826 research outputs found
Treatment of ADHD with Cannabinoids
No full textIntroductionAdults with ADHD describe self-medicating with cannabis, with some reporting a preference for cannabis over ADHD medications.ObjectivesThe experimental medicine in ADHD-cannabinoids study was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex oromucosal spray, in 30 adults with ADHD.MethodsThe primary outcome was cognitive performance and activity level using QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms.ResultsThirty participants were randomly assigned to the active (n = 15) or placebo (n = 15) group. For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est = -0.17, 95%CI-0.40 to 0.07, P = 0.16, n = 15/11 active/placebo). For secondary outcomes, Sativex was associated with non-significant improvements in hyperactivity/impulsivity (P = 0.03), a cognitive measure of inhibition (P = 0.05), inattention (P = 0.10) and emotional lability. Per-protocol effects were higher.ConclusionResults did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. This provides some preliminary evidence in support of the self-medication theory of cannabis use in ADHD. A larger trial is warranted.Disclosure of interestKings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech speaker at sponsored events for Shire, Lilly and Novartis.</jats:sec
Offspring of Women with Systemic Autoimmune Diseases: Fetal and Neonatal Complications and Inheritance of Autoimmune Diseases
No full textThis chapter discusses the women affected by systemic autoimmune diseases. Patients affected by systemic lupus erythematosus (SLE) are discouraged from becoming pregnant. It is observed that the disease can worsen during gestation; high disease activity has profound implications on fetal outcome. Owing to the increasing knowledge of pathophysiologic mechanisms and the development of clinics with combined obstetric and medical care, pregnancy is now a nearly normal event in women with SLE and other autoimmune diseases. Pregnancies in this group of patients remain at high risk, even though now many women do not experience major complications. Potential adverse events include renal crisis in systemic sclerosis (SSc), thrombosis, miscarriage, and preeclampsia in patients with anti-phospholipid antibodies (aPL) with or without SLE, neonatal lupus in babies born to mothers with anti-Ro/SSA antibodies, independent of maternal disease. Some drugs that are used to care for the mothers can interfere with fetal outcome
Síndrome antifosfolipídico catastrófico
No full text[spa] INTRODUCCIÓN: El síndrome antifosfolipídico catastrófico fue descrito por Asherson en el año 1992 como una variante del síndrome antifosfolipídico (SAF) que conduce a insuficiencia multiorgánica, caracteriza por la oclusión trombótica de los vasos de pequeño calibre, que se produce en un breve período de tiempo en presencia de anticuerpos antifosfolipídicos. Representa aproximadamente el 1% de los pacientes con SAF, pero la mortalidad es mayor del 50%. Las causas y los factores pronósticos que influyen es esta elevada mortalidad son desconocidos.HIPÓTESIS: El SAF catastrófico debería ser considerado en el diagnóstico diferencial de los pacientes con fallo multiorgánico (FMO), síndrome de distrés respiratorio agudo (SDRA) y anenia hemolítica microangiopática (AHM). El esquema terapéutico combinando glucorticoides (GC) junto a anticoagulación efectiva (AC) y recambio plasmático (RP), sería es el que consigue mayores tasas de supervivencia. Por tanto, la utilización de esta triple terapia podría mejorar la evolución de estos pacientes.OBJETIVOS: Analizar las características clínica y biológicas de los pacientes con SAF catastrófico, especialmente en aquellos que desarrollan SDRA y AHM. Determinar las causas y los factores pronósticos que condicionan su elevada mortalidad como así también la influencia del tratamiento en la evolución de estos enfermos.MATERIAL Y MÉTODOS:Debido a la baja prevalencia del síndrome es imposible que un solo centro reúna un número de pacientes suficientes para realizar estudios de investigación, por lo que se creó un registro internacional denominado "CAPS registry" con el fin de reunir todos los pacientes con SAF catastrófico. El servicio de enfermedades autoimmnes del Hospital Clínico de Barcelona es el centro coordinador para la recepción de la información y los directores y doctorando de esta tesis son los responsables del diseño, confección y actualización del mismo. El registro está patrocinado por el Europeam Forum on Antiphospholipid Antibodies y se diseñó como un portal abierto de libre acceso a través de la siguiente dirección: www.med.ub.es /MIMMUN/FORUM/CAPS. HTM. TRABAJOS PUBLICADOS:1. Espinosa G, Bucciarelli S, Cervera R et al. Thrombotic hemolitic microangiopathic anaemia and antiphospholipid antibodies. Ann Reum Dis 2004; 63: 730-736 (IF 6,96). 