Does oppositional defiant disorder have temperament and psychopathological profiles independent of attention deficit/hyperactivity disorder?

Background

Most studies on temperamental and behavioral/emotional characteristics of oppositional defiant disorder (ODD) did not rule out the effect of comorbid attention-deficit/hyperactivity disorder (ADHD). The main objective of this study was to identify the temperamental and psychopathological patterns of ODD independent of comorbid ADHD. We also aimed to compare the patterns of temperament and psychopathology between ODD with and without ADHD.

Method

Parents of 2673 students, randomly selected from 19 representative schools in Seoul, Korea, completed the Diagnostic Interview Schedule for Children Version IV. Among 118 children and adolescents with ODD diagnosed by the Diagnostic Interview Schedule for Children Version IV, the parents of 94 subjects (mean age, 10.4 ± 3.0 years) and the parents of a random sample of 94 age- and gender-matched non-ODD/non-ADHD children and adolescents completed the parent's version of the Child Behavior Checklist (CBCL) and the Junior Temperament and Character Inventory.

Results

Subjects with ODD showed temperament and character profiles of high Novelty Seeking, low Self-directedness, and low Cooperativeness, a distinct pattern on the CBCL, and were at increased risk for anxiety and mood disorders compared to the controls after controlling for the effect of comorbid ADHD. The children and adolescents with both ODD and ADHD showed decreased levels of Persistence and Self-directedness and higher scores on 4 subscales of the CBCL (Anxious/Depressed, Attention Problems, Delinquent Behaviors, and Aggressive Behaviors) compared to those with ODD only.

Conclusions

Oppositional defiant disorder is associated with specific temperamental and behavioral/emotional characteristics, independent of ADHD. Moreover, the results of this study support that co-occurring ADHD and ODD have differentially higher levels of behavioral and emotional difficulties.     

Are oppositional defiant and conduct disorder symptoms normative behaviors in preschoolers? A comparison of referred and nonreferred children

OBJECTIVE: The authors' goal was to test the hypothesis that DSM-IV symptoms of oppositional defiant disorder and conduct disorder can be validly applied to preschoolers. METHOD: Using a semistructured diagnostic interview, they assessed rates of symptoms of DSM-IV oppositional defiant and conduct disorders in 2.5-5.5-year-old children who were referred to a psychiatry clinic and a comparison group of nonreferred children. RESULTS: Clinically referred preschool children had significantly higher rates of oppositional defiant and conduct disorder symptoms than nonreferred children. Among nonreferred preschoolers, rates of all oppositional defiant and conduct disorder symptoms were at or below 8%. CONCLUSIONS: DSM-IV symptoms of oppositional defiant and conduct disorders distinguish referred from nonreferred preschool children in a pattern consistent with that seen in older children. Preschool children who are not seeking mental health services do not have high rates of disruptive behavior problems. The DSM-IV nosology appears to be a valid diagnostic system for discriminating between typical and atypical disruptive behaviors in preschool children.     

On the link between attention deficit/hyperactivity disorder and obesity: do comorbid oppositional defiant and conduct disorder matter?

The link between attention deficit/hyperactivity disorder (ADHD) and elevated body weight/obesity can be regarded as well established. Because oppositional defiant disorder (ODD)/conduct disorder (CD) has also been found to be associated with these characteristics and ADHD and ODD/CD often occur comorbidly, we investigated whether ODD/CD and ADHD are independently linked with body weight and obesity. The clinical records of 360 children, 257 (6–12 years) with diagnoses of ADHD, ODD/CD, or comorbid ADHD and ODD/CD and 103 children with adjustment disorder (as a control group) constituted the database. All children were seen for the first time in two outpatient psychiatric clinics. Associations of the psychiatric diagnoses (ADHD present vs. not present; ODD/CD present vs. not present) with the standard deviation scores (according to German reference data) of the child’s body mass index (BMI-SDS) and presence of obesity were analyzed by ANCOVA and hierarchical logistic regression analysis, respectively. Children with ODD/CD showed higher BMI-SDS (F = 7.67, p < 0.006) and rate of obesity (Wald = 4.12, p < 0.05, OR = 2.43) while controlling for ADHD comorbidity. While adjusting for ODD/CD comorbidity, the links between ADHD and BMI-SDS or obesity did not reach statistical significance. Given a cross validation of these findings, future (preferably prospective longitudinal) research should analyze the mediating mechanism between the psychiatric conditions and obesity. This knowledge could be helpful for preventive interventions.     

