1
|
Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
Collapse
Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| |
Collapse
|
2
|
Miklósi M, Kovács B, Janovicz J, Lelki F, Kassai R. Adult attention-deficit/hyperactivity symptoms and parental cognitions: a meta-analysis. Front Psychiatry 2024; 14:1321078. [PMID: 38268568 PMCID: PMC10807045 DOI: 10.3389/fpsyt.2023.1321078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Attention-deficit/hyperactivity disorder (ADHD) symptoms in adults interfere with parental functioning. Dysfunctional parental cognitions may play a role in this impairment. Despite the importance of parental cognitions on parents and children's outcomes, up to now, no systematic review or meta-analysis of these findings is available. To fill this gap, this meta-analysis aimed to evaluate the relationship between adult ADHD symptoms and parental cognitions. Methods We conducted searches in Web of Science, PubMed, and ProQuest from January 2000 to June 2023. Studies were included if they provided data on the relationship between parental ADHD symptoms and parental cognitions by means of a row correlational coefficient, or means and standard deviation were reported for each study group. A random-effects model was used. Publication bias was assessed by funnel plot and Rosenthal's fail-safe N. Moderator analyses were conducted by means of subgroup analysis and meta-regression analyses. Results Fifteen published papers were included (N = 2851), and 51 effect sizes were analysed. The weighted mean effect size was small but significant (Fisher's Z = 0.186, k = 15, 95% CI [0.120 - 0.252], z = 5.539, p < 0.001), indicating that ADHD symptoms in adults are associated with more negative and less positive parental cognitions. The Fail-Safe N analysis suggested a robust effect. Tweedie's trim and fill results suggested that five studies were missing; after five missing studies had been imputed, the mean overall effect size dropped to 0.116 (0.080 - 0.152). There was significant heterogeneity among effect sizes. The methodology of the study was found to be a significant moderator. Meta-regression analyses revealed that the lower age of the parent and the child were related to more negative parental cognitions. Discussion Though the analysis might be inflated by publication bias, our results suggest a significant association between ADHD symptom level and dysfunctional parental cognitions. Biased negative perceptions of the parental role, the child and co-parenting may play a central mediator role between parental ADHD and parent and child outcomes. Given the familiar nature of ADHD, targeting dysfunctional parental cognitions in parent training programs is warranted. Systematic review registration osf.io/pnur7.
Collapse
Affiliation(s)
- Mónika Miklósi
- Psychological Institute, Eötvös Loránd University, Budapest, Hungary
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Centre of Mental Health, Heim Pál National Paediatric Institute, Budapest, Hungary
| | - Barbara Kovács
- Psychological Institute, Eötvös Loránd University, Budapest, Hungary
| | - Júlia Janovicz
- Psychological Institute, Eötvös Loránd University, Budapest, Hungary
| | - Franciska Lelki
- Psychological Institute, Eötvös Loránd University, Budapest, Hungary
| | - Réka Kassai
- School of Doctoral Studies, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
3
|
Bär A, Bär HE, Rijkeboer MM, Lobbestael J. Early Maladaptive Schemas and Schema Modes in clinical disorders: A systematic review. Psychol Psychother 2023; 96:716-747. [PMID: 37026578 DOI: 10.1111/papt.12465] [Citation(s) in RCA: 4] [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: 07/06/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. METHODS We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non-clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. RESULTS Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. CONCLUSIONS The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.
