Smoking and ADHD: an evaluation of self medication and behavioral disinhibition models based on comorbidity and personality patterns

Association of temperament and character traits with ADHD and its comorbidities

BACKGROUND

Increasing evidence suggests that personality traits may be associated with ADHD and comorbid concerns. We investigated temperament and character traits associated with internalizing and externalizing comorbidities in adolescents with or without ADHD.

METHODS

The population consisted of a subsample (n = 457) of the Northern Finland Birth Cohort 1986 (NFBC1986) that comprised 16-year-old adolescents with and without symptoms of ADHD. ADHD and psychiatric comorbidities were assessed using the Kiddie-SADS-PL and temperament and character profiles were determined with TCI-125. Outcomes were examined using Pearson's chi-square test, Analyses of Covariance and Cohen's d.

RESULTS

The adolescents with ADHD endorsed more novelty seeking and less persistence, self-directedness, and cooperativeness than those without. Comparison of the personality traits and psychiatric comorbidities with the ADHD cases showed that comorbidities did not particularly affect the temperament and character profiles, but rather ADHD accounted for the differences between the personality traits. However, the temperament and character traits predicted externalizing and internalizing psychiatric disorders in the control group.

CONCLUSIONS

Our findings reveal unique comorbidity-related temperament factors, which may have implications for adaptive and personalizing intervention efforts.

No prescription? No problem: A qualitative study investigating self-medication with novel psychoactive substances (NPS)

BACKGROUND

The proliferation of Novel Psychoactive Substances (NPS) presents a challenge for global drug policy. The ease of online drug purchase and the emergence of the dark web have created new avenues for the growth of NPS. Despite the global nature of this issue, limited research has examined motivations of use. These include perceived safety or convenience, an interest in novel pharmacology and self-exploration. Recent evidence has suggested individuals may be self-medicating with NPS, however this phenomenon has yet to be thoroughly explored. This study aims to investigate the occurrence of NPS self-medication, identify the specific NPS involved, and understand the motivations behind their use.

METHODS

Discussions surrounding self-medication using NPS were collected between October 2022 and February 2023 via a content analysis of a Reddit community. Ninety-three threads, comprising 182,490 words and 5023 comments, were collected and cleaned. A frequency analysis was conducted to identify the NPS discussed, and data was analysed systematically through the process of iterative categorization (IC).

RESULTS

Our study revealed frequent discussions about the self-medication with several NPS, notably etizolam, clonazolam, diclazepam, flualprazolam, 2-FMA, 4F-MPH, 3-FPM and 3-MeO-PCP. Individuals were mainly self-treating ADHD, anxiety and depression. Motivations for choosing NPS included access, cost, legality and a dissatisfaction with conventional healthcare. Substances were often chosen based on a profile of "Functionality" and outcomes varied. The use of clonazolam was highlighted as particularly problematic.

CONCLUSION

The current study provides insight into the phenomenon of self-medication with NPS within an internet demographic, exploring the motivations behind why individuals choose NPS for a variety of disorders. The easy access to NPS and lack of scientific data pose a significant challenge for drug policy. Future policies should focus on improving healthcare providers knowledge of NPS use, removing barriers to adult ADHD diagnosis and rebuilding trust between individuals and addiction services.

Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

Catecholaminergic and cholinergic neuromodulation in autism spectrum disorder: A comparison to attention-deficit hyperactivity disorder

