Is there evidence of a causal link between childhood maltreatment and attention deficit/hyperactivity disorder? A systematic review of prospective longitudinal studies using the Bradford-Hill criteria

Background

Studies report an elevated risk of maltreatment in children with attention deficit/hyperactivity disorder (ADHD), and elevated levels of ADHD in people who suffered childhood maltreatment (CM). However, the direction(s) of causality between CM and ADHD remain unclear-does ADHD create a context for CM, does CM cause ADHD, or both?

Objective

This study systematically reviews and qualitatively synthesizes the research evidence relating to this question using Bradford-Hill criteria for establishing causality-strength, temporality, dose-response and plausibility.

Methods

We conducted a systematic review, following PRISMA guidelines, of prospective longitudinal studies examining both CM and ADHD. We then used Bradford-Hill criteria to assess the quality of evidence for a causal link between CM and ADHD.

Results

All 11 included studies demonstrated an association between CM and ADHD. Seven included evidence for temporality: five suggesting that CM precedes ADHD in the lifespan; two suggesting ADHD precedes CM. Four studies demonstrated a dose response relationship in which greater CM exposure was associated with elevated risk of ADHD. Studies presented a range of plausible mechanisms, including CM causing ADHD through biological programming, versus ADHD causing CM through parental stress.

Conclusions

The high quality prospective longitudinal studies reviewed confirm the association between ADHD and CM, but present conflicting evidence about the direction of causality and mechanisms underpinning this association. To better understand the complex interplay between CM and ADHD, more studies using new research designs will be required that can partition effects by type of CM and account for bidirectional effects and other complexities.

Psychometric properties of the Revised Child Anxiety and Depression Scale in Greek Adolescents

The psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS-47) are established cross-culturally but lacking for the Greek population. The present study examined RCADS internal consistency and validity (structural and concurrent) in Greek adolescents, and tested measurement invariance across sex and age groups. We recruited 619 secondary school students (n = 321 females), aged 12-18 years (n = 318, 12-14-year-olds). Besides RCADS, all students completed Strengths and Difficulties Questionnaire (SDQ), a subsample (n = 300) completed Screen for Child Anxiety-Related Emotional Disorders (SCARED), whereas a non-overlapping subsample (n = 219) completed Depression Self-Rating Scale (DSRS). Structural validity was examined with Confirmatory Factor Analysis and measurement invariance was assessed with Multiple Indicators Multiple Causes (MIMIC) modeling. Convergent and divergent validity were examined using Spearman correlations between RCADS subscales and DSRS, SCARED, and SDQ validators. The six-factor model fitted the data best, validating the originally proposed RCADS structure. Three items displayed differential item functioning for sex, another three for age group, and one item for both, albeit with trivial effect sizes (d < 0.2). Cronbach's alpha was .94. Convergent and divergent validity were also established. In conclusion, the RCADS is a valid and reliable instrument for assessing anxiety and depression symptoms in Greek adolescents.

Diverse patterns of vulnerability to visual illusions in children with neurodevelopmental disorders

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8 years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

Salivary cortisol and alpha-amylase daily profiles and stress responses to an academic performance test and a moral cognition task in children with neurodevelopmental disorders

There is evidence that children with neurodevelopmental disorders may exhibit atypical responses to stress and alterations in concentrations and diurnal secretion of stress hormones. We assessed diurnal profiles and stress responses of salivary cortisol and alpha-amylase (sAA) in children with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and specific learning disorder (SLD) compared to typically developing children (TD). A total of 157 children of both sexes, aged between 6 and 12 years old, took part in the study distributed into four groups: ADHD (N = 34), ASD (N = 56), SLD (N = 43) and TD (N = 24). Salivary samples were collected at three time points during a day, as well as before and 5 min after an academic performance test and a moral cognition task. ADHD children had lower evening and diurnal sAA levels, adjusted for age. Also, ASD children showed lower diurnal sAA secretion, adjusted for age. The mean percentage change for salivary cortisol and sAA after both tests did not differ between the groups. In conclusion, we demonstrated alterations in diurnal autonomic functioning in children with ADHD and ASD, while hypothalamic-pituitary-adrenal axis functioning did not differ between the clinical and the comparison groups.

