Psychiatric disorders and comorbidity in a Spanish sample of prisoners at the end of their sentence : Prevalence rates and associations with criminal history

This study examined, for the first time, the prevalence of mental disorders and comorbidities among inmates who were about to be released, and their association with criminal history. A Spanish sample of 140 prisoners at the end of their sentence was recruited from an occupational program. Psychiatric disorders were determined according to the Diagnostic and Statistical Manual of Mental Disorders criteria. Bivariate analyses followed by multivariate regression models were conducted to identify significant variables for repeat incarceration and violent offending. The lifetime prevalence of Axis I disorders was 81.4%, with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) being the most common diagnoses (51.4 and 31.4%, respectively). The current prevalence of Axis I disorders was 59.0%, including learning disorders (38.6%), ADHD (16.4%), and SUD (5.71%) among the most frequent syndromes. Thirty-six (26.5%) participants met criteria for a current Axis II disorder, which commonly was an antisocial personality disorder (12.5%). The majority of the sample (60.8%) suffered from two or more comorbid disorders during their lifetime, although the current prevalence fell to 23.3%. Childhood ADHD increased the number of imprisonments, while inmates convicted of a violent crime were more likely to present a learning disorder. Having a lifetime diagnosis of SUD or multiple psychiatric disorders appeared to be associated with both repeat incarceration and violent offending. Given the high rate of mental disorders still present among subjects completing prison sentences and the challenges they may encounter to benefit from vocational programs, our results suggest that appropriate psychiatric care should be provided during imprisonment and after release to facilitate their community reintegration

The impact of psychopathology on academic performance in school-age children and adolescents

Anxiety; Depression; Psychiatric disordersAnsiedad; Depresión; Desórdenes psiquiátricosAnsietat; Depressió; Trastorns psiquiàtricsPsychiatric symptoms have consistently been associated with negative educational outcomes. However, possible confounding variables, such as comorbid mental and environmental conditions, have not been well addressed. This study examined whether mental health problems were significantly linked to academic performance in a Spanish school-based sample, after adjustment for co-occurring psychiatric symptoms and multiple contextual factors. Parents completed a questionnaire regarding child’s sociodemographic characteristics (i.e., gender, age, type of school, socioeconomic status, ethnicity), stressful events (i.e., adoption, parental divorce/separation, grade retention) and lifestyle (i.e., diet, sleep, screen time), along with the Child Behavior Checklist (CBCL). Academic performance was obtained from school records. The sample comprised 7036 students aged 5–17 with full data on the CBCL. Mixed-effects ordinal logistic regression analyses were conducted to investigate the association between psychopathology and academic achievement, controlling for potential confounders. When examined separately, higher scores on the CBCL scales were related to lower grades, regardless of sociodemographic factors. However, after controlling for the presence of other psychiatric symptoms, we found that students who reported more anxious/depressed and thought problems were less likely to perform poorly, while those with increased levels of attention problems and delinquent behavior had higher risk for academic underachievement. These associations remained mainly the same once stressful events and lifestyle were taken into account. This investigation demonstrates that anxious/depressed symptoms, thought problems, attention problems, and delinquent behavior are independently associated with academic performance, which emphasize the need for preventive and treatment interventions targeted at students’ mental health to improve their psychological well-being and functioning at school.This work was funded by “la Caixa” Banking Foundation, Diputació de Barcelona, Diputació de Lleida, and Ministry of Health of Generalitat de Catalunya

The impact of attention-deficit/hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle- and a high-income population

Past research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), specific learning disorders (SLD), and socioeconomic status (SES) affect a host of educational outcomes. However, there are no studies examining whether SES moderates the association between these neurodevelopmental disorders (ND) and the academic achievement of children and adolescents. The present investigation examined the impact of ADHD and SLD on academic performance in 1,287 Spanish students aged 5-17 from a low-middle (LM)- and a high-income population, when adjusted for comorbidity and demographic factors that may influence educational functioning. Parents completed a questionnaire regarding demographic data along with the Strengths and Difficulties Questionnaire. Additionally, teachers provided information on learning difficulties trough the Protocol for Detection and Management of Dyslexia. Teacher's Version. Academic performance across multiple domains (i.e., first language, foreign language, mathematics) was obtained from school records. ND were determined using standardized diagnostic methods based on the Diagnostic and Statistical Manual of Mental Disorders criteria. To examine the effects of ADHD and SLD on academic achievement and the potential moderating role of SES, a series of ordinal logistic regressions were conducted. Emotional/behavioral problems, learning difficulties, and ND were more frequent among individuals from the LM-income population. After controlling for gender, age, parental divorce/separation, grade retention, frequency of screen use, and daily meals, both ADHD and SLD were associated with worse educational outcomes. Lower SES also increased the risk for academic impairment, although the interactions with ADHD or SLD were not significant. These findings indicate that ADHD and SLD exert a pervasive impact on academic performance across different socioeconomic backgrounds. Therefore, early detection and effective intervention strategies aimed at students with these ND are crucial to improve their educational functioning and mitigate the negative consequences related to academic problems