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by social impairments and restricted, repetitive behaviors. Treatment of ASD is notoriously difficult and might benefit from identification of underlying mechanisms that overlap with those disturbed in other developmental disorders, for which treatment options are more obvious. One example of the latter is attention-deficit hyperactivity disorder (ADHD), given the efficacy of especially stimulants in treatment of ADHD. Deficiencies in catecholaminergic systems [dopamine (DA), norepinephrine (NE)] in ADHD are obvious targets for stimulant treatment. Recent findings suggest that dysfunction in catecholaminergic systems may also be a factor in at least a subgroup of ASD. In this review we scrutinize the evidence for catecholaminergic mechanisms underlying ASD symptoms, and also include in this analysis a third classic ascending arousing system, the acetylcholinergic (ACh) network. We complement this with a comprehensive review of DA-, NE-, and ACh-targeted interventions in ASD, and an exploratory search for potential treatment-response predictors (biomarkers) in ASD, genetically or otherwise. Based on this review and analysis we propose that (1) stimulant treatment may be a viable option for an ASD subcategory, possibly defined by genetic subtyping; (2) cerebellar dysfunction is pronounced for a relatively small ADHD subgroup but much more common in ASD and in both cases may point toward NE- or ACh-directed intervention; (3) deficiency of the cortical salience network is sizable in subgroups of both disorders, and biomarkers such as eye blink rate and pupillometric data may predict the efficacy of targeting this underlying deficiency via DA, NE, or ACh in both ASD and ADHD.

Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders

The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)-behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)-and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.

Risk for substance use among adolescents at-risk for childhood victimization: The moderating role of ADHD

BACKGROUND

Youth who are victimized by violence are at heightened risk for substance use (SU) during adolescence, a period characterized by elevated impulsivity and risk-taking behavior. This risk may be magnified by attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To examine risk/protective factors for adolescent SU among adolescents at-risk for victimization and whether ADHD moderates these associations.

PARTICIPANTS AND SETTING

Participants were 1058 caregiver-adolescent dyads in the U.S. who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN).

METHOD

Binary logistic regression analyses were conducted for each SU type. First-order effects of all variables were tested first and for each SU outcome, followed by tests of two-way interactions between ADHD group and each predictor, after controlling for first-order effects.

RESULTS

More externalizing behavior (odds ratio [OR] = 1.38; 95 % confidence interval [CI]:1.12, 1.71) and less parental knowledge (OR = .75; 95 %CI: .60, .95) were associated with greater risk for subsequent tobacco use. Less positive peer affiliation was associated with greater risk for subsequent illicit SU (OR = .59; 95 %CI: .36, .96). More deviant peer affiliation were associated with greater risk for all forms of SU. ADHD moderated the association between deviant peer affiliation and marijuana use [b = .9, p < .05, 95 %CI: .03, 1.77), such that deviant peer affiliation was a significantly stronger predictor of marijuana use among adolescents with ADHD than those without.

CONCLUSIONS

Findings suggest risk and protective factors for SU are largely consistent for adolescents at-risk for victimization with and without ADHD, but at-risk adolescents with ADHD may be more susceptible to deviant peer influences.

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND

The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians.

METHODS

Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported.

RESULTS

Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h.

CONCLUSIONS

Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Adolescent Externalizing Psychopathology and Its Prospective Relationship to Marijuana Use Development from Age 14 to 30: Replication Across Independent Longitudinal Twin Samples

Externalizing psychopathology in early adolescence is a highly heritable risk factor for drug use, yet how it relates to marijuana use development is not well-characterized. We evaluate this issue in independent twin samples from Colorado (N = 2608) and Minnesota (N = 3630), assessed from adolescence to early adulthood. We used a biometric latent growth model of marijuana use frequency with data from up to five waves of assessment from ages 14 to 30, to examine change in marijuana use and its relationship with a factor model of adolescent externalizing psychopathology. The factor structure of adolescent externalizing psychopathology was similar across samples, as was the association between that common factor and early marijuana use (Minnesota r = 0.67 [0.60, 0.75]; Colorado r = 0.69 [0.59, 0.78]), and increase in use (Minnesota r = 0.18 [0.10, 0.26]; Colorado r = 0.20 [0.07, 0.34]). Early use was moderately heritable in both samples (Minnesota h² = 0.57 [0.37, 0.79]; Colorado h² = 0.42 [0.14, 0.73]). Increase in use was highly heritable in Minnesota (h² = 0.82 [0.72, 0.88]), less so in Colorado (h² = 0.22 [0.01, 0.66]), and shared environmental effects were larger in Colorado (c² = 0.55 [0.14, 0.83]) than Minnesota (c² = 0 [0, 0.06]). We found moderate genetic correlations between externalizing psychopathology and early use in both samples. Finally, additional analyses in the Minnesota sample indicated that marijuana use decreased during the late 20s. This decline is strongly heritable (h² = 0.73 [0.49, 0.91]) and moderately negatively correlated with adolescent externalizing psychopathology (r = - 0.41 [- 0.54, - 0.28]). Adolescent externalizing psychopathology is genetically correlated with change in late adolescent marijuana use (late teens, early 20s), as well as maintenance of use in early adulthood (late 20 s) even after controlling for the effects of early use.

