149 research outputs found
Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?
No full textBackground: Expressed Emotions (EE) are associated with oppositional behavior (OPB) in children with Attention Deficit/Hyperactivity Disorder (ADHD). EE has been linked to altered stress responses in some disorders, but ADHD has not been studied. We test the hypothesis that OPB in ADHD is mediated by altered stress-related cortisol reactivity to EE.Methods: Two groups of children (with/without ADHD) and their respective parents wererandomly assigned to two different conditions with/without negative emotion and participated in an emotion provocation task. Parents’ EE, their ratings of their children’s OPB and theirchildren’s salivary cortisol levels were measured.Results: Low parental warmth was associated with OPB in ADHD. High levels of parental EE elicited a larger cortisol response. Stress-related cortisol reactivity mediated the EE-OPB link for all children. This highlights the general importance of parent-child interactions on externalizing behavior problems.Conclusion: High EE is a salient stressor for ADHD children that leads to increased levels of cortisol and OPB. The development of OPB might be mediated by the stress-response to high EE.<br/
Dopamine: Go/No-Go motivation vs. switching
No full textAbstract: Sensitivity to incentive motivation has a formative influence on extraversion. Mesoamygdaloid dopamine (DA) activity may, at one level, act as a micro-gate permitting an incentive to influence behavioral organization -'Go/No-Go' in this scheme. However data on function elsewhere in the mesocorticolimbic DA system is taken to support this particular function. At another level of analysis, the data in this review by D&C along with that on the rest of the VTA system may fit better with a "switching" function in information processing. This link is supported by correlations between measures of extraversion, learned inattention and overall DA activity. The point is extended to the novelty-seeking feature of the extraverted personality. Commentary: The neurotransmitter dopamine (DA), in areas innervated by the VTA, is undoubtedly an important part of the substrate for motor activation and responses to novelty, as expressed in the mesolimbic and modulated by the mesocortical system. Thus, via activation and impulsivity (D&C's terms), modulation by DA of limbic and neocortical activity in the expression of extraversion is not in contention. We support this in the animal model with psychostimulants (rearing, head-turning, and orientingmovements, Oades et al. 1985; What is in dispute is the exclusive role of the VTA-DA projection system in 'incentive motivation'. D&C section 3.3 specifically state that the approach of a rewarding goal is the essence of incentive motivation and this is facilitated by VTA-DA activity. They then qualify this (section 4.1) by saying that this facilitation does not consist of mediation (the strong version of the postulate) but instead should be seen as modulation. This 'weak' version flies in the face of the 'strong' version promulgated by Schultz and colleagues (e.g., 1995b) whom they so willingly cite in section 4.2, (the titles alone illustrate the point). Both versions are a kind of Go/No-Go theory to explain the extraversion/ introversion conflict over signals of reward and punishment described in section 2.4. A more widely applicable and more parsimonious alternative lies in selective information processing
Differential measures of 'sustained attention' in children with attention-deficit/hyperactivity or tic disorders: relations to monoamine metabolism
No full textIntroduction: Controversy exists on whether the constructs related to sustained attention and tested by paper/pencil tasks and computerized continuous-performance-tests (CPT) are similar, and whether the deficits recorded in children with attention-deficit/hyperactivity symptoms (ADHD) using these different forms of testing information processing are comparable.
Methods: Signal-detection measures (d-prime and beta-criterion) and type of error were recorded on four such tests of 'sustained attention', with increasing working-memory requirements (respond to 'x', respond to 'x' only after 'a') in healthy children (n = 14, mean 10 years of age), and those with ADHD (n = 14, mean 10 years of age) or a tic syndrome (TS, n = 11, mean 11 years of age). Clinical associations were sought from 24h-urinary measures of monoamine activity (parent amines and metabolites), - dopamine (DA), HVA, noradrenaline (NA), MHPG, serotonin (5-HT), 5-HIAA.