The impact of psychopathology on academic performance in school-age children and adolescents

Psychiatric symptoms have consistently been associated with negative educational outcomes. However, possible confounding variables, such as comorbid mental and environmental conditions, have not been well addressed. This study examined whether mental health problems were significantly linked to academic performance in a Spanish school-based sample, after adjustment for co-occurring psychiatric symptoms and multiple contextual factors. Parents completed a questionnaire regarding child's sociodemographic characteristics (i.e., gender, age, type of school, socioeconomic status, ethnicity), stressful events (i.e., adoption, parental divorce/separation, grade retention) and lifestyle (i.e., diet, sleep, screen time), along with the Child Behavior Checklist (CBCL). Academic performance was obtained from school records. The sample comprised 7036 students aged 5-17 with full data on the CBCL. Mixed-effects ordinal logistic regression analyses were conducted to investigate the association between psychopathology and academic achievement, controlling for potential confounders. When examined separately, higher scores on the CBCL scales were related to lower grades, regardless of sociodemographic factors. However, after controlling for the presence of other psychiatric symptoms, we found that students who reported more anxious/depressed and thought problems were less likely to perform poorly, while those with increased levels of attention problems and delinquent behavior had higher risk for academic underachievement. These associations remained mainly the same once stressful events and lifestyle were taken into account. This investigation demonstrates that anxious/depressed symptoms, thought problems, attention problems, and delinquent behavior are independently associated with academic performance, which emphasize the need for preventive and treatment interventions targeted at students' mental health to improve their psychological well-being and functioning at schoo

The impact of attention-deficit/hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle- and a high-income population

IntroductionPast research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), specific learning disorders (SLD), and socioeconomic status (SES) affect a host of educational outcomes. However, there are no studies examining whether SES moderates the association between these neurodevelopmental disorders (ND) and the academic achievement of children and adolescents. The present investigation examined the impact of ADHD and SLD on academic performance in 1,287 Spanish students aged 5–17 from a low-middle (LM)- and a high-income population, when adjusted for comorbidity and demographic factors that may influence educational functioning.MethodsParents completed a questionnaire regarding demographic data along with the Strengths and Difficulties Questionnaire. Additionally, teachers provided information on learning difficulties trough the Protocol for Detection and Management of Dyslexia. Teacher’s Version. Academic performance across multiple domains (i.e., first language, foreign language, mathematics) was obtained from school records. ND were determined using standardized diagnostic methods based on the Diagnostic and Statistical Manual of Mental Disorders criteria. To examine the effects of ADHD and SLD on academic achievement and the potential moderating role of SES, a series of ordinal logistic regressions were conducted.ResultsEmotional/behavioral problems, learning difficulties, and ND were more frequent among individuals from the LM-income population. After controlling for gender, age, parental divorce/separation, grade retention, frequency of screen use, and daily meals, both ADHD and SLD were associated with worse educational outcomes. Lower SES also increased the risk for academic impairment, although the interactions with ADHD or SLD were not significant.ConclusionThese findings indicate that ADHD and SLD exert a pervasive impact on academic performance across different socioeconomic backgrounds. Therefore, early detection and effective intervention strategies aimed at students with these ND are crucial to improve their educational functioning and mitigate the negative consequences related to academic problems

Integrative genomic analysis of methylphenidate response in attention-deficit/hyperactivity disorder

