Personality differences related to smoking and adult attention deficit hyperactivity disorder

The relationship of personality traits to substance abuse in patients with bipolar disorder

Purpose

The aim of this study is to determine if personality traits contribute to the likelihood of substance abuse in Bipolar Disorder (BD).

Subjects/materials and methods

Fifty-nine patients meeting DSM-IV criteria for BD: 20 without any history of Substance Related Disorder (SRD), 21 with a lifetime history of SRD but without current SRD, and 18 with current SRD. Patients filled out the TCI, the differences were analyzed by ANOVA and the likelihood was obtained by Multinomial Logistic Regression.

Results

Only Novelty Seeking (NS) is statistically different between the groups. Patients with BD with current SRD have higher rates in NS than those with past SRD, and those without a history of SRD. NS was confirmed as a predicting variable, both to current SRD (OR [CI 95%] = 1.039/1.351; p = 0.011) and past SRD (OR [CI 95%] = 1.004/1.277; p = 0.042) on patients with BD.

Discussion

The results shown would appear to confirm the relationship of NS with the SRD, so long as there is no clear evidence that indicates the association of NS with BD.

Conclusions

There appears a greater predisposition to develop SRD in those patients with a higher degree of NS. The use of the Cloninger's TCI could be used in BD to determine the risk of developing an SRD. Early detection might help improve prognosis.

Proprioceptive Indicators of Personality and Individual Differences in Behavior in Children With ADHD

Researchers have suggested that the link between personality traits and Attention-Deficit/Hyperactivity Disorder (ADHD) could be a crucial factor in understanding the disorder’s diatheses. The aim of our study was to contribute to research on personality differences (based on fine motor precision – a novel approach) in children with and without ADHD symptoms. The Children Sustained Attention Task (CSAT) and Proprioceptive Diagnostics of Temperament and Character (DP-TC) were administered to children with an ADHD diagnosis and age-matched controls. Correlational and ANOVA analyses were performed to see the association between the results of both tests and the groups’ performance. Correlational analysis suggests significant relationships between some personality dimensions (DP-TC) and correct detection in a sustained attention task (CSAT). Statistically significant differences were found between the groups on the personality dimensions (DP-TC), with the following characteristics for ADHD children: (a) temperamental tendency to pessimism; (b) high temperamental excitability; (c) high Emotionality, and (d) Behavioral Rigidity (meaning also less adaptation to changes in the environment, in temperament and character). Correct detection in the sustained attention test was significantly correlated with reaction time and the personality variables Style of Attention and Irritability. The results also showed high proprioceptive Emotionality and lack of emotional control in children with ADHD. This is an exploratory study, investigating for the first time the differences in personality (based on fine motor precision) and the relation of personality traits to scores in sustained attention for children with and without ADHD.

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.

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.

Sex- and Subtype-Related Differences of Personality Disorders (Axis II) and Personality Traits in Persistent ADHD

OBJECTIVE

Despite growing awareness of adult ADHD and its comorbidity with personality disorders (PDs), little is known about sex- and subtype-related differences.

METHOD

In all, 910 patients (452 females, 458 males) affected with persistent adult ADHD were assessed for comorbid PDs with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire.

RESULTS

The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type.

CONCLUSION

Sex- and subtype-related differences in Axis II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD.

Personality Traits and Comorbidity in Adults With ADHD

OBJECTIVE

To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures.

METHOD

Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI.

RESULTS

The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD).

CONCLUSION

It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD.

Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings

Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.

The influence of personality traits on smokers' affect, withdrawal and cessation intervention outcome

The personality traits of harm avoidance (HA), novelty seeking (NS), and reward dependence (RD), as measured by the Tridimensional Personality Questionnaire (TPQ), have been linked to smoking behavior. The extent to which these traits are associated with smoking withdrawal and cessation outcome is unclear. We sought to address this question among 131 treatment-seeking smokers who were randomly assigned to either a smoking cessation treatment (four 30-min behavioral counseling sessions) or a control condition. We found that HA was positively associated with baseline depressive symptoms, baseline negative affect, and post-quit withdrawal, and negatively associated with positive affect at both baseline and post-quit. Additionally, we found that smokers with higher HA scores were more likely to be abstinent. NS was negatively associated with post-quit positive affect and positively associated with post-quit negative affect and withdrawal. RD was not found to be related to any outcome measures. Our findings suggest that, despite experiencing greater baseline and post-quit negative affect, smokers higher in trait harm avoidance are more likely to quit smoking. The treatment and theoretical ramifications of these findings are discussed.

Gently restless: association of ADHD-like traits with response inhibition and interference control

Impairment of inhibition-related functions is one of the most pronounced cognitive deficits found in attention-deficit/hyperactivity disorder (ADHD). Compelling evidence from studies of unaffected relatives of patients with ADHD and of ADHD-like traits in healthy subjects suggest the continuous distribution of ADHD symptoms in the population. A more subtle inhibitory deficit can also be found in healthy relatives of patients and in subjects with high ADHD-like traits. Here, we examined the relationship between inhibitory performance and ADHD-like traits, for the first time, in a large sample of healthy adults by applying multiple, widely used tests of inhibition-related functions. ADHD-like traits, in general, were independently predicted by Stroop interference score and, at trend level, by go/no-go commission error rate while controlling for socio-demographic factors, verbal intelligence and neuroticism. Additionally, higher inattentive traits were related to worse Stroop performance at trend level, and higher hyperactive/impulsive traits were significantly associated with more go/no-go commission errors. ADHD-like traits were strongly related to neuroticism. The study shows that individual differences in ADHD-like traits are related to variance in fundamental inhibition-related functions over and above effects of negative affect regulation, but the relationships tend to be small. The results suggest the quasi-dimensionality of ADHD and raise further questions about the relationship between genetic factors and the deficit of inhibition-related functions in the ADHD spectrum.

