Interaction between behavioral inhibition and neural alcohol cue-reactivity in ADHD and alcohol use disorder.

RATIONALE: Compared to the general population, adult Attention-Deficit / Hyperactivity Disorder (ADHD) is more prevalent in patients with Alcohol Use Disorder (AUD). Impaired behavioral inhibition is a common characteristic in both ADHD and AUD. Relapse risk is increased in patients with AUD and comorbid, untreated ADHD and in AUD patients with increased neural cue-reactivity. OBJECTIVES: In this study, we examined the interaction between neural correlates of behavioral inhibition and alcohol cue-reactivity with a hybrid imaging task. METHODS: Out of 69 adult study participants, we included n = 49 in our final analyses: Individuals had a diagnosis of either AUD (n = 13), ADHD (n = 14) or both (n = 5), or were healthy controls (HC; n = 17). The functional magnetic resonance imaging paradigm aimed to examine the combined effects of both an interference-inhibition task ("Simon-task") and an alcohol cue-reactivity task. Instead of segregating by diagnostic group, we pursued a dimensional approach in which we compared measures of AUD and ADHD severity, as well as the interaction of both, using multiple regression analyses. RESULTS: The four groups did not differ on the behavioral level on either the inhibition task or the alcohol cue-reactivity task. However, brain activation in frontal control and reward-related regions during completion of the combined tasks were related to ADHD and AUD severity (symptom load). During presentation of both alcohol cues and the inhibition task, participants with higher AUD and ADHD symptom load exhibited greater BOLD (blood oxygen level dependent) responses in subcortical reward-related regions. CONCLUSIONS: Our findings support the hypothesis that ADHD additionally diminishes inhibition ability in individuals with AUD. This may increase relapse risk when confronted with alcohol cues. Further, it is crucial for patients with comorbid AUD and ADHD to take into account not only reduced cognitive control over behavioral inhibition but also simultaneously heightened alcohol cue-reactivity.

Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins.

BACKGROUND: This was a prospective study of radiofrequency segmental thermal ablation (RFA) for the treatment of incompetent varicose great saphenous veins (GSVs). The present report describes long-term follow-up at 5 years. METHODS: The 5-year follow-up of this multicentre European study included assessment of the Venous Clinical Severity Score (VCSS), and GSV occlusion and reflux on duplex imaging. RESULTS: A total of 225 patients had 295 GSVs treated by RFA, achieving an initial vein occlusion rate of 100 per cent. With 80·0 per cent compliance, Kaplan-Meier analyses showed a GSV occlusion rate of 91·9 per cent and a reflux-free rate of 94·9 per cent at 5 years. Among the 15 GSVs noted with reflux during follow-up, only three showed full recanalization of the GSV at 1 week, 6 months and 3 years. Of the 12 legs with partial recanalization, reflux originated at the saphenofemoral junction in ten, with a mean length of the patent segment of 5·8 (range 3·2-10) cm; only six patients were symptomatic. Mean(s.d.) VCSS scores improved from 3·9(2·1) at baseline to 0·6(1·2), 0·9(1·3) and 1·3(1·7) at 1, 3 and 5 years. CONCLUSION: At 5 years RFA proved to be an efficient endovenous treatment for incompetent GSVs in terms of sustained clinical and anatomical success for the vast majority of treated patients.

Treatment adherence and persistence in adult ADHD: results from a twenty-four week controlled clinical trial with extended release methylphenidate.

PURPOSE: The aim of this analysis is to describe medication adherence, and treatment persistence, in adults with attention deficit/hyperactivity disorder (ADHD) treated for 24 weeks with extended release methylphenidate (MPH-ER). Additionally, patient-, disorder- and treatment-related factors associated with adherence and persistence will be identified. METHOD: Post-hoc analysis of the active treatment group of a placebo-controlled, randomised, 24 week trial with MPH-ER with univariate description and multiple logistic regression models and Hosmer and Lemeshow tests. RESULTS: In the sample of 241 adults with ADHD (mean age of 35.2 ± 10.1 years), 9.4% of the patients were non-adherent, taking less than 80% of the dispensed medication. Factors associated with non-adherence included age<25 years, education level lower than secondary education, lacking family history of ADHD, lower ADHD baseline severity and lower self- and observer-rated medication efficacy. Lacking family history of ADHD, lower education level and lower self-rated medication efficacy, predicted non-adherence with a prediction accuracy of 16%. Seventeen percent of the patients discontinued early with most discontinuing within the first five weeks of the MPH-ER titration phase. Mean persistence in the discontinuing group was 63.4 ± 49.4 days. Factors associated with discontinuation included male gender, lower education level, lacking family history of ADHD and lower self- and observer-rated medication efficacy. Treatment non-response, male gender and lower education level predicted treatment discontinuation with a prediction accuracy of 22.7%. CONCLUSION: Male adults without relatives with ADHD, with lower educational level and lower self- and observer-rated medication efficacy, who are newly treated with MPH-ER, are at increased risk of non-adherence and treatment discontinuation. Patients are at increased risk of treatment discontinuation during the medication titration phase.