Results:
The cancellation paper/pencil test revealed no group differences for errors or signal detection measures. In contrast, on the CPTx ADHD children made more omission and commission errors than controls, but TS children made mostly omissions. This reflected the poor perceptual sensitivity (d-prime, d') for ADHD and conservative response criteria (beta) for TS children.
This group difference extended to the CPT ax which was shown on a regression analysis to test for putative working-memory-related abilities as well as concentration. In all children immediate response-feedback (vs. feedback at the end of the test) reduced omissions, and modestly improved d'. CPT ax performance related negatively to dopamine metabolism in controls and to serotonin metabolism in the ADHD group. But comparisons between the metabolites in the ADHD group suggest that increased serotonin- and decreased noradrenaline- with respect to dopamine-metabolism may detract from CPT performance in terms of d-prime.
Conclusions: CPT tasks demonstrated a perceptual-based impairment in ADHD and response conservatism in TS patients independent of difficulty. Catecholamine activity was implicated in the promotion of perceptual processing in normal and ADHD children, but serotonin activity may contribute to poor CPTax performance (emphasis on working-memory function) in ADHD patients
Stimulus dimension shifts in patients with schizophrenia, with and without paranoid hallucinatory symptoms, or obsessive compulsive disorder: strategies, blocking and monoamine status
No full textIntroduction: Reversal and intra-dimensional (ID) and extra-dimensional (ED) non-reversal shifts in task discrimination learning were compared. The aim was to see if "learned inattention" to the irrelevant dimension differentially influenced the efficacy of learning and of the stimulus choice strategy. (An overall indicator of monoamine metabolism was measured for potential congruence between switches of attention and dopamine activity: see Oades, Neurosci. Biobehav. Rev., , 9, 261-283, 1985).
Methods: Performance on pattern-discrimination discrimination shifts was compared with conditioned blocking (CB: another test of "learned inattention") and related to the status of monoamine neurotransmitter metabolism reflected in 24h-urine samples between tests. Results are reported for 29 healthy subjects (mean age 18.0y), 13 patients with obsessive compulsive disorder (OCD: mean age16.3y), and 28 with schizophrenia, including 14 paranoid hallucinatory (PH: 19.6y) and 14 nonparanoid patients (NP: 17.5y).
Results:
1. PH and NP patients improved learning with practice but showed an impaired shift on each task.
2. Unlike PH and control subjects, the NP shift impairment was non-specific and related to their problems on simple reversal of the discrimination.
3. The length of the stimulus-response sequences showed that all subjects were able to acquire a set for colour.
4. An analysis of choice on sequential pairs of stimuli showed that while all patients showed fewer win-stay sequences, only PH patients perseverated with lose-stay sequences. This type of error in PH patients contrast with the increase of win-shift errors in NP patients (figure 1).
5. Learning about the added stimulus on the CB task related to the efficiency of intra-dimensional shift in NP patients.
6. An impairment with OCD patients was restricted to the ED-shift (not reversal or ID-shift).
7. Increases of dopamine activity related to slower initial learning, but to more switches (and rapid learning) on all shift tasks: (positive correlations with win/lose-shift, negative with win-stay). NA activity in PH and NP patients related to increased win-stay and decreased lose-shift decisions (figure 1).
8. Increased serotonin activity correlated with faster learning in controls, OCD and PH patients. But the opposite relationships for dopamine and serotonin activity held for NP patients (figure 2).
Conclusions:
The different tasks of the "learned inattention" paradigm have different if related requirements and correlates. The monoamine data are consistent with the postulated function of noradrenaline in tuning and dopamine in switching operations. The behavioural data are consistent with the automatization of endogenous information processing, while NP patients use exogenous attentional strategies fir selecting information and PH patients show inefficient endogenous control of attention
WS08.1 The utility of oxygen uptake efficiency as a marker of aerobic fitness in children with cystic fibrosis
No full textThis is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record
Postraumatic stress disorder in context of liver transplantation
No full textDie posttraumatische Belastungsstörung im Kontext der Lebertransplantation
Die Lebertransplantation ist oft die einzig kurative Therapie bei einer Erkrankung, die zu einem Versagen der Leberfunktion führt. Diese Operation geht mit vielfältigen somatischen und psychischen Belastungen der Patienten vor und nach der Transplantation einher. Es ergibt sich die Frage, ob eine Transplantation ein traumatisches Ereignis darstellt und ob diese Erfahrung zu einer persistierenden psychischen Störung, der posttraumatischen Belastungsstörung (posttraumatische Belastungsstörung = PTBS, auf Englisch posttraumatic stress disorder = PTSD), führen kann.
