Aviv Segev

Association Between Continuous Performance and Response Inhibition Tests in Adults With ADHD

Objective: The study of ADHD uses various computerized tests to assess cognitive functions. Uncertainty exists regarding the association between deficits found by different tools testing similar or different cognitive functions (e.g., continuous performance tests [CPT] and response inhibition [RI] tests).We hypothesized that different tools that measure continuous performance will be better correlated between themselves than with a tool that examines RI. Method: Thirty-six adults with ADHD performed two different CPTs and a RI task. We analyzed correlations between different measures examined by the tasks. Results: There were strong correlations between corresponding measures in the CPTs. Correlations between the results in CPT and the RI task were only minimal. Conclusion: These findings support the specificity of impairments in different cognitive domains (continuous attention vs. RI) beyond the specific test used in the study of ADHD. Also, these findings strengthen the importance of specific discriminative cognitive domains in ADHD.

Novelty-seeking trait predicts the effect of methylphenidate on creativity.

In recent years the use of psychostimulants for cognitive enhancement in healthy individuals with no psychiatric disorders has been on the rise. However, it is still unclear whether psychostimulants improve certain cognitive functions at the cost of others, and how these psychostimulants interact with individual personality differences. In the current study, we investigated whether the effect of one common stimulant, methylphenidate (MPH), on creativity is associated with novelty seeking. Thirty-six healthy adults, without attention-deficit hyperactivity disorder (ADHD) symptomology, were assigned randomly in a double-blind fashion to receive MPH or placebo. We found that the effect of MPH on creativity was dependent on novelty-seeking (NS) personality characteristics of the participants. MPH increased creativity in individuals with lower NS, while it reduced creativity levels in individuals with high NS. These findings highlight the role of the dopaminergic system in creativity, and indicate that among healthy individuals NS can be seen as a predictor of the effect of MPH on creativity.

Methylphenidate Reduces State Anxiety During a Continuous Performance Test That Distinguishes Adult ADHD Patients From Controls.

Objective: We hypothesized that patients with ADHD were typified by distress more than by functional difficulties. Thus, a decline in state anxiety while performing a cognitive task when taking methylphenidate would discriminate between ADHD patients and controls. Method: State anxiety and cognitive performance on a continuous performance test were assessed in ADHD patients and controls with and without taking methylphenidate. Results: State anxiety and cognitive performance improved from baseline in 36 ADHD adults after taking methylphenidate. In 25 controls, cognitive performance improved, but state anxiety did not abate after a recess. In two additional studies, 5 controls were evaluated at baseline and after receiving methylphenidate, and showed improvement in cognitive assessment but not in state anxiety. Five ADHD adults were assessed at baseline and after a recess, and showed no improvement. Conclusion: Our results support the hypothesis that adult ADHD patients are characterized by distress and the relief of this distress under effective therapy as expressed by a decline in state anxiety while they perform a cognitive task.

A possible effect of methylphenidate on state anxiety: A single dose, placebo controlled, crossover study in a control group

Methylphenidate affects state-anxiety in ADHD patients. The current study examines the effect of Methylphenidate on state-anxiety in healthy subjects. In a cross-over, randomized, controlled, double-blind study, 36 healthy subjects received either Methylphenidate or placebo. As a group, no change in state-anxiety was detected with Methylphenidate. However, participants reporting higher anxiety levels experienced a significant and specific state-anxiety reduction following Methylphenidate. Moreover, a strong negative correlation was found between the initial-level of anxiety and net-change in state-anxiety. These changes were unrelated to self-perceived attention levels. Our results point to the state-dependent effects of Methylphenidate on anxiety.

Evaluating Computer Screen Time and Its Possible Link to Psychopathology in the Context of Age: A Cross-Sectional Study of Parents and Children

Background Several studies have suggested that high levels of computer use are linked to psychopathology. However, there is ambiguity about what should be considered normal or over-use of computers. Furthermore, the nature of the link between computer usage and psychopathology is controversial. The current study utilized the context of age to address these questions. Our hypothesis was that the context of age will be paramount for differentiating normal from excessive use, and that this context will allow a better understanding of the link to psychopathology. Methods In a cross-sectional study, 185 parents and children aged 3–18 years were recruited in clinical and community settings. They were asked to fill out questionnaires regarding demographics, functional and academic variables, computer use as well as psychiatric screening questionnaires. Using a regression model, we identified 3 groups of normal-use, over-use and under-use and examined known factors as putative differentiators between the over-users and the other groups. Results After modeling computer screen time according to age, factors linked to over-use were: decreased socialization (OR 3.24, Confidence interval [CI] 1.23–8.55, p = 0.018), difficulty to disengage from the computer (OR 1.56, CI 1.07–2.28, p = 0.022) and age, though borderline-significant (OR 1.1 each year, CI 0.99–1.22, p = 0.058). While psychopathology was not linked to over-use, post-hoc analysis revealed that the link between increased computer screen time and psychopathology was age-dependent and solidified as age progressed (p = 0.007). Unlike computer usage, the use of small-screens and smartphones was not associated with psychopathology. Conclusions The results suggest that computer screen time follows an age-based course. We conclude that differentiating normal from over-use as well as defining over-use as a possible marker for psychiatric difficulties must be performed within the context of age. If verified by additional studies, future research should integrate those views in order to better understand the intricacies of computer over-use.