46 pacientes con AHM y anticuerpos antifosfolipídicos (aFL) fueron revisados. La presentación clínica fué: síndrome hemolítico urémico (26%), SAF catastrófico (23%), purpura trombótica trombocitopénica (13%) y síndrome HELLP (4%). El 70 % de los pacientes que recibieron recambio plasmático se recuperaron. La mortalidad fué del 22%.2. Bucciarelli S, Espinosa G, Cervera R. The acute respiratory distress syndrome in catastrophic antiphospholipid syndrome.Ann Rheum Dis 2006; 65:81-86 (IF : 6,96). El 68 % de los pacientes tuvieron afectación pulmonar y en el 31% se manifestó como SDRA. El 70% de los pacientes en los que se dispuso de anatomía patológica presentaron microtrombosis.3. Bucciarelli S, Espinosa G, Cervera R et al. Mortality in the catastrophic antiphospholipid syndrome. Prognostic factors in a series of 250 patients. Arthritis Rheum 2006 (en prensa) (IF: 7,42) La mortalidad global fue del 44%. La principal causa de muerte fue la afectación neurológica (27,9%) seguida por la afectación cardiaca y las infecciones en un 19,8%. La presencia de lupus eritematoso sistémico se asoció a una mayor mortalidad. La mayor tasa de recuperación estuvo se obtuvo con la utilización de GC+AC+RP. La mortalidad disminuyó un 20% después del 2001 asociada a una mayor utilización de la terapia combinada con GC+AC+RP.CONCLUSIONES:El SAF catastrófico debe ser considerado en el diagnóstico diferencial de los pacientes con FMO, SDRA y AHM. El tratamiento combinado con AC+GC+RP debe ser considerada como terapia de primera línea en los pacientes con SAF catastrófico.[eng] "CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME"BACKGROUND: The term catastrophic antiphospholipid syndrome (APS) was proposed by Asherson in 1992 for defining an accelerated form of APS resulting in multiorgan failure, developed in a very short period of time. Although patients with catastrophic APS represent less than 1% of patients with APS, the mortality rate is more than 50%. The causes of this high mortality are still unknown.HYPOTHESES: The catastrophic APS would be considered as differential diagnosis among multiorgan dysfunction, thrombotic haemolytic microangiopathic anaemia and acute respiratory distress syndrome. A higher recovery rate would be associated with combined treatment with anticoagulation + corticosteroids + plasma exchange (AC+CS+PE). OBJECTIVES: to analyse the clinical and laboratory features of patients with catastrophic APS mainly in those patients who develop thrombotic miroangiopathic anaemia (THMA) and acute respiratory distress syndrome (ARDS). To assess the main causes of death and the prognostic factors that can influence mortality in patients with catastrophic APS.METHOD: We analysed the patients with catastrophic APS included in the "CAPS registry" in order to achieve the objectives.RESULTS: FIRST STUDY: 46 patients were reviewed with AMTH and aPL. The clinical presentations were: hemolytic-uremic syndrome (26%), catastrophic APS (23%), thrombotic thrombocytopenic purpura (13%), and HELLP syndrome (4%). Recovery occurred in 70% of episodes treated with Plasm Exchange. SECOND STUDY: Pulmonary involvement was reported in 68% patients with catastrophic APS and 31% of them were diagnosed as having ARDS. Microthromboses was present in 70% patients. THIRD STUDY: Death occurred in 44%. Cerebral involvement was considered the main cause of death (27.2%) followed by cardiac involvement and infection (19.8% one each). The presence of systemic lupus erythematosus was associated with a higher mortality. A higher recovery rate was associated with combined treatment with anticoagulation + corticosteroids + plasma exchange (AC+CS+PE) (77.8%). The mortality decreased 20% from 2001 associated with the higher use rate of combined treatment with AC+CS+PE and/or IVIg.CONCLUSIONS: The catastrophic APS should be considered as differential diagnosis among multiorgan dysfunction, thrombotic haemolytic microangiopathic anaemia and acute respiratory distress syndrome. The combined therapy with AC+CS+PE should be the first line of therapy in patients with catastrophic APS
supplement_material – Supplemental material for Does Co-Occurring Anxiety Modulate ADHD-Related Cognitive and Neurophysiological Impairments?
No full textSupplemental material, supplement_material for Does Co-Occurring Anxiety Modulate ADHD-Related Cognitive and Neurophysiological Impairments? by Nicoletta Adamo, Giorgia Michelini, Celeste H. M. Cheung, Jan K. Buitelaar, Philip Asherson, Fruhling Rijsdijk and Jonna Kuntsi in Journal of Attention Disorders</p
A consideration of the potential role of genetic factors in individual differences in response to early institutional deprivation: the case of inattention/overactivity in the English and Romanian adoptees study
No full textSupplementary_Table_predictor_of_late-onset_ADHD_20190410 – Supplemental material for Early Predictors of De Novo and Subthreshold Late-Onset ADHD in a Child and Adolescent Cohort
No full textSupplemental material, Supplementary_Table_predictor_of_late-onset_ADHD_20190410 for Early Predictors of De Novo and Subthreshold Late-Onset ADHD in a Child and Adolescent Cohort by Chao-Yu Liu, Philip Asherson, Essi Viding, Corina U. Greven and Jean-Baptiste Pingault in Journal of Attention Disorders</p
sj-docx-1-jad-10.1177_10870547231159908 – Supplemental material for The Etiological and Predictive Association Between ADHD and Cognitive Performance From Childhood to Young Adulthood
No full textSupplemental material, sj-docx-1-jad-10.1177_10870547231159908 for The Etiological and Predictive Association Between ADHD and Cognitive Performance From Childhood to Young Adulthood by Isabella Vainieri, Giorgia Michelini, Celeste H. M. Cheung, Olakunle A. Oginni, Philip Asherson, Frühling Rijsdijk and Jonna Kuntsi in Journal of Attention Disorders</p
Plugging the Attention Deficit: Perceptual Load Counters Increased Distraction in ADHD.
