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Degremont A, Jain R, Philippou E, Latunde-Dada GO. Brain iron concentrations in the pathophysiology of children with attention deficit/hyperactivity disorder: a systematic review. Nutr Rev 2021; 79:615-626. [PMID: 32974643 DOI: 10.1093/nutrit/nuaa065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CONTEXT Attention deficit/hyperactivity disorder (ADHD) is a neurological disorder associated with iron dysregulation in children. Although previous focus was on examining systemic iron status, brain iron content may be a more reliable biomarker of the disorder. OBJECTIVE This systematic review examines whether children with ADHD have lower serum as well as brain iron concentrations, compared with healthy control subjects (HCS). DATA SOURCES A systematic literature search was conducted in Medline via PubMed, the Cochrane Library, Web of Science, Embase. and Ovid for papers published between 2000 and June 7, 2019. DATA EXTRACTION Studies were included if the mean difference of iron concentration, measured as serum iron, serum ferritin, or brain iron, between children with ADHD and HCS was an outcome measure. DATA ANALYSIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Risks of bias within and between studies were assessed using the quality assessment tools of the National Institutes of Health. Of 599 records screened, 20 case-control studies met the inclusion criteria. In 10 of 18 studies in which serum ferritin concentration was assessed, and 2 of 10 studies that assessed serum iron, a significant difference between children with ADHD and HCS was observed. Results of systemic iron levels were inconsistent. In 3 studies in which brain iron concentration was assessed, a statistically significant, lower thalamic iron concentration was found in children with ADHD than in HCS. CONCLUSION The evidence, though limited, reveals that brain iron rather than systemic iron levels may be more associated with the pathophysiology of ADHD in children. Larger, longitudinal, magnetic resonance imaging studies are needed to examine any correlations of iron deficiency in specific brain regions and symptoms of ADHD.
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Affiliation(s)
- Alexia Degremont
- Department of Nutrition and Dietetics, King's College London, London, UK
| | - Rishika Jain
- Department of Nutrition and Dietetics, King's College London, London, UK
| | - Elena Philippou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Takahashi N, Ishizuka K, Inada T. Peripheral biomarkers of attention-deficit hyperactivity disorder: Current status and future perspective. J Psychiatr Res 2021; 137:465-470. [PMID: 33798973 DOI: 10.1016/j.jpsychires.2021.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/08/2021] [Indexed: 01/28/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. Since the diagnosis of ADHD is defined by operational diagnostic criteria consisting of several clinical symptoms, a number of heterogeneous mechanisms have been considered to be implicated in its pathophysiology. Although no clinically reliable biomarkers are available for the diagnosis of ADHD, several plausible candidate biomarkers have been proposed based on recent advances in biochemistry and molecular biology. This review article summarizes potential peripheral biomarkers associated with ADHD, mainly from recently published case-control studies. These include 1) biochemical markers: neurotransmitters and their receptors, neurotrophic factors, serum electrolytes, and inflammation markers; 2) genetic and epigenetic markers: microRNA, mRNA expression, and peripheral DNA methylation; 3) physiological markers: eye movement and electroencephalography. It also discusses the limitations and future directions of these potential biomarkers for application in clinical practice.
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Affiliation(s)
- Nagahide Takahashi
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan; Research Center for Child Mental Development, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, 431-3192, Shizuoka, Japan
| | - Kanako Ishizuka
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Toshiya Inada
- Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan.
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Dupuy C, Castelnau P, Mavel S, Lefevre A, Nadal-Desbarats L, Bodard S, Busson J, Dufour-Rainfray D, Blasco H, Emond P, Galineau L. SHR/NCrl rats as a model of ADHD can be discriminated from controls based on their brain, blood, or urine metabolomes. Transl Psychiatry 2021; 11:235. [PMID: 33888684 PMCID: PMC8062531 DOI: 10.1038/s41398-021-01344-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. The neurobiological mechanisms underlying ADHD are still poorly understood, and its diagnosis remains difficult due to its heterogeneity. Metabolomics is a recent strategy for the holistic exploration of metabolism and is well suited for investigating the pathophysiology of diseases and finding molecular biomarkers. A few clinical metabolomic studies have been performed on peripheral samples from ADHD patients but are limited by their access to the brain. Here, we investigated the brain, blood, and urine metabolomes of SHR/NCrl vs WKY/NHsd rats to better understand the neurobiology and to find potential peripheral biomarkers underlying the ADHD-like phenotype of this animal model. We showed that SHR/NCrl rats can be differentiated from controls based on their brain, blood, and urine metabolomes. In the brain, SHR/NCrl rats displayed modifications in metabolic pathways related to energy metabolism and oxidative stress further supporting their importance in the pathophysiology of ADHD bringing news arguments in favor of the Neuroenergetic theory of ADHD. Besides, the peripheral metabolome of SHR/NCrl rats also shared more than half of these differences further supporting the importance of looking at multiple matrices to characterize a pathophysiological condition of an individual. This also stresses out the importance of investigating the peripheral energy and oxidative stress metabolic pathways in the search of biomarkers of ADHD.
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Affiliation(s)
- Camille Dupuy
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Pierre Castelnau
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU Tours, Tours, France
| | - Sylvie Mavel
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Antoine Lefevre
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | | | - Sylvie Bodard
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Julie Busson
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Diane Dufour-Rainfray
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU Tours, Tours, France
| | - Helene Blasco
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU Tours, Tours, France
| | - Patrick Emond
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU Tours, Tours, France
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Taylor SG, Roberts AM, Zarrett N. A Brief Mindfulness-Based Intervention (bMBI) to Reduce Teacher Stress and Burnout. TEACHING AND TEACHER EDUCATION 2021; 100:103284. [PMID: 35391939 PMCID: PMC8986160 DOI: 10.1016/j.tate.2021.103284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Teacher stress and burnout contribute to attrition and stress-related health concerns. Despite some positive effects, previous mindfulness-based interventions (MBI) have failed to incorporate key elements of methodological rigor and have included large dosages despite research suggesting that such dosages are iatrogenic. The current study demonstrates the efficacy of a brief MBI (bMBI; four sessions, six total hours) to reduce self-reported stress, burnout, and depression, and suggests the bMBI can protect against deleterious impacts to physiological functioning. The study informs the design and implementation of future MBIs, including strategies for reducing intervention dosages, in order to improve effectiveness and maximize cost-effectiveness.
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Affiliation(s)
- Stephen G. Taylor
- University of South Carolina, Columbia, SC, USA, Department of Psychology
| | - Alex M. Roberts
- University of South Carolina, Columbia, SC, USA, Department of Psychology
| | - Nicole Zarrett
- University of South Carolina, Columbia, SC, USA, Department of Psychology
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Rahi V, Kumar P. Animal models of attention-deficit hyperactivity disorder (ADHD). Int J Dev Neurosci 2021; 81:107-124. [PMID: 33428802 DOI: 10.1002/jdn.10089] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/14/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neuropsychiatric disorder characterized by three primary symptoms hyperactivity, attention deficit, and impulsiveness, observed in both children and adults. In childhood, this disorder is more common in boys than in girls, and at least 75% will continue to suffer from the disorder until adulthood. Individuals with ADHD generally have poor academic, occupational, and social functioning resulting from developmentally inappropriate levels of hyperactivity and impulsivity, as well as impaired ability to maintain attention on motivationally relevant tasks. Very few drugs available in clinical practice altogether abolish the symptoms of ADHD, therefore, to find new drugs and target it is essential to understand the neuropathological, neurochemical, and genetic alterations that lead to the progression of ADHD. With this contrast, an animal study is the best approach because animal models provide relatively fast invasive manipulation, rigorous hypothesis testing, as well as it provides a better angle to understand the pathological mechanisms involved in disease progression. Moreover, animal models, especially for ADHD, serve with good predictive validity would allow the assessment and development of new therapeutic interventions, with this aim, the present review collect the various animal models on a single platform so that the research can select an appropriate model to pursue his study.
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Affiliation(s)
- Vikrant Rahi
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, India
| | - Puneet Kumar
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, India
- Department of Pharmacology, Central University of Punjab, Bathinda, India
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Aydoğan Avşar P, Işık Ü, Aktepe E, Kılıç F, Doğuç DK, Büyükbayram Hİ. Serum zonulin and claudin-5 levels in children with attention-deficit/hyperactivity disorder. Int J Psychiatry Clin Pract 2021; 25:49-55. [PMID: 32757874 DOI: 10.1080/13651501.2020.1801754] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to investigate serum zonulin and claudin-5 levels of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and healthy controls by controlling the parameters such as age, sex and body mass index (BMI) percentile which are known to affect these parameters. METHOD A total of 80 treatment-naive children and adolescents with ADHD and 40 healthy volunteer controls aged 8-12 years were enrolled in this study. The severities of ADHD symptoms were assessed via parent- and teacher-rated questionnaires. The severity of anxiety and depression symptoms of the children were assessed by the self-report inventories. Serum levels of zonulin and claudin-5 were measured using commercial enzyme-linked immunosorbent assay kits. RESULTS The multivariate analysis of covariance (MANCOVA) revealed a significant main effect of groups in the serum zonulin and claudin-5 levels, an effect that was independent of age, sex and BMI percentile. Significant differences were found between the study groups in terms of serum log-claudin-5 levels. However, there was no significant difference between the study groups in terms of serum zonulin levels. CONCLUSION These findings provide additional evidence for dysregulation of the blood-brain barrier, especially abnormalities in claudin-5 function, which may be involved in the aetiology of ADHD.Key pointsADHD is one of the most common neurodevelopmental disorders of childhood. Although ADHD is quite common, its aetiology has yet to be fully explained.In recent years, studies on the relationship between intestinal and blood-brain brain barrier permeability and psychiatric disorders have increased.In our study, serum claudin-5 levels were higher in the ADHD group compared to the control group, while serum zonulin levels did not differ between the groups.
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Affiliation(s)
- Pınar Aydoğan Avşar
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Süleyman Demirel University, Isparta, Turkey
| | - Ümit Işık
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Süleyman Demirel University, Isparta, Turkey
| | - Evrim Aktepe
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Süleyman Demirel University, Isparta, Turkey
| | - Faruk Kılıç
- Faculty of Medicine, Department of Psychiatry, Süleyman Demirel University, Isparta, Turkey
| | - Duygu Kumbul Doğuç
- Department of Biochemistry, Süleyman Demirel University, Isparta, Turkey
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Magnin E. Neurodevelopmental and Neurodegenerative Similarities and Interactions: A Point of View About Lifelong Neurocognitive Trajectories. J Alzheimers Dis 2021; 79:1397-1407. [PMID: 33459644 DOI: 10.3233/jad-201207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurodevelopmental and neurodegenerative disorders are both growing major public health topics with similarities and frequent complex interactions with each other. Taking these aspects into account can provide a new point of view on lifelong neurocognitive trajectories. Assessing both neurodevelopmental and neurodegenerative dimensions during cognitive and behavioral clinical assessments is challenging but might improve diagnostic accuracy and physiopathological understanding. It is therefore necessary to understand the lifelong specific neurocognitive trajectory of each patient in order to develop personalized precision cognitive medicine.