Temperament correlates in adult ADHD: A systematic review★★

BACKGROUND

Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children, but adult-ADHD is still an under-diagnosed and untreated condition. Treating adult-ADHD is complex and requires effective strategies for ADHD symptoms and comorbidities. Because of its high comorbidity rate with mood disorders and the growing interest in symptoms of emotional dysregulation in these patients, our aim was to collect studies that investigated temperament correlates in adult people with ADHD, to better understand the association between them and the eventual role of temperament as a prognostic-therapeutic marker.

METHODS

We performed a systematic review of the literature. We included only studies that measured temperament traits in ADHD adults using the Temperament Evaluation of Memphis, Paris and San Diego-Auto-questionnaire (TEMPS-A) or the Temperament and Character Inventory (TCI).

RESULTS

We retrieved 15 papers that used the TCI and 6 papers that used the TEMPS-A. In the TCI studies, ADHD was associated with high scores on Novelty Seeking and Harm Avoidance and low scores on Persistence. For the TEMPS-A studies, ADHD and Bipolar Disorders share some similarities in temperament scores, except for the hyperthymic temperament score.

LIMITATIONS

A comparison between the TCI and TEMPS-A results was not possible. The number of papers included was small. Among them, the type of sample, the number of recruited subjects and the ADHD assessment were very different.

CONCLUSIONS

The majority of ADHD individuals share temperament traits such as lability, irritability and excessiveness of emotional responses. Further research is needed to better understand whether temperament influences the pharmacological response of ADHD patients and whether temperament scores affect the long-term therapeutic outcome.

Impulsivity related personality traits and cigarette smoking in adults: A meta-analysis using the UPPS-P model of impulsivity and reward sensitivity

BACKGROUND

Although there is considerable evidence of an association between impulsivity and cigarette smoking, the magnitude of this association varies across studies. Impulsivity comprises several discrete traits that may influence cigarette use in different ways. The present meta-analysis aims to examine the direction and magnitude of relationships between specific impulsivity-related traits, namely lack of premeditation, lack of perseverance, sensation seeking, negative urgency, positive urgency and reward sensitivity and both smoking status and severity of nicotine dependence in adults across studies and to delineate differences in effects across these relationships.

METHODS

Ninety-seven studies were meta-analysed using random-effects models to examine the relationship between impulsivity-related traits and smoking status and severity of nicotine dependence. A number of demographic and methodological variables were also assessed as potential moderators.

RESULTS

Smoking status and severity of nicotine dependence were significantly associated with all impulsivity-related traits except reward sensitivity. Lack of premeditation and positive urgency showed the largest associations with smoking status (r = 0.20, r = 0.24 respectively), while positive urgency showed the largest association with severity of nicotine dependence (r = 0.23). Study design moderated associations between lack of premeditation and lack of perseverance and smoking status, with larger effects found in cross-sectional compared to prospective studies.

CONCLUSIONS

Finding suggest that impulsivity is associated with an increased likelihood of being a smoker and greater nicotine dependence. Specific impulsivity-related traits differentially relate to smoking status and severity of nicotine dependence. Understanding the complexity of impulsivity-related traits in relation to smoking can help to identify potential smokers and could inform cessation treatment.

Attention-Deficit/Hyperactivity Disorder and Nicotine Dependence in Adults

Introduction

The aim of this study is to assess clinical characteristics and smoking profiles of individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and compare their nicotine dependence status with healthy controls for better understanding the mutual and complex relationship between ADHD and smoking.

