1
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Nielsen RL, Bornaes O, Storgaard IK, Kallemose T, Jørgensen LM, Jawad BN, Altintas I, Juul-Larsen HG, Tavenier J, Durhuus JA, Bengaard AKP, Holst JJ, Kolko M, Sonne DP, Breindahl T, Damgaard M, Porrini E, Hornum M, Andersen O, Pedersen MM, Rasmussen HH, Munk T, Lund TM, Jensen PS, Andersen AL, Houlind MB. Appetite stimulation with cannabis-based medicine and methods for assessment of glomerular filtration in older patients with medical illness: A study protocol. Basic Clin Pharmacol Toxicol 2023; 133:237-253. [PMID: 37314893 DOI: 10.1111/bcpt.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Malnutrition in older patients is linked to poor appetite. Cannabis-based medicine may have orexigenic properties in older patients, but this has to our knowledge never been investigated. In older patients, uncertainty applies to the accuracy of estimated glomerular filtration rate (eGFR) based on creatinine, which is crucial for medication prescribing. In older patients with poor appetite, the study aims (1) to assess the efficacy of Sativex® (8.1-mg delta-9-tetrahydrocannabinol [THC] and 7.5-mg cannabidiol [CBD]) to stimulate appetite and (2) to compare the performance of various GFR-estimates and measured-GFR (mGFR) for determining gentamicin clearance utilizing population pharmacokinetic (popPK) modelling methods. METHODS AND OBJECTIVES This study is composed of two substudies. Substudy 1 is an investigator-initiated single-center, double-blinded, randomized, placebo-controlled, superiority, cross-over study. Substudy 1 will recruit 17 older patients with poor appetite, who will also be invited to substudy 2. Substudy 2 is a single-dose pharmacokinetics study and will recruit 55 patients. Participants will receive Sativex® and placebo in substudy 1 and gentamicin with simultaneous measurements of GFR in substudy 2. The primary endpoints are as follows: Substudy 1-the difference in energy intake between Sativex® and placebo conditions; substudy 2- the accuracy of different eGFR equations compared to mGFR. The secondary endpoints include safety parameters, changes in the appetite hormones, total ghrelin and GLP-1 and subjective appetite sensations, and the creation of popPK models of THC, CBD, and gentamicin.
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Affiliation(s)
- R L Nielsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - O Bornaes
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I K Storgaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - T Kallemose
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - L M Jørgensen
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - B N Jawad
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I Altintas
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - H G Juul-Larsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J Tavenier
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J A Durhuus
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, Copenhagen, Denmark
| | - A K P Bengaard
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - J J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - D P Sonne
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Breindahl
- Department of Clinical Biochemistry, North Denmark Regional Hospital, Hjørring, Denmark
| | - M Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - E Porrini
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - M Hornum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - O Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - M M Pedersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H H Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T M Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - P S Jensen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Orthopeadic Surgery, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - A L Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M B Houlind
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- The Hospital Pharmacy, Herlev, Denmark
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Di Lonardo Burr SM, LeFevre JA, Arnold LE, Epstein JN, Hinshaw SP, Molina BSG, Hechtman L, Hoza B, Jensen PS, Vitiello B, Pelham WE, Howard AL. Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories. Child Dev 2022; 93:e563-e580. [PMID: 35635061 DOI: 10.1111/cdev.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.
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Affiliation(s)
- Sabrina M Di Lonardo Burr
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada
| | - Jo-Anne LeFevre
- Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA
| | - Jeffrey N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California, USA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Peter S Jensen
- The REACH Institute, New York, New York, USA.,Department of Psychiatry, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - William E Pelham
- College of Arts, Sciences, and Education, Florida International University, Miami, Florida, USA
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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3
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Fisher PM, Ozenne B, Ganz M, Frokjaer VG, Dam VN, Penninx BW, Sankar A, Miskowiak K, Jensen PS, Knudsen GM, Jorgensen MB. Emotional faces processing in major depressive disorder and prediction of antidepressant treatment response: A NeuroPharm study. J Psychopharmacol 2022; 36:626-636. [PMID: 35549538 DOI: 10.1177/02698811221089035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent neuropsychiatric illness for which it is important to resolve underlying brain mechanisms. Current treatments are often unsuccessful, precipitating a need to identify predictive markers. AIM We evaluated (1) alterations in brain responses to an emotional faces functional magnetic resonance imaging (fMRI) paradigm in individuals with MDD, compared to controls, (2) whether pretreatment brain responses predicted antidepressant treatment response, and (3) pre-post change in brain responses following treatment. METHODS Eighty-nine medication-free, depressed individuals and 115 healthy controls completed the fMRI paradigm. Depressed individuals completed a nonrandomized, open-label, 8-week treatment with escitalopram, including the option to switch to duloxetine after 4 weeks. We examined patient-control group differences in regional fMRI responses at baseline, whether baseline fMRI responses predicted treatment response at 8 weeks, including early life stress moderating effects, and change in fMRI responses in 36 depressed individuals rescanned following 8 weeks of treatment. RESULTS Task reaction time was 5% slower in patients. Multiple brain regions showed significant task-related responses, but we observed no statistically significant patient-control group differences (Cohen's d < 0.35). Patient pretreatment brain responses did not predict antidepressant treatment response (area under the curve of the receiver operator characteristic (AUC-ROC) < 0.6) and brain responses were not statistically significantly changed after treatment (Cohen's d < 0.33). CONCLUSION This represents the largest prediction study to date examining emotional faces fMRI features as predictors of antidepressant treatment response. Brain response to this fMRI emotional faces paradigm did not distinguish depressed individuals from healthy controls, nor was it predictive of antidepressant treatment response.Clinical Trial Registration: Site: https://clinicaltrials.gov, Trial Number: NCT02869035, Trial Title: Treatment Outcome in Major Depressive Disorder.
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Affiliation(s)
- Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ganz
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Nh Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brenda Wjh Penninx
- BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anajli Sankar
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Miskowiak
- BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin B Jorgensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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4
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Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, Molina BS, Jensen PS, Hinshaw SP, Roy A, Chronis-Tuscano A, Newcorn JH, Rohde LA. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry 2022; 179:142-151. [PMID: 34384227 PMCID: PMC8810708 DOI: 10.1176/appi.ajp.2021.21010032] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. METHODS Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. RESULTS Approximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time. CONCLUSIONS The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle Children’s Research Institute
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Nisonger Center, Columbus Ohio
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Elizabeth Owens
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | | | | | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | | | | | - Jeffrey H. Newcorn
- Department of Psychiatry & Pediatrics, Icahn School of Medicine at Mount Sinai
| | - Luis A. Rohde
- ADHD and Developmental Psychiatry Programs, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul
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5
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Marstrand-Joergensen MR, Madsen MK, Stenbæk DS, Ozenne B, Jensen PS, Frokjaer VG, Knudsen GM, Fisher PM. Default Mode Network Functional Connectivity Negatively Associated with Trait Openness to Experience. Soc Cogn Affect Neurosci 2021; 16:950-961. [PMID: 33891043 PMCID: PMC8610093 DOI: 10.1093/scan/nsab048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/30/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
Evaluating associations between the five-factor personality domains and resting-state functional connectivity networks (e.g., default mode network, DMN) highlights distributed neurobiological systems linked to behaviorally relevant phenotypes. Establishing these associations can highlight a potential underlying role for these neural pathways in related clinical illness and treatment response. Here we examined associations between within- and between-network resting-state functional connectivity with functional magnetic resonance imaging (fMRI) and the five-factor personality domains: Openness to experience (Openness), Extraversion, Neuroticism, Agreeableness and Conscientiousness. We included data from 470 resting-state scan sessions and personality assessments in 295 healthy participants. Within- and between-network functional connectivity from 32 a priori defined regions was computed across seven resting-state networks. The association between functional connectivity and personality traits was assessed using generalized least squares. Within-network DMN functional connectivity was significantly negatively associated with trait Openness (regression coefficient= -0.0010; [95% CI] = [-0.0017, -0.0003]; pFWER = 0.033), seemingly driven by association with the Fantasy subfacet. Trait Extraversion was significantly negatively associated with functional connectivity between the visual and dorsal attention networks and positively associated with functional connectivity between the frontoparietal and language networks. Our findings provide evidence that resting-state DMN is associated with trait Openness and gives insight into personality neuroscience.