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Affiliation(s)
- Eloi Magnin
- Department of Neurology, University Hospital of Besançon, Besançon, France.,Clinical and Integrative Neuroscience, Research Laboratory 481, Bourgogne Franche-Comté University, Besançon, France
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Caldani S, Delorme R, Moscoso A, Septier M, Acquaviva E, Bucci MP. Improvement of Pursuit Eye Movement Alterations after Short Visuo-Attentional Training in ADHD. Brain Sci 2020; 10:brainsci10110816. [PMID: 33158057 PMCID: PMC7694101 DOI: 10.3390/brainsci10110816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder without validated and objective diagnostic procedures. Several neurological dysfunctions in the frontal circuit, in the thalamus, and in the cerebellum have been observed in subjects with ADHD. These cortical and subcortical areas are responsible for eye movement control. Therefore, studying eye movements could be a useful tool to better understand neuronal alterations in subjects with ADHD. The aim of the present study was firstly to compare the quality of pursuit eye movements in a group of 40 children with ADHD (age 8.2 ± 1.2) and in a group of 40 sex-, IQ-, age-matched typically developing (TD) children; secondly, we aimed to examine if a short visuo-attentional training could affect pursuit performances in children with ADHD. Findings showed that children with ADHD presented a greater number of catch-up saccade and lower pursuit gain compared to TD children. Differently to TD children, in children with ADHD, the number of catch-up saccades and the pursuit gain were not significantly correlated with children's age. Furthermore, a short visuo-attentional training period can only slightly improve pursuit performance in children with ADHD, leading to a decrease of the occurrence of catch-up saccades only, albeit the effect size was small. The absence of any improvement in pursuit performance with age could be explained by the fact that the prefrontal and fronto-cerebellar circuits responsible for pursuit triggering are still immature. Pursuit eye movements can be used as a useful tool for ADHD diagnosis. However, attentional mechanisms controlled by these cortical structures could be improved by a short visuo-attentional training period. Further studies will be necessary to explore the effects of a longer visuo-attentional training period on oculomotor tasks in order to clarify how adaptive mechanisms are able to increase the attentional capabilities in children with ADHD.
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Affiliation(s)
- Simona Caldani
- MoDyCo, UMR 7114 CNRS Université Paris Nanterre, 92001 Nanterre, France;
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Robert Debré Hospital, 75019 Paris, France
- Correspondence:
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, 75019 Paris, France; (R.D.); (A.M.); (M.S.); (E.A.)
- Paris 7, Paris Diderot University, 75013 Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, 75015 Paris, France
| | - Ana Moscoso
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, 75019 Paris, France; (R.D.); (A.M.); (M.S.); (E.A.)
| | - Mathilde Septier
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, 75019 Paris, France; (R.D.); (A.M.); (M.S.); (E.A.)
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, 75019 Paris, France; (R.D.); (A.M.); (M.S.); (E.A.)
| | - Maria Pia Bucci
- MoDyCo, UMR 7114 CNRS Université Paris Nanterre, 92001 Nanterre, France;
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Robert Debré Hospital, 75019 Paris, France
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Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review. Lancet Psychiatry 2020; 7:955-970. [PMID: 33069318 DOI: 10.1016/s2215-0366(20)30312-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many potential environmental risk factors, environmental protective factors, and peripheral biomarkers for ADHD have been investigated, but the consistency and magnitude of their effects are unclear. We aimed to systematically appraise the published evidence of association between potential risk factors, protective factors, or peripheral biomarkers, and ADHD. METHODS In this umbrella review of meta-analyses, we searched PubMed including MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, from database inception to Oct 31, 2019, and screened the references of relevant articles. We included systematic reviews that provided meta-analyses of observational studies that examined associations of potential environmental risk factors, environmental protective factors, or peripheral biomarkers with diagnosis of ADHD. We included meta-analyses that used categorical ADHD diagnosis criteria according to DSM, hyperkinetic disorder according to ICD, or criteria that were less rigorous than DSM or ICD, such as self-report. We excluded articles that did not examine environmental risk factors, environmental protective factors, or peripheral biomarkers of ADHD; articles that did not include a meta-analysis; and articles that did not present enough data for re-analysis. We excluded non-human studies, primary studies, genetic studies, and conference abstracts. We calculated summary effect estimates (odds ratio [OR], relative risk [RR], weighted mean difference [WMD], Cohen's d, and Hedges' g), 95% CI, heterogeneity I2 statistic, 95% prediction interval, small study effects, and excess significance biases. We did analyses under credibility ceilings, and assessed the quality of the meta-analyses with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). This study is registered with PROSPERO, number CRD42019145032. FINDINGS We identified 1839 articles, of which 35 were eligible for inclusion. These 35 articles yielded 63 meta-analyses encompassing 40 environmental risk factors and environmental protective factors (median cases 16 850, median population 91 954) and 23 peripheral biomarkers (median cases 175, median controls 187). Evidence of association was convincing (class I) for maternal pre-pregnancy obesity (OR 1·63, 95% CI 1·49 to 1·77), childhood eczema (1·31, 1·20 to 1·44), hypertensive disorders during pregnancy (1·29, 1·22 to 1·36), pre-eclampsia (1·28, 1·21 to 1·35), and maternal acetaminophen exposure during pregnancy (RR 1·25, 95% CI 1·17 to 1·34). Evidence of association was highly suggestive (class II) for maternal smoking during pregnancy (OR 1·6, 95% CI 1·45 to 1·76), childhood asthma (1·51, 1·4 to 1·63), maternal pre-pregnancy overweight (1·28, 1·21 to 1·35), and serum vitamin D (WMD -6·93, 95% CI -9·34 to -4·51). INTERPRETATION Maternal pre-pregnancy obesity and overweight; pre-eclampsia, hypertension, acetaminophen exposure, and smoking during pregnancy; and childhood atopic diseases were strongly associated with ADHD. Previous familial studies suggest that maternal pre-pregnancy obesity, overweight, and smoking during pregnancy are confounded by familial or genetic factors, and further high-quality studies are therefore required to establish causality. FUNDING None.
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Air Pollution-Related Brain Metal Dyshomeostasis as a Potential Risk Factor for Neurodevelopmental Disorders and Neurodegenerative Diseases. ATMOSPHERE 2020. [DOI: 10.3390/atmos11101098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence links air pollution (AP) exposure to effects on the central nervous system structure and function. Particulate matter AP, especially the ultrafine (nanoparticle) components, can carry numerous metal and trace element contaminants that can reach the brain in utero and after birth. Excess brain exposure to either essential or non-essential elements can result in brain dyshomeostasis, which has been implicated in both neurodevelopmental disorders (NDDs; autism spectrum disorder, schizophrenia, and attention deficit hyperactivity disorder) and neurodegenerative diseases (NDGDs; Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis). This review summarizes the current understanding of the extent to which the inhalational or intranasal instillation of metals reproduces in vivo the shared features of NDDs and NDGDs, including enlarged lateral ventricles, alterations in myelination, glutamatergic dysfunction, neuronal cell death, inflammation, microglial activation, oxidative stress, mitochondrial dysfunction, altered social behaviors, cognitive dysfunction, and impulsivity. Although evidence is limited to date, neuronal cell death, oxidative stress, and mitochondrial dysfunction are reproduced by numerous metals. Understanding the specific contribution of metals/trace elements to this neurotoxicity can guide the development of more realistic animal exposure models of human AP exposure and consequently lead to a more meaningful approach to mechanistic studies, potential intervention strategies, and regulatory requirements.
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Robberecht H, Verlaet AAJ, Breynaert A, De Bruyne T, Hermans N. Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD). Molecules 2020; 25:molecules25194440. [PMID: 32992575 PMCID: PMC7583976 DOI: 10.3390/molecules25194440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/21/2022] Open
Abstract
In this study, we critically review the literature concerning the relation of Mg, Fe, Zn, Cu and Se and attention-deficit/hyperactivity disorder (ADHD). Elemental status is estimated using peripheral blood parameters, hair, urine, daily intake and response to supplementation. The observed associations between concentration levels of the elements Mg, Fe, Zn, Cu and Se and ADHD symptoms are contradictory. This is partly due to the heterogeneity and complexity of the disorder. As a trend, lower ferritin and zinc levels can be observed. However, this correlation is not causative, as illustrated by placebo-controlled trials reporting conflicting evidence on the efficacy of supplementation. Well-defined studies on changes in concentration levels of the elements in relation to ADHD symptoms before and after treatment with therapeutics it will be possible to shed more light on the significance of these elements in this behavioral disorder. The discussion on whether a change in concentration of an element is cause or consequence of ADHD is not within the scope of this article.
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Yde Ohki CM, Grossmann L, Alber E, Dwivedi T, Berger G, Werling AM, Walitza S, Grünblatt E. The stress-Wnt-signaling axis: a hypothesis for attention-deficit hyperactivity disorder and therapy approaches. Transl Psychiatry 2020; 10:315. [PMID: 32948744 PMCID: PMC7501308 DOI: 10.1038/s41398-020-00999-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/27/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric neurodevelopmental disorders in children and adolescents. Although ADHD has been studied for nearly a century, the cause and pathophysiology of ADHD is yet largely unknown. However, findings from previous studies have resulted in the formation of a new hypothesis: Apart from the well-known multifactorial etiology of ADHD, recent evidence suggests that the interaction between genetic and environmental factors and especially Wnt- and mTOR-signaling pathways might have an important role in the pathophysiology of ADHD. The Wnt-signaling pathway is known to orchestrate cellular proliferation, polarity, and differentiation, and the mTOR pathway is involved in several significant processes of neurodevelopment and synaptic plasticity. As a result, dysregulations of these pathways in a time-dependent manner could lead to neurodevelopmental delays, resulting in ADHD phenotype. This review presents further evidence supporting our hypothesis by combining results from studies on ADHD and Wnt- or mTOR-signaling and the influence of genetics, methylphenidate treatment, Omega-3 supplementation, and stress.
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Affiliation(s)
- Cristine Marie Yde Ohki
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Leoni Grossmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Emma Alber
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Tanushree Dwivedi
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Anna Maria Werling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland
- Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Zürich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zürich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zürich, Switzerland.
- Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Zürich, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zürich, Switzerland.
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Possible links between gut-microbiota and attention-deficit/hyperactivity disorders in children and adolescents. Eur J Nutr 2020; 59:3391-3403. [PMID: 32918136 DOI: 10.1007/s00394-020-02383-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022]
Abstract
An association between gut-microbiota and several neuropsychiatric conditions including autism, depression, anxiety, schizophrenia, and attention-deficit/hyperactivity disorder (ADHD) has been observed. Despite being the most prevalent neurodevelopmental disorders in children and adolescents worldwide, the etiology and curative approaches to treatment of ADHD remain unclear. There is a probability that gut-microbiota may contribute to ADHD via bidirectional communication between the gut and brain, a system known as the "gut-brain axis". Although a mechanistic link in the gut-brain axis in ADHD has been proposed, there is still a lack of information about the correlation of the microbiome profile with the mechanisms involved. The objective of this review was to summarize the diversity of the gut-microbiota and taxonomic profiles in children and adolescents with ADHD. In this review, we have provided an overview of the association between ADHD and gut-microbiota. The evidence pertinent to potentially distinctive gut-microbiota in children and adolescents with ADHD is also discussed and compared to that of their non-ADHD peers. Finally, the implications and future directions for investigation into the gut microbiome in ADHD patients are proposed.