Methods

We included the following participants in the study: 40 adults with the diagnosis of ADHD, 40 participants who visited the smoking cessation polyclinic without any psychiatric disorders, and 40 healthy controls. A sociodemographic data form, Wender Utah Rating Scale (WURS), Adult ADD/ADHD Diagnosis and Evaluation Inventory, and Fagerstrom Nicotine Dependence Test (FNDT) were administered to the participants.

Results

Mean age of the ADHD, nicotine dependence, and control groups was 28.68±7.22, 34.17±8.60, 33.70±7.45 years, respectively. Percentages of females and males were 27.5% and 72.5% in the ADHD group, 50% and 50% in the nicotine dependence group, 47.5% and 52.5% in the control group. The attention-deficit scores in the ADHD, nicotine dependence, and control groups were 21.18±5.05, 7.23±3.96, 4.75±2.65, respectively (p=0.001), whereas the hyperactivity scores were.73±5.84, 6.43±4.2, and 3.58±2.27, respectively (p=0.001). The related features scores were 56.53±12.96, 24.30±13.93, and 13.13±6.11, respectively (p=0.001), whereas the WURS scores were 61.88±12.69, 23.03±16.07, 11.90±8.15, respectively (p=0.001). FNDT scores in ADHD and nicotine dependence groups were 5.83±2.11 and 6.20±2.74, respectively (p=0.495).

Conclusion

Considering the argument of ADHD being an independent risk factor for nicotine dependence, we think the co-occurrence of the smoking addiction and ADHD symptoms in the context of dopamine dysregulation is important in the clinical setting. Treatment modalities and of preventive strategies should be considered while keeping this in mind.

Personality patterns and Smoking behavior among students in Tabriz, Iran

INTRODUCTION

Psychological factors have always been considered for their role on risk taking behavior such as substance abuse, risky driving and smoking. The aim of this study was to determine the association between smoking behavior and potential personality patterns among high school students in Tabriz, Iran.

METHODS

Through a multistage sampling in a cross-sectional study, 1000 students were enrolled to represent the final grade high school student population of Tabriz, Iran in 2013. The personality patterns along with smoking status and some background information were collected through standard questionnaires along with Millon Clinical Multiaxial Inventory-III (MCMI-III). Fourteen personality patterns and ten clinical syndromes. ANOVA and Kruskal Wallis tests were used to compare numeric scales among the study participants, with respect to their smoking status. Stata version 13 statistical software package was used to analyze the data. Multivariate logistic regression was used to predict likelihood of smoking by personality status.

RESULTS

Two logistic models were developed in both of whom male sex was identified as a determinant of regular smoking (1st model) and ever-smoking (2nd model). Depressive personality increased the likelihood of being a regular smoker by 2.8 times (OR=2.8, 95% CI: 1.3-6.1). The second personality disorder included in the model was sadistic personality with an odds ratio of 7.9 (96% CI: 1.2-53%). Histrionic personality increased the likelihood of experiencing smoking by 2.2 times (OR=2.2, 95% CI: 1.6-3.1) followed by borderline personality (OR=2.8, 95% CI: 0.97-8.1).

CONCLUSION

Histrionic and depressive personalities could be considered as strong associates of smoking, followed by borderline and sadistic personalities. A causal relationship couldn't be assumed unless well controlled longitudinal studies reached the same findings using psychiatric interviews.

Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions

BACKGROUND

Nicotine use has been reported to ameliorate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Furthermore, adults with ADHD have a relatively high prevalence of cigarette smoking and greater difficulty abstaining from smoking. Overall, though, there is scant literature investigating the beliefs, perceptions and experiences of smokers with ADHD regarding smoking cessation and withdrawal.

METHODS

Our participants (n = 20) fulfilling criteria for ADHD and a past or current dependence from nicotine were recruited from the in- and outpatient clinic of the Zurich University Psychiatric Hospital and the Psychiatric Services Aargau (Switzerland). We conducted in-depth interviews to explore their motivations to quit, past experiences with and expectations about quitting using a purposeful sampling plan. The sample was selected to provide diversity in relation to level of nicotine dependence, participation in a smoking-cessation program, gender, age, martial status and social class. Mayring's qualitative content analysis approach was used to evaluate findings.