[Adult attention deficit/hyperactivity disorder, associated symptoms and comorbid psychiatric disorders: diagnosis and pharmacological treatment]. / Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen mit assoziierter Symptomatik und komorbiden psychiatrischen Erkrankungen: Diagnostik und medikamentöse Behandlung.

Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions.

Driving performance in adults with ADHD: results from a randomized, waiting list controlled trial with atomoxetine.

PURPOSE: To investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD. METHODS: Parallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire). RESULTS: Forty-three of the 64 included patients completed the study (n=22 ATX, n=21 controls). Mean intervention period was 11.9±3.0 weeks, mean daily ATX dosage was 71.6±14.9mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P<0.05; risk-related self-control, P<0.005; driver skills, P<0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P<0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P<0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups. CONCLUSION: Our study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD.

Preschool children born moderately preterm have increased waist circumference at two years of age despite low body mass index.

AIM: To investigate the development of waist circumference (WC) in preschool children born preterm compared with a population-based reference. BACKGROUND: Children born preterm are reported to be insulin resistant, despite being lean during early childhood. We hypothesize that the mechanism is through increased visceral adiposity. METHODS: Data from 4446 preschool children (2169 girls/2277 boys) born in 2001-2006 from a population-based study were compared with longitudinal measurements of body mass index (BMI) and WC from a cohort of 152 children (64 girls/88 boys) born moderately preterm in 2002-2004 (gestational age, 32-37 weeks). RESULTS: In the preterm children, the mean WC was 2.8 cm larger compared with the reference group (p < 0.001) at 2 years of age but not at 5 years of age. There was no significant difference in the mean BMI at 2 years of age. The preterm group was significantly leaner at 5 years of age, with a mean BMI of 15.13 compared with 15.98 in the reference group (p < 0.001). CONCLUSION: Children born moderately preterm present as lean during early childhood but have an increased waist circumference in infancy, pointing towards a change in fat distribution with more abdominal fat. This may have implications for their metabolic status.

A randomized, waiting list-controlled 12-week trial of atomoxetine in adults with ADHD.

BACKGROUND: With the increasing recognition of adult attention-deficit/hyperactivity disorder (ADHD) there is an emerging need to investigate medication in this population. METHODS: In this waiting list-controlled trial, 64 ADHD-patients (mean age 35.8 ± 8.7 years) were randomly assigned to a daily dosage of up to 80 mg atomoxetine (Atx) or waiting list for 12-weeks. Primary outcome was the change of the observer-rated DSM-IV total ADHD score on the Conners' Adult ADHD Rating Scales (CAARSO: L DSM-IV total ADHD score) from baseline to endpoint. Other efficacy measures included selfrated CAARS-S:L DSM-IV total ADHD score, CAARS-O/S:L problems with self-concept and emotional lability score, Wender-Reimherr Adult Attention Defi cit Disorder Scale Emotional Dysregulation Score, and General Activities Score on the Quality of Life Enjoyment and Satisfaction Questionnaire. Efficacy measures were analysed in the per-protocol population. RESULTS: Mean change in CAARS:O-L DSM-IV total ADHD score was -13.1 ± 7.7 in the Atx vs. -0.4 ± 4.8 in the control group (p < 0.005). Treatment response ( ≥ 30 % reduction) was 60.1 % in the Atx vs. 0 % in the waiting list group. The other efficacy measures also showed significant improvements. The overall incidence of adverse events (AEs) was 70.4 % in the Atx group, the most frequent included fatigue, irritability, nausea and decreased appetite. In Atx-treated patients 18.5 % discontinued early due to AEs. DISCUSSION: Our results suggest that Atx is an effective treatment in adult ADHD. It reduces ADHD core and associated emotional symptoms and increases self-esteem and quality of life. AEs were consistent with those reported in other studies in adult ADHD.

