Yuzuru Harada

Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder

Aim:  An increasing number of neuroimaging studies have been conducted to uncover the pathophysiology of attention‐deficit–hyperactivity disorder (ADHD). The findings are inconsistent, however, at least partially due to methodological differences. In the present study voxel‐based morphometry (VBM) was used to evaluate brain morphology in ADHD subjects after taking into account the confounding effect of oppositional defiant disorder (ODD) and conduct disorder (CD) comorbidity.

Psychosocial problems in attention-deficit hyperactivity disorder with oppositional defiant disorder

Abstract The purpose of this study is to clarify psychosocial characteristics of the comorbidity of attention‐deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in comparison with ADHD or ODD alone. Thirty‐one patients with ADHD comorbid with ODD were compared with 23 ADHD alone and 10 with ODD alone, in terms of various examination items including objective assessment scales. The comorbid group demonstrated higher Children Depression Inventory score and State‐Trait Anxiety Inventory for Children (state‐anxiety) score than the ADHD or the ODD group, possessing more problems in the relationship with teachers than the ADHD group, with friends more than the ADHD or the ODD group, and with their mothers more than the ADHD group and less than the ODD group. School refusal occurred more frequently in the comorbid group than the ADHD group and less than the ODD group. The comorbid group had more psychosocial problems than the ADHD group and the ODD group. These problems could be classified into three types: (i) those derived from ODD, problems in the relationship with teachers; (ii) those derived from ODD but reduced by the coexistence of ADHD, problems in the relationship with their mothers; and (iii) those resulting from the comorbidity of ADHD and ODD, problems in the relationship with friends and anxious and depressive tendency. The difficulties in the relationship with teachers and friends observed in the comorbid group may lead to school refusal.

The reliability and validity of the Oppositional Defiant Behavior Inventory.

The aim of this study was to develop an evaluation scale for use as a supplementary tool for the diagnosis of oppositional defiant disorder (ODD). The subjects were 98 Japanese children (91 males and 7 females), aged 6–15 years, diagnosed with attention deficit/hyperactivity disorder (ADHD) or ODD. Internal consistency, test-retest reliability, concurrent validity and divergent validity of the oppositional defiant behavior inventory (ODBI), an evaluation scale of oppositional defiant tendency, were examined. Cronbach’s α coefficient of the ODBI was 0.925. The correlation coefficient between the test and the retest was 0.820 (p < 0.0001). Both the ODBI scores (test and retest) were correlated with the number of items that matched the ODD diagnostic criteria of DSM-IV (r = 0.660, 0.659, p < 0.001), and with the ODD-scale of Disruptive Behavior Disorders Rating Scale (r = 0.725, 0.654, p < 0.001). Compared with the ADHD group or controls, the ADHD and ODD group showed a significantly higher ODBI score at p < 0.0001. The concurrent use of this scale with clinical examination is expected to increase the accuracy of the diagnosis of ODD.

Behavioral and developmental disorders among conduct disorder

The purpose of the present study was to clarify the percentage of children with conduct disorder (CD) who also have behavioral and developmental disorders. A survey of comorbidity observed in children with CD, was carried out on 33 subjects from a disciplinary facility for children. Female teachers as the mother were interviewed as regards the subjects’ condition using the semistructured interview, and male teachers as the father were interviewed for their psychosocial problems. The subjects underwent the Wechsler Intelligence Scale for Children (WISC)‐III and their conditions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM‐IV). Of the 33 children, 27 were diagnosed as having CD. Of the 27 CD children, 18 (67%) were diagnosed as having attention deficit hyperactivity disorder (ADHD), and 19 (70%) had oppositional defiant feature (ODF). Eight children (30%) were diagnosed as having mental retardation and in seven children (26%), the verbal IQ was significantly lower than the performance IQ. Two (7%) were diagnosed as having pervasive developmental disorders (PDD). Of 27 children diagnosed with CD, 23 (85%) had some behavioral and developmental disorders. The classification of these behavioral and developmental disorders into the following three types appeared to be clinically useful: type 1, ADHD and ODF; type 2, low intelligence, especially low verbal intelligence; and type 3, PDD. To understand and treat children with CD, the accurate diagnosis of these underlying behavioral and developmental disorders is indispensable.

Impact of behavioral/developmental disorders comorbid with conduct disorder

Aims:  The aim of the present study was to verify the comorbidity of conduct disorder (CD) and behavioral/developmental disorders in children and adolescents, and to examine the traits of CD comorbid with them.

Establishing the cut‐off point for the Oppositional Defiant Behavior Inventory

Abstract  The purpose of the present paper was to make a detailed examination of the cut‐off point for the Oppositional Defiant Behavior Inventory (ODBI). The subjects were 56 untreated boys (age 6–15 years), who were diagnosed to have oppositional defiant disorder and who presented between December 2001 and March 2008. Controls were 690 boys with no history of contacting hospitals and no developmental or behavioral disorders at two elementary schools and two junior high schools in a city and its suburbs. It was shown that the level of opposition in boys could be evaluated regardless of the age groups by the ODBI, because there was no significant difference in the ODBI score for the one‐way analysis of variance. Based on the sensitivity (88.2%), specificity (90.0%), positive predictive value (75.0%) and negative predictive value (95.7%), a score of 20 points was thus established as a suitable cut‐off point to distinguish the children who are eligible for ODD diagnosis from those who are not.