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Affiliation(s)
- Maja Rou Marstrand-Joergensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin K Madsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dea S Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Psychiatry Copenhagen, Mental Health Services Capital Region of Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
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Jensen PS. Editorial: The Vanishing Value of Evidence-based Treatments: Is Our Mental Health Expertise Irrelevant? J Am Acad Child Adolesc Psychiatry 2021; 60:441-444. [PMID: 33358848 DOI: 10.1016/j.jaac.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
The article in this issue of JAACAP by the CAMELS (Child/Adolescent Anxiety Multimodal Extended Long-term Study) study team, Peris et al.1, offers 2 very important contributions. Conveniently, the first contribution is also the stated purpose of this report: to present findings detailing the extent to which children and adolescents who previously participated (averaging 6.5 years previously) in the landmark Child and Adolescent Multimodal Study of Anxiety (CAMS) multisite randomized controlled trial (RCT)2 did or did not receive follow-up services. This is not a good-news story. By and large, over the 6-year follow-up, only 35% of the previous RCT-treated children and youth received "consistent" continuing services, either through medication or cognitive-behavioral therapy (CBT), despite ongoing issues of anxiety and significant impairment.
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Affiliation(s)
- Peter S Jensen
- The REACH Institute, New York, and the University of Arkansas for Medical Sciences, Little Rock.
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7
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Mitchell JT, Sibley MH, Hinshaw SP, Kennedy TM, Chronis-Tuscano A, Arnold LE, Swanson JM, Hechtman LT, Molina BS, Caye A, Tamm L, Owens EB, Roy A, Weisner TS, Murray DW, Jensen PS. A Qualitative Analysis of Contextual Factors Relevant to Suspected Late-Onset ADHD. J Atten Disord 2021; 25:724-735. [PMID: 30929549 PMCID: PMC9678489 DOI: 10.1177/1087054719837743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.
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Affiliation(s)
- John T. Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Margaret H. Sibley
- Department of Psychiatry and Behavioral Health, Florida International University
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley,Department of Psychiatry, University of California, San Francisco
| | | | | | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital
| | - Brooke S.G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh
| | - Arthur Caye
- Department of Psychiatry, Federal University of Rio Grande do Sul
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine
| | | | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg
| | - Thomas S. Weisner
- Departments of Anthropology and Psychiatry, University of California, Los Angeles
| | - Desiree W. Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill
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8
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Greenhill LL, Swanson JM, Hechtman L, Waxmonsky J, Arnold LE, Molina BSG, Hinshaw SP, Jensen PS, Abikoff HB, Wigal T, Stehli A, Howard A, Hermanussen M, Hanć T. Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:978-989. [PMID: 31421233 PMCID: PMC7021562 DOI: 10.1016/j.jaac.2019.06.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate long-term stimulant treatment associations on standardized height, weight, and body mass index trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). METHOD Of 579 children with DSM-IV ADHD-combined type at baseline (aged 7.0-9.9 years) and 289 classmates (local normative comparison group [LNCG]), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (n = 53, 9%), Inconsistent (n = 374, 66%), and Negligible (n = 141, 25%) stimulant medication use, as well as patients starting stimulants prior to MTA entry (n = 211, 39%). Height and weight growth trajectories were calculated for each subgroup. RESULTS Height z scores trajectories differed among subgroups (F = 2.22, p < .0001) and by stimulant use prior to study entry (F = 2.22, p < .001). The subgroup-by-assessment interaction was significant (F = 2.81, p < .0001). Paired comparisons revealed significant subgroup differences at endpoint: Consistent was shorter than Negligible (-0.66 z units /-4.06 cm /1.6 inches, t = -3.17, p < 0.0016), Consistent shorter than Inconsistent (-0.45 z units /-2.74 cm /-1.08 inches, t = -2.39, p < .0172), and the Consistent shorter than LNCG (-0.54 z units/+3.34 cm/ 1.31 inches, t = -3.30, p < 0.001). Weight z scores initially diverged among subgroups, converged in adolescence, and then diverged again in adulthood when the Consistent outweighed the LNCG (+ 3.561 z units /+7.47 kg /+16.46 lb, p < .0001). CONCLUSION Compared with those negligibly medicated and the LNCG, 16 years of consistent stimulant treatment of children with ADHD in the MTA was associated with changes in height trajectory, a reduction in adult height, and an increase in weight and body mass index. CLINICAL TRIAL REGISTRATION INFORMATION Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); https://clinicaltrials.gov/; NCT00000388.
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Affiliation(s)
- Laurence L Greenhill
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY.
| | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - James Waxmonsky
- Pennsylvania State University Division of Child and Adolescent Psychiatry, Centre County
| | | | | | - Stephen P Hinshaw
- University of California, Berkeley, and the University of California, San Francisco
| | - Peter S Jensen
- University of Arkansas for Medical Sciences, Little Rock, and The REACH Institute, New York, NY
| | - Howard B Abikoff
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY
| | - Timothy Wigal
- Clinical Services for Avida Inc., Newport Beach, California
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9
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Spies M, Nasser A, Ozenne B, Jensen PS, Knudsen GM, Fisher PM. Common HTR2A variants and 5-HTTLPR are not associated with human in vivo serotonin 2A receptor levels. Hum Brain Mapp 2020; 41:4518-4528. [PMID: 32697408 PMCID: PMC7555071 DOI: 10.1002/hbm.25138] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
The serotonin 2A receptor (5‐HT2AR) is implicated in the pathophysiology and treatment of various psychiatric disorders. [18F]altanserin and [11C]Cimbi‐36 positron emission tomography (PET) allow for high‐resolution imaging of 5‐HT2AR in the living human brain. Cerebral 5‐HT2AR binding is strongly genetically determined, though the impact of specific variants is poorly understood. Candidate gene studies suggest that HTR2A single nucleotide polymorphisms including rs6311/rs6313, rs6314, and rs7997012 may influence risk for psychiatric disorders and mediate treatment response. Although known to impact in vitro expression of 5‐HT2AR or other serotonin (5‐HT) proteins, their effect on human in vivo brain 5‐HT2AR binding has as of yet been insufficiently studied. We thus assessed the extent to which these variants and the commonly studied 5‐HTTLPR predict neocortex in vivo 5‐HT2AR binding in healthy adult humans. We used linear regression analyses and likelihood ratio tests in 197 subjects scanned with [18F]altanserin or [11C]Cimbi‐36 PET. Although we observed genotype group differences in 5‐HT2AR binding of up to ~10%, no genetic variants were statistically significantly predictive of 5‐HT2AR binding in what is the largest human in vivo 5‐HT2AR imaging genetics study to date. Thus, in vitro and post mortem results suggesting effects on 5‐HT2AR expression did not carry over to the in vivo setting. To any extent these variants might affect clinical risk, our findings do not support that 5‐HT2AR binding mediates such effects. Our observations indicate that these individual variants do not significantly contribute to genetic load on human in vivo 5‐HT2AR binding.
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Affiliation(s)
- Marie Spies
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Arafat Nasser
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Jensen
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
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10
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Nadeem E, Jensen PS. Teacher Consultation Research in Attention Deficit Hyperactivity Disorder: A Cause for Congratulation or Consolation? School Psychology Review 2019. [DOI: 10.1080/02796015.2009.12087848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Erum Nadeem
- New York State Psychiatric Institute/Columbia University
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11
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Dam VH, Thystrup CK, Jensen PS, Bland AR, Mortensen EL, Elliott R, Sahakian BJ, Knudsen GM, Frokjaer VG, Stenbæk DS. Psychometric Properties and Validation of the EMOTICOM Test Battery in a Healthy Danish Population. Front Psychol 2019; 10:2660. [PMID: 31849772 PMCID: PMC6901831 DOI: 10.3389/fpsyg.2019.02660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 01/23/2023] Open
Abstract
Disruptions in hot cognition, i.e., the processing of emotionally salient information, are prevalent in most neuropsychiatric disorders and constitute a potential treatment target. EMOTICOM is the first comprehensive neuropsychological test battery developed specifically to assess hot cognition. The aim of the study was to validate and establish a Danish language version and reference data for the EMOTICOM test battery. To evaluate the psychometric properties of 11 EMOTICOM tasks, we collected data from 100 healthy Danish participants (50 males, 50 females) including retest data from 49 participants. We assessed test-retest reliability, floor and ceiling effects, task-intercorrelations, and correlations between task performance and relevant demographic and descriptive factors. We found that test-retest reliability varied from poor to excellent while some tasks exhibited floor or ceiling effects. Intercorrelations among EMOTICOM task outcomes were low, indicating that the tasks capture different cognitive constructs. EMOTICOM task performance was largely independent of age, sex, education, and IQ as well as current mood, personality, and self-reported motivation and diligence during task completion. Overall, many of the EMOTICOM tasks were found to be useful and objective measures of hot cognition although select tasks may benefit from modifications to avoid floor and ceiling effects in healthy individuals.
