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Shkalim Zemer V, Manor I, Weizman A, Cohen HA, Hoshen M, Menkes Caspi N, Cohen S, Faraone SV, Shahar N. The influence of COVID-19 on attention-deficit/hyperactivity disorder diagnosis and treatment rates across age, gender, and socioeconomic status: A 20-year national cohort study. Psychiatry Res 2024; 339:116077. [PMID: 39053214 DOI: 10.1016/j.psychres.2024.116077] [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] [Received: 01/06/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 07/27/2024]
Abstract
Infection and lockdowns resulting from COVID-19 have been suggested to increase the prevalence and treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD). To accurately estimate the pandemic's effects, pre-pandemic data can be used to estimate diagnosis and treatment rates during the COVID-19 years as if the COVID-19 pandemic did not occur. However, accurate predictions require a broad dataset, both in terms of the number of cases and the pre-pandemic timeframe. In the current study, we modeled monthly ADHD diagnosis and treatment rates over the 18 years preceding the COVID-19 pandemic. The dataset included ∼3 million cases for individuals aged 6 to 18 from the Clalit Health Services' electronic database. Using a trained model, we projected monthly rates for post-lockdown and post-infection periods, enabling us to estimate the expected diagnosis and treatment rates without the COVID-19 pandemic. We then compared these predictions to observed data, stratified by age groups, gender, and socioeconomic status. Our findings suggest no influence of the COVID-19 pandemic on ADHD diagnosis or treatment rates. We show that a narrower timeframe for pre-COVID-19 data points can lead to incorrect conclusions that COVID-19 affected ADHD diagnosis rates. Findings are discussed, given the assumed impact of the COVID-19 pandemic on ADHD.
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Affiliation(s)
- Vered Shkalim Zemer
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dan-Petach-Tikva District, Clalit Health Services, Israel.
| | - Iris Manor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dan-Petach-Tikva District, Clalit Health Services, Israel; Geha Mental Health Center, Petah Tikva, Israel
| | - Abraham Weizman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dan-Petach-Tikva District, Clalit Health Services, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Herman Avner Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Ambulatory Community Clinic, Petach Tikva, Israel
| | - Moshe Hoshen
- Dan-Petach-Tikva District, Clalit Health Services, Israel; Bioinformatics Department, Jerusalem College of Technology, Jerusalem, Israel
| | | | - Shira Cohen
- Geha Mental Health Center, Petah Tikva, Israel
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Nitzan Shahar
- The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Merzon E, Israel A, Krone B, Medvejer S, Cohen S, Green I, Golan-Cohen A, Vinker S, Faraone SV, Newcorn JH, Ashkenazi S, Weizman A, Manor I. Increased Rate of Familial Mediterranean Fever in Children With ADHD: A Population-Based Case-Control Study. J Atten Disord 2024; 28:669-676. [PMID: 38069539 DOI: 10.1177/10870547231215045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE There is growing evidence of involvement of inflammatory mechanisms in ADHD. Previous studies found significantly higher rates of ADHD among children with FMF. The present study examined the rate of exposure to FMF in children with a later (within a 5-year period) diagnosis of ADHD compared to non-ADHD children. METHODS A population-based case-control study of all children (<18 years) registered in Leumit Health Services during 01.01.2006 to 06.30.2021. All cases met ICD-9/10 criteria for ADHD. They were matched by age, sex, and socioeconomic status on a 1:2 rate to randomly selected non-ADHD controls. RESULTS Fifty-six (0.30%) children with ADHD (N = 18,756) were previously diagnosed with FMF compared to 65 of 37,512 controls (0.17%). A significant, independent association existed between a preceding FMF diagnosis and a later ADHD diagnosis [OR = 1.72 (95% CI 1.18-2.51); p = .003]. CONCLUSIONS The mechanisms underlying the association w between FMF and later ADHD diagnosis merit further elucidation.
