1
|
Matsuzaki K, Sugimoto N, Hossain S, Islam R, Sumiyoshi E, Hashimoto M, Kishi H, Shido O. Theobromine improves hyperactivity, inattention, and working memory via modulation of dopaminergic neural function in the frontal cortex of spontaneously hypertensive rats. Food Funct 2024; 15:5579-5595. [PMID: 38713055 DOI: 10.1039/d4fo00683f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder and dopaminergic dysfunction in the prefrontal cortex (PFC) may play a role. Our previous research indicated that theobromine (TB), a methylxanthine, enhances cognitive function in rodents via the PFC. This study investigates TB's effects on hyperactivity and cognitive function in stroke-prone spontaneously hypertensive rats (SHR), an ADHD animal model. Male SHRs (6-week old) received a diet containing 0.05% TB for 40 days, while control rats received normal diets. Age-matched male Wistar-Kyoto rats (WKY) served as genetic controls. During the TB administration period, we conducted open-field tests and Y-maze tasks to evaluate hyperactivity and cognitive function, then assessed dopamine concentrations and tyrosine hydroxylase (TH), dopamine receptor D1-5 (DRD1-5), dopamine transporter (DAT), vesicular monoamine transporter-2 (VMAT-2), synaptosome-associated protein-25 (SNAP-25), and brain-derived neurotrophic factor (BDNF) expressions in the PFC. Additionally, the binding affinity of TB for the adenosine receptors (ARs) was evaluated. Compared to WKY, SHR exhibited hyperactivity, inattention and working memory deficits. However, chronic TB administration significantly improved these ADHD-like behaviors in SHR. TB administration also normalized dopamine concentrations and expression levels of TH, DRD2, DRD4, SNAP-25, and BDNF in the PFC of SHR. No changes were observed in DRD1, DRD3, DRD5, DAT, and VMAT-2 expression between SHR and WKY rats, and TB intake had minimal effects. TB was found to have affinity binding to ARs. These results indicate that long-term TB supplementation mitigates hyperactivity, inattention and cognitive deficits in SHR by modulating dopaminergic nervous function and BDNF levels in the PFC, representing a potential adjunctive treatment for ADHD.
Collapse
Affiliation(s)
- Kentaro Matsuzaki
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
| | - Naotoshi Sugimoto
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shahdat Hossain
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh.
| | - Rafiad Islam
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
- Department of Psychiatry, Yale University School of Medicine, CT, USA.
| | - Eri Sumiyoshi
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
- Department of Sports and Health Science, Faculty of Human Health Science, Matsumoto University, Matsumoto, Japan.
| | - Michio Hashimoto
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
| | - Hiroko Kishi
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
| | - Osamu Shido
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Izumo, Japan.
- Shimane Rehabilitation College, Oku-izumo, Shimane, Japan.
| |
Collapse
|
2
|
Ferranti AS, Luessen DJ, Niswender CM. Novel pharmacological targets for GABAergic dysfunction in ADHD. Neuropharmacology 2024; 249:109897. [PMID: 38462041 DOI: 10.1016/j.neuropharm.2024.109897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopment disorder that affects approximately 5% of the population. The disorder is characterized by impulsivity, hyperactivity, and deficits in attention and cognition, although symptoms vary across patients due to the heterogenous and polygenic nature of the disorder. Stimulant medications are the standard of care treatment for ADHD patients, and their effectiveness has led to the dopaminergic hypothesis of ADHD in which deficits in dopaminergic signaling, especially in cortical brain regions, mechanistically underly ADHD pathophysiology. Despite their effectiveness in many individuals, almost one-third of patients do not respond to stimulant treatments and the long-term negative side effects of these medications remain unclear. Emerging clinical evidence is beginning to highlight an important role of dysregulated excitatory/inhibitory (E/I) balance in ADHD. These deficits in E/I balance are related to functional abnormalities in glutamate and Gamma-Aminobutyric Acid (GABA) signaling in the brain, with increasing emphasis placed on GABAergic interneurons driving specific aspects of ADHD pathophysiology. Recent genome-wide association studies (GWAS) have also highlighted how genes associated with GABA function are mutated in human populations with ADHD, resulting in the generation of several new genetic mouse models of ADHD. This review will discuss how GABAergic dysfunction underlies ADHD pathophysiology, and how specific receptors/proteins related to GABAergic interneuron dysfunction may be pharmacologically targeted to treat ADHD in subpopulations with specific comorbidities and symptom domains. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".
Collapse
Affiliation(s)
- Anthony S Ferranti
- Department of Pharmacology, Vanderbilt University, Nashville, TN, 37232, USA; Warren Center for Neuroscience Drug Discovery, Nashville, TN, 37232, USA
| | - Deborah J Luessen
- Department of Pharmacology, Vanderbilt University, Nashville, TN, 37232, USA; Warren Center for Neuroscience Drug Discovery, Nashville, TN, 37232, USA
| | - Colleen M Niswender
- Department of Pharmacology, Vanderbilt University, Nashville, TN, 37232, USA; Warren Center for Neuroscience Drug Discovery, Nashville, TN, 37232, USA; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA; Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, 37232, USA; Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 37232, USA.
| |
Collapse
|
3
|
Dimitrov LV, Kaminski JW, Holbrook JR, Bitsko RH, Yeh M, Courtney JG, O'Masta B, Maher B, Cerles A, McGowan K, Rush M. A Systematic Review and Meta-analysis of Chemical Exposures and Attention-Deficit/Hyperactivity Disorder in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:225-248. [PMID: 38108946 PMCID: PMC11132938 DOI: 10.1007/s11121-023-01601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/19/2023]
Abstract
Exposure to certain chemicals prenatally and in childhood can impact development and may increase risk for attention-deficit/hyperactivity disorder (ADHD). Leveraging a larger set of literature searches conducted to synthesize results from longitudinal studies of potentially modifiable risk factors for childhood ADHD, we present meta-analytic results from 66 studies that examined the associations between early chemical exposures and later ADHD diagnosis or symptoms. Studies were eligible for inclusion if the chemical exposure occurred at least 6 months prior to measurement of ADHD diagnosis or symptomatology. Included papers were published between 1975 and 2019 on exposure to anesthetics (n = 5), cadmium (n = 3), hexachlorobenzene (n = 4), lead (n = 22), mercury (n = 12), organophosphates (n = 7), and polychlorinated biphenyls (n = 13). Analyses are presented for each chemical exposure by type of ADHD outcome reported (categorical vs. continuous), type of ADHD measurement (overall measures of ADHD, ADHD symptoms only, ADHD diagnosis only, inattention only, hyperactivity/impulsivity only), and timing of exposure (prenatal vs. childhood vs. cumulative), whenever at least 3 relevant effect sizes were available. Childhood lead exposure was positively associated with ADHD diagnosis and symptoms in all analyses except for the prenatal analyses (odds ratios (ORs) ranging from 1.60 to 2.62, correlation coefficients (CCs) ranging from 0.14 to 0.16). Other statistically significant associations were limited to organophosphates (CC = 0.11, 95% confidence interval (CI): 0.03-0.19 for continuous measures of ADHD outcomes overall), polychlorinated biphenyls (CC = 0.08, 95% CI: 0.02-0.14 for continuous measures of inattention as the outcome), and both prenatal and childhood mercury exposure (CC = 0.02, 95% CI: 0.00-0.04 for continuous measures of ADHD outcomes overall for either exposure window). Our findings provide further support for negative impacts of prenatal and/or childhood exposure to certain chemicals and raise the possibility that primary prevention and targeted screening could prevent or mitigate ADHD symptomatology. Furthermore, these findings support the need for regular review of regulations as our scientific understanding of the risks posed by these chemicals evolves.
Collapse
Affiliation(s)
- Lina V Dimitrov
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Yeh
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph G Courtney
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | |
Collapse
|
4
|
Choi EJ, Vandewouw MM, Taylor MJ, Stevenson RA, Arnold PD, Brian J, Crosbie J, Kelley E, Liu X, Jones J, Lai MC, Schachar RJ, Lerch JP, Anagnostou E. Dorsal Striatal Functional Connectivity and Repetitive Behavior Dimensions in Children and Youths With Neurodevelopmental Disorders. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:387-397. [PMID: 38000717 DOI: 10.1016/j.bpsc.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Impairing repetitive behaviors are one of the core diagnostic symptoms in autism spectrum disorder and obsessive-compulsive disorder, but they also manifest in attention-deficit/hyperactivity disorder. Although the dorsal striatal circuit has been implicated in repetitive behaviors, extensive heterogeneity in and cross-diagnostic manifestations of these behaviors have suggested phenotypic and likely neurobiological heterogeneity across neurodevelopmental disorders (NDDs). METHODS Intrinsic dorsal striatal functional connectivity was examined in 3 NDDs (autism spectrum disorder, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder) and typically developing control participants in a large single-cohort sample (N = 412). To learn how diagnostic labels and overlapping behaviors manifest in dorsal striatal functional connectivity measured with functional magnetic resonance imaging, the main and interaction effects of diagnosis and behavior were examined in 8 models (2 seed functional connectivity [caudate and putamen] × 4 sub-behavioral domains [sameness/ritualistic, self-injury, stereotypy, and compulsions]). RESULTS The obsessive-compulsive disorder group demonstrated distinctive patterns in visual and visuomotor coordination regions compared with the other diagnostic groups. Lower-order repetitive behaviors (self-injury and stereotypy) manifesting across all participants were implicated in regions involved in motor and cognitive control, although the findings did not survive effects of multiple comparisons, suggesting heterogeneity in these behavioral domains. An interaction between self-injurious behavior and an attention-deficit/hyperactivity disorder diagnosis were observed on caudate-cerebellum functional connectivity. CONCLUSIONS These findings confirmed high heterogeneity and overlapping behavioral manifestations in NDDs and their complex underlying neural mechanisms. A call for diagnosis-free symptom measures that can capture not only observable symptoms and severity across NDDs but also the underlying functions and motivations of such behaviors across diagnoses is needed.
Collapse
Affiliation(s)
- Eun Jung Choi
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada.
| | - Marlee M Vandewouw
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Margot J Taylor
- Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Psychology and Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ryan A Stevenson
- Department of Psychology, Western University, London, Ontario, Canada; Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Paul D Arnold
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Brian
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology and Centre for Neuroscience Studies, Queens' University, Kingston, Ontario, Canada; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Xudong Liu
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Jessica Jones
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Meng-Chuan Lai
- Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Russell J Schachar
- Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jason P Lerch
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Neurosciences & Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Bogdańska-Chomczyk E, Równiak M, Huang ACW, Kozłowska A. Parvalbumin interneuron deficiency in the prefrontal and motor cortices of spontaneously hypertensive rats: an attention-deficit hyperactivity disorder animal model insight. Front Psychiatry 2024; 15:1359237. [PMID: 38600979 PMCID: PMC11005678 DOI: 10.3389/fpsyt.2024.1359237] [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: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 04/12/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is characterized by impairments in developmental-behavioral inhibition, resulting in impulsivity and hyperactivity. Recent research has underscored cortical inhibition deficiencies in ADHD via the gamma-aminobutyric acid (GABA)ergic system, which is crucial for maintaining excitatory-inhibitory balance in the brain. This study explored postnatal changes in parvalbumin (PV) immunoreactivity, indicating GABAergic interneuron types, in the prefrontal (PFC) and motor (MC) cortices of spontaneously hypertensive rats (SHRs), an ADHD animal model. Methods Examining PV- positive (PV+) cells associated with dopamine D2 receptors (D2) and the impact of dopamine on GABA synthesis, we also investigated changes in the immunoreactivity of D2 and tyrosine hydroxylase (TH). Brain sections from 4- to 10-week-old SHRs and Wistar Kyoto rats (WKYs) were immunohistochemically analyzed, comparing PV+, D2+ cells, and TH+ fiber densities across age-matched SHRs and WKYs in specific PFC/MC regions. Results The results revealed significantly reduced PV+ cell density in SHRs: prelimbic (~20% less), anterior cingulate (~15% less), primary (~15% less), and secondary motor (~17% less) cortices. PV+ deficits coincided with the upregulation of D2 in prepubertal SHRs and the downregulation of TH predominantly in pubertal/postpubertal SHRs. Conclusion Reduced PV+ cells in various PFC regions could contribute to inattention/behavioral alterations in ADHD, while MC deficits could manifest as motor hyperactivity. D2 upregulation and TH deficits may impact GABA synthesis, exacerbating behavioral deficits in ADHD. These findings not only shed new light on ADHD pathophysiology but also pave the way for future research endeavors.