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Affiliation(s)
- Vibeke H. Dam
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christa K. Thystrup
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter S. Jensen
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Amy R. Bland
- Neuroscience and Psychiatric Unit, The University of Manchester, Manchester, United Kingdom
| | - Erik L. Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Elliott
- Neuroscience and Psychiatric Unit, The University of Manchester, Manchester, United Kingdom
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Gitte M. Knudsen
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G. Frokjaer
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dea S. Stenbæk
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Connor DF, Newcorn JH, Saylor KE, Amann BH, Scahill L, Robb AS, Jensen PS, Vitiello B, Findling RL, Buitelaar JK. Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents. J Child Adolesc Psychopharmacol 2019; 29:576-591. [PMID: 31453715 PMCID: PMC6786344 DOI: 10.1089/cap.2019.0039] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as "aggression," "aggressive behavio(u)r," "maladaptive aggression," "juvenile," and "developmental trajectory." These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.
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Affiliation(s)
- Daniel F. Connor
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut Medical School, Farmington, Connecticut.,Address correspondence to: Daniel F. Connor, MD, Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut Medical School, 263 Farmington Avenue, MC 1410, Farmington, CT 06030-1410
| | - Jeffrey H. Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Adelaide S. Robb
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia.,Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
| | - Peter S. Jensen
- Department of Psychiatry, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Algorta GP, Kragh CA, Arnold LE, Molina BSG, Hinshaw SP, Swanson JM, Hetchman L, Copley LM, Lowe M, Jensen PS. Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children. J Atten Disord 2018; 22:1266-1277. [PMID: 25525155 PMCID: PMC5505803 DOI: 10.1177/1087054714561290] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers' personality traits and own ADHD symptoms could also affect parenting stress. METHOD 430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers' group and maternal personality/ADHD symptoms related to parenting stress. RESULTS Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers' group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers. CONCLUSION Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.
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14
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Weisner TS, Murray DW, Jensen PS, Mitchell JT, Swanson JM, Hinshaw SP, Wells K, Hechtman L, Molina BSG, Arnold LE, Sorensen P, Stehli A. Follow-Up of Young Adults With ADHD in the MTA: Design and Methods for Qualitative Interviews. J Atten Disord 2018; 22:10S-20S. [PMID: 28617075 PMCID: PMC5711631 DOI: 10.1177/1087054717713639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Qualitative interviews with 183 young adults (YA) in the follow-up of the Multimodal Treatment Study of Children With and Without ADHD (MTA) provide rich information on beliefs and expectations regarding ADHD, life's turning points, medication use, and substance use (SU). METHOD Participants from four MTA sites were sampled to include those with persistent and atypically high SU, and a local normative comparison group (LNCG). Respondents were encouraged to "tell their story" about their lives, using a semistructured conversational interview format. RESULTS Interviews were reliably coded for interview topics. ADHD youth more often desisted from SU because of seeing others going down wrong paths due to SU. Narratives revealed very diverse accounts and explanations for SU-ADHD influences. CONCLUSION Qualitative methods captured the perspectives of YAs regarding using substances. This information is essential for improving resilience models in drug prevention and treatment programs and for treatment development for this at-risk population.
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Affiliation(s)
| | - Desiree W. Murray
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Peter S. Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA and the Reach Institute, New York, NY, USA
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA and the University of California, San Francisco, CA, USA
| | - Karen Wells
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
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15
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Mitchell JT, Weisner TS, Jensen PS, Murray DW, Molina BS, Arnold LE, Hechtman L, Swanson JM, Hinshaw SP, Victor EC, Kollins SH, Wells KC, Belendiuk KA, Blonde A, Nguyen C, Ambriz L, Nguyen JL. How Substance Users With ADHD Perceive the Relationship Between Substance Use and Emotional Functioning. J Atten Disord 2018; 22:49S-60S. [PMID: 28166690 PMCID: PMC5538943 DOI: 10.1177/1087054716685842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed qualitative-quantitative approach to explore this relationship. METHOD Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group [LNCG]) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). RESULTS SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. CONCLUSION Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related risk for cannabis use.
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Affiliation(s)
- John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Thomas S. Weisner
- Departments of Psychiatry & Anthropology, UCLA, Los Angeles, CA, USA
| | - Peter S. Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA and the Reach Institute, New York, NY, USA
| | - Desiree W. Murray
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Brooke S.G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA and the University of California, San Francisco, CA, USA
| | - Elizabeth C. Victor
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Scott H. Kollins
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Karen C. Wells
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Andrew Blonde
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Celeste Nguyen
- School of Medicine, University of California, Irvine, CA, USA
| | - Lizeth Ambriz
- Departments of Psychiatry & Anthropology, UCLA, Los Angeles, CA, USA
| | - Jenny L. Nguyen
- School of Medicine, University of California, Irvine, CA, USA
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16
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Jensen PS, Weisner T, Hinshaw SP. Introduction: Just Say No? New Insights About Change Versus Constancy in Substance Use Behavioral Decisions in Youth With and Without ADHD. J Atten Disord 2018; 22:3S-9S. [PMID: 29633895 PMCID: PMC6718161 DOI: 10.1177/1087054718763729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite enormous social-psychological and economic consequences of substance abuse in youth and young adults, too little is known about effective interventions among substance users, both with and without ADHD. This special issue reports on four linked investigations that employed a novel research strategy when the Multimodal Treatment Children with ADHD Study (MTA) participants were between ages 21.7 and 27.3 years old (14-16 years after initial assessments). Using combination of in-depth qualitative narrative interviews and quantitative analyses ("mixed methods") of 183 participants from four to six original MTA sites, investigators sought to obtain a more complete understanding of factors contributing to youths' substance use (SU) initiation, maintenance, and desistence, (both among youth with ADHD and control participants). The articles in this special issue illuminate important new insights about possible influences contributing to SU, particularly persistent use/abuse. Findings also illustrate the benefits of mixed-methods studies, not only to better understand the linkages between ADHD and SU, but also to understand other areas of child/adult psychopathology.
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Affiliation(s)
- Peter S. Jensen
- University of Arkansas for Medical Sciences, Little Rock, USA
- The REACH Institute, New York, NY, USA
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17
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Jensen PS, Yuki K, Murray D, Mitchell JT, Weisner T, Hinshaw S, Molina B, Swanson J, Arnold LE, Hechtman L, Wells K. Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use? J Atten Disord 2018; 22:38S-48S. [PMID: 28423975 PMCID: PMC5623613 DOI: 10.1177/1087054717700977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. METHOD The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. RESULTS ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. CONCLUSION ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in individuals with SU/A or to prevent SU/A initiation in ADHD individuals.
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Affiliation(s)
- Peter S Jensen
- 1 University of Arkansas for Medical Science, Little Rock, USA
| | - Kumi Yuki
- 2 Reach Institute, New York, NY, USA
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18
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Zuckerbrot RA, Cheung A, Jensen PS, Stein RE, Laraque D, Levitt A, Birmaher B, Campo J, Clarke G, Emslie G, Kaufman M, Kelleher KJ, Kutcher S, Malus M, Sacks D, Waslick B, Sarvet B. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics 2018; 141:peds.2017-4081. [PMID: 29483200 DOI: 10.1542/peds.2017-4081] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To update clinical practice guidelines to assist primary care (PC) clinicians in the management of adolescent depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of adolescent depression in PC settings. METHODS By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of adolescents with depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of depression in youth who are at high risk; (4) systematic assessment procedures by using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS This part of the guidelines is intended to assist PC clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for depression management in adolescents. Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.
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Affiliation(s)
- Rachel A. Zuckerbrot
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, and New York State Psychiatric Institute, New York, New York
| | | | - Peter S. Jensen
- University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Ruth E.K. Stein
- Albert Einstein College of Medicine, Bronx, New York, New York; and
| | - Danielle Laraque
- State University of New York Upstate Medical University, Syracuse, New York
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19
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Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein RE, Levitt A, Birmaher B, Campo J, Clarke G, Emslie G, Kaufman M, Kelleher KJ, Kutcher S, Malus M, Sacks D, Waslick B, Sarvet B. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics 2018; 141:peds.2017-4082. [PMID: 29483201 DOI: 10.1542/peds.2017-4082] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To update clinical practice guidelines to assist primary care (PC) in the screening and assessment of depression. In this second part of the updated guidelines, we address treatment and ongoing management of adolescent depression in the PC setting. METHODS By using a combination of evidence- and consensus-based methodologies, the guidelines were updated in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) revision and iteration among the steering committee, including youth and families with lived experience. RESULTS These updated guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in PC, including (1) active monitoring of mildly depressed youth, (2) treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression, (3) close monitoring of side effects, (4) consultation and comanagement of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and the grade of its evidence base are summarized. CONCLUSIONS The Guidelines for Adolescent Depression in Primary Care cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist PC clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of depressed youth in PC is needed, including the usability, feasibility, and sustainability of guidelines, and determination of the extent to which the guidelines actually improve outcomes of depressed youth.