Neurotrophic Factors Mediated Activation of Astrocytes Ameliorate Memory Loss by Amyloid Clearance after Transplantation of Lineage Negative Stem Cells

Alzheimer's disease (AD) is one of the untreatable neurodegenerative disorders with associated societal burden. Current therapies only provide symptomatic relief without altering the rate of disease progression as reported by Lanctot et al. (Therapeutic Advances in Neurological Disorders 2 (3):163-180, 2009). The increased number of failed clinical trials in last two decades indicates the imperative need to explore alternative therapies for AD as reported by Tuszynski et al. (Nature Medicine 11 (5):551-555, 2005) and Liyanage et al. (Alzheimer's & Dementia 4:628-635, 2005). In this study, we aimed to decipher the role of neurotrophic factors in the reversal of memory loss by transplantation of lineage negative (Lin-ve) stem cells in a male mouse model of cognitive impairment induced by intrahippocampal injection of amyloid β-42 (Aβ-42). The efficacy of human umbilical cord blood (hUCB) derived Lin-ve stem cells were analyzed by neurobehavioral parameters, i.e., Morris water maze and passive avoidance after bilateral intra-hippocampal transplantation using stereotaxic surgery. Real-time PCR and immunohistochemistry was carried out in brain tissues in order to analyze the expression of neurotrophic factors, apoptotic, astrocytic, and other neuronal cell markers. The transplantation of Lin-ve stem cells led to reversal of memory loss associated with reduction of Aβ-42 deposition from the brains. The molecular analysis revealed increase in neurotrophic factors, i.e., glial derived neurotrophic factor (GDNF), ciliary derived neurotrophic factor (CNTF), and Brain-derived neurotrophic factor (BDNF) after transplantation. The administration of ANA-12, a TrkB inhibitor, reversed the behavioral and molecular effects of stem cell transplantation suggesting involvement of BDNF-TrkB pathway in the rescue of memory loss. We believe that the amyloid clearance results from activation of astrocytes and anti-apoptotic pathways added by neurotrophic factors.

Agreement between psychiatric evaluations and court decisions concerning criminal responsibility

Introduction

To our knowledge, a relatively small number of studies address the agreement between psychiatrists and court decisions concerning criminal responsibility among psychiatric offenders.

Objectives

The objective of the present study was to examine the agreement between psychiatric evaluations and court decisions in Greek penal cases.

Methods

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were studied, and agreement was assessed by the κ (kappa) statistic.

Results

Seventy eight percent of the subjects had had contact with psychiatric services before the commitment of the crime. The most common diagnoses were schizophrenia spectrum psychosis (18%), antisocial/borderline/mixed personality disorder (15%) and substance use disorder (15%). In 30% of the cases criminal insanity/partial responsibility was attributed in the first-degree court. The presence of a psychiatrist (n = 63), attending, defense, prosecution or appointed by the court, significantly increased the possibility of such an attribution (41.3% versus 10.8%).

The highest agreement (κ = 0.780) was observed between court's decision and the evaluation of the psychiatrist appointed by the court, in the 35 cases in which such an expert was present (P < 0.001). Very significant agreement (κ = 0.805) was observed between the decisions of second and first-degree courts (P < 0.001). In 91% of the cases, the decisions remained unchanged.

Conclusions

Criminal insanity/diminished responsibility, were attributed in 30% of the reviewed cases. The presence of a psychiatrist already at the first-degree court is a prerequisite for such an attribution, especially when, he is appointed by the Court.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Demographic and criminal data among psychiatric patients in Greece

Introduction

To our knowledge, a limited number of studies address criminality among psychiatric patients as depicted in legal files.

Objectives

The objective of the present study was to provide demographic, psychiatric, legal/criminal data about psychiatric patients in Greece.

Methods

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were reviewed.