Collapse
Affiliation(s)
- Ewelina Bogdańska-Chomczyk
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Maciej Równiak
- Department of Animal Anatomy and Physiology, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Anna Kozłowska
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
6
|
Arca AA, Mouloua M, Hancock PA. Individual differences, ADHD diagnosis, and driving performance: effects of traffic density and distraction type. ERGONOMICS 2024; 67:288-304. [PMID: 37267092 DOI: 10.1080/00140139.2023.2221417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023]
Abstract
The present study examined the impact of individual differences, attention, and memory deficits on distracted driving. Drivers with ADHD are more susceptible to distraction which results in more frequent collisions, violations, and licence suspensions. Consequently, the present investigation had 36 participants complete preliminary questionnaires, memory tasks, workload indices, and four, 4-min simulated driving scenarios to evaluate such impact. It was hypothesised ADHD diagnosis, type of cellular distraction, and traffic density would each differentially and substantively impact driving performance. Results indicated traffic density and distraction type significantly affected the objective driving facets measured, as well as subjective and secondary task performance. ADHD diagnosis directly impacted secondary task performance. Results further showed significant interactions between distraction type and traffic density on both brake pressure and steering wheel angle negatively impacting lateral and horizontal vehicle control. Altogether, these findings provide substantial empirical evidence for the deleterious effect of cellphone use on driving performance.Practitioner summary: This study examined how ADHD diagnosis, traffic density, and distraction type affect driver behaviour. Participants completed driving behaviour questionnaires, memory tasks, workload indices, and driving scenarios. Results showed that ADHD diagnosis impacted secondary task performance, while traffic and distractions significantly impacted driving performance as well secondary task performance and workload.
Collapse
Affiliation(s)
- Alejandro A Arca
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Mustapha Mouloua
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Peter A Hancock
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
7
|
de Cássia Collaço R, Lammens M, Blevins C, Rodgers K, Gurau A, Yamauchi S, Kim C, Forrester J, Liu E, Ha J, Mei Y, Boehm C, Wohler E, Sobreira N, Rowe PC, Valle D, Brock MV, Bosmans F. Anxiety and dysautonomia symptoms in patients with a Na V1.7 mutation and the potential benefits of low-dose short-acting guanfacine. Clin Auton Res 2024; 34:191-201. [PMID: 38064009 DOI: 10.1007/s10286-023-01004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE Guanfacine is an α2A-adrenergic receptor agonist, FDA-approved to treat attention-deficit hyperactivity disorder and high blood pressure, typically as an extended-release formulation up to 7 mg/day. In our dysautonomia clinic, we observed that off-label use of short-acting guanfacine at 1 mg/day facilitated symptom relief in two families with multiple members presenting with severe generalized anxiety. We also noted anecdotal improvements in associated dysautonomia symptoms such as hyperhidrosis, cognitive impairment, and palpitations. We postulated that a genetic deficit existed in these patients that might augment guanfacine susceptibility. METHODS We used whole-exome sequencing to identify mutations in patients with shared generalized anxiety and dysautonomia symptoms. Guanfacine-induced changes in the function of voltage-gated Na+ channels were investigated using voltage-clamp electrophysiology. RESULTS Whole-exome sequencing uncovered the p.I739V mutation in SCN9A in the proband of two nonrelated families. Moreover, guanfacine inhibited ionic currents evoked by wild-type and mutant NaV1.7 encoded by SCN9A, as well as other NaV channel subtypes to a varying degree. CONCLUSION Our study provides further evidence for a possible pathophysiological role of NaV1.7 in anxiety and dysautonomia. Combined with off-target effects on NaV channel function, daily administration of 1 mg short-acting guanfacine may be sufficient to normalize NaV channel mutation-induced changes in sympathetic activity, perhaps aided by partial inhibition of NaV1.7 or other channel subtypes. In a broader context, expanding genetic and functional data about ion channel aberrations may enable the prospect of stratifying patients in which mutation-induced increased sympathetic tone normalization by guanfacine can support treatment strategies for anxiety and dysautonomia symptoms.
Collapse
Affiliation(s)
- Rita de Cássia Collaço
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium
| | - Maxime Lammens
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium
| | - Carley Blevins
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kristen Rodgers
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrei Gurau
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Suguru Yamauchi
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christine Kim
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jeannine Forrester
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Edward Liu
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jinny Ha
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yuping Mei
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Corrine Boehm
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Wohler
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter C Rowe
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David Valle
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Malcolm V Brock
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Frank Bosmans
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium.
| |
Collapse
|
8
|
Oh S, Choi J, Han DH, Kim E. Effects of game-based digital therapeutics on attention deficit hyperactivity disorder in children and adolescents as assessed by parents or teachers: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024; 33:481-493. [PMID: 36862162 DOI: 10.1007/s00787-023-02174-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by pharmacological and non-pharmacological interventions. Despite the available treatment options and prevention measures, conventional treatments have several limitations. Digital therapeutics (DTx) like EndeavorRx® is an emerging alternative to overcome these limitations. EndeavorRx® is the first FDA-approved, game-based DTx approved for the treatment of pediatric ADHD. We investigated the effects of game-based DTx in randomised controlled trials (RCTs) on children and adolescents with ADHD. In this systematic review and meta-analysis, we searched PubMed, Embase, and PsycINFO databases up to January 2022. The protocol was registered (CRD42022299866). The assessor was defined as parents and teachers. The primary outcome was differences in inattention reported by the assessor, and the secondary outcome was differences in hyperactivity and hyperactivity/impulsivity reported by the assessor and the relative comparisons between game-based DTx, medicine, and control with indirect meta-analysis. Game-based DTx improved inattention more than the control upon assessment by assessors (standard mean difference (SMD) 0.28, 95% confidence interval (CI) 0.14-0.41; SMD 0.21, 95% CI 0.03-0.39, respectively), while medication improved inattention more than game-based DTx (SMD - 0·62, 95% CI - 1·04 to - 0·20) upon assessment by the teacher. Game-based DTx improved hyperactivity/impulsivity than the control upon assessment by assessors (SMD 0.28, 95% CI 0.03-0.53; SMD 0.30, 95% CI 0.05-0.55, respectively), and medication improved hyperactivity/impulsivity significantly than game-based DTx upon assessment by the teacher. Hyperactivity has not been reported extensively. As a result, game-based DTx had a more significant effect than the control, however medication was more effective.
Collapse
Affiliation(s)
- SuA Oh
- Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Jina Choi
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung Ang University Hospital, Seoul, 06974, Republic of Korea
| | - EunYoung Kim
- Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
- Regulatory Science, Pharmaceutical Industry, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
| |
Collapse
|
9
|
Moloney RA, Pavy CL, Kahl RGS, Palliser HK, Hirst JJ, Shaw JC. Dual isolation of primary neurons and oligodendrocytes from guinea pig frontal cortex. Front Cell Neurosci 2024; 17:1298685. [PMID: 38269115 PMCID: PMC10806141 DOI: 10.3389/fncel.2023.1298685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Primary cell culture is a technique that is widely used in neuroscience research to investigate mechanisms that underlie pathologies at a cellular level. Typically, mouse or rat tissue is used for this process; however, altricial rodent species have markedly different neurodevelopmental trajectories comparatively to humans. The use of guinea pig brain tissue presents a novel aspect to this routinely used cell culture method whilst also allowing for dual isolation of two major cell types from a physiologically relevant animal model for studying perinatal neurodevelopment. Primary neuronal and oligodendrocyte cell cultures were derived from fetal guinea pig's frontal cortex brain tissue collected at a gestational age of 62 days (GA62), which is a key time in the neuronal and oligodendrocyte development. The major advantage of this protocol is the ability to acquire both neuronal and oligodendrocyte cellular cultures from the frontal cortex of one fetal brain. Briefly, neuronal cells were grown in 12-well plates initially in a 24-h serum-rich medium to enhance neuronal survival before switching to a serum-free media formulation. Oligodendrocytes were first grown in cell culture flasks using a serum-rich medium that enabled the growth of oligodendrocyte progenitor cells (OPCs) on an astrocyte bed. Following confluency, the shake method of differential adhesion and separation was utilized via horizontally shaking the OPCs off the astrocyte bed overnight. Therefore, OPCs were plated in 12-well plates and were initially expanded in media supplemented with growth hormones, before switching to maturation media to progress the lineage to a mature phenotype. Reverse transcription-polymerase chain reaction (RT-PCR) was performed on both cell culture types to analyze key population markers, and the results were further validated using immunocytochemistry. Primary neurons displayed the mRNA expression of multiple neuronal markers, including those specific to GABAergic populations. These cells also positively stained for microtubule-associated protein 2 (MAP2; a dendritic marker specific to neurons) and NeuN (a marker of neuronal cell bodies). Primary oligodendrocytes expressed all investigated markers of the oligodendrocyte lineage, with a majority of the cells displaying an immature oligodendrocyte phenotype. This finding was further confirmed with positive oligodendrocyte transcription factor (OLIG2) staining, which serves as a marker for the overall oligodendrocyte population. This study demonstrates a novel method for isolating both neurons and oligodendrocytes from the guinea pig brain tissue. These isolated cells display key markers and gene expression that will allow for functional experiments to occur and may be particularly useful in studying neurodevelopmental conditions with perinatal origins.
Collapse
Affiliation(s)
- Roisin A. Moloney
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| | - Carlton L. Pavy
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| | - Richard G. S. Kahl
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| | - Hannah K. Palliser
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| | - Jon J. Hirst
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| | - Julia C. Shaw
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Mothers and Babies Research Centre, Newcastle, NSW, Australia
| |
Collapse
|
10
|
Kyriakidou M, Caballero-Puntiverio M, Andreasen JT, Thomsen M. Relationship between two forms of impulsivity in mice at baseline and under acute and sub-chronic atomoxetine treatment. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110841. [PMID: 37586638 DOI: 10.1016/j.pnpbp.2023.110841] [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: 03/06/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
RATIONALE Impulsivity is a symptom of various mental disorders, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, and addiction. Impulsivity is not a unitary construct, but is present in different forms, yet only a few rodent studies have explored the relationship between these forms within individual subjects. OBJECTIVES In this study, we compared behaviors representing two impulsivity forms, delay discounting (choice impulsivity) and premature responding (waiting impulsivity), within the same mice. METHODS C57BL/6J male mice were concurrently trained and tested in the delay discounting task and the rodent continuous performance test in a counterbalanced design. The effects of the ADHD medication atomoxetine were tested in both tasks, after both acute (0.3-5.0 mg/kg) and sub-chronic (0.3 mg/kg twice daily for seven days) administration. RESULTS There was no correlation between the two impulsivity forms at baseline. Acute atomoxetine treatment (1, 3, and 5 mg/kg) significantly reduced premature responding. Furthermore, sub-chronic treatment with 0.3 mg/kg of atomoxetine caused a stable decrease in premature responding. Atomoxetine had no significant effect on delay discounting after acute or sub-chronic administration, although the acute administration of 1 mg/kg showed a trend towards increasing delay discounting. CONCLUSIONS The present results support that delay discounting and premature responding represent two different forms of impulsivity that show dissimilar responses to atomoxetine treatment. The consistency with findings in humans lends support to the translatability of the results in mice.
Collapse
Affiliation(s)
- Maria Kyriakidou
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | | | - Jesper T Andreasen
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Morgane Thomsen
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark; Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Meisinger C, Freuer D. Understanding the causal relationships of attention-deficit/hyperactivity disorder with mental disorders and suicide attempt: a network Mendelian randomisation study. BMJ MENTAL HEALTH 2023; 26:e300642. [PMID: 37669871 PMCID: PMC11146378 DOI: 10.1136/bmjment-2022-300642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a lifespan neurodevelopmental condition resulting from complex interactions between genetic and environmental risk factors. There is evidence that ADHD is associated with other mental disorders, but it remains unclear whether and in what way a causal relationship exists. OBJECTIVE To investigate the direct and indirect causal paths between ADHD and seven common mental disorders. METHODS Two-sample network Mendelian randomisation analysis was performed to identify psychiatric disorders causally related to ADHD. Total and direct effects were estimated in an univariable and multivariable setting, respectively. Robustness of results was ensured in three ways: a range of pleiotropy-robust methods, an iterative approach identifying and excluding outliers, and use of up to two genome-wide association studies per outcome to replicate results and calculate subsequently pooled meta-estimates. RESULTS Genetic liability to ADHD was independently associated with the risk of anorexia nervosa (OR 1.28 (95% CI 1.11 to 1.47); p=0.001). A bidirectional association was found with major depressive disorder (OR 1.09 (95% CI 1.03 to 1.15); p=0.003 in the forward direction and OR 1.76 (95% CI 1.50 to 2.06); p=4×10-12 in the reverse direction). Moreover, after adjustment for major depression disorder, a direct association with both suicide attempt (OR 1.30 (95% CI 1.16 to 1.547); p=2×10-5) and post-traumatic stress disorder (OR 1.18 (95% CI 1.05 to 1.33); p=0.007) was observed. There was no evidence of a relationship with anxiety, bipolar disorder or schizophrenia. CONCLUSIONS This study suggests that ADHD is an independent risk factor for a number of common psychiatric disorders. CLINICAL IMPLICATIONS The risk of comorbid psychiatric disorders in individuals with ADHD needs to be considered both in diagnosis and treatment.