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Scassellati C, Bonvicini C, Benussi L, Ghidoni R, Squitti R. Neurodevelopmental disorders: Metallomics studies for the identification of potential biomarkers associated to diagnosis and treatment. J Trace Elem Med Biol 2020; 60:126499. [PMID: 32203724 DOI: 10.1016/j.jtemb.2020.126499] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/10/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diagnosis and treatment of complex diseases such as Neurodevelopmental Disorders (NDDs) can be resolved through the identification of biomarkers. Metallomics (research on biometals) and metallomes (metalloproteins/metalloenzymes/chaperones) along with genomics, proteomics and metabolomics, can contribute to accelerate and improve this process. AIM This review focused on four NDDs pathologies (Schizophrenia, SZ; Attention Deficit Hyperactivity Disorder, ADHD; Autism, ADS; Epilepsy), and we reported, for the first time, different studies on the role played by the principal six essential trace elements (Cobalt, Co; Copper, Cu; Iron, Fe; Manganese, Mn; Selenium, Se; Zinc, Zn) that can influence diagnosis/treatment. RESULTS in light of the literature presented, based on meta-analyses, we suggest that Zn (glutamatergic neurotransmission, inflammation, neurodegeneration, autoimmunity alterations), could be a potential diagnostic biomarker associated to SZ. Moreover, considering the single association studies going in the same direction, increased Cu (catecholamine alterations, glucose intolerance, altered lipid metabolism/oxidative stress) and lower Fe (dopaminergic dysfunctions) levels were associated with a specific negative symptomatology. Lower Mn (lipid metabolism/oxidative stress alterations), and lower Se (metabolic syndrome) were linked to SZ. From the meta-analyses in ADHD, it is evidenced that Fe (and ferritin in particular), Mn, and Zn (oxidative stress dysfunctions) could be potential diagnostic biomarkers, mainly associated to severe hyperactive or inattentive symptoms; as well as Cu, Fe, Zn in ADS and Zn in Epilepsy. Fe, Zn and Mn levels seem to be influenced by antipsychotics treatment in SZ; Mn and Zn by methylphenidate treatment in ADHD; Cu and Zn by antiepileptic drugs in Epilepsy. CONCLUSIONS Although there is controversy and further studies are needed, this work summarizes the state of art of the literature on this topic. We claim to avoid underreporting the impact of essential trace elements in paving the way for biomarkers research for NDDs.
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Affiliation(s)
- Catia Scassellati
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Cristian Bonvicini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rosanna Squitti
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Işık Ü, Kılıç F, Aktepe E, Tanrıtanır B. The Relationship between Second-to-Fourth Digit Ratios, Attention-Deficit/Hyperactivity Disorder Symptoms, Aggression, and Intelligence Levels in Boys with Attention-Deficit/Hyperactivity Disorder. Psychiatry Investig 2020; 17:596-602. [PMID: 32517417 PMCID: PMC7324736 DOI: 10.30773/pi.2020.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/15/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Observations of sex differences have led some scientists to doubt whether the neuroendocrine system is involved in attentiondeficit/hyperactivity disorder (ADHD) etiology. One of the interesting study subjects in this context is prenatal steroid hormone exposure. The aim of the present study was to replicate and extend previous work by addressing two research questions: 1) Are second-tofourth digit (2D:4D) ratios lower in ADHD than in controls? 2) Is there a correlation between 2D:4D ratios and symptoms of ADHD, aggression and intelligence scores in boys with ADHD? METHODS The study included 100 treatment-naive male children diagnosed with ADHD and 55 healthy male children. We measured the ratios of 2D:4D and administered a Wechsler Intelligence Scale for Children-Revised to assess IQ scores, as well as behavioral rating scales, in children with ADHD and comparison individuals. RESULTS We observed lower 2D:4D ratios in the right hand in ADHD in comparison to the control group. The left-hand ratios of 2D:4D, however, did not differ between ADHD and control groups. There were negative correlations between the left-hand 2D:4D ratios and the hyperactivity scores. However, no significant correlation was detected between right-hand 2D:4D ratios and the psychological questionnaire scores. CONCLUSION These results provide further evidence that fetal androgen exposure may contribute to the pathophysiology of ADHD, at least in boys.
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Affiliation(s)
- Ümit Işık
- Department of Child and Adolescent Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Faruk Kılıç
- Department of Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Evrim Aktepe
- Department of Child and Adolescent Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Attention-Deficit/Hyperactivity Disorder, Its Pharmacotherapy, and Adrenal Gland Dysfunction: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103709. [PMID: 32466107 PMCID: PMC7277140 DOI: 10.3390/ijerph17103709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/25/2022]
Abstract
This study aims to examine the co-occurrence rate of attention deficit hyperactivity disorder (ADHD) and adrenal gland disorders, as well as whether pharmacotherapy may affect ADHD patients’ risk of developing adrenal gland disorder. One group of patients newly diagnosed with ADHD (n = 75,247) and one group of age- and gender-matching controls (n = 75,247) were chosen from Taiwan′s National Health Insurance database during the period of January 1999 to December 2011. Both patients and controls were monitored through December 31, 2011, in order to identify the occurrence of adrenal gland disorders (ICD-9-CM code 255.X). We also explored the potential effect of methylphenidate (MPH) and atomoxetine (ATX) treatments on the risk of developing adrenal gland disorders. We found that ADHD patients showed a significantly increased probability of developing an adrenal gland disorder compared to the control group (0.2% of ADHD vs. 0.1% of controls). However, neither MPH nor ATX treatment significantly influenced the patients’ risk of developing adrenal gland dysfunction. We propose that patients with ADHD had greater comorbid rates with adrenal gland dysfunction than the control subjects. Nevertheless, undergoing treatment with MPH or ATX did not significantly influence the risk of developing adrenal gland dysfunction among ADHD patients.
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Kornelsen E, Buchan MC, Gonzalez A, Ferro MA. Hair Cortisol Concentration and Mental Disorder in Children With Chronic Physical Illness. ACTA ACUST UNITED AC 2020; 3:2470547019875116. [PMID: 32440601 PMCID: PMC7219865 DOI: 10.1177/2470547019875116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
Abstract
Background To examine changes in hair cortisol concentrations (HCC) in children with
chronic physical illness and identify patterns of association between HCC
and mental comorbidity. Methods A sample of 50 children aged 6 to 16 years were recruited within six months
of being diagnosed with a chronic physical illness. Data were collected via
hair samples, structured interviews, and behavioral checklists. Results There was no change in HCC over six months. Baseline HCC was associated with
internalizing—odds ratio (OR) = 1.29 (90% confidence interval (CI):
1.01–1.66)—and externalizing disorders—OR = 1.32 (90% CI: 1.07–1.64).
Externalizing disorder at six months was associated with elevated
baseline—OR = 1.25 (90% CI: 1.02–1.53)—and six-month HCC—OR = 1.25 (90% CI:
1.02–1.54). Associations between HCC and mental disorder weakened over time,
and for internalizing disorders, changed direction (i.e., inverse
association), albeit not significantly. Conclusion Results provide preliminary evidence that physiological stress, measured
using HCC, may be implicated in the relationship between physical and mental
illness, and these associations align with attenuated stress responses over
time.
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Affiliation(s)
- Emily Kornelsen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - M Claire Buchan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Abstract
Many authors have contributed to the description of attention deficit/hyperactivity disorder (ADHD) for the two last centuries. In this chapter, we review the current diagnostic criteria, epidemiology, and history of ADHD. The different phenotypes (predominantly inattentive, predominantly hyperactive/impulsive, or combined) and diagnostic process are detailed. The DSM-5 includes the three phenotypes that begin before age 12, are present in at least two settings, and cannot be explained by another condition. Theoretical underpinnings and biological and environmental etiologies reported in the latest literature are discussed. There are many comorbidities associated with ADHD, which are associated with an increase in the negative impact on everyday life. Treatment decisions involve a complex interaction between child's age, symptom severity levels, comorbidities, functional impairments, and parents' preferences. Medication (psychostimulant and nonstimulant) and psychosocial (mainly behavioral parent training) treatments as well as school-based interventions are described.
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Affiliation(s)
- Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States.
| | - Russell Barkley
- Department of Psychiatry, Virginia Commonwealth University Medical Center, Richmond, VA, United States
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Low hair cortisol concentration predicts the development of attention deficit hyperactivity disorder. Psychoneuroendocrinology 2019; 110:104442. [PMID: 31585236 DOI: 10.1016/j.psyneuen.2019.104442] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Low activity of the hypothalamic-pituitary-adrenal axis (HPAA) resulting from genetic and early environmental factors has been thought to indicate risk for the development of attention deficit hyperactivity disorder (ADHD) and externalizing disorders. However, longitudinal research on this issue is scarce. We analyzed whether hair cortisol concentration (HCC), i.e. accumulated long-term HPAA activity, predicts the development of ADHD between preschool and school age. METHODS A community-based sample of 126 children was assessed at the ages of 4, 5 and 8 years. ADHD and symptoms of oppositional defiant and conduct disorder (ODD/CD), callous unemotional (CU) traits, and internalizing symptoms were measured by clinical parent interviews and parent and teacher questionnaires. HCC was analyzed in the most proximal 3-cm scalp hair segment using luminescence immunoassay. RESULTS Low HCC at preschool age predicted an increase in ADHD symptoms between preschool and school age while adjusting for gender of child, maternal education level, and internalizing symptoms (F(1,119) = 6.5; p = .012). The prediction held after additionally adjusting for ODD/CD symptoms and CU traits (F(1,116) = 4.1; p = .045). The same was true for the prediction of the ADHD diagnosis at the age of 8 years (Chi2(1) = 7.3; p = .007). The prediction of ADHD was mainly based on the presentation of inattention symptoms (F(1,119) = 7.4, p = .008). CONCLUSION Low HCC in preschool children indicates an increased risk of developing ADHD at school age. In future research, it would be of theoretical and clinical importance to further circumscribe this HCC-related developmental pathway and track its further course of development.
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Dinces SM, Rowell LN, Benson J, Hile SN, Tang AC, Annett RD. Normalized Cortisol Reactivity Predicts Future Neuropsychological Functioning in Children With Mild/Moderate Asthma. Front Psychol 2019; 10:2570. [PMID: 31803112 PMCID: PMC6877752 DOI: 10.3389/fpsyg.2019.02570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022] Open
Abstract
Cortisol reactivity to adrenocorticotropic hormone (ACTH) has been associated with neuropsychological processes including attention and memory in children with asthma. While cortisol reactivity to a psychological stressor is often considered a measure of current neuroendocrine functioning, this study examines the association of the cortisol reactivity and subsequent neuropsychological functioning. Using prospective data from the Childhood Asthma Management Program (CAMP), we explored the predictive ability of cortisol reactivity to ACTH and children's later attention and memory using traditional and an alternative cortisol reactivity (normalized cortisol) measures. Cortisol reactivity was assessed at study entry and 1-year follow-up, and neuropsychological functioning was assessed at 3-year follow-up. Cortisol reactivity was assessed through plasma cortisol concentrations collected at baseline (CORTBASELINE) and 30 min post-ACTH challenge (CORTPOST-A CTH). An alternative measure of cortisol reactivity was developed through post-ACTH stimulation cortisol, normalized by cortisol by baseline (CORTNORM -ACTH). CORT B ASELINE positively predicted year 3 attention, while CORTNORM -ACTH negatively predicted attention, suggesting convergence of cortisol variables in prediction of neuropsychological function. Year 1 CORTACTH positively predicted child memory at year 3; Year 1 CORTNORM-ACTH negatively predicted year 3 sustained attentions. These findings demonstrate that HPA reactivity, including the application of normalized cortisol reactivity, can predict subsequent neuropsychological functioning of children with mild to moderate asthma.
