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ADHD is a prevalent and highly heritable mental disorder associated with significant impairment, morbidity and increased rates of mortality. This combination of high prevalence and high morbidity/mortality seen in ADHD and other mental disorders presents a challenge to natural selection-based models of human evolution. Several hypotheses have been proposed in an attempt to resolve this apparent paradox. The aim of this study was to review the evidence for these hypotheses.
We conducted a systematic review of the literature on empirical investigations of natural selection-based evolutionary accounts for ADHD in adherence with the PRISMA guideline. The PubMed, Embase, and PsycINFO databases were screened for relevant publications, by combining search terms covering evolution/selection with search terms covering ADHD.
The search identified 790 records. Of these, 15 full-text articles were assessed for eligibility, and three were included in the review. Two of these reported on the evolution of the seven-repeat allele of the ADHD-associated dopamine receptor D4 gene, and one reported on the results of a simulation study of the effect of suggested ADHD-traits on group survival. The authors of the three studies interpreted their findings as favouring the notion that ADHD-traits may have been associated with increased fitness during human evolution. However, we argue that none of the three studies really tap into the core symptoms of ADHD, and that their conclusions therefore lack validity for the disorder.
This review indicates that the natural selection-based accounts of ADHD have not been subjected to empirical test and therefore remain hypothetical.
The study investigated the effectiveness of an 8-week intensive residential treatment programme based on principles from intensive short-term dynamic psychotherapy for patients with known treatment-resistant anxiety- and/or depressive disorders (mainly with comorbid personality disorders).
Patients (N=95) with prior repeated treatment failure were included. Changes in self-reported target complaints, symptom severity, and overall interpersonal problems have been presented for these patients in two previous articles. We now expand upon the existing knowledge by presenting novel data from a number of important observer-based and self-reported outcome domains (diagnostic changes on Axis I and II, changes in overall personality dysfunction, disorder complexity, medication use, health care utilisation, and occupational activity).
There were pervasive and significant improvements on all measures during treatment, which were maintained or further improved during follow-up. Fourteen months after the end of treatment, 46.26% of patients had recovered in terms of Axis I pathology, 63.79% had recovered in terms of Axis II pathology, 71.18% had returned to work, and there was a 28.62% reduction in regular use of psychotropic medications. Health care utilisation was reduced by 65.55%, and there were large improvements in disorder complexity and levels of personality dysfunction.
The treatment programme was highly effective for patients with common and complex treatment-resistant mental disorders. Results are encouraging for the relatively large number of patients who tend not to benefit from standard formats of treatment for debilitating psychological problems.
The present research explored the cortical correlates of rewarding mechanisms and cortical ‘unbalance’ effect in internet addiction (IA) vulnerability.
Internet Addiction Inventory (IAT) and personality trait (Behavioural Inhibition System, BIS; Behavioural Activation System, BAS) were applied to 28 subjects. Electroencephalographic (EEG, alpha frequency band) and response times (RTs) were registered during a Go-NoGo task execution in response to different online stimuli: gambling videos, videogames or neutral stimuli. Higher-IAT (more than 50 score, with moderate or severe internet addiction) and lower-IAT (<50 score, with no internet addiction).
Alpha band and RTs were affected by IAT, with significant bias (reduced RTs) for high-IAT in response to gambling videos and videogames; and by BAS, BAS-Reward subscale (BAS-R), since not only higher-IAT, but also BAS and BAS-R values determined an increasing of left prefrontal cortex (PFC) activity (alpha reduction) in response to videogames and gambling stimuli for both Go and NoGo conditions, in addition to decreased RTs for these stimuli categories.
The increased PFC responsiveness and the lateralisation (left PFC hemisphere) effect in NoGo condition was explained on the basis of a ‘rewarding bias’ towards more rewarding cues and a deficit in inhibitory control in higher-IAT and higher-BAS subjects. In contrast lower-IAT and lower-BAS predicted a decreased PFC response and increased RTs for NoGo (inhibitory mechanism). These results may support the significance of personality (BAS) and IAT measures for explaining future internet addiction behaviour based on this observed ‘vulnerability’.
To examine the unique neuropsychological presentation in adults with high functioning autism spectrum disorders (HF-ASD) by comparison with adults with attention deficit hyperactivity disorder (ADHD).
Adults with ASD referred to a specialty clinic (n=26) were compared to two non-ASD groups with (n=52) and without (n=52) ADHD of similar age and sex.
No differences in IQ were found. Subjects with HF-ASD were significantly more impaired than both comparison groups in processing speed, cognitive flexibility and sight words. Subjects with HF-ASD were more impaired than controls in working memory, but not the ADHD group.
These findings suggest that there may be specific neuropsychological correlates of HF-ASD differing from ADHD that could have significant implications for identifying individuals at risk for ASD.
The escalating tendency of elderly population aged 65 and over, which grown up to 9% since 2001 in Taiwan, remarks the important issue of mental health among ageing population. Depression in the elderly is frequently undetected or inadequately treated. This study aimed to investigate the pharmacotherapy of elderly patients with depression by comparing the patterns of prescribing psychotropic drugs (psychotropics) of psychiatrists and non-psychiatrists.
A random sampling of 5% of inpatients from the National Health Insurance (NHI) database in Taiwan from 2001 to 2003 was selected. In all, 1058 (0.9%) inpatients aged 65 and older with a diagnosis of any depressive disorder were included. The psychotropic prescribing pattern and the dosages used were analysed and compared. Physician specialties were based on the record of NHI database. Non-psychiatrists were defined by physicians other than psychiatry.
A total of 88% of elderly depressed inpatients had two or more comorbid physical illnesses. The most commonly prescribed psychotropics were: antidepressants (71.4%), anxiolytics (62.6%) and hypnotics (51.4%). Psychiatrists had a higher rate of prescribing psychotropics, except anxiolytics, than non-psychiatrists. Although selective serotonin reuptake inhibitors were commonly prescribed, non-psychiatrists preferred the use of tricyclic antidepressants and moclobemide. Trazodone was the most preferred antidepressant, but was generally used in low dosages.
Psychiatrists generally utilised higher dosages of newer antidepressants than non-psychiatrists. Differences in the prescribing pattern of psychotropics existed between physician specialties. Further investigations are warranted to determine how the selection and dosing of drugs influence the outcome of depression on the elderly.
We investigated how different levels of prenatal exposure to testosterone influence physiological reactions to dyadic interactions, hypothesising that higher levels of prenatal testosterone are linked to greater physiological responses.
Autonomic nervous system responses to dyadic interactions focussed on social or physical norms were measured. Physiological assessment of excitability (heart rate, facial temperature) and a behavioural assessment (Likert items judgements) were run on 25 neurotypical participants who had distinct testosterone exposure levels in utero. In utero exposure to testosterone was assessed measuring 2D : 4D (ratio between the lengths of the index and the ring fingers).
Higher testosterone exposure participants showed greater physiological arousal: a greater heart rate decrease, independent from scenario type (p<0.05), and opposite facial temperature changes in response to social (increase) (vs.) physical scenarios (decrease) were found (Left-cheek: p<0.05; Right-cheek: p<0.05).
These findings suggest a long-term influence of prenatal environment on adults’ physiological responses during social situations.