Results

Seventy eight percent of the subjects had at least one psychiatric evaluation prior to the commitment of the crime. The main diagnoses at the time of the criminal act were: schizophrenia spectrum psychosis (18%), anti-social/borderline/mixed personality disorder (15%), substance use disorder (15%), alcohol use disorder (10%), depressive affective disorder (6%), mixed anxiety/depressive disorder (6%), bipolar disorder (5%), anti-social personality disorder/substance use disorder (5%), schizophrenia/substance use disorder (3%). In 11% the diagnosis was unknown. Eighty four percent of the crimes committed were homicides/attempted homicides, 6% assaults/(attempted) homicides, 3% property crimes/(attempted) homicides and below 3% assaults, property crimes, sexual offences, drug crimes. The weapon used was a knife/sharp object (42%) or a gun (40%). Perpetrator and victim were strangers in 25% of the cases, just acquaintances in 14%, had a professional relationship in 7%, their relationship was conjugal (15%), they were partners (13%) or relatives (7%). In persons with schizophrenia spectrum psychosis the victims were relatives/spouses in 41.2%, while in other diagnoses the respective percentage was 21.5% (P = 0.044).

Conclusions

In accordance to the international literature, there is a vast need for further research in order to improve forensic psychiatric services and prevent criminality among psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Criminal insanity and psychiatric diagnoses in Greek penal cases

Introduction

To our knowledge, few studies address the issue of criminal responsibility among psychiatric offenders. In Greece, articles 34 and 36 of the penal code regulate criminal insanity and diminished responsibility, respectively.

Objectives

The objective of the present study was to provide psychiatric/legal data considering the appeal to articles 34/36 of the Greek penal code.

Methods

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were examined.

Results

According to the first degree court, one defendant was found criminally insane, 29 with partial responsibility, while the rest were regarded as fully capable. The decisions of the court of appeal/the supreme court of appeal were 2 criminally insane, 36 partially responsible and 62, fully criminally responsible. The decisions were unanimous in 78% of the cases.

The most common diagnoses were schizophrenia spectrum psychosis (18%), antisocial/borderline/mixed personality disorder (15%) and substance use disorder (15%). Court decisions of criminal insanity/diminished responsibility were higher when the perpetrator had an Axis I diagnosis (47.5%), significantly lower in cases of personality disorder (22.2%) and even lower in cases of substance use disorder (16.7%). In patients with prior hospitalizations the percentage of criminal insanity/diminished responsibility was 55.6%, significantly higher than in cases without (24.4%).

Conclusions

Schizophrenia is the most common mental disorder correlated with offenders criminally insane/partially responsible, while a history of psychiatric hospitalization is a very strong positive predictive factor for the successful appeal of the aforementioned articles.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Inhibition of histone deacetylase (HDAC) 6 sensitizes human leukemia and breast cancer cells to antagonists of heat shock protein (hsp) 90 and/or bortezomib (BZ)