Collapse
Affiliation(s)
- Christa Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| |
Collapse
|
12
|
Morales‐Muñoz I, Upthegrove R, Lawrence K, Thayakaran R, Kooij S, Gregory AM, Marwaha S. The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study. J Child Psychol Psychiatry 2023; 64:930-940. [PMID: 36597271 PMCID: PMC10952536 DOI: 10.1111/jcpp.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. METHODS Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. RESULTS Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003). CONCLUSIONS Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.
Collapse
Affiliation(s)
| | - Rachel Upthegrove
- Institute for Mental HealthUniversity of BirminghamBirminghamUK
- Early Intervention Service, Birmingham Women's and Children's NHS TrustBirminghamUK
| | - Kate Lawrence
- Department of PsychologySt Mary's University Twickenham LondonLondonUK
| | - Rasiah Thayakaran
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Sandra Kooij
- Department of Psychiatry, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
- PsyQ, Expertise Center Adult ADHDThe HagueThe Netherlands
| | - Alice M Gregory
- Department of Psychology, GoldsmithsUniversity of LondonLondonUK
| | - Steven Marwaha
- Institute for Mental HealthUniversity of BirminghamBirminghamUK
- Specialist Mood Disorders ClinicZinnia CentreBirminghamUK
- The Barberry National Centre for Mental HealthBirminghamUK
| |
Collapse
|
13
|
Schildroth S, Friedman A, White RF, Kordas K, Placidi D, Bauer JA, Webster TF, Coull BA, Cagna G, Wright RO, Smith D, Lucchini RG, Horton M, Claus Henn B. Associations of an industry-relevant metal mixture with verbal learning and memory in Italian adolescents: The modifying role of iron status. ENVIRONMENTAL RESEARCH 2023; 224:115457. [PMID: 36773645 PMCID: PMC10117691 DOI: 10.1016/j.envres.2023.115457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Biomarker concentrations of metals are associated with neurodevelopment, and these associations may be modified by nutritional status (e.g., iron deficiency). No prior study on associations of metal mixtures with neurodevelopment has assessed effect modification by iron status. OBJECTIVES We aimed to quantify associations of an industry-relevant metal mixture with verbal learning and memory among adolescents, and to investigate the modifying role of iron status on those associations. METHODS We used cross-sectional data from 383 Italian adolescents (10-14 years) living in proximity to ferroalloy industry. Verbal learning and memory was assessed using the California Verbal Learning Test for Children (CVLT-C), and metals were quantified in hair (manganese, copper, chromium) or blood (lead) using inductively coupled plasma mass spectrometry. Serum ferritin, a proxy for iron status, was measured using immunoassays. Covariate-adjusted associations of the metal mixture with CVLT subtests were estimated using Bayesian Kernel Machine Regression, and modification of the mixture associations by ferritin was examined. RESULTS Compared to the 50th percentile of the metal mixture, the 90th percentile was associated with a 0.12 standard deviation [SD] (95% CI = -0.27, 0.50), 0.16 SD (95% CI = -0.11, 0.44), and 0.11 SD (95% CI = -0.20, 0.43) increase in the number of words recalled for trial 5, long delay free, and long delay cued recall, respectively. For an increase from its 25th to 75th percentiles, copper was beneficially associated the recall trials when other metals were fixed at their 50th percentiles (for example, trial 5 recall: β = 0.31, 95% CI = 0.14, 0.48). The association between copper and trial 5 recall was stronger at the 75th percentile of ferritin, compared to the 25th or 50th percentiles. CONCLUSIONS In this metal mixture, copper was beneficially associated with neurodevelopment, which was more apparent at higher ferritin concentrations. These findings suggest that metal associations with neurodevelopment may depend on iron status, which has important public health implications.
Collapse
Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA.
| | - Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA; Department of Neurology, Boston University, Boston MA, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Donatella Placidi
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Julia A Bauer
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Giuseppa Cagna
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Donald Smith
- Department of Microbiology and Environmental Toxicology, University of California Santa Cruz, Santa Cruz CA, USA
| | - Roberto G Lucchini
- Department of Occupational Health, University of Brescia, Brescia, Italy; Department of Environmental Health Sciences, Florida International University, Miami FL, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
| |
Collapse
|
14
|
Custodio RJP, Kim M, Chung YC, Kim BN, Kim HJ, Cheong JH. Thrsp Gene and the ADHD Predominantly Inattentive Presentation. ACS Chem Neurosci 2023; 14:573-589. [PMID: 36716294 DOI: 10.1021/acschemneuro.2c00710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
There are three presentations of attention-deficit/hyperactivity disorder (ADHD): the predominantly inattention (ADHD-PI), predominantly hyperactive-impulsive (ADHD-HI), and combined (ADHD-C) presentations of ADHD. These may represent distinct childhood-onset neurobehavioral disorders with separate etiologies. ADHD diagnoses are behaviorally based, so investigations into potential etiologies should be founded on behavior. Animal models of ADHD demonstrate face, predictive, and construct validity when they accurately reproduce elements of the symptoms, etiology, biochemistry, and disorder treatment. Spontaneously hypertensive rats (SHR/NCrl) fulfill many validation criteria and compare well with clinical cases of ADHD-C. Compounding the difficulty of selecting an ideal model to study specific presentations of ADHD is a simple fact that our knowledge regarding ADHD neurobiology is insufficient. Accordingly, the current review has explored a potential animal model for a specific presentation, ADHD-PI, with acceptable face, predictive, and construct validity. The Thrsp gene could be a biomarker for ADHD-PI presentation, and THRSP OE mice could represent an animal model for studying this distinct ADHD presentation.
Collapse
Affiliation(s)
- Raly James Perez Custodio
- Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors─IfADo, Ardeystraße 67, 44139 Dortmund, Germany
| | - Mikyung Kim
- Department of Chemistry & Life Science, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea.,Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, 101 Daehakro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hee Jin Kim
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Jae Hoon Cheong
- Institute for New Drug Development, School of Pharmacy, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896, Republic of Korea
| |
Collapse
|
15
|
Agoalikum E, Klugah-Brown B, Wu H, Hu P, Jing J, Biswal B. Structural differences among children, adolescents, and adults with attention-deficit/hyperactivity disorder and abnormal Granger causality of the right pallidum and whole-brain. Front Hum Neurosci 2023; 17:1076873. [PMID: 36866118 PMCID: PMC9971633 DOI: 10.3389/fnhum.2023.1076873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood mental health disorder that often persists to adulthood and is characterized by inattentive, hyperactive, or impulsive behaviors. This study investigated structural and effective connectivity differences through voxel-based morphometry (VBM) and Granger causality analysis (GCA) across child, adolescent, and adult ADHD patients. Structural and functional MRI data consisting of 35 children (8.64 ± 0.81 years), 40 adolescents (14.11 ± 1.83 years), and 39 adults (31.59 ± 10.13 years) was obtained from New York University Child Study Center for the ADHD-200 and UCLA dataset. Structural differences in the bilateral pallidum, bilateral thalamus, bilateral insula, superior temporal cortex, and the right cerebellum were observed among the three ADHD groups. The right pallidum was positively correlated with disease severity. The right pallidum as a seed precedes and granger causes the right middle occipital cortex, bilateral fusiform, left postcentral gyrus, left paracentral lobule, left amygdala, and right cerebellum. Also, the anterior cingulate cortex, prefrontal cortex, left cerebellum, left putamen, left caudate, bilateral superior temporal pole, middle cingulate cortex, right precentral gyrus, and the left supplementary motor area demonstrated causal effects on the seed region. In general, this study showed the structural differences and the effective connectivity of the right pallidum amongst the three ADHD age groups. Our work also highlights the evidence of the frontal-striatal-cerebellar circuits in ADHD and provides new insights into the effective connectivity of the right pallidum and the pathophysiology of ADHD. Our results further demonstrated that GCA could effectively explore the interregional causal relationship between abnormal regions in ADHD.
Collapse
Affiliation(s)
- Elijah Agoalikum
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Benjamin Klugah-Brown
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China,*Correspondence: Bharat Biswal Benjamin Klugah-Brown
| | - Hongzhou Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Peng Hu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Junlin Jing
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bharat Biswal
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States,*Correspondence: Bharat Biswal Benjamin Klugah-Brown
| |
Collapse
|
16
|
Smith DR, Strupp BJ. Animal Models of Childhood Exposure to Lead or Manganese: Evidence for Impaired Attention, Impulse Control, and Affect Regulation and Assessment of Potential Therapies. Neurotherapeutics 2023; 20:3-21. [PMID: 36853434 PMCID: PMC10119373 DOI: 10.1007/s13311-023-01345-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/01/2023] Open
Abstract
Behavioral disorders involving attention and impulse control dysfunction, such as ADHD, are among the most prevalent disorders in children and adolescents, with significant impact on their lives. The etiology of these disorders is not well understood, but is recognized to be multifactorial, with studies reporting associations with polygenic and environmental risk factors, including toxicant exposure. Environmental epidemiological studies, while good at establishing associations with a variety of environmental and genetic risk factors, cannot establish causality. Animal models of behavioral disorders, when properly designed, can play an essential role in establishing causal relationships between environmental risk factors and a disorder, as well as provide model systems for elucidating underlying neural mechanisms and testing therapies. Here, we review how animal model studies of developmental lead or manganese exposure have been pivotal in (1) establishing a causal relationship between developmental exposure and lasting dysfunction in the domains of attention, impulse control, and affect regulation, and (2) testing the efficacy of specific therapeutic approaches for alleviating the lasting deficits. The lead and manganese case studies illustrate how animal models can advance knowledge in ways that are not possible in human studies. For example, in contrast to the Treatment of Lead Poisoned Children (TLC) human clinical trial evaluating succimer chelation efficacy to improve cognitive functioning in lead-exposed children, our developmental lead exposure animal model showed that succimer chelation can produce lasting cognitive benefits if chelation sufficiently reduces brain lead levels. In addition, this study revealed that succimer treatment in the absence of lead exposure produces lasting cognitive dysfunction, highlighting potential risks of chelation in off-label uses, such as the treatment of autistic children without a history of lead exposure. Our animal model of developmental manganese exposure has demonstrated that manganese can cause lasting attentional and sensorimotor deficits, akin to an ADHD-inattentive behavioral phenotype, thereby providing insights into the role of environmental exposures as contributors to ADHD. These studies have also shown that oral methylphenidate (Ritalin) can fully alleviate the deficits produced by early developmental Mn exposure. Future work should continue to focus on the development and use of animal models that appropriately recapitulate the complex behavioral phenotypes of behavioral disorders, in order to determine the mechanistic basis for the behavioral deficits caused by developmental exposure to environmental toxicants, and the efficacy of existing and emerging therapies.
Collapse
Affiliation(s)
- Donald R Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95060, USA.
| | - Barbara J Strupp
- Division of Nutritional Sciences and Department of Psychology, Cornell University, Ithaca, NY, 14853, USA
| |
Collapse
|
17
|
Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA. Adult ADHD: Underdiagnosis of a Treatable Condition. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:11-19. [PMID: 36743427 PMCID: PMC9884156 DOI: 10.1007/s42843-023-00077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Attention-deficit/hyperactivity disorder is a common neurodevelopmental disorder, well-characterized within the pediatric population and representing one of the most prevalent mental conditions among children and adolescents. Once diagnosed, pharmacologic and psychosocial therapies can reduce symptomatic expression and functional impairment. Traditionally thought to resolve by young adulthood, it is now recognized that ADHD persists into adulthood. Many of these individuals were never evaluated for ADHD as children and remain undiagnosed as adults, continuing to struggle with symptoms. It is common to develop compensatory strategies geared at mitigating the disruptive effects of ADHD. In this article, we provide an overview of adult ADHD, review changes to DSM-5 diagnostic criteria meant to facilitate diagnosis of ADHD during adulthood, and discuss various factors that serve as barriers to accurate detection of adult ADHD.