No full textObjective: Increased vulnerability to extraneous distraction is a key symptom of Attention-Deficit Hyperactivity Disorder (ADHD), which may have particularly disruptive consequences. Here we apply Load Theory of attention to increase understanding of this symptom, and to explore a potential method for ameliorating it. Previous research in nonclinical populations has highlighted increased perceptual load as a means of improving the ability to focus attention and avoid distraction. The present study examines whether adults with ADHD can also benefit from conditions of high perceptual load to improve their focused attention abilities. Method: We tested adults with ADHD and age- and IQ-matched controls on a novel measure of irrelevant distraction under load, designed to parallel the form of distraction that is symptomatic of ADHD. During a letter search task, in which perceptual load was varied through search set size, participants were required to ignore salient yet entirely irrelevant distractors (colorful images of cartoon characters) presented infrequently (10% of trials). Results: The presence of these distractors produced a significantly greater interference effect on the search RTs for the adults with ADHD compared with controls, p = .005, ηp2 = .231. Perceptual load, however, significantly reduced distractor interference for the ADHD group and was as effective in reducing the elevated distractor interference in ADHD as it was for controls. Conclusions: These findings clarify the nature of the attention deficit underlying increased distraction in ADHD, and demonstrate a tangible method for overcoming it. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Continuity of ADHD Across the Lifespan
No full textIntroductionFor many years ADHD was thought to be a childhood onset disorder that has limited impact on adult psychopathology. However, the symptoms and impairments that define ADHD often affect the adult population, with similar responses to drugs such as methylphenidate, dexamphetamine and atomoxetine to those seen in children and adolescents. As a result, there has been a rapidly increasing awareness of ADHD in adults and an emergence of new clinical practice across the world. Despite this, treatment of adult ADHD in Europe and many other regions of the world is not yet common practice and diagnostic services are often unavailable or restricted to a few specialist centres.ObjectiveHere we address some of the key conceptual issues surrounding the continuity of ADHD across the lifespan, with a focus relevant to practicing health care professionals working with adult populations.ConclusionsWe conclude that ADHD should be recognised within adult mental health in the same way as other common adult mental health disorders. Failure to recognise and treat ADHD will be detrimental to the well being of many patients seeking help for common mental health problems.Disclosure of interestThe author declares that he has no competing interest.</jats:sec
Health-related quality of life and work productivity of adults with ADHD: A UK web-based survey
No full textIntroductionEuropean data on health-related quality of life (HRQoL) in adults with attention deficit/hyperactivity disorder (ADHD) in the general population is sparse.Aims and objectivesTo report HRQoL in UK adults with ADHD.MethodsUK residents aged 18–55 years with a diagnosis of adult ADHD completed an online, cross-sectional survey including questions on disease history, the EuroQol Five Dimensions questionnaire with five-levels (EQ-5D-5L) and the Work productivity and activity impairment questionnaire: general health (WPAI:GH). ADHD symptom severity was assessed by telephone using ADHD rating scale version IV with adult prompts (ADHD-RS-IV).ResultsThe survey was completed by 233 participants (65.2% women; 77.3% white British), mean age 32.6 years (standard deviation [SD] 9.5), mean ADHD-RS-IV total score 43.46 (SD 7.88). Their mean EQ-5D-5L utility score of 0.74 (SD 0.21) was lower than the UK population norm of 0.86 (SD 0.23).[1] WPAI:GH scores indicated that health problems resulted in impairments of 32.04% in work productivity and 45.79% in regular daily activities. Regression analyses adjusting for gender, age and comorbidities demonstrated associations between EQ-5D-5L utility scores and gender (men had lower scores, P < 0.001), work impairment due to health problems (increasing impairment was associated with lower scores, P = 0.005) and age (for each additional year of age, scores decreased by 0.007, P = 0.010).ConclusionsThese results highlight the impact on health utility, work productivity and regular daily activities, and add to the description of the disease burden of adult ADHD in the UK.This study was funded by Shire Development LLC.Disclosure of interestKings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech speaker at sponsored events for Shire, Lilly and Novartis.</jats:sec
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