13039

Background: HDAC6 is a cytosolic α-tubulin deacetylase, which shuttles misfolded polyubiquitylated proteins into aggresomes. Our studies demonstrated that the hydroxamic acid (HA) analogue pan-HDAC inhibitors (HDIs), e.g., LAQ824 and LBH589, induce α-tubulin and hsp90 acetylation, thereby inhibiting ATP-binding and chaperone function of hsp90. This promotes the polyubiquitylation and degradation of the pro-growth and pro-survival hsp90 client proteins, e.g., Bcr-Abl, mutant FLT-3, c-Raf and AKT in leukemia and Her-2 in breast cancer cells. Methods: Human CML K562 and breast cancer SKBR-3 and BT-474 cells were exposed to LAQ824 (100 nM) or LBH589 (20 to 50 nM) and/or 17-AAG (1 to 5 μM) and/or BZ (5 to 100 nM). K562 and BT-574 cells were also transfected with siRNA to HDAC6. Immunoprecipitation and/or immunoblot analysis were performed to determine the expression or binding of HDAC6 with hsp90, and of hsp90 acetylation and binding with its co-chaperones and client proteins. Immunofluorescent microscopy was utilized to estimate aggresome formation. Cellular cytotoxicity was determined by % inhibition of colony growth. Results: HDAC6 knockdown by its siRNA induced the acetylation of hsp90 and α-tubulin but not of the co-chaperones p23 and hsp40. HDAC6 binds to hsp90. Hsp90 acetylation increased its binding to biotinylated-geldanamycin (GM) and its analogue 17-AAG. Depletion of HDAC6 levels (∼70%) or its activity by treatment with HA-HDI also inhibited the binding of hsp90 to ATP, p23 and hsp90 client proteins, which was augmented by co-treatment with 17-AAG. Knockdown of HDAC6 sensitized the cells to loss of clonogenic survival induced by HA-HDI and/or BZ and/or 17-AAG. Depletion of HDAC6 led to attenuation of Her-2 levels and loss of survival of Her-2 amplified SKBR-3 and BT-474 cells. Co-localization of HDAC6 and polyubiquitylated proteins into aggresomes was enhanced by co-treatment with BZ and/or 17-AAG. This was inhibited by depletion of HDAC6 activity. Conclusions: These findings support the in vivo testing of HDAC6 inhibitors, which through inhibition of hsp90 and aggresome formation sensitizes cancer cells to 17-AAG and/or BZ induced cellular stress due to misfolded and polyubiquitylated proteins.

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Germ cell-specific localization of immunoreactive riboflavin carrier protein in the male golden hamster: appearance during spermatogenesis and role in sperm function

Riboflavin carrier protein (RCP) is a phosphoglycoprotein (37 kDa) that is well studied in chicken. An immunologically cross-reacting protein was identified in mammals and active immunization of male rats and bonnet monkeys with chicken RCP lead to an approximately 80% reduction in fertility. However, the physiological mechanism responsible for inhibition of male fertility has not been investigated. Moreover, information on the cell type-specific localization and the origin of immunoreactive RCP during spermatogenesis is extremely limited. Hence, studies were carried out to determine the pattern of expression of immunoreactive RCP during spermatogenesis and its role in sperm function in the golden hamster. Immunoreactive RCP was germ cell-specific, found to be associated with the acrosome-organizing region of early spermatids and showed interesting patterns of immunolocalization during late stages of spermiogenesis. Mature spermatozoa exhibited acrosome-specific localization, mainly in the peri-acrosomal membrane. The immunoreactive protein was undetectable in (non)gonadal somatic cells tested. The protein had a molecular mass of 45-55 kDa and was biosynthesized by round spermatids. The acrosome-specific localization of immunoreactive RCP was unchanged during capacitation, but it was substantially lost during acrosome reaction. Functional studies indicated that treatment of spermatozoa with anti-RCP antibodies did not have any effect on either capacitation or acrosome reaction, but markedly reduced the rate of sperm penetration into zona-free hamster oocytes. These results show the existence of male germ cell-specific immunoreactive RCP, having a potential role in sperm-egg interaction in hamsters. Also the pattern of immunoreactive-RCP localization makes it an ideal marker to monitor development of acrosome in mammalian spermatozoa.

Developmental and hormonal regulation of type II DNA topoisomerase in rat testis

Type II DNA topoisomerase (topo II) is required for diverse biological functions including DNA replication, maintenance of genome stability, chromosome segregation and chromosome condensation. While the identity of topo II in rodent testis has been established, the regulation of topo II expression during the development of the postnatal testis and gametogenesis is unclear. Here, we report that rat testis topo II is developmentally and hormonally regulated. Topo IIalpha mRNA levels peaked prior to the onset of puberty, declined sharply thereafter and stabilized in adult testis. In contrast, the topo II enzyme content was lower in prepubertal testis but increased after the onset of puberty. Topo II was expressed in a cell-specific manner within germ cells, being detected only in pachytene spermatocytes. While testosterone markedly increased topo IIalpha mRNA levels in prepubertal testis, continued treatment failed to enhance topo IIalpha mRNA above postpubertal control levels. The extent of topo II activity remained steady regardless of the testosterone-induced increase in topo IIalpha mRNA levels. Inhibition of testosterone function in postpubertal animals by ethanedimethane sulphonate (EDS) and flutamide resulted in a significant decrease in topo IIalpha gene expression and topo II activity. The administration of exogenous testosterone (T) to EDS- and flutamide-treated rats restored topo IIalpha mRNA levels and topo II activity similar to the levels seen in the testis of age-matched control animals. Histochemical analyses of testes indicated that the effect of T on spermatogenesis was separable from its effect on topo IIalpha expression. Our results reveal that testosterone acts as a positive regulator of topo IIalpha gene expression and is required for the maintenance of topo IIalpha expression during the development of the postnatal testis and spermatogenesis.