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Affiliation(s)
- Eugene Merzon
- Lehumit Health Services, Tel-Aviv, Israel
- Ariel University, Israel
| | | | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Shira Cohen
- Geha Mental Health Center, Petah Tikva, Israel
| | - Ilan Green
- Lehumit Health Services, Tel-Aviv, Israel
- Tel Aviv University, Israel
| | | | - Shlomo Vinker
- Lehumit Health Services, Tel-Aviv, Israel
- Tel Aviv University, Israel
| | | | | | | | - Abraham Weizman
- Tel Aviv University, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Iris Manor
- Tel Aviv University, Israel
- Geha Mental Health Center, Petah Tikva, Israel
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Iakunchykova O, Leonardsen EH, Wang Y. Genetic evidence for causal effects of immune dysfunction in psychiatric disorders: where are we? Transl Psychiatry 2024; 14:63. [PMID: 38272880 PMCID: PMC10810856 DOI: 10.1038/s41398-024-02778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
The question of whether immune dysfunction contributes to risk of psychiatric disorders has long been a subject of interest. To assert this hypothesis a plethora of correlative evidence has been accumulated from the past decades; however, a variety of technical and practical obstacles impeded on a cause-effect interpretation of these data. With the advent of large-scale omics technology and advanced statistical models, particularly Mendelian randomization, new studies testing this old hypothesis are accruing. Here we synthesize these new findings from genomics and genetic causal inference studies on the role of immune dysfunction in major psychiatric disorders and reconcile these new data with pre-omics findings. By reconciling these evidences, we aim to identify key gaps and propose directions for future studies in the field.
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Affiliation(s)
- Olena Iakunchykova
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Esten H Leonardsen
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Yunpeng Wang
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway.
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Merzon E, Magen E, Ashkenazi S, Weizman A, Manor I, Krone B, Green I, Golan-Cohen A, Vinker S, Faraone SV, Israel A. The Association between Glucose 6-Phosphate Dehydrogenase Deficiency and Attention Deficit/Hyperactivity Disorder. Nutrients 2023; 15:4948. [PMID: 38068806 PMCID: PMC10708268 DOI: 10.3390/nu15234948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency, impacting 4.9% of the population and more prevalent in Mediterranean communities, is a common enzymopathy with potential relevance to Attention Deficit/Hyperactivity Disorder (ADHD). This study investigated this association. METHODS The clinical characteristics of 7473 G6PD-deficient patients and 29,892 matched case-controls (selected at a 1:4 ratio) from a cohort of 1,031,354 within the Leumit Health Services database were analyzed using Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS In total, 68.7% were male. The mean duration of follow-up was 14.3 ± 6.2 years at a mean age of 29.2 ± 22.3 years. G6PD deficiency was associated with an increased risk of being diagnosed with ADHD (Odds Ratio (OR) = 1.16 [95% CI, 1.08-1.25], p < 0.001), seeking care from adult neurologists (OR = 1.30 [95% CI, 1.22-1.38], p < 0.001), and consulting adult psychiatrists (OR = 1.12 [95% CI, 1.01-1.24], p = 0.048). The use of stimulant medications among G6PD-deficient individuals was 17% higher for the methylphenidate class of drugs (OR = 1.17 [95% CI, 1.08, 1.27], p < 0.001), and there was a 16% elevated risk for amphetamine use (OR = 1.16 [95% CI, 1.03, 1.37], p = 0.047). CONCLUSIONS G6PD deficiency signals an increased risk of ADHD diagnosis, more severe presentations of ADHD and a greater need for psychiatric medications to treat ADHD.
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Affiliation(s)
- Eugene Merzon
- Adelson School of Medicine, Ariel University, Ariel 40776, Israel;
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
| | - Eli Magen
- Department of Medicine A, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Beer Sheba 84990, Israel;
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 40776, Israel;
| | - Abraham Weizman
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Laboratory of Molecular and Biological Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Iris Manor
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ilan Green
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Stephen V. Faraone
- Department of Psychiatry, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Ariel Israel
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Epidemiology and Disease Prevention, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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