Kiriakos Xenitidis

Caregiver Burden as People With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder Transition into Adolescence and Adulthood in the United Kingdom

OBJECTIVE There is increasing recognition that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are associated with significant costs and burdens. However, research on their impact has focused mostly on the caregivers of young children; few studies have examined caregiver burden as children transition into adolescence and young adulthood, and no one has compared the impact of ASD to other neurodevelopmental disorders (e.g., ADHD). METHOD We conducted an observational study of 192 families caring for a young person (aged 14 to 24 years) with a childhood diagnosis of ASD or ADHD (n = 101 and n = 91, respectively) in the United Kingdom. A modified stress-appraisal model was used to investigate the correlates of caregiver burden as a function of family background (parental education), primary stressors (symptoms), primary appraisal (need), and resources (use of services). RESULTS Both disorders were associated with a high level of caregiver burden, but it was significantly greater in ASD. In both groups, caregiver burden was mainly explained by the affected young persons unmet need. Domains of unmet need most associated with caregiver burden in both groups included depression/anxiety and inappropriate behavior. Specific to ASD were significant associations between burden and unmet needs in domains such as social relationships and major mental health problems. CONCLUSIONS Adolescence and young adulthood are associated with high levels of caregiver burden in both disorders; in ASD, the level is comparable to that reported by persons caring for individuals with a brain injury. Interventions are required to reduce caregiver burden in this population.

Executive functioning differences between adults with attention deficit hyperactivity disorder and autistic spectrum disorder in initiation, planning and strategy formation

Executive functioning deficits characterize the neuropsychological profiles of the childhood neurodevelopmental disorders of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). This study sought to determine whether similar impairments exist in adults with ADHD (N = 53) and ASD (N = 45) in comparison with a healthy control group (N = 31), whether the two disorders can be distinguished on the basis of their executive functioning features, and whether these impairments are related to symptom severity. Both clinical groups were found to exhibit executive functioning deficits. The ADHD group had difficulty withholding a response, with relative preservation of initiation and planning abilities. In contrast, the ASD group exhibited significant impairments in initiation, planning and strategy formation. The specific executive functioning deficits were related to severity of response inhibition impairments in ADHD and stereotyped, repetitive behaviours in ASD. These findings suggest the pattern of executive functioning deficits follows a consistent trajectory into adulthood.

Adults with attention deficit hyperactivity disorder: an investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity.

BACKGROUND The outcomes of attention deficit hyperactivity disorder (ADHD) have been studied extensively in the first decades of life, but less is known about ADHD in adulthood. Hence we investigated cross-sectional age-related differences in behavioural symptoms, neuropsychological function and severity of co-morbid disorders within a clinically referred adult ADHD population. METHOD We subdivided 439 referrals of individuals with ADHD (aged 16-50 years) into four groups based on decade of life and matched for childhood ADHD severity. We compared the groups on measures of self- and informant-rated current behavioural ADHD symptoms, neuropsychological performance, and self-rated co-morbid mood and anxiety symptoms. RESULTS There was a significant age-related reduction in the severity of all ADHD symptoms based on informant-ratings. In contrast, according to self-ratings, inattentive symptoms increased with age. Neuropsychological function improved across age groups on measures of selective attention and response inhibition. There was a mild correlation between the severity of depression symptoms and increasing age. CONCLUSIONS This observational study suggests that, in adulthood, ADHD symptoms as measured using informant-ratings and neuropsychological measures continue to improve with increasing age. However the subjective experience of people with ADHD is that their symptoms worsen. This dichotomy may be partially explained by the presence of co-morbid affective symptoms. The main limitation of the study is that it is cross-sectional rather than longitudinal, and the latter design would provide more conclusive evidence regarding age-related changes in an adult ADHD population.