The role of impulsivity in dropout from treatment for cigarette smoking

Impulsivity is a variable that has been associated with drug use. This study analyzes impulsivity from two different paradigms, one considering it as a trait and the other based on its behavioral correlates, such as disinhibition and impulsive decision-making in the treatment prognosis (maintain abstinence, relapse and dropout) of smokers after outpatient treatment. The participants in the study were 113 smokers who requested treatment for nicotine addiction. They were assigned to three groups according to whether or not they remained abstinent one month after beginning treatment; thus, group 1 was abstinent, group 2 had relapsed, and group 3 had dropped out of treatment. The participants filled out the Semi-structured Interview for Smokers, the Fargerström Test for Nicotine Dependence, the Temperament and Character Inventory-Revised (TCI-R) and the Delay Discounting Task (DDT). The Delay Discounting variable presents lower scores in the dropout group than in the relapse and abstinent groups, with the highest scores in the relapse group. Differences were also found on the Harm Avoidance (HA) variable, with lower scores in the dropout group compared to the relapse group. The importance of these results lies in the consideration of the smoker's personality profile in order to prevent both dropout and relapse.

ADHD and personality: a meta-analytic review

We report a meta-analysis of up to 40 data sets that examined the personality dimensions in the Five-Factor Model (FFM) and the integrated Five-Factor Model (IFFM) in relation to ADHD symptom domains of inattention (IA) and hyperactivity/impulsivity (HI). The IFFM incorporated the dimensions of other personality models (in particular, those of Eysenck, Tellegen, and Cloninger, as well as the FFM). Major findings were: (1) IA and HI were both associated with low conscientious inhibition/conscientiousness, and low agreeable inhibition/agreeableness, and with high negative emotionality/neuroticism; (2) conscientious inhibition and conscientiousness were more strongly related to IA than HI; (3) agreeable inhibition and agreeableness were more strongly related to HI than IA; and (4) the association of conscientious inhibition and conscientiousness with HI was moderated by age group and source from where participants were recruited (associations were stronger in children than adults, and clinical samples than community samples). These findings are discussed in relation to single and multiple pathway theories, underlying factors and processes for the personality-ADHD link, and clinical implications.

Human CLOCK gene-associated attention deficit hyperactivity disorder-related features in healthy adults: quantitative association study using Wender Utah Rating Scale

Circadian rhythm disturbance is highly prevalent in attention deficit hyperactivity disorder (ADHD). Recently, the association between the CLOCK gene and ADHD has been demonstrated in clinical samples, and the CLOCK gene's role was thought to be mediated by rhythm dysregulation. Meanwhile, ADHD has been suggested as the extreme end of a continuously distributed trait that can be found in the general population. Therefore, we examined two possibilities: (1) an ADHD-related continuous trait may be associated with the CLOCK gene, and (2) this association may be mediated by the degree of individuals' evening preference. To explore these possibilities, we performed a quantitative trait locus association study with a sample of 1,289 healthy adults. The Wender Utah Rating Scale (WURS) and the Composite Scale of Morningness (CSM) were utilized to measure the quantitative traits. Quantitative association analysis was performed using PLINK software. We found that rs1801260 (=T3111C) was associated with WURS scores in both allele-wise (p = 0.018) and haplotype-wise analyses (range of p values: 0.0155-0.0171) in male participants only. After controlling for the CSM total score as a covariate, the strength of the association did not change at all, suggesting that the association was not mediated by evening preference. Despite the very weak association signal, our results provide evidence that the CLOCK gene's association with ADHD in clinical samples may be generalizable to traits measured in the normal population. However, as our results failed to show a mediating role of evening preference, ongoing efforts are needed to identify the mechanisms by which the CLOCK gene determines ADHD-related traits.

Symptom dimensions of attention deficit hyperactivity disorder and nicotine withdrawal symptoms

Research suggests that Attention Deficit Hyperactivity Disorder (ADHD) and nicotine withdrawal symptoms are related; however, it is unknown how this relationship extends across ADHD symptom gradations, differs between inattention and hyperactivity-impulsivity symptom types, and generalizes to a national sample. This study examined cross-sectional associations between childhood ADHD symptom indexes (total, inattention, and hyperactivity-impulsivity) and lifetime DSM-IV nicotine withdrawal symptoms. Results showed that each ADHD symptom index associated with almost every withdrawal symptom (Ps < .01). After controlling for hyperactivity-impulsivity and inattention symptom overlap, inattention (but not hyperactivity-impulsivity) retained incremental associations with most withdrawal symptoms. These findings are relevant for understanding mechanisms of ADHD and smoking comorbidity.

PPP2R2C as a candidate gene of a temperament and character trait-based endophenotype of ADHD

There are several lines of evidence that the 4p16 region is a candidate locus of both attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder. None of the harbored candidate genes of this region were hitherto shown to be associated with ADHD despite promising functionality. One of the most promising candidate genes in this region is protein phosphatase 2, regulatory subunit B, gamma (PPP2R2C), which, however, thus far has not been assessed for a potential association with ADHD. A total of 513 in- and outpatients affected with adult ADHD and 536 controls as well as 170 nuclear families with 249 children affected with ADHD were genotyped for 35 SNPs, which tagged the promoter region, the 5' and 3' UTRs, and the exons of the PPP2R2C. Two independent samples provided evidence that the major G allele of rs16838844 increases risk toward ADHD. Allelic variations of PPP2R2C rs16838698 on the other hand might be associated with a variety of personality traits. There is evidence that allelic variation in PPP2R2C may be associated with a variety of personality traits and ADHD per se. Nevertheless, as all those conditions are comorbid, PPP2R2C might reflect a common underlying neurobiological risk factor.