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Affiliation(s)
| | - Rachel A. Zuckerbrot
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York
| | - Peter S. Jensen
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Danielle Laraque
- State University of New York Upstate Medical University, Syracuse, New York; and
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20
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Abstract
Pediatric primary care providers (PPCPs) are increasingly expected to know how to assess, diagnose, and treat a wide range of mental health problems in children and adolescents. For many PPCPs, this means learning and performing new practice behaviors that were not taught in their residency training. Typical continuing education approaches to engage PPCPs in new practices have not yielded the desired changes in provider behavior. This article summarizes behavior change principles identified through basic behavior science, adult education, and communication research, and discusses their application to a patient-centered pediatric primary care mental health curriculum.
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Affiliation(s)
- Allison R Love
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 654, Little Rock, AR 72205, USA
| | - Peter S Jensen
- Child and Adolescent Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 654, Little Rock, AR 72205, USA; The Resource for Advancing Children's Health (REACH) Institute, 404 5th Avenue, 3rd Floor, New York, NY 10018, USA.
| | - Lisa Khan
- Patient-Centered Mental Health in Pediatric Primary Care Program, The REACH Institute, 404 5th Avenue, 3rd Floor, New York, NY 10018, USA
| | - Tiffany West Brandt
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 654, Little Rock, AR 72205, USA
| | - James Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
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Tuominen L, Miettunen J, Cannon DM, Drevets WC, Frokjaer VG, Hirvonen J, Ichise M, Jensen PS, Keltikangas-Järvinen L, Klaver JM, Knudsen GM, Takano A, Suhara T, Hietala J. Neuroticism Associates with Cerebral in Vivo Serotonin Transporter Binding Differently in Males and Females. Int J Neuropsychopharmacol 2017; 20:963-970. [PMID: 29020405 PMCID: PMC5716061 DOI: 10.1093/ijnp/pyx071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Neuroticism is a major risk factor for affective disorders. This personality trait has been hypothesized to associate with synaptic availability of the serotonin transporter, which critically controls serotonergic tone in the brain. However, earlier studies linking neuroticism and serotonin transporter have failed to produce converging findings. Because sex affects both the serotonergic system and the risk that neuroticism poses to the individual, sex may modify the association between neuroticism and serotonin transporter, but this question has not been investigated by previous studies. METHODS Here, we combined data from 4 different positron emission tomography imaging centers to address whether neuroticism is related to serotonin transporter binding in vivo. The data set included serotonin transporter binding potential values from the thalamus and striatum and personality scores from 91 healthy males and 56 healthy females. We specifically tested if the association between neuroticism and serotonin transporter is different in females and males. RESULTS We found that neuroticism and thalamic serotonin transporter binding potentials were associated in both males and females, but with opposite directionality. Higher neuroticism associated with higher serotonin transporter binding potential in males (standardized beta 0.292, P=.008), whereas in females, higher neuroticism associated with lower serotonin transporter binding potential (standardized beta -0.288, P=.014). CONCLUSIONS The finding is in agreement with recent studies showing that the serotonergic system is involved in affective disorders differently in males and females and suggests that contribution of thalamic serotonin transporter to the risk of affective disorders depends on sex.
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Affiliation(s)
- Lauri Tuominen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala),Correspondence: Lauri Tuominen, MD, PhD, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Charlestown, MA 02129 ()
| | - Jouko Miettunen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Dara M Cannon
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Wayne C Drevets
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Vibe G Frokjaer
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Jussi Hirvonen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Masanori Ichise
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Peter S Jensen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Liisa Keltikangas-Järvinen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Jacqueline M Klaver
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Gitte M Knudsen
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Akihiro Takano
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Tetsuya Suhara
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
| | - Jarmo Hietala
- Turku PET Centre, Turku University Hospital, Turku, Finland (Drs Tuominen, Hirvonen, and Hietala); Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA (Dr Tuominen); Center for Life Course Health Research, University of Oulu, Finland & Medical Research Center (MRC) Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Dr Miettunen); Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland (Dr Cannon); Janssen Research & Development, LLC, of Johnson & Johnson, Titusville, NJ (Dr Drevets); Neurobiology Research Unit, Rigshospitalet, Denmark (Dr Knudsen); Center for Integrated Molecular Brain Imaging, Rigshospitalet, Denmark (Dr Frokjaer and Mr Jensen); Department of Radiology, University of Turku, Turku, Finland (Dr Hirvonen); Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Ichise, Takano, and Suhara); IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland (Dr Keltikangas-Järvinen); Department of Psychology, Southern Illinois University, Carbondale, Illinois (Dr Klaver); Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Knudsen); Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Dr Takano); Department of Psychiatry, University of Turku, Turku, Finland (Dr Hietala)
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Sibley MH, Swanson JM, Arnold LE, Hechtman LT, Owens LE, Stehli A, Abikoff H, Hinshaw SP, Molina BS, Mitchell JT, Jensen PS, Howard A, Lakes KD, Pelham WE. Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatry 2017; 58:655-662. [PMID: 27642116 PMCID: PMC5809153 DOI: 10.1111/jcpp.12620] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5-75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood. METHOD Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood. RESULTS Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold. CONCLUSION The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an 'or' rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.
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Affiliation(s)
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus Ohio
| | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | | | - Howard Abikoff
- Child Study Center at New York University Langone Medical Center
| | | | - Brooke S.G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
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Croarkin PE, Luby JL, Cercy K, Geske JR, Veldic M, Simonson M, Joshi PT, Wagner KD, Walkup JT, Nassan MM, Cuellar-Barboza AB, Casuto L, McElroy SL, Jensen PS, Frye MA, Biernacka JM. Genetic Risk Score Analysis in Early-Onset Bipolar Disorder. J Clin Psychiatry 2017; 78:1337-1343. [PMID: 28199072 PMCID: PMC5818996 DOI: 10.4088/jcp.15m10314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 05/02/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In this study, we performed a candidate genetic risk score (GRS) analysis of early-onset bipolar disorder (BD). METHODS Treatment of Early Age Mania (TEAM) study enrollment and sample collection took place from 2003 to 2008. Mayo Clinic Bipolar Biobank samples were collected from 2009 to 2013. Genotyping and analyses for the present study took place from 2013 to 2014. The diagnosis of BD was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Eight single-nucleotide polymorphisms (SNPs), previously reported in genome-wide association studies to be associated with BD, were chosen for GRS analysis in early-onset bipolar disease. These SNPs map to 3 genes: CACNA1C (calcium channel, voltage-dependent, L type, alpha 1C subunit), ANK3 (ankyrin-3, node of Ranvier [ankyrin G]), and ODZ4 (teneurin transmembrane protein 4 [formerly "odz, odd Oz/10-m homolog 4 {Drosophila}, ODZ4"]). The 8 candidate SNPs were genotyped in patients from the TEAM study (n = 69); adult patients with BD (n = 732), including a subset with early-onset illness (n = 192); and healthy controls (n = 776). GRS analyses were performed to compare early-onset cases with controls. In addition, associations of early-onset BD with individual SNPs and haplotypes were explored. RESULTS GRS analysis revealed associations of the risk score with early-onset BD (P = .01). Gene-level haplotype analysis comparing TEAM patients with controls suggested association of early-onset BD with a CACNA1C haplotype (global test, P = .01). At the level of individual SNPs, comparison of TEAM cases with healthy controls provided nominally significant evidence for association of SNP rs10848632 in CACNA1C with early-onset BD (P = .017), which did not remain significant after correction for multiple comparisons. CONCLUSIONS These preliminary analyses suggest that previously identified BD risk loci, especially CACNA1C, have a role in early-onset BD, possibly with stronger effects than for late-onset BD.
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Bass L, Jensen PS, Kuo DZ. Collaboration between Pediatric Primary Care Providers and Child and Adolescent Psychiatrists in Arkansas: Where to Start? J Ark Med Soc 2016; 113:110-111. [PMID: 30005460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a considerable shortage of child and adolescent psychiatrists (CAPs) in Arkansas. Collaboration between pediatric primary care providers (PCPs) and CPSs is an innovative model of care that may address this shortage. A tiered model of collaboration, ranging from brief speciality consultation to intensive psychiatric services, may help with early treatment and expeansion of available services to a larger population. We describe the current state of collaboration in Arkansas between the two specialties and steps for additional collaboration.
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Hechtman L, Swanson JM, Sibley MH, Stehli A, Owens EB, Mitchell JT, Arnold LE, Molina BS, Hinshaw SP, Jensen PS, Abikoff HB, Algorta GP, Howard AL, Hoza B, Etcovitch J, Houssais S, Lakes KD, Quyen Nichols J. Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA Results. J Am Acad Child Adolesc Psychiatry 2016; 55:945-952.e2. [PMID: 27806862 PMCID: PMC5113724 DOI: 10.1016/j.jaac.2016.07.774] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/08/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). METHOD Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. RESULTS Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. CONCLUSION Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.
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Affiliation(s)
- Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | | | | | | | | | | | | | | | - Peter S. Jensen
- University of Arkansas for Medical Sciences, Little Rock, and The REACH Institute, New York
| | - Howard B. Abikoff
- Child Study Center at New York University Langone Medical Center, New York
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Affiliation(s)
- Peter S Jensen
- REACH Institute, New York and the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock.