Glutamate/glutamine and neuronal integrity in adults with ADHD: a proton MRS study

There is increasing evidence that abnormalities in glutamate signalling may contribute to the pathophysiology of attention-deficit hyperactivity disorder (ADHD). Proton magnetic resonance spectroscopy ([1H]MRS) can be used to measure glutamate, and also its metabolite glutamine, in vivo. However, few studies have investigated glutamate in the brain of adults with ADHD naive to stimulant medication. Therefore, we used [1H]MRS to measure the combined signal of glutamate and glutamine (Glu+Gln; abbreviated as Glx) along with other neurometabolites such as creatine (Cr), N-acetylaspartate (NAA) and choline. Data were acquired from three brain regions, including two implicated in ADHD—the basal ganglia (caudate/striatum) and the dorsolateral prefrontal cortex (DLPFC)—and one ‘control’ region—the medial parietal cortex. We compared 40 adults with ADHD, of whom 24 were naive for ADHD medication, whereas 16 were currently on stimulants, against 20 age, sex and IQ-matched healthy controls. We found that compared with controls, adult ADHD participants had a significantly lower concentration of Glx, Cr and NAA in the basal ganglia and Cr in the DLPFC, after correction for multiple comparisons. There were no differences between stimulant-treated and treatment-naive ADHD participants. In people with untreated ADHD, lower basal ganglia Glx was significantly associated with more severe symptoms of inattention. There were no significant differences in the parietal ‘control’ region. We suggest that subcortical glutamate and glutamine have a modulatory role in ADHD adults; and that differences in glutamate–glutamine levels are not explained by use of stimulant medication.

Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units

BackgroundADHD is a common childhood onset mental health disorder that persists into adulthood in two-thirds of cases. One of the most prevalent and impairing comorbidities of ADHD in adults are substance use disorders. We estimate rates of ADHD in patients with substance abuse disorders and delineate impairment in the co-morbid group.MethodScreening for ADHD followed by a research diagnostic interview in people attending in-patient drug and alcohol detoxification units.ResultsWe estimated prevalence of undiagnosed ADHD within substance use disorder in-patients in South London around 12%. Those individuals with substance use disorders and ADHD had significantly higher self-rated impairments across several domains of daily life; and higher rates of substance abuse and alcohol consumption, suicide attempts, and depression recorded in their case records.ConclusionsThis study demonstrates the high rates of untreated ADHD within substance use disorder populations and the association of ADHD in such patients with greater levels of impairment. These are likely to be a source of additional impairment to patients and represent an increased burden on clinical services.

ADHD Symptom Presentation and Trajectory in Adults with Borderline and Mild Intellectual Disability.

BACKGROUND This study examined symptoms and lifetime course of Attention Deficit Hyperactivity Disorder (ADHD) in adults with borderline and mild Intellectual Disability (ID). METHOD A total of 48 adults with ID and ADHD were compared with 221 adults with ADHD without ID using the informant Barkley scale for childhood and adulthood symptoms. RESULTS The ADHD/ID group presented with greater severity of (adult and childhood) symptoms compared with the non-ID group. For the ADHD/non-ID group, most symptoms improved significantly from childhood to adulthood, whereas only two symptoms changed significantly for the ID group. Principal component analysis revealed scattered loading of different items into five components for the ADHD/ID group that were not consistent with the classic clusters of inattentive, hyperactive and impulsive symptoms. A negative correlation was found between severity of symptoms and IQ. CONCLUSIONS ADHD in adults with ID may have a more severe presentation and an uneven and less favourable pattern of improvement across the lifespan in comparison with adults without ID.

Interpersonal Support Evaluation List (ISEL)--college version: validation and application in a Greek sample.

