Psychiatric Comorbidity in the Subtypes of ADHD in Children and Adolescents with ADHD According to DSM-IV

Introduction: The prevalence rate of psychiatric comorbidity in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) was 60-80%. The objective of this study was to examine comorbid disorders associated with ADHD and the subtypes of ADHD in children and adolescents with the diagnosis of ADHD. Method: The study included 326 children and adolescents aged between 8-15 years who were diagnosed with ADHD for the first time as a result of an interview by psychiatry, in a child adolescent psychiatry clinic in Izmir. Sociodemographic form, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale and Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version were used to assess psychiatric comorbidity. Results: The comorbidities accompanied ADHD were disruptive behavior disorder (28.8%), depressive disorder (13.2%), obsessive-compulsive disorder (9.5%) and anxiety disorder (6.1%), in respectively. When the subtypes of ADHD were assessed according to psychiatric comorbidity, oppositional defiant disorder and conduct disorder were frequently seen with ADHD combined type, whereas anxiety disorder was seen more frequent in children diagnosed with ADHD inattentive type. Discussion: Especially the presents of comorbidities in cases with ADHD Combined type increases the severity of disease, causes to retard in responses to treatment and exacerbates prognosis. Therefore, it is very important to determine which psychiatric diagnosis accompany with ADHD

Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD

Objective Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. Methods The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. Results The mean age was 10.88 +/- 1.45 and 11 +/- 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. Conclusion These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task

Methylphenidate significantly improves neurocognitive impairments in children with ADHD

This study aimed to investigate the effects of methylphenidate (MPH) on scores on a neurocognitive test battery for individuals with various presentations of attention deficit/hyperactivity disorder (ADHD) and the effect of comorbidities on executive function. This study included 861 children and adolescents aged 7-17 years who were diagnosed with ADHD according to DSM-V criteria. The CNS Vital Signs Battery was utilized to compare the neuropsychological characteristics and MPH treatment responses of patients with predominantly inattentive (ADHD-I) and combined (ADHD-C) presentations of ADHD. Before MPH administration, a statistically significant difference was observed between groups only for complex attention. In addition, the overall prevalence rate of psychiatric comorbidities was 45.5%, and no statistically significant differences were found in the ADHD-I group pre-versus post-MPH administration. Prior to the administration of MPH, statistically significant differences were observed within the ADHD-C group between those with or without comorbidities. However, after MPH administration, these differences between the groups disappeared. The effects of MPH on improving scores on neuropsychological subtests were similar between the groups with different presentations of ADHD. Additionally, MPH treatment was effective despite the presence of comorbidities

Aripirazole and Cognitive Behavioral Therapy in Adolescents with Obsessive-Compulsive Disorder: Case Study

Obsessive compulsive disorder is an anxiety disorder characterized by presence of obsessions and compulsions. Obsessions are defined by recurrent and persistent thoughts, urges or images that experienced at some time during the disturbance, as intrusive and unwanted and that cause marked anxiety. Repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession or acording to rules that must be applied rigidly because of preventing or reducing anxiety. Several drug and pschosocial treatments have been suggested for OCD that including both cognitive and behavioral aspects. Cognitive behavioral therapy and seratonin reuptake inhibitors are first-line treatment for OCD. In this case we studied the association of cognitive behavioral therapy and aripiprazole treatment. While the reduction in OCD symptoms with aripiprazole, treatment resistance is disappeare providing significant improvements in functionality and motivation to treatment with CBT. [JCBPR 2016; 5(1.000): 44-49

A Case of Asperger Syndrome With Comorbidity of Posttraumatic Stress Disorder and Selective Mutism Significant Remission With the Combination of Aripiprazole and Eye Movement Desensitization and Reprocessing

WOS: 000391838500025PubMed ID: 2797746

Psychiatric Comorbidity and Demographic Characteristics of 1,000 Children and Adolescents With ADHD in Turkey