A systematic review of global publication trends regarding long-term outcomes of ADHD

There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.

Severity of childhood attention-deficit hyperactivity disorder--a risk factor for personality disorders in adult life?

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.

Cognitive and emotional processing associated with the Season of Birth and dopamine D4 receptor gene

The 7-repeats variant of the dopamine D4 receptor (7R) VNTR polymorphism has been associated with higher novelty seeking (NS) and disadvantageous decision making in the Iowa Gambling Task (IGT). Season of Birth (SOB) is a significant determinant of NS. SOB and L-DRD4 genetic polymorphism may independently and interactively influence similar behaviors through their common effects on the dopaminergic system. Two hundred and twenty-seven healthy males grouped in summer-born/4-repeats (4R) (n=75), winter-born/4R (n=90), summer-born/7R (n=31) and winter-born/7R (n=31) groups, completed multimodal assessment for personality, planning for problem solving and decision making. Winter-born/7R subjects had significantly worse IGT performance throughout the task compared to 4R individuals, while summer-born 7R subjects had intermediate, although not significantly different performance. Moreover, winter-born/7R subjects had increased behavioral approach to reward without parallel reduction in sensitivity to fear or to social approval cues. The DRD4-by-SOB groups did not differ in planning for problem solving. These results suggest that a DRD4-by-SOB interaction is associated with increased behavioral approach to reward and risk taking but efficient problem solving. In addition, these results further support the hypothesis that SOB modifies the behavioral expression of dopaminergic genetic polymorphism. SOB should be included in future studies of risky behaviors and behavioral genetic studies of the dopamine system.

Smoking and Cloninger's Temperament and Character Inventory

INTRODUCTION

Cloninger's neuropsychopharmacological theory identifies four temperament traits and three character traits that are largely heritable and are associated with addictions.

METHODS

We tested whether these personality traits were associated with smoking behavior and predicted smoking cessation and tobacco withdrawal symptoms. We conducted an Internet cohort study in 2005-2009. The Temperament and Character Inventory (TCI, 226 items, French version) was assessed in 2,993 people (1,593 current, 969 former, and 419 never-smokers). Subsets of participants indicated their smoking status after 30 days (n = 1,452, 48.5%) and answered the TCI again and reported tobacco withdrawal symptoms after 61 days (n = 644, 21.5%).

RESULTS

Compared with never- and former smokers, daily smokers had higher scores of Harm Avoidance (HA) and lower scores of Persistence and Self-Directedness (SD). Daily smokers had higher scores of Novelty Seeking than never-smokers. In daily smokers, the level of tobacco dependence was associated with higher scores of HA and lower scores of SD. In the 60 daily smokers who had stopped smoking after 61 days, after adjustment for tobacco dependence level and baseline tobacco withdrawal ratings, SD predicted lower scores of depressed mood and anxiety at 61-day follow-up and HA predicted higher scores of depressed mood at 61-day follow-up. Personality ratings did not predict smoking cessation at follow-up in daily smokers or relapse in former smokers.

DISCUSSION

A consistent association was found between smoking and high HA and low SD. Knowledge about these associations may be useful to clinicians to tailor counseling.

Correlation of a set of gene variants, life events and personality features on adult ADHD severity

Increasing evidence suggests that symptoms of attention deficit hyperactivity disorder (ADHD) could persist into adult life in a substantial proportion of cases. The aim of the present study was to investigate the impact of (1) adverse events, (2) personality traits and (3) genetic variants chosen on the basis of previous findings and (4) their possible interactions on adult ADHD severity. One hundred and ten individuals diagnosed with adult ADHD were evaluated for occurrence of adverse events in childhood and adulthood, and personality traits by the Temperament and Character Inventory (TCI). Common polymorphisms within a set of nine important candidate genes (SLC6A3, DBH, DRD4, DRD5, HTR2A, CHRNA7, BDNF, PRKG1 and TAAR9) were genotyped for each subject. Life events, personality traits and genetic variations were analyzed in relationship to severity of current symptoms, according to the Brown Attention Deficit Disorder Scale (BADDS). Genetic variations were not significantly associated with severity of ADHD symptoms. Life stressors displayed only a minor effect as compared to personality traits. Indeed, symptoms' severity was significantly correlated with the temperamental trait of Harm avoidance and the character trait of Self directedness. The results of the present work are in line with previous evidence of a significant correlation between some personality traits and adult ADHD. However, several limitations such as the small sample size and the exclusion of patients with other severe comorbid psychiatric disorders could have influenced the significance of present findings.

Temperament and character dimensions associated with clinical characteristics and treatment outcome in attention-deficit/hyperactivity disorder boys

BACKGROUND

Although differential patterns of temperament and character have been documented in subjects with attention-deficit/hyperactivity disorder (ADHD), few studies have investigated relations between these dimensions, clinical features of ADHD, and treatment outcome.

METHODS

Ninety-five boys with ADHD and 87 controls participated in the study; 88.5% of the referred patients were reassessed after optimal titration of methylphendiate treatment.

