Attention Deficit Hyperactivity Disorder, other mental health problems, substance use and driving: Examination of a population-based, representative Canadian sample

Purpose: The purpose of this study is to examine the relationships among self-reported screening measures of ADHD, other psychiatric problems, and driving-related outcomes in a provincially representative sample of adults 18 years and older living in the province of Ontario, Canada. Methods: The study examined the results of the Centre for Addictions and Mental Health (CAMH) Ontario Monitor, an ongoing repeated cross-sectional telephone survey of Ontario adults over a two year period. Measures: ADHD measures (Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1), previous ADHD diagnosis, ADHD medication use); psychiatric distress measures (General Health Questionnaire (GHQ12), pain, anxiety and depression medication use); antisocial behaviour measure (The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview (APD)); substance use and abuse measures (alcohol, cannabis and cocaine), Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)); driving-related outcomes (driving after drinking, driving after cannabis use, street racing, collisions in past year) and socio-demographics (gender, age, vehicle km travelled). Results: A total of 4014 Ontario residents were sampled, of which 3485 reported having a valid driver’s licence. Overall, 3.22% screened positively for ADHD symptoms on the ASRS-V1.1 screening tool. A greater percent of those who screened positively were younger, reported previous ADHD diagnosis and medication use, distress, antisocial behaviour, anti-anxiety and anti-depressant medication use, substance use and social problems compared to those who screened negatively. However, there were no statistically significant differences between those who screened positively or negatively for ADHD symptoms on self-reported driving after having two or more drinks in the previous hour, within an hour of using cannabis, marijuana or hash, in a street race or collision involvement as a driver in the past year. When a sequential regression was conducted to predict self-reported collisions, younger age, higher weekly kilometres driven showed higher odds of collision involvement, while the odds ratio for cannabis use ever, approached statistical significance. Discussion: This study is the first population-based study of a representative sample of adults 18 years and older living in Ontario, Canada. These results showed no relationship between the ADHD screen and collision when age, sex and kilometers driven are controlled for. However, these analyses are based on self-report screeners and not psychiatric diagnoses and a limited sample of ADHD respondents. Thus, these results should be interpreted with caution

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: Sex differences in a representative, population survey

Background: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. Methods: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. Results: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. Conclusions: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner

Attention deficit hyperactivity disorder symptoms, comorbidities, substance use, and social outcomes among men and women in a canadian sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%-3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence

Background Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. Aims To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. Method Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. Results Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. Conclusions Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: Sex differences in a representative, population survey

Background: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. Methods: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. Results: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. Conclusions: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner

The Endocannabinoid System, Aggression, and the Violence of Synthetic Cannabinoid Use, Borderline Personality Disorder, Antisocial Personality Disorder, and Other Psychiatric Disorders

Endogenous and exogenous cannabinoids bind to central cannabinoid receptors to control a multitude of behavioral functions, including aggression. The first main objective of this review is to dissect components of the endocannabinoid system, including cannabinoid 1 and cannabinoid 2 receptors; the endogenous cannabinoids anandamide and 2-arachidonoylglycerol; and the indirect cannabinoid modulators fatty acid amide hydrolase and monoacylglycerol lipase; that have shown abnormalities in basic research studies investigating mechanisms of aggression. While most human research has concluded that the active ingredient of marijuana, Δ9-tetrahydrocannabinol, tends to dampen rather than provoke aggression in acute doses, recent evidence supports a relationship between the ingestion of synthetic cannabinoids and emergence of violent or aggressive behavior. Thus, another objective is to evaluate the emerging clinical data. This paper also discusses the relationship between prenatal and perinatal exposure to cannabis as well as use of cannabis in adolescence on aggressive outcomes. A final objective of the paper is to discuss endocannabinoid abnormalities in psychotic and affective disorders, as well as clinically aggressive populations, such as borderline personality disorder and antisocial personality disorder. With regard to the former condition, decreased anandamide metabolites have been reported in the cerebrospinal fluid, while some preliminary evidence suggests that fatty acid amide hydrolase genetic polymorphisms are linked to antisocial personality disorder and impulsive-antisocial psychopathic traits. To summarize, this paper will draw upon basic and clinical research to explain how the endocannabinoid system may contribute to the genesis of aggressive behavior

Monoamine Oxidase-A in Borderline Personality Disorder and Antisocial Personality Disorder

Monoamine oxidase A (MAO-A) is a brain enzyme that serves several physiologic functions, including metabolism of monoamine neurotransmitters and induction of pro-apoptotic signaling pathways. Increased brain MAO-A level is present in clinical disorders characterized by low mood states, whereas decreased brain MAO-A level is associated with higher trait impulsivity and aggression in healthy volunteers. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are common psychiatric conditions that exact a high healthcare and societal burden. BPD is associated with acute episodes of severe dysphoria, and ASPD presents high levels of impulsivity and aggression. The overall aim of the thesis was to investigate MAO-A brain level in BPD and ASPD. The first experiment used [11C] harmine positron emission tomography (PET) to assess MAO-A total distribution volume (MAO-A VT), an index of MAO-A density, in females with BPD. Our results showed that MAO-A VT was elevated in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) of severe BPD compared to control groups. Greater PFC and ACC MAO-A VT was additionally associated with more severe mood symptoms and suicidality in BPD. The second experiment applied [11C] harmine PET to examine MAO-A VT in impulsive, violent male offenders with ASPD. We found that orbitofrontal cortex and ventral striatum (VS) MAO-A VT were lower in ASPD compared to controls. Behavioral, self-report, and clinician-rated measures of impulsivity were also negatively correlated with VS MAO-A VT. The third experiment employed functional magnetic resonance imaging to measure VS resting state functional connectivity (FC) in ASPD. Our results demonstrated functional coupling between superior VS and bilateral dorsomedial prefrontal cortex that was correlated with VS MAO-A VT, and functional coupling between inferior VS and right hippocampus that was anti-correlated with VS MAO-A VT. The observed FC patterns were additionally associated with measures of impulsivity. Taken together, this body of research implicates abnormal brain MAO-A level in the pathophysiology of two related yet distinct personality disorders and their symptom clusters. Novel interventions targeting abnormal brain MAO-A level could emerge as potential new therapeutics for these disorders.Ph.D.2017-06-30 00:00:0

Elevated Brain Fatty Acid Amide Hydrolase Induces Depressive-Like Phenotypes in Rodent Models: A Review

Altered activity of fatty acid amide hydrolase (FAAH), an enzyme of the endocannabinoid system, has been implicated in several neuropsychiatric disorders, including major depressive disorder (MDD). It is speculated that increased brain FAAH expression is correlated with increased depressive symptoms. The aim of this scoping review was to establish the role of FAAH expression in animal models of depression to determine the translational potential of targeting FAAH in clinical studies. A literature search employing multiple databases was performed; all original articles that assessed FAAH expression in animal models of depression were considered. Of the 216 articles that were screened for eligibility, 24 articles met inclusion criteria and were included in this review. Three key findings emerged: (1) FAAH expression is significantly increased in depressive-like phenotypes; (2) genetic knockout or pharmacological inhibition of FAAH effectively reduces depressive-like behavior, with a dose-dependent effect; and (3) differences in FAAH expression in depressive-like phenotypes were largely localized to animal prefrontal cortex, hippocampus and striatum. We conclude, based on the animal literature, that a positive relationship can be established between brain FAAH level and expression of depressive symptoms. In summary, we suggest that FAAH is a tractable target for developing novel pharmacotherapies for MDD