Collapse
Affiliation(s)
- Andreas Bär
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hannah E Bär
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
4
|
Pan MR, Zhang SY, Chen CL, Qiu SW, Liu L, Li HM, Zhao MJ, Dong M, Si FF, Wang YF, Qian QJ. Bidirectional associations between maladaptive cognitions and emotional symptoms, and their mediating role on the quality of life in adults with ADHD: a mediation model. Front Psychiatry 2023; 14:1200522. [PMID: 37547201 PMCID: PMC10400449 DOI: 10.3389/fpsyt.2023.1200522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background/objectives Adults with attention-deficit/hyperactivity disorder (ADHD) have more maladaptive cognitions, emotional problems and a poorer quality of life (QoL). A verification of the psychological model in clinical samples is needed for a better understanding of the mechanisms of ADHD diagnosis on QoL via maladaptive cognitions, emotional symptoms, and their interactions. Methods 299 ADHD participants and 122 healthy controls were recruited. ADHD core symptoms, maladaptive cognitions, emotional symptoms and psychological QoL were rated. Pearson's correlation and structural equation modeling were analyzed to explore the relationship and influence of ADHD diagnosis on QoL. Results More maladaptive cognitions, emotional symptoms, and poorer QoL were found in the ADHD group, and the dysfunctional attitudes were on par between ADHD with or without medication (p = 0.368). Moderate to strong correlations were found between emotional symptoms, maladaptive cognitions and QoL, and ADHD core symptoms presented correlations among the above scores (r = 0.157 ~ 0.416, p < 0.01) in ADHD participants. The influence of ADHD diagnosis on QoL was mediated through maladaptive cognitions, emotional symptoms, and their bidirectional interactions (p < 0.05), especially those with stable medication. Conclusion Our study is the first to verify the psychological model in adults with ADHD in China. The findings determined the direct influence of ADHD diagnosis on QoL and the indirect influence through maladaptive cognitions, emotional symptoms, and their interactions, emphasizing the importance of interventions for emotional symptoms and maladaptive cognitions for ADHD patients both with or without medication for a better QoL outcome.
Collapse
Affiliation(s)
- Mei-Rong Pan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shi-Yu Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Cai-Li Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Sun-Wei Qiu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lu Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hai-Mei Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Meng-Jie Zhao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Min Dong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Fei-Fei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qiu-Jin Qian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| |
Collapse
|
5
|
van Dijk SDM, Veenstra MS, van den Brink RHS, van Alphen SPJ, Oude Voshaar RC. A Systematic Review of the Heterogeneity of Schema Therapy. J Pers Disord 2023; 37:233-262. [PMID: 37002933 DOI: 10.1521/pedi.2023.37.2.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.
Collapse
Affiliation(s)
- Silvia D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Martine S Veenstra
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob H S van den Brink
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sebastiaan P J van Alphen
- Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Richard C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
6
|
Gómez-Cano S, Zapata-Ospina JP, Arcos-Burgos M, Palacio-Ortiz JD. The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:65-72. [PMID: 37085236 DOI: 10.1016/j.rcpeng.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/05/2021] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. METHODS A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. RESULTS ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. CONCLUSIONS ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.
Collapse
Affiliation(s)
- Sujey Gómez-Cano
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan Pablo Zapata-Ospina
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Mauricio Arcos-Burgos
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Palacio-Ortiz
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
7
|
Are Perceived Executive Functions Beneficial for Adolescents Who Experience Peer Victimization? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-10005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
AbstractPeer victimization can lead to dysfunctional cognitions and numerous internalizing psychological problems. Thus, it is essential to identify factors that can moderate the impact of victimization. This study aimed to analyze the potential moderating role of perceived executive functions (PEF) in the impact of peer victimization (traditional and online) on internalizing symptoms (depression and social anxiety), early maladaptive schemas (disconnection/rejection domain), and PEF in adolescents. A two-wave longitudinal study was carried out with 680 Spanish adolescents between 12 and 17 years of age (M = 14.58, SD = 1.36; 41.18% girls). Participants completed measures of self-reported executive functions, traditional and online victimization, early maladaptive schemas of the disconnection/rejection domain, depressive symptoms, and social anxiety symptoms in waves 1 and 2. Traditional and online perpetration was completed only in wave 1. The results indicated that when PEF were high (i.e., adolescents perceive that they have good executive functions), traditional and online victimization predicted more schemas of the disconnection/rejection domain and internalizing symptoms of depression and social anxiety. In non-victims, high PEF showed a protective role in the development of depressive symptoms and schemas of the disconnection/rejection domain. The findings highlight that PEF have a protective role that disappears when victimization (traditional and online) occurs.