RESULTS

Compared with controls, boys with ADHD showed a temperament profile of high novelty seeking, low reward dependence, and persistence, as well as low scores on both self-determination and cooperativeness character dimensions. No significant differences were found between subjects with ADHD and controls in harm avoidance. Temperament and character traits were related to specific symptom domains and comorbidity but did not predict global severity of ADHD. Persistent and immature children with ADHD were more likely to experience short-term remission.

Personality traits among ADHD adults: implications of late-onset and subthreshold diagnoses

BACKGROUND

Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish onset prior to the DSM-IV criterion of age 7 or if the number of symptoms does not achieve the DSM threshold for diagnosis. Previous work has assessed the validity of such diagnoses based on psychiatric co-morbidity, family history and neuropsychological functions but none of these studies have used personality as a validation criterion.

METHOD

We compared four groups of adults: (1) full ADHD subjects who met all DSM-IV criteria for childhood-onset ADHD; (2) late-onset subjects who met all criteria except the age at onset criterion, (3) subthreshold subjects who did not meet full symptom criteria and (4) non-ADHD subjects who did not meet any of the above criteria. Diagnoses were made by using the Structured Clinical Interview for DSM-IV (SCID) and the Temperament and Character Inventory (TCI) was used to assess personality traits.

RESULTS

We found that full ADHD and late-onset ADHD showed similar personality profiles with significant deviations on all TCI scales except reward dependence and self-transcendence. By contrast, subthreshold cases only showed deviations on novelty seeking and self-directiveness.

CONCLUSIONS

These data call into question the stringent age of onset of ADHD symptom criteria for adults when making retrospective diagnoses of ADHD. Subthreshold ADHD seems to be a milder form of the disorder that is consistent with dimensional views of the disorder.

ADHD and smoking: from genes to brain to behavior

Attention-deficit/hyperactivity disorder (ADHD) and tobacco smoking are among the most common and costly psychiatric and behavioral problems. The rates of co-occurrence of these two common problems are larger than expected by chance. Despite progress in identifying the neural and genetic substrates of each, the mechanisms underlying the high rates of comorbidity between ADHD and smoking remain largely unknown. We propose that ADHD and smoking involve dysregulation of dopaminergic and nicotinic-acetylcholinergic circuits and that these aberrations are likely to arise, at least in part, from genetic variations. This review describes an integrative model of the ADHD-smoking comorbidity, with an emphasis on shared neuropharmacological mechanisms. We first describe the prevalence of smoking among ADHD patients. We then describe how ADHD influences stages of smoking behavior (e.g., initiation, maintenance, and relapse). We review common potential genetic substrates of ADHD and smoking, focusing on genes that regulate monoaminergic neurotransmission. We review the behavioral and neuropharmacological bases of smoking and ADHD, focusing on the modulatory roles of nicotine on attention and behavioral control. Finally, we discuss the implications of this model for prevention and clinical outcomes.

Cigarette smoking associated with attention deficit hyperactivity disorder

OBJECTIVE

To evaluate the association between attention deficit hyperactivity disorder (ADHD) and severity of physical dependence on nicotine in a controlled study of adolescents and young adults with ADHD.

STUDY DESIGN

In controlled longitudinal family studies of ADHD, we examined self-reports on the modified Fagerström Tolerance Questionnaire (mFTQ) for degrees of physical dependence on nicotine.

RESULTS

We obtained mFTQ data from 80 ADHD probands and 86 control probands (mean age, 19.2 years). The smokers with ADHD had significantly higher scores on the mFTQ, indicative of more severe physical dependence on nicotine. Similarly, in current smokers, a positive linear relationship was found between mFTQ score and both inattentive and hyperactive ADHD symptoms. Environmental factors, such as current parental smoking, peer smoking, and living with a smoker, all increased the risk for smoking in those with ADHD compared with controls.

CONCLUSION

Male and female smokers with ADHD manifest more severe physical dependence on smoking compared with controls. Important environmental factors appear to add to the risk of smoking associated with ADHD.

Patterns of temperament and character in a clinical sample of Korean children with attention-deficit hyperactivity disorder

AIMS

The purpose of the present study was to assess patterns of temperament and character in a clinical sample of Korean children with attention-deficit hyperactivity disorder (ADHD) and to investigate the relationship between patterns of temperament and character and the severity of ADHD symptoms.

METHODS

Fifty-one children who met DSM-IV criteria for ADHD and 51 age- and sex-matched healthy comparison subjects completed the Junior Temperament and Character Inventory (JTCI) and the DuPaul's ADHD Rating Scale (ARS-IV).

RESULTS

Children with ADHD had significantly higher scores of Novelty Seeking and lower scores of Self-directedness in both parents' rating and children's self-rating. In addition, low Self-directedness scores predicted higher total scores of ARS-IV.

CONCLUSIONS

In a clinical sample of Korean children with ADHD, a distinct pattern of temperament and character was found. The current findings suggest that low Self-directedness may be related to the severity of ADHD symptoms.

Associations between Cloninger's temperament dimensions and acute tobacco withdrawal

This study examined associations between three temperament dimensions measured by the Temperament and Character Inventory-125 [Cloninger, C.R. (1992). The Temperament and Character Inventory-125 (TCI-125; Version 1.)] and tobacco abstinence effects. Smokers (N=203, >/= 15 cigarettes/day) attended two laboratory sessions, one following 12 h of abstinence and the other following ad libitum smoking (order counterbalanced). Participants completed measures of withdrawal symptoms, cigarette urges, and affect. Smokers high in Novelty Seeking reported greater abstinence-induced increases in several nicotine withdrawal symptoms, negative affect, and cigarette craving. Smokers high in Harm Avoidance reported greater abstinence-induced increases in negative affect and urges to smoke to relieve distress. Reward Dependence was not associated with abstinence effects. Novelty Seeking and Harm Avoidance showed independent predictive associations with negative affect and urges, and their associations with abstinence effects persisted when controlling for FTND scores. Smokers with different temperaments display different patterns of acute tobacco withdrawal, and may benefit from treatments matched to their particular abstinence profile.

Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center

OBJECTIVE

The prevalence and consequences of co-morbid axis-I and axis-II disorders as well as personality traits were examined in a large cohort of adult attention-deficit/hyperactivity disorder (AADHD) at a tertiary referral center.

METHODS

In- and outpatients referred for diagnostic assessment of AADHD were screened. 372 affected probands were examined by means of the Structured Clinical Interview of DSM-IV axis-I/II disorders, the Revised NEO Personality Inventory (NEO-PI-R), and the Tridimensional Personality Questionnaire (TPQ).

RESULTS

Lifetime co-morbidity with mood disorders was 57.3%, with anxiety disorders 27.2%, and with substance use disorders 45.0%. The histrionic personality disorder (35.2%) was the most frequent personality disorder. AADHD patients exhibited significantly altered scores on most of the NEO-PI-R and TPQ personality dimensions. The extent of substance abuse and dependence, as well as the presence of antisocial personality disorder alone or the cumulative number of other specific personality disorders was associated with lower psychosocial status (p<.0001).

DISCUSSION

In a cohort of patients with AADHD referred to a single tertiary center co-morbidity with axis-I/II disorders was remarkably prevalent. In AADHD co-morbid mood, anxiety, and personality disorders as well as substance abuse/dependence is likely to be predictive of poor outcome.

The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities

Attention-deficit/hyperactivity disorder (ADHD) is an impairing but usually treatable condition. Popular culture propagates the myth that ADHD recedes with age; this is not the case. Although it is common, <20% of adults with ADHD are diagnosed or treated. Adults with ADHD show significant comorbidities with depressive disorders, anxiety disorders, substance use, oppositional defiant disorder, personality disorders, sleep problems, and learning disabilities. However, symptoms that result from ADHD, such as mood symptoms or lability, are often mistaken for comorbid disorders. Comorbidity with ADHD impacts treatment compliance, treatment response, and patient insight. Insufficient data on the interaction between ADHD and comorbidities impedes proper diagnosis and treatment. Better clinical tools for assessing these conditions are needed. Food and Drug Administration-approved pharmacologic treatments for adult ADHD include stimulants, dexmethylphenidate, and the nonstimulant atomoxetine. Effect sizes of approved medicines at approved doses are half those seen in children. Adults may also need longer duration of medication effects than children. Short-acting stimulants are likely to result in poorer adherence and have a higher risk for diversion or abuse. Risk of abuse is a major concern; stimulant treatments are controlled substances, and children with ADHD show increased risk of substance abuse. Psychosocial interventions may be beneficial in treating both ADHD and comorbidities.In this expert roundtable supplement, Margaret Weiss, MD, PhD, presents a comprehensive overview of complications surrounding differential diagnosis in adults with ADHD. Next, Mark A. Stein, PhD, reviews evaluation, comorbidity, and development of a treatment plan in this population. Finally, Jeffrey H. Newcorn, MD, provides a discussion on the pharmacologic options available for adults with ADHD, considering dosages specific to adults and common comorbidities.

Emotional stress in pregnancy predicts human infant reactivity

BACKGROUND

Infant distress to novelty at 4 months of life has previously been identified as an important predictor of longer term emotional development in childhood and adolescence.

AIM

To investigate the relationship between prenatal stress and infant reactivity to unfamiliar visual, auditory and olfactory stimuli.

STUDY DESIGN

Maternal emotional stress, life events and medical adversities during pregnancy and maternal personality characteristics were assessed by interview, questionnaire and patient charts at 2 weeks postnatal age. Postnatal maternal psychopathology was assessed at 2 weeks and 4 months postnatal age. Infant outcome was examined 4 months postnatally.

SUBJECTS

102 mother-infant pairs were recruited in local obstetric units, complete datasets were available for 96 mother-infant-pairs.

OUTCOME MEASURE

Infant reactivity to unfamiliar stimuli was assessed when the infants were 4 months postnatal age.

RESULTS

Maternal prenatal emotional stress was significantly associated with infant affective reactivity to novelty. Maternal postnatal psychopathology did not have an influence on affective infant reactivity.

CONCLUSIONS

These data provide evidence for an impact of maternal emotional stress in pregnancy on early infant distress to novel stimuli, a behavioral trait whose stability throughout childhood and adolescence has previously been demonstrated.

The molecular genetic architecture of human personality: beyond self-report questionnaires

Molecular genetic studies of personality began with two high impact papers in 1996 that showed provisional associations between the dopamine DRD4 exon III repeat region and Novelty Seeking/Extraversion. These first two reports were shortly followed by an investigation linking Neuroticism/Harm Avoidance with the serotonin transporter (SLC6A4) promoter region polymorphism (5-HTTLPR). In the ensuing decade, thousands of subjects have been studied for association between these genes and personality, assessed by using self-report questionnaires, with erratic success in replication of the first findings for Novelty Seeking (DRD4) and Harm Avoidance (5-HTTLPR). Small effect sizes characteristic of non-Mendelian traits, polygenic patterns of inheritance and true heterogeneity between studies confound attempts to reach a consensus regarding the role of common polymorphisms in contributing to personality domains. Nevertheless, the current state of personality genetics is far from being bleak. Several new paradigms especially functional neuroimaging or 'imaging genomics' have strengthened the connection between 5-HTTLPR and anxiety-related personality traits. The demonstrations that early environmental information can considerably strengthen and even uncover associations between genes and behavior (Caspi's seminal studies and more recently the demonstration that early environment impacts on DRD4 and Novelty Seeking) are notable and herald a new era of personality genetics. Finally, consideration of the broader phenotypic expression of common polymorphisms (e.g. the 'social brain', altruism, etc.) and the use of new experimental paradigms including neurophysiological, neuropsychological and computer games that go beyond the narrow self-report questionnaire design will enable a deeper understanding of how common genetic polymorphisms modulate human behavior. Human personality, defined by Webster as the quality or state of being a person or the complex of characteristics that distinguishes an individual, surely requires a more encompassing view towards understanding its complex molecular genetic architecture.

