Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD

Abstract

Objectives. Treatment investigations with methylphenidate in adults with ADHD focus preferentially on the classical psychopathology: inattention, hyperactivity and impulsivity. ADHD-associated emotional symptoms, which are frequently present at least in ADHD subpopulations, were studied rarely. The vast majority of the placebo-controlled trials had observation periods between 4 and 8 weeks. To assess the medium- to long-term effects of extended release methylphenidate (MPH-ER) on emotional symptoms and other psychopathology frequently seen in ADHD patients, we conducted a large-scale, multicenter treatment study. Methods. We performed a randomised, 24-week, double-blind, placebo-controlled study in adults with ADHD. The diagnosis was made on the basis of the DSM-IV criteria, which were confirmed by clinical history and a structured psychopathological interview and the use of rating instruments. 363 patients were randomized to MPH-ER or placebo at a ratio of 2:1. The duration of the titration period was 5 weeks followed by a maintainance phase of 19 weeks. The efficacy measures were the observer rated 10-item Emotional Dysregulation Scale (EDS) derived from the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and a self-report, six-item Emotional Lability Scale (ELS) extracted from the long version of the Conners Adult ADHD Self Report Scale (CAARS:S:L). In addition we used the SCL-90-R for the assessment of ADHD associated and comorbid psychopathology. Results. MPH-ER was statistically superior to placebo in reducing emotional symptoms as assessed by the EDS and the ELS. Obsessive-compulsive symptoms and those of problems with self-concept declined until the end of the observation period. The decline was more pronounced in MPH-ER treated individuals. The effects remained robust during the entire maintenance period until week 24. Symptoms of anxiety, depression, anger and hostility, phobia, paranoid ideations and psychoticism were not improved. Conclusions. MPH-ER appears to be an efficacious treatment for emotional symptoms with ADHD. Also obsessive-compulsive symptoms and problems with self-concept were affected positively.     

Prevalence and Clinical Correlates of Insomnia in Depressive Disorders: The CRESCEND Study

Objective

To investigate the prevalence, clinical manifestations, and clinical correlates of insomnia in a large cohort of Korean patients with depressive disorders.

Methods

We recruited 944 patients with depressive disorders from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Psychometric scales were used to assess depression (HAMD), anxiety (HAMA), psychotic symptoms (BPRS), global severity (CGI-S), and functioning (SOFAS). Insomnia levels were determined by adding the scores for all items on the HAMD insomnia subscale. The clinical characteristics of the patients with ''low insomnia'' (summed score ≤3 on the HAMD subscale) and ''high insomnia'' (score ≥4) were compared using statistical analyses. A logistic regression model was constructed to identify factors associated with ''high insomnia'' status.

Results

Symptoms of insomnia were present in 93% of patients, while simultaneous early, middle, and late insomnia affected 64.1%. The high insomnia patients were characterized by significantly greater age, higher symptom levels (including core, gastrointestinal somatic and anxiety symptoms, and suicidal ideation), higher global severity and incidence of physical disorders, and greater insight. Explanatory factors of ''high insomnia'' status were older age, higher gastrointestinal somatic and anxiety symptom levels, higher global severity, and greater insight.

Conclusion

In clinical psychiatry, insomnia has been significantly underdiagnosed and undertreated. It affects most patients with depressive disorders, and is indicative of the global severity of depression. Active efforts to diagnose and treat insomnia in patients with depressive disorders should be strongly encouraged. Further research is needed to improve the diagnosis and treatment of insomnia in depressive patients.     

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng’s Spinal Manipulation, hot fomentation, and bed rest (treatment group). The remaining 46 patients were treated with hot fomentation and bed rest only (control group). After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng’s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.     

Are special abilities in autism spectrum disorder associated with a distinct clinical presentation?

