Associations between inattention and impulsivity ADHD symptoms and disordered eating risk in a community sample of young adults

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.

METHODS

We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, M_age = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.

RESULTS

Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R² = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R² = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.

CONCLUSIONS

These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.

The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study

BACKGROUND

The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs.

METHOD

Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping.

RESULTS

The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs.

CONCLUSIONS

Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs.

HST and VLT investigations of the fragments of comet C/1999 S4 (LINEAR)

At least 16 fragments were detected in images of comet C/1999 S4 (LINEAR) taken on 5 August 2000 with the Hubble Space Telescope (HST) and on 6 August with the Very Large Telescope (VLT). Photometric analysis of the fragments indicates that the largest ones have effective spherical diameters of about 100 meters, which implies that the total mass in the observed fragments was about 2 x 10(9) kilograms. The comet's dust tail, which was the most prominent optical feature in August, was produced during a major fragmentation event, whose activity peaked on UT 22.8 +/- 0.2 July 2000. The mass of small particles (diameters less than about 230 micrometers) in the tail was about 4 x 10(8) kilograms, which is comparable to the mass contained in a large fragment and to the total mass lost from water sublimation after 21 July 2000 (about 3 x 10(8) kilograms). HST spectroscopic observations during 5 and 6 July 2000 demonstrate that the nucleus contained little carbon monoxide ice (ratio of carbon monoxide to water is less than or equal to 0.4%), which suggests that this volatile species did not play a role in the fragmentation of C/1999 S4 (LINEAR).

The comparative binding characteristics of nicotinic ligands and their pharmacology

Five drugs [(-)- and (+)-nicotine, (-)-lobeline, (-)-anabasine and (-)-cytisine] were infused IV into the urethane-pentobarbital anesthetized rat. Changes in heart rate, blood pressure, respiratory rate, minute and tidal volume, which appeared to be largely centrally mediated, were studied. Each of these compounds produced different pharmacologic profiles. The nature of these dissimilarities is not readily explained on the basis of pharmacokinetic considerations suggesting that the drugs have different mechanisms of action. Binding data obtained with these compounds using the rat brain P2 preparation also show differences. (-)-Lobeline and (-)-anabasine, like the nicotinic antagonists mecamylamine and hexamethonium, bind predominantly to low affinity sites with KDs in the micromolar range whereas (-)-cytisine binds only to a single high affinity site with a KD in the nanomolar range. Further, the binding patterns of these drugs are different from (-)- and (+)-nicotine which bind to both high and low affinity sites but differ from each other in binding characteristics. Thus the binding data are consistent with the pharmacologic data in suggesting that the drugs have different modes of action and support the concept that the low affinity site has an important role in the central nervous system action of these compounds.

Fourth ventricle effects of nicotine, 2-methylpiperidine and cytisine in dogs

Four distinguishable nicotinic binding sites have been identified as well as four nicotinic ligands with different specificities: (+/-)-2-methylpiperidine which binds to a very high affinity site (Site 1) and produces up-regulation of the high affinity site (Site 2); (-)-nicotine which binds to Site 1 and Site 2 as well as to a low affinity site (Site 4); (+)-nicotine which binds to Site 1, Site 4 and Site 3 which is also a high affinity site; and (-)-cytisine which binds to Sites 1 and 2. These drugs were injected into the 4th ventricle of 5 dogs in graded concentrations (12.5 to 400 micrograms) and their effects on the EEG, skin twitch reflex latency, heart rate, rectal temperature, pupillary diameter, blood pressure and the amplitude of the flexor reflex were measured. Drugs which act predominantly on Site 1 [(+/-)-2-methylpiperidine and (+)-nicotine] produced EEG synchronization and hyperalgesia while drugs which interact with Sites 2 and 4 produce EEG desynchronization, analgesia and tachycardia. These data indicate that nicotinic ligands which have different binding specificities have different actions in medullary function and support the hypothesis that the different binding sites have different pharmacologic significance.