Nicotinic effects on cognitive function: behavioral characterization, pharmacological specification, and anatomic localization

RATIONALE

Nicotine has been shown in a variety of studies in humans and experimental animals to improve cognitive function. Nicotinic treatments are being developed as therapeutic treatments for cognitive dysfunction.

OBJECTIVES

Critical for the development of nicotinic therapeutics is an understanding of the neurobehavioral bases for nicotinic involvement in cognitive function.

METHODS

Specific and diverse cognitive functions affected by nicotinic treatments are reviewed, including attention, learning, and memory. The neural substrates for these behavioral actions involve the identification of the critical pharmacologic receptor targets, in particular brain locations, and how those incipient targets integrate with broader neural systems involved with cognitive function.

RESULTS

Nicotine and nicotinic agonists can improve working memory function, learning, and attention. Both alpha4beta2 and alpha7 nicotinic receptors appear to be critical for memory function. The hippocampus and the amygdala in particular have been found to be important for memory, with decreased nicotinic activity in these areas impairing memory. Nicotine and nicotinic analogs have shown promise for inducing cognitive improvement. Positive therapeutic effects have been seen in initial studies with a variety of cognitive dysfunctions, including Alzheimer's disease, age-associated memory impairment, schizophrenia, and attention deficit hyperactivity disorder.

CONCLUSIONS

Discovery of the behavioral, pharmacological, and anatomic specificity of nicotinic effects on learning, memory, and attention not only aids the understanding of nicotinic involvement in the basis of cognitive function, but also helps in the development of novel nicotinic treatments for cognitive dysfunction. Nicotinic treatments directed at specific receptor subtypes and nicotinic cotreatments with drugs affecting interacting transmitter systems may provide cognitive benefits most relevant to different syndromes of cognitive impairment such as Alzheimer's disease, schizophrenia, and attention deficit hyperactivity disorder. Further research is necessary in order to determine the efficacy and safety of nicotinic treatments of these cognitive disorders.

Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure

Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.

Biogenetic temperament and character and attention deficit hyperactivity disorder in Korean children

BACKGROUND

The objective of this study was to evaluate the relationship between symptoms of attention deficit hyperactivity disorder (ADHD) and biogenetic temperament, as assessed by the Junior Temperament and Character Inventory (JTCI) in Korean elementary school children.

SAMPLING AND METHODS

Five hundred and sixteen elementary school students (254 boys and 262 girls; age range 9-14 years, mean age 11.0 +/- 1.0 years) were studied. The Junior Temperament and Character Inventory, both the self-rating and parent rating scales, the DuPaul ADHD rating scale (ARS-IV) for parents and teachers and the Child Behavior Checklist have been completed by study subjects. Children with high ARS-IV scores (the upper 10th percentile, n = 52) were defined to have ADHD. Fifty-two age- and sex-matched non-ADHD control subjects were selected randomly from a pool of 464 subjects.

RESULTS

Inattention and hyperactivity/impulsivity symptoms correlated positively with Novelty Seeking in both children and parent ratings. These symptoms correlated negatively with Persistence, Self-Directedness and Cooperativeness. Novelty Seeking also had significant correlations with attention problems, delinquent behavior, aggressive behavior, externalizing problems and social problems in the Child Behavior Checklist. The ADHD group (n = 52) had higher scores of Novelty Seeking and lower scores of Self-Directedness and Cooperativeness, compared with the control group.

CONCLUSIONS

There were significant correlations between ADHD symptoms and Novelty Seeking. Current findings suggest that Novelty Seeking and ADHD share biogenetic backgrounds.

Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults

OBJECTIVE

The aim of this study was to examine the relationship between current active attention-deficit/hyperactivity disorder (ADHD) symptoms, medication treatment, and substance use patterns among college students.

METHOD

Three hundred and thirty-four students at a local college were surveyed for current ADHD symptoms and psychopharmacological treatment. The survey was conducted in conjunction with an annual national survey that probes students about their substance use patterns and attitudes.

RESULTS

Participants with ADHD as ascertained by medication treatment of ADHD had greater past-year tobacco and marijuana use. Among those with ADHD, participants with active ADHD symptoms were more likely to have past-year tobacco and other drug (besides tobacco, alcohol, and marijuana) use as compared to those without active ADHD symptoms. In addition, participants with active ADHD symptoms were more likely to have past-month "other" drug use as compared to those without active ADHD symptoms. Among those prescribed medications for ADHD, 25% reported ever using their medication to "get high" and almost 29% reported ever giving or selling their medication to someone else.

CONCLUSIONS

Results of our preliminary study indicated that ADHD symptom control may be important to protect against increased risk of substance use (particularly tobacco and drugs other than alcohol and marijuana) among college-age students with ADHD. Further studies of misuse/diversion of prescription stimulant medication among college students are needed.