Methylphenidate (MPH) is the most frequently used pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD). However, a considerable interindividual variability exists in clinical outcome. Thus, we performed a genome-wide association study of MPH efficacy in 173 ADHD paediatric patients. Although no variant reached genome-wide significance, the set of genes containing single-nucleotide polymorphisms (SNPs) nominally associated with MPH response (P < 0.05) was significantly enriched for candidates previously studied in ADHD or treatment outcome. We prioritised the nominally significant SNPs by functional annotation and expression quantitative trait loci (eQTL) analysis in human brain, and we identified 33 SNPs tagging cis-eQTL in 32 different loci (referred to as eSNPs and eGenes, respectively). Pathway enrichment analyses revealed an over-representation of genes involved in nervous system development and function among the eGenes. Categories related to neurological diseases, psychological disorders and behaviour were also significantly enriched. We subsequently meta-analysed the association with clinical outcome for the 33 eSNPs across the discovery sample and an independent cohort of 189 ADHD adult patients (target sample) and we detected 15 suggestive signals. Following this comprehensive strategy, our results provide a better understanding of the molecular mechanisms implicated in MPH treatment effects and suggest promising candidates that may encourage future studies

Shared genetic background between children and adults with attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by age-inappropriate symptoms of inattention, impulsivity, and hyperactivity that persist into adulthood in the majority of the diagnosed children. Despite several risk factors during childhood predicting the persistence of ADHD symptoms into adulthood, the genetic architecture underlying the trajectory of ADHD over time is still unclear. We set out to study the contribution of common genetic variants to the risk for ADHD across the lifespan by conducting meta-analyses of genome-wide association studies on persistent ADHD in adults and ADHD in childhood separately and jointly, and by comparing the genetic background between them in a total sample of 17,149 cases and 32,411 controls. Our results show nine new independent loci and support a shared contribution of common genetic variants to ADHD in children and adults. No subgroup heterogeneity was observed among children, while this group consists of future remitting and persistent individuals. We report similar patterns of genetic correlation of ADHD with other ADHD-related datasets and different traits and disorders among adults, children, and when combining both groups. These findings confirm that persistent ADHD in adults is a neurodevelopmental disorder and extend the existing hypothesis of a shared genetic architecture underlying ADHD and different traits to a lifespan perspective

Bases genètiques del trastorn per dèficit d'atenció amb hiperactivitat i de la resposta farmacològica al metilfenidat