Effectiveness of the prevention program for externalizing problem behaviour (PEP) in children with symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder – generalization to the real world

The aim of the present study was to test the effectiveness of the Prevention Program for Externalizing Problem Behaviour (PEP). PEP has already been evaluated as an efficacy study, i.e., with high internal validity. The main concern of the current study was to test the effects of PEP under conditions of high external validity.58 child therapists of 37 local institutions of the public health system held PEP trainings. The intervention was evaluated by a within-subject control group design with three assessment points, two before (pre1 and pre2) and one immediately after (post) the PEP training. Depending on the type of analysis, 198 up to 277 families with children aged 3-10 years were included. Data were collected by questionnaires and comprised symptomatology of the child and the mother as well as parenting. For parenting and child behaviour problems, changes after treatment were greater than changes during the waiting period. PEP produced effect sizes in the small to moderate range. The results suggest that PEP can be delivered under routine care settings without loss of positive treatment effects. As worse results are often obtained in effectiveness trials, these findings have to be regarded as particularly promising.     

Gender difference in the association between adult attention deficit hyperactivity disorder symptoms and morningness–eveningness

We aimed to investigate the association between attention deficit hyperactivity disorder (ADHD) and morningness–eveningness in adulthood. Subjects without psychiatric comorbidity on the Structured Clinical Interview for DSM-IV Axis I Disorders (n = 344) completed the Morningness–Eveningness Questionnaire (MEQ) and the Adult Self-Report Scale for ADHD. MEQ showed an independent and negative association with ADHD symptoms (P < 0.0001). In male subjects, both inattention (P < 0.0001) and hyperactivity–impulsivity were associated with MEQ (P = 0.01). In female subjects, only inattention was associated with MEQ (P < 0.001). Our findings suggest that eveningness may be strongly associated with inattention of adult ADHD and that it may be associated with hyperactivity–impulsivity of adult ADHD in male subjects only.     

Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996–2005: a national population-based study

Purpose

We used National Health Insurance (NHI) database to examine the prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder (ADHD) diagnosis in Taiwan.

Methods

The National Health Research Institute provided a database of 10,00,000 random subjects for study. A population-based random sample of 372,642 patients aged younger than 18 was obtained as a dynamic cohort. Those study subjects who had at least one service claim from 1996 to 2005, with a principal diagnosis of ADHD, were identified.

Results

The cumulative prevalence of ADHD diagnosis increased from 0.06 to 1.64?% from 1996 to 2005. The annual incidence of ADHD diagnosis increased from 0.02 to 0.34?% from 1997 to 2005. The highest incidence rates of ADHD diagnosis for both males and females were in the 6- to 11-year age group. Higher incidence was detected in males (HR 3.76, 95?% CI 3.48–4.07), those who lived in northern region (HR 1.35, 95?% CI 1.07–1.71) and urban area (HR 1.53, 95?% CI 1.40–1.66). The percentage of stimulant use in children with ADHD diagnosis increased from 39.6 to 54.0?% from 1997 to 2005.

Conclusions

Our findings suggest increases in the prevalence and incidence rates of ADHD diagnosis in Taiwan, which was in line with those studies of Western countries. However, the prevalence of ADHD diagnosis in the NHI program was still much lower than in the community studies. The percentage of stimulant use in children with ADHD diagnosis also has an increasing trend, which warrants further study.     

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study

Objective

Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample.

Methods

The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25-64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998-2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed.

Results

BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores.