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Lasky AK, Weisner TS, Jensen PS, Hinshaw SP, Hechtman L, Arnold LE, W Murray D, Swanson JM. ADHD in context: Young adults' reports of the impact of occupational environment on the manifestation of ADHD. Soc Sci Med 2016; 161:160-8. [PMID: 27299978 DOI: 10.1016/j.socscimed.2016.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 01/03/2023]
Abstract
Does changing context play a role in the decline in ADHD symptoms in adulthood? Insufficient research has explored the functioning of adults with ADHD. As adults, individuals with ADHD have significantly more latitude to control aspects of their day-to-day environments. Do the new contexts young adults find themselves in alter their experience of ADHD? Are there particular occupational or educational contexts in which young adults report functioning better than others? To examine this issue, we conducted semi-structured interviews at four North American sites in 2010-11 with 125 young adults, originally diagnosed with ADHD as children, regarding their work and post-secondary educational environments. Many subjects describe their symptoms as context-dependent. In some contexts, participants report feeling better able to focus; in others, their symptoms-such as high energy levels-become strengths rather than liabilities. Modal descriptions included tasks that were stressful and challenging, novel and required multitasking, busy and fast-paced, physically demanding or hands-on, and/or intrinsically interesting. Consistent with a developmental psychopathology framework, ADHD is experienced as arising from an interaction between our subjects and their environments. These findings demonstrate the need to account for the role of context in our understanding of ADHD as a psychiatric disorder, especially as it manifests in young adulthood.
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Affiliation(s)
- Arielle K Lasky
- David Geffen School of Medicine and Department of Anthropology, University of California, Los Angeles, USA.
| | - Thomas S Weisner
- Departments of Psychiatry and Anthropology, University of California, Los Angeles, USA.
| | - Peter S Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, USA.
| | | | - Lily Hechtman
- Department of Psychiatry, McGill University, Canada.
| | | | - Desiree W Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, USA.
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA.
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Vande Voort JL, Singh A, Bernardi J, Wall CA, Swintak CC, Schak KM, Jensen PS. Treatments and Services Provided to Children Diagnosed with Bipolar Disorder. Child Psychiatry Hum Dev 2016; 47:494-502. [PMID: 26323583 DOI: 10.1007/s10578-015-0582-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To better understand the types and quantity of mental health services and medication usage for youth diagnosed with bipolar disorder (BD) within an integrated healthcare system, medical records were reviewed from 2000 to 2011. Eighty-five youth diagnosed with BD were identified and healthcare services (medication and psychotherapy follow-up appointments, emergency room (ER) visits, admissions, phone contacts) and visit-related details (medication usage) were abstracted for 2 years after initial BD diagnosis. Despite complex medication regimens (91.7 and 81.2 % received mood stabilizers and antipsychotic agents, respectively), medication appointments were infrequent, averaging 1 visit every 2 months. Only 36 (42 %) of 85 youth were noted to receive psychotherapy services following BD diagnosis, also averaging 1 visit every 2 months. Most (58.8 %) patients needed one or more hospitalizations during the follow-up period; nearly half (48.2 %) had psychiatric ER visits. The relative lack of psychotherapy and infrequent follow-up visits suggests need for improvement to optimize healthcare delivery.
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Affiliation(s)
- Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amandeep Singh
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julio Bernardi
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Christopher A Wall
- PrairieCare Medical Group, University of Minnesota Medical School Affiliate, Rochester, MN, USA
| | - Cosima C Swintak
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kathryn M Schak
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Stenbæk DS, Fisher PM, Budtz-Jørgensen E, Pinborg A, Hjordt LV, Jensen PS, Knudsen GM, Frokjaer VG. Sex hormone manipulation slows reaction time and increases labile mood in healthy women. Psychoneuroendocrinology 2016; 68:39-46. [PMID: 26943343 DOI: 10.1016/j.psyneuen.2016.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/23/2016] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women show increased risk of depressive symptoms in life phases where ovarian steroid hormone levels fluctuate or decline rapidly. The risk mechanisms may include changes in mental state and affective cognition possibly mediated by serotonergic neurotransmission. METHODS In a randomized controlled double-blinded trial, 61 healthy women (mean age 24.3±4.9 years) were tested with measures of affective verbal memory, reaction time, mental distress, and serotonin transporter binding at baseline and at follow-up after receiving gonadotropin-releasing hormone agonist (GnRHa) or placebo intervention. Women also reported daily mood profiles during intervention. We tested direct effects of intervention and indirect effects through changes in serotonin transporter binding on verbal affective memory, simple reaction time and self-reported measures of mental distress, and further effects of GnRHa on daily mood. RESULTS GnRHa induced an increase in simple reaction time (p=0.03) and more pronounced fluctuations in daily self-reported mood in a manner dependent on baseline mood (p=0.003). Verbal affective memory recall, overall self-perceived mental distress, and serotonin transporter binding were not affected. CONCLUSIONS In healthy women transient sex-steroid hormone fluctuations decrease speed of information processing and further produce more labile mood only in women with elevated levels of mood disturbances at baseline.
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Affiliation(s)
- D S Stenbæk
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - P M Fisher
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - E Budtz-Jørgensen
- Department of Biostatistics, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark.
| | - A Pinborg
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Fertility Department, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - L V Hjordt
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - P S Jensen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - G M Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - V G Frokjaer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
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Jakobsen GR, Fisher PM, Dyssegaard A, McMahon B, Holst KK, Lehel S, Svarer C, Jensen PS, Knudsen GM, Frokjaer VG. Brain serotonin 4 receptor binding is associated with the cortisol awakening response. Psychoneuroendocrinology 2016; 67:124-32. [PMID: 26894483 DOI: 10.1016/j.psyneuen.2016.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 12/13/2022]
Abstract
Serotonin signalling is considered critical for an appropriate and dynamic adaptation to stress. Previously, we have shown that prefrontal serotonin transporter (SERT) binding is positively associated with the cortisol awakening response (CAR) (Frokjaer et al., 2013), which is an index of hypothalamic-pituitary-adrenal (HPA)-axis output dynamics. Here, we investigated in healthy individuals if cerebral serotonin 4 receptor (5-HT4r) binding, reported to be a proxy for serotonin levels, is associated with CAR. Thirty healthy volunteers (25 males, age range 20-56 years) underwent 5-HT4r PET imaging with [(11)C]-SB207145, genotyping of the SERT-linked polymorphic region (5-HTTLPR), and performed serial home sampling of saliva (5 time points from 0 to 60min from awakening) to assess CAR. The association between 5-HT4r binding in 4 regions of interest (prefrontal cortex, anterior cingulate cortex, pallidostriatum, and hippocampus) and CAR was tested using multiple linear regression with adjustment for age and 5-HTTLPR genotype. Finally, an exploratory voxel-based analysis of the association was performed. CAR was negatively associated with 5-HT4r binding in pallidostriatum (p=0.01), prefrontal cortex (p=0.03), and anterior cingulate cortex (p=0.002), respectively, but showed no association in hippocampus. The results remained significant when taking into account other potentially relevant covariates. In conclusion, our finding reinforces an association between HPA-axis function and serotonin signaling in vivo in humans. We suggest that higher synaptic serotonin concentration, here indexed by lower 5-HT4r binding, supports HPA-axis dynamics, which in healthy volunteers is reflected by a robust CAR.
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Affiliation(s)
- Gustav R Jakobsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark
| | - Agnete Dyssegaard
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark
| | - Brenda McMahon
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Klaus K Holst
- Department of Biostatistics, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | | | - Claus Svarer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark
| | - Peter S Jensen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, DK-2100 Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark.
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Yuki K, Bhagia J, Mrazek D, Jensen PS. How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder? World J Psychiatry 2016; 6:118-127. [PMID: 27014602 PMCID: PMC4804260 DOI: 10.5498/wjp.v6.i1.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/10/2015] [Accepted: 12/21/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate child and adolescent psychiatrists’ (CAPs) attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) diagnoses and treatments in real-world clinical practice.
METHODS: The medical records of 69 ADHD children (mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales (VADRSs), CAPs’ diagnoses of ADHD and ODD, and CAPs’ treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs’ ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs’ treatment recommendations against established ADHD and ODD guidelines.
RESULTS: Among 63 ADHD subjects, the majority of the subjects (92%) met full ADHD diagnostic criteria at least in one setting (parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings (parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found (95%CI: -0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these case-positives, which is considered as a fair agreement between CAPs and VADRSs (95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.
CONCLUSION: CAPs’ ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD’s most common comorbid condition - ODD - may be under-recognized.
