Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates

Trastorn per dèficit d'atenció i hiperactivitat; Comorbilitat; Trastorn d'insomniTrastorno por déficit de atención e hiperactividad; Comorbilidad; Trastorno de insomnioAttention deficit and hyperactivity disorder; Comorbidity; Insomnia disorderIntroduction: Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). However, the relationship between insomnia disorder and adult ADHD has been neglected in research. The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life. Material and Methods: Two hundred and fifty-two adult patients with ADHD (mean age 37.60 ± 13.22 years; ADHD presentations—combined: 56.7%, inattentive: 39.7%, hyperactive/impulsive: 3.6%) were evaluated with an exhaustive clinical and psychological evaluation protocol including semistructured interviews (for comorbidities and ADHD assessment) and symptom rating scales for ADHD. The diagnosis of ADHD and insomnia disorder was made according to DSM-5 criteria. Furthermore, the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale were administered. Results: Insomnia disorder was found in 44.4% of adult ADHD patients and was more common in combined presentation (64.3%) and in patients with more ADHD severity. Comorbidities (both medical and psychiatric), especially mood disorders (42%), anxiety disorder (26.8%), personality disorder (39.3%), and any substance use disorder (11.6%), were associated with a higher insomnia disorder prevalence. ADHD stimulant treatment was related to lower insomnia disorder compared to patients without medication, as well as ADHD stable treatment. Additionally, worse health-related quality of life was associated with insomnia disorder. Conclusion: Insomnia disorder is highly prevalent in adult ADHD and is related to higher ADHD severity and more psychiatric and medical comorbidities. Some stimulants and stable pharmacological ADHD treatment are associated with better outcomes of insomnia disorder.The research leading to these results has received funding from the Instituto de Salud Carlos III (PI18/01788) and supported by the EU's Horizon 2020 Programme (Grant No. 667302, CoCA and Grant No. 728018 Eat2beNICE)

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Tractament psicològic grupal per a adults amb trastorn per dèficit d'atenció i hiperactivitat. Desenvolupament d'un programa breu cognitiu-conductual