A Pilot Study of Possible Easy-to-Use Electrophysiological Index for Early Detection of Antidepressive Treatment Non-Response

Introduction The evaluation of response to pharmacological treatment in MDD requires 4–8 weeks. Therefore, the ability to predict response, and especially lack of response to treatment, as early as possible after treatment onset or change, is of prime significance. Many studies have demonstrated significant results regarding the ability to use EEG and ERP markers, including attention-associated markers such as P300, for early prediction of response to treatment. But these markers are derived from long EEG/ERP samples, often from multiple channels, which render them impractical for frequent sampling. Methods and results We developed a new electrophysiological attention-associated marker from a single channel (two electrodes), using 1-min samples with auditory oddball stimuli. This work presents an initial evaluation of the ability to use this marker’s dynamics between repetitive measures for early (<2 weeks) differentiation between responders and non-responders to antidepressive treatment, in 26 patients with various levels of depression and heterogeneous treatment interventions. The slope of change in the marker between early consecutive samples was negative in the non-responders, but not in the responders. This differentiation was stronger for patients suffering from severe depression (p < 0.001). Conclusion This pilot study supports the feasibility of the EEG marker for early recognition of treatment-resistant depression. If verified in large-scale prospective studies, it can contribute to research and clinical work.

A bit of shame and a proud sham.

[9] Praharaj SK, Ram D, Arora M. Efficacy of high frequency (rapid) suprathreshold repetitive transcranialmagnetic stimulation of right prefrontal cortex in bipolar mania: a randomized sham controlled study. J Affect Disord 2009;117:146e50. [10] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. revised 4th ed. Washington, DC: American Psychiatric Association; 2000. [11] Honigfeld G, Klett CJ. The nurses’ observation scale for inpatient evaluation: a new scale for measuring improvement in chronic schizophrenia. J Clin Psychol 1965;21:65e71. [12] Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429e35. [13] NitscheMA, Cohen LG,Wassermann EM, Priori A, LangN, Antal A, et al. Transcranial direct current stimulation: state of the art 2008. Brain Stimul 2008;1:206e23. [14] Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993;328:839e46. [15] Mick TM, Hollander E. Impulsive-compulsive sexual behavior. CNS Spectr 2006;11:944e55. [16] Devinsky O, Vazquez B. Behavioral changes associated with epilepsy. Neurol Clin 1993;11:127e49. [17] Gondim FA, Thomas FP. Episodic hyperlibidinism in multiple sclerosis. Mult Scler 2001;7:67e70. [18] Alkhalil C, Tanvir F, Alkhalil B, Lowenthal DT. Treatment of sexual disinhibition in dementia: case reports and review of the literature. Am J Ther 2004;11:231e5.

Listening to the Patient Perspective: Psychiatric Inpatients’ Attitudes Towards Physical Restraint

When other options fail, physical restraint is used in inpatient psychiatric units as a means to control violent behavior of agitated inpatients and to prevent them from harm. The professional and social discourse regarding the use of restrictive measures and the absence of the inpatients’ attitudes towards these measures is notable. Our research therefore tries to fill this gap by interviewing inpatients about these issues. To assess the subjective experience and attitudes of inpatients who have undergone physical restraint. Forty inpatients diagnosed with psychiatric disorders were interviewed by way of a structured questionnaire. Descriptive statistics were conducted via use of SPSS statistical software. 1.Inpatients reported that physical restraint evoked an experience of loneliness (77.5%) and loss of autonomy (82.5%). 2.Staff visits during times of physical restraint were reported as beneficial according to 73.6% of the inpatients interviewed. 3.Two thirds of the inpatients viewed the use of physical restraints as justified when an inpatient was dangerous. 4.Two thirds of the inpatients regarded physical restraint as the most aversive experience of their hospitalization. Our pilot study explored the subjective experience and attitudes of psychiatric inpatients towards the use of physical restraint. Inpatients viewed physical restraint as a practice that was sometimes justified but at the same time evoked negative subjective feelings. We conclude that listening to inpatients’ perspectives can help caregivers to evaluate these measures.

Author Correction: Listening to the Patient Perspective: Psychiatric Inpatients’ Attitudes Towards Physical Restraint

The original version of this article unfortunately contained a mistake in the author group section. The correct name of the second author is “Saed Maree” and the third author is “Aviv Segev.”