Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD

BACKGROUND

Persistent mind-wandering processes are associated with negative emotions; however, mindful states exhibit an anticorrelation with mind-wandering patterns. The aim of this study is to investigate the mediating role of excessive mind wandering (EMW), rumination, and trait mindfulness between attention-deficit hyperactivity disorder (ADHD) symptoms and the severity of anxiety/depression in adults with ADHD.

METHODS

Medication-free 159 adults diagnosed with ADHD completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Hospital Anxiety Depression Scale, Mind Excessively Wandering Scale, Ruminative Response Scale, and Freiburg Mindfulness Inventory after the diagnostic examination according to the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5).

RESULTS

ADHD symptoms exhibited an indirect, but not a direct, association with the severity of anxiety and depression, mediated by increased excessive mind wandering and rumination, as well as decreased trait mindfulness.

LIMITATIONS

This study was carried out within a clinical population using a cross-sectional design. While diagnostic assessments were conducted using SCID-5, psychiatric symptoms were evaluated through self-report measures.

CONCLUSIONS

Coping with EMW and rumination and promoting mindfulness ability may be promising targets in treating comorbid conditions in adults with ADHD. These findings have highlighted the effects of mentation processes on depression and anxiety, which are common comorbidities with ADHD in adults; however, longitudinal studies are needed.

Heterogeneity of associations between dissociation and attention deficit symptoms

Childhood trauma and dissociative experiences are suggested to be predisposing transdiagnostic factors for attention deficit /hyperactivity disorder (ADHD) as well as many psychiatric disorders. Trauma-related symptoms such as motor restlessness, emotional instability, and concentration problems can mimic, trigger, or exacerbate ADHD symptoms. Moreover, given the relationship between ADHD and trauma-induced distress, it has been suggested that dissociative experiences and attention problems may reveal overlapping characteristics. The aim of this study was to investigate the associations between dissociative experiences and attention deficits by carrying out mixture analysis. A thousand and thirty-seven participants volunteered to the online investigation. Participants completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Wender Utah Rating Scale (WURS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Item responses on the DES and attention deficit symptoms as indexed by the ASRS were subjected to latent class analysis. The three-latent-class model outperformed alternative mixture models. Mixture analysis classified the sample into three homogenous subgroups as follows: (1) No/low dissociation or attention problems; (2) Moderate dissociation with attention problems; and (3) High dissociation with attention problems. High dissociators with attention problems were characterized by heightened scores on somatoform dissociation and emotional neglect. No/low dissociation or attention problems latent class reported significantly lower scores on hyperactivity/impulsivity, depression, attention deficit in childhood, and sexual abuse than both moderate and high dissociation latent classes. High dissociators and moderate dissociators significantly differed on conduct problems and physical abuse. We concluded that impulsive hyperactivity, depression, and childhood sexual abuse were common features in heightened dissociation latent classes, as well as attention deficit.

Dissociative Absorption May Contribute to Internet Gaming Disorder Independent of Childhood Trauma and ADHD Symptoms Among Male University Students

OBJECTIVE

We aimed to investigate the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable attention-deficit hyperactivity disorder determined by both childhood and current attention-deficit hyperactivity disorder symptoms.

MATERIALS AND METHODS

Volunteers were 376 university students who completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Wender Utah Rating Scale, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, and Internet Gaming Disorder Scale-Short Form. Volunteers were divided into 2 groups as with and without probable attention-deficit hyperactivity disorder D based on both childhood and current attentiondeficit hyperactivity disorder symptoms.

RESULTS

Childhood Trauma Questionnaire (t=-3.94; P < .01), Dissociative Experiences Scale (t=-5.97; P < .01), Somatoform Dissociation Questionnaire (t=-3.80; P < .01), and Internet Gaming Disorder Scale-Short Form (t=-5.21; P < .01) scores were significantly higher in the group with probable attentiondeficit hyperactivity disorder than in those without. Two different hierarchical regression analysis models in which internet gaming disorder scores were dependent variables showed that dissociative experiences in first model (β=0.15, t=2.28, P = .023) and dissociative absorption in second model (β=0.22, t=2.76, P = .006) were associated with internet gaming disorder after controlling for childhood trauma and attentiondeficit hyperactivity disorder symptoms.