Collapse
|
8
|
Köse Karaca B, Armağan Küçükseymen ZC, Aytaç M, Karaosmanoğlu HA. Turkish Adaptation of the Dusseldorf Illustrated Schema Questionnaire for Children: Psychometric Properties and Relationship with Childhood Difficulties. Int J Cogn Ther 2022; 15:336-353. [PMID: 35991193 PMCID: PMC9375193 DOI: 10.1007/s41811-022-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/27/2022]
Abstract
Dusseldorf Illustrated Schema Questionnaire for Children (DISC) measures early maladaptive schemas (EMS) in childhood. EMS are emotional and cognitive rules and patterns formed in childhood and adolescence because of unmet emotional needs which are maintained throughout life and negatively affect one’s potential. The first aim of the current study is to adapt DISC to the Turkish language and examine its psychometric properties to facilitate preventive intervention during early childhood. The second aim of the study is to investigate the relationship between schemas and childhood difficulties. The sample consisted of 771 (419 females, 352 males) children of first graders (8-year-old) to twelfth graders (14-year-old) from 54 of the 81 cities in Turkey. Cronbach’s α value for the total of 36 items was calculated as .89 and α values for subscales ranged between .42 and .83. The test–retest reliability coefficient of the total of the scale was .79 at 1 month and subscales’ test–retest values ranged between .31 and .91. Confirmatory factor analysis showed a good fit for the purported 18-factor model of the original DISC in the Turkish version within a sample of children from diverse socio-economic and cultural backgrounds from Turkey. The Turkish version of the DISC indicated a reliable and valid instrument to assess maladaptive schemas in children.
Collapse
|
9
|
Pan MR, Zhang SY, Qiu SW, Liu L, Li HM, Zhao MJ, Dong M, Si FF, Wang YF, Qian QJ. Efficacy of cognitive behavioural therapy in medicated adults with attention-deficit/hyperactivity disorder in multiple dimensions: a randomised controlled trial. Eur Arch Psychiatry Clin Neurosci 2022; 272:235-255. [PMID: 33615398 DOI: 10.1007/s00406-021-01236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
The study aimed to evaluate the efficacy of group cognitive behavioural therapy (CBT) in medicated adults with attention-deficit/hyperactivity disorder (ADHD) with a multidimensional evaluation and follow-up to week 36. Ninety-eight adult ADHD were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M) only group. The primary endpoint was the ADHD-Rating Scale (ADHD-RS). Secondary endpoints included emotional symptoms, self-esteem, automatic thoughts, quality of life (QoL), and executive function (EF). The outcome measures were obtained at baseline (T1), after the 12-week CBT treatment (T2), and at two follow-up time points (week 24, T3, and week 36, T4). Compared to the M-only group, the patients in the CBT + M group showed an overall significantly greater reduction from baseline in ADHD core symptoms (ADHD-RS total score at T3, and inattention subscale at T2 and T3), depression and anxiety symptoms (T2-T4), state anxiety (T2 and T3) and trait anxiety (T2), automatic thoughts questionnaire at T3, and QoL (physical domain, psychological domain, and social domain, most significant at T3 and weakened at T4). These findings further confirmed the efficacy of CBT on multiple dimensions and verified improvements in automatic thinking in adult ADHD. The superiority of the combination treatment mainly manifested in reduced inattention, emotional symptoms, and maladaptive thoughts and improved QoL. Trial registration number ChiCTR1900021705 (March-05-2019).
Collapse
Affiliation(s)
- Mei-Rong Pan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Shi-Yu Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Sun-Wei Qiu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Lu Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Hai-Mei Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Meng-Jie Zhao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Min Dong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Fei-Fei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Qiu-Jin Qian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, 100191, China. .,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| |
Collapse
|
10
|
Gómez-Cano S, Zapata-Ospina JP, Arcos-Burgos M, Palacio-Ortiz JD. The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00048-2. [PMID: 33849717 DOI: 10.1016/j.rcp.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. METHODS A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. RESULTS ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. CONCLUSIONS ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.
Collapse
Affiliation(s)
- Sujey Gómez-Cano
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan Pablo Zapata-Ospina
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Mauricio Arcos-Burgos
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Palacio-Ortiz
- Hospital San Vicente de Paúl, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría (GIPSI), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
11
|
Kiraz S, Sertçelik S. Adult attention deficit hyperactivity disorder and early maladaptive schemas. Clin Psychol Psychother 2021; 28:1055-1064. [PMID: 33586830 DOI: 10.1002/cpp.2569] [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] [Received: 10/09/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
The purpose of the current study is to present the early maladaptive schemas in adult attention deficit hyperactivity disorder (ADHD). The study sample comprised 107 participants, including 55 adult ADHD and 52 healthy volunteers. The age of the participants ranged between 18 and 32 years. Structured Clinical Interview Form for DSM-IV Axis I (SCID-I) and Structured Clinical Interview Form for DSM-III-R Disorders (SCID-II) were applied to all participants and Diagnostic Interview for ADHD (DIVA) for ADHD group based on DSM-5 criteria. The participants filled the Young Schema Questionnaire (YSQ-S3), Adult ADHD Self-Report Scale (ASRS), Wender Utah RatingScale-25 (WURS), Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI). All maladaptive schemas were found to be statistically significantly higher in the ADHD group. As compatible with ADHD core symptoms, "Failure," "Emotional Inhibition," "Insufficient Self-Control" and "Social Isolation" were the most seen maladaptive schemas in the ADHD group. "Approval Seeking," "Entitlement/Grandiosity" and "Punitiveness" were found the weakest schemas in the ADHD group. This study besides supporting the theory of early maladaptive schemas suggests that identifying and modifying maladaptive schemas interventions based on specific schemas can be an important and useful method for psychotherapy in treatment of ADHD.