Die Hauptthese dieser Studie ist: Patienten nach einer Lebertransplantation zeigen, bezogen auf die PTSD, ein vergleichbare psychische Reaktion wie Patienten nach einer Herztransplantation. Als weitere Hypothesen wurden angenommen, eine PTSD geht mit reduzierter Lebensqualität sowie erhöhter psychischer Symptombelastung einher. Die Ausprägung einer PTSD wird von soziodemographischen Faktoren, wie zum Beispiel dem Bildungsstand, beeinflusst.
In einer ca. 18-monatigen Querschnittuntersuchung wurde die Prävalenz von PTSD nach einer Lebertransplantation untersucht. An der Studie nahmen 103 Patienten teil, die sich zur medizinischen Nachsorge in der Essener Transplantationsambulanz einfanden. Die eingesetzten psychometrischen Instrumente umfassten den Fragebogen zur Sozialen Unterstützung, das Essener Trauma-Inventar, das Brief Symptom Inventory und den Fragebogen zum Gesundheitszustand.
Ergebnisse:
Die Patienten gaben ihre traumatischen Erfahrungen im Rahmen der Lebertransplantation an. Fünf Patienten (4, 9%) zeigten eine vollausgeprägte PTSD, weitere 16 (15,5 %) eine partielle PTSD. Die PTSD-Prävalenz erwies sich als höher als die Norm, aber als niedriger als bei Patienten nach einer Herztransplantation.
Ein hoher PTSD-Score korreliert signifikant mit niedrigerer Lebensqualität und hoher psychischer Symptombelastung, aber nicht mit der Höhe des Bildungsstand
Das am häufigsten genannte traumatische Erleben war bei ca. 80% der PTSD-Patienten die Diagnosemitteilung.
Zwei Schlussfolgerungen sind aus vorliegender Studie zu ziehen: Eine psychosoziale Nachsorge für Patienten muss angeboten werden; Ärzte müssen in empathischer Gesprächsführung geschult werden
Analysis of oxygen uptake efficiency parameters in young people with cystic fibrosis
No full textThis is the author accepted manuscript. The final version is available from Springer via the DOI in this recordPURPOSE: This study characterised oxygen uptake efficiency (OUE) in children with mild-to-moderate cystic fibrosis (CF). Specifically, it investigated (1) the utility of OUE parameters as potential submaximal surrogates of peak oxygen uptake ([Formula: see text]), and (2) the relationship between OUE and disease severity. METHODS: Cardiopulmonary exercise test (CPET) data were collated from 72 children [36 CF, 36 age- and sex-matched controls (CON)], with OUE assessed as its highest 90-s average (plateau; OUEP), the gas exchange threshold (OUEGET) and respiratory compensation point (OUERCP). Pearson's correlation coefficients, independent t tests and factorial ANOVAs assessed differences between groups and the use of OUE measures as surrogates for [Formula: see text]. RESULTS: A significant (p < 0.05) reduction in allometrically scaled [Formula: see text] and all OUE parameters was found in CF. Significant (p < 0.05) correlations between measurements of OUE and allometrically scaled [Formula: see text], were observed in CF (r = 0.49-0.52) and CON (r = 0.46-0.52). Furthermore, measures of OUE were significantly (p < 0.05) correlated with pulmonary function (FEV1%predicted) in CF (r = 0.38-0.46), but not CON (r = -0.20-0.14). OUEP was able to differentiate between different aerobic fitness tertiles in CON but not CF. CONCLUSIONS: OUE parameters were reduced in CF, but were not a suitable surrogate for [Formula: see text]. Clinical teams should, where possible, continue to utilise maximal CPET parameters to measure aerobic fitness in children and adolescents with CF. Future research should assess the prognostic utility of OUEP as it does appear sensitive to disease status and severity.Funding for the original research was provided by a number of Royal Devon and Exeter NHS Foundation Trust Small Grants Fund. In addition, LV Chubbock was awarded a summer scholarship by the Cystic Fibrosis Trust to undertake some of the data analysis for this study