German validation of the Conners Adult ADHD Rating Scales (CAARS) II: reliability, validity, diagnostic sensitivity and specificity.

BACKGROUND: The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires. METHODS: CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales. RESULTS: Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales. CONCLUSION: The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.

Bed-sharing among six-month-old infants in western Sweden.

AIM: In spite of several reports of an increased risk of sudden infant death syndrome (SIDS) in connection with bed-sharing, it is not an uncommon practice. The aim of this study was to examine bed-sharing at 6 months of age and the factors that are associated with bed-sharing. METHODS: Our cohort comprised 8176 randomly chosen families. At 6 month of age, the families received an invitation to the study, with a questionnaire, which was completed by 5605 families (response rate 68.5%). RESULTS: Of the families, 19.8% bed-shared. In the multivariate analysis, we found a correlation between breast-feeding and bed-sharing (breast-feeding at 6 months: OR 1.94; 95% CI 1.56, 2.41). Moreover, we found an association with 3+ nightly awakenings at 6 months (2.70; 2.20, 3.32). It was more common to share a bed if the parent was single (2.04; 1.19, 3.51) and less common if the infant was bottle-fed in the first week (0.70; 0.54, 0.90). Never using a pacifier was associated with a higher frequency of bed-sharing. CONCLUSION: We found a correlation between breast-feeding and bed-sharing as well as between sleeping problems and a single parent. A lower percentage of infants sleeping in the parental bed were seen in association with formula feeding in the first week after birth.

[Methylphenidate. Therapy option for adults with ADHD and comorbid substance use disorder?]. / Methylphenidat. Therapieoption bei ADHS und Suchterkrankung im Erwachsenenalter?

Attention-deficit/hyperactivity disorder (ADHD) in adults is often associated with a comorbid substance use disorder (SUD). To date, no treatment algorithms are available. The question of whether the administration of methylphenidate (MPH) is justified in the treatment of adult patients with ADHD and comorbid SUD still remains unclear. While animal studies indicate an addictive potential of intravenous application of the drug, controlled oral treatment with MPH does not seem to carry the potential for abuse in humans. It remains controversial whether MPH treatment of ADHD during childhood protects against the development of SUD during adulthood. Although data remain inconsistent, a small number of studies and our own clinical observations of ADHD patients with SUD treated with MPH support a reduction not only of ADHD-related symptoms, but also of craving and substance abuse. The treatment of the adult ADHD with comorbid SUD with MPH should be conducted after a risk-benefit assessment, taking into consideration the abused substances, the motivation to abstinence and the quality of the physician-patient relationship; it should be evaluated critically, monitored closely and accompanied by treatment of the SUD and specific psychotherapy/psychoeducation.

Sudden infant death syndrome during low incidence in Sweden 1997-2005.

BACKGROUND: Following the change from prone to supine in preferred sleeping position, the incidence of Sudden Infant Death Syndrome (SIDS) in Sweden fell from 1.1 per 1000 live births in 1992 to 0.41 in 1995. After a further small decline, we have been experiencing a plateau at around 0.25 since 2000. AIM: To identify the changes that have occurred in the epidemiology of SIDS since the end of the Nordic Epidemiological SIDS Study in 1995. METHODS: Data from the Medical Birth Register of Sweden, covering the years 1995-2005, were used. Sleeping position is not included in the register. RESULTS: The incidence of SIDS has remained low in Sweden. Independent risk factors were smoking during early pregnancy, parents not living together, low maternal age, high parity and short gestational age. The odds ratio for smoking has continued to increase and the median age of death has continued to decrease since the previous study. We found no signs of seasonality in the current material. CONCLUSIONS: Age at death continued to decrease. The high incidence during weekends persisted. Seasonality was not significant. There was no evidence of a changing effect from risk factors in the studied period.

Gender differences in self- and investigator-rated psychopathology in adult attention-deficit/hyperactivity disorder.