Collapse
Affiliation(s)
- Seda Kiraz
- Department of Psychiatry, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Sencan Sertçelik
- Department of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
12
|
[ADHD in the transition to adulthood: prevalence, symptoms, risks, and care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:910-915. [PMID: 32588062 DOI: 10.1007/s00103-020-03175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In contrast to earlier assumptions, ADHD at least partially persists into adulthood in 50-80% of the patients.This narrative review article highlights the risks, treatment options, and care requirements associated with the transition to adulthood. Available epidemiological and routine care data and guidelines are reviewed and screened for indications and recommendations to improve the health-care of adolescents with ADHD.Epidemiological and routine care data point to a care gap for adolescents with ADHD in the sensitive phase of transition from adolescence to adulthood. Specific transition concepts should be expanded and their effectiveness scientifically investigated.
Collapse
|
13
|
[Nonpharmacological treatment options for attention deficit hyperactivity disorder in adulthood: an update]. DER NERVENARZT 2020; 91:591-598. [PMID: 32399608 DOI: 10.1007/s00115-020-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) in adulthood is a frequent disorder with a prevalence of 2.5%, which can successfully be treated by pharmacotherapy in 50-70% of cases, depending on the response criteria. Therefore, besides medication nonpharmacological interventions are an important component of the treatment. The essential nonpharmacological interventions are presented and described with respect to the evidence for treatment. According to the S3 guidelines an extensive psychoeducation (PE) functions as the basis of the treatment. If there is still a need for treatment after PE and the clarification of associated disorders, pharmacotherapy is applied. Further psychosocial interventions can then be used as accompaniment or supplement, e.g. when the effectiveness of medication treatment is insufficient. In particular, cognitive behavioral concepts and their variations (dialectic behavioral therapy, metacognitive training, reasoning and rehabilitation therapy) and coaching should be mentioned here, which show increasing evidence for treatment. Neurofeedback can be used if no other psychosocial treatment options are delayed or omitted due to the treatment. Mindfulness training and sport interventions seem to be meaningful as supplementation but similarly to the individualized cognitive training, further research studies are necessary to enable clear statements regarding treatment evidence in adulthood. Further controlled investigations regarding the effectiveness of nonpharmacological interventions on ADHD and associated symptoms and disorders are therefore desirable.
Collapse
|
14
|
Nenadić I, Voss A, Besteher B, Langbein K, Gaser C. Brain structure and symptom dimensions in borderline personality disorder. Eur Psychiatry 2020; 63:e9. [PMID: 32093800 PMCID: PMC8057374 DOI: 10.1192/j.eurpsy.2019.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) presents with symptoms across different domains, whose neurobiology is poorly understood. METHODS We applied voxel-based morphometry on high-resolution magnetic resonance imaging scans of 19 female BPD patients and 50 matched female controls. RESULTS Group comparison showed bilateral orbitofrontal gray matter loss in patients, but no significant changes in the hippocampus. Voxel-wise correlation of gray matter with symptom severity scores from the Borderline Symptom List (BSL-95) showed overall negative correlation in bilateral prefrontal, right inferior temporal/fusiform and occipital cortices, and left thalamus. Significant (negative) correlations with BSL-95 subscores within the patient cohort linked autoaggression to left lateral prefrontal and insular cortices, right inferior temporal/temporal pole, and right orbital cortex; dysthymia/dysphoria to right orbitofrontal cortex; self-perception to left postcentral, bilateral inferior/middle temporal, right orbitofrontal, and occipital cortices. Schema therapy-based Young Schema Questionnaire (YSQ-S2) scores of early maladaptive schemas on emotional deprivation were linked to left medial temporal lobe gray matter reductions. CONCLUSIONS Our results confirm orbitofrontal structural deficits in BPD, while providing a framework and preliminary findings on identifying structural correlates of symptom dimensions in BPD, especially with dorsolateral and orbitofrontal cortices.