Prolonged treatment of breast cancer cells with antiestrogens increases the activating protein-1-mediated response: involvement of the estrogen receptor

At micromolar (pharmacological) concentrations, the action of tamoxifen on the proliferation of estrogen-dependent cells can be mediated not only by the estrogen receptor (ER), but also by other target molecules, such as protein kinase-C (PKC), which are easily inhibited by antiestrogens in cell-free experiments. By developing MTLN and MDT cell lines, in which any modulation of PKC activity is reflected by a variation of the expression of an activating protein-1 (AP-1)-controlled firefly luciferase gene, we investigated whether such antiestrogen inhibitory effects on PKC occurred in intact breast cancer cells. Firstly, in short term (4-h) treatment of both cell lines, antiestrogens only inhibited the 12-O-tetradecanoyl-phorbol-13-acetate-induced luciferase activity at very high concentrations (30 microM). A cytolytic effect was also observed. Secondly, in prolonged (4-day) treatments of MTLN (ER-positive) cells, low antiestrogen concentrations (nanomolar) decreased the basal AP-1 response by about 2 and increased the 12-O-tetradecanoyl-phorbol-13-acetate-stimulated AP-1 response by about 3-4. This stimulation was mediated by ER, because 1) dose-response curves established with tamoxifen and hydroxytamoxifen were in agreement with their affinity for ER; 2) when present with antiestrogens, estradiol abolished this phenomenon; and 3) this effect was not observed in MDT (ER-negative) cells. Such a latent activation of AP-1 pathway could appear in the course of breast cancer antiestrogen treatment, in conditions where natural PKC activators are abnormally produced with unexpected consequences on the results of a long term antiestrogen treatment.

Prevalence of high risk factors in mothers in urban slums of Delhi

Point prevalence of 'High Risk' factors was assessed in 450 mothers of reproductive age group residing in two urban slum communities. Major risk factors prevalent were non-pregnant weight less than 43.5 kg (24%), elderly grand multipara (17%), and history of previous still births and/or intrauterine death (3%).

Care of the newborn by traditional birth attendants

The study was carried out in a slum cum resettlement colony (Area-I) and four villages (Area-II) of Delhi. Management of the newborn by the 25 functioning Traditional Birth Attendants (TBA's) who conducted 83.64% deliveries in Area-I and 16.22% in Area-II was studied. Majority of TBA's did not have the concept of washing hands before conducting per vaginum (P/V) examinations or deliveries. Most of the TBA's, i.e., 21 out of 25 used a razor blade to cut the umbilical cord of which 9 used a fresh blade. No TBA left the cord untied. Vigorous patting in upright and also after holding the baby upside down was the commonest (68%) method of neonatal resuscitation. All TBA's massaged and bathed the baby everyday. Majority of the TBA's (18 out of 25) referred the baby to a health agency for immunization though they did not know the exact schedule.

Nutritional status of pre-school children of urban slum communities in Delhi

Nutritional status of 486 preschool children residing in urban slums was assessed by making domiciliary visits. The overall prevalence of protein energy malnutrition (PEM) was found to be 81.8%, while 31.8, 44.1, 5.7 and 0.2% of children had Grades I, II, III and IV PEM, respectively. Age, sex and education had a significant association with PEM.