Dopamine, learning, and impulsivity: a biological account of attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) affects up to 10% of school-age children. The impulsivity which is seen as its core feature persists over years, yet experimental measures of impulsivity can be altered in a single session. In this study, we tested the theory that both the persistence and the variability of impulsivity could be the result of abnormalities in learning mechanisms and environment.

METHOD

We extended an existing model of the role of dopamine in operant conditioning to address the delayed response time task, which is one of the standard tests for impulsivity in ADHD. In this task, subjects choose between immediate responding for a small reinforcer and later responding for a larger one. We studied the influence on impulsivity of four key parameters of the model: The learning rate, discount factor, brittleness, and action bias.

RESULTS

The behavior of the model is broadly comparable with electrophysiological (monkey) and behavioral (ADHD and normal) data. Variations in any of the parameters can cause impulsivity. All parameters except the discount factor show inverted U-shaped curves for their effects on impulsivity, suggesting, for example, how either hyper- or hypofunctioning of dopamine can cause impulsivity. The model suggests how decision making can be affected by environmental unpredictability, and thus offers an account of one aspect of the natural history of ADHD.

CONCLUSIONS

Some types of ADHD may be caused by specific deficits in reinforcement learning and in the use of learned lessons. Environmental factors can interact with these deficits to delay maturation.

Sensation seeking and symptoms of disruptive disorder: association with nicotine, alcohol, and marijuana use in early and mid-adolescence

This study examined the association of Sensation Seeking and symptoms of Disruptive Disorders and investigated the associations of each with the risk of nicotine, alcohol, and marijuana use in 11- to 14-yr.-old boys and girls from psychiatric and pediatric clinics (n = 206). Sensation Seeking and symptoms of Disruptive Disorder were significantly related, and both were associated with drug use. In particular, Sensation Seeking was strongly associated with drug use in early and mid-adolescents seen in a clinical setting. Measurement of Sensation Seeking and symptoms of Disruptive Disorder should help identify and characterize youth who are at increased risk for drug use during early and mid-adolescence-a time when onset of use may be a harbinger of long-term habit.

Temperament and character factors in a prepubertal and early adolescent bipolar disorder phenotype compared to attention deficit hyperactive and normal controls

OBJECTIVE

To compare temperament and character (T/C) factors in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP), attention deficit hyperactivity disorder (ADHD), and normal community controls (NC).

METHODS

Subjects in PEA-BP (n = 101), ADHD (n = 68), and NC (n = 94) groups were diagnostically assessed with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia given separately to mothers about their children and to children about themselves. Diagnosis of PEA-BP was defined as Diagnostic and Statistical Manual of Mental Disorders, fourth edition, bipolar disorder (manic or mixed phase) with at least one cardinal symptom of mania (i.e., elation and/or grandiosity) to avoid diagnosing mania by symptoms that overlapped with those for ADHD. The Junior Temperament and Character Inventory (JTCI) was used to measure T/C factors. Separate JTCI data were obtained from mothers about their children and from children about themselves.

RESULTS

Parent- and child-reported novelty seeking were significantly higher in PEA-BP than in NC subjects. Novelty seeking was significantly higher in the ADHD group than in the NC group only by parent report. Parent and/or child report showed PEA-BP and ADHD subjects to be significantly less reward-dependent, persistent, self-directed, and cooperative than NC subjects. Parent-reported cooperativeness was significantly lower in PEA-BP than in ADHD subjects.

CONCLUSION

These findings are consistent with studies of novelty seeking in adults who had either BP or ADHD and are discussed in relationship to genetic studies of dopamine receptors and novelty seeking.

Personality differences associated with smoking experimentation among adolescents with and without comorbid symptoms of ADHD

This study evaluated differences in adolescent personality (novelty seeking, harm avoidance, and reward dependence), lifetime cigarette smoking, and symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) among 1051 youths enrolled in several public high schools in middle Atlantic towns in the United States in 2000 and 2001. Psychological and behavioral data were obtained via self-report on the Temperament and Character Inventory (personality), standard epidemiological survey items (smoking), and the Current Symptoms Scale (ADHD). The results indicated that adolescent "ever smokers" with high-normal symptoms of ADHD had the highest novelty seeking scores compared to all other study groups. These data highlight the greater "vulnerability" to smoking that is associated with novelty seeking and symptoms of inattention and hyperactivity. To the extent that novelty seeking and ADHD share cognitive and/or behavioral elements that may negatively impact upon youths' ability to attend to tobacco control communications, additional research on ways to adjust the delivery and content of smoking prevention and intervention program messages to meet the needs of these adolescents is warranted.

Patterns of inattentive and hyperactive symptomatology in cocaine-addicted and non-cocaine-addicted smokers diagnosed with adult attention deficit hyperactivity disorder

Despite a robust relationship between Attention Deficit Hyperactivity Disorder (ADHD) and cigarette smoking, as well as increased prevalence of other substance use disorders in these individuals, little is known about the particular patterns of ADHD symptomatology associated with different forms of drug abuse. The present study com- pared ADHD adults with and without cocaine dependence (COCDEP) on severity of ADHD symptomatology. Groups did not differ in smoking rate or degree of nicotine dependence. COCDEP ADHD smokers reported significantly more childhood and adult hyperactive/impulsive symptoms, and a higher number of symptoms overall, during adulthood, even after controlling for group differences in age and sex. Our finding of a more severe adult ADHD symptom profile among ADHD smokers with cocaine dependence, accounted for by elevated hyperactive/impulsive but not inattentive features, suggests that cocaine use in smokers with ADHD may be driven by excesses in hyperactivity. These findings have important implications for research, since similarities and differences in patterns and severity of ADHD symptomatology may shed light on drug-specific mechanisms. Our results may also point to improved approaches for treatment of substance abuse based on attention to patterns of ADHD symptomatology specific to different drugs.

