Real-time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190-3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Meta-Analysis of fMRI Studies of Disruptive Behavior Disorders.

OBJECTIVE: Functional magnetic resonance imaging (fMRI) studies in conduct disorder and in oppositional defiant disorder have shown inconsistencies. The aim of this meta-analysis of fMRI studies in disruptive behavior disorders was to establish the most consistent brain dysfunctions and to address task- and subtype-related heterogeneity. METHOD: Web-based publication databases were searched to conduct a meta-analysis of all whole-brain fMRI studies of youths with disruptive behavior disorder or conduct problems up to August 2015. Sub-meta-analyses were conducted in functional subdomains of emotion processing; in cool and hot executive functions, which refer to goal-directed higher cognitive functions with and without motivational and affective significance; and in a subgroup of youths with additional psychopathic traits. The authors performed a meta-analysis of voxel-based group differences in functional activation using the anisotropic effect-size version of seed-based d mapping. RESULTS: Across 24 studies, 338 youths with disruptive behavior disorder or conduct problems relative to 298 typically developing youths had consistent underactivation in the rostral and dorsal anterior cingulate and in the medial prefrontal cortex and ventral caudate. Sub-meta-analyses of fMRI studies showed that medial fronto-cingulate dysfunction was driven by hot executive function. The sub-meta-analysis of emotion processing fMRI studies showed the most consistent underactivation in the dorsolateral prefrontal cortex and temporal pole, while cool executive functions were associated with temporal abnormalities. Youths with disruptive behavior disorder with psychopathic traits showed reduced ventromedial prefrontal-hypothalamic-limbic activation, but they also showed hyperactivation in cognitive control mediating dorsolateral prefrontal-dorsal and striatal regions. CONCLUSIONS: The findings show that the most consistent dysfunction in youths with disruptive behavior disorder is in the rostro-dorsomedial, fronto-cingulate, and ventral-striatal regions that mediate reward-based decision making, which is typically compromised in the disorder. Youths with psychopathic traits, on the other hand, have dysfunctions associated with the ventromedial prefrontal cortex and limbic system, together with dorsal and fronto-striatal hyperfunctioning, which may reflect poor affect reactivity and empathy in the presence of hyperactive executive control. These findings provide potential targets for neurotherapeutic and pharmacological interventions.

Brain abnormalities in attention-deficit hyperactivity disorder: a review.

AIM: To review the magnetic resonance imaging findings in child and adult attention-deficit hyperactivity disorder (ADHD). DEVELOPMENT: Studies have shown that ADHD is characterised by multiple functional and structural neural network abnormalities including most prominently fronto-striatal, but also fronto-parieto-temporal, fronto-cerebellar and even fronto-limbic networks. Evidence from longitudinal structural imaging studies has shown that ADHD is characterised by a delay in structural brain maturation. This is reinforced by indirect evidence from cross-sectional imaging studies for more immature brain function as well as structural and functional connectivity patterns, which, however, needs corroboration by longitudinal studies. Dysfunction of the ventrolateral prefrontal cortex seems to be more pronounced in ADHD relative to other pediatric disorders and there is some evidence for differential abnormalities in the basal ganglia. A meta-analysis of stimulant effects on brain function shows that the most consistent mechanism of action of acute psychostimulant medication is the increased activation of the inferior prefrontal cortex and the basal ganglia. First attempts to use neuroimaging data to make individual diagnostic classifications of ADHD children based on pattern recognition techniques are promising but need replication across centres and scanners. CONCLUSIONS: The last two decades of neuroimaging have shaped out biomarkers of ADHD. Future studies will need to focus on using this information for clinical translation such as using neuroimaging for individual diagnostic and prognostic classification or by using neuroimaging as a neurotherapy to reverse those brain function abnormalities that have been established over the last two decades of neuroimaging.