Collapse
|
18
|
Abu-Elfotuh K, Abdel-Sattar SA, Abbas AN, Mahran YF, Alshanwani AR, Hamdan AME, Atwa AM, Reda E, Ahmed YM, Zaghlool SS, El-Din MN. The protective effect of thymoquinone or/and thymol against monosodium glutamate-induced attention-deficit/hyperactivity disorder (ADHD)-like behavior in rats: Modulation of Nrf2/HO-1, TLR4/NF-κB/NLRP3/caspase-1 and Wnt/β-Catenin signaling pathways in rat model. Biomed Pharmacother 2022; 155:113799. [PMID: 36271575 DOI: 10.1016/j.biopha.2022.113799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022] Open
Abstract
Both thymoquinone (TQ) and thymol (T) have been proved to possess a positive impact on human health. In this research, we aimed to investigate the effect of these compounds separately and together on the Attention-deficit/hyperactivity disorder (ADHD)-like behavior induced by monosodium glutamate (MSG) in rats. Forty male, Spargue Dawley rat pups (postnatal day 21), were randomly allocated into five groups: Normal saline (NS), MSG, MSG+TQ, MSG+T, and MSG+TQ+T. MSG (0.4 mg/kg/day), TQ (10 mg/kg/day) and T (30 mg/kg/day) were orally administered for 8 weeks. The behavioral tests proved that rats treated with TQ and/or T showed improved locomotor, attention and cognitive functions compared to the MSG group with more pronounced effect displayed with their combination. All treated groups showed improvement in MSG-induced aberrations in brain levels of GSH, IL-1β, TNF-α, GFAP, glutamate, calcium, dopamine, norepinephrine, Wnt3a, β-Catenin and BDNF. TQ and/or T treatment also enhanced the mRNA expression of Nrf2, HO-1 and Bcl2 while reducing the protein expression of TLR4, NFκB, NLRP3, caspase 1, Bax, AIF and GSK3β as compared to the MSG group. However, the combined therapy showed more significant effects in all measured parameters. All of these findings were further confirmed by the histopathological examinations. Current results concluded that the combined therapy of TQ and T had higher protective effects than their individual supplementations against MSG-induced ADHD-like behavior in rats.
Collapse
|
19
|
Topriceanu CC, Moon JC, Captur G, Perera B. The use of attention-deficit hyperactivity disorder medications in cardiac disease. Front Neurosci 2022; 16:1020961. [PMID: 36340760 PMCID: PMC9626759 DOI: 10.3389/fnins.2022.1020961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/03/2022] [Indexed: 09/02/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset usually in childhood characterized by inattention, impulsivity, and hyperactivity causing a functional impairment. Untreated ADHD, or treatment delay is associated with adverse outcomes and poor quality of life. Although conservative management strategies such as behavioral and psychological interventions are important, pharmacological treatment has a strong evidence base with improved outcomes. ADHD medications are broadly divided into stimulant and non-stimulant medications. Stimulant medications are generally more effective than non-stimulants. Cardiovascular safety of ADHD medication has been a matter of debate for decades. Treatment guidelines advise the careful consideration of risks and benefits in people with cardiovascular diseases such as congenital heart disease or cardiomyopathy. Although stimulants can increase systemic blood pressure and heart rate, no significant associations were found between their use and serious cardiovascular events. Concerns regarding QT effects and attendant sudden cardiac death risks deter clinicians from initiating much-needed ADHD medications in patients with heart disease. This overly cautious approach is potentially depriving low-risk individuals from significant benefits associated with timely ADHD drug treatment. This review discusses the cardiovascular risks reportedly associated with ADHD medications, the evidence base for their safe usage in persons with established cardiovascular disease, and highlights future research directions.
Collapse
Affiliation(s)
- Constantin-Cristian Topriceanu
- Barnet, Enfield and Haringey Mental Health Trust, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Cardiac MRI Unit, Barts Heart Centre, London, United Kingdom
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - James C. Moon
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardiac MRI Unit, Barts Heart Centre, London, United Kingdom
| | - Gabriella Captur
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Department of Cardiology, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, London, United Kingdom
| | - Bhathika Perera
- Barnet, Enfield and Haringey Mental Health Trust, London, United Kingdom
| |
Collapse
|
20
|
Effect of Sopoongsan on Skin Inflammation and Hyperlocomotion in Socially Isolated Mice with Atopic Dermatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3323201. [PMID: 36159556 PMCID: PMC9507749 DOI: 10.1155/2022/3323201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/11/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022]
Abstract
Psychological stress is a major exacerbating factor of atopic dermatitis (AD), a chronic inflammatory skin disease. Sopoongsan (SPS), a traditional herbal formula, has been indicated for the treatment of various skin disorders, including AD. This study investigated the effects of SPS on a 2,4-dinitrochlorobenzene- (DNCB-) induced AD mice model exposed to social isolation (SI) stress. The severity of the AD symptoms and behavioral abnormalities was evaluated. SPS reduced the clinical skin score as evaluated with the SCORing Atopic Dermatitis (SCORAD) index and suppressed the cutaneous infiltration of T-lymphocyte cells, mast cells, and eosinophils in SI-AD mice. The SPS treatment decreased the total distance and mean speed and increased resting time in the open field test (OFT) for these mice. In addition, the time spent in the social zone in the social interaction test also improved when SPS treatment was given. The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in the prefrontal cortex (PFC) in the SI-AD mice were reduced by the oral administration of SPS. HaCaT and BV2 cells were used for the in vitro experiments. The pretreatment with SPS reduced the protein levels of the thymus and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC) in the HaCaT cells stimulated with TNF-α and interferon-gamma (IFN-γ) (TI). SPS also suppressed TNF-α and IL-6 secretion in lipopolysaccharide- (LPS-) stimulated BV2 cells. These results imply that SPS could be a promising candidate for the treatment of AD in patients under stress conditions and at risk of exacerbation.
Collapse
|
21
|
Distractibility and impulsivity neural states are distinct from selective attention and modulate the implementation of spatial attention. Nat Commun 2022; 13:4796. [PMID: 35970856 PMCID: PMC9378734 DOI: 10.1038/s41467-022-32385-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
In the context of visual attention, it has been classically assumed that missing the response to a target or erroneously selecting a distractor occurs as a consequence of the (miss)allocation of attention in space. In the present paper, we challenge this view and provide evidence that, in addition to encoding spatial attention, prefrontal neurons also encode a distractibility-to-impulsivity state. Using supervised dimensionality reduction techniques in prefrontal neuronal recordings in monkeys, we identify two partially overlapping neuronal subpopulations associated either with the focus of attention or overt behaviour. The degree of overlap accounts for the behavioral gain associated with the good allocation of attention. We further describe the neural variability accounting for distractibility-to-impulsivity behaviour by a two dimensional state associated with optimality in task and responsiveness. Overall, we thus show that behavioral performance arises from the integration of task-specific neuronal processes and pre-existing neuronal states describing task-independent behavioral states. Failing to detect relevant information has been assumed to be a consequence of misallocation of attention. Here, the authors present findings showing that optimal behavioral performance results from the absence of interference between internal neural states and attention control.
Collapse
|
22
|
Quintero J, Gutiérrez-Casares JR, Álamo C. Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review. Neurol Ther 2022; 11:1489-1517. [PMID: 35951288 DOI: 10.1007/s40120-022-00392-2] [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: 04/06/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset neurodevelopmental disorder characterised by persistent inattention, hyperactivity and impulsivity. Moreover, ADHD is commonly associated with other comorbid diseases (depression, anxiety, bipolar disorder, etc.). The ADHD symptomatology interferes with subject function and development. The treatment of ADHD requires a multidisciplinary approach based on a combination of non-pharmacological and pharmacological treatments with the aim of ameliorating the symptomatology; among first-line pharmacological treatments are stimulants [such as methylphenidate (MPH) and lisdexamfetamine dimesylate (LDX)]. In this review we explored recent ADHD- and stimulants-related literature, with the aim of compiling available descriptions of molecular pathways altered in ADHD, and molecular mechanisms of current first-line stimulants MPH and LDX. While conducting the narrative review, we applied structured search strategies covering PubMed/MEDLINE database and performed handsearching of reference lists on the results of those searches. The aetiology and pathophysiology of ADHD are incompletely understood; both genetic and environmental factors have been associated with the disorder and its grade of burden, and also the relationship between the molecular mechanisms of pharmacological treatments and their clinical implications. The lack of comprehensive understanding of the underlying molecular pathology makes both the diagnosis and treatment difficult. Few published studies evaluating molecular data on the mechanism of action (MoA) of MPH and LDX on ADHD are available and most of them are based on animal models. Further studies are necessary to improve the knowledge of ADHD pathophysiology and how the MoAs of MPH and LDX differentially modulate ADHD pathophysiology and control ADHD symptomatology.
Collapse
Affiliation(s)
- Javier Quintero
- Servicio de Psiquiatría y Salud Mental, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
| | - José R Gutiérrez-Casares
- Unidad Ambulatoria de Psiquiatría y Salud Mental de la Infancia, Niñez y Adolescencia, Hospital Perpetuo Socorro, Badajoz, Spain.
| | - Cecilio Álamo
- Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| |
Collapse
|
23
|
Rosenau PT, van den Hoofdakker BJ, Matthijssen AFM, van de Loo-Neus GHH, Buitelaar JK, Hoekstra PJ, Dietrich A. Withdrawing methylphenidate in relation to serum levels of ferritin and zinc in children and adolescents with attention-deficit/hyperactivity disorder. J Psychiatr Res 2022; 152:31-37. [PMID: 35714551 DOI: 10.1016/j.jpsychires.2022.06.014] [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: 02/17/2022] [Revised: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Iron and zinc have been associated with attention-deficit/hyperactivity disorder (ADHD), executive functioning, and response to methylphenidate, given their link with the dopaminergic system. This study aimed to investigate the effect of withdrawing methylphenidate after long-term treatment on serum levels of ferritin and zinc; and if baseline (pre-discontinuation) serum levels of these nutritional markers moderated the effects of withdrawing methylphenidate on ADHD and oppositional defiant disorder (ODD) symptoms, and working memory. Blood samples were collected from 63 children and adolescents who participated in a randomized, placebo-controlled methylphenidate discontinuation study. They were assigned to either seven weeks of continued treatment with methylphenidate or to gradual withdrawal to placebo. With mixed models for repeated measures we (i) compared changes in ferritin and zinc serum levels between both groups, and (ii) investigated moderating effects of ferritin and zinc on the effects of discontinuation on ADHD and ODD symptoms, and working memory. We additionally explored correlations of baseline and change serum levels with respective symptom scores. Withdrawing methylphenidate led to a decrease in ferritin levels. Higher baseline ferritin was associated with a larger increase (i.e., worsening) of teacher-rated hyperactivity-impulsivity and ODD symptoms after withdrawal; and higher baseline zinc with a larger increase in number of errors on the working memory task after withdrawal. Serum levels did not correlate with ADHD and ODD symptoms. Our preliminary results suggest that ferritin and zinc may be potential biomarkers for the effectiveness of long-term treatment with methylphenidate.
Collapse
Affiliation(s)
- Paul T Rosenau
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands.
| | - Barbara J van den Hoofdakker
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Anne-Flore M Matthijssen
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry Center Nijmegen, Nijmegen, the Netherlands; Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| |
Collapse
|
24
|
Peridontitis as a Risk Factor for Attention Deficit Hyperactivity Disorder: Possible Neuro-inflammatory Mechanisms. Neurochem Res 2022; 47:2925-2935. [PMID: 35764847 DOI: 10.1007/s11064-022-03650-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 10/17/2022]
Abstract
Periodontitis is a condition caused mostly by the creation of a biofilm by the bacterium P. gingivalis, which releases toxins and damages the tooth structure. Recent research studies have reported association between dental health and neuropsychiatric illnesses. Neuroinflammation triggered by the first systemic inflammation caused by the bacterium present in the oral cavities is a plausible explanation for such a relationship. Substantial amount of evidence supports the role of neuroinflammation and dysfunction of the dopaminergic system in the pathology of ADHD (Attention deficit hyperactivity disorders). Recent epidemiological, microbiological and inflammatory findings strengthen that, periodontal bacteria, which cause systemic inflammation can contribute to neuroinflammation and finally ADHD. Although both diseases are characterized by inflammation, the specific pathways and crosslink's between periodontitis and ADHD remain unknown. Here, the authors describe the inflammatory elements of periodontitis, how this dental illness causes systemic inflammation, and how this systemic inflammation contributes to deteriorating neuroinflammation in the evolution of ADHD. Therefore, the aim of this review is to present possible links and mechanisms that could confirm the evidence of this association.
