In the study, we have used a structured questionnaire for assessing the risk factors for suicidal behavior, and self-assessment scales for measuring depression and self-esteem. The research included 4,692 adolescents aged from 14 to 19 years. The sample is representative of the population of Slovene high school students. RESULTS: The prevalence of suicidal ideation was 44% at anytime in respondent's life, and 10.3% during the recent month, and statistically significantly more frequent in girls than in boys. Suicidal ideation proved to be linked to high level of depression and low self-esteem, and also to the important psychosocial risk factors for suicidal behavior, such as: tendency to react on stress by consuming alcohol, alcohol and substance abuse, frequent conflicts with parents and frequently running away from home, pessimism about the future and self estimation of high probability of suicide in the future. CONCLUSIONS: Suicidal ideation is an important suicide risk factor in adolescence, and requires adequate attention among all other relevant risk factors.

Measurement of simple reaction time in antipsychotic treatment of patients with schizophrenia.

BACKGROUND: The role of simple reaction time in schizophrenia has been extensively reported to date in professional literature. However, most studies have examined basic reaction time under static conditions using a single measurement. The aim of the present study was to establish whether any changes occur in simple reaction time during treatment with risperidone or olanzapine in in-patients suffering a relapse of schizophrenia. METHODS: Seventeen in-patients suffering acute relapse of schizophrenia (DSM IV criteria) and twenty matched, healthy controls participated in an eight-week, double-blind pilot study. The patients were treated with conventional antipsychotics for seven days after admission and were then randomised to the treatment arms with risperidone (4 mg/day) or with olanzapine (10 mg/day) at a fixed dosage in the first week and thereafter in flexible dosages for the remaining seven weeks. Since no differences were found between reaction times of patients treated with risperidone or olanzapine, the two treatment groups were merged in the statistical analysis before being compared with the normal controls. Psychopathological symptoms were assessed using the Positive and Negative Symptom Scale (PANSS) and extrapyramidal symptoms with the Simpson Angus Scale and Abnormal Involuntary Movement Scale. Reaction time was measured with the Alpha apparatus, connected to a personal computer. All assessments and measurements were conducted four times during the treatment phase of the study. RESULTS: The reaction time of patients was significantly longer than that of the healthy controls (t1 = 17.11; p1 < 0.05). After eight weeks of treatment the reaction time of patients significantly improved but did not reach that of the healthy controls (t4 = 28.18, p4 < 0.05). Furthermore, the improved reaction time in the patients did not correlate with improvement of psychopathological symptoms or with improved extrapyramidal symptoms. CONCLUSION: The results of the study suggest that simple reaction time can improve during treatment with atypical antipsychotics.

Mental health services in Slovenia.

BACKGROUND: Development of mental health services in Slovenia has some originalities described in the present article. Slovenia is a small Central European country with a population of 2 million. Its mental health system has been influenced by the western de-institutionalization movement and eastern models of care which are predominately institutional. AIMS: Mental health reform in the 1970s was a silent one with displacement of long-term psychiatric patients to old-people's homes, asylums and to their families. During the last decade community mental health services have been established in the non-government sector, primarily as social institutions providing support to patients with severe mental illness. Psychosocial rehabilitation movement changed some therapeutic approaches in hospitals and has been gaining more and more influence in the NGO services. RESULTS: The article describes Slovene psychiatric hospitals and community rehabilitation services. Mental health services in Slovenia are compared to services in Slovakia, the United Kingdom and The Netherlands. CONCLUSIONS: The authors are proposing guidelines for future development of mental health services for the severely mentally ill in our country in order to improve the present deficient state of care.

Community rehabilitation service for patients with severe psychotic disorders: the Slovene experience.

BACKGROUND: Rehabilitation can be carried out at various sites. METHOD: Two groups of patients with severe mental disorders were compared: those included in community rehabilitation service and those only attending an outpatient clinic regarding their clinical status, social functioning, standard of living and quality of life. RESULTS: We found no significant global differences in group characteristics, social functioning and clinical status, but we did prove the lower social status of the group included in the rehabilitation service and their satisfaction with the services they use. CONCLUSIONS: The community rehabilitation services in Slovenia are coping with existential social needs of their users but this study failed to demonstrate their success in improving health or social functioning.