Despite the growing interest in the diagnosis of ADHD in adults, most of the knowledge in ADHD still relies on research with children and adolescents. Gender differences in adult ADHD patients were neglected for a long time and only few studies have focused this topic. The goal of this study was to investigate differences in ADHD psychopathology in male and female adults. We examined gender differences in ADHD core and associated symptoms and in personality traits in adults with ADHD. In order to discriminate between general and ADHD-specific gender differences, we compared data of adult ADHD patients with two control groups (patients with substance abuse and healthy controls). Regarding differences in ADHD core symptoms-attention problems, hyperactivity, and impulsivity-between male and female subjects, we found inconsistent results depending on the applied diagnostic instruments. Using standardized self-report, there were no gender differences regarding attention problems and hyperactivity but regarding impulsivity. Results of a semi-standardized interview (WRAADDS) according to the Utah criteria of adult ADHD showed no gender differences regarding impulsivity and hyperactivity but regarding attention problems. Moreover, differences were found between female and male healthy controls in the domains "over reactivity" and "hot temper" but not in the group of ADHD patients. Thus, it seems that gender differences in normal population were leveled by the disorder. Concerning general personality traits, some differences between male and female ADHD patients were also present in healthy controls, suggesting no ADHD-specific effect of gender. In conclusion, male and female ADHD patients seem to be more similar than different regarding ADHD-related psychopathology and general personality traits.

Early introduction of fish decreases the risk of eczema in infants.

BACKGROUND: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. AIMS: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. METHODS: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant's birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). RESULTS: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. CONCLUSIONS: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.

[Age and gender aspects of attention-deficit hyperactivity disorder]. / Alters- und geschlechtsspezifische Besonderheiten der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome with onset in childhood which persists at least partially in about 60% of afflicted individuals. Core symptoms include inattention, hyperactivity, and impulsivity. Additional psychopathology with disorganized behavior and emotional dysregulation is common in adulthood. The vast majority of adults affected also present psychiatric comorbidities. There is severe impairment of everyday life and quality of life. Developmental psychopathologic changes, age-related comorbidity, and functional and psychosocial problems associated with ADHD must be taken into account during the diagnostic process. Regarding clinical subtypes of ADHD according to DSM-IV and particularly gender differences, knowledge about these factors in adults with ADHD is limited.

Driving-related risks and impact of methylphenidate treatment on driving in adults with attention-deficit/hyperactivity disorder (ADHD).

This study assesses driving behaviour and history of driving outcomes through a semi-structured interview in 27 clinically referred German adults with ADHD and 27 age-, gender- and education-matched non-ADHD controls. In nineteen of the ADHD-subjects a test battery of driving-related cognitive measures was performed (ART 2020) and re-assessed after at least six weeks of treatment with methylphenidate (n = 9) or after a six-week medication free period (n = 10).ADHD-subjects drove significantly more kilometres per year, were more often registered by traffic authorities and fined more frequently, were involved in more accidents and described their driving style as more insecure and hectic than controls. A high-risk driving group was delineated with 3-6 accidents per ADHD-subject. All results were controlled for intercorrelations with driving experience. Methylphenidate treatment resulted in improved information processing, e.g., better visu-motor coordination under high-stress conditions, improved visual orientation and sustained visual attention compared to baseline and our untreated control group.

[Effect of subtype and psychiatric comorbidities on methylphenidate treatment in adults with attention-deficit hyperactivity disorder]. / Methylphenidatbehandlung bei Erwachsenen mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung. Bedeutung von Störungssubtyp und aktueller psychiatrischer Komorbidität.

The present study was intended to examine the efficacy of immediate-release methylphenidate (MPH IR) in the treatment of adults with attention-deficit hyperactivity disorder (ADHD) under consideration of subtype according to DSM-IV criteria and psychiatric comorbidity. After baseline assessment over 3 weeks, 47 patients aged 18-59 years with combined ADHD (ADHD-C) (n=27) and predominantly inattentive ADHD (ADHD-I; n=20) were treated in an open, uncontrolled design with an average dose of 0.5 mg MPH IR per kg over 7 weeks. Thirty-nine patients finished the study. The two groups did not differ in response to treatment with regard to ADHD symptoms (very good to good outcome in ADHD-C 73.9%, in ADHD-I 66.7%) or cognitive measures (sustained attention, information processing speed, divided attention). However, ADHD patients with psychiatric comorbidities had significantly worse outcome: total ADHS scores on the T2 Brown Attention Deficit Disorder Scales (BADDS) were 66.2+/-15.5 with psychiatric comorbidity and 51.7+/-13.7 without (P=0.04), despite significantly higher doses of MPH IR (0.56+/-0.17 mg/kg vs 0.46+/-0.13 mg/kg; P=0.004). This effect was mainly seen in the patients with clinically significant depressive symptoms (Beck Depression Inventory > or =18), who clearly benefited less from treatment (total T2 BADDS scores with depressive symptoms 70.7+/-15.9 and without depressive symptoms 48.1+/-21.2; P=0.001).

