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Albumin is a protein which serves as a transporter for a variety of metabolites and as a storage for a lot of substances. Although albumin cannot pass the blood-brain-barrier and thus influence the CNS directly, a negative relation between cognitive impairment and serum albumin level has been observed in studies of normal and pathological aging.
The aim of the present study was to investigate the association between albumin and social cognition in ADHD.
20 adult patients with ADHD and 20 healthy controls participated in a double-blind within subjects crossover study. Participants completed the Moral-Judgment-Test, Tuebingen Affect Battery, the Movie for the Assessment of Social Cognition (MASC) and Cambridge Behaviour Scale (EQ). In addition, ADHD symptoms were assessed by the Wender Utah Rating Scale (WURS-K) and ADHD Self Rating Scale. Serum albumin levels were determined after blood withdrawal.
In the patient group serum albumin levels were negatively associated with ADHD pathology measured by WURS-K. In addition, a low level of albumin was related with poorer performance in theory of mind, moral judgment competence and affective prosody tasks.
The results suggest that albumin is related to social cognition in younger patients with ADHD. This is, to the knowledge of the authors, the first investigation, in which the association between albumin and cognition has been investigated in ADHD. Thus the findings of the present study need replication and the neural mechanisms have to be explored in future studies. Further studies are needed to exclude a possible medication effect.
Recent data support the view that the neurodegeneration underlying sporadic Alzheimer's Disease (AD) is in part related to brain insulin deficiency and brain insulin resistance. There is a higher incidence of AD in patients with diabetes mellitus type II (T2D) and both diseases show a decline in memory function. In a preceding trial intranasal insulin improved memory function in healthy volunteers so that an increase of central-nervous insulin concentration may improve cognitive function in both amnestic patient groups.
We want to analyse the effects of intranasal insulin on patients with early Alzheimers's disease (eAD) and patients with T2D in the state of amnestic mild cognitive impairment (aMCI).
Recruitment of 30 patients with eAD, 30 patients with T2D in aMCI state and 30 age-matched healthy controls. All patients undergo a run-in period of 2 weeks with 4 × daily administration of placebo. It follows a double blinded trial with daily intranasal administration of 4 × 40 I.U. insulin vs. placebo for 8 weeks and another 8 weeks of follow-up. At 4 defined time points memory function is assessed by word lists comprising 30 items of emotional, nutritional and neutral content which have to be memorized and are recalled after one week. To assess structural changes of the brain, a quantitative analysis for hippocampal N-acetyl-aspartate, choline and creatine is performed by 3 Tesla magnetic resonance spectroscopy.
Results: Since the study has not finished yet, we present experiences from the initiation and the beginning phase.
Attention deficit disorder (ADHD) is a psychiatric disorder, which is characterized by deficits of executive functions (EF) and impulsivity. Whereas a variety of studies on the involvement of the dopaminergic system in ADHD exists, the impact of the serotonergic system to EF in ADHD in adults is underinvestigated.
To ascertain the effects of rapid tryptophan depletion (RTD) and the resultant reduction of the central nervous levels of serotonin on the EF of male adult patients with ADHD.
20 ADHD patients and 20 healthy controls completed the RTD test on one day and a placebo on another day in a double-blind within subject crossover design.- In addition, the subtest alertness of the TAP and a modified Version of the Continuous performance test (AX-CPT) with three stimulus conditions (AX, AY, BX) were administered.
Statistical analysis revealed significant shorter reaction times, more errors and more omission errors in the ADHD group in the AX-CPT. The omissions error rate increased in both groups in the RTD condition but not in the placebo condition. Statistical analyses did not yield any significant differences between groups in the subtest alertness and no significant interaction of group and effect of the RTD condition could be observed.
In addition to higher impulsivity of patients with ADHD as reflected by shorter reaction times and higher error rates, the results of the present study imply an involvement of the serotonergic system as reflected by RTD in sustained and selective attention.
Adult patients with ADHD suffer from marriage problems and increased divorce rates significantly more often. There are, however, only a few studies which analyse romantic attachment to a partner or romantic relationships among patients with ADHD in view of attachment theory.
The aim of the present study is to research if ADHD patients show a diminished quality of romantic relationships in comparison to a matched sample of healthy controls. Furthermore, correlations between ADHD specific characteristics and particular variables of partnership perception and psychosomatic discomfort were analysed within the ADHD subgroup.
We recruited 39 patients with ADHD and compared them with a matched sample of healthy controls. Self-estimation measures were used to examine the quality of attachment, dimensions of attachment, love styles, psychosomatic discomfort and ADHD specific symptoms.