Pathology in Senile Patients with Abnormal Body Sensation

Background: Senile people tend to develop abnormal body sensations such as delusion of parasitosis. To discuss the pathology of senile abnormal body sensation, we studied patients with abnormal body sensation, cenesthopathy, and delusion of parasitosis and investigated their age and gender.

Negative Correlation between Serum Cytokine Levels and Cognitive Abilities in Children with Autism Spectrum Disorder

Evidence suggests that cytokines may be one of the major factors influencing cognitive development in those with autism spectrum disorder (ASD). To shed light on the neural and cognitive mechanisms of ASD, we investigated the association between peripheral cytokine levels and cognitive profiles in children with ASD. The serum levels of 10 cytokines (granulocyte macrophage colony-stimulating factor, interferon (IFN)-γ, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and tumor necrosis factor-α) were examined in 14 children with ASD using the Human Ultrasensitive Cytokine Magnetic 10-Plex Panel for the Luminex platform. The Wechsler Intelligence Scale for Children (WISC) was administered to each subject, and the relationships between WISC scores and serum levels of the cytokines were examined. The full-scale intelligence quotient (IQ) was significantly negatively correlated with the levels of IL-6 (Spearman’s rank, p < 0.0001, false discovery rate q < 0.01). The levels of IL-6 and IFN-γ showed significant negative correlations with the verbal comprehension index (p < 0.001, q < 0.01) and working memory index (p < 0.01, q < 0.05), respectively. No other cytokines were significantly correlated with full-scale IQ or with any of the subscale scores of the WISC. The present results suggest negative correlations of IL-6 and IFN-γ levels with cognitive development of children with ASD. Our preliminary findings add to the evidence that cytokines may play a role in the neural development in ASD.

High-dose paroxetine treatment for an adolescent with obsessive–compulsive disorder comorbid with Asperger's disorder

DESPITE THE FREQUENT comorbidity of obsessive– compulsive disorder (OCD) with pervasive developmental disorders (PDD), little evidence is available to guide treatment of such cases. We report a case of OCD comorbid with Asperger’s disorder, in which high-dose paroxetine treatment was effective in improving obsessive–compulsive behaviors. Written parental informed consent was obtained for publication of this report. A 15-year-old girl with severe contamination fears and contamination-related checking behaviors was admitted to hospital. She was diagnosed as having OCD according to DSMIV-TR. Several medication trials prior to hospitalization, including fluvoxamine 100 mg/day, risperidone 2 mg/day, haloperidol 6 mg/day, and paroxetine 20 mg/day, had been ineffective in reducing her symptoms. Upon admission the patient’s Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score was 40. A detailed review of her past history indicated socially inappropriate behaviors since early childhood, such as being uncooperative with other children in preschool. Her obsessive traits became prominent in her grade-school years, spending several hours on simple handwriting assignments to do it as neatly as possible. She was very specific about her dress, sometimes refusing to put anything on because she was unsatisfied with her clothing. Her impairment in social interaction without delay in language and her persistence since childhood led us to diagnose her as having Asperger’s disorder according to DSMIV-TR, in addition to previously diagnosed OCD. Although obsessive traits had been apparent since childhood, the onset of OCD, which was when contamination fears appeared, was at the age of 15. Paroxetine was started concurrently with behavioral therapy, and the dose was titrated to 60 mg/day. After 8 weeks her contamination fears began to lessen. During the course of treatment the patient experienced irritability and excess sweating, which diminished after the paroxetine dose was reduced to 40 mg/day in the third month. Her Y-BOCS score at 6 months after initiation of paroxetine was 14. Her obsessive tendencies remained even after her contamination fears almost completely disappeared. The important role of serotonin in OCD and PDD has been hypothesized from the efficacy of selective serotonin re-uptake inhibitors (SSRI). Results from a randomized, double-blind, placebo-controlled trial indicated that paroxetine is an effective treatment in pediatric OCD, and several other studies have suggested therapeutic benefit of SSRI in PDD. Studies investigating candidate genes related to serotonin regulation, however, such as serotonin transporter gene, have not found any associations in PDD or OCD. Whether obsessive–compulsive symptoms in OCD and PDD have overlapping etiologies remain unclear. Although concurrent behavioral therapy complicates the evaluation of pharmacotherapeutic effectiveness, it is inferred that paroxetine showed dose-dependent efficacy for OCD in a patient with Asperger’s disorder. Considering the evidence of efficacy in both disorders, pharmacotherapy with SSRI is recommended in such patients. There are no guidelines, however, for treatment of OCD symptoms in those diagnosed with PDD, and thus patients for whom the pharmacotherapy could be beneficial may not be receiving adequate treatment. We believe that clinical trials are warranted to clarify the benefits versus the risks of using SSRI in children and adolescents dually diagnosed with PDD and OCD. It is noteworthy that, in the present case, the contamination fears disappeared with paroxetine treatment while obsessive traits of PDD, which had been present since before the onset of OCD, remained. Further studies may clarify the difference between obsessive symptoms observed in PDD and OCD in regard to medication response, which may lead to the drawing of a distinction between the two disorders.