Perceived stress partially accounts for the association between Attention Deficit Hyperactivity Disorder (ADHD) symptoms and suicidal ideation among students

Inflammatory biotype of ADHD is linked to chronic stress: a data-driven analysis of the inflammatory proteome

The association between Attention Deficit Hyperactivity Disorder (ADHD) and low-grade inflammation has been explored in children but rarely in adults. Inflammation is characteristic of some, but not all, patients with ADHD and might be influenced by ADHD medication but also lifestyle factors including nutrition, smoking, and stress. It is also still unclear if any specific symptoms are related to inflammation. Therefore, we assessed 96 inflammatory proteins in a deeply phenotyped cohort of 126 adult ADHD participants with a stable medication status using OLINK technology. A data-based, unsupervised hierarchical clustering method could identify two distinct biotypes within the 126 ADHD participants based on their inflammatory profile: a higher inflammatory potential (HIP) and a lower inflammatory protein potential (LIP) group. Biological processes that differed strongest between groups were related to the NF-κB pathway, chemokine signaling, IL-17 signaling, metabolic alterations, and chemokine attraction. A comparison of sample characteristics revealed that the HIP group was more likely to have higher levels of chronic stress (p < 0.001), a higher clinical global impression scale score (p = 0.030), and a higher risk for suicide (p = 0.032). Medication status did not influence protein levels significantly (p ≥ 0.074), but psychotropic co-medication (p ≤ 0.009) did. In conclusion, our data suggest the presence of two distinct biotypes in adults with ADHD. Higher levels of inflammatory proteins in ADHD are linked to higher levels of chronic perceived stress in a linear fashion. Further research on inflammation in adults with ADHD should take stress levels into account.

Effectiveness of cognitive-behavioral therapy on perceived stress among patients undergoing percutaneous coronary intervention: A randomized controlled trial

PURPOSE

This study aimed to determine the effectiveness of cognitive-behavioral therapy on perceived stress of patients undergoing percutaneous coronary intervention (PCI).

DESIGN AND METHODS

This was a randomized clinical trial in which the patients under coronary intervention were allocated to two groups, intervention and control by using block randomization. The experiment group received eight sessions of cognitive-behavioral therapy. The patients' perceived stress was measured before, immediately, and 1-month post ntervention.

FINDINGS

The results showed the perceived stress scores changed significantly in the intervention group compared with the control group immediately and 1 month after the intervention. Therefore, the perceived stress level significantly reduced in the patients of the intervention group (p < 0.001).

PRACTICE IMPLICATIONS

Cognitive-behavioral therapy significantly reduced perceived stress in patients undergoing PCI.

Potential Targets and Action Mechanism of Gastrodin in the Treatment of Attention-Deficit/Hyperactivity Disorder: Bioinformatics and Network Pharmacology Analysis

Objective

Gastrodin is a main medicinal component of traditional Chinese medicine (TCM) Gastrodia elata Blume (G. elata), presenting the potential for the treatment of attention-deficit/hyperactivity disorder (ADHD). However, the underlying targets and action mechanisms of the treatment have not been identified.

Methods

The gastrodin-related microarray dataset GSE85871 was obtained from the GEO database and analyzed by GEO2R to obtain differentially expressed genes (DEGs). Subsequently, the targets of gastrodin were supplemented by the Encyclopedia of Traditional Chinese Medicine (ETCM), PubChem, STITCH, and SwissTargetPrediction databases. ADHD-associated genes were collected from six available disease databases (i.e., TTD, DrugBank, OMIM, PharmGKB, GAD, and KEGG DISEASE). The potential targets of gastrodin during ADHD treatment were obtained by mapping gastrodin-related targets with ADHD genes, and their protein–protein interaction (PPI) relationship was constructed by the STRING database. The GO function and KEGG pathway enrichment analyses were performed using the ClueGO plug-in in the Cytoscape software and DAVID database, respectively. Finally, the binding affinity between gastrodin and important targets was verified by molecular docking.

Results

A total of 460 gastrodin-related DEGs were identified from GSE85871, and 124 known gastrodin targets were supplemented from 4 databases, including ETCM. A total of 440 genes were collected from the above 6 disease databases, and 267 ADHD-relevant genes were obtained after duplicate removal. Through mapping the 584 gastrodin targets to the 267 ADHD genes, 16 potential therapeutic targets were obtained, among which the important ones were DRD2, DRD4, CHRNA3, CYP1A1, TNF, IL6, and KCNJ3. The enrichment analysis results indicated that 16 potential targets were involved in 25 biological processes (e.g., dopamine (DA) transport) and 22 molecular functions (e.g., postsynaptic neurotransmitter receptor activity), which were mainly localized at excitatory synapses. The neuroactive ligand-receptor interaction, cholinergic synapse, and dopaminergic synapse might be the core pathways of gastrodin in ADHD treatment. Through molecular docking, it was preliminarily verified that gastrodin showed good binding activity to seven important targets and formed stable binding conformations.