Collapse
|
25
|
Midhun T, Krishna SS, Wilson SK. Tetrahydrobiopterin and Its Multiple Roles in Neuropsychological Disorders. Neurochem Res 2022; 47:1202-1211. [PMID: 35142994 DOI: 10.1007/s11064-022-03543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
Tetrahydrobiopterin (BH4) is a multifunctional co-factor of various enzymes and a substantial amount of studies have shown BH4 as a key regulator in the synthesis of neurotransmitters such as serotonin, nor-epinephrine as well as dopamine. The imbalance of BH4 may affect neurotransmitter production which can lead to many abnormalities in CNS. This article reviews the role of BH4 in neurodegenerative and neurodevelopmental disorders. We focus on the therapeutic potential of BH4 in various brain diseases that involves neurotransmitters and attempt to address how the modulation of BH4 may provide a novel strategy in various neuropsychological conditions.
Collapse
Affiliation(s)
- Midhun T
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, 682041, Kerala, India
| | - S Swathi Krishna
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, 682041, Kerala, India
| | - Samson K Wilson
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi, 682041, Kerala, India.
| |
Collapse
|
26
|
Luking KR, Jirsaraie RJ, Tillman R, Luby JL, Barch DM, Sotiras A. Timing and Type of Early Psychopathology Symptoms Predict Longitudinal Change in Cortical Thickness From Middle Childhood Into Early Adolescence. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:397-405. [PMID: 34273555 PMCID: PMC9529372 DOI: 10.1016/j.bpsc.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early-life experiences have profound effects on functioning in adulthood. Altered cortical development may be one mechanism through which early-life experiences, including poverty and psychopathology symptoms, affect outcomes. However, there is little prospective research beginning early in development that combines clinician-rated psychopathology symptoms and multiwave magnetic resonance imaging to examine when these relationships emerge. METHODS Children from the Preschool Depression Study who completed diagnostic interviews at three different developmental stages (preschool, school age, early adolescent) and up to three magnetic resonance imaging scans beginning in middle childhood participated in this study (N = 138). Multilevel models were used to calculate intercepts and slopes of cortical thickness within a priori cortical regions of interest. Linear regressions probed how early-life poverty and psychopathology (depression, anxiety, and externalizing symptoms at separate developmental periods) related to intercept/slope. RESULTS Collectively, experiences during the preschool period predicted reduced cortical thickness, via either reduced intercept or accelerated thinning (slope). Early-life poverty predicted intercepts within sensory and sensory-motor integration regions. Beyond poverty, preschool anxiety symptoms predicted intercepts within the insula, subgenual cingulate, and inferior parietal cortex. Preschool externalizing symptoms predicted accelerated thinning within prefrontal and parietal cortices. Depression and anxiety/externalizing symptoms at later ages were not significant predictors. CONCLUSIONS Early childhood is a critical period of risk; experiences at this developmental stage specifically have the potential for prolonged influence on brain development. Negative early experiences collectively predicted reduced cortical thickness, but the specific neural systems affected aligned with those typically implicated in these individual disorders/experiences.
Collapse
Affiliation(s)
- Katherine R Luking
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri.
| | - Robert J Jirsaraie
- Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
27
|
Song IG, Kim HS, Cho YM, Lim YN, Moon DS, Shin SH, Kim EK, Park J, Shin JE, Han J, Eun HS. Association between birth weight and neurodevelopmental disorders assessed using the Korean National Health Insurance Service claims data. Sci Rep 2022; 12:2080. [PMID: 35136157 PMCID: PMC8827104 DOI: 10.1038/s41598-022-06094-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/11/2022] [Indexed: 01/23/2023] Open
Abstract
The risk of neurodevelopmental disorders in low birth weight (LBW) infants has gained recognition but remains debatable. We investigated the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-aged children according to their birth weight. We conducted a retrospective cohort study using the Korean National Health Insurance claims data of 2,143,652 children who were born between 2008 and 2012. Gestational age of infants was not available; thus, outcomes were not adjusted with it. Not only infants with birth weights of < 1.5 kg, but also 2.0–2.4 kg and 1.5–1.9 kg were associated with having ADHD; odds ratio (OR), 1.41 (95% confidence interval [CI] 1.33–1.50), and 1.49 (95% CI 1.33–1.66), respectively. The OR in infants with birth weights of 2.0–2.4 kg and 1.5–1.9 kg was 1.91 (95% CI 1.79–2.05) and 3.25 (95% CI 2.95–3.59), respectively, indicating increased odds of having ASD. Subgroup analysis for children without perinatal diseases showed similar results. In this national cohort, infants with birth weights of < 2.5 kg were associated with ADHD and ASD, regardless of perinatal history. Children born with LBW need detailed clinical follow-up.
Collapse
Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea.
| | - Yoon-Min Cho
- Health Insurance Research Institute, National Health Insurance Service, Wonju, South Korea
| | - You-Na Lim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Duk-Soo Moon
- Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jungno-gu, Seoul, 03080, Republic of Korea
| | - Joonsik Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Han
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Seon Eun
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
28
|
Pongpitakdamrong A, Chirdkiatgumchai V, Ruangdaraganon N, Roongpraiwan R, Sirachainan N, Soongprasit M, Udomsubpayakul U. Effect of Iron Supplementation in Children with Attention-Deficit/Hyperactivity Disorder and Iron Deficiency: A Randomized Controlled Trial. J Dev Behav Pediatr 2022; 43:80-86. [PMID: 34313619 DOI: 10.1097/dbp.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the effectiveness of combined iron supplementation and methylphenidate treatment on attention-deficit/hyperactivity disorder (ADHD) symptoms in children/adolescents with ADHD and iron deficiency compared with methylphenidate alone. METHODS In total, 116 children/adolescents with ADHD were screened for iron deficiency. Participants who exhibited iron deficiency were randomized into 2 groups (ferrous supplementation vs placebo). Vanderbilt ADHD rating scales were completed by parents and teachers at prestudy and poststudy periods. Student's t tests were used to determine improvements of Vanderbilt scores between the groups. RESULTS Among 116 children who participated in this study, 44.8% (52/116) met the criteria for iron deficiency. Of the total 52 participants with iron deficiency, 26 were randomized to the ferrous group and 26 to the placebo group. Most participants in each group had been prescribed short-acting methylphenidate twice daily in the morning and at noon. After a 12-week study period, total parents' Vanderbilt ADHD symptom scores showed a significant improvement between the groups (mean decrement = -3.96 ± 6.79 vs 0 ± 6.54, p = 0.037). However, teachers' Vanderbilt ADHD symptom scores showed no difference between the groups. CONCLUSION Children with ADHD and iron deficiency being on methylphenidate and iron supplementation had shown improvement of ADHD symptoms that were reported by parents.
Collapse
Affiliation(s)
- Atcha Pongpitakdamrong
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Institute of Medicine Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Vilawan Chirdkiatgumchai
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichara Ruangdaraganon
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rawiwan Roongpraiwan
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manas Soongprasit
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Umaporn Udomsubpayakul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
29
|
Abstract
During evolution, the cerebral cortex advances by increasing in surface and the introduction of new cytoarchitectonic areas among which the prefrontal cortex (PFC) is considered to be the substrate of highest cognitive functions. Although neurons of the PFC are generated before birth, the differentiation of its neurons and development of synaptic connections in humans extend to the 3rd decade of life. During this period, synapses as well as neurotransmitter systems including their receptors and transporters, are initially overproduced followed by selective elimination. Advanced methods applied to human and animal models, enable investigation of the cellular mechanisms and role of specific genes, non-coding regulatory elements and signaling molecules in control of prefrontal neuronal production and phenotypic fate, as well as neuronal migration to establish layering of the PFC. Likewise, various genetic approaches in combination with functional assays and immunohistochemical and imaging methods reveal roles of neurotransmitter systems during maturation of the PFC. Disruption, or even a slight slowing of the rate of neuronal production, migration and synaptogenesis by genetic or environmental factors, can induce gross as well as subtle changes that eventually can lead to cognitive impairment. An understanding of the development and evolution of the PFC provide insight into the pathogenesis and treatment of congenital neuropsychiatric diseases as well as idiopathic developmental disorders that cause intellectual disabilities.
Collapse
Affiliation(s)
- Sharon M Kolk
- Department of Molecular Neurobiology, Donders Institute for Brain, Cognition and Behaviour and Faculty of Science, Radboud University, Nijmegen, The Netherlands.
| | - Pasko Rakic
- Department of Neuroscience and Kavli Institute for Neuroscience, Yale University, New Haven, Connecticut, USA.
| |
Collapse
|
30
|
Boberg E, Iacobaeus E, Greenfield MS, Wang Y, Msghina M, Le Blanc K. Reduced prefrontal cortex and sympathetic nervous system activity correlate with fatigue after aHSCT. Bone Marrow Transplant 2022; 57:360-369. [PMID: 34864824 PMCID: PMC8907068 DOI: 10.1038/s41409-021-01539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Long-term fatigue and cognitive dysfunction affects 35% of allogeneic haematopoietic stem cell transplantation (aHSCT) survivors, suggesting a dysfunctional prefrontal cortex. In this study, we assessed prefrontal cortex and sympathetic nervous system activity in aHSCT patients with fatigue (n = 12), non-fatigued patients (n = 12) and healthy controls (n = 27). Measurement of near-infrared spectroscopy and electrodermal activity was carried out at rest and during cognitive performance (Stroop, verbal fluency and emotion regulation tasks). Prefrontal cortex and sympathetic nervous system activity were also analyzed in response to dopamine and noradrenaline increase after a single dose of methylphenidate. Baseline cognitive performance was similar in the two patient groups. However, after methylphenidate, only non-fatigued patients improved in Stroop accuracy and had better verbal fluency task performance compared to the fatigued group. Task-related activation of prefrontal cortex in fatigued patients was lower compared to non-fatigued patients during all cognitive tests, both before and after methylphenidate administration. During the Stroop task, reaction time, prefrontal cortex activation, and sympathetic nervous system activity were all lower in fatigued patients compared to healthy controls, but similar in non-fatigued patients and healthy controls.Reduced prefrontal cortex activity and sympathetic arousal suggests novel treatment targets to improve fatigue after aHSCT.
Collapse
Affiliation(s)
- Erik Boberg
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden.
| | - Ellen Iacobaeus
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Yanlu Wang
- grid.24381.3c0000 0000 9241 5705Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Radiology, Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mussie Msghina
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Katarina Le Blanc
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Cellular therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
31
|
Sithisarn T, Legan SJ, Westgate PM, Bada HS, Wilson ME. Understanding the effects of opioids vs non-opioids in the treatment of neonatal abstinence syndrome, an in vitro model. Front Pediatr 2022; 10:1068330. [PMID: 36483468 PMCID: PMC9723166 DOI: 10.3389/fped.2022.1068330] [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: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
Neonatal abstinence syndrome (NAS) refers to cadre of withdrawal manifestations in infants born to mothers who used illicit and licit substances during pregnancy. The increasing prevalence of NAS has been largely due to the maternal use of opioids during pregnancy. NAS contributes to increased morbidity and long-term disability in surviving infants. Clinically, oral opioid therapies for opioid exposure have been a standard treatment with morphine (MO) being the most commonly used medication. Recently, a non-opioid agent, clonidine (CD) has also been used with potentially favorable short- and long-term outcomes in infants. However, data regarding the cellular and molecular effects of these treatments on the developing brain is still lacking due to a lack of a reliable animal model that targets the neonatal brain. To address this gap in knowledge we determined the effects of MO or CD on the cell death of neonatal cortical explant cultures that were exposed to oxycodone (OXY) in utero. Sprague Dawley rats were randomized and implanted with programmable infusion pumps before mating to receive either the OXY (dose increasing from 1.21-1.90 mg/kg/day to a maximum dose of 2.86-3.49 mg/kg/day) or normal saline (NS) throughout pregnancy and until one week after delivery. Male and female rat pups were sacrificed on postnatal day 4, and the prefrontal cortex (PFC) and hippocampus (HC) were dissected and treated with MO (0.10-1.00 µM) or CD (1.20-120.00 µM) in culture media. After 5 days of treatment the explants were labeled with propidium iodide to detect cell death. Dead cells were analyzed and counted under fluorescence microscopy. In explants from the PFC, cell death was greater in those prenatally exposed to OXY and postnatally treated with MO (OXY/MO) (736.8 ± 76.5) compared to OXY/CD (620.9 ± 75.0; p = 0.005). In the HC explants, mean cell death counts were not significantly different between groups regardless of prenatal exposure or postnatal treatment (p = 0.19). The PFC is vital in controlling higher-order executive functions such as behavioral flexibility, learning and working memory. Therefore, our finding is consistent with executive function problems in children with prenatal opioid exposure.