Evaluation of two years of residential care treatment for early-onset schizophrenia
No full textIn dieser Untersuchung wurden 24 Jugendliche und junge Erwachsene untersucht, die an einer Schizophrenie (ICD-10: F20) oder schizoaffektiven Störung (ICD-10: F25) mit frü-hem Beginn litten. Zwölf von ihnen wurden in der Therapeutisch-Pädagogischen Wohn-gruppe Trialog der Prof. Eggers-Stiftung für zwei Jahre betreut, bei der anderen Hälfte erfolgte eine Behandlung und Betreuung mit den herkömmlichen Angeboten (Treatment-as-usual). Stellung genommen werden sollte zu der Frage, ob die Betreuung in der WG Trialog Vorteile für den Verlauf der Erkrankung, das soziale Funktionsniveau und die in-tellektuellen Fähigkeiten der Betroffenen bietet. Durch die Zuweisung und Kostenüber-nahme für eine Intensivbetreuung wurden Patienten ausgewählt, die einen niedrigeren so-zioökonomischen Status aufwiesen und über geringer ausgeprägte handlungsorientierte Fähigkeiten verfügten. Der akuten Psychose gingen früher beginnende und längere Prodromalstadien voraus, es zeigten sich mehr positive Symptome, eine hohe Rezidivrate mit langen Behandlungszeiten schon im ersten Jahr der Erkrankung sowie mehr komorbide Störungen.
Dennoch hatten sich nach zweijähriger intensiver Betreuung und Förderung sowohl positi-ve als auch negative Symptome bei den Betreuten stärker gebessert als bei der Vergleichs-gruppe. Die Lebensqualität konnte nur hinsichtlich der erlebten Qualität familiärer Bezie-hungen gesteigert werden, was prognostisch ein gutes Zeichen ist. Ihr soziales Funktions-niveau war der Vergleichsgruppe überlegen hinsichtlich selbständiger Wohnformen und Teilnahme an schulischen, berufsbildenden oder tagesstrukturierenden und therapeutischen Maßnahmen. Trotz niedrigerer handlungsorientierter Teilfähigkeiten konnten sie zu einem vergleichbaren Anteil einen Schulabschluss erzielen wie die Vergleichsgruppe. Aufmerk-samkeit, Merkfähigkeit und einige exekutive Funktionen entwickelten sich bei ihnen posi-tiv, während es in der Vergleichsgruppe im Mittel zu einem Rückgang kam.
Die Vergleichsgruppe polarisierte sich zwischen denjenigen, die eine für sie zu bewälti-gende Tätigkeit gefunden hatten und denjenigen, bei denen dies nicht der Fall war. Die Lebenssituation letzterer zeigte in mancher Hinsicht eine therapeutische, soziale und intel-lektuelle Vernachlässigung. Ihre Angehörigen waren mit ihrer Betreuung überfordert. Sie waren von einem chronischen Verlauf der Schizophrenie bedroht.Introduction: The Trialog project offers 8 EOS patients a two-year programme of residential outpatient care following discharge from a clinic aimed to support further recovery and independence including interactive and psychoeducational family care, coping with persistent symptoms, development of socio-emotional competence, independent house keeping, and support of school and vocational training.
Aims and Methods: To evaluate psychopathology along with social and neuropsychological function for 12 participants over 2 years. Their progress was compared with 12 EOS patients who did not attend Trialog following discharge.