TITLE: Anomalias cerebrales en el trastorno por deficit de atencion/hiperactividad: una revision.Objetivo. Revisar los hallazgos de los estudios con resonancia magnetica en el trastorno por deficit de atencion/hiperactividad (TDAH) infantil y adulto. Desarrollo. Dichos estudios han demostrado que el TDAH se caracteriza por la presencia de multiples anomalias de caracter estructural y funcional, primordialmente en los circuitos frontoestriatales, pero tambien en los circuitos frontoparietotemporales, frontocerebelares e, incluso, frontolimbicos. Los datos aportados por los estudios longitudinales de resonancia magnetica estructural demuestran que el TDAH se caracteriza por un retraso en la maduracion estructural del cerebro. Esta conclusion se ve reforzada por los indicios indirectos ofrecidos por los estudios de cortes transversales, que indican la existencia de una inmadurez sustancial tanto en la funcion cerebral como en los patrones de conectividad estructural y funcional, indicios que, sin embargo, estan pendientes de confirmar en estudios longitudinales. La alteracion funcional de la corteza prefrontal ventrolateral parece estar mas afectada en el TDAH que en otros trastornos pediatricos, y existen algunos indicios de anomalias distintivas en los ganglios basales. Un metaanalisis sobre los efectos de los estimulantes en la funcion cerebral demuestra que el mecanismo de accion agudo mas congruente de los farmacos psicoestimulantes consiste en el aumento de la activacion de la corteza prefrontal inferior y los ganglios basales. Los primeros intentos por utilizar los datos de los estudios de neuroimagen para elaborar clasificaciones diagnosticas individuales de los niños con TDAH a partir de tecnicas de reconocimiento de patrones han cosechado resultados alentadores, pero todavia deben ser replicados por mas centros y aparatos de resonancia magnetica. Conclusiones. Durante los ultimos 20 años, las tecnicas de neuroimagen han perfilado los biomarcadores del TDAH, pero es necesario que nuevos estudios descubran la utilidad clinica de esa informacion, como el uso de tales tecnicas como instrumento de clasificacion diagnostica y pronostica individualizada o como terapia para revertir las anomalias de la funcion cerebral que han sido confirmadas durante los dos decenios anteriores.

Anomalías cerebrales en el trastorno por déficit de atención/hiperactividad: una revisión / Brain abnormalities in attention-deficit hyperactivity disorder: a review

Objetivo. Revisar los hallazgos de los estudios con resonancia magnética en el trastorno por déficit de atención/hiperactividad (TDAH) infantil y adulto. Desarrollo. Dichos estudios han demostrado que el TDAH se caracteriza por la presencia de múltiples anomalías de carácter estructural y funcional, primordialmente en los circuitos frontoestriatales, pero también en los circuitos frontoparietotemporales, frontocerebelares e, incluso, frontolímbicos. Los datos aportados por los estudios longitudinales de resonancia magnética estructural demuestran que el TDAH se caracteriza por un retraso en la maduración estructural del cerebro. Esta conclusión se ve reforzada por los indicios indirectos ofrecidos por los estudios de cortes transversales, que indican la existencia de una inmadurez sustancial tanto en la función cerebral como en los patrones de conectividad estructural y funcional, indicios que, sin embargo, están pendientes de confirmar en estudios longitudinales. La alteración funcional de la corteza prefrontal ventrolateral parece estar más afectada en el TDAH que en otros trastornos pediátricos, y existen algunos indicios de anomalías distintivas en los ganglios basales. Un metaanálisis sobre los efectos de los estimulantes en la función cerebral demuestra que el mecanismo de acción agudo más congruente de los fármacos psicoestimulantes consiste en el aumento de la activación de la corteza prefrontal inferior y los ganglios basales. Los primeros intentos por utilizar los datos de los estudios de neuroimagen para elaborar clasificaciones diagnósticas individuales de los niños con TDAH a partir de técnicas de reconocimiento de patrones han cosechado resultados alentadores, pero todavía deben ser replicados por más centros y aparatos de resonancia magnética. Conclusiones. Durante los últimos 20 años, las técnicas de neuroimagen han perfilado los biomarcadores del TDAH, pero es necesario que nuevos estudios descubran la utilidad clínica de esa información, como el uso de tales técnicas como instrumento de clasificación diagnóstica y pronóstica individualizada o como terapia para revertir las anomalías de la función cerebral que han sido confirmadas durante los dos decenios anteriores (AU)

Aim. To review the magnetic resonance imaging findings in child and adult attention-deficit hyperactivity disorder (ADHD). Development. Studies have shown that ADHD is characterised by multiple functional and structural neural network abnormalities including most prominently fronto-striatal, but also fronto-parieto-temporal, fronto-cerebellar and even fronto-limbic networks. Evidence from longitudinal structural imaging studies has shown that ADHD is characterised by a delay in structural brain maturation. This is reinforced by indirect evidence from cross-sectional imaging studies for more immature brain function as well as structural and functional connectivity patterns, which, however, needs corroboration by longitudinal studies. Dysfunction of the ventrolateral prefrontal cortex seems to be more pronounced in ADHD relative to other pediatric disorders and there is some evidence for differential abnormalities in the basal ganglia. A meta-analysis of stimulant effects on brain function shows that the most consistent mechanism of action of acute psychostimulant medication is the increased activation of the inferior prefrontal cortex and the basal ganglia. First attempts to use neuroimaging data to make individual diagnostic classifications of ADHD children based on pattern recognition techniques are promising but need replication across centres and scanners. Conclusions. The last two decades of neuroimaging have shaped out biomarkers of ADHD. Future studies will need to focus on using this information for clinical translation such as using neuroimaging for individual diagnostic and prognostic classification or by using neuroimaging as a neurotherapy to reverse those brain function abnormalities that have been established over the last two decades of neuroimaging (AU)

Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

BACKGROUND: Psychostimulant medication, most commonly the catecholamine agonist methylphenidate, is the most effective treatment for attention-deficit/hyperactivity disorder (ADHD). However, relatively little is known on the mechanisms of action. Acute effects on brain function can elucidate underlying neurocognitive effects. We tested methylphenidate effects relative to placebo in functional magnetic resonance imaging (fMRI) during three disorder-relevant tasks in medication-naïve ADHD adolescents. In addition, we conducted a systematic review and meta-analysis of the fMRI findings of acute stimulant effects on ADHD brain function. METHODS: The fMRI study compared 20 adolescents with ADHD under either placebo or methylphenidate in a randomized controlled trial while performing stop, working memory, and time discrimination tasks. The meta-analysis was conducted searching PubMed, ScienceDirect, Web of Knowledge, Google Scholar, and Scopus databases. Peak coordinates of clusters of significant effects of stimulant medication relative to placebo or off medication were extracted for each study. RESULTS: The fMRI analysis showed that methylphenidate significantly enhanced activation in bilateral inferior frontal cortex (IFC)/insula during inhibition and time discrimination but had no effect on working memory networks. The meta-analysis, including 14 fMRI datasets and 212 children with ADHD, showed that stimulants most consistently enhanced right IFC/insula activation, which also remained for a subgroup analysis of methylphenidate effects alone. A more lenient threshold also revealed increased putamen activation. CONCLUSIONS: Psychostimulants most consistently increase right IFC/insula activation, which are key areas of cognitive control and also the most replicated neurocognitive dysfunction in ADHD. These neurocognitive effects may underlie their positive clinical effects.

Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions.

Despite the 3:1 prevalence ratio of men versus women with Antisocial Personality Disorder (ASPD), research on sex differences on correlates of ASPD in the general population is scarce. The purpose of this study was to examine sex differences in childhood and adult adverse events, lifetime psychiatric comorbidity, and clinical correlates of DSM-IV ASPD. The sample included 819 men and 407 women with DSM-IV ASPD diagnosis. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 43,093). Compared to men, women with ASPD reported more frequent childhood emotional neglect (AOR = 2.25; 95% CI: 1.52-3.34) and sexual abuse (AOR = 4.20; 95% CI: 2.78-6.35), any parent-related adverse event during childhood (e.g., parental substance use disorder) (AOR = 2.47; 95% CI: 1.60-3.82), and adverse events during adulthood (AOR = 4.20; 95% CI: 2.78-6.35). Although women with ASPD present less violent antisocial behaviors and higher rates of aggressiveness and irritability (OR = 0.46; 95% CI: 0.31-0.67), they have higher rates of victimization, greater impairment, and lower social support. Our findings suggest increased mental health needs in women with ASPD, meriting development of different treatment programs for women and men.

Factors contributing to the utilization of adult mental health services in children and adolescents diagnosed with hyperkinetic disorder.

OBJECTIVES: To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. METHODS: Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. RESULTS: 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. CONCLUSIONS: Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS.

Age of first suicide attempt in men and women: an admixture analysis.

OBJECTIVES: To define different subgroups of suicide attempters according to age at onset of suicide attempts. METHODS: Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. RESULTS: The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43-50.0). CONCLUSIONS: Age at onset of suicide attempts characterizes different subpopulations of suicide attempters.