In comparison to the control sample, adult ADHD patients show a significantly reduced quality of relationships. ADHD patients rank themselves as more scared of attachment and showing more avoidance of interpersonal relationships in general as well as romantic relationships. They also feel less romantic love. ADHD specific characteristics correlate moderately with the attachment dimensions “Fear” and “Avoidance”, the love style “Mania” and psychosomatic discomfort.
This study lends further support to the assumption that adult patients with ADHD show an impaired quality of attachment, increased fear and avoidance of relationships as well as less romantic love. The results strongly underline the necessity to account for individual attachment styles in psychotherapy of ADHD.
Numerous results from investigations including children with ADHD show associations between a diminished serotonin synthesis and memory impairments as well as higher aggression scores. The aim of the present study was the investigation of the association between a diminished serotonin synthesis, logical memory and impulsive aggression in male adult patients with ADHD.
Twenty male adult patients with ADHD and twenty healthy controls were recruited for this double-blind within subjects crossover study. Subjects completed the Rapid Tryptophan Depletion (RTD) Test or a placebo condition (balanced amino acid load) on either one of two examination days. Clinical variables and general intellectual functioning were assessed. The neuropsychological test battery included the subtest logical memory from the Wechsler Memory Scale (WMS-R), self-assessment of aggression as well as the Point Subtraction Aggression Game (PSAG).
Statistical analysis revealed significant memory impairments of ADHD patients, which were associated with severity of symptoms in early childhood as well as subjective aggression scores. Effects of the tryptophan depletion were not found, neither for the logical memory subtest nor performance in the PSAG.
In contrast to previous studies, these findings suggest that the serotonergic system as reflected by the RTD Test has no effect on memory performance or impulsive aggression. However, these results may be due to possible interactions of other catecholamine systems with the serotonergic system that were not controlled in this study. Therefore an additional study is needed to further explore the catecholamine systems and their effects on memory and impulsive aggression.
Unemployment is associated with various psychosocial strain factors. Previous studies show correlations between unemployment and impaired mental health. Present examinations on this set of problems mainly focused on younger unemployed, while specific psychosocial strains of senior unemployed persons were scarcely presented.
Investigation on psychiatric services for senior long term unemployed persons
To examine the exigency and feasibility of specific mental health interventions for senior long term unemployed persons
Senior long term unemployed participants in a vocational reintegration program underwent psychiatric examination and counseling. Placement officers recommended participation by choice to their clients and diagnostic examinations including clinical interviews and questionnaires were performed. Clients then received either direct treatment by the project staff, e.g. focal short-term therapy, or were placed in appropriate treatments. Numbers of clients who consented and who refused participation, dropout rates, psychiatric diagnoses and treatment placements were recorded.
Attendance in the program was recommended to 161 clients to the date of this report. 136 clients consented with participation and 90 were included into examination. 21% discontinued participation in the course of examination. Of the unemployed persons surveyed, 96% received a psychiatric diagnosis and 80% multiple psychiatric diagnoses. 7% were placed to inpatient-treatment and 31% to ambulatory treatment.
Psychiatric services were highly requested and senior unemployed persons are specifically affected by mental disorders that presumably interfere with vocational reintegration. According to this, vocational reintegration programs should be flanked by psychiatric services to give consideration to the specific psychosocial strains of unemployed persons.
There are complex associations between work and mental health. Self-efficacy, experience of own abilities and appropriate challenges are important prerequisites of mental health. Availability of these factors is specifically decreased in the elder long term unemployed and results in higher vulnerability for mental impairment.
Investigation on mental health of elder long term unemployed persons
To examine incidence of mental disorders in elder long term unemployed persons
Senior long term unemployed participants in a vocational reintegration program were examined. Clients were allocated by choice to the study by their placement officers. An extensive psychiatric examination including structured clinical interviews (SKID) and clinical and personality questionnaires (BDI, STAI, MSWS, SCL 90-R, SF36, AUDIT, FTNA) was performed with each subject.
90 subjects were included into the study so far and 42 completed the psychiatric examination. The mean age was 54.7 years and gender ratio was balanced. 94% were diagnosed with a psychiatric disorder and 80% were diagnosed with more than one disorder according to ICD-10. In particular, 78.6% of the subjects had depression, 40.5% anxiety disorders, 35.7% combined personality disorders, 26.2% posttraumatic disorders, 21.4% addiction disorders, 16.7% single personality disorders and 7.1% psychotic disorders.
A large proportion of the long term unemployed persons examined is affected by mental disorders. Along with the high incidence of depressive, anxiety and addiction disorders there was a considerable number of personality and specifically trauma-related disorders. Accordingly, personality disorders may be a risk factor for unemployment in elder people too.
The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.
CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.
Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.
The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.
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