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Affiliation(s)
- Sarah M. Dinces
- Department of Psychology, The University of New Mexico, Albuquerque, NM, United States
| | - Lauren N. Rowell
- Department of Psychology, The University of New Mexico, Albuquerque, NM, United States
| | - Jennifer Benson
- Department of Psychology, The University of New Mexico, Albuquerque, NM, United States
| | - Sarah N. Hile
- Department of Psychology, The University of New Mexico, Albuquerque, NM, United States
| | - Akaysha C. Tang
- Faculty of Education, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert D. Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
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Dynamical properties of elemental metabolism distinguish attention deficit hyperactivity disorder from autism spectrum disorder. Transl Psychiatry 2019; 9:238. [PMID: 31551411 PMCID: PMC6760156 DOI: 10.1038/s41398-019-0567-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental conditions of overlapping etiologies and phenotypes. For ASD, we recently reported altered elemental metabolic patterns in the form of short and irregular zinc and copper cycles. Here, we extend the application of these biomarkers of prenatal and early postnatal elemental metabolism to distinguish between individuals diagnosed with ADHD and/or ASD and neurotypical controls. We recruited twins discordant for ADHD, ASD and other neurodevelopmental diagnoses from national twin studies in Sweden (N = 74) diagnosed according to DSM-5 clinical consensus and standardized psychiatric instruments. Detailed temporal profiles of exposure to 10 metals over the prenatal and early childhood periods were measured using tooth biomarkers. We used recurrence quantification analysis (RQA) to characterize properties of cyclical metabolic patterns of these metals. Regularity (determinism) and complexity (entropy) of elemental cycles was consistently reduced in ADHD for cobalt, lead, and vanadium (determinism: cobalt, β = -0.03, P = 0.017; lead, β = -0.03, P = 0.016; and vanadium, β = -0.03, P = 0.01. Entropy: cobalt, β = -0.13, P = 0.017; lead, β = -0.18, P = 0.016; and vanadium, β = -0.15, P = 0.008). Further, we found elemental pathways and dynamical features specific to ADHD vs ASD, and unique characteristics associated with ADHD/ASD combined presentation. Dysregulation of cyclical processes in elemental metabolism during prenatal and early postnatal development not only encompasses pathways shared by ADHD and ASD, but also comprise features specific to either condition.
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Liu L, Qiao Y, Shao Y, Yu SY, Zhang C, Zhang R, Wang DX, Zhao M, Xie B. Association of Corticotropin-Releasing Hormone Receptor-1 Gene Polymorphisms and Personality Traits with Violent Aggression in Male Adolescents. J Mol Neurosci 2019; 70:145-154. [PMID: 31452059 DOI: 10.1007/s12031-019-01396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022]
Abstract
There is evidence that corticotropin-releasing hormone receptor 1 (CRHR1) gene polymorphisms and indifferent impulsive personality traits play an important role in violent aggression in male adolescents. Genotyping for two tag single-nucleotide polymorphisms (SNP) (rs242924, rs17689966) was conducted using TaqMan SNP for 138 violent young male criminals, 98 nonviolent young male criminals, and 153 noncriminal adults. The general situation and personality traits (SSP) questionnaire was given to the young violent and nonviolent male criminal groups. The results showed that the frequency of the G allele in rs242924 of the CRHR1 gene in the violent aggression group was higher than that in the normal adult controls (P < 0.025, OR = 2.29, 95% CI = 1.13-4.62). The difference in genotype distribution was significant among the three groups (P < 0.05), and when the violent group was compared with the two control groups, no significant difference was found (P > 0.025). The impulsiveness, trait irritability, verbal trait aggression, and physical trait aggression scores in the violent group were significantly higher than those in the nonviolent group of adolescents. These findings suggest that the variance in CRHR1 gene polymorphisms and personality traits may play a role in violent aggression in male adolescents, and that the interaction of the CRHR1 gene and the impulsive personality trait may cause an increased susceptibility to violence towards others.
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Affiliation(s)
- Li Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Yi Qiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China.
| | - Shun-Ying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Ran Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Dong-Xiang Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China.
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Dempsey JL, Little M, Cui JY. Gut microbiome: An intermediary to neurotoxicity. Neurotoxicology 2019; 75:41-69. [PMID: 31454513 DOI: 10.1016/j.neuro.2019.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/04/2019] [Accepted: 08/16/2019] [Indexed: 12/12/2022]
Abstract
There is growing recognition that the gut microbiome is an important regulator for neurological functions. This review provides a summary on the role of gut microbiota in various neurological disorders including neurotoxicity induced by environmental stressors such as drugs, environmental contaminants, and dietary factors. We propose that the gut microbiome remotely senses and regulates CNS signaling through the following mechanisms: 1) intestinal bacteria-mediated biotransformation of neurotoxicants that alters the neuro-reactivity of the parent compounds; 2) altered production of neuro-reactive microbial metabolites following exposure to certain environmental stressors; 3) bi-directional communication within the gut-brain axis to alter the intestinal barrier integrity; and 4) regulation of mucosal immune function. Distinct microbial metabolites may enter systemic circulation and epigenetically reprogram the expression of host genes in the CNS, regulating neuroinflammation, cell survival, or cell death. We will also review the current tools for the study of the gut-brain axis and provide some suggestions to move this field forward in the future.
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Affiliation(s)
- Joseph L Dempsey
- Department of Environmental and Occupational Health Sciences, University of Washington, United States
| | - Mallory Little
- Department of Environmental and Occupational Health Sciences, University of Washington, United States
| | - Julia Yue Cui
- Department of Environmental and Occupational Health Sciences, University of Washington, United States.
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Pinho R, Wang B, Becker A, Rothenberger A, Outeiro TF, Herrmann-Lingen C, Meyer T. Attention-deficit/hyperactivity disorder is associated with reduced levels of serum low-density lipoprotein cholesterol in adolescents. Data from the population-based German KiGGS study. World J Biol Psychiatry 2019; 20:496-504. [PMID: 29243550 DOI: 10.1080/15622975.2017.1417636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial, complex and the most common neurodevelopmental disorder in childhood. In this analysis, we tested the hypothesis that altered serum lipid patterns are associated with ADHD. Methods: Using data from the nationwide, population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we compared serum levels of total cholesterol, high-density (HDL) and low-density lipoprotein (LDL) cholesterol, and also triglycerides, in participants with physician-diagnosed and/or suspected ADHD, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), with non-ADHD controls. Results: Among 6,898 participants aged between 11 and 17 years, 666 (9.7%) had a physician-based diagnosis of ADHD and/or suspected ADHD. We found correlations between the parent-rated SDQ scores on the hyperactivity-inattention subscale and concentrations of triglycerides (r = 0.064, p < .001), total cholesterol (r = -0.026, p = .033), HDL cholesterol (r = -0.059, p < .001) and LDL cholesterol (r = -0.027, p = .031). In multivariate models, low serum levels of LDL cholesterol remained a significant predictor of ADHD (Exp(β) = 0.382, 95% confidence interval = 0.165-0.888, p = .025). Conclusions: Our findings in a large, nationwide and representative sample of German adolescents demonstrated a small, but significant and inverse link between LDL cholesterol levels and symptoms of ADHD. Further studies are required to decipher the biochemical mechanisms behind this relationship.
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Affiliation(s)
- Raquel Pinho
- Department of Experimental Neurodegeneration, Centre for Nanoscale Microscopy and Molecular Physiology of the Brain, University Medical Centre Göttingen , Göttingen , Germany.,Faculty of Medicine, University of Porto , Porto , Portugal
| | - Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Tiago F Outeiro
- Department of Experimental Neurodegeneration, Centre for Nanoscale Microscopy and Molecular Physiology of the Brain, University Medical Centre Göttingen , Göttingen , Germany.,Max Planck Institute for Experimental Medicine , Göttingen , Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, University of Göttingen, and German Centre for Cardiovascular Research (DZHK) , Göttingen , Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, University of Göttingen, and German Centre for Cardiovascular Research (DZHK) , Göttingen , Germany
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75
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Wang LJ, Lee SY, Chou MC, Lee MJ, Chou WJ. Dehydroepiandrosterone sulfate, free testosterone, and sex hormone-binding globulin on susceptibility to attention-deficit/hyperactivity disorder. Psychoneuroendocrinology 2019; 103:212-218. [PMID: 30711898 DOI: 10.1016/j.psyneuen.2019.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
The neuroendocrine system may affect the pathophysiology of gender differences in attention deficit/hyperactivity disorder (ADHD). This study examines whether the relationships among dehydroepiandrosterone sulfate (DHEA-S), free testosterone, or sex hormone-binding globulin (SHBG) and ADHD presentations exhibit gender differences. A total of 113 boys and 35 girls with ADHD (all drug naïve) and 46 and 26 healthy control boys and girls, respectively, were recruited. Blood samples were obtained to measure the serum levels of DHEA-S, free testosterone, and SHBG in each child. The Swanson, Nolan, and Pelham Scale for ADHD Version IV (SNAP-IV) was used to evaluate behavioral symptoms and the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and the Conners' Continuous Performance Test (CPT) were utilized to assess neurocognitive functions. Patients with ADHD had lower DHEA-S levels than male and female healthy control subjects, and no significant differences were observed in free testosterone and SHBG levels between the patients and the controls. DHEA-S levels were negatively correlated with children's impulsivity performance in the CPT. SHBG levels were negatively correlated with ADHD behavior symptoms among boys. Free testosterone levels were not significantly correlated with either ADHD clinical symptoms or neuropsychological functions. We propose that DHEA-S serves as a potential biomarker of ADHD and is consistently involved in the pathogenesis of ADHD in both boys and girls. SHBG may be involved in behaviors associated with ADHD in boys. Additional studies with basic scientific measures are warranted to elucidate the relationship between androgen hormones and clinical presentations of ADHD.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Miao-Chun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Testosterone to cortisol ratio and aggression toward one's partner: Evidence for moderation by provocation. Psychoneuroendocrinology 2019; 103:130-136. [PMID: 30682629 DOI: 10.1016/j.psyneuen.2019.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/03/2018] [Accepted: 01/17/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Consistent with the dual-hormone hypothesis, the combination of high testosterone levels and low cortisol levels has been linked to increased dominant and aggressive behaviors. However, recent research indicates that this association is weaker or even reversed following provocation. It is also unclear whether the association between testosterone/cortisol and aggression is similar for men and women and for those with and without attention-deficit/hyperactivity disorder (ADHD). METHODS Using data from a larger project examining ADHD in the context of romantic relationships, the current study tested the dual-hormone hypothesis in 32 heterosexual young adult couples who engaged in a conflict discussion and a competitive reaction time task in the laboratory. Aggressive behavior was indexed by greater noise blast intensity toward one's partner during the competitive reaction time task. Two potential sources of provocation were examined: 1) affective responses to a conflict discussion task preceding the competitive reaction time task, and 2) whether participants received/did not receive a noise blast before the first two trials of the competitive reaction time task. Salivary testosterone and cortisol were assessed three times throughout the laboratory session, and the ratio of testosterone to cortisol output across the session (T/C AUCg ratio) was calculated. RESULTS Consistent with the dual-hormone hypothesis, greater AUCg T/C ratios were associated with greater aggression. Further, T/C ratio-aggression associations were weaker under provoked conditions but did not differ as a function of sex or ADHD status. CONCLUSIONS Results provide support for the dual-hormone hypothesis and suggest that provocation may be an important moderator of the T/C-aggression relationship.