Differences among major depressive disorder with and without co-occurring substance use disorders and substance-induced depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To investigate the association between substance use disorders (SUDs) and the clinical presentation, risk factors, and correlates of major depressive disorder (MDD) by examining differences among 3 groups: (1) individuals with lifetime MDD and no comorbid SUD (MDD-NSUD); (2) individuals with comorbid MDD and SUD (MDD-SUD); and (3) individuals with substance-induced depressive disorder (SIDD). METHOD: Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: The lifetime prevalence of MDD-NSUD was 7.41%, whereas those of MDD-SUD and SIDD were 5.82% and 0.26%, respectively. Overall, risk factors for MDD were more common among individuals with MDD-SUD and SIDD than among those with MDD-NSUD. Individuals with MDD-SUD and SIDD had similar rates of comorbidity with any psychiatric disorder, but both groups had higher rates than individuals with MDD-NSUD (odds ratio [OR] = 2.3; 95% CI, 1.9-2.7 and OR = 2.5; 95% CI, 1.4-4.4, respectively). Individuals with SIDD were significantly less likely to receive medication than those with MDD-SUD or MDD-NSUD (OR = 0.5; 95% CI, 0.3-0.9 for both groups). CONCLUSIONS: MDD-SUD is associated with high overall vulnerability to additional psychopathology, a higher number of and more severe depressive episodes, and higher rates of suicide attempts in comparison to individuals with MDD-NSUD. SIDD has low prevalence in the general population but is associated with increased clinical severity and low rates of medication treatment. Similar patterns of comorbidity and risk factors in individuals with SIDD and those with MDD-SUD suggest that the 2 conditions may share underlying etiologic factors.

Gender, HIV status, and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: More than 30 years after the onset of the human immunodeficiency virus (HIV) epidemic, there is no information on the prevalence of psychiatric disorders among HIV-positive individuals in the general population. We sought to compare the prevalence of 12-month psychiatric disorders among HIV-positive and HIV-negative adults stratified by sex and to examine the differential increase in risk of a psychiatric disorder as a function of the interaction of sex and HIV status. METHOD: Face-to-face interviews were conducted between 2004 and 2005 with participants in the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2, a large nationally representative sample of US adults (34,653). The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: When compared with their HIV-negative same-sex counterparts, HIV-positive men were more likely to have any mood disorder (odds ratio [OR] = 6.10; 95% confidence interval [CI], 2.99-12.44), major depressive disorder/dysthymia (OR = 3.77; 95% CI, 1.16-12.27), any anxiety disorder (OR = 4.02; 95% CI, 2.12-7.64), and any personality disorder (OR = 2.50; 95% CI, 1.34-4.67). In relation to their same-sex HIV-negative counterparts, the effect of HIV status on the odds of any mood disorder (OR = 7.17; 95% CI, 2.52-20.41), any anxiety disorder (OR = 3.45; 95% CI, 1.27-9.38), and any personality disorder (OR = 2.66; 95% CI, 1.16-6.10) was significantly greater for men than women. CONCLUSIONS: HIV status was significantly more strongly associated with psychiatric disorders in men than in women. HIV-positive men had a higher prevalence than HIV-negative men of most psychiatric disorders. By contrast, HIV-positive women were not significantly more likely than HIV-negative women to have psychiatric disorders.

Improving the accuracy of suicide attempter classification.

OBJECTIVE: Psychometrical questionnaires such as the Barrat's impulsiveness scale version 11 (BIS-11) have been used in the assessment of suicidal behavior. Traditionally, BIS-11 items have been considered as equally valuable but this might not be true. The main objective of this article is to test the discriminative ability of the BIS-11 and the international personality disorder evaluation screening questionnaire (IPDE-SQ) to predict suicide attempter (SA) status using different classification techniques. In addition, we examine the discriminative capacity of individual items from both scales. MATERIALS AND METHODS: Two experiments aimed at evaluating the accuracy of different classification techniques were conducted. The answers of 879 individuals (345 SA, 384 healthy blood donors, and 150 psychiatric inpatients) to the BIS-11 and IPDE-SQ were used to compare the classification performance of two techniques that have successfully been applied in pattern recognition issues, Boosting and support vector machines (SVM) with respect to linear discriminant analysis, Fisher linear discriminant analysis, and the traditional psychometrical approach. RESULTS: The most discriminative BIS-11 and IPDE-SQ items are "I am self controlled" (Item 6) and "I often feel empty inside" (item 40), respectively. The SVM classification accuracy was 76.71% for the BIS-11 and 80.26% for the IPDE-SQ. CONCLUSIONS: The IPDE-SQ items have better discriminative abilities than the BIS-11 items for classifying SA. Moreover, IPDE-SQ is able to obtain better SA and non-SA classification results than the BIS-11. In addition, SVM outperformed the other classification techniques in both questionnaires.

Short self-reported sleep duration and suicidal behavior: a cross-sectional study.

BACKGROUND: Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. DESIGN: Cross-sectional. PARTICIPANTS: Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. MEASUREMENTS: Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. STATISTICAL ANALYSES: Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. RESULTS: Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. LIMITATIONS: Sleep duration was assessed only by self-report. CONCLUSIONS: The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.

Distinguishing the relevant features of frequent suicide attempters.