RESULTS

Adult smokers with ADHD had made several attempts to quit, experienced intense withdrawal symptoms, and relapsed early and often. They also often perceived a worsening of ADHD symptoms with nicotine abstinence. We identified three motives to quit smoking: 1) health concerns, 2) the feeling of being addicted, and 3) social factors. Most participants favored a smoking cessation program specifically designed for individuals with ADHD because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation program should address specific symptoms of this disorder.

CONCLUSIONS

Since treatment initiation and adherence associate closely with perception, we hope these findings will result in better cessation interventions for the vulnerable subgroup of smokers with ADHD.

Mediating and Moderating Role of Depression, Conduct Disorder or Attention-Deficit/Hyperactivity Disorder in Developing Adolescent Substance Use Disorders: A Population-Based Study

Objective

To evaluate the mediating/moderating effects of common internalizing /externalizing disorders on the association between ADHD and adolescent substance use disorders (SUD) in a population-based birth cohort.

Methods

Among 5718 children in the birth cohort, 343 ADHD incident cases and 712 matched controls were identified. Psychiatric diagnoses prior to age 19 were classified into DSM-IV categories. The association between ADHD and SUD was summarized (hazard ratios (HR), 95% CI). The effect of depression, CD/ODD, anxiety was evaluated separately.

Results

Assessment of the joint effects of ADHD and each psychiatric disorder did not support a moderating effect of these disorders on SUD on additive scale. However, the association between ADHD and SUD was partially explained by a mediating role of these psychiatric disorders.

Conclusion

For clinicians our results emphasize that depression (or CD/ODD) confers greater risk for SUD than ADHD alone. Early detection/treatment of SUD among adolescents with depression (or CD/ODD) is crucial regardless of ADHD.

Changing relationships between smoking and psychiatric disorders across twentieth century birth cohorts: clinical and research implications

As the risks of tobacco use become recognized and smoking becomes stigmatized, new smokers may be increasingly driven to smoke by biological or genetic vulnerabilities rather than social desirability. Given that genetic risk for deviant proneness is shared across other psychiatric and addictive disorders, we predicted that as rates of smoking decreased through the latter half of the twentieth century, associations between smoking and psychopathology would increase. Participants (N=25 412) from a large US study-the National Epidemiologic Survey on Alcohol and Related Conditions, NESARC-were interviewed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV Version (AUDADIS-IV) and classified into one of five birth cohort decades (1940s to 1980s) and three smoking history (nonsmokers, never-dependent smokers and ever-dependent smokers) groups. We found that the prevalence of smoking decreased across the five birth cohorts, but associations of smoking with drug and AUDs, attention-deficit hyperactivity disorder, bipolar disorder and antisocial personality disorder, each increased monotonically in more recently born cohorts, even after adjusting for concurrent demographic and socioeconomic changes. For drug and AUDs, increases were observed among smokers both with and without a history of nicotine dependence; for other outcomes, increases were entirely driven by nicotine-dependent smokers. Findings suggest that smokers in more recent cohorts have disproportionately high psychiatric vulnerability, and may benefit from greater mental health screenings. Differentiating between casual and dependent smokers may further help prioritize those at greatest risk. Researchers should also be aware of potential variation in psychiatric comorbidity based on cohort of birth when defining groups of smokers, to minimize confounding.

Social Networking Site Use While Driving: ADHD and the Mediating Roles of Stress, Self-Esteem and Craving

BACKGROUND

Adults who present ADHD symptoms have an increased risk for vehicle accidents. One conceivable overlooked account for this association is the possibility that people with ADHD symptoms use rewarding technologies such as social networking sites (SNS) while driving, more than others. The objective of this study was to understand if and how ADHD symptoms can promote SNS use while driving and specifically to conceptualize and examine mechanisms which may underlie this association. To do so, ADHD is viewed in this study as an underlying syndrome that promotes SNS use while driving in a manner similar to how addictive syndromes promote compulsive seeking of drug rewards.