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Varela Casal P, Lorena Esposito F, Morata Martínez I, Capdevila A, Solé Puig M, de la Osa N, Ezpeleta L, Perera I Lluna A, Faraone SV, Ramos-Quiroga JA, Supèr H, Cañete J. Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children. J Atten Disord 2019; 23:599-614. [PMID: 29357741 DOI: 10.1177/1087054717749931] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. METHOD To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30). RESULTS We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). CONCLUSION In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.
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Affiliation(s)
- Paloma Varela Casal
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | | | | | - Alba Capdevila
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain
| | | | - Núria de la Osa
- 6 Departament de Psicologia Clínica i de la Salud, Universitat Autònoma de Barcelona, Spain
| | - Lourdes Ezpeleta
- 6 Departament de Psicologia Clínica i de la Salud, Universitat Autònoma de Barcelona, Spain
| | | | | | - Josep Antoni Ramos-Quiroga
- 2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain.,8 Hospital Universitari Vall d'Hebron, Barcelona, Spain.,9 Biomedical Network Research Centre on Mental Health, Barcelona, Spain
| | - Hans Supèr
- 3 University of Barcelona, Spain.,4 Braingaze SL, Mataró, Spain.,10 Institut de Neurociències, Universitat de Barcelona, Spain ( www.ir3c.ub.edu ).,12 Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jose Cañete
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain
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78
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Rucklidge JJ, Eggleston MJF, Darling KA, Stevens AJ, Kennedy MA, Frampton CM. Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:181-192. [PMID: 30217770 DOI: 10.1016/j.pnpbp.2018.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intent-to-treat analyses from a randomized controlled trial showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement, but no group differences on clinician, parent and teacher ratings of overall ADHD symptoms. There was an advantage of micronutrients over placebo in improving overall function, emotional regulation, aggression, and reducing impairment as well as improving inattention based on clinician but not parent observation. No group differences were observed on hyperactive-impulsive symptoms. We investigated predictors of response defined by pre-treatment variables. METHOD We conducted analyses of data from a clinical trial of children (7-12 years) with ADHD, whereby participants were randomized to receive micronutrients or placebo for 10 weeks followed by a 10 week open-label (OL) phase. We included only children who had been exposed to micronutrients for a full 10 week period and demonstrated satisfactory adherence, either in RCT phase (n = 40) or OL phase (those who received placebo during RCT phase; n = 31). Seven outcomes were examined: change in ADHD symptoms (clinician/parent), ADHD responder, overall responder, change in mood, change in functioning, and change in aggression. Demographic, developmental variables, current clinical and physical characteristics, MTHFR genotype at two common variants, and pre-treatment serum/plasma levels (vitamin D, B12, folate, zinc, copper, iron, ferritin, potassium, calcium, magnesium, and homocysteine) were all considered as putative predictors. RESULTS Substantial nutrient deficiencies pre-treatment were observed only for vitamin D (13%) and copper (15%), otherwise most children entered the trial with nutrient levels falling within expected ranges. Regression analyses showed varying predictors across outcomes with no one predictor being consistently identified across different variables. Lower pre-treatment folate and B12 levels, being female, greater severity of symptoms and co-occurring disorders pre-treatment, more pregnancy complications and fewer birth problems were identified as possible predictors of greater improvement for some but not all outcome measures although predictive values were weak. Lower IQ and higher BMI predicted greater improvement in aggression. CONCLUSIONS This study replicates Rucklidge et al. (2014b) showing the limited value of using serum nutrient levels to predict treatment response although we cannot rule out that other non-assayed nutrient levels may be more valuable. Additionally, no specific demographic or clinical characteristics, including MTHFR genetic status, were identified that would preclude children with ADHD from trying this treatment approach.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand.
| | | | - Kathryn A Darling
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Aaron J Stevens
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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79
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Huang YH, Zeng BY, Li DJ, Cheng YS, Chen TY, Liang HY, Yang WC, Lin PY, Chen YW, Tseng PT, Lin CH. Significantly lower serum and hair magnesium levels in children with attention deficit hyperactivity disorder than controls: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:134-141. [PMID: 30496768 DOI: 10.1016/j.pnpbp.2018.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 01/01/2023]
Abstract
The pathophysiology of attention deficient hyperactivity disorder (ADHD) is still obscure. Some studies have discussed that magnesium levels are lower in the serum and erythrocytes of children with ADHD. However, these findings are controversial. The aim of our study is to identify whether magnesium levels are in fact lower in children with ADHD. We conducted a thorough search of the literature and examined the connection between magnesium insufficiency and ADHD. A total of twelve studies were included into the current meta-analysis. The results of our meta-analysis found that peripheral blood magnesium levels, either in plasma, serum, or whole blood, of children diagnosed with ADHD were significantly lower than those in controls (k = 8, Hedges' g = -0.547, 95% CI = -0.818 to -0.276, p < .001). The subgroup meta-analysis with serum sample sources also suggested that peripheral serum magnesium levels of children diagnosed with ADHD were significantly lower than those in controls (k = 6, Hedges' g = -0.733, 95% CI = -0.911 to -0.555, p < .001). The subgroup meta-analysis focusing on subjects with ADHD diagnosed by definite diagnostic criteria also suggested significantly lower peripheral serum magnesium levels in ADHD children than those in controls (k = 4, Hedges' g = -0.780, 95% CI = -0.985 to -0.574, p < .001). We also noted that magnesium levels in the hair of children diagnosed with ADHD were significantly lower than those in controls (k = 4, Hedges' g = -0.713, 95% CI = -1.359 to -0.067, p = .031). In this meta-analysis, we found that children diagnosed with ADHD have lower serum and hair magnesium levels than children without ADHD. Further study may be needed to investigate the behavioral influence on ADHD due to lower magnesium levels, the association between brain and serum magnesium levels, and the effects brought about by larger longitudinal cohort studies.
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Affiliation(s)
- Yu-Hui Huang
- Department of Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Jen-Ai's Home, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Yi Liang
- Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan and Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chieh Yang
- Department of Pediatrics, Da-An Women and Children Hospital, Tainan, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in the Specialty of Psychiatry, Kaohsiung City, Taiwan.
| | - Ching-Hua Lin
- Department of Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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80
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Smoller JW, Andreassen OA, Edenberg HJ, Faraone SV, Glatt SJ, Kendler KS. Psychiatric genetics and the structure of psychopathology. Mol Psychiatry 2019; 24:409-420. [PMID: 29317742 PMCID: PMC6684352 DOI: 10.1038/s41380-017-0010-4] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022]
Abstract
For over a century, psychiatric disorders have been defined by expert opinion and clinical observation. The modern DSM has relied on a consensus of experts to define categorical syndromes based on clusters of symptoms and signs, and, to some extent, external validators, such as longitudinal course and response to treatment. In the absence of an established etiology, psychiatry has struggled to validate these descriptive syndromes, and to define the boundaries between disorders and between normal and pathologic variation. Recent advances in genomic research, coupled with large-scale collaborative efforts like the Psychiatric Genomics Consortium, have identified hundreds of common and rare genetic variations that contribute to a range of neuropsychiatric disorders. At the same time, they have begun to address deeper questions about the structure and classification of mental disorders: To what extent do genetic findings support or challenge our clinical nosology? Are there genetic boundaries between psychiatric and neurologic illness? Do the data support a boundary between disorder and normal variation? Is it possible to envision a nosology based on genetically informed disease mechanisms? This review provides an overview of conceptual issues and genetic findings that bear on the relationships among and boundaries between psychiatric disorders and other conditions. We highlight implications for the evolving classification of psychopathology and the challenges for clinical translation.
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Affiliation(s)
- Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Ole A Andreassen
- NORMENT-KG Jebsen Centre, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephen J Glatt
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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81
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Yang R, Zhang Y, Gao W, Lin N, Li R, Zhao Z. Blood Levels of Trace Elements in Children with Attention-Deficit Hyperactivity Disorder: Results from a Case-Control Study. Biol Trace Elem Res 2019; 187:376-382. [PMID: 29909491 DOI: 10.1007/s12011-018-1408-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
Some trace elements may participate in the pathogenesis of attention-deficit hyperactivity disorder (ADHD). This study aimed to investigate the trace element status of zinc (Zn), copper (Cu), iron (Fe), magnesium (Mg), and lead (Pb) in children with ADHD, and to compare them with normal controls. Associations between examined elements and SNAP-IV rating scores of ADHD symptoms were also assessed. Four hundred nineteen children with ADHD (8.8 ± 2.1 years) and 395 matched normal controls (8.9 ± 1.7 years) were recruited in the study. The concentrations of Zn, Fe, Cu, Mg, and Pb in the whole blood were measured by atomic absorption spectrometry. Lower zinc levels (P < 0.001) and the number out of normal ranges (P = 0.015) were found in children with ADHD when compared with the normal control group. The difference remained when adjusting the factor of BMI z-score. No significant between-group differences were found in levels of other elements. Zinc levels were negatively correlated with parent-rated scores of inattentive subscale of SNAP-IV (r = - 0.40) as well as with total score of SNAP-IV (r = - 0.24). Other significant associations were not observed. The present results indicated that there were alterations in blood levels of zinc, which was associated with the symptom scores of ADHD.
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Affiliation(s)
- Rongwang Yang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China.
| | - Yanyi Zhang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Nannan Lin
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Rong Li
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Zhengyan Zhao
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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82
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Medin T, Jensen V, Skare Ø, Storm-Mathisen J, Hvalby Ø, Bergersen LH. Altered α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor function and expression in hippocampus in a rat model of attention-deficit/hyperactivity disorder (ADHD). Behav Brain Res 2018; 360:209-215. [PMID: 30552946 DOI: 10.1016/j.bbr.2018.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/22/2022]
Abstract
Glutamatergic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) carry the bulk of excitatory synaptic transmission. Their modulation plays key roles in synaptic plasticity, which underlies hippocampal learning and memory. A dysfunctional glutamatergic system may negatively affect learning abilities and underlie symptoms of attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate whether the expression and function of AMPARs were altered in ADHD. We recorded AMPAR mediated synaptic transmission at hippocampal excitatory synapses and quantified immunogold labelling density of AMPAR subunits GluA1 and GluA2/3 in a rat model for ADHD; the spontaneously hypertensive rat (SHR). Electrophysiological recordings showed significantly reduced AMPAR mediated synaptic transmission at the CA3-to-CA1 pyramidal cell synapses in stratum radiatum and stratum oriens in SHRs compared to control rats. Electronmicroscopic immunogold quantifications did not show any statistically significant changes in labelling densities of the GluA1 subunit of the AMPAR on dendritic spines in stratum radiatum or in stratum oriens. However, there was a significant increase of the GluA2/3 subunit intracellularly in stratum oriens in SHR compared to control, interpreted as a compensatory effect. The proportion of synapses lacking AMPAR subunit labelling was the same in the two genotypes. In addition, electronmicroscopic examination of tissue morphology showed the density of this type of synapse (i.e., asymmetric synapses on spines), and the average size of the synaptic membranes, to be the same. AMPAR dysfunction, possibly involving molecular changes, in hippocampus may in part reflect altered learning in individuals with ADHD.