Conclusion

Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.     

Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications. A commentary

Abstract Tourette’s Syndrome (TS) is now recognised to be a common childhood onset neurodevelopmental disorder. Attention deficit hyperactivity disorder (ADHD) is also a common childhood disorder. There are many cases in which the two disorders are comorbid. The reasons for this are unclear, but the comorbidity does not necessarily point to one genetic cause. Sleep is also often disturbed in individuals with TS and ADHD. The treatment implications of ADHD in the setting of tics or TS are important. Clonidine is suggested as a first line treatment. It was once thought that stimulants were contraindicated in the treatment of ADHD in the setting of TS, whereas it is suggested that they may be safe, but should be used judiciously. In addition, it was once thought that the combination of stimulants and clonidine was contraindicated, but from a large study the combination does appear to be safe. A relatively new medication for ADHD is atomoxetine, and although not documented widely in the setting of tics and TS, it may prove useful in this setting; further research is required. This commentary briefly discusses the comorbidity between TS and ADHD and offers treatment suggestions. *Emeritus Professor of Neuropsychiatry, UCL, London, UK Visiting Professor and Honorary Consultant, St George’s Hospital and Medical School, London, UK Senior Visiting Fellow, Institute of Neurology, UCL, London, UK     

Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

OBJECTIVE: This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates. METHOD: We investigated 129 prison inmates (mean age+/-SE: 19.2+/-2.0 years) and 54 healthy male control subjects (mean age+/-SE: 22.2+/-3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM-IV and ICD-10-research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM-IV (SCID). RESULTS: The overall prevalence of ADHD according to DSM-IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD-10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases). CONCLUSION: The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.     

Treatment of substance use disorders in schizophrenia: A unifying neurobiological mechanism?

Substance use disorders (SUDs) are highly prevalent and are associated with poor outcomes among individuals with schizophrenia. Integrating treatments for both disorders improves outcomes. Numerous individual pharmacologic and psychosocial treatments have shown effectiveness at reducing substance use in individuals with a primary diagnosis of schizophrenia and co-occurring substance use disorders. Of these treatments, medications such as certain atypical antipsychotics and naltrexone, and psychosocial treatments such as contingency management, seem to be particularly promising. The development and evaluation of psychopharmacologic and psychosocial treatments for SUDs in schizophrenia would benefit from a better understanding of the neurobiological mechanisms underlying the effectiveness of such treatments. Several theories have been put forth to explain the heightened risk for SUDs in schizophrenia. Of these, brain reward circuitry dysfunction, hypothesized to be etiologically important in SUDs, may be an especially salient target for treatments aimed at the reduction of substance use in patients with schizophrenia. We review current pharmacologic and psychosocial treatments for SUDs in schizophrenia, and theoretical mechanisms underlying the increased risk for SUDs in this population. We propose that effective treatments may in part work through the modulation of brain reward circuitry dysfunction.     

Does alexithymia expose to mental disorder symptoms in late adolescence? A 4-year follow-up study

ObjectiveTo investigate the possible causal link between alexithymia and the emergence of anxiety and depression symptoms, as well as alcohol consumption in a sample of late adolescents.MethodThe nonclinical sample comprised late adolescents (n= 315), including both females (n= 256) and males (n= 59). The follow-up period was 4 years, and at baseline, the mean age of the subjects was 19 years (range 17−21 years). Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), depression symptoms with the short form of the Beck Depression Inventory (RBDI), anxiety with the State-Trait Anxiety Inventory (STAI) and alcohol consumption with the Alcohol Use Disorders Identification Test (AUDIT). The three TAS-20 subscales were assessed separately. Linear and cumulative logistic regression analyses were used for the evaluation of associations, and the analyses were adjusted with the corresponding baseline scores.ResultsThe TAS-20 total and subscale scores did not predict the RBDI or AUDIT scores at follow-up. However, the TAS-20 subscale “difficulty identifying feelings” was significantly associated with both STAI-State (P= .007) and STAI-Trait (P= .004) scores at follow-up.ConclusionsAlexithymic features may be individual predictors of later anxiety symptoms. The significant differences between the various dimensions of alexithymia should be considered in future studies.     