METHODS

Time-lagged survey data regarding ADHD, stress, self-esteem, SNS craving experience, SNS use while driving, and control variables were collected from a sample of 457 participants who use a popular SNS (Facebook) and drive, after face-validity examination with a panel of five users and pretest with a sample of 47. These data were subjected to structural equation modeling (SEM) analyses using the frequency of ADHD symptoms measured with ASRS v1.1 Part A as a continuous variable, as well as multivariate analysis of variance using ADHD classification based on ASRS v1.1 scoring guidelines.

RESULTS

ADHD symptoms promoted increased stress and reduced self-esteem, which in turn, together with ADHD symptoms, increased one's cravings to use the SNS. These cravings ultimately translated into increased SNS use while driving. Using the ASRS v1.1 classification, people having symptoms highly consistent with ADHD presented elevated levels of stress, cravings to use the SNS, and SNS use while driving, as well as decreased levels of self-esteem. Cravings to use the SNS among men were more potent than among women.

CONCLUSION

SNS use while driving may be more prevalent than previously assumed and may be indirectly associated with ADHD symptoms. It is a new form of impulsive and risky behavior which is more common among people with symptoms compatible with ADHD than among others. Consistent with addiction and decision making models, SNS use while driving can be viewed as a form of a compensatory reward seeking behavior. As such, prevention and reduction interventions that target the mediating perceptions and states should be devised.

Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families

A strong genetic role in the etiology of attention-deficit hyperactivity disorder (ADHD) has been demonstrated by several studies using different methodologies. Shortcomings of genetic studies often include the lack of golden standard practices for diagnosis for ADHD, the use of categorical instead of a dimensional approach, and the disregard for assortative mating phenomenon in parents. The current study aimed to overcome these shortcomings and analyze data through a novel statistical approach, using multilevel analyses with Bayesian procedures and a specific mathematical model, which takes into account data with an elevated number of zero responses (expected in samples with few or no ADHD symptoms). Correlations of parental clinical variables (ADHD, anxiety and depression) to offspring psychopathology may vary according to gender and type of symptoms. We aimed to investigate how those variables interact within each other. One hundred families, comprising a proband child or adolescent with ADHD or a typically developing child or adolescent were included and all family members (both biological parents, the proband child or adolescent and their sibling) were examined through semi-structured interviews using DSM-IV criteria. Results indicated that: (a) maternal clinical variables (ADHD, anxiety and depression) were more correlated with offspring variables than paternal ones; (b) maternal inattention (but not hyperactivity) was correlated with both inattention and hyperactivity in the offspring; (c) maternal anxiety was correlated with offspring inattention; on the other hand, maternal inattention was correlated with anxiety in the offspring. Although a family study design limits the possibility of revealing causality and cannot disentangle genetic and environmental factors, our findings suggest that ADHD, anxiety and depression are variables that correlate in families and should be addressed together. Maternal variables significantly correlated with offspring variables, but the paternal variables did not.

Drug use and antisocial behavior among adolescents attending public schools in Brazil

INTRODUCTION

Drug use is a social and a public health problem that has been related with antisocial behavior. The aim of this study was to evaluate the relationship between drug use and antisocial behavior among adolescents attending public schools in Brazil.

METHOD

A total of 7,176 adolescents from low-income neighborhoods and public schools aged 14 to 19 years were assessed in five geographical regions in Brazil. Data on biosociodemographic characteristics and on drug use and antisocial behavior were assessed from complete answers to a national survey on risk and protective factors among adolescents.

RESULTS

Over 80% of the adolescents who used alcohol and cigarettes were between 14 and 17 years old. The percentage of participants with antisocial behaviors was significantly higher among users of marijuana, cocaine, or crack than among adolescents who were not drug users.

CONCLUSIONS

Prevention programs aimed at reducing substance use might help to decrease antisocial behaviors.