El Trastorn per Dèficit d'atenció i Hiperactivitat (TDAH) és un trastorn del neurodesenvolupament que s'inicia a la infància i que pot persistir i continuar durant la vida adulta. El TDAH afecta al voltant del 5% dels nens i adolescents i al voltant del 2,5% dels adults a tot el món. És una condició crònica que es caracteritza per una manca d'atenció i/o hiperactivitat i impulsivitat. Aquestes dificultats poden comportar experiències que acostumen a desencadenar pensaments desadaptatius i el desenvolupament d'estratègies d'afrontament compensatòries errònies com l'evitació, la confrontació i la conducta dirigida al reforç immediat. Aquestes variables psicològiques dificulten el maneig dels símptomes del TDAH i acaben generant conseqüències emocionals de culpa, ansietat, ràbia, tristesa i preocupació. La Teràpia Cognitiu-Conductual (TCC) aborda principalment aquestes variables psicològiques i ha demostrat ser, en adults, la intervenció més eficaç pel tractament psicològic del TDAH i dels símptomes comòrbids d'ansietat i depressió. Fins a la data actual, el model amb major recolzament empíric és el model de Safren que combina tècniques cognitiu - conductuals i de tipus motivacional. És un tractament basat en la pràctica d'habilitats per a l'afrontament dels símptomes i la integració d'aquestes estratègies a la vida quotidiana de la persona. Tots els mòduls contenen elements de l'entrevista motivacional i es basen en la pràctica, la repetició i la revisió de les habilitats apreses prèviament. La TCC ha demostrat ser eficaç en la reducció significativa dels símptomes del TDAH. L'efecte del tractament es manté durant el seguiment. El principal objectiu del present treball és dissenyar un programa de TCC breu de 6 sessions de durada per a tractar pacients adults amb TDAH que, tot i estar en tractament farmacològic estable, continuen presentant símptomes significatius de TDAH, així com, analitzar l'eficàcia i l'acceptació d'aquest nou programa de TCC breu aplicat en format grupal, a curt termini (al finalitzar el programa) i a llarg termini (seguiments als 3 i als 6 mesos), en comparació amb un programa estandarditzat de TCC de 12 sessions. Es tracta d'un estudi amb un disseny longitudinal aleatoritzat i controlat amb dos grups de comparació. Un total de 81 pacients s'han aleatoritzat als dos grups de tractament (1:1). El grup experimental realitza el programa de TCC breu de 6 sessions i el grup control realitza la TCC de 12 sessions. Els resultats obtinguts confirmen que tant el grup de TCC breu de 6 sessions com el grup de TCC de 12 sessions milloren de forma significativa la simptomatologia global de TDAH després del tractament, destacant unes mides de l'efecte gran. Aquesta millora també s'observa en la funcionalitat i en la simptomatologia comòrbida d'ansietat i depressió. Els canvis del post-tractament es mantenen als 3 i als 6 mesos de seguiment en les dues modalitats de tractament. Es pot concloure que el programa desenvolupat de TCC breu de 6 sessions és igual d'eficaç que el programa de TCC de 12 sessions a curt i a llarg termini.El Trastorno por Déficit de Atención y Hiperactividad (TDAH) es un trastorno del neurodesarrollo que se inicia en la infancia y que puede persistir y continuar durante la vida adulta. El TDAH afecta a alrededor del 5% de los niños y adolescentes y alrededor del 2,5% de los adultos en todo el mundo. Es una condición crónica que se caracteriza por una falta de atención y / o hiperactividad e impulsividad. Estas dificultades pueden conllevar experiencias que suelen desencadenar pensamientos desadaptativos y el desarrollo de estrategias de afrontamiento compensatorias erróneas como la evitación, la confrontación y la conducta dirigida al refuerzo inmediato. Estas variables psicológicas dificultan el manejo de los síntomas del TDAH y acaban generando consecuencias emocionales de culpa, ansiedad, rabia, tristeza y preocupación. La Terapia Cognitivo-Conductual (TCC) aborda principalmente estas variables psicológicas y ha demostrado ser la intervención más eficaz para el tratamiento psicológico del TDAH en adultos y de los síntomas comórbidos de ansiedad y depresión. Hasta la fecha actual, el modelo con mayor apoyo empírico es el modelo de Safren que combina técnicas cognitivo - conductuales y de tipo motivacional. Es un tratamiento basado en la práctica de habilidades para el afrontamiento de los síntomas y la integración de estas estrategias en la vida cotidiana de la persona. Todos los módulos contienen elementos de la entrevista motivacional y se basan en la práctica, la repetición y la revisión de las habilidades aprendidas previamente. La TCC ha demostrado ser eficaz en la reducción significativa de los síntomas del TDAH. El efecto del tratamiento se mantiene durante el seguimiento. El principal objetivo del presente trabajo es diseñar un programa de TCC breve de 6 sesiones de duración para tratar pacientes adultos con TDAH que, a pesar de estar en tratamiento farmacológico estable, continúan presentando síntomas significativos de TDAH, así como, analizar la eficacia y la aceptación de este nuevo programa de TCC breve aplicado en formato grupal, a corto plazo (al finalizar el programa) y a largo plazo (seguimiento a los 3 y a los 6 meses), en comparación con un programa estandarizado de TCC de 12 sesiones. Se trata de un estudio con un diseño longitudinal aleatorizado y controlado con dos grupos de comparación. Un total de 81 pacientes se han aleatorizado a los dos grupos de tratamiento (1: 1). El grupo experimental realiza el programa de TCC breve de 6 sesiones y el grupo control realiza la TCC de 12 sesiones. Los resultados obtenidos confirman que tanto el grupo de TCC breve de 6 sesiones como el grupo de TCC de 12 sesiones mejoran de forma significativa la sintomatología global del TDAH después del tratamiento, destacando un tamaño del efecto grande. Esta mejoría también se observa en la funcionalidad y en la sintomatología comórbida de ansiedad y depresión. Los cambios del post-tratamiento se mantienen a los 3 y a los 6 meses de seguimiento en las dos modalidades de tratamiento. Se puede concluir que el programa desarrollado de TCC breve de 6 sesiones es igual de eficaz que el programa de TCC de 12 sesiones a corto y a largo plazo.Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopment disorder that begins in childhood and can persist and continue into adulthood. ADHD affects about 5% of children and adolescents and about 2.5% of adults worldwide. It is a chronic condition characterized by a lack of attention and / or hyperactivity and impulsivity. These difficulties often cause maladaptive thoughts and the development of erroneous compensatory coping strategies such as avoidance, confrontation, and behavior aimed at obtaining immediate reinforcement. These psychological variables make the management of ADHD symptoms more difficult, also generating emotional consequences of guilt, anxiety, anger, sadness, and having worries. Cognitive-Behavioral Therapy (CBT) mainly deals with these psychological variables proving to be the most effective intervention for psychological treatment of adults with ADHD and for comorbid symptoms such as anxiety and depression. Nowadays, the Safren model, combining cognitive-behavioral and motivational techniques, is the one that has received the most empirical support. This treatment is based on the practice of skills for dealing with symptoms and its integration into daily life of patients. Each of the modules contains elements of the motivational interview focusing on practice, repetition and revision of previously learned skills. CBT has been shown to be effective reducing ADHD symptoms significantly and treatment effect is maintained throughout the follow-up. The main objective of the present work is to design a short 6-session CBT program to treat adult patients with ADHD who, even being on stable pharmacological treatment, still have significant ADHD symptoms. In addition, to analyze efficacy and acceptance of this new short CBT program in group format in two moments, at the end of the program (short term) and 3 and 6 months later (long term). This longitudinal randomized controlled study compares two groups. A total of 81 patients were randomized and assigned to one of them (1:1). One, the experimental group, received 6 CBT sessions and the control group received 12 CBT sessions (conventional treatment). The results confirmed that both, short 6-session and 12-session CBT groups significantly improved the overall symptoms of ADHD after treatment, highlighting some large effect sizes. This improvement is observed in functionality also in comorbid anxiety and depression. In conclusion, the 6-session CBT program is just as effective as the 12-session program in both, short and long term.Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatri

