ADHD symptomatology in eating disorders : a secondary psychopathological measure of severity?

Background: Attention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits. Methods: 191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R. Results: The ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness. Conclusions: Bingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology

The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization

BACKGROUND: The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. The purpose of this paper is to evaluate its criterion and construct validity. METHODS: Data from 10 different primary care studies have been used. Criterion validity was assessed by comparing the 4DSQ scores with clinical diagnoses, the GPs' diagnosis of any psychosocial problem for Distress, standardised psychiatric diagnoses for Depression and Anxiety, and GPs' suspicion of somatization for Somatization. ROC analyses and logistic regression analyses were used to examine the associations. Construct validity was evaluated by investigating the inter-correlations between the scales, the factorial structure, the associations with other symptom questionnaires, and the associations with stress, personality and social functioning. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA). The associations with other questionnaires were assessed with Pearson correlations and regression analyses. RESULTS: Regarding criterion validity, the Distress scale was associated with any psychosocial diagnosis (area under the ROC curve [AUC] 0.79), the Depression scale was associated with major depression (AUC = 0.83), the Anxiety scale was associated with anxiety disorder (AUC = 0.66), and the Somatization scale was associated with the GPs' suspicion of somatization (AUC = 0.65). Regarding the construct validity, the 4DSQ scales appeared to have considerable inter-correlations (r = 0.35-0.71). However, 30–40% of the variance of each scale was unique for that scale. CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92. The 4DSQ scales correlated with most other questionnaires measuring corresponding constructs. However, the 4DSQ Distress scale appeared to correlate with some other depression scales more than the 4DSQ Depression scale. Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave. CONCLUSION: The 4DSQ seems to be a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients. The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems

Microstructural Abnormalities in Subcortical Reward Circuitry of Subjects with Major Depressive Disorder

Previous studies of major depressive disorder (MDD) have focused on abnormalities in the prefrontal cortex and medial temporal regions. There has been little investigation in MDD of midbrain and subcortical regions central to reward/aversion function, such as the ventral tegmental area/substantia nigra (VTA/SN), and medial forebrain bundle (MFB).We investigated the microstructural integrity of this circuitry using diffusion tensor imaging (DTI) in 22 MDD subjects and compared them with 22 matched healthy control subjects. Fractional anisotropy (FA) values were increased in the right VT and reduced in dorsolateral prefrontal white matter in MDD subjects. Follow-up analysis suggested two distinct subgroups of MDD patients, which exhibited non-overlapping abnormalities in reward/aversion circuitry. The MDD subgroup with abnormal FA values in VT exhibited significantly greater trait anxiety than the subgroup with normal FA values in VT, but the subgroups did not differ in levels of anhedonia, sadness, or overall depression severity.These findings suggest that MDD may be associated with abnormal microstructure in brain reward/aversion regions, and that there may be at least two subtypes of microstructural abnormalities which each impact core symptoms of depression

Comparison of health-related quality of life among men with different co-existing severe mental disorders in treatment for substance use

Abstract Background Patient-perceived health-related quality of life has become an important outcome in health care as an indicator of treatment effectiveness and recovery for patients with substance use disorder. As no study has assessed health-related quality of life among male patients with substance use disorder and co-existing severe mental illness, we compared health-related quality of life among patients with substance use disorder and the following severe mental illness diagnosis in Barcelona, Spain: schizophrenia, bipolar disorder, major depressive disorder, and examined the associations with clinically related variables. Additionally, we compared results for health-related quality of life in patients with substance use disorder and severe mental illness, with Spanish population norms. Methods We assessed 107 substance use disorder male patients using the 36-Item Short Form Health Survey comparing results across three groups with: comorbid schizophrenia (n = 37), comorbid bipolar disorder (n = 34), and comorbid major depressive disorder (n = 36). Multiple analyses of variance were performed to explore health-related quality of life by the type of co-existing SMI and linear regression analyses examined clinical correlates for the 36-Item Short Form Health Survey dimensions for each group. Results There were differences in Physical Functioning, Vitality and the Physical Composite Scale among groups. Poorer Physical Functioning was observed for patients with comorbid schizophrenia (80.13±3.27) and major depressive disorder (81.97±3.11) compared with comorbid bipolar disorder patients (94.26±1.93). Patients with substance use disorder and schizophrenia presented lower scores in Vitality (41.6±2.80) than those with co-existing bipolar disorder (55.68±3.66) and major depressive disorder (53.63±2.92). Finally, results in the Physical Composite Scale showed lower scores for patients with comorbid schizophrenia (51.06±1.41) and major depressive disorder (51.99±1.87) than for those with bipolar disorder (60.40±2.17). Moreover, all groups had poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms. Different clinical variables (e.g. medical disease comorbidity, severity of addiction, psychiatric symptomatology, suicide attempts, drug relapses) were related to different health-related quality of life dimensions depending on the co-existing severe mental illness. Conclusions Among male patients with substance use disorder, co-existing severe mental illness may influence some health-related quality of life dimensions and clinically related variables. Such differences may require tailored therapeutic interventions

Equality and territorial (in-)justice? Exploring the impact of devolution on social welfare for older people in the UK

This paper examines the impact of devolution on social welfare for older people and the associated administration of age equality. Analysis of policy discourse, rights and stakeholders’ views reveals divergent practice in the constituent nations of the UK. In normative terms this is shown to present a tension between universal welfare rights and entitlements – and regional differentiation. It is argued that this presents a dilemma in terms of territorial justice. Whilst, in distributive-welfare terms, variations between polities might be seen as unjust, they are founded on the autonomy of national minorities to determine local priorities and are shown to have fostered progressive practices that go beyond the prescriptions of the central state