Adult attention-deficit/hyperactivity disorder and nicotine use: a qualitative study of patient perceptions

BACKGROUND

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with high rates of comorbid substance use disorders, and cigarette smoking has a particularly high prevalence in this population. However, there is an ongoing debate as to whether this tobacco use is an attempt at "self-medication" or due to behavioral disinhibition. There is a surprising lack of qualitative studies that investigate the subjective perceptions of adults with ADHD regarding cigarette smoking. The present study was designed to fill this gap in the literature.

METHODS

We recruited twelve adult patients with ADHD and comorbid tobacco use from our ADHD consultation service, an outpatient facility of the Zurich University Psychiatric Hospital. Subjects were interviewed using qualitative methodology, and Mayring's qualitative content analysis was used to evaluate findings.

RESULTS

We identified two explanatory models linking ADHD and tobacco use: smoking as an attempt at self-medication and "smoking as a social behavior". On one hand, subjects considered tobacco a therapeutic aid, reporting positive effects on "inner tension" and cognitive function, and noted possible antidepressant properties as well. On the other hand, subjects considered smoking to enhance social functioning and to have a positive impact on interpersonal relationships. The majority believed that stimulant medications offered only a transient decrease in patterns of tobacco use because their ability to reduce nicotine cravings wore off quickly. Others believed that stimulants had no effect or even reinforced cigarette use.

CONCLUSIONS

Participants had different views about the link between cigarette smoking and ADHD. While the majority thought of nicotine as a sort of therapy, viewing smoking as a way to self-medicate symptoms of ADHD, motivations for nicotine use were also related to self-image, desire to belong to a peer-group, and a drive to undermine perceived social norms. Ultimately, these findings can be used by clinicians to improve treatment alliance and collaboration.

Anhedonia in obsessive-compulsive disorder: beyond comorbid depression

Obsessive-compulsive disorder (OCD) has been linked to reward dysfunctions, highlighting a possible role of anhedonia in OCD. Surprisingly, anhedonia in OCD has never been evaluated. Moreover, although nicotine typically has anti-anhedonic effects, anecdotal reports suggest low prevalence rates of smoking in OCD. To address these two phenomena, 113 individuals with OCD completed a battery of questionnaires assessing symptom severity, anhedonia, and smoking. 28.3% of the sample met criteria for clinically significant anhedonia, which correlated with Y-BOCS scores (r=0.44), even when controlling for depressive symptoms. 13.3% of the sample endorsed current smoking, a lower rate than seen in psychiatric disorders (40-90%) and the general adult population (19%). Results highlight high rates of anhedonia and yet reduced prevalence of smoking in OCD. In contrast to the known positive association between anhedonia and smoking, a negative association emerged. Future research is needed to address the unique interface between anhedonia and reward responsiveness in OCD. Potential clinical implications are discussed.

ADHD diagnosis may influence the association between polymorphisms in nicotinic acetylcholine receptor genes and tobacco smoking

Polymorphisms in the CHRNA5-CHRNA3-CHRNB4 gene cluster have been shown to be involved in tobacco smoking susceptibility. Considering that attention deficit/hyperactivity disorder (ADHD) not only increases the risk but may also influence the molecular mechanisms of tobacco smoking, we analyzed the association between polymorphisms in the nicotinic acetylcholine receptor genes and tobacco smoking among individuals with or without ADHD. The sample included 1,118 subjects divided into four groups according to smoking status and ADHD diagnosis. Our results demonstrate that the minor alleles of two polymorphisms (rs578776 and rs3743078) in the CHRNA3 gene are associated with an increased risk of tobacco smoking only among patients with ADHD. These alleles have been shown in previous studies to be protective factors for smoking in subjects without ADHD. These findings add to existing evidence that ADHD may exert an important modifying effect on the genetic risk of smoking and should be considered in tobacco smoking association studies.

Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study

Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate.