SIDS risk factors and factors associated with prone sleeping in Sweden.

OBJECTIVE: To compare the current prevalence of risk factors for sudden infant death syndrome (SIDS) in Sweden with a decade earlier, and assess factors associated with prone sleeping. METHODS: The results of a cohort study (Infants of Western Sweden) and a population based case-control study (Nordic Epidemiological SIDS Study) were examined. Subjects were 5600 healthy 6 month old infants born in 2003 in the Western Sweden region and 430 healthy Swedish infants born between 1991 and 1995. RESULTS: Prone sleeping decreased from 31.8% to 5.6% and supine sleeping increased from 35.3% to 47.3%. Side or side/supine sleeping increased from 25.2% to 43.8%. Maternal smoking during pregnancy decreased from 23.5% to 9.5%. The risk for prone sleeping increased if the mother was unemployed (OR 2.4, 95% CI 1.5 to 4.0), if she was a heavy smoker in the third trimester (OR 44.1, 95% CI 1.6 to 1199.6), and if the child was irritable (OR 2.5, 95% CI 1.3 to 5.1), shared a bedroom with siblings (OR 2.6, 95% CI 1.0 to 6.6), or never used a dummy (OR 3.2, 95% CI 1.9 to 5.4). CONCLUSIONS: Parents have complied with advice to prevent SIDS given at infant welfare centres for the last 10 years. A change in the preferred sleeping position from side variants to exclusively supine, and reducing the number of pregnant women smoking may be beneficial. Use of a prone sleeping position was associated with maternal employment status, maternal smoking, temperament of the child, dummy use, and sharing a bedroom with siblings.

[Long-acting methylphenidate. An alternative medical therapy for adult patients with attention deficit hyperactivity disorder]. / Retardiertes Methylphenidat. Eine Alternative in der medikamentösen Therapie bei erwachsenen Patienten mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung.

We report a 44-year-old female patient with attention deficit hyperactivity disorder (ADHD), combined subtype (DSM-IV: 314.01), who was treated with 0.5 mg of short-acting immediate-release methylphenidate/kg body weight given t.i.d. (total daily MPH IR dosage 45 mg). Under this medication, the patient reported significant reduction of symptoms. However, several times a day she experienced severe rebound phenomena with pronounced concentration disturbances, unrest, and dysphoric mood. After changing the medication to long-acting methylphenidate once daily (total daily OROS MPH dosage 54 mg), the rebound phenomena stopped, with equivalent beneficial clinical effects.

[Attention deficit hyperactivity disorder in adults. An overview]. / Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bei Erwachsenen. Ein Uberblick.

Attention deficit hyperactivity disorder (ADHD), which is characterized by the inability to appropriately modulate attention and/or impulse control and hyperactivity, resulting in social, academic and occupational underachievement, is presently the topic of intensive discussion in German psychiatry. With a prevalence of 3-5%, ADHD is one of the most frequently seen disorders in child and adolescent psychiatry. With nearly 50% of childhood patients also affected during adulthood, this disorder is of much higher clinical significance for psychiatry than presumed thus far. The present review discusses current results of epidemiology, etiology, clinical symptoms and comorbidity, diagnostic assessment, pharmacotherapy, and psychological interventions for adults with ADHD.

Vitamin A and sudden infant death syndrome in Scandinavia 1992-1995.

AIM: To assess the effect of vitamin supplementation on the risk of sudden infant death syndrome (SIDS). METHODS: The analyses are based on data from the Nordic Epidemiological SIDS Study, a case-control study in which parents of SIDS victims in the Scandinavian countries were invited to participate together with parents of four matched controls between 1 September 1992 and 31 August 1995. The odds ratios presented are computed by conditional logistic regression analysis. RESULTS: The crude odds ratio in Scandinavia for not giving vitamin substitution was 2.8 (95% CI (1.9, 4.3)). This effect was statistically significant in Norway and Sweden, which use A and D vitamin supplementation, but not in Denmark, where only vitamin D supplementation is given. The odds ratios remained significant in Sweden when an adjustment was made for confounding factors (OR 28.4, 95% CI (4.7, 171.3)). CONCLUSION: We found an association between increased risk of sudden infant death syndrome and infants not being given vitamin supplementation during their first year of life. This was highly significant in Sweden, and the effect is possibly connected with vitamin A deficiency. This effect persisted when an adjustment was made for potential confounders, includingsocioeconomic factors.