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Affiliation(s)
- Tirill Medin
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, P.O. Box 4, St. Olavs Plass, 0130, Oslo, Norway; The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Department of Oral Biology, University of Oslo, NO-0316, Oslo, Norway; Synaptic Neurochemistry and Amino Acid Transporters Labs, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB) and Healthy Brain Ageing Centre (SERTA), University of Oslo, NO-0317, Oslo, Norway.
| | - Vidar Jensen
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB), University of Oslo, NO-0317, Oslo, Norway
| | - Øyvind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Jon Storm-Mathisen
- Synaptic Neurochemistry and Amino Acid Transporters Labs, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB) and Healthy Brain Ageing Centre (SERTA), University of Oslo, NO-0317, Oslo, Norway
| | - Øyvind Hvalby
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB), University of Oslo, NO-0317, Oslo, Norway
| | - Linda Hildegard Bergersen
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Department of Oral Biology, University of Oslo, NO-0316, Oslo, Norway; Synaptic Neurochemistry and Amino Acid Transporters Labs, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB) and Healthy Brain Ageing Centre (SERTA), University of Oslo, NO-0317, Oslo, Norway; Center for Healthy Aging, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, DK-2200, Copenhagen N, Denmark
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83
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Schloß S, Müller V, Becker K, Skoluda N, Nater UM, Pauli-Pott U. Hair cortisol concentration in mothers and their children: roles of maternal sensitivity and child symptoms of attention-deficit/hyperactivity disorder. J Neural Transm (Vienna) 2018; 126:1135-1144. [PMID: 30374597 DOI: 10.1007/s00702-018-1944-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/14/2018] [Indexed: 01/26/2023]
Abstract
Associations between mothers' and children's cortisol secretion parameters are well established. According to the bio-behavioral synchrony model, these associations reflect influences of the mother-child relationship, the child's social adjustment, and might also reflect shared genetic dispositions. From the bio-behavioral synchrony model, we predicted a stronger mother-child hair cortisol concentration (HCC) link in mothers showing highly adequate (compared to those showing less adequate) parenting behaviors and in children showing low (compared to those showing high) ADHD symptoms. From a genetic perspective, no such moderator effects, or a stronger mother-child HCC link in children with high ADHD symptoms, can be expected. The study sample consisted of 111 4-5-year-old children (64 of whom screened positive for increased ADHD symptoms) and their mothers. ADHD symptoms were assessed by a clinical interview and parent and teacher questionnaires. Maternal sensitive/responsive parenting behavior was assessed by an at-home behavior observation procedure. In mothers and children, HCC in the most proximal 3-cm scalp hair segment was analyzed using luminescence immunoassay. Overall HCCs of mothers and their children correlated significantly. Maternal sensitivity/responsiveness and child ADHD symptoms proved to be significant moderator variables of this association: High maternal sensitivity/responsiveness and low ADHD symptoms of the child were associated with a stronger mother-child link in HCC. The findings are in line with the bio-behavioral synchrony model in the mother-child relationship, and are less compatible with a genetic perspective. The results might hint at environmental events influencing the development of stress axis functioning in subgroups of preschoolers with high ADHD symptoms.
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Affiliation(s)
- Susan Schloß
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Viola Müller
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Nadine Skoluda
- Clinical Biopsychology, Department of Psychology, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.,Clinical Psychology, Department of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
| | - Urs M Nater
- Clinical Biopsychology, Department of Psychology, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.,Clinical Psychology, Department of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
| | - Ursula Pauli-Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany.
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84
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Wang LJ, Yu YH, Fu ML, Yeh WT, Hsu JL, Yang YH, Chen WJ, Chiang BL, Pan WH. Attention deficit-hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin. Sci Rep 2018; 8:10229. [PMID: 29980754 PMCID: PMC6035203 DOI: 10.1038/s41598-018-28702-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/28/2018] [Indexed: 12/12/2022] Open
Abstract
This study investigated whether common comorbidities or biochemical factors, such as allergic disease, anemia, inflammation, and neurotransmitters, are singly or additively associated with an increased risk of attention deficit–hyperactivity disorder (ADHD). We recruited 216 children diagnosed with ADHD and 216 age-, sex-, height-, weight-, and class-matched controls from 31 elementary schools in Taipei, Taiwan. The International Study of Asthma and Allergies in Childhood questionnaire was used to measure allergic symptoms. Fasting venous blood was collected and analyzed for complete blood count, white blood cell differential count, immunoglobulin (Ig) E level, and serotonin (5-HT) level. The results showed that symptoms of both rhinitis (OR = 2.08, 95% CI = 1.42–3.05) and eczema (OR = 1.72, 95% CI = 1.02–2.88) were significantly associated with increased risk of ADHD. Children with ADHD showed considerably lower levels of hemoglobin (p = 0.001) and 5-HT (p < 0.001) and higher IgE level (p < 0.001) and eosinophil count (p = 0.001) than did control children. ADHD risk increased with the number of aforementioned biochemical risk factors present (one factor: OR = 1.87, 95% CI = 0.87–4.18; two factors: OR = 2.90, 95% CI = 1.29–6.48; three factors: OR = 4.47, 95% CI = 1.97–10.13; four factors: OR = 6.53, 95% CI = 2.43–17.57). Findings suggest that either ADHD’s etiology is multidimensional or the aforementioned conditions have shared etiology with ADHD.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Hui Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Ling Fu
- Department of Food and Nutrition, Chung-Hwa University of Medical Technology, Tainan, Taiwan
| | - Wen-Ting Yeh
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jung-Lung Hsu
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. .,Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan.
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85
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Kamradt JM, Momany AM, Nikolas MA. A meta-analytic review of the association between cortisol reactivity in response to a stressor and attention-deficit hyperactivity disorder. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2018; 10:99-111. [PMID: 28875432 PMCID: PMC5837926 DOI: 10.1007/s12402-017-0238-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
A substantial literature suggests that abnormal cortisol reactivity may be a vulnerability for deleterious mental health outcomes, including ADHD. ADHD has been linked with difficulty in emotion regulation and increased risk of experiencing stressors, both of which may be related to psychobiological abnormalities (e.g., abnormal cortisol reactivity). Research has been mixed regarding the association between cortisol reactivity and ADHD. Therefore, the present meta-analytic review (k = 12) sought to quantify this association and review the relevant methodological issues and theoretical implications of this area of research. Overall, no effect was found between cortisol reactivity and ADHD (r = 0), although significant heterogeneity in the analyses suggested that there might be moderators of this association, if one does exist. Results highlight the importance of addressing limitations of the current literature on cortisol reactivity and ADHD and exploring additional indices of emotion regulation that may be associated with ADHD. Implications for future research efforts are discussed.
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Affiliation(s)
- Jaclyn M Kamradt
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA.
| | - Allison M Momany
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA
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86
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Ramalho R, Pereira AC, Vicente F, Pereira P. Docosahexaenoic acid supplementation for children with attention deficit hyperactivity disorder: A comprehensive review of the evidence. Clin Nutr ESPEN 2018; 25:1-7. [PMID: 29779801 DOI: 10.1016/j.clnesp.2018.03.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is considered the most common behavioural disorder in school-age children. ADHD is a complex and multifactorial disorder characterised by a variety of symptoms, including concentration problems, excessive motor activity and impulsivity which interferes with execution of simple school tasks. Diagnosis has been essentially subjective, since no specific laboratory tests are available. However, ADHD remains overdiagnosed, probably due to social pressures for children to be successful in school from an early age, which leads parents to seek medical support. Although therapeutic approaches for ADHD have been essentially pharmacologic, in recent years several studies were performed to investigate the role of nutrition, especially omega 3 polyunsaturated fatty acid (omega 3-PUFA), in the development and treatment of this disorder. In this review, the authors gathered the most relevant evidence regarding omega 3-PUFA, mainly docosahexaenoic acid, as coadjutant or as a single therapy, in the management of ADHD symptoms. The authors also reviewed this disorder's current medical and therapeutic features.
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Affiliation(s)
- Renata Ramalho
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal.
| | - Ana Colaço Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Filipa Vicente
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Paula Pereira
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
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87
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Verlaet AAJ, Maasakkers CM, Hermans N, Savelkoul HFJ. Rationale for Dietary Antioxidant Treatment of ADHD. Nutrients 2018; 10:nu10040405. [PMID: 29587355 PMCID: PMC5946190 DOI: 10.3390/nu10040405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 12/27/2022] Open
Abstract
Increasing understanding arises regarding disadvantages of stimulant medication in children with ADHD (Attention-Deficit Hyperactivity Disorder). This review presents scientific findings supporting dietary antioxidant treatment of ADHD and describes substantial alterations in the immune system, epigenetic regulation of gene expression, and oxidative stress regulation in ADHD. As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation, as well as by neuronal oxidative damage and loss of normal cerebral functions. Therefore, modulation of immune system activity and oxidant-antioxidant balance using nutritional approaches might have potential in ADHD treatment. The use of natural antioxidants against oxidative conditions is an emerging field in the management of neurodegenerative diseases. Dietary polyphenols, for example, have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy. This review can stimulate the development and investigation of dietary antioxidant treatment in ADHD, which is highly desired.
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Affiliation(s)
- Annelies A J Verlaet
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
| | - Carlijn M Maasakkers
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
- Cell Biology and Immunology Group, Wageningen University, De Elst 1 Building 122, 6709 PG Wageningen, The Netherlands.
| | - Nina Hermans
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
| | - Huub F J Savelkoul
- Cell Biology and Immunology Group, Wageningen University, De Elst 1 Building 122, 6709 PG Wageningen, The Netherlands.
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88
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Schloß S, Ruhl I, Müller V, Becker K, Skoluda N, Nater UM, Pauli-Pott U. Low hair cortisol concentration and emerging attention-deficit/hyperactivity symptoms in preschool age. Dev Psychobiol 2018; 60:722-729. [DOI: 10.1002/dev.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/21/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Susan Schloß
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Philipps-University of Marburg; Marburg Germany
| | - Isabelle Ruhl
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Philipps-University of Marburg; Marburg Germany
| | - Viola Müller
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Philipps-University of Marburg; Marburg Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Philipps-University of Marburg; Marburg Germany
| | - Nadine Skoluda
- Clinical Biopsychology; Department of Psychology; Philipps-University of Marburg; Marburg Germany
- Department of Psychiatry and Psychotherapy; University of Tübingen; Tübingen Germany
| | - Urs M. Nater
- Clinical Biopsychology; Department of Psychology; Philipps-University of Marburg; Marburg Germany
- Clinical Psychology; Department of Psychology; University of Vienna; Vienna Austria
| | - Ursula Pauli-Pott
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Philipps-University of Marburg; Marburg Germany
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89
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Işık Ü, Bilgiç A, Toker A, Kılınç I. Serum levels of cortisol, dehydroepiandrosterone, and oxytocin in children with attention-deficit/hyperactivity disorder combined presentation with and without comorbid conduct disorder. Psychiatry Res 2018; 261:212-219. [PMID: 29324397 DOI: 10.1016/j.psychres.2017.12.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/10/2017] [Accepted: 12/31/2017] [Indexed: 01/02/2023]
Abstract
The present study aimed to investigate serum cortisol, dehydroepiandrosterone (DHEA), and oxytocin levels of children with attention-deficit/hyperactivity disorder (ADHD) combined presentation and those diagnosed with ADHD combined presentation and coexisting conduct disorder. A total of 74 drug-naive children with ADHD combined presentation alone, 32 children with ADHD combined presentation + conduct disorder, and 42 healthy controls were included. The severities of ADHD and conduct disorder symptoms were assessed via parent- and teacher-rated questionnaires. The severity of aggression, anxiety, and depression symptoms of the children were assessed by the self-report inventories. Independent of potential confounders, including age, sex, pubertal stage, and severity of depression and anxiety, serum oxytocin levels of the ADHD combined presentation + conduct disorder group were significantly lower than those of both the ADHD combined presentation alone and control groups. There was also a trend for the ADHD combined presentation + conduct disorder group to show lower serum DHEA levels than that of the ADHD combined presentation alone group. However, serum cortisol levels did not show significant alterations among the groups. These findings suggest that oxytocin and DHEA may play a role in the pathophysiology of conduct disorder, at least in the presence of ADHD combined presentation.