CONCLUSION

Dissociative absorption may contribute to internet gaming disorder independent of childhood trauma and attention-deficit hyperactivity disorder symptoms, however further studies are needed to investigate this claim.

A case of trazodone induced prolonged hypogeusia

Introduction

Plenty of antidepressants have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Trazodone induced hypogeusia (decreased taste sensation) is a rare side effect. In this report, we would like to present a male patient with with hypogeusia after trazodona use and persisting for 3 months after the drug was discontinued will be discussed.

Objectives

A 52-year-old male, Trazodone 50 mg/day was started 4 months ago due to difficulty in falling asleep. On the 25th day of her daily treatment, her sense of taste began to decrease and gradually became more severe. So he stopped his treatment and he applied to the internal medicine and neurology polyclinics. Routine blood tests were within normal limits. To rule out the possibility of covid 19, 2 pcr tests were done and it was found negative. No recommendations other than chewing gum. The patient applied to the psychiatry polyclinic with the complaint of decreased taste sensation that in the 3rd month of his complaints.

Methods

CASE REPORT

Results

CASE REPORT

Conclusions

Chemosensory side effects due to drugs are frequently seen in the elderly and in polypharmacy. It is usually accompanied by a decrease in salivary secretion. It resolves shortly after the causative drug(s) are stopped. It is important that our patient is middle-aged, does not have additional medical diseases and does not use drugs, and his complaints continue for 3 months after the stopped of Trazodone.

Disclosure

No significant relationships.

Dissociative Experiences Associated With Internet Gaming Disorder After Controlling For Childhood Trauma And ADHD Diagnosis

The aim of this study was to investigate the relationships among childhood trauma, dissociative experiences, and internet gaming disorder (IGD) in young adults diagnosed with attention deficit hyperactivity disorder (ADHD) and age- and gender-matched controls. Forty participants diagnosed with ADHD at a university hospital psychiatric outpatient clinic and 40 healthy controls completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Internet Gaming Disorder Scale - Short Form (IGDS9-SF). The CTQ (t = -4.61, p < .01), DES (t = -4.71, p < .01), SDQ (t = -2.40, p < .01), and IGDS9-SF (t = -4.89, p < .01) scores were significantly higher in the ADHD group than in the control group. A hierarchical regression analysis that explained 50% of unique variance in internet gaming disorder (IGD) indicated that being male (β = 0.41, t = 4.61, p < .001) and having an ADHD diagnosis (β = 0.48, t = 5.49, p < .001) are robust predictors. Additionally, the DES score, which indicates the severity of psychoform dissociation (β = 0.34, t = 2.43, p = .017), was found to be significantly associated with IGD after controlling for ADHD diagnosis and childhood trauma. While excessive gaming may increase dissociative symptoms, the mental state of dissociative experiences may be a predisposing factor for IGD; however, further studies are needed to investigate these claims.

The use of buprenorphine + naloxone sublingual tablet in the treatment of neonatal opioid withdrawal syndrome: Two case reports

INTRODUCTION

Neonatal opioid withdrawal syndrome occurs after exposure during pregnancies of mothers with an opioid use disorder. If non-pharmacological treatment is insufficient, pharmacological options are preferred, but a common treatment guideline has not yet been determined. Sublingual buprenorphine tablet is more prominent in the treatment. Since oral alternatives are not available in many clinics, as in our unit, parenteral morphine is still the drug of the first choice. In this paper, we reported that two babies with neonatal opioid withdrawal syndrome were successfully treated with a buprenorphine/naloxone combination, which was not previously shown in the literature.