Collapse
Affiliation(s)
- Thitinart Sithisarn
- Department of Pediatrics, University of Kentucky, Lexington KY, United States
| | - Sandra J Legan
- Department of Physiology, University of Kentucky, Lexington KY, United States
| | - Philip M Westgate
- Department of Biostatistics, University of Kentucky, Lexington KY, United States
| | - Henrietta S Bada
- Department of Pediatrics, University of Kentucky, Lexington KY, United States
| | - Melinda E Wilson
- Department of Physiology, University of Kentucky, Lexington KY, United States
| |
Collapse
|
32
|
Gillett G, Watson G, Saunders KE, McGowan NM. Sleep and circadian rhythm actigraphy measures, mood instability and impulsivity: A systematic review. J Psychiatr Res 2021; 144:66-79. [PMID: 34601378 DOI: 10.1016/j.jpsychires.2021.09.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 01/04/2023]
Abstract
The normal spectrum trait measures of mood instability and impulsivity are implicated in and comprise core symptoms of several psychiatric disorders. A bidirectional relationship between these traits and sleep disturbance and circadian rhythm dysfunction has been hypothesised, although has not been systematically assessed using objective measures in naturalistic settings. We systematically reviewed the literature following PRISMA guidelines, according to a pre-registered protocol (PROSPERO: CRD 42018108213). Peer-reviewed quantitative studies assessing an association between actigraphic variables and any measure of mood instability or impulsivity in participants aged 12-65 years old were included. Studies were critically appraised using the AXIS tool. Twenty-three articles were retained for inclusion. There was significant heterogeneity in the selection and reporting of actigraphic variables and metrics of mood instability and impulsivity. We identified emerging evidence of a positive association between circadian rest-activity pattern disturbance and delayed sleep timing with both mood instability and impulsivity. Evidence for an association with sleep duration, sleep efficiency or sleep quality was inconsistent. Future research should focus on longitudinal intra-individual associations to establish the directionality between these measures and may lead to the development of chronotherapeutic interventions for a number of psychiatric disorders.
Collapse
Affiliation(s)
- George Gillett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Gareth Watson
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Kate Ea Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| |
Collapse
|
33
|
Liu L, Zhao Q, Yu X, Xu D, Li H, Ji N, Wu Z, Cheng J, Su Y, Cao Q, Sun L, Qian Q, Wang Y. Monoaminergic Genetic Variants, Prefrontal Cortex-Amygdala Circuit, and Emotional Symptoms in Children With ADHD: Exploration Based on the Gene-Brain-Behavior Relationship. J Atten Disord 2021; 25:1272-1283. [PMID: 31910717 DOI: 10.1177/1087054719897838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: This study aimed to explore the association between monoaminergic genetic variants and emotional lability (EL) symptoms in children with ADHD. In addition, genetic effects on prefrontal cortex (PFC)-amygdala functional connectivity (FC) were investigated. Method: Children with ADHD and controls were genotyped for five monoaminergic genetic variants and were evaluated for EL symptoms. Imaging genetic exploration was conducted with previously reported aberrant PFC-amygdala resting-state functional connectivities (RSFCs) as target features. Results: A genotypic effect on EL symptoms was only found for NET1-rs3785143, indicating higher EL symptoms in TT genotype carriers than in C-allele carriers. Imaging genetic analyses indicated a marginal effect of NET1-rs3785143 on ADHD-altered FC between the superficial amygdala (SFA) and middle frontal gyrus (MFG). Mediation analysis suggested potential effects of NET1-rs3785143 via RSFC (SFA-MFG) on EL. Conclusion:NET1 variants might participate in the pathogenesis of EL in children with ADHD by influencing the function of the PFC-amygdala circuit.
Collapse
Affiliation(s)
- Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Qihua Zhao
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China.,Beijing Chaoyang District Third Hospital, Beijing, China
| | - Xiaoyan Yu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Defeng Xu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China.,Shandong Mental Health Center, Jinan, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Ning Ji
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Zhaomin Wu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China.,Shenzhen Children's Hospital, Shenzhen, China
| | - Jia Cheng
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Yi Su
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Qingjiu Cao
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, the NHC Key Laboratory of Mental Health, Peking University, Beijing, China
| |
Collapse
|
34
|
Findling RL, Candler SA, Nasser AF, Schwabe S, Yu C, Garcia-Olivares J, O'Neal W, Newcorn JH. Viloxazine in the Management of CNS Disorders: A Historical Overview and Current Status. CNS Drugs 2021; 35:643-653. [PMID: 34003459 PMCID: PMC8219567 DOI: 10.1007/s40263-021-00825-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Viloxazine has a long history of clinical use in Europe as an antidepressant, and has recently been repurposed into an extended-release form for the treatment of attention-deficit/hyperactivity disorder in the USA. An immediate-release formulation was approved for the treatment of depression in the UK in 1974, and was subsequently marketed there and in several European countries for 30 years with no major safety concerns. In contrast to first-generation antidepressants (e.g., tricyclic antidepressants, monoamine oxidase inhibitors), viloxazine was associated with a relatively low risk for cardiotoxicity. Gastrointestinal symptoms were the most commonly reported side effects. The therapeutic effects of viloxazine are thought to be primarily the result of its action as a norepinephrine reuptake inhibitor, although in vitro and preclinical in vivo animal data suggest that viloxazine may also impact the serotoninergic system. This review summarizes the evolving knowledge of viloxazine based on information from previously published preclinical and clinical investigations, and acquired unpublished historical study reports from both open-label and blinded controlled clinical trials. We review the chemical properties, mechanism of action, safety, and tolerability across these studies, and discuss the contemporary rationale for the development of this agent as an extended-release oral formulation for the treatment of attention-deficit/hyperactivity disorder.
Collapse
Affiliation(s)
- Robert L Findling
- VCU Department of Psychiatry, 501 North 2nd Street, Richmond, VA, 23298-0308, USA.
| | | | | | | | - Chungping Yu
- Supernus Pharmaceuticals, Inc., Rockville, MD, USA
| | | | | | - Jeffrey H Newcorn
- Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
35
|
Lasley SM, Fornal CA, Mandal S, Strupp BJ, Beaudin SA, Smith DR. Early Postnatal Manganese Exposure Reduces Rat Cortical and Striatal Biogenic Amine Activity in Adulthood. Toxicol Sci 2021; 173:144-155. [PMID: 31560393 DOI: 10.1093/toxsci/kfz208] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Growing evidence from studies with children and animal models suggests that elevated levels of manganese during early development lead to lasting cognitive and fine motor deficits. This study was performed to assess presynaptic biogenic amine function in forebrain of adult Long-Evans rats exposed orally to 0, 25, or 50 mg Mn/kg/day over postnatal day 1-21 or continuously from birth to the end of the study (approximately postnatal day 500). Intracerebral microdialysis in awake rats quantified evoked outflow of biogenic amines in the right medial prefrontal cortex and left striatum. Results indicated that brain manganese levels in the early life exposed groups (postnatal day 24) largely returned to control levels by postnatal day 66, whereas levels in the lifelong exposed groups remained elevated 10%-20% compared with controls at the same ages. Manganese exposure restricted to the early postnatal period caused lasting reductions in cortical potassium-stimulated extracellular norepinephrine, dopamine, and serotonin, and reductions in striatal extracellular dopamine. Lifelong manganese exposure produced similar effects with the addition of significant decreases in cortical dopamine that were not evident in the early postnatal exposed groups. These results indicate that early postnatal manganese exposure produces persistent deficits in cortical and striatal biogenic amine function. Given that these same animals exhibited lasting impairments in attention and fine motor function, these findings suggest that reductions in catecholaminergic activity are a primary factor underlying the behavioral effects caused by manganese, and indicate that children exposed to elevated levels of manganese during early development are at the greatest risk for neuronal deficiencies that persist into adulthood.
Collapse
Affiliation(s)
- Stephen M Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine Peoria, Peoria, Illinois 61605
| | - Casimir A Fornal
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine Peoria, Peoria, Illinois 61605
| | - Shyamali Mandal
- Business Development, BioVision Inc, Milpitas, California 95035
| | - Barbara J Strupp
- Division of Nutritional Sciences and Department of Psychology, Cornell University, Ithaca, New York 14853
| | - Stephane A Beaudin
- Department of Psychology and Cognitive Science, University of California Merced, Merced, California 95340
| | - Donald R Smith
- Department of Microbiology and Environmental Toxicology, University of California - Santa Cruz, Santa Cruz, California 95064
| |
Collapse
|
36
|
Boczek T, Mackiewicz J, Sobolczyk M, Wawrzyniak J, Lisek M, Ferenc B, Guo F, Zylinska L. The Role of G Protein-Coupled Receptors (GPCRs) and Calcium Signaling in Schizophrenia. Focus on GPCRs Activated by Neurotransmitters and Chemokines. Cells 2021; 10:cells10051228. [PMID: 34067760 PMCID: PMC8155952 DOI: 10.3390/cells10051228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/13/2023] Open
Abstract
Schizophrenia is a common debilitating disease characterized by continuous or relapsing episodes of psychosis. Although the molecular mechanisms underlying this psychiatric illness remain incompletely understood, a growing body of clinical, pharmacological, and genetic evidence suggests that G protein-coupled receptors (GPCRs) play a critical role in disease development, progression, and treatment. This pivotal role is further highlighted by the fact that GPCRs are the most common targets for antipsychotic drugs. The GPCRs activation evokes slow synaptic transmission through several downstream pathways, many of them engaging intracellular Ca2+ mobilization. Dysfunctions of the neurotransmitter systems involving the action of GPCRs in the frontal and limbic-related regions are likely to underly the complex picture that includes the whole spectrum of positive and negative schizophrenia symptoms. Therefore, the progress in our understanding of GPCRs function in the control of brain cognitive functions is expected to open new avenues for selective drug development. In this paper, we review and synthesize the recent data regarding the contribution of neurotransmitter-GPCRs signaling to schizophrenia symptomology.
Collapse
Affiliation(s)
- Tomasz Boczek
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Joanna Mackiewicz
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Marta Sobolczyk
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Julia Wawrzyniak
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Malwina Lisek
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Bozena Ferenc
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
| | - Feng Guo
- Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, China;
| | - Ludmila Zylinska
- Department of Molecular Neurochemistry, Faculty of Health Sciences, Medical University of Lodz, 92215 Lodz, Poland; (T.B.); (J.M.); (M.S.); (J.W.); (M.L.); (B.F.)
- Correspondence:
| |
Collapse
|
37
|
Aiding diagnosis of childhood attention-deficit/hyperactivity disorder of the inattentive presentation: Discriminant function analysis of multi-domain measures including EEG. Biol Psychol 2021; 161:108080. [PMID: 33744372 DOI: 10.1016/j.biopsycho.2021.108080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We developed a neurocognitive assessment tool (NCAT) in consultation with mental health professionals working with children with AD/HD as a diagnostic aid and screening tool. This study examines the predictive utility of NCAT in the classification of children with AD/HD Inattentive presentation. METHOD Fifty three children with AD/HD Inattentive presentation and 161 typically-developing children completed an NCAT assessment. Discriminant function analyses examined group membership prediction for separate components of NCAT and for the components combined. RESULTS The combined model correctly classified 93.4 % of participants, with 91.4 % sensitivity and 93.9 % specificity. Contributions to classification were from SNAP-IV, psychological needs satisfaction, self-regulation, executive function performance, and EEG. The combined model resulted in a 9.3 % increase in specificity and 5.9 % increase in sensitivity compared to SNAP-IV alone. CONCLUSIONS NCAT provides good discrimination between children with and without AD/HD of the Inattentive presentation, and further investigation including other subtypes and comorbidities is warranted.
