Are attention-deficit/hyperactivity disorder symptoms associated with negative health outcomes in individuals with psychotic experiences? Findings from a cross-sectional study in Japan

ObjectiveAlthough research has indicated that the prevalence of attention-deficit/hyperactivity disorder (ADHD) may be elevated in individuals with psychotic disorders, as yet, there has been comparatively little research on this association and its effects among adults at the subclinical level. To address this deficit, the current study examined the association between psychotic experiences (PE) and ADHD symptoms in Japanese individuals and whether the presence of ADHD symptoms increases the risk for negative health outcomes in people with PE.MethodData were analyzed from an online sample of 1,452 individuals (age 18–89; 51.5% female) collected in 2021. Information on PE was obtained with the PRIME Screen-Revised (PS-R), while the Adult ADHD Self-Report Scale (ASRS) Screener was used to measure ADHD symptoms. Information was also obtained on a number of health outcomes including anxiety and depressive symptoms and suicidal ideation. Logistic regression was used to assess associations.ResultsIn a fully adjusted analysis PE were associated with almost three times higher odds for ADHD symptoms (OR: 2.92, 95%CI: 1.19–7.17). In an analysis that was restricted to individuals with PE, ADHD symptoms were associated with significantly increased odds for depressive symptoms, lifetime suicidal ideation, perceived stress and severe sleep problems.ConclusionADHD symptoms are present in some individuals with PE and increase the odds for several detrimental health outcomes in this population. Identifying co-occurring PE and ADHD/ADHD symptoms may facilitate treatment options and help prevent negative health outcomes in individuals with these conditions

Estimation of Mental Effort in Learning Visual Search by Measuring Pupil Response

Perceptual learning refers to the improvement of perceptual sensitivity and performance with training. In this study, we examined whether learning is accompanied by a release from mental effort on the task, leading to automatization of the learned task. For this purpose, we had subjects conduct a visual search for a target, defined by a combination of orientation and spatial frequency, while we monitored their pupil size. It is well known that pupil size reflects the strength of mental effort invested in a task. We found that pupil size increased rapidly as the learning proceeded in the early phase of training and decreased at the later phase to a level half of its maximum value. This result does not support the simple automatization hypothesis. Instead, it suggests that the mental effort and behavioral performance reflect different aspects of perceptual learning. Further, mental effort would be continued to be invested to maintain good performance at a later stage of training

Electrode montage for transcranial direct current stimulation governs its effect on symptoms and functionality in schizophrenia

BackgroundsPatients with schizophrenia suffer from cognitive impairment that worsens real-world functional outcomes. We previously reported that multi-session transcranial direct current stimulation (tDCS) delivered to the left dorsolateral prefrontal cortex (DLPFC) improved daily living skills, while stimulation on the left superior temporal sulcus (STS) enhanced performance on a test of social cognition in these patients. To examine the region-dependent influence of tDCS on daily-living skills, neurocognition, and psychotic symptoms, this study compared effects of anodal stimulation targeting either of these two brain areas in patients with schizophrenia.MethodsData were collected from open-label, single-arm trials with anodal electrodes placed over the left DLPFC (N = 28) or STS (N = 15). Daily-living skills, neurocognition, and psychotic symptoms were measured with the UCSD performance-based skills assessment-brief (UPSA-B), Brief Assessment of Cognition in Schizophrenia (BACS), and Positive and Negative Syndrome Scale (PANSS), respectively. After baseline evaluation, tDCS (2 mA × 20 min) were delivered two times per day for 5 consecutive days. One month after the final stimulation, clinical assessments were repeated.ResultsPerformance on the UPSA-B was significantly improved in patients who received anodal tDCS at the left DLPFC (d = 0.70, p < 0.001), while this effect was absent in patients with anodal electrodes placed on the left STS (d = 0.02, p = 0.939). Significant improvement was also observed for scores on the BACS with anodal tDCS delivered to the DLPFC (d = 0.49, p < 0.001); however, such neurocognitive enhancement was absent when the STS was stimulated (d = 0.05, p = 0.646). Both methods of anodal stimulation showed a significant improvement of General Psychopathology scores on the PANSS (DLPFC, d = 0.50, p = 0.027; STS, d = 0.44, p = 0.001).ConclusionThese results indicate the importance of selecting brain regions as a target for tDCS according to clinical features of individual patients. Anodal stimulation of the left DLPFC may be advantageous in improving higher level functional outcomes in patients with schizophrenia.Trial registrationThese studies were registered within the University hospital Medical Information Network Clinical Trials Registry [(24), UMIN000015953], and the Japan Registry of Clinical Trials [(28), jRCTs032180026]

Normalized pupil diameter as a function of time.