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Elmaadawi AZ, Jensen PS, Arnold LE, Molina BSG, Hechtman L, Abikoff HB, Hinshaw SP, Newcorn JH, Greenhill LL, Swanson JM, Galanter CA. Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up. World J Psychiatry 2015; 5:412-424. [PMID: 26740933 PMCID: PMC4694555 DOI: 10.5498/wjp.v5.i4.412] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/18/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the prevalence of bipolar disorder (BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder (ADHD) through 14 years’ follow-up, when participants were between 21-24 years old.
METHODS: First, we examined rates of BD type I and II diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD (MTA). We used the diagnostic interview schedule for children (DISC), administered to both parents (DISC-P) and youth (DISCY). We compared the MTA study subjects with ADHD (n = 579) to a local normative comparison group (LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts (TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic (PM) and non-specific manic (NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.
RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD (1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001).
CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.
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Nassan M, Croarkin PE, Luby JL, Veldic M, Joshi PT, McElroy SL, Post RM, Walkup JT, Cercy K, Geske J, Wagner KD, Cuellar-Barboza AB, Casuto L, Lavebratt C, Schalling M, Jensen PS, Biernacka JM, Frye MA. Association of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with early-onset bipolar disorder. Bipolar Disord 2015; 17:645-52. [PMID: 26528762 PMCID: PMC4672380 DOI: 10.1111/bdi.12323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Brain-derived neurotrophic factor (BDNF) Val66Met (rs6265) functional polymorphism has been implicated in early-onset bipolar disorder. However, results of studies are inconsistent. We aimed to further explore this association. METHODS DNA samples from the Treatment of Early Age Mania (TEAM) and Mayo Clinic Bipolar Disorder Biobank were investigated for association of rs6265 with early-onset bipolar disorder. Bipolar cases were classified as early onset if the first manic or depressive episode occurred at age ≤19 years (versus adult-onset cases at age >19 years). After quality control, 69 TEAM early-onset bipolar disorder cases, 725 Mayo Clinic bipolar disorder cases (including 189 early-onset cases), and 764 controls were included in the analysis of association, assessed with logistic regression assuming log-additive allele effects. RESULTS Comparison of TEAM cases with controls suggested association of early-onset bipolar disorder with the rs6265 minor allele [odds ratio (OR) = 1.55, p = 0.04]. Although comparison of early-onset adult bipolar disorder cases from the Mayo Clinic versus controls was not statistically significant, the OR estimate indicated the same direction of effect (OR = 1.21, p = 0.19). When the early-onset TEAM and Mayo Clinic early-onset adult groups were combined and compared with the control group, the association of the minor allele rs6265 was statistically significant (OR = 1.30, p = 0.04). CONCLUSIONS These preliminary analyses of a relatively small sample with early-onset bipolar disorder are suggestive that functional variation in BDNF is implicated in bipolar disorder risk and may have a more significant role in early-onset expression of the disorder.
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Affiliation(s)
- Malik Nassan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Paramjit T Joshi
- Department of Psychiatry and Behavioral Sciences, Children’s National Medical Center, Washington, DC
| | | | | | - John T Walkup
- Department of Psychiatry, Weil Cornell Medical College, New York, NY
| | - Kelly Cercy
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jennifer Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Karen D Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Knudsen GM, Jensen PS, Erritzoe D, Baaré WFC, Ettrup A, Fisher PM, Gillings N, Hansen HD, Hansen LK, Hasselbalch SG, Henningsson S, Herth MM, Holst KK, Iversen P, Kessing LV, Macoveanu J, Madsen KS, Mortensen EL, Nielsen FÅ, Paulson OB, Siebner HR, Stenbæk DS, Svarer C, Jernigan TL, Strother SC, Frokjaer VG. The Center for Integrated Molecular Brain Imaging (Cimbi) database. Neuroimage 2015; 124:1213-1219. [PMID: 25891375 DOI: 10.1016/j.neuroimage.2015.04.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 01/07/2023] Open
Abstract
We here describe a multimodality neuroimaging containing data from healthy volunteers and patients, acquired within the Lundbeck Foundation Center for Integrated Molecular Brain Imaging (Cimbi) in Copenhagen, Denmark. The data is of particular relevance for neurobiological research questions related to the serotonergic transmitter system with its normative data on the serotonergic subtype receptors 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT4 and the 5-HT transporter (5-HTT), but can easily serve other purposes. The Cimbi database and Cimbi biobank were formally established in 2008 with the purpose to store the wealth of Cimbi-acquired data in a highly structured and standardized manner in accordance with the regulations issued by the Danish Data Protection Agency as well as to provide a quality-controlled resource for future hypothesis-generating and hypothesis-driven studies. The Cimbi database currently comprises a total of 1100 PET and 1000 structural and functional MRI scans and it holds a multitude of additional data, such as genetic and biochemical data, and scores from 17 self-reported questionnaires and from 11 neuropsychological paper/computer tests. The database associated Cimbi biobank currently contains blood and in some instances saliva samples from about 500 healthy volunteers and 300 patients with e.g., major depression, dementia, substance abuse, obesity, and impulsive aggression. Data continue to be added to the Cimbi database and biobank.
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Affiliation(s)
- Gitte M Knudsen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark.
| | - Peter S Jensen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - David Erritzoe
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - William F C Baaré
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark
| | - Anders Ettrup
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Patrick M Fisher
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Nic Gillings
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; PET and Cyclotron Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Hanne D Hansen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Lars Kai Hansen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; DTU Compute, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - Steen G Hasselbalch
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Susanne Henningsson
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark
| | - Matthias M Herth
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; PET and Cyclotron Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Klaus K Holst
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biostatistics, University of Copenhagen, DK-1014 Copenhagen, Denmark
| | - Pernille Iversen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Julian Macoveanu
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark; Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kathrine Skak Madsen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark
| | - Erik L Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, DK-2200 Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Finn Årup Nielsen
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; DTU Compute, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - Olaf B Paulson
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Hartwig R Siebner
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, DK-2400 Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, DK-2400 Copenhagen, Denmark
| | - Dea S Stenbæk
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Claus Svarer
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Terry L Jernigan
- Center for Human Development, University of California, San Diego, La Jolla, CA 92093, USA
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Vibe G Frokjaer
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Abstract
OBJECTIVE Therapeutic goals for chronic mental disorders like major depressive disorder (MDD) and schizophrenia have evolved in parallel with the growing medical knowledge about the course and treatment of these disorders. Although the knowledge base regarding the clinical course of ADHD, a chronic psychiatric disorder, has evolved beyond symptomatic improvement and short-term treatment response, long-term goals, such as functional remission, have not yet been clearly defined. METHOD A PubMed literature search was conducted to investigate the therapeutic goals of pharmacologic treatment referenced in the published literature from January 1998 through February 2010 using the following commonly used ADHD treatments as keywords: amphetamine, methylphenidate, atomoxetine, lisdexamfetamine, guanfacine, and clonidine. This search was then combined with an additional search that included the following outcome keywords: remission, relapse, remit, response, normal, normalization, recovery, and effectiveness. RESULTS Our search identified 102 publications. The majority (88.2% [90/102]) of these contained predefined criteria for treatment response. Predefined criteria for normalization and remission and/or relapse were presented in 4.9% (5/102), 12.7% (13/102), and 3.9% (4/102) of publications, respectively. There was a lack of consistency between the instruments used to measure outcomes as well as the criteria used to define treatment response, normalization, and remission as well as relapse. CONCLUSION The therapeutic goals in treating ADHD should address optimal treatment outcomes that go beyond modest reductions of ADHD symptoms to include syndromatic, symptomatic, and functional remission. Future work should focus on reliable and valid tools to measure these outcomes in the clinical trial setting.
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Affiliation(s)
| | - Peter S Jensen
- The REACH Institute, New York, NY, USA Mayo Clinic, Rochester, MN, USA
| | - Daniel F Connor
- University of Connecticut School of Medicine, Farmington, USA
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Fisher PM, Holst KK, Adamsen D, Klein AB, Frokjaer VG, Jensen PS, Svarer C, Gillings N, Baare WFC, Mikkelsen JD, Knudsen GM. BDNF Val66met and 5-HTTLPR polymorphisms predict a human in vivo marker for brain serotonin levels. Hum Brain Mapp 2014; 36:313-23. [PMID: 25220079 DOI: 10.1002/hbm.22630] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/29/2014] [Accepted: 08/29/2014] [Indexed: 11/12/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) has been implicated in multiple aspects of brain function including regulation of serotonin signaling. The BDNF val66met polymorphism (rs6265) has been linked to aspects of serotonin signaling in humans but its effects are not well understood. To address this, we evaluated whether BDNF val66met was predictive of a putative marker of brain serotonin levels, serotonin 4 receptor (5-HT4 ) binding assessed with [11C]SB207145 positron emission tomography, which has also been associated with the serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphism. We applied a linear latent variable model (LVM) using regional 5-HT4 binding values (neocortex, amygdala, caudate, hippocampus, and putamen) from 68 healthy humans, allowing us to explicitly model brain-wide and region-specific genotype effects on 5-HT4 binding. Our data supported an LVM wherein BDNF val66met significantly predicted a LV reflecting [11C]SB207145 binding across regions (P = 0.005). BDNF val66met met-carriers showed 2-9% higher binding relative to val/val homozygotes. In contrast, 5-HTTLPR did not predict the LV but S-carriers showed 7% lower neocortical binding relative to LL homozygotes (P = 7.3 × 10(-6)). We observed no evidence for genetic interaction. Our findings indicate that BDNF val66met significantly predicts a common regulator of brain [11C]SB207145 binding, which we hypothesize reflects brain serotonin levels. In contrast, our data indicate that 5-HTTLPR specifically affects 5-HT4 binding in the neocortex. These findings implicate serotonin signaling as an important molecular mediator underlying the effects of BDNF val66met and 5-HTTLPR on behavior and related risk for neuropsychiatric illness in humans.