[cat] El trastorn per dèficit d’atenció amb hiperactivitat (TDAH) és un trastorn del neurodesenvolupament caracteritzat per símptomes d’inatenció i/o hiperactivitat/impulsivitat. Nombrosos estudis suggereixen un important component genètic en l’etiologia del TDAH, amb una heretabilitat estimada del 70-80%. Tanmateix, la majoria de variants genètiques identificades només expliquen una petita proporció de la variabilitat fenotípica observada i la seva associació, en general, no ha estat replicada consistentment. A més, s’han descrit diversos factors ambientals que tendeixen a incrementar el risc de presentar TDAH i que sovint contribueixen a agreujar-ne les manifestacions. Les discrepàncies en els resultats obtinguts, per tant, podrien ser degudes, entre d’altres, a la influència de variables ambientals, capaces de modular els efectes dels factors genètics a través d’interaccions gen × ambient. Pel que fa a l’abordatge terapèutic del TDAH, el principal tractament farmacològic consisteix en l’administració de psicoestimulants com el metilfenidat (MPH), un potent inhibidor de la recaptació de dopamina. No obstant això, aproximadament un 30% dels pacients no respon adequadament al fàrmac, fet que podria estar determinat, en part, per influències genètiques. La recerca farmacogenètica del MPH s’ha centrat de forma quasi exclusiva en gens suposadament relacionats amb el seu mecanisme d’acció, entre els quals destaquen el transportador de dopamina (SLC6A3) i el receptor dopaminèrgic D4 (DRD4), malgrat que els resultats aportats han estat predominantment negatius o discordants. La majoria d’investigacions, a més, han avaluat un únic o un nombre molt reduït de polimorfismes en base a la seva presumpta rellevància funcional, sense tenir en compte la possible interacció entre ells o amb influències ambientals. L’objectiu de la present tesi doctoral fou, per una banda, aprofundir en els processos etiològics implicats en el TDAH mitjançant un estudi d’associació amb vuit gens candidats (DRD4, SLC6A3, COMT, ADRA2A, CES1, CYP2D6, LPHN3 i OPRM1) en què s’avaluaren dotze polimorfismes potencialment funcionals en una mostra de sis-cents quatre pacients adults i sis-cents onze individus control. A continuació, s’investigà la influència d’experiències estressants durant la infantesa en la gravetat del trastorn, així com la possible interacció entre l’adversitat ambiental i les variants genètiques de risc identificades. Els resultats de l’esmentat estudi revelaren la contribució de DRD4 en la persistència del TDAH a l’edat adulta i proporcionaren evidències preliminars sobre el seu paper com a mediador de l’efecte que els esdeveniments vitals adversos exerceixen en la gravetat de la simptomatologia. Per altra banda, es proposà identificar marcadors genètics de la resposta i la tolerabilitat al MPH. Per a aquesta finalitat, s’empraren dues estratègies complementàries. En primer lloc, s’examinaren cinquanta-set polimorfismes distribuïts al llarg dels principals gens de la neurotransmissió dopaminèrgica (DRD1-5, SLC6A3, TH, COMT i DBH) en una mostra de cent set pacients pediàtrics amb TDAH. A més, s’explorà la influència de variables ambientals pre i perinatals en els efectes del tractament, així com la presència d’interaccions gen × gen i gen × ambient. Els resultats de la segona investigació suggeriren la implicació de DRD3, DBH, TH i l’exposició prenatal al tabac en l’eficàcia clínica del MPH. Concretament, s’observà un major risc de resistència al tractament en individus susceptibles genèticament i amb mares fumadores durant l’embaràs mentre que l’aparició d’efectes adversos s’associà a la variabilitat a DBH i DRD2. En segon lloc, s’analitzà l’associació amb la resposta al MPH a escala genòmica en cent setanta-tres infants amb el trastorn. Les dades obtingudes es combinaren amb evidències biològiques i bioinformàtiques, fet que posà de manifest la participació de gens relacionats amb el desenvolupament i funció del sistema nerviós, malalties neurològiques i psiquiàtriques, com el dèficit d’aprenentatge, o la conducta, com el comportament hiperactiu. En definitiva, els resultats que conformen la present tesi doctoral aporten informació innovadora i rellevant al camp de l’etiologia i la farmacogenètica del TDAH a través de la identificació de loci genètics implicats en el sistema dopaminèrgic i el neurodesenvolupament, i de factors ambientals com els esdeveniments vitals estressants o el consum matern de tabac durant l’embaràs.[eng] Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a strong genetic component. However, most of the identified genetic variants explain only a small proportion of the phenotypic variance. Additionally, several environmental factors have been reported to increase the risk and severity of ADHD. Thus, the absence of clear conclusions might be caused by environmental influences that moderate the effects of genetic factors through gene-environment interactions. Stimulant medications such as methylphenidate (MPH), a dopamine reuptake inhibitor, are generally the first-line choice in ADHD pharmacological treatment. Nevertheless, approximately 30% of ADHD patients do not respond favorably to treatment, which may reflect underlying genetic influences. Pharmacogenetic studies of MPH have focused on genes presumably related to its mechanism of action, especially the dopamine transporter (SLC6A3) and the dopamine receptor D4 (DRD4), although findings have been predominantly negative or inconsistent. Furthermore, the majority of investigations have evaluated a single or few polymorphisms based on their putative functional implications, without considering the possible interaction between them or with environmental factors. The objective of the present doctoral thesis was to elucidate the etiological processes implicated in ADHD through an association study with eight candidate genes (DRD4, SLC6A3, COMT, ADRA2A, CES1, CYP2D6, LPHN3 and OPRM1), which examined 12 potentially functional polymorphisms in a sample of 604 adult patients and 611 controls. We subsequently investigated the impact of childhood stressful experiences on the severity of ADHD, as well as the possible interaction between environmental adversity and the identified genetic risk variants. On the other hand, the doctoral thesis aimed to identify pharmacogenetic markers of MPH response and tolerability. Firstly, we analyzed 57 polymorphisms across the main genes of the dopaminergic neurotransmission (DRD1-5, SLC6A3, TH, COMT and DBH) in a sample of 107 ADHD pediatric patients. We also explored the influence of prenatal and perinatal risk factors on treatment effects, as well as the presence of gene-gene and gene-environment interactions. Secondly, we conducted a genome-wide association study of MPH response in 173 children with ADHD and we combined the data obtained with bioinformatic and biological evidence. The results of the present doctoral thesis provide innovative and relevant information to the field of ADHD etiology and pharmacogenetics through the identification of genetic loci implicated in the dopaminergic system and neurodevelopment, and environmental factors such as stressful life events or maternal smoking during pregnancy