Special abilities may be common in autism spectrum disorders (ASD). The aim of this study was to investigate the clinical presentation of ASD with special abilities. Special abilities were defined based on the Autism Diagnostic Interview-Revised (ADI-R). Based on a sample of 398 children, ages 2–7 years old with ASD, 112 with special skills were compared to an age- and gender-matched group without special abilities (n = 79). The examined measures included autism symptoms severity, adaptive behaviors and head circumference percentile. Children with ASD and special abilities seemed to exhibit significantly less impaired ASD symptoms in the social, communication and stereotyped behaviors and significantly better adaptive skills than individuals with ASD without special skills. Children with ASD and special abilities had a larger head circumference percentile than children without special abilities. Special abilities occurred in 28% of the study participants. Memory skills were the most frequently reported special ability, followed by musical, visuospatial and reading skills. The authors conclude that individuals with ASD and special abilities might represent a distinct ASD subgroup with milder clinical ASD presentation. Larger head circumference in ASD was previously associated with enhanced “local” connectivity which provides detailed information processing and therefore might be related to the appearance of special abilities.     

An analysis of the predictors of comorbid psychopathology,gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder

Mannion, Leader, and Healy (2013) examined the frequency of comorbid disorders in children and adolescents with autism spectrum disorder and the predictors of sleep problems. This study will extend this research by investigating the predictors of comorbidity in 89 participants. Age, gender, level of intellectual disability, presence of epilepsy, attention deficit/hyperactivity disorder (AD/HD) and an anxiety disorder were determined using a self-constructed demographic questionnaire. The Autism Spectrum Disorder-Comorbid for Children (ASD-CC) was administered to informants to assess symptoms of comorbid psychopathology. The Children's Sleep Habits Questionnaire (CSHQ) and Gastrointestinal symptom inventory were administered to assess sleep problems and gastrointestinal symptoms respectively. Sleep problems predicted gastrointestinal symptoms. Level of intellectual disability predicted gastrointestinal symptoms. Specifically, those with no intellectual disability were more likely to present with gastrointestinal symptoms. Gastrointestinal symptoms in turn predicted total comorbid psychopathology score and the individual subscales of worry/depressed, avoidant behavior, conduct behavior and tantrum behavior on the ASD-CC. Gender and ASD-CC total score predicted an individual having an anxiety disorder. Specifically, being male predicted an anxiety disorder. The ASD-CC subscales of worry/depressed and avoidant behavior predicted an anxiety disorder. The implications of these findings are discussed in the study.     

Influence of remaining coronal structure and of the marginal design on the fracture strength of roots restored with cast post and core

Abstract

Objective. The purpose of this study was to evaluate the fracture strength of roots that were prosthetically restored with cast post and core with or without any remaining coronal structure and with different finish lines. Materials and methods. Sixty bovine incisors were sectioned below the cementoenamel junction, endodontically treated and randomly divided into six experimental groups (n = 10) containing teeth with or without any remaining coronal structure and with a beveled shoulder, a chanfered or a shoulder finish line design. The cast post and core were luted with dual-cured resin cement. The metal crowns were cemented with zinc phosphate cement. The specimens were subjected to a tangential compressive load (135° angle) at a crosshead speed of 0.5 mm/min until failure, using a universal testing machine. The fracture strength data were analyzed using the ANOVA and LSMeans (least square means) tests (α = 0.05). Results. The data indicated that the teeth with 2 mm of remaining coronal structure showed the highest fracture strength values when compared with the teeth without any remaining structure (p < 0.05). As to the different finish line designs, the highest fracture strength values were obtained for the beveled shoulder, followed by the chanfered and then by the shoulder designs (p < 0.05). Conclusions. It may be concluded that, to increase fracture strength, a beveled shoulder and 2 mm of remaining coronal structure are the ideal conditions.     