Conclusions

Gastrodin might exert an anti-ADHD effect by upgrading the dopaminergic system and central cholinergic system, inhibiting the inflammatory response and GIRK channel, and exerting a synergistic effect with other drugs on ADHD. For this reason, gastrodin should be considered a multitarget drug for ADHD treatment.

ADHD, Religiosity, and Psychiatric Comorbidity in Adolescence and Adulthood

OBJECTIVE

Religiosity has been repeatedly proposed as protective in the development of depression, sociopathy and addictions. ADHD frequently co-occurs with these same conditions. Although ADHD symptoms may affect religious practice, religiosity in ADHD remains unexplored.

METHOD

Analyses examined data from >8000 subjects aged 12 to 34 in four waves of the Add Health Study. Relationships of religious variables with childhood ADHD symptoms were statistically evaluated. Observed correlations of ADHD symptoms to depression, delinquency, and substance use were tested for mediation and moderation by religiosity.

RESULTS

ADHD symptoms correlated with lower levels of all religious variables at nearly all waves. In some analyses at Wave IV, prayer and attendance interacted with ADHD to predict worsened psychopathology.

CONCLUSION

ADHD symptoms predicted lower engagement in religious life. In adulthood, some aspects of religiosity interacted with ADHD symptoms to predict worse outcomes. Further research should explore whether lower religiosity partially explains prevalent comorbidities in ADHD.

Attention-deficit/hyperactivity disorder symptoms, perceived stress, and suicidal ideation during the COVID-19 pandemic

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) symptoms have been linked to suicidal behavior. However, little is known about the mechanisms involved in this association. This study examined ADHD symptoms and suicidal ideation during the COVID-19 pandemic and the role of self-perceived stress in this association.

METHOD

Data were analyzed from an online sample of 1,452 Japanese individuals aged 18 to 89 obtained in February 2021. Information was collected on past-year suicidal ideation. ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener while stress was measured with the Perceived Stress Scale (PSS-14). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9), while the Generalized Anxiety Disorder scale (GAD-7) was used to assess anxiety symptoms. Logistic regression was used to examine associations.

RESULTS

Fifty-one (3.5%) individuals had ADHD symptoms, while more than one in ten (11.7%) of the respondents reported past-year suicidal ideation. In an analysis adjusted for sociodemographic factors, ADHD symptoms were associated with eight times higher odds for past-year suicidal ideation. However, adjusting the analysis for mental health variables (anxiety and depressive symptoms) attenuated the association which became non-significant (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 0.92-4.18). In contrast, in an analysis adjusted for mental health, individuals with ADHD symptoms and stress had significantly higher odds for suicidal ideation (OR: 3.72, 95%CI: 1.43-9.67) whereas, ADHD symptoms without stress were not linked to suicidal ideation (OR: 1.25, 95%CI: 0.38-4.18).

CONCLUSIONS

Self-perceived stress is important in the association between ADHD symptoms and suicidal ideation among individuals in Japan during the COVID-19 pandemic. Detecting and managing stress and its effects in individuals with ADHD/ADHD symptoms should be a therapeutic focus for improving health-related outcomes in this population both during the COVID-19 pandemic and beyond.

The Effects of Working Memory Load on Auditory Distraction in Adults With Attention Deficit Hyperactivity Disorder

Cognitive control provides us with the ability to inter alia, regulate the locus of attention and ignore environmental distractions in accordance with our goals. Auditory distraction is a frequently cited symptom in adults with attention deficit hyperactivity disorder (aADHD)-yet few task-based fMRI studies have explored whether deficits in cognitive control (associated with the disorder) impedes on the ability to suppress/compensate for exogenously evoked cortical responses to noise in this population. In the current study, we explored the effects of auditory distraction as function of working memory (WM) load. Participants completed two tasks: an auditory target detection (ATD) task in which the goal was to actively detect salient oddball tones amidst a stream of standard tones in noise, and a visual n-back task consisting of 0-, 1-, and 2-back WM conditions whilst concurrently ignoring the same tonal signal from the ATD task. Results indicated that our sample of young aADHD (n = 17), compared to typically developed controls (n = 17), had difficulty attenuating auditory cortical responses to the task-irrelevant sound when WM demands were high (2-back). Heightened auditory activity to task-irrelevant sound was associated with both poorer WM performance and symptomatic inattentiveness. In the ATD task, we observed a significant increase in functional communications between auditory and salience networks in aADHD. Because performance outcomes were on par with controls for this task, we suggest that this increased functional connectivity in aADHD was likely an adaptive mechanism for suboptimal listening conditions. Taken together, our results indicate that aADHD are more susceptible to noise interference when they are engaged in a primary task. The ability to cope with auditory distraction appears to be related to the WM demands of the task and thus the capacity to deploy cognitive control.