BACKGROUND: In spite of the high prevalence of suicide behaviours and the magnitude of the resultant burden, little is known about why individuals reattempt. We aim to investigate the relationships between clinical risk factors and the repetition of suicidal attempts. METHODS: 1349 suicide attempters were consecutively recruited in the Emergency Room (ER) of two academic hospitals in France and Spain. Patients were extensively assessed and demographic and clinical data obtained. Data mining was used to determine the minimal number of variables that blinded the rest in relation to the number of suicide attempts. Using this set, a probabilistic graph ranking relationships with the target variable was constructed. RESULTS: The most common diagnoses among suicide attempters were affective disorders, followed by anxiety disorders. Risk of frequent suicide attempt was highest among middle-aged subjects, and diminished progressively with advancing age of onset at first attempt. Anxiety disorders significantly increased the risk of presenting frequent suicide attempts. Pathway analysis also indicated that frequent suicide attempts were linked to greater odds for alcohol and substance abuse disorders and more intensive treatment. CONCLUSIONS: Novel statistical methods found several clinical features that were associated with a history of frequent suicide attempts. The identified pathways may promote new hypothesis-driven studies of suicide attempts and preventive strategies.

Comorbidity of generalized anxiety disorder and substance use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: Prior research has consistently documented a strong association between generalized anxiety disorder (GAD) and substance use disorder (SUD). Comorbidity of GAD and SUD (GAD-SUD) represents clinical challenges, as the patients' symptoms are often more severe and are frequently prolonged, making their management more complex when compared with individuals with GAD only. The purpose of this study was to examine whether individuals with GAD-SUD differ meaningfully from individuals with GAD and no SUD comorbidity (GAD-NSUD) in terms of demographic characteristics, risk factors, psychiatric comorbidity, and clinical correlates. METHOD: Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: We found that the lifetime prevalence rate of GAD-SUD is about 2.04%, while that of GAD-NSUD is 2.10%. Individuals with GAD-SUD showed higher psychiatric comorbidity rates than those with GAD-NSUD. Treatment-seeking rates for GAD are equally low in individuals with GAD-SUD and GAD-NSUD. Both groups were as likely to receive pharmacologic treatment for anxiety. CONCLUSIONS: The findings of our study indicate that individuals with GAD-SUD constitute half of the lifetime prevalence of GAD and that GAD-SUD is associated with high overall vulnerability for additional psychopathology, particularly in the externalizing spectrum; higher disability; and higher use of alcohol and drugs to relieve anxiety symptoms.

Prevalence and correlates of fire-setting in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

OBJECTIVE: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population. METHOD: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001-2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). RESULTS: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0-1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR] = 21.8; CI, 6.6-28.5), drug dependence (OR = 7.6; 95% CI, 5.2-10.9), bipolar disorder (OR = 5.6; 95% CI, 4.0-7.9), and pathological gambling (OR = 4.8; 95% CI, 2.4-9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates. CONCLUSIONS: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis of ASPD.

[Impact of the spanish consensus on physical health of patients with schizophrenia]. / Impacto del Consenso Español sobre la Salud Física del Paciente con Esquizofrenia.

INTRODUCTION: This study evaluates the physical health of patients with schizophrenia and analyzes the change in the percentage of patients with evaluations in the known diabetes and cardiovascular risk predictors before and 6 months after the dissemination of the "Consensus on Physical Health in Schizophrenia Patients". MATERIAL AND METHODS: This is an epidemiological non-interventional and transversal study, in which 229 psychiatrists evaluated 1,193 clinical records of patients with a diagnose of schizophrenia according to ICD-10, attended in the psychiatry consultations planned in January and September of 2007. Study results were analyzed using descriptive statistics. RESULTS: 1,193 evaluable patients were included, with a mean age of 39.7±11.6 years, diagnosed of schizophrenia 15.0±10.3 years ago, and a 65.90% were men. The presence of concomitant diseases was 39.98%, being hypercholesterolemia (46.33%), hypertriglyceridaemia (33.54%) and arterial hypertension (26.00%) the most frequent. After the dissemination of the Consensus, the percentage of patients who had all the physical measurements taken increased by 13.75%. Forty eight per cent of the psychiatrists were considered as being aware of the Consensus. The percentage of measurements taken was higher within the psychiatrists who were aware of the Consensus (17.32%) than within those who were not aware of it (10.33%). CONCLUSIONS: The results of this study show an increase of the physical health control from patients with schizophrenia after the dissemination of the Consensus, which should improve an integral approach of these patients to ensure a similar life expectancy, quality of life and function to the general population.