Are personality traits familial risk factors for substance use disorders? Results of a controlled family study

OBJECTIVE: The well-documented association between maladaptive personality traits and substance use disorders has given rise to diverse explanatory models. In this investigation the authors examined one such explanation, that certain personality traits are familial risk factors for the development of substance abuse or dependence. METHOD: Data were collected from a controlled family study using direct diagnostic interviews. The Multidimensional Personality Questionnaire was used to assess the personality traits of 325 probands, 205 of whom had diagnoses of substance abuse or dependence, and 262 of their first-degree relatives. RESULTS: Probands with substance use disorders scored higher on alienation and negative emotionality than did probands without substance use disorders, and they scored lower on control, harm avoidance, and constraint. Relatives with substance use disorders also differed from relatives without these conditions on several of these same dimensions. To examine whether such personality traits could be conceptualized as familial risk factors for substance use disorders, a second set of analyses were limited to relatives without substance use disorders themselves but varying in terms of family history for these conditions. These groups of relatives did not differ significantly from each other on any of the identified personality traits. CONCLUSIONS: These findings argue for caution in characterizing the personality correlates of substance use disorders as representing familial or heritable risk factors.     

Quality of life and self-esteem in 7-year-old children with familial high risk of schizophrenia or bipolar disorder: the Danish High Risk and Resilience Study-VIA 7—a population-based cohort study

European Child & Adolescent Psychiatry - It is well established that children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) have a higher risk of developing...     

Does substance use disorder affect clinical expression in first-hospitalization patients with schizophrenia? Analysis of a prospective cohort

Although several papers reported a wide range of negative outcomes among patients with both schizophrenia and Substance Use Disorder (SUD), only a few studies evaluated the impact of SUD on psychopathology and thus on the length of first-hospitalization. The aim of the present study was to compare clinical expression of first-episode of schizophrenia between inpatients with and without SUD, giving close attention to the length of stay. One hundred and thirty inpatients at first-episode of schizophrenia were assigned to either SUD or not SUD group depending on SUD diagnosis and were assessed through BPRS at admission, during hospitalization and at discharge. Cross-sectional and longitudinal statistical analysis were performed to investigate differences between groups and also a linear regression was used to evaluate relationship between length of stay and BPRS scores. SUD group showed more disorganization at admission, less marked improvement of symptoms (disorganization, thought disturbance, anergia), and longer hospital stay than not SUD group. Moreover BPRS total score during hospitalization was a significant positive predictor for length of stay. Taken together, these findings suggest that SUD patients have a more severe and drug-resistant expression of schizophrenia, hence, they need longer treatment to achieve the overall symptoms improvement required for discharge.     

Adults with attention-deficit/hyperactivity disorder — A diffusion-tensor imaging study of the corpus callosum

The objective of the present study was to investigate the microstructure and the macrostructure of the corpus callosum (CC) in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) by means of magnetic resonance imaging (MRI). Twenty-nine participants with ADHD and 37 controls were included from the Norwegian ADHD project in Bergen. We measured the fractional anisotropy (FA) values, as well as the size of different subdivisions of the CC, using diffusion tensor imaging (DTI) and anatomical MRI. The isthmus/splenium part of the CC in the ADHD group showed reduced FA values compared to the control group, whereas the size of the CC did not differ across groups. Our findings thus demonstrate a divergence between microstructural and macrostructural measures in the CC of adults with ADHD. This contrasts with findings in children demonstrating callosal abnormalities in both microstructure and macrostructure. Our results may indicate that adults with ADHD in part have succeeded in passing by an earlier developmental delay of the CC, resulting in a normalization of callosal macrostructure into adulthood. However, microstructural differences are still present in adults, which may point to an abnormal lateralization in adults with ADHD, or could be a sign of a persisting impairment.