<p>(A) Each function represents the averaged pupil diameter of 12 subjects during the conduction of the visual conjunction search task. The data in each trial was normalized relative to the pupil size during the cross fixation period immediately preceding the trial. Different functions denote the different training day: 1^st, 3^rd, 5^th, and 10^th day, respectively. (B) Each function represents the averaged pupil diameter of 12 subjects conducting the passive viewing task. In passive condition subjects observed the visual search display, but no task was imposed. The data in each trial was normalized relative to the pupil size during the cross fixation period immediately preceding the trial. Different functions denote the different experimental day: 1^st, 3^rd, 5^th, and 10^th day, respectively.</p

Attention-deficit/hyperactivity disorder symptoms, perceived stress, and suicidal ideation during the COVID-19 pandemic

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) symptoms have been linked to suicidal behavior. However, little is known about the mechanisms involved in this association. This study examined ADHD symptoms and suicidal ideation during the COVID-19 pandemic and the role of self-perceived stress in this association. METHOD: Data were analyzed from an online sample of 1,452 Japanese individuals aged 18 to 89 obtained in February 2021. Information was collected on past-year suicidal ideation. ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener while stress was measured with the Perceived Stress Scale (PSS-14). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9), while the Generalized Anxiety Disorder scale (GAD-7) was used to assess anxiety symptoms. Logistic regression was used to examine associations. RESULTS: Fifty-one (3.5%) individuals had ADHD symptoms, while more than one in ten (11.7%) of the respondents reported past-year suicidal ideation. In an analysis adjusted for sociodemographic factors, ADHD symptoms were associated with eight times higher odds for past-year suicidal ideation. However, adjusting the analysis for mental health variables (anxiety and depressive symptoms) attenuated the association which became non-significant (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 0.92-4.18). In contrast, in an analysis adjusted for mental health, individuals with ADHD symptoms and stress had significantly higher odds for suicidal ideation (OR: 3.72, 95%CI: 1.43-9.67) whereas, ADHD symptoms without stress were not linked to suicidal ideation (OR: 1.25, 95%CI: 0.38-4.18). CONCLUSIONS: Self-perceived stress is important in the association between ADHD symptoms and suicidal ideation among individuals in Japan during the COVID-19 pandemic. Detecting and managing stress and its effects in individuals with ADHD/ADHD symptoms should be a therapeutic focus for improving health-related outcomes in this population both during the COVID-19 pandemic and beyond

Normalized average pupil diameter as a function of the training day.

<p>Filled squares denote the averaged pupil diameter of 12 subjects conducting the visual conjunction search task. In the passive condition (blank triangles), subjects observed the same display but no task was imposed. The data was calculated from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0021973#pone-0021973-g003" target="_blank">Fig. 3</a>. Error bars represent ±1SEM.</p

Typical display for the visual search task.

<p>Sixteen Gabor patches appeared on the screen. Half of the trials contained a target, which was defined by the combination of orientation and spatial frequency. In this display, the target has a high spatial frequency and is oriented counter-clockwise. It is located at second-row and second-column. The position of the target and the distracters were randomized between trials.</p

Normalized pupil diameter 1 second after the onset of the visual search display.

<p>Filled squares denote the averaged pupil diameter of 12 subjects 1 second after the onset of the visual search display, as a function of the training day. The data was calculated from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0021973#pone-0021973-g003" target="_blank">Fig. 3(A)</a>. Error bars represent ±1SEM.</p

Learning curve of the conjunction search task.

<p>Reaction time in seconds as a function of training day is plotted. Filled red squares denote the data when the target is presented. Blank blue squares denote when the target is absent. The data from 12 subjects are averaged. Error bars represent ±1SEM.</p