Binding characteristics of (-)- and (+)-nicotine to the rat brain P2 fraction

Saturation studies employing (-)- and (+)-[3H]nicotine indicate that the isomers bind to different very high and high affinity sites since the binding density for (-)-[3H]nicotine is 10 times that for (+)-[3H]nicotine. Both isomers also bind to a low affinity site (KDS = approximately 10(-5) to 10(-4) M). Competition studies employing unlabelled (-)- and (+)-nicotine reveal greater complexities. The isomers also appear to bind to a separate site which enhances binding at the (-)- and (+)-nicotine high affinity sites. (+)-Nicotine is more effective in increasing the binding of (-)-[3H]nicotine at its high affinity site than (-)-nicotine. Further, (+)-nicotine has a greater specificity for enhancing binding than (-)-nicotine in that it enhances (-)-[3H]nicotine binding at lower concentrations and inhibits binding at higher concentrations than (-)-nicotine.

Stereospecificity of 2-methylpiperidine binding to a nicotinic up-regulatory site in the rat brain P2 preparation

(+/-)-2-Methylpiperidine has a high degree of specificity in enhancing the binding of (-)-[3H]nicotine in the rat brain P2 preparation. (-)- and (+)-2-Methylpiperidine have been resolved. The (+) but not the (-) isomer increased the binding of (-)-[3H]nicotine. The two isomers were equally effective in inhibiting the binding of (-)-[3H]nicotine in high concentrations. These data provide additional support for a stereospecific nicotinic up-regulatory site.

Structure-activity relationships of some pyridine, piperidine, and pyrrolidine analogues for enhancing and inhibiting the binding of (+/-)-[3H]nicotine to the rat brain P2 preparation

Previous studies have shown that (+/-)-[3H]nicotine binds to multiple sites in the rat brain P2 preparation. Using a series of pyridine, piperidine and pyrrolidine analogues, the present studies identified drugs with specificity for a separate up-regulatory site that increases the density of nicotine binding at another site. Of these compounds, (+/-)-2-methylpiperidine was the most specific. Some compounds inhibited without enhancing (+/-)-[3H]nicotine binding, but none bound with the very high affinity exhibited by nicotine and none could be classified as specific in inhibiting binding at a specific site. Structural changes in the 1- and 2-positions of pyridine and piperidine appear to be important for conferring specificity for the up-regulatory site whereas 3-position changes may be important for binding specificity.

Delayed carbon monoxide encephalopathy: clinical and research implications

Delayed onset of carbon monoxide encephalopathy may present to a psychiatrist as a functional illness in patients with a psychiatric history. Early detection is important as increased activity is antitherapeutic. A case report is described in which there was initial difficulty in confirming the diagnosis. New treatment approaches that might well prove beneficial to this particular syndrome are discussed.

Management of coarctation of the aorta during pregnancy

In this report, we shall describe the instantaneous electronic monitoring of the fetal heart rate at 24 weeks' gestation. The mother was undergoing resection of coarctation of the aorta. Because the fetal heart rate reflects by physiological and pharmacologic events, monitoring this rate enabled the anesthesiologists and surgeons to make therapeutic intervention sooner and on a more rational basis.

The removal and metabolism of prostaglandin E-1 by rabbit lung

In isolated rabbit lung preparations perfused with tritiated PGE-1, it was found that, (1) PGE-1, is rapidly and almost completely metabolized during perfusion through rabbit lung. (2) During perfusion, there is no net uptake of PGE-1. (3) The process of metabolism of PGE-1 in the rabbit lung is inhibited by hypothermia.

Serum Glutamic Oxalacetic Transaminase Content in Hypothermia

When the body temperature of pentobarbitalized dogs was lowered, by surface-immersion technique, to 27 degrees -26 degrees C, elevations in serum glutamic oxalacetic transaminase were found only after a period of prolonged hypothermia (12 hours). When the animals were rewarmed, serum levels returned to normal. Histologic study of organs rich in glutamic oxalacetic transaminase revealed no necrosis. The cause for the elevations is not known, although increased membrane permeability secondary to prolonged cold may be a factor.