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Affiliation(s)
- Patrick M Fisher
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital Rigshospitalet, Copenhagen O, Denmark; Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen O, Denmark
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Ellegaard K, Terslev L, Christensen R, Szkudlarek M, Schmidt WA, Jensen PS, Bliddal H, Torp-Pedersen S. Comparison of discrimination and prognostic value of two US Doppler scoring systems in rheumatoid arthritis patients: a prospective cohort study. Clin Exp Rheumatol 2014; 32:495-500. [PMID: 24960526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this paper is to investigate sensitivity to change (SRM), predictive validity and discriminative ability of a quantitative (QS) and a semi-quantitative (SQS) Doppler ultrasound scoring systems in patients with rheumatoid arthritis (RA) treated with anti-TNF-α therapy. METHODS RA patients with wrist joint affection treated with TNF-α inhibitor were followed for one year. The wrist was examined with Doppler before initiating therapy and after one year. DAS28 was determined at both visits. One person trained in the SQS system and one in the QS system evaluated the anonymised images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0.6). A decrease in Doppler activity was seen for both systems after anti-TNF-α therapy. Sensitivity to change was seen, SRM=-0.52 (95%CI; -0.83 to -0.21; QS) and -0.24 (-0.53 to -0.05; SQS). Predictive value was poor (QS rs=-0.24; SQS rs=-0.05). Construct validity was; QS: rs=0.29, SQS: rs=0.23. CONCLUSIONS Both systems were to some extent sensitive to change. Predictive validity and discriminate capacity of both systems showed only a weak association to DAS 28 in the study population. The QS was a little superior to the SQS. The results do not necessarily reflect Doppler evaluation as being ineffective, but may be caused by DAS28 not being a perfect marker of inflammation.
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Affiliation(s)
- Karen Ellegaard
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark.
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Thomsen G, Ziebell M, Jensen PS, da Cuhna-Bang S, Knudsen GM, Pinborg LH. No correlation between body mass index and striatal dopamine transporter availability in healthy volunteers using SPECT and [123I]PE2I. Obesity (Silver Spring) 2013; 21:1803-6. [PMID: 23696269 DOI: 10.1002/oby.20225] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 11/19/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dopamine plays an important role in both the rewarding and conditioning effects of food. These effects involve mesolimbic, mesocortical, and nigrostriatal pathways. In humans, the most consistent finding has been reduced striatal dopamine D2/3 receptor availability. In striatum, dopamine is inactivated by reuptake via the dopamine transporter (DAT). The aim of the study was to test the hypothesis of lower DAT availability in obese healthy subjects using a selective DAT radiotracer in a sample of subjects with a wide range of BMI values. DESIGN AND METHODS Thirty-three healthy subjects with a mean age of 48.4 ± 13.3 (range, 21-71) years and a mean BMI of 29.6 ± 7.8 kg/m2 (range, 21.0-49.5) were included in the study. We used [123I]PE2I and SPECT to measure DAT availability. RESULTS Using multiple linear regression analyses with striatal DAT as the dependent variable and BMI, age and gender as predictors was performed. We found no correlation between BMI and striatal DAT availability in striatum (P = 0.99), caudate nucleus (P = 0.61), and putamen (P = 0.30). Furthermore, we found no group difference between obese/severely obese (BMI > 30 kg/m2) and normal weight controls (BMI ≤ 25 kg/m2). CONCLUSIONS We did not find any correlation between BMI and DAT availability in healthy volunteers.
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Affiliation(s)
- G Thomsen
- Neurobiology Research Unit 9201, Copenhagen University Hospital, Rigshospitalet, Denmark
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Thomsen G, Knudsen GM, Jensen PS, Ziebell M, Holst KK, Asenbaum S, Booij J, Darcourt J, Dickson JC, Kapucu OL, Nobili F, Sabri O, Sera T, Tatsch K, Tossici-Bolt L, Laere KV, Borght TV, Varrone A, Pagani M, Pinborg LH. No difference in striatal dopamine transporter availability between active smokers, ex-smokers and non-smokers using [123I]FP-CIT (DaTSCAN) and SPECT. EJNMMI Res 2013; 3:39. [PMID: 23688063 PMCID: PMC3671201 DOI: 10.1186/2191-219x-3-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/10/2013] [Indexed: 11/30/2022] Open
Abstract
Background Mesolimbic and nigrostriatal dopaminergic pathways play important roles in both the rewarding and conditioning effects of drugs. The dopamine transporter (DAT) is of central importance in regulating dopaminergic neurotransmission and in particular in activating the striatal D2-like receptors. Molecular imaging studies of the relationship between DAT availability/dopamine synthesis capacity and active cigarette smoking have shown conflicting results. Through the collaboration between 13 SPECT centres located in 10 different European countries, a database of FP-CIT-binding in healthy controls was established. We used the database to test the hypothesis that striatal DAT availability is changed in active smokers compared to non-smokers and ex-smokers. Methods A total of 129 healthy volunteers were included. Subjects were divided into three categories according to past and present tobacco smoking: (1) non-smokers (n = 64), (2) ex-smokers (n = 39) and (3) active smokers (n = 26). For imaging of the DAT availability, we used [123I]FP-CIT (DaTSCAN) and single photon emission computed tomography (SPECT). Data were collected in collaboration between 13 SPECT centres located in 10 different European countries. The striatal measure of DAT availability was analyzed in a multiple regression model with age, SPECT centre and smoking as predictor. Results There was no statistically significant difference in DAT availability between the groups of active smokers, ex-smokers and non-smokers (p = 0.34). Further, we could not demonstrate a significant association between striatal DAT and the number of cigarettes per day or total lifetime cigarette packages in smokers and ex-smokers. Conclusion Our results do not support the hypothesis that large differences in striatal DAT availability are present in smokers compared to ex-smokers and healthy volunteers with no history of smoking.
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Affiliation(s)
- Gerda Thomsen
- Neurobiology Research Unit 9201, Rigshospitalet and Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark.
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Molina BSG, Hinshaw SP, Eugene Arnold L, Swanson JM, Pelham WE, Hechtman L, Hoza B, Epstein JN, Wigal T, Abikoff HB, Greenhill LL, Jensen PS, Wells KC, Vitiello B, Gibbons RD, Howard A, Houck PR, Hur K, Lu B, Marcus S. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. J Am Acad Child Adolesc Psychiatry 2013; 52:250-63. [PMID: 23452682 PMCID: PMC3589108 DOI: 10.1016/j.jaac.2012.12.014] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261). METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. RESULTS The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex. CONCLUSIONS Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.
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Affiliation(s)
- Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA.
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Adams RE, Laraque D, Chemtob CM, Jensen PS, Boscarino JA. Does a one-day educational training session influence primary care pediatricians' mental health practice procedures in response to a community disaster? Results from the reaching children initiative (RCI). Int J Emerg Ment Health 2013; 15:3-14. [PMID: 24187883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although many children and adolescents need assessment and treatment for psychological problems, few get such treatment from mental health specialists after a community disaster Research suggests that a very large proportion of children are seen in pediatric primary care settings and that pediatricians can provide appropriate care for many social and emotional problems in children. However few pediatricians have received training in providing this help. The focus of this study was to assess whether brief training to increase the capacity of primary care pediatricians (PCPs) to respond to the social or emotional problems of children after the World Trade Center terrorist attacks improved the quality of services to disaster-affected children. Pediatricians (N = 137) attended a one-day training workshop covering best practice treatments for mental health problems with an emphasis on trauma, bereavement, and medication use. We surveyed attendees prior to training, immediately post-intervention, and 1- and 6-months later. At 6-months post-intervention, 64% of the primary care clinicians reported instituting practice changes recommended during training. Reported use of formal mental health screening instruments increased, but greater use of medications was more limited. Although participants in the immediate post-intervention survey indicated strong agreement with the desirability to implement specific practice changes, the perceived desirability of such changes declined substantially at the 6-month follow-up. Changes in PCPs 'mental health related practice procedures can be facilitated by brief educational interventions, but continued training and support may be needed. We discuss these results relative to preparedness for community disasters.
