Long-term efficacy and safety outcomes with OROS-MPH in adults with ADHD

Methylphenidate (MPH) is widely prescribed for adults with attention deficit hyperactivity disorder (ADHD), but data on long-term treatment and maintenance of effect are lacking. Osmotic release oral system-methylphenidate (OROS–MPH) was evaluated in a 52-wk open-label study in subjects who had previously completed a short-term placebo-controlled trial and short-term open-label extension. Efficacy was assessed using the investigator- and subject-rated Conners’ Adult ADHD Rating Scales (CAARS:O-SV and CAARS:S-S), and the Clinical Global Impression – Severity (CGI-S), Sheehan Disability Scale (SDS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Subjects completing ≥52 wk of treatment were eligible for a 4-wk randomized, placebo-controlled withdrawal phase in which loss of treatment effect was assessed using CAARS:O-SV and CGI-S. In the open-label phase (n=156), mean CAARS:O-SV score decreased from baseline by 1.9±7.8 (p<0.01), and small, statistically significant improvements from baseline were observed for CAARS:S-S, CGI-S and SDS. In the double-blind phase (OROS-MPH, n=23; placebo, n=22), CAARS:O-SV increased from double-blind baseline in the OROS-MPH and placebo arms (4.0±7.6 vs. 6.5±7.8, not statistically significant). Long-term OROS-MPH treatment was well tolerated, and there was no evidence of withdrawal or rebound after discontinuation. In conclusion, the short-term benefits of OROS-MPH continue during long-term open-label treatment. Maintenance of efficacy in a placebo-controlled withdrawal design remains to be confirmed in larger patient populations

A Comparison of Cognitive-Behavioral Therapy and Pharmacotherapy vs. Pharmacotherapy Alone in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD)—A Randomized Controlled Trial

In the treatment of adult attention-deficit/hyperactivity disorder (ADHD) the importance of psychological interventions in combination with pharmacotherapy is widely accepted in contemporary clinical routine. The natural course of the disorder seems to justify additional psychological interventions because even in patients who are highly compliant to pharmacotherapy full remission is not always achieved. The aim of the present study was to analyze the contribution of psychotherapy to the treatment of adult ADHD patients. In a randomized controlled study, the efficacy of a combined treatment of psychotherapy with pharmacotherapy is compared to pharmacological intervention alone. After initiation and stabilization of treatment with methylphenidate (MPH) in all subjects randomization to the two different treatment conditions was done. Afterwards both groups underwent treatment for about 10–12 weeks, the experimental group receiving sessions of cognitive-behavioral therapy (CBT) whereas the control group only received medication and standard clinical management (SCM). ADHD symptoms differed statistically during time but not between the two different treatment conditions. This result was the same for the single ADHD symptoms—inattention, hyperactivity, impulsivity, and emotional symptoms—and also for impairment. Individual standardized ADHD specific CBT program was not able to outperform SCM

Elternschaft und Belastungserleben: Psychometrische Überprüfung des Parenting-Stress-Index (PSI) an einer deutschsprachigen Stichprobe

The Parenting Stress Index (PSI) consists of 120 items measuring the subjective burden--labelled as parenting stress--of adults in parenting children from the age of newborns up to 12 years. The PSI is a self report scale which was developed in the US in 1976. Since then the PSI has been widely used in family and parenting research and was validated in many different languages but not yet in German. Therefore we administered the PSI to a sample of 372 German speaking parents with children from newborns up to 12 years of age in Basel, Switzerland. The questionnaire was handed out to parents in schools, kindergartens and day care centers along with one other complementary questionnaire such as the Beck Depression Inventory (BDI) or the Dyadic Adjustment Scale (DAS) measuring similar or divergent constructs. Internal consistency was high with a Cronbach's alpha Coefficient of 0.95 for total stress and 0.91 and 0.92 for the subscores of the child domain and parent domain respectively. The selectivity of most items ranged from sufficient to good. In order to assess the structure of the PSI factor analysis was performed. The principle component analysis revealed a two-factor solution accounting for 58 % of variance. The factorial structure of the original scale was therefore replicated. However, a three-factor solution seemed to describe data better. Correlations with other self report scales resulted as predicted. In summary the German translation of the PSI proved to assess reliably the construct of parenting stress. This instrument will serve family researchers and clinicians in German speaking countries to detect families at risk

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.

Rumination is common in individuals diagnosed with obsessive–compulsive disorder (OCD). We sought to clarify the causal role of rumination in the immediate and intermediate maintenance of obsessive–compulsive symptoms and depressed mood. In total, 145 individuals diagnosed with OCD were asked to read aloud their most distressing obsessive thought (OT). OT activation was followed by a thought-monitoring phase in which frequency of the OT was assessed. Participants were randomly allocated to one of three experimental conditions: rumination about obsessive–compulsive symptoms, rumination about mood, or distraction. Ratings of distress, urge to neutralize, and depressed mood and frequency ratings of the OTs were taken before and after the experimental manipulation. Obsessive–compulsive symptom severity and affect were assessed 2, 4, and 24 hr after the laboratory experiment using ecological momentary assessment. Compared to distraction, both types of rumination resulted in an immediate reduced decline of distress, urge to neutralize, depressed mood, and frequency of OTs, with medium to large effect sizes. Rumination about obsessive–compulsive symptoms did not have a stronger immediate effect than rumination about mood. Rumination about obsessive–compulsive symptoms increased obsessive–compulsive symptom severity and reduced positive affect compared to rumination about mood 24 hr later. Regarding negative affect, there was no difference in effect between the two types of rumination in the intermediate term. To conclude, rumination in OCD has an immediate and intermediate maintaining effect on obsessive–compulsive symptoms and mood and may require additional psychological interventions that supplement cognitive behavioral therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study

Rumination is common in individuals diagnosed with obsessive-compulsive disorder (OCD). We sought to clarify the causal role of rumination in the immediate and intermediate maintenance of obsessive-compulsive symptoms and depressed mood. In total, 145 individuals diagnosed with OCD were asked to read aloud their most distressing obsessive thought (OT). OT activation was followed by a thought-monitoring phase in which frequency of the OT was assessed. Participants were randomly allocated to one of three experimental conditions: rumination about obsessive-compulsive symptoms, rumination about mood, or distraction. Ratings of distress, urge to neutralize, and depressed mood and frequency ratings of the OTs were taken before and after the experimental manipulation. Obsessive-compulsive symptom severity and affect were assessed 2, 4, and 24 hr after the laboratory experiment using ecological momentary assessment. Compared to distraction, both types of rumination resulted in an immediate reduced decline of distress, urge to neutralize, depressed mood, and frequency of OTs, with medium to large effect sizes. Rumination about obsessive-compulsive symptoms did not have a stronger immediate effect than rumination about mood. Rumination about obsessive-compulsive symptoms increased obsessive-compulsive symptom severity and reduced positive affect compared to rumination about mood 24 hr later. Regarding negative affect, there was no difference in effect between the two types of rumination in the intermediate term. To conclude, rumination in OCD has an immediate and intermediate maintaining effect on obsessive-compulsive symptoms and mood and may require additional psychological interventions that supplement cognitive behavioral therapy