Results: Participants showed a significantly greater decrease of positive and negative symptoms with respect to the comparison group. Measures of social function, neuropsychological indicators of memory, (selective) attention, and speed improved more than in the comparison subjects. Neither group showed changes in measures of intelligence or the subjective quality of life.
Conclusions: For EOS patients the residential training programme was more beneficial than treatment as usual
The topography of 4 subtraction ERP-waveforms derived from a 3-tone auditory oddball task in healthy young adults
No full textIntroduction: Five components were studied in 4 subtraction waveforms derived from ERPs obtained in passive and active conditions of a 3-tone oddball task (common=70%, C, 0.8 KHz; deviant=15%, D, 2 KHz; 1.4 KHz=15%, t, also used as a target (T)). These waveforms reflect different stimulus-mismatch processes and thus their topography could be revealing of different brain regions mediating them.
Methods: The following mismatches were studied: stimulus-mismatch (deviant - common, D/C, rarity and pitch confounded, known as the mismatch negativity, MMN), pitch-mismatch (T - deviant, T/D, rarity not target features controlled, known as processing negativity PN), attention - mismatch (T - t), T/t, controlled for pitch and rarity to show the influence of target features, known as the Negative difference Nd). These are compared with Goodin's procedure (G-wv, (T-common (active) - (t-common (passive)- the "Goodin-waveform").
Results: There were main site effects in normalized data in all cases (not P2 and N2 latency). There were separate frontal and posterior contributions to P1, with the former emphasized where target comparisons were involved.
Frontal N1 peaks, largest in D/C (MMN), spread posterior and to the right where target matching was involved. P2 posterior maxima were also less localized where target features were involved in the comparison. N2 topography was similar between waveforms but spread slightly more to each side in the T/t comparison (i.e. Nd).
Onset was earlier in the D/C comparison (i.e MMN). Parietal P3 peaks in waves based on target-ERPs showed a left temporal shift (vs D/C), though in T/D P3 was in fact maximal on the right (i.e. PN waveform).
Conclusions: Thus an attentional effect(controlled processing) is evident as early as 60 ms. Target features modify the anteroposterior distribution of positivity and negativity for the early components and in the lateralization of P3-like positivity. A comparison of waveforms by latency of potential shift (running t-test) vs. peak identification (MANOVA) is illustrated and discussed. D/C (MMN) and T/t (Nd) waveforms, rather than T/D or G-wv (PN & Goodin waveforms) waveforms are recommended for distinguishing comparator mechanisms for stimulus- and task-relevant features
Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems?
No full textIn view of ICD-11 revision, we evaluate whether the 18 DSM-IV diagnostic items retained by DSM-5 could be further improved (i) in predicting ADHD 'caseness' and 'impairment' and (ii) discriminating ADHD without CD (ADHD - CD) cases from ADHD with CD (ADHD + CD) cases. In a multi-centre study sample consisting of 1497 ADHD probands and 291 unaffected subjects, 18 diagnostic items were examined for redundancy; then each item was evaluated for association with caseness, impairment and CD status using Classical Test Theory, Item-Response Theory and logistic regression methods. First, all 18 DSM-IV items contributed significantly and independently to the clinical diagnosis of ADHD. Second, not all the DSM-IV items carried equal weighting. "Often loses things", "forgetfulness" and "difficulty sustaining attention" mark severity for Inattentiveness (IA) items and "often unduly noisy", "exhibits a persistent pattern of restlessness", "leaves seat in class" and "often blurts out answers" for Hyperactivity/Impulsivity (HI) items. "Easily distracted", "inattentive to careless mistakes", "often interrupts" and "often fidgets" are associated with milder presentations. In the IA domain, "distracted" yields most information in the low-severity range of the latent trait, "careless" in the mid-severity range and "loses" in the high-severity range. In the HI domains, "interrupts" yields most information in the low-severity range and "motor" in the high-severity range. Third, all 18 items predicted impairment. Fourth, specific ADHD items are associated with ADHD + CD status. The DSM-IV diagnostic items were valid and not redundant; however, some carried more weight than others. All items were associated with impairment
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