The antimicrobial effect of apical box versus apical cone preparation using iodine potassium iodide as root canal dressing: A pilot study

Abstract

Purpose. The purpose was to study the reduction of intra-canal microflora in premolars with apical periodontitis instrumented with either apical box or apical cone preparation and to provide measurements of intervention effects to allow proper power calculation in future clinical trials. Methods. Twenty-four patients were centrally randomized to apical box preparation (size #60) or cone preparation (apical size #25). The groups were comparable regarding the presence of primary caries and type of coronal restoration. In the course of canal preparation each tooth was irrigated with 2.5% NaOCl (12 ml). Lastly, the canals were filled with 17% EDTA (2 × 30 s) and 5% iodine potassium iodide (IKI) for 10 min. The canals were sampled for micro-organisms on four occasions: before instrumentation, after instrumentation, after application of IKI dressing and at the beginning of the second appointment 1 week later. Between the treatment sessions, the root canals were sealed with IRM cement. In the laboratory, culture techniques were used to measure microbial growth, which was classified as: none, very sparse, sparse, moderate, heavy or very heavy. Results. Initially, microbes were recovered in 88% of the teeth. Growth was classified as none in 35% of the teeth after instrumentation and in 50% after the application of IKI. Irrespective of the time of sampling, no significant difference in microbial growth reduction was observed between the two types of apical preparation. Based on the 1-week post-sampling, a power calculation revealed that over 900 patients are needed to show a difference of 9% between the two protocols tested. Conclusions. Future trials should be conducted using stringent protocols and as multi-centre trials for reaching the required information size.     

Morphology of Mandibular First Molars Analyzed by Cone-beam Computed Tomography in a Korean Population: Variations in the Number of Roots and Canals

Introduction

The aim of this study was to determine the root and canal morphology of the mandibular first molars in a Korean population of Mongolian origin by retrospective analysis of a large number of cone-beam computed tomography (CBCT) images.

Methods

A total of 976 subjects with bilateral mandibular first molars were examined by using in vivo CBCT methods. The number and configuration of roots, the number of root canals, and the canal configuration based on Vertucci's classification were determined.

Results

Overall, 25.82% of examined molars had 3 roots, 73.51% had 2 roots, and 0.67% had 1 root. The incidence of fourth canal was 50.36%. A right-sided predominance was noted for extra distal roots (P < .001), whereas a left-sided predominance was observed for extra distal canals (P < .001). No significant sex-related differences were shown for their prevalence. The bilateral prevalence rate was 69.13% for extra distal roots and 78.08% for extra distolingual (DL) canals. In the mesial roots, type IV canal was the most frequent (76.86% for 2-rooted molars and 72.96% for 3-rooted molars). In the distal roots, type l was the most common (66.62% for 2-rooted molars and 99.40%–100% for 3-rooted molars). The incidence of 2 canals in distobuccal roots, first reported in this study, was 0.15%.

Conclusions

Among mandibular first molars, there is a high prevalence of a separate DL root and/or a separate DL canal, and such molars commonly have 4 canals in the Korean population. CBCT is a useful tool for determining root and canal morphology.     

Detection of Vertical Root Fractures in the Presence of Intracanal Metallic Post: A Comparison between Periapical Radiography and Cone-beam Computed Tomography

Introduction

This in vitro study compared cone-beam computed tomography (CBCT) exam with different voxel sizes with digital periapical radiography in the detection of vertical root fractures in teeth with and without intracanal metallic posts.

Methods

Eighteen single-rooted human teeth were endodontically treated, prepared for cast metal posts, and artificially fractured. After positioning the teeth in dry mandibular sockets, the samples were subjected twice (with and without posts) to digital periapical radiography at 3 different angles and to CBCT examinations with 2 voxel sizes, 0.125 and 0.25 mm. The images were evaluated by 3 oral radiologists. Indices of sensitivity, specificity, and positive and negative predictive values, in addition to the areas under the receiver operating characteristic curves (accuracy), were calculated. Comparison of the accuracy of the imaging methods was assessed by using the χ² test. Comparison of the accuracy between teeth with and without posts was determined by using the Fisher exact test.

Results

The accuracy of the imaging methods showed no significant differences (P = .08). The comparison between teeth with and without posts in each examination revealed significant differences for CBCT with a voxel of 0.125 mm (P = .04) and for periapical radiography (P = .04).

Conclusions

No significant differences were observed between CBCT and periapical radiography in the detection of vertical root fractures, except for teeth with metallic posts in images from CBCT with a voxel of 0.125 mm and in digital periapical radiography. Furthermore, voxel size did not significantly influence the diagnosis of vertical root fractures.