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Affiliation(s)
- Ümit Işık
- Department of Child and Adolescent Psychiatry, Yozgat City Hospital, Yozgat, Turkey.
| | - Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Ibrahim Kılınç
- Department of Biochemistry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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90
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Bonvicini C, Faraone SV, Scassellati C. Common and specific genes and peripheral biomarkers in children and adults with attention-deficit/hyperactivity disorder. World J Biol Psychiatry 2018; 19:80-100. [PMID: 28097908 PMCID: PMC5568996 DOI: 10.1080/15622975.2017.1282175] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Elucidating the biological mechanisms involved in attention-deficit/hyperactivity disorder (ADHD) has been challenging. Relatively unexplored is the fact that these mechanisms can differ with age. METHODS We present an overview on the major differences between children and adults with ADHD, describing several studies from genomics to metabolomics performed in ADHD children and in adults (cADHD and aADHD, respectively). A systematic search (up until February 2016) was conducted. RESULTS From a PRISMA flow-chart, a total of 350 and 91 genomics and metabolomics studies were found to be elligible for cADHD and aADHD, respectively. For children, associations were found for genes belonging to dopaminergic (SLC6A3, DRD4 and MAOA) and neurodevelopmental (LPHN3 and DIRAS2) systems and OPRM1 (Yates corrected P = 0.016; OR = 2.27 95%CI: 1.15-4.47). Studies of adults have implicated circadian rhythms genes, HTR2A, MAOB and a more generic neurodevelopmental/neurite outgrowth network (BCHE, SNAP25, BAIAP2, NOS1/NO, KCNIP4 and SPOCK3; Yates corrected P = 0.007; OR = 3.30 95%CI: 1.33-8.29). In common among cADHD and aADHD, the most significant findings are for oxidative stress proteins (MAD, SOD, PON1, ARES, TOS, TAS and OSI), and, in the second level, DISC1, DBH, DDC, microRNA and adiponectin. CONCLUSIONS Through a convergent functional genomics, this review contributes to clarification of which genetic/biological mechanisms differ with age. The effects of some genes do not change throughout the lifetime, whereas others are linked to age-specific stages. Additional research and further studies are needed to generate firmer conclusions that might someday be useful for predicting the remission and persistence of the disorder. Despite the limitations, some of these genes/proteins could be potential useful biomarkers to discriminate cADHD from aADHD.
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Affiliation(s)
- Cristian Bonvicini
- Genetics Unit, IRCCS “Centro S. Giovanni di Dio” Fatebenefratelli, Brescia, Italy
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Catia Scassellati
- Genetics Unit, IRCCS “Centro S. Giovanni di Dio” Fatebenefratelli, Brescia, Italy
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91
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Gu X, Yuan FF, Huang X, Hou Y, Wang M, Lin J, Wu J. Association of PIK3CG gene polymorphisms with attention-deficit/hyperactivity disorder: A case-control study. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:169-177. [PMID: 29097255 DOI: 10.1016/j.pnpbp.2017.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/14/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a complicated neurodevelopmental disorder with high heritability. This study explores the association of PIK3CG gene single nucleotide polymorphisms (rs1129293, rs12536620, rs12667819, rs17847825, rs2230460) with ADHD in children and the relation of interaction between SNPs and environmental factors, including blood lead levels (BLLs) and feeding style. A case-control study was conducted with children aged 6-18years old, consisting of 389 children newly diagnosed with ADHD via the DSM-IV at the Wuhan Women and Children Medical Care Center, and 393 control participants were healthy children for physical examination during the same period. All participants were tested using the Chinese Wechsler Intelligence Scale for Children and Parent Symptom Questionnaire (PSQ). Furthermore, a self-designed questionnaire was used to investigate the general situation and related environmental factors, and the BLLs were measured by atomic absorption spectrophotometry. The genotyping was performed using Sequenom MassArray. In our study, PIK3CG gene rs12667819 was consistently shown to be associated with ADHD risk in dominant model (OR=1.656, 95% CI=1.229-2.232), ADHD-I type (OR=2.278, 95% CI=1.666-4.632), and symptom scores. Moreover, rs12536620 has been observed to be related to ADHD-C type and symptom scores. Intriguingly, gene-environmental interactions analysis consistently revealed the potential interactions of rs12667819 collaborating with blood lead (Pmul=0.045) and feeding style (Pmul=0.041) to modify ADHD risk. Expression quantitative trait loci analysis suggested that rs12667819 may mediate PIK3CG gene expression. Therefore, our results suggest that selected PIK3CG gene variants may have a significant effect on ADHD risk.
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Affiliation(s)
- Xue Gu
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Fang-Fen Yuan
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Xin Huang
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Yuwei Hou
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Min Wang
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China
| | - Jun Lin
- Department of Rehabilitation, Wuhan Women and Children Medical Care Center, No. 100 Hong Kong Road, Wuhan 430015, People's Republic of China
| | - Jing Wu
- Key Laboratory of Environment and Health, Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, People's Republic of China.
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92
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Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Sci Rep 2018; 8:788. [PMID: 29335588 PMCID: PMC5768671 DOI: 10.1038/s41598-017-19096-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/16/2017] [Indexed: 01/11/2023] Open
Abstract
There is growing recognition that the risk of attention-deficit hyperactivity disorder (ADHD) in children may be influenced by micronutrient deficiencies, including iron. We conducted this meta-analysis to examine the association between ADHD and iron levels/iron deficiency (ID). We searched for the databases of the PubMed, ScienceDirect, Cochrane CENTRAL, and ClinicalTrials.gov up to August 9th, 2017. Primary outcomes were differences in peripheral iron levels in children with ADHD versus healthy controls (HCs) and the severity of ADHD symptoms in children with/without ID (Hedges' g) and the pooled adjusted odds ratio (OR) of the association between ADHD and ID. Overall, seventeen articles met the inclusion criteria. Peripheral serum ferritin levels were significantly lower in ADHD children (children with ADHD = 1560, HCs = 4691, Hedges' g = -0.246, p = 0.013), but no significant difference in serum iron or transferrin levels. In addition, the severity of ADHD was significantly higher in the children with ID than those without ID (with ID = 79, without ID = 76, Hedges' g = 0.888, p = 0.002), and there was a significant association between ADHD and ID (OR = 1.636, p = 0.031). Our results suggest that ADHD is associated with lower serum ferritin levels and ID. Future longitudinal studies are required to confirm these associations and to elucidate potential mechanisms.
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93
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Shih JH, Zeng BY, Lin PY, Chen TY, Chen YW, Wu CK, Tseng PT, Wu MK. Association between peripheral manganese levels and attention-deficit/hyperactivity disorder: a preliminary meta-analysis. Neuropsychiatr Dis Treat 2018; 14:1831-1842. [PMID: 30140155 PMCID: PMC6054766 DOI: 10.2147/ndt.s165378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Evidence has suggested that dysregulation of the dopaminergic system may play a significant role in the pathogenesis of attention-deficit/hyperactivity disorder (ADHD) in children. Manganese, a neurotoxicant, has been reported to exert its neurotoxicity by affecting the dopaminergic system. However, the association between peripheral manganese levels and ADHD has not been comprehensively reviewed. This study aimed to investigate the association between peripheral manganese levels and ADHD in children. An electronic search was performed on databases including PubMed, ProQuest, ClinicalKey, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and ScienceDirect with last search on March 25th, 2018. As per the inclusion criteria, human observational studies investigating peripheral manganese levels in children with ADHD and controls were included. The meta-analysis was performed using a random-effects model, and possible confounders were examined by subgroup analysis. In total, four articles with 175 ADHD children and 999 controls were recruited. The manganese levels were significantly higher in ADHD children than in controls (p=0.033), when studies investigating blood levels and those investigating hair levels were included. However, when only studies investigating blood levels were included, there was no significant difference between ADHD children and controls (p=0.076). Our results support higher peripheral manganese levels in children diagnosed with ADHD than those in controls. Further primary studies are needed to clarify this association.
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Affiliation(s)
- Jun-Hao Shih
- Department of Occupational and Environmental Health Consultation, EMHA Consulting International Incorporation, Hsinchu, Taiwan.,Taiwan Environmental and Occupational Medicine Association, Tainan, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, .,Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan
| | - Ching-Kuan Wu
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan,
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan,
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Wang LJ, Li SC, Lee MJ, Chou MC, Chou WJ, Lee SY, Hsu CW, Huang LH, Kuo HC. Blood-Bourne MicroRNA Biomarker Evaluation in Attention-Deficit/Hyperactivity Disorder of Han Chinese Individuals: An Exploratory Study. Front Psychiatry 2018; 9:227. [PMID: 29896131 PMCID: PMC5987559 DOI: 10.3389/fpsyt.2018.00227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly genetic neurodevelopmental disorder, and its dysregulation of gene expression involves microRNAs (miRNAs). The purpose of this study was to identify potential miRNAs biomarkers and then use these biomarkers to establish a diagnostic panel for ADHD. Design and methods: RNA samples from white blood cells (WBCs) of five ADHD patients and five healthy controls were combined to create one pooled patient library and one control library. We identified 20 candidate miRNAs with the next-generation sequencing (NGS) technique (Illumina). Blood samples were then collected from a Training Set (68 patients and 54 controls) and a Testing Set (20 patients and 20 controls) to identify the expression profiles of these miRNAs with real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). We used receiver operating characteristic (ROC) curves and the area under the curve (AUC) to evaluate both the specificity and sensitivity of the probability score yielded by the support vector machine (SVM) model. Results: We identified 13 miRNAs as potential ADHD biomarkers. The ΔCt values of these miRNAs in the Training Set were integrated to create a biomarker model using the SVM algorithm, which demonstrated good validity in differentiating ADHD patients from control subjects (sensitivity: 86.8%, specificity: 88.9%, AUC: 0.94, p < 0.001). The results of the blind testing showed that 85% of the subjects in the Testing Set were correctly classified using the SVM model alignment (AUC: 0.91, p < 0.001). The discriminative validity is not influenced by patients' age or gender, indicating both the robustness and the reliability of the SVM classification model. Conclusion: As measured in peripheral blood, miRNA-based biomarkers can aid in the differentiation of ADHD in clinical settings. Additional studies are needed in the future to clarify the ADHD-associated gene functions and biological mechanisms modulated by miRNAs.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sung-Chou Li
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Miao-Chun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lien-Hung Huang
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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95
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Hair cortisol concentration in preschoolers with attention-deficit/hyperactivity symptoms-Roles of gender and family adversity. Psychoneuroendocrinology 2017; 86:25-33. [PMID: 28910602 DOI: 10.1016/j.psyneuen.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/14/2017] [Accepted: 09/01/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Previous studies on the association between hypothalamic-pituitary-adrenal axis (HPAA) activity and ADHD yielded inconsistent findings, particularly in younger children. This might be due to the heterogeneity of the disorder, making moderator effects of variables probable, which circumscribe more homogenous subgroups. There have been indications of moderator effects on this association by gender of child and exposure to family adversity. Moreover, difficulties in capturing long-term basal HPAA activity in younger children might have contributed to the inconsistencies. We therefore analyzed moderator effects of gender and family adversity while using the hair cortisol concentration (HCC) to assess integrated long-term HPAA. METHODS The community-based sample consisted of 122 4-5-year-old preschoolers (71 screened positive for elevated ADHD symptoms). ADHD symptoms were measured by a clinical parent interview and parent and teacher questionnaires. HCC in the most proximal 3-cm scalp hair segment was analyzed using luminescence immunoassay. An extended family adversity index was used. RESULTS Hierarchical linear regression analyses yielded an interaction effect (p<.05) between ADHD symptom groups and gender on HCC, indicating a low HCC in boys with elevated ADHD symptoms. Further exploratory analyses revealed that this interaction effect was most pronounced under the condition of family adversity. The results held after controlling for oppositional, anxiety, and depressive symptoms. CONCLUSION Low HCC might indicate a specific pathogenic mechanism in boys with elevated ADHD symptoms. This mechanism might further involve an exposure to family adversity. However, the results need to be cross-validated before definitive conclusions can be drawn.