Collapse
|
38
|
Nweze T, Nwoke MB, Nwufo JI, Aniekwu RI, Lange F. Working for the future: parentally deprived Nigerian Children have enhanced working memory ability. J Child Psychol Psychiatry 2021; 62:280-288. [PMID: 32302431 DOI: 10.1111/jcpp.13241] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/04/2020] [Accepted: 03/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The dominant view based on the deficit model of developmental psychopathology is that early adverse rearing impairs cognition. In contrast, an emerging evolutionary-developmental model argues that individuals exposed to early-life stress may have improved cognitive abilities that are adapted to harsh environments. We set out to test this hypothesis by examining cognitive functions in parentally deprived children in Nigeria. METHODS Cognitive performance was compared between 53 deprived children who currently live in institutional homes and foster families and 51 nondeprived control participants. We used a multifaceted neurocognitive test battery for the assessment of inhibition, set-shifting and working memory. RESULTS Results showed that the deprived and nondeprived group did not significantly differ in their performance on set-shifting and inhibition tasks. Conversely, the deprived group performed significantly better than the nondeprived group in the working memory task. DISCUSSION We interpret the enhanced working memory ability of the deprived group as a correlate of its ecological relevance. In Nigeria, underprivileged children may need to rely to a larger extent on working memory abilities to attain success through academic work. This study provides further evidence that exposure to early adversity does not necessarily impair cognitive functions but can even enhance it under some conditions and in some domains.
Collapse
Affiliation(s)
- Tochukwu Nweze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Mary Basil Nwoke
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | | | | | - Florian Lange
- Behavioral Engineering Group, KU Leuven, Leuven, Belgium
| |
Collapse
|
39
|
Dela Peña I, Shen G, Shi WX. Droxidopa alters dopamine neuron and prefrontal cortex activity and improves attention-deficit/hyperactivity disorder-like behaviors in rats. Eur J Pharmacol 2021; 892:173826. [PMID: 33347825 DOI: 10.1016/j.ejphar.2020.173826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
Finding alternative treatments for attention-deficit/hyperactivity disorder (ADHD) is crucial given the safety and efficacy problems of current ADHD medications. Droxidopa, also known as L-threo-dihydroxyphenylserine (L-DOPS), is a norepinephrine prodrug that enhances brain norepinephrine and dopamine levels. In this study, we used electrophysiological tests to examine effects of L-DOPS on the prefrontal cortex (PFC) and dopamine neurons in the ventral tegmental area. We also conducted behavioral tests to assess L-DOPS' effects on ADHD-like behaviors in rats. In chloral hydrate-anesthetized rats, PFC local field potentials oscillated between the active, depolarized UP state and the hyperpolarized DOWN state. Mimicking the effect of d-amphetamine, L-DOPS, given after the peripheral amino acid decarboxylase inhibitor, benserazide (BZ), increased the amount of time the PFC spent in the UP state, indicating an excitatory effect of L-DOPS on PFC neurons. Like d-amphetamine, L-DOPS also inhibited dopamine neurons, an effect significantly reversed by the D2-like receptor antagonist raclopride. In the behavioral tests, BZ + L-DOPS improved hyperactivity, inattention and impulsive action of the adolescent spontaneously hypertensive rat (SHR/NCrl), well-validated animal model of the combined type of ADHD. BZ + L-DOPS also reduced impulsive choice and impulsive action of Wistar rats, but did not ameliorate the inattentiveness of Wistar Kyoto rats (WKY/NCrl), proposed model of the ADHD-predominantly inattentive type. In conclusion, L-DOPS produced effects on the PFC and dopamine neurons characteristic of drugs used to treat ADHD. BZ + L-DOPS ameliorated ADHD-like behaviors in rats suggesting its potential as an alternative ADHD treatment.
Collapse
Affiliation(s)
- Ike Dela Peña
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA, 92350, USA.
| | - Guofang Shen
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA, 92350, USA
| | - Wei-Xing Shi
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA, 92350, USA; Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| |
Collapse
|
40
|
Clark SV, Semmel ES, Aleksonis HA, Steinberg SN, King TZ. Cerebellar-Subcortical-Cortical Systems as Modulators of Cognitive Functions. Neuropsychol Rev 2021; 31:422-446. [PMID: 33515170 DOI: 10.1007/s11065-020-09465-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Over the past few decades, research has established that the cerebellum is involved in executive functions; however, its specific role remains unclear. There are numerous theories of cerebellar function and numerous cognitive processes falling under the umbrella of executive function, making investigations of the cerebellum's role in executive functioning challenging. In this review, we explored the role of the cerebellum in executive functioning through clinical and cognitive neuroscience frameworks. We reviewed the neuroanatomical systems and theoretical models of cerebellar functions and the multifaceted nature of executive functions. Using attention deficit hyperactivity disorder and cerebellar tumor as clinical developmental models of cerebellar dysfunction, and the functional magnetic resonance imaging literature, we reviewed evidence for cerebellar involvement in specific components of executive function in childhood, adolescence, and adulthood. There is evidence for posterior cerebellar contributions to working memory, planning, inhibition, and flexibility, but the heterogeneous literature that largely was not designed to study the cerebellum makes it difficult to determine specific functions of the cerebellum or cerebellar regions. In addition, while it is clear that cerebellar insult in childhood affects executive function performance later in life, more work is needed to elucidate the mechanisms by which executive dysfunction occurs and its developmental course. The limitations of the current literature are discussed and potential directions for future research are provided.
Collapse
Affiliation(s)
- Sarah V Clark
- Department of Psychology, Georgia State University, GA, 30303, Atlanta, USA
| | - Eric S Semmel
- Department of Psychology, Georgia State University, GA, 30303, Atlanta, USA
| | - Holly A Aleksonis
- Department of Psychology, Georgia State University, GA, 30303, Atlanta, USA
| | | | - Tricia Z King
- Department of Psychology, Georgia State University, GA, 30303, Atlanta, USA. .,Neuroscience Institute, Georgia State University, GA, 30303, Atlanta, USA.
| |
Collapse
|
41
|
Brain micro-architecture and disinhibition: a latent phenotyping study across 33 impulsive and compulsive behaviours. Neuropsychopharmacology 2021; 46:423-431. [PMID: 32919402 PMCID: PMC7116462 DOI: 10.1038/s41386-020-00848-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Impulsive and compulsive symptoms are common, tend to co-occur, and collectively account for a substantive global disease burden. Latent phenotyping offers a promising approach to elucidate common neural mechanisms conferring vulnerability to such symptoms in the general population. We utilised the Neuroscience in Psychiatry Network (NSPN), a cohort of young people (aged 18-29 years) in the United Kingdom, who provided questionnaire data and Magnetic Resonance Imaging scans. Partial Least Squares was used to identify brain regions in which intra-cortical myelination (measured using Magnetisation Transfer, MT) was significantly associated with a disinhibition phenotype, derived from bi-factor modelling of 33 impulsive and compulsive problem behaviours. The neuroimaging sample comprised 126 participants, mean 22.8 (2.7 SD) years old, being 61.1% female. Disinhibition scores were significantly and positively associated with higher MT in the bilateral frontal and parietal lobes. 1279 genes associated with disinhibition-related brain regions were identified, which were significantly enriched for functional biological interactions reflecting receptor signalling pathways. This study indicates common microstructural brain abnormalities contributing to a multitude of related, prevalent, problem behaviours characterised by disinhibition. Such a latent phenotyping approach provides insights into common neurobiological pathways, which may help to improve disease models and treatment approaches. Now that this latent phenotyping model has been validated in a general population sample, it can be extended into patient settings.
Collapse
|
42
|
Murugesan GK, Ganesh C, Nalawade S, Davenport EM, Wagner B, Kim WH, Maldjian JA. BrainNET: Inference of Brain Network Topology Using Machine Learning. Brain Connect 2020; 10:422-435. [PMID: 33030350 DOI: 10.1089/brain.2020.0745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To develop a new functional magnetic resonance image (fMRI) network inference method, BrainNET, that utilizes an efficient machine learning algorithm to quantify contributions of various regions of interests (ROIs) in the brain to a specific ROI. Methods: BrainNET is based on extremely randomized trees to estimate network topology from fMRI data and modified to generate an adjacency matrix representing brain network topology, without reliance on arbitrary thresholds. Open-source simulated fMRI data of 50 subjects in 28 different simulations under various confounding conditions with known ground truth were used to validate the method. Performance was compared with correlation and partial correlation (PC). The real-world performance was then evaluated in a publicly available attention-deficit/hyperactivity disorder (ADHD) data set, including 134 typically developing children (mean age: 12.03, males: 83), 75 ADHD inattentive (mean age: 11.46, males: 56), and 93 ADHD combined (mean age: 11.86, males: 77) subjects. Network topologies in ADHD were inferred using BrainNET, correlation, and PC. Graph metrics were extracted to determine differences between the ADHD groups. Results: BrainNET demonstrated excellent performance across all simulations and varying confounders in identifying the true presence of connections. In the ADHD data set, BrainNET was able to identify significant changes (p < 0.05) in graph metrics between groups. No significant changes in graph metrics between ADHD groups were identified using correlation and PC. Conclusion: We describe BrainNET, a new network inference method to estimate fMRI connectivity that was adapted from gene regulatory methods. BrainNET out-performed Pearson correlation and PC in fMRI simulation data and real-world ADHD data. BrainNET can be used independently or combined with other existing methods as a useful tool to understand network changes and to determine the true network topology of the brain under various conditions and disease states. Impact statement Developed a new functional magnetic resonance image (fMRI) network inference method named as BrainNET using machine learning. BrainNET out-performed Pearson correlation and partial correlation in fMRI simulation data and real-world attention-deficit/hyperactivity disorder data. BrainNET does not need to be pretrained and can be applied to infer fMRI network topology independently on individual subjects and for varying number of nodes.
Collapse
Affiliation(s)
| | - Chandan Ganesh
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sahil Nalawade
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Ben Wagner
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Won Hwa Kim
- Department of Computer Science, The University of Texas at Arlington, Arlington, Texas, USA
| | - Joseph A Maldjian
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
43
|
Attention Networks in ADHD Adults after Working Memory Training with a Dual n-Back Task. Brain Sci 2020; 10:brainsci10100715. [PMID: 33050115 PMCID: PMC7600375 DOI: 10.3390/brainsci10100715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Patients affected by Attention-Deficit/Hyperactivity Disorder (ADHD) are characterized by impaired executive functioning and/or attention deficits. Our study aim is to determine whether the outcomes measured by the Attention Network Task (ANT), i.e., the reaction times (RTs) to specific target and cue conditions and alerting, orienting, and conflict (or executive control) effects are affected by cognitive training with a Dual n-back task. We considered three groups of young adult participants: ADHD patients without medication (ADHD), ADHD with medication (MADHD), and age/education-matched controls. Working memory training consisted of a daily practice of 20 blocks of Dual n-back task (approximately 30 min per day) for 20 days within one month. Participants of each group were randomly assigned into two subgroups, the first one with an adaptive mode of difficulty (adaptive training), while the second was blocked at the level 1 during the whole training phase (1-back task, baseline training). Alerting and orienting effects were not modified by working memory training. The dimensional analysis showed that after baseline training, the lesser the severity of the hyperactive-impulsive symptoms, the larger the improvement of reaction times on trials with high executive control/conflict demand (i.e., what is called Conflict Effect), irrespective of the participants’ group. In the categorical analysis, we observed the improvement in such Conflict Effect after the adaptive training in adult ADHD patients irrespective of their medication, but not in controls. The ex-Gaussian analysis of RT and RT variability showed that the improvement in the Conflict Effect correlated with a decrease in the proportion of extreme slow responses. The Dual n-back task in the adaptive mode offers as a promising candidate for a cognitive remediation of adult ADHD patients without pharmaceutical medication.
Collapse
|
44
|
Yu C, Garcia-Olivares J, Candler S, Schwabe S, Maletic V. New Insights into the Mechanism of Action of Viloxazine: Serotonin and Norepinephrine Modulating Properties. J Exp Pharmacol 2020; 12:285-300. [PMID: 32943948 PMCID: PMC7473988 DOI: 10.2147/jep.s256586] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Viloxazine was historically described as a norepinephrine reuptake inhibitor (NRI). Since NRIs have previously demonstrated efficacy in attention deficit/hyperactivity disorder (ADHD), viloxazine underwent contemporary investigation in the treatment of ADHD. Its clinical and safety profile, however, was found to be distinct from other ADHD medications targeting norepinephrine reuptake. Considering the complexity of neuropsychiatric disorders, understanding the mechanism of action (MoA) is an important differentiating point between viloxazine and other ADHD medications and provides pharmacology-based rationale for physicians prescribing appropriate therapy. Methods Viloxazine was evaluated in a series of in vitro binding and functional assays. Its effect on neurotransmitter levels in the brain was evaluated using microdialysis in freely moving rats. Results We report the effects of viloxazine on serotoninergic (5-HT) system. In vitro, viloxazine demonstrated antagonistic activity at 5-HT2B and agonistic activity at 5-HT2C receptors, along with predicted high receptor occupancy at clinical doses. In vivo, viloxazine increased extracellular 5-HT levels in the prefrontal cortex (PFC), a brain area implicated in ADHD. Viloxazine also exhibited moderate inhibitory effects on the norepinephrine transporter (NET) in vitro and in vivo, and elicited moderate activity at noradrenergic and dopaminergic systems. Conclusion Viloxazine’s ability to increase 5-HT levels in the PFC and its agonistic and antagonistic effects on certain 5-HT receptor subtypes, which were previously shown to suppress hyperlocomotion in animals, indicate that 5-HT modulating activity of viloxazine is an important (if not the predominant) component of its MoA, complemented by moderate NET inhibition. Supported by clinical data, these findings suggest the updated psychopharmacological profile of viloxazine can be best explained by its action as a serotonin norepinephrine modulating agent (SNMA).