Smoking patterns and abstinence effects in smokers with no ADHD, childhood ADHD, and adult ADHD symptomatology

Cigarette smokers are known to be overrepresented among adults with Attention Deficit Hyperactivity Disorder (ADHD). To date, however, no attempt has been made to determine the extent to which a lifetime diagnosis of ADHD may be associated with smoking even in the absence of current symptomatology. We hypothesized that nicotine dependence and abstinence effects-especially effects relevant to ADHD symptomatology-would be more pronounced in adult ADHD smokers in comparison with those who reported childhood ADHD symptoms only. Results indicated that, in contrast to controls without ADHD symptomatology, both adult and childhood ADHD groups were significantly more likely to experience a number of nicotine withdrawal symptoms, including irritability and difficulty concentrating; in no instance did the ADHD groups differ from one another in this regard. Thus, studying people with childhood symptoms of ADHD, even in the absence of an adult diagnosis, may shed light on the known association between smoking and ADHD.

Regulatory strategies to reduce tobacco addiction in youth

Preventing tobacco addiction and achieving cessation in established users are the cornerstones of efforts to reduce tobacco use and disease. It has been increasingly recognised that reducing tobacco toxin exposure has theoretical potential to reduce disease in continuing tobacco users. This has been controversial because such approaches also carry the potential to undermine prevention and cessation. As complicated as harm reduction issues are for adults, they are still more complicated for youth. Harm reduction is not a singular approach, but rather a concept that encompasses an extremely diverse array of potential approaches. These carry equally diverse potential risks and benefits. The regulatory framework (for example, whether or not the Food and Drug Administration regulates the approach) is also predicted to be a major factor in determining the consequences of harm reduction approaches. This paper examines the various issues and potential approaches concerning the application of harm reduction to youth. We conclude that although some carry great risk, others may actually support broader tobacco control efforts to prevent tobacco use and foster cessation in youth and adults.

Test-retest reliability of the Temperament and Character Inventory in patients with opiate dependence

We examined the test-retest reliability of the Temperament and Character Inventory (TCI) in a clinical sample of 29 inpatients with opiate dependence disorder (DSM-IV). The previously validated French translation of the TCI was administered at baseline and again four weeks later. Intraclass correlation coefficients (ICCs) were used to estimate stability of the TCI over time for the 15 patients who completed the study. For all ICCs, the TCI showed satisfactory to excellent stability across all factors (ICC= 0.66-0.82). Stability was lower for the two temperamental traits of 'persistence' (ICC=0.51) and 'reward dependence' (ICC=0.63), possibly reflecting both clinical instability and measurement errors. These results highlighted the overall stability of the TCI in patients with opiate dependence and provided evidence for the usefulness of this questionnaire, which was originally designed to explore genetic and environmental factors underlying normal and abnormal personality dimensions. Further studies are required to confirm these results on larger clinical samples.

Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence

In this 12-week double-blind placebo-controlled trial of methylphenidate (MTP) versus placebo in 48 cocaine-dependent attention-deficit/hyperactivity disorder (ADHD) adults, the authors sought to determine whether MTP would be safe, control ADHD symptoms, and affect cocaine use. Efficacy indexes revealed significantly greater ADHD symptom relief in the MTP group. There were no group differences in self-reported cocaine use, urinalysis results, or cocaine craving. Because of the relatively small sample size, the results are preliminary. However, we found that MTP improved subjective reports of ADHD symptoms and did not worsen cocaine use while participants were in treatment.

Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis

Historically, the focus for Attention Deficit Hyperactivity Disorder (ADHD) has been on children, with considerable research and many opinions available in this area. More recently, the focus has been expanded to include ADHD in adults. Assessment of ADHD in adults is complicated by the high rate of co-occurring disorders as well as symptom overlap with a number of disorders. One popular family of measures for the assessment of attention and executive control is the continuous performance test (CPT). A review of the available research on CPTs reveals that they are quite sensitive to CNS dysfunction. This is both a strength and a limitation of CPTs in that multiple disorders can result in impaired performance on a CPT. The high sensitivity of CPTs is further complicated by the multiple variations of CPTs available, some of which may be more sensitive or demonstrate better specificity to ADHD in adults than others. If CPTs are to be used clinically, further research will be needed to answer the questions raised by this review.

Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers

We compared nicotine dependence and withdrawal in male alcoholic and control ever-smokers, controlling for relevant demographic and clinical variables. Alcoholics were more likely to meet criteria for moderate or severe nicotine dependence and endorse more nicotine dependence symptoms. Symptoms reported more frequently by alcoholics included: (a) using nicotine in larger amounts or over a longer time than intended; (b) continued use despite problems caused or exacerbated by nicotine; (c) marked tolerance; and (d) experiencing characteristic nicotine withdrawal symptoms. Alcoholics also smoked more heavily. Other than "headaches," and "decreased heart rate," alcoholics consistently endorsed nicotine withdrawal symptoms at a higher rate. After controlling for demographic and clinical variables and level of nicotine dependence, only "feel depressed" differed significantly between groups. Our research supports previous findings suggesting that nicotine dependence is more severe in those with a history of alcohol dependence. As a result, alcoholics may experience greater discomfort from nicotine withdrawal upon smoking cessation.