CASES

We followed two babies whose mothers had an opioid use disorder during their pregnancies. The modified Finnegan scoring scale was used for the assessment of the babies. Both infants developed persistent seizures with resistant withdrawal signs. An effective parenteral route could not be provided due to hemodynamic instability. Thus, IV morphine could not be used. Due to the lack of oral treatment alternatives, first, we tried phenobarbital up to 40 mg/kg orally. Afterward, we used buprenorphine/naloxone combined tablet sublingually, which has not been used in children before. Detailed written consent was obtained from the parents for the emergency use of this drug in advance. Shortly after this treatment, the seizures and withdrawal signs were controlled. There were no adverse effects and babies were discharged fully recovered.

CONCLUSION

Sublingual Buprenorphine 2 mg + Naloxone 0.5 mg (4:1) tablet could be used efficiently and without side effects to treat neonatal opioid withdrawal syndrome.

Feeding and Eating Disorders in the Context of Circadian Rhythms

A circadian rhythm is a 24-hour rhythm controlled by a master clock, the suprachiasmatic nucleus, and driven by synchronizing internal/external zeitgebers. Food intake is one of the most important external cues/zeitgebers. Studies in humans and animals have shown that misalignment of food intake leads to chronodisruption, which is associated with metabolic disruption, obesity, and disordered eating attitudes. The term chronotype, which expresses the circadian typology, has been classified into 3 main types that represent the differences in the reflection of circadian rhythms shown in human studies on daily behaviors. It has been reported that evening-type individuals are more prone to disrupted eating attitudes, such as skipping meals, eating at night, and consuming a calorie-rich diet. In addition, eating disorders up to the diagnostic level is associated with the evening type. The bidirectional relationship between impaired circadian rhythms and disordered eating attitudes has brought chronotherapeutic interventions, which are biological rhythm-oriented treatment approaches, to the agenda. Bright light therapy has been found to reduce bulimic eating behaviors and night eating symptoms. More evidence is needed regarding the effect of chronotherapeutic approaches on metabolic disorders, disordered eating attitudes, and eating disorders associated with obesity.

Feeding and Eating Disorders in the Context of Circadian Rhythms

A circadian rhythm is a 24-hour rhythm controlled by a master clock, the suprachiasmatic nucleus, and driven by synchronizing internal/external zeitgebers. Food intake is one of the most important external cues/zeitgebers. Studies in humans and animals have shown that misalignment of food intake leads to chronodisruption, which is associated with metabolic disruption, obesity, and disordered eating attitudes. The term chronotype, which expresses the circadian typology, has been classified into 3 main types that represent the differences in the reflection of circadian rhythms shown in human studies on daily behaviors. It has been reported that evening-type individuals are more prone to disrupted eating attitudes, such as skipping meals, eating at night, and consuming a calorie-rich diet. In addition, eating disorders up to the diagnostic level is associated with the evening type. The bidirectional relationship between impaired circadian rhythms and disordered eating attitudes has brought chronotherapeutic interventions, which are biological rhythm-oriented treatment approaches, to the agenda. Bright light therapy has been found to reduce bulimic eating behaviors and night eating symptoms. More evidence is needed regarding the effect of chronotherapeutic approaches on metabolic disorders, disordered eating attitudes, and eating disorders associated with obesity.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients

OBJECTIVE

We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level.

METHOD

The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link.

RESULTS

The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms.

CONCLUSIONS

Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

The mediating effects of self-perception and somatoform dissociation in the relationship between domestic violence and suicidal ideation

Domestic violence (DV) against women is a multidimensional public health problem that has both psychologically and socially devastating consequences, especially in patriarchal societies. The aim of this study was to investigate the mediating role of self-perception and somatoform dissociation in the relationship between DV and suicidal ideation in women living in Turkey. The sociodemographic data form, Severity of Violence Against Women Scale, Somatoform Dissociation Questionnaire, Social Comparison Scale, and Suicidal Ideation Scale were administered to 102 participants. In addition to descriptive statistics, linear and mediation regression analyses were performed. DV scores were significantly negatively correlated with self-perception and positively correlated with somatoform dissociation scores. While negative self-perception and increased somatoform dissociation were partial mediators in the relationship of threat and sexual violence with suicidal ideation and full mediators in the relationship of physical violence with suicidal ideation. Negative self-perception and increased somatoform dissociation were critical mediators in relation to DV and suicidal ideation in women. Psychotherapeutic approaches focused on self-perception and somatoform symptoms may reduce the risk of suicide in women who have been exposed to DV. Long-term clinical studies are needed to investigate the factors mediating suicidal ideation in women who have been exposed to DV.