###EgeUn###Objective: The objective was to examine the frequency of comorbid disorders in children and adolescents with ADHD in Turkey and to evaluate the distribution of comorbidities according to the subtypes of ADHD and sociodemographic features. Method: The sample consisted of 1,000 children, 6 to 18 years of age, including 242 females and 758 males, from Ege University who were diagnosed with ADHD. Results: The overall prevalence rate of psychiatric comorbidity in the study was 56.3%. The most frequently observed comorbidity was oppositional defiant disorder with a rate of 37.4%. Conduct disorder, depressive disorder, obsessive-compulsive disorder, and anxiety disorder accompanied ADHD, respectively. The results revealed that 70.2% of the children with ADHD-Combine type had at least one psychiatric comorbidity. Oppositional defiant disorder, conduct disorder, depressive disorder, and obsessive-compulsive disorder accompanied ADHD-Combine type in 54.6%, 12.6%, 8.1%, and 8.8% of the participants, respectively. Conclusion: These findings provide valuable information about the comorbid disorders in children and adolescents with a very large clinical sample of ADHD children

Effect of Methylphenidate on Neurocognitive Test Battery An Evaluation According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Subtypes

WOS: 000338854700009PubMed ID: 24875071The aims of this study were to evaluate the neuropsychological characteristics of the restrictive (R) subtype according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the attention-deficit/hyperactivity disorder (ADHD) combined (CB) type and predominantly inattentive (PI) type subtypes and to evaluate whether methylphenidate (MPH) affects neurocognitive test battery scores according to these subtypes. This study included 360 children and adolescents (277 boys, 83 girls) between 7 and 15 years of age who had been diagnosed with ADHD and compared the neuropsychological characteristics and MPH treatment responses of patients with the R subtype-which has been suggested for inclusion among the ADHD subtypes in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-with those of patients with the PI and CB subtypes. They did not differ from the control subjects in the complex attention domain, which includes Continuous Performance Test, Stroop test, and Shifting Attention Test, which suggests that the R subtype displayed a lower level of deterioration in these domains compared with the PI and CB subtypes. The patients with the CB and PI subtypes did not differ from the control subjects in the Continuous Performance Test correct response domain, whereas those with the R subtype presented a poorer performance than the control subjects. The R subtype requires a more detailed evaluation because it presented similar results in the remaining neuropsychological evaluations and MPH responses

Successful Treatment Response with Aripiprazole Augmentation of SSRIs in Refractory Obsessive-Compulsive Disorder in Childhood

WOS: 000412534900002PubMed ID: 27812841The aim of this study is to evaluate the aripiprazole augmentation of selective seratonine reuptake inhibitors (SSRIs) in children and adolescents with treatment-resistant OCD. Forty-eight children and adolescents (14 girls, 34 boys), who are non-responders to treatment with at least two types of SSRIs and CBT, were administered a 12-week of augmentation. Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression-Severity and Improvement (CGI-S and CGI-I) sub-scales were used for evaluation of the treatment outcomes. The results showed that total CY-BOCS scores were decreased from 33.3 +/- 7.5 to 11.7 +/- 9.3 (p < 0.001), CGI-S scores decreased from 6.3 +/- 0.9 to 2.7 +/- 1.6 (p < 0.001), and CGI-I scores improved from 4.3 +/- 0.6 to 2.2 +/- 1.1 (p < 0.001). Sensitivity analyses in 29 patients without SSRI dose escalation along with aripiprazole augmentation have also revealed that improvement effect was still significant, and CY-BOCS scores were improved from 34.2 +/- 7.9 to 13 +/- 10.3, CGI-S improved from 6.4 +/- 1.0 to 3.0 +/- 1.7, and CGI-I improved from 4.4 +/- 1.0 to 2.3 +/- 1.1 (p < 0.001 for all). Analyses revealed that a significant clinical improvement has been observed with aripiprazole augmentation. Aripiprazole augmentation of SSRIs is a promising strategy in the management of treatment-refractory OCD children and adolescents