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Affiliation(s)
- Richard E Adams
- Department of Sociology, Kent State University, Kent, Ohio, USA
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Boesen M, Ellegaard K, Boesen L, Cimmino MA, Jensen PS, Terslev L, Torp-Pedersen S, Danneskiold-Samsøe B, Bliddal H. Ultrasound Doppler score correlates with OMERACT RAMRIS bone marrow oedema and synovitis score in the wrist joint of patients with rheumatoid arthritis. Ultraschall Med 2012; 33:E166-E172. [PMID: 21259184 DOI: 10.1055/s-0029-1245922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE MRI is considered the standard of reference for advanced imaging in rheumatoid arthritis (RA). However, in daily clinical practice ultrasound (US) imaging with Doppler information is more versatile and often used for fast and dynamic assessment of joint inflammation. The aim was to compare low-field MRI scores with the US Doppler measurements in the wrist joint of patients with RA. MATERIAL AND METHODS Fifty consecutive patients with RA (46 women & 4 men) completed both low-field dedicated extremity MRI (E-scan®, Esaote) and a high-end US (Sequioa®, Siemens) imaging of the wrist before initiating either biological treatment (n = 26) or intraarticular injection of Depomedrole® (n = 24). Mean age was 56 years (range 21 - 83 years); mean disease duration 87.2 months (range 4 - 349 months), mean DAS 28 4,8 (range 2 - 7). MRI was scored according to the OMERACT RAMRIS recommendations and US Doppler colour-fractions were determined. RESULTS Using Spearman's rho, we found a relatively good to moderate correlation between the US colour-fraction and the total OMERACT bone marrow oedema and synovitis scores on MRI (r = 0.6; p < 0.001 and r = 0.4; p < 0.006 respectively). There was a trend but no significant correlation with the total OMERACT erosion score (r = 0.3; p = 0.06). CONCLUSION Within limits, the OMERACT RAMRIS scores of inflammation in RA patients (bone marrow oedema and synovial enhancement) are comparable to the US colour-fraction measurements using a high-end US scanner. Both imaging modalities detect inflammation although showing different aspects of the inflammatory process in the wrist joint. The higher correlation between US colour-fractions and MRI bone marrow oedema indicates a potential importance of US Doppler in monitoring inflammatory disease changes in RA.
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Affiliation(s)
- M Boesen
- Radiology, Frederiksberg Hospital
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Fisher PM, Holst KK, Mc Mahon B, Haahr ME, Madsen K, Gillings N, Baaré WF, Jensen PS, Knudsen GM. 5-HTTLPR status predictive of neocortical 5-HT4 binding assessed with [11C]SB207145 PET in humans. Neuroimage 2012; 62:130-6. [DOI: 10.1016/j.neuroimage.2012.05.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/19/2012] [Accepted: 05/04/2012] [Indexed: 01/30/2023] Open
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Terslev L, Ellegaard K, Christensen R, Szkudlarek M, Schmidt WA, Jensen PS, Bliddal H, Torp-Pedersen S. Head-to-head comparison of quantitative and semi-quantitative ultrasound scoring systems for rheumatoid arthritis: reliability, agreement and construct validity. Rheumatology (Oxford) 2012; 51:2034-8. [PMID: 22847682 DOI: 10.1093/rheumatology/kes124] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and agreement of semi-quantitative scoring (SQS) and quantitative scoring (QS) systems. To compare the two types of scoring system and investigate the construct validity for both scoring systems. METHODS A total of 46 RA patients (median disease duration of 6.5 years) were enrolled in the study. They were investigated with colour Doppler ultrasound using the central position of the wrist. Disease activity score based on 28 joints (DAS-28) was determined for all patients using CRP. Two participants trained in the SQS system and two in the QS system evaluated the 46 anonymized images. All images were scored twice by each of the two assessors in order to assess both intra- and inter-reader reliability. RESULTS The reliability for the two systems were 0.964 for the QS, and 0.817 for the SQS, with a comparable inter-reader agreement for both scoring systems; 95% limits of agreement for the QS being between -7.7% and +6.7% on the colour fraction scale (0-100%), whereas SQS was between -0.8 and +0.8 on the ordinal scale from 0 to 3. There was a direct but non-linear relationship between the two modalities (Spearman's r = 0.73) and critical conceptual issues in the agreement between the scoring systems were revealed. The construct validity was poor for both systems with only a weak correlation to CRP. CONCLUSION High reliability and good agreement of both scoring systems were found when applied to the same patient cohort. Different scoring systems appear to be highly correlated.
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Affiliation(s)
- Lene Terslev
- Department of Rheumatology, University Hospital at Glostrup, Copenhagen, Denmark.
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Aarons GA, Glisson C, Green PD, Hoagwood K, Kelleher KJ, Landsverk JA, Weisz JR, Chorpita B, Gibbons R, Glisson C, Green EP, Hoagwood K, Jensen PS, Kelleher K, Landsverk J, Mayberg S, Miranda J, Palinkas L, Schoenwald S. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implement Sci 2012; 7:56. [PMID: 22726759 PMCID: PMC3444886 DOI: 10.1186/1748-5908-7-56] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 06/07/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED ABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States. METHODS In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics. RESULTS We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice. CONCLUSIONS The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes.
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Affiliation(s)
- Gregory A Aarons
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, USA.
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Coletti DJ, Pappadopulos E, Katsiotas NJ, Berest A, Jensen PS, Kafantaris V. Parent perspectives on the decision to initiate medication treatment of attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2012; 22:226-37. [PMID: 22537185 PMCID: PMC3374352 DOI: 10.1089/cap.2011.0090] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. METHODS Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. RESULTS Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and distorted ideas about treatment risks. Parents, however, took pride in successfully pursuing efforts to manage their child behaviorally and to avoid medication when possible. CONCLUSIONS Focus group data identified social, cognitive, and affective influences on treatment decision making. Results support prior research comparing family/social functioning, physician characteristics, and adherence. Findings suggest that parent attitudes to psychiatric care need to be assessed comprehensively at initial evaluation to aid the development of psychoeducational messages, and a more careful consideration about how parents interpret and respond to adherence-related questioning.
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Affiliation(s)
- Daniel J. Coletti
- Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York
| | - Elizabeth Pappadopulos
- Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York.,Pfizer Inc., New York, New York
| | - Nikki J. Katsiotas
- Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York
| | - Alison Berest
- Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York
| | - Peter S. Jensen
- Department of Psychiatry and Psychology, The Mayo Clinic, Rochester, Minnesota.,The REACH Institute, New York, New York
| | - Vivian Kafantaris
- Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York
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Scotto Rosato N, Correll CU, Pappadopulos E, Chait A, Crystal S, Jensen PS. Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management. Pediatrics 2012; 129:e1577-86. [PMID: 22641763 DOI: 10.1542/peds.2010-1361] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. METHODS Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process. RESULTS This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes. CONCLUSIONS Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.
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Affiliation(s)
- Nancy Scotto Rosato
- State of New Jersey, Department of Health and Senior Services, Trenton, New Jersey, USA
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Knapp P, Chait A, Pappadopulos E, Crystal S, Jensen PS. Treatment of maladaptive aggression in youth: CERT guidelines I. Engagement, assessment, and management. Pediatrics 2012; 129:e1562-76. [PMID: 22641762 DOI: 10.1542/peds.2010-1360] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop guidelines for management and treatment of maladaptive aggression in the areas of family engagement, assessment and diagnosis, and initial management, appropriate for use by primary care clinicians and mental health providers. Maladaptive aggression in youth is increasingly treated with psychotropic medications, particularly second-generation antipsychotic agents. Multiple treatment modalities are available, but guidance for clinicians' assessment and treatment strategies has been inadequately developed. To address this need, the Center for Education and Research on Mental Health Therapeutics and the REACH Institute convened a steering group of national experts to develop evidence-based treatment recommendations for maladaptive aggression in youth. METHODS Evidence was assembled and evaluated in a multistep process that included a systematic review of published literature; a survey of experts on recommended treatment practices; a consensus conference that brought together clinical experts along with researchers, policy makers, and family advocates; and subsequent review and discussion by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth (T-MAY) guidelines reflect a synthesis of the available evidence, based on this multistep process. RESULTS The current article describes 9 recommendations for family engagement, assessment, and diagnosis as key prerequisites for treatment selection and initiation. CONCLUSIONS Recognizing the family and social context in which aggressive symptoms arise, and understanding the underlying psychiatric conditions that may be associated with aggression, are essential to treatment planning.
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Affiliation(s)
- Penelope Knapp
- Department of Psychiatry, University of California, Davis, Davis, California, USA
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