Collapse
Affiliation(s)
- Chungping Yu
- Supernus Pharmaceuticals, Inc., Rockville, MD, USA
| | | | | | | | - Vladimir Maletic
- Department of Psychiatry/Behavioral Science, University of South Carolina School of Medicine, Greenville, SC, USA
| |
Collapse
|
45
|
Conley TE, Beaudin SA, Lasley SM, Fornal CA, Hartman J, Uribe W, Khan T, Strupp BJ, Smith DR. Early postnatal manganese exposure causes arousal dysregulation and lasting hypofunctioning of the prefrontal cortex catecholaminergic systems. J Neurochem 2020; 153:631-649. [PMID: 31811785 PMCID: PMC7261255 DOI: 10.1111/jnc.14934] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 12/24/2022]
Abstract
Studies have reported associations between environmental manganese (Mn) exposure and impaired cognition, attention, impulse control, and fine motor function in children. Our recent rodent studies established that elevated Mn exposure causes these impairments. Here, rats were exposed orally to 0, 25, or 50 mg Mn kg-1 day-1 during early postnatal life (PND 1-21) or lifelong to determine whether early life Mn exposure causes heightened behavioral reactivity in the open field, lasting changes in the catecholaminergic systems in the medial prefrontal cortex (mPFC), altered dendritic spine density, and whether lifelong exposure exacerbates these effects. We also assessed astrocyte reactivity (glial fibrillary acidic protein, GFAP), and astrocyte complement C3 and S100A10 protein levels as markers of A1 proinflammatory or A2 anti-inflammatory reactive astrocytes. Postnatal Mn exposure caused heightened behavioral reactivity during the first 5-10 min intervals of daily open field test sessions, consistent with impairments in arousal regulation. Mn exposure reduced the evoked release of norepinephrine (NE) and caused decreased protein levels of tyrosine hydroxylase (TH), dopamine (DA) and NE transporters, and DA D1 receptors, along with increased DA D2 receptors. Mn also caused a lasting increase in reactive astrocytes (GFAP) exhibiting increased A1 and A2 phenotypes, with a greater induction of the A1 proinflammatory phenotype. These results demonstrate that early life Mn exposure causes broad lasting hypofunctioning of the mPFC catecholaminergic systems, consistent with the impaired arousal regulation, attention, impulse control, and fine motor function reported in these animals, suggesting that mPFC catecholaminergic dysfunction may underlie similar impairments reported in Mn-exposed children.
Collapse
Affiliation(s)
- Travis E. Conley
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| | - Stephane A. Beaudin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| | - Stephen M. Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, 61605, USA
| | - Casimir A. Fornal
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, 61605, USA
| | - Jasenia Hartman
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| | - Walter Uribe
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| | - Tooba Khan
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| | - Barbara J. Strupp
- Division of Nutritional Sciences and Department of Psychology, Cornell University, Ithaca, NY, 14853, USA
| | - Donald R. Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, 95064, USA
| |
Collapse
|
46
|
Salehzadeh SA, Mohammadian A, Salimi F. Effect of chronic methamphetamine injection on levels of BDNF mRNA and its CpG island methylation in prefrontal cortex of rats. Asian J Psychiatr 2020; 48:101884. [PMID: 31830601 DOI: 10.1016/j.ajp.2019.101884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 01/16/2023]
Abstract
Methamphetamine (METH) is a highly addictive psychostimulant. Its abuse causes problems in cognition, attention, or psychiatric conditions such as psychosis. Prefrontal cortex is involved in many aspects of drug addiction and in mental disorders similar to those triggered by METH. Brain-derived neurotrophic factor (BDNF), plays important roles in modulating different aspects of addiction, and is implicated in psychiatric conditions reminiscent of those suffered by METH-abusers. Male Wistar rats were intra-peritoneally injected with METH (8 mg/kg/day) for 14 days while control group received normal saline. After extraction of prefrontal cortices, expression of BDNF IV splice variant and methylation level of its CpG island were evaluated. The relative expression of BDNF IV in METH-treated group was 2.15 fold higher than the control group. Seven out of 29 CpG sites were significantly hypomethylated in the METH group, although none survived Bonferroni adjustment. However, the overall methylation level of the 29 CpGs was significantly lower in METH cases than in controls. We discuss the importance of our results and its implications in detail.
Collapse
Affiliation(s)
- Seyed Ahmad Salehzadeh
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Mohammadian
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Fatemeh Salimi
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
47
|
Sex differences in the association between exposure to indoor particulate matter and cognitive control among children (age 6-14 years) living near coal-fired power plants. Neurotoxicol Teratol 2020; 78:106855. [PMID: 31917336 DOI: 10.1016/j.ntt.2020.106855] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/18/2019] [Accepted: 01/01/2020] [Indexed: 01/09/2023]
Abstract
Coal fly ash consists of inhalable particulate matter with varying concentrations of neurotoxic metals. Children living near coal-fired power plants with coal fly ash storage facilities may be exposed to coal fly ash when it escapes as fugitive dust emissions into surrounding communities. Previous research on outdoor particulate matter air pollution of similar aerodynamic diameter (PM10) suggests exposure may be associated with impaired cognitive control. The purpose of this research was to investigate sex-differences in the association between exposure to indoor PM10 and cognitive control among children (n = 221), ages 6-14 years, living near coal-fired power plants with fly ash storage facilities. In an ongoing community-based study, we measured indoor PM10 concentrations in participants' housing units and used performance measures from the BARS (Behavior Assessment and Research System) Continuous Performance Test (CPT) and Selective Attention Test (SAT) to assess neurotoxic effects on cognitive control. In adjusted negative binomial regression models, we found children living in housing units with higher indoor PM10 concentrations had a higher risk of commission errors on the CPT (incidence rate ratio (IRR) = 1.22 per interquartile range difference (IQR = 0.72 μg/m3) in natural log-transformed PM10 concentrations; 95% CI = 1.01, 1.46) and SAT (IRR = 1.14; 95% CI = 1.01, 1.28). Furthermore, child sex modified the association between PM10 concentration and CPT commission errors. Among females, higher PM10 concentration was associated with higher risk of CPT commission errors (IRR = 1.39; 95% CI = 1.06, 1.82), but we found no association among males (IRR = 1.01; 95% CI = 0.79, 1.30). We found no association between PM10 concentrations and CPT or SAT response latency. Our results suggest females living near coal-fired plants with coal fly ash storage facilities may be more susceptible to impaired cognitive control associated with particulate matter exposure. Children living near coal-fired power plants with coal fly ash storage facilities who are exposed to particulate matter may have an increased risk of impulse control problems.
Collapse
|
48
|
McCoy KT, Pancione K, Hammonds LS, Costa CB. Management of Attention-Deficit/Hyperactivity Disorder in Primary Care. Nurs Clin North Am 2019; 54:517-532. [PMID: 31703777 DOI: 10.1016/j.cnur.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Management of attention-deficit/hyperactivity disorders require provider skill, rapport, and referral acumen to treat patients across the life span. Incidence and prevalence have increased in the United States and globally. There are innovative models of evidence-informed screening techniques, treatment strategies to help providers work with patients and their families. Diplomatic management of highly charged treatment controversies, drug diversion, and risk factor reduction helps to ethically address this growing public health phenomenon. This article examines risk factors and treatment considerations in the United States for evidence-informed care, with a focus on affordable and readily accessible treatment in primary care settings.
Collapse
Affiliation(s)
- Kathleen T McCoy
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Kirsten Pancione
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Linda Sue Hammonds
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Christine B Costa
- California State University Long Beach, School of Nursing, 1250 Bellflower Boulevard, MS 0301, Long Beach, CA 90804, USA.
| |
Collapse
|
49
|
Transcriptome-wide association study of attention deficit hyperactivity disorder identifies associated genes and phenotypes. Nat Commun 2019; 10:4450. [PMID: 31575856 PMCID: PMC6773763 DOI: 10.1038/s41467-019-12450-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/10/2019] [Indexed: 01/11/2023] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental psychiatric disorder. Genome-wide association studies (GWAS) have identified several loci associated with ADHD. However, understanding the biological relevance of these genetic loci has proven to be difficult. Here, we conduct an ADHD transcriptome-wide association study (TWAS) consisting of 19,099 cases and 34,194 controls and identify 9 transcriptome-wide significant hits, of which 6 genes were not implicated in the original GWAS. We demonstrate that two of the previous GWAS hits can be largely explained by expression regulation. Probabilistic causal fine-mapping of TWAS signals prioritizes KAT2B with a posterior probability of 0.467 in the dorsolateral prefrontal cortex and TMEM161B with a posterior probability of 0.838 in the amygdala. Furthermore, pathway enrichment identifies dopaminergic and norepinephrine pathways, which are highly relevant for ADHD. Overall, our findings highlight the power of TWAS to identify and prioritize putatively causal genes. A recent GWAS reported 12 genetic loci for attention deficit/hyperactivity disorder (ADHD). Here, Liao et al. perform transcriptomic imputation using these data and 12 brain-relevant tissues from GTEx and CMC to identify 9 genes associated with ADHD by TWAS, 3 of which had not yet been reported for ADHD.
Collapse
|
50
|
Hermes G, Hyman SM, Fogelman N, Kosten TR, Sinha R. Lofexidine in Combination With Oral Naltrexone for Opioid Use Disorder Relapse Prevention: A Pilot Randomized, Double-Blind, Placebo-Controlled Study. Am J Addict 2019; 28:480-488. [PMID: 31448846 DOI: 10.1111/ajad.12942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/20/2019] [Accepted: 07/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lofexidine (LFX), an α2A adrenergic receptor agonist, known to alleviate opioid withdrawal symptoms, was assessed in combination with oral naltrexone (NTX) for effects on opioid use outcomes and NTX treatment compliance. METHODS Detoxified individuals (ages 18-55, 80% male) with opioid use disorder Diagnostic and Statistical Manual of Mental Disorders, 4th edition were randomized to 2.4 mg/day of LFX (n = 26) or Placebo (PBO, n = 31) in a double-blind manner for 12 weeks of treatment. NTX compliance, opioid-free urine samples, opioid craving as well as vital signs, subjective opioid withdrawal symptoms were assessed. RESULTS Intent to treat analysis revealed significantly better control over opioid craving in the LFX/NTX vs PBO/NTX group (P < .03), but no differences between groups in NTX compliance, opioid use, and overall opioid craving. However, subject withdrawal due to medication intolerance was significantly higher in the LFX/NTX (5/26) vs PBO/NTX (0/31) (P < .01). Two additional patients were withdrawn due to acute hepatitis infection. Post hoc secondary analyses with the nonwithdrawn sample indicated significantly higher rates of treatment completion (P < .05) and NTX compliance (P < .01), lower percent opioid urine samples (P < .05), and lower overall opioid craving (P < .05) in the LFX/NTX vs the PBO/NTX group. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Although preliminary, these findings suggest that LFX at doses up to 2.4 mg/daily was safe and improved control over opioid cravings. Among those who tolerated the medication, LFX/NTX significantly improved the opioid craving, delayed return to opioid use, and improved treatment compliance and completion rates. These findings support further assessment of LFX dose titration schedule along with the adjunctive use of LFX with NTX treatment to enhance opioid relapse prevention. (Am J Addict 2019;00:1-9).
Collapse
Affiliation(s)
- Gretchen Hermes
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
| | - Scott M Hyman
- Doctoral Program in Clinical Psychology, Albizu University, Doral, Florida
| | - Nia Fogelman
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
| | | | - Rajita Sinha
- The Yale Stress Center, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|