Collapse
Affiliation(s)
- Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps University Marburg & Marburg University Hospital/UKGM, Marburg, Germany.,Center for Mind, Brain, and Behaviour (CMBB), Marburg, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Annika Voss
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
| |
Collapse
|
15
|
Abstract
Objective: We computationally analyze the language of social media users diagnosed with ADHD to understand what they talk about, and how their language is correlated with users' characteristics such as personality and temporal orientation. Method: We analyzed approximately 1.3 million tweets written by 1,399 Twitter users with self-reported diagnoses of ADHD, comparing their posts with those used by a control set matched by age, gender, and period of activity. Results: Users with ADHD are found to be less agreeable, more open, to post more often, and to use more negations, hedging, and swear words. Posts are suggestive of themes of emotional dysregulation, self-criticism, substance abuse, and exhaustion. A machine learning model can predict which of these Twitter users has ADHD with an out-of-sample AUC of .836. Conclusion: Based on this emerging technology, conjectures of future uses of social media by researchers and clinicians to better understand the naturalistic manifestations and sequelae of ADHD.
Collapse
|
16
|
Khosravani V, Mohammadzadeh A, Sharifi Bastan F, Amirinezhad A, Amini M. Early maladaptive schemas and suicidal risk in inpatients with bipolar disorder. Psychiatry Res 2019; 271:351-359. [PMID: 30529318 DOI: 10.1016/j.psychres.2018.11.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022]
Abstract
The present study aimed to assess the associations of early maladaptive schemas (EMSs) and clinical factors (hypomanic/manic and depressive symptoms) with suicidal risk (current suicidal ideation and lifetime suicide attempts) in inpatients with bipolar disorder (BD). One hundred inpatients with BD completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Bipolar Depression Rating Scale (BDRS), the Young Mania Rating Scale (YMRS), and the Beck Scale for Suicide Ideation (BSSI). 59% of patients had lifetime suicide attempts and 59% showed high suicidal risk (BSSI ≥ 6). BD patients with lifetime suicide attempts had higher scores on the entitlement and social isolation schemas, depression, and hypomanic/manic symptoms than those without such attempts. Patients with high suicidal risk had higher levels of depressive and hypomanic/manic symptoms as well as some EMSs than those without high suicidal risk. Logistic regression analyses revealed that hypomanic/manic symptoms as well as the entitlement and defectiveness schemas were significantly associated with current suicidal ideation. Also, the entitlement and social isolation schemas were associated with lifetime suicide attempts. These results suggest that the entitlement, social isolation, and defectiveness schemas may relate to suicidal risk in patients with BD.
Collapse
Affiliation(s)
- Vahid Khosravani
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | | | - Ali Amirinezhad
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Marziyeh Amini
- Clinical Psychology, Mohaghegh Ardebili University, Ardabil, Iran
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Schema therapy conceptualizes personality disorders in terms of modes and underlying schemas. This article reviews the literature on schema therapy conceptualization of personality disorder functioning and traits, and proposes how these findings apply to novel personality disorder classification in ICD-11 and the DSM-5 Alternative Model of Personality Disorders (AMPD). RECENT FINDINGS Maladaptive schemas and modes are generally associated with personality dysfunction and traits in conceptually coherent ways. The healthy adult mode, a transdiagnostic core concept in schema therapy, corresponds to the ICD-11 and DSM-5-AMPD features of core personality functioning. Modes and underlying schemas substantially overlap with specific ICD-11 and DSM-5-AMPD traits, which denote individual themes and styles of personality dysfunction. SUMMARY The dimensional personality disorder framework in ICD-11 and DSM-5-AMPD is largely compatible with the schema therapy model. The ICD-11 and DSM-5-AMPD provide a scientifically derived and theory-free framework for all practitioners, which may be connected to clinical theory of schema therapy in a coherent manner. Level of personality functioning can be conceptualized as healthy adult functioning (e.g. sense of identity, self-worth, emotion regulation, intimacy, and fulfillment), which inform intensity of treatment. Trait qualifiers can be conceptualized by associated modes (e.g., compliant surrender) and underlying schemas (e.g. abandonment), which inform focus and style of treatment.
Collapse
|
18
|
Tucha O. Supporting patients with ADHD: Missed opportunities? ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2017; 9:69-71. [PMID: 28523492 DOI: 10.1007/s12402-017-0233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|