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96
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Kuppili PP, Manohar H, Pattanayak RD, Sagar R, Bharadwaj B, Kandasamy P. ADHD research in India: A narrative review. Asian J Psychiatr 2017; 30:11-25. [PMID: 28709018 DOI: 10.1016/j.ajp.2017.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with no clear etiopathogenesis. Owing to unique socio cultural milieu of India, it is worthwhile reviewing research on ADHD from India and comparing findings with global research. Thereby, we attempted to provide a comprehensive overview of research on ADHD from India. METHODS A boolean search of articles published in English from September 1966 to January 2017 on electronic search engines Google Scholar, PubMed, IndMED, MedIND, using the search terms "ADHD", "Attention Deficit and Hyperactivity Disorder", "Hyperactivity" ,"Child psychiatry", "Hyperkinetic disorder", "Attention Deficit Disorder", "India"was carried out and peer - reviewed studies conducted among human subjects in India were included for review. Case reports, animal studies, previous reviews were excluded from the current review. RESULTS Results of 73 studies found eligible for the review were organized into broad themes such as epidemiology, etiology, course and follow up, clinical profile and comorbidity, assessment /biomarkers, intervention/treatment parameters, pathways to care and knowledge and attitude towards ADHD. DISCUSSION There was a gap noted in research from India in the domains of biomarkers, course and follow up and non-pharmacological intervention. The prevalence of ADHD as well as comorbidity of Bipolar Disorder was comparatively lower compared to western studies. The studies found unique to India include comparing the effect of allopathic intervention with Ayurvedic intervention, yoga as a non pharmacological intervention. There is a need for studies from India on biomarkers, studies with prospective research design, larger sample size and with matched controls.
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Affiliation(s)
- Pooja Patnaik Kuppili
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India.
| | - Harshini Manohar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India.
| | - Raman Deep Pattanayak
- Room No. 4091, Department of Psychiatry, 4th Floor Academic Block, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
| | - Rajesh Sagar
- Department of Psychiatry, 4th Floor Academic Block, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Preeti Kandasamy
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
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Changes in serum levels of kynurenine metabolites in paediatric patients affected by ADHD. Eur Child Adolesc Psychiatry 2017; 26:1433-1441. [PMID: 28527020 DOI: 10.1007/s00787-017-1002-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/12/2017] [Indexed: 12/14/2022]
Abstract
This study aims at determining serum levels of tryptophan and other metabolites of the kynurenine pathway in children with attention deficit hyperactivity disorder (ADHD) compared to healthy controls. Such metabolites interact with glutamate receptors in the central nervous system, potentially modulating mechanisms that are pivotal in ADHD and thus potentially representing peripheral biomarkers of the disorder. We measured serum levels of tryptophan and some metabolites of the kynurenine pathway in 102 children with ADHD and 62 healthy controls by liquid chromatography-tandem mass spectrometry (LC-MS/MS). As compared to healthy controls, children with ADHD showed a reduction in serum levels of anthranilic acid (-60%), kynurenic acid (-11.2%), and xanthurenic acid (-12.5%). In contrast, serum levels of tryptophan (+11.0%) and kynurenine (+48.6%) were significantly enhanced, and levels of quinolinic acid were unchanged in children with ADHD. In a logistic regression model, the presence of ADHD was predicted by low anthranilic acid and high tryptophan levels. These findings support the involvement of the kynurenine pathway in the pathophysiology of ADHD and suggest that anthranilic acid and tryptophan levels should be investigated as potential peripheral biomarker for ADHD.
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98
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Kuppili PP, Pattanayak RD, Sagar R, Mehta M, Vivekanandhan S. Thyroid and Cortisol hormones in Attention Deficit Hyperactivity Disorder: A case-control study. Asian J Psychiatr 2017; 28:73-77. [PMID: 28784401 DOI: 10.1016/j.ajp.2017.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Abstract
AIM There is paucity of research in the putative role of hormonal biomarkers in Attention Deficit Hyperactivity Disorder (ADHD). The current study aimed to analyze the clinical profile, socio-demographic status, co-morbidity, hormonal biomarkers namely Thyroid hormones and Cortisol in children with ADHD and compare them with healthy controls and to explore the association of the hormonal biomarkers with severity of ADHD. METHODS Thirty children with DSM-IV TR diagnosis of ADHD were assessed using semi structured proforma, Conners' Parent Rating Scale revised short (CPRS - R: S) , Mini international neuropsychiatric interview for children and adolescents and Childrens' Global Assessment Scale as well as serum levels of total Triiodothyronine (T3) ,total Thyroxine (T4) , Thyroid Stimulating Hormone (TSH) and Cortisol using chemiluminescent immunometric assay and compared with 30 age- and gender -matched controls. RESULTS The typical profile of cases of ADHD was of a male with mean age of 9.47 years (S.D=2.43) belonging to Hyperactive subtype of ADHD. Serum T4 was significantly lower in cases compared to controls. No significant difference was found in serum T3, TSH and Cortisol levels. No significant correlation between the CPRS : R-S scores and the hormonal biomarkers. CONCLUSIONS There is need for exploration of Serum T4 as putative biomarker for ADHD with replication in future studies. It may also be important to report the negative finding of Cortisol as a biomarker of ADHD in the context of effective utilization of resources for research with special relevance to resource deficit developing countries.
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Affiliation(s)
- Pooja Patnaik Kuppili
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India.
| | | | - Rajesh Sagar
- Department of Psychiatry, AIIMS , New Delhi, India.
| | - Manju Mehta
- Clinical Psychology, Department of Psychiatry, AIIMS , New Delh, India.
| | - S Vivekanandhan
- Department of Neurobiochemistry, Neurosciences Centre, AIIMS, New Delhi, India.
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99
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Increased Oxidative Parameters and Decreased Cytokine Levels in an Animal Model of Attention-Deficit/Hyperactivity Disorder. Neurochem Res 2017; 42:3084-3092. [PMID: 28664398 DOI: 10.1007/s11064-017-2341-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/25/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly heterogeneous disorder characterized by impairing levels of hyperactivity, impulsivity and inattention. Oxidative and inflammatory parameters have been recognized among its multiple predisposing pathways, and clinical studies indicate that ADHD patients have increased oxidative stress. In this study, we aimed to evaluate oxidative (DCFH oxidation, glutathione levels, glutathione peroxidase, catalase and superoxide dismutase activities) and inflammatory (TNF-α, IL-1β and IL-10) parameters in the most widely accepted animal model of ADHD, the spontaneously hypertensive rats (SHR). Prefrontal cortex, cortex (remaining regions), striatum and hippocampus of adult male SHR and Wistar Kyoto rats were studied. SHR presented increased reactive oxygen species (ROS) production in the cortex, striatum and hippocampus. In SHR, glutathione peroxidase activity was decreased in the prefrontal cortex and hippocampus. TNF-α levels were reduced in the prefrontal cortex, cortex (remaining regions), hippocampus and striatum of SHR. Besides, IL-1β and IL-10 levels were decreased in the cortex of the ADHD model. Results indicate that SHR presented an oxidative profile that is characterized by an increase in ROS production without an effective antioxidant counterbalance. In addition, this strain showed a decrease in cytokine levels, mainly TNF-α, indicating a basal deficit. These results may present a new approach to the cognitive disturbances seen in the SHR.
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100
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van der Meer D, Hoekstra PJ, van Donkelaar M, Bralten J, Oosterlaan J, Heslenfeld D, Faraone SV, Franke B, Buitelaar JK, Hartman CA. Predicting attention-deficit/hyperactivity disorder severity from psychosocial stress and stress-response genes: a random forest regression approach. Transl Psychiatry 2017; 7:e1145. [PMID: 28585928 PMCID: PMC5537639 DOI: 10.1038/tp.2017.114] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 12/20/2022] Open
Abstract
Identifying genetic variants contributing to attention-deficit/hyperactivity disorder (ADHD) is complicated by the involvement of numerous common genetic variants with small effects, interacting with each other as well as with environmental factors, such as stress exposure. Random forest regression is well suited to explore this complexity, as it allows for the analysis of many predictors simultaneously, taking into account any higher-order interactions among them. Using random forest regression, we predicted ADHD severity, measured by Conners' Parent Rating Scales, from 686 adolescents and young adults (of which 281 were diagnosed with ADHD). The analysis included 17 374 single-nucleotide polymorphisms (SNPs) across 29 genes previously linked to hypothalamic-pituitary-adrenal (HPA) axis activity, together with information on exposure to 24 individual long-term difficulties or stressful life events. The model explained 12.5% of variance in ADHD severity. The most important SNP, which also showed the strongest interaction with stress exposure, was located in a region regulating the expression of telomerase reverse transcriptase (TERT). Other high-ranking SNPs were found in or near NPSR1, ESR1, GABRA6, PER3, NR3C2 and DRD4. Chronic stressors were more influential than single, severe, life events. Top hits were partly shared with conduct problems. We conclude that random forest regression may be used to investigate how multiple genetic and environmental factors jointly contribute to ADHD. It is able to implicate novel SNPs of interest, interacting with stress exposure, and may explain inconsistent findings in ADHD genetics. This exploratory approach may be best combined with more hypothesis-driven research; top predictors and their interactions with one another should be replicated in independent samples.
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Affiliation(s)
- D van der Meer
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- K.G. Jebsen Centre for Psychosis Research/Norwegian Centre for Mental Disorder Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P J Hoekstra
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M van Donkelaar
- Department of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Bralten
- Department of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - D Heslenfeld
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - S V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
- K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - B Franke
- Department of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C A Hartman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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