The role of a mineralocorticoid receptor gene functional polymorphism in the symptom dimensions of persistent ADHD

Attention-deficit/hyperactivity disorder (ADHD) affects approximately 5 % of school-aged children and 2.5 % of adults. Genetic studies in ADHD have pointed to genes in different neurobiological systems, with relatively small individual effects. The mineralocorticoid receptor is the main receptor involved in the initial triggering of stress response. Therefore, its encoding gene (NR3C2) is a candidate for psychiatric disorder studies, including ADHD, and behavioral phenotypes. There is evidence that the Val allele of the MRI180V polymorphism (rs5522) increases the risk of depression, attention and cognitive deficits. We investigated the possible role of the mineralocorticoid receptor gene in the symptom dimensions and susceptibility to persistent ADHD. We compared genotype and allele frequencies in 478 adult patients with ADHD and 597 controls and symptom dimensions in 449 patients and 132 controls. Diagnoses were based on the DSM-IV criteria. ADHD symptom dimensions were investigated with SNAP-IV for ADHD severity and Barkley scales for severity and impairment. Carriers of the Val allele presented higher inattention, hyperactivity/impulsivity and impairment scores, while genotype and allele frequencies did not differ between patients and controls. These results are consistent with a possible link between genetic variations in the HPA axis and inattention and hyperactivity measures.

MR and GR functional SNPs may modulate tobacco smoking susceptibility

A number of studies have demonstrated that stress is involved in all aspects of smoking behavior, including initiation, maintenance and relapse. The mineralocorticoid (MR) and glucocorticoid (GR) receptors are expressed in several brain areas and play a key role in negative feedback of the hypothalamic-pituitary-adrenal (HPA) axis. As nicotine increases the activation of the HPA axis, we wondered if functional SNPs (single nucleotide polymorphisms) in MR and GR coding genes (NR3C2 rs5522 and NR3C1 rs6198, respectively) may be involved in smoking susceptibility. The sample included 627 volunteers, of which 514 were never-smokers and 113 lifetime smokers. We report an interaction effect between rs5522 and rs6198 SNPs. The odds ratio (OR) for the presence of the NR3C2 rs5522 Val allele in NR3C1 rs6198 G carriers was 0.18 (P = 0.007), while in rs6198 G noncarriers the OR was 1.83 (P = 0.027). We also found main effects of the NR3C1 rs6198 G allele on number of cigarettes smoked per day (P = 0.027) and in total score of the Fagerström Test for Nicotine Dependence (P = 0.007). These findings are consistent with a possible link between NR3C2 and NR3C1 polymorphisms and smoking behavior and provide a first partial replication for a nominally significant GWAS finding between NR3C2 and tobacco smoking.

Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder

OBJECTIVE

Children with attention-deficit/hyperactivity disorder (ADHD) often have sleep complaints and also higher rates of psychiatric comorbidities such as mood and anxiety disorders that may affect sleep. The authors hypothesized that children with ADHD and psychiatric comorbidities would have higher overall sleep disturbance scores as measured by a sleep questionnaire than children with ADHD without comorbidities.

METHODS

This cross-sectional analysis in an academic center studied 317 children with ADHD; 195 subjects had no comorbid conditions, 60 were anxious and 62 were depressed. Participants completed the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present State, 4th Revised Edition and the Children's Sleep Habits Questionnaire.

RESULTS

Median age (range) was 8.9 (6-18.7) years; 78% were male. Median (interquartile range) Total Sleep Disturbance Score (TSDS) on Children's Sleep Habits Questionnaire for subjects with no comorbidities was 44 (40-49); anxiety, 48 (43-54); and depression, 46 (41-52). Compared with subjects without comorbidities, TSDS in anxious subjects was greater (p = .008). TSDS in depressed subjects was not significantly different. Compared with subjects without comorbidities, anxious subjects had higher Bedtime Resistance, Sleep Onset Delay, and Night Wakings subscales (p = .03, .007, and .007, respectively); depressed subjects had higher Sleep Onset Delay and Sleep Duration subscales (p = .003 and .01, respectively).

CONCLUSIONS

Anxiety in children with ADHD contributed to higher overall sleep disturbance scores, compared with children with ADHD alone. Both comorbidities were associated with higher Sleep Onset Latency subscale scores. Further study of the impact of psychiatric comorbidities on sleep in children with ADHD is warranted.