Eye vergence responses during an attention task in adults with ADHD and clinical controls

Objective: ADHD patients show poor oculomotor control and recent studies show that attention-related eye vergence is weak in ADHD children. We aimed to assess vergence as a potential diagnostic biomarker for ADHD in adults. Method: We assessed the modulation in the angle of vergence while performing an attention task (N = 144), comparing the results for adults previously diagnosed with ADHD (N = 108) with age-matched clinical controls (N = 36). Results: Significant differences in eye vergence response modulation between clinical controls and ADHD patients were documented. Diagnostic test accuracy was 79%. Conclusion: In combination with an attention task, eye vergence responses could be used as an objective marker to support the clinical diagnosis of adult ADHDPeer ReviewedPostprint (author's final draft

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

Revolution: Museo de las estrellas un paseo por la fama : Hollywood

Convocatoria proyectos de innovación de Extremadura 2020/2021Se describe un proyecto llevado a cabo entre 13 centros educativos extremeños que consistió en desarrollar cinco unidades de trabajo gamificadas, cinco historias detectivescas con misterios por resolver, donde se ponían a prueba las habilidades de lógica, la capacidad de observación, de concentración y de atención de los alumnos. Los objetivos principales de la propuesta fueron: promover la puesta en práctica de proyectos intercentros; impulsar pedagogías activas; desarrollar la competencia digital a través del uso de las pedagogías emergentes lo que ha permitido llevar a cabo una enseñanza presencial, híbrida y virtual y atender a la diversidadExtremaduraES