Objectives: a) To validate the Interpersonal Support Evaluation List (ISEL) - college version in a Greek population sample and b) To test the hypothesis that students scoring high on the ISEL present stronger resistance to stressful experiences and fewer psychological or physical problems. Design: Rating scale assessment and analytical cross-sectional study. Method: The ISEL was translated into Greek and then back-translated into English. A random sample of 145 students of the Faculty of Medicine completed: a) the translated version of the ISEL, b) the Symptom Check List 90-R (SCL-90-R), c) the Scale of Stressful Life Events (SSLE) and d) a questionnaire about physical health problems. Comparisons were conducted between the scores on the ISEL and the scores on the other measures. Correlations were also calculated between the scores on the Global Severity Index (GSI) of the SCL-90-R and SSLE, separately for students with high, fair and low social support, in order to assess the protective role of social support. The test-retest reliability and the internal consistency of the ISEL were also investigated. Results: The students with a lower score in social support reported more psychological and somatic symptoms. The students with a higher score in social support were protected against the harmful effect of stressful events. The ISEL presents good internal consistency (Cronbach’s alpha: 0.452-0.752) and test-retest reliability (intraclass correlation coefficients (ICC): 0.631-0.847). Conclusions: The ISEL is a valid and reliable instrument for measuring social support among Greek students. A higher score on the ISEL is correlated with a significant stress-buffering effect.

Collective Trauma Transmission and Traumatic Reactions Among Descendants of Armenian Refugees

Background: It has been suggested, mainly by case reports, that the collective trauma generated by mass calamities may be transmitted to, and have long-lasting effects on, new generations. Aims: To investigate the psychological impact on contemporary Armenians of traumatic events suffered by Armenians during the period 1914—1918. Methods: A descriptive, cross-sectional study investigating demographic and cultural characteristics of a population of 689 people of Armenian origin, residents of Greece and Cyprus. Subjects were recruited during a range of Armenian cultural, athletic or charitable events. The participants completed a version of the Post-Traumatic Stress Disorder (PTSD) (Self-Rating) Scale and a questionnaire including ad hoc questions regarding their relationship to the Armenian community, their attitudes and their source of information about the 1914—1918 events. Results: Over a third (35.7%) of participants presented at least sub-clinical forms of such reactions during long periods of their lives. Women, older people, participants with a close relative lost during the events and those with strong connections to the Armenian community were more vulnerable. Conclusion: The results are indicative of a long-lasting (though gradually fading) cross-generational traumatizing effect of the discussed events. Clinicians having to deal with patients belonging to cultural or ethnic groups that suffered persecutions in the past should take into account the probable effects caused by a trauma-transmission mechanism.

Self-Reported Substance Misuse in Greek Male Prisoners

The aim of this survey was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. The Mini International Neuropsychiatric Interview (MINI) was used to assess psychiatric disorders including substance abuse and dependence. All prisoners who participated completed the Alcohol Use Disorders Identification Test (AUDIT). Those who reported daily use of opiates and stimulants completed the Severity of Dependence Scale (SDS). Information was obtained from medical notes about the prisoners’ hepatitis B and HIV status. The MINI identified 27.5% of the prisoners as dependent on opiates, 26.3% on alcohol and 73.8% as cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated, using SDS, as serious for all opiate and stimulant users. In terms of physical health examination of medical records indicated that no prisoner was HIV-positive but 26.5% were hepatitis-B-positive. Of those who had a previous history of substance misuse, 31.2% fulfilled the criteria for depression and 37.5% for antisocial personality disorder. Similarly, 15% of those misusing substances had a previous history of deliberate self-harm and 16% were assessed to have moderate to high suicide risk.

Group psychosocial interventions for adults with schizophrenia and bipolar illness: The evidence base in the light of publications between 1986 and 2006

Aim: The treatment of major mental disorders usually combines medical and psychosocial interventions. The present study reviews research pertaining to the efficacy of group psychosocial interventions for people with psychotic illness. Method: An electronic search was conducted through Medline and PsychINFO to identify articles relevant to group therapy for people with schizophrenia and bipolar affective disorder. Articles published in the English language, between January 1986 and May 2006, were considered. Studies were included if they had a control group and at least 20 participants. The search resulted in 23 articles concerning patients with schizophrenia and five concerning patients with bipolar affective disorder. Results and Conclusion: The therapeutic approach in the majority of the studies was along the lines of cognitive behaviour therapy and psychoeducation. All studies reported improvement in at least one parameter. Most of them report improvement in skills and overall functioning.