From the urge to see one's own blood to the urge to drink it: Can hemomania be specified as an impulse control disorder? Two case reports

At least half of self-mutilative individuals report that seeing their own blood is comforting, while a quarter report that they have tasted it. Bloodletting and blood-drinking behaviors have been discussed in case reports of disorders such as borderline personality disorder, bulimia nervosa, dissociative identity disorder, and psychotic disorder. The role of blood-drinking behavior, however, needs to be clarified in the psychiatric literature. This paper is the first to discuss blood-drinking behavior as a possible impulse control disorder that progresses from a desire to see or taste one's own blood. It presents the cases of two patients who report drawing blood from their own arms via syringe and drinking it. The first patient began to suck her own blood by removing scabs at age 8. The second started cutting his arm during his middle school years to reduce tension. Both eventually began to drink their own blood by draining it impulsively. This paper presents two cases with blood-drinking behavior diagnosed as impulse control disorder not otherwise specified according to the Diagnostic and Statistical Manual of Mental Disorders. We propose the term "hemomania" to describe an impulse control disorder characterized by impaired functioning due to at least one of the following urges: seeing one's own blood, self-bloodletting, and tasting/drinking one's own blood. We argue that hemomania progresses from an urge to see one's own blood to the urge to drink it, though randomized controlled studies are needed to support this claim.

Comparison of venlafaxine alone versus venlafaxine plus late partial sleep deprivation therapy combination for major depressive disorder

Treatment resistance, medication non-adherence, and side effects of pharmacotherapeutics make treatment difficult in major depressive disorder. Sleep deprivation is a fast-acting and tolerable reinforcement treatment method. In this study, we investigated the effects of late partial sleep deprivation (PSD) therapy added to venlafaxine treatment on symptoms of anxiety and depression, sleep quality and treatment process. This study was conducted in a sample of 40 patients who were admitted to our inpatient psychiatric unit with a diagnosis of major depressive disorder. While the venlafaxine (Ven) group received only venlafaxine treatment, the venlafaxine+partial sleep deprivation (Ven+PSD) group underwent late partial sleep deprivation therapy three times in the first week in addition to venlafaxine treatment. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Insomnia Severity Index (ISI) were administered to both groups at the baseline and at the end of the 1st, 4th, and 6th weeks and, additionally, Profile of Mood State (POMS) was administered to the Ven+PSD group before and after each PSD. The Ven+PSD group had lower HAM-D and HAM-A scores than the Ven group at the end of the 1st and 6th week. Both anxiety and depression subscale scores on the POMS showed a significant decrease after PSD in the Ven+PSD group. The mean venlafaxine dose (mg/d) was significantly lower in the Ven+PSD group than in the Ven group. Late partial sleep deprivation is a fast-acting and tolerable therapy in major depressive disorder.

Relationships of neutrophil-lymphocyte and platelet-lymphocyte ratios with the severity of major depression

We aimed to evaluate the neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of inpatients and outpatients suffering from different levels of major depression. In total, 100 inpatients and 60 patients treated at an outpatient clinic were included the study. The presence of mood and anxiety disorders was identified with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version, and the Hamilton Depression Rating Scale was used to assess the severity of major depression (MD). Inpatients and outpatients with MD did not differ in NLR or PLR. The PLRs of patients who had severe major depression with psychotic features were higher than those of patients with other types of depression, but no differences in NLRs were detected across types of depression. The PLRs were higher in patients with severe levels of major depression with psychotic features than in other patients. This parameter may be more predictive than is NLR for assessing the prognosis of major depression.