ADHD (ATTENTION DEFFICIT HYPERACTIVITY DISORDER)--A TROUBLING ENTITY, SOMETIMES PERPETUATING DURING ADULT LIFE.

Attention deficit hyperactivity disorder (ADHD) is considered a neurologic development disorder resulting in impairment of attention and inhibitory control, manifested as attention deficit, hyperactivity, impulsiveness; symptoms should develop between age six and twelve and have to persist for more than six months. Approximately 30-50% of the diagnosed cases are manifesting the disorder during adulthood and 2.5-5% of the adults are suffering of ADHD. Genetics are important factors in ADHD, being involved in 75% of the cases, as well in the persistence of ADHD during adult life. Three subtypes of ADHD are described--one in which is predominating the attention deficit, one with predominant hyperactivity and impulsiveness and a third combined subtype. Diagnosis criteria in ADHD are established by the American Psychiatric Association (DSM criteria) and by World Health Organization. Differential diagnosis is mainly considering bipolar disorder and borderline personality disorder. Management of ADHD is including behavioral therapies and medication, alone or combined. Stimulant medications such as amphetamine represent the therapy of choice, being effective in 80% of the cases. New data are underlying the need for following up of the cases during adulthood, since the risk for development of psychiatric conditions such as depression, anxiety, as well as the suicidal behavior is higher than in the general population.

Polycystic Ovary Syndrome, A Complex Entity Involving Reproductive and Metabolic Impairments: A Systematic Review.

We attempt to synthesize main data in what concerns pathogenesis, signs and symptoms, diagnosis and management of polycystic ovary syndrome PCOS. The issue was the systematization of main data regarding different features of PCOS and stressing its peculiar association with characteristics of metabolic syndrome, main diagnostic criteria and most important therapeutic options, finally contouring an updated general picture of PCOS. We pointed also on associated morbidities, such as endometrial cancer, insulin resistance and need for individualized therapy, including changing in lifestyle, especially weight loss.

Main neuroendocrine features, diagnosis and therapeutic possibilities in the chronic fatigue syndrome, an underdiagnosed entity.

Chronic fatigue syndrome is characterized by severe, persistent fatigue which is not relieved by rest and is not associated to other medical conditions. Other common symptoms are including concentration and memory impairment, muscle and multiple joints pain, extreme exhaustion after physical or mental exertions, irritable bowel syndrome-like symptoms and depression, anxiety, mood swings and panic attacks. Etiology of the syndrome is not yet clear, post-viral and stress hypotheses were not verified. Diagnosis is confirmed in case of new onset of severe fatigue, for six consecutive months or more; fatigue is leading to significant reduction of the activity levels and is accompanied by other four or more of the specific associated symptoms, which are also lasting for six months or longer. The management of the disease is based on cognitive behavioral therapy, graded exercise therapy and pacing; medication plays a minor role in therapy. The occupational status is severely affected, more than half of the cases being unable to work. Full recovery rate is in average of about 5%.

Bipolar disorder, not so rare diagnosis: subtypes of different degrees of severity, diagnosis, therapy.

Bipolar disorder is manifesting as a mood disorder, typically showing episodes of mania, alternating with depressive episodes. The subtypes are including bipolar I disorder (one or several manic episodes) and bipolar II disorder (hypomanic episodes and one or several major depressive episodes). Nevertheless, sub-threshold diagnosis criteria may include another 5.1, up to 6.4% of the population as having a bipolar spectrum disorder diagnosis. Anyone who received the diagnosis is not considered cured afterwards (just in remission). Diagnosis is considering the symptoms of mania, hypomania and depression. Therapy is based on lithium, anticonvulsants, for the manic symptoms, lamotrigine for the depressive episodes and antipsychotics. Under medication, most of the affected subjects are living a normal life; to a certain degree, medication may also prevent the relapses.

Metabolic syndrome a widespread threatening condition; risk factors, diagnostic criteria, therapeutic options, prevention and controversies: an overview.

Metabolic syndrome diagnostic criteria include at least three of five of the following medical conditions: abdominal obesity, high blood pressure, abnormal high fasting plasma glucose, elevated serum triglycerides and low HDL (high-density cholesterol) level. Sedentary, overweight and obesity are characteristically associated with the syndrome, nevertheless there are new studies which indicate that chronic stress, through deregulation of the hypothalamic-pituitary-adrenal (HPA) axis is also involved in the development of the syndrome. Metabolic syndrome represents a significant risk for the development of the cardiovascular diseases. New studies in the USA have estimated its prevalence at approximately 34% of the adult population and its prevalence is increasing with age. Diagnosis guidelines are establishing the metabolic syndrome diagnostic when are met three of the following five conditions: fasting glucose > or = 100 mg/dL or type 2 diabetes receiving drug therapy for hyperglycemia; high blood pressure > or = 130/85 mm Hg or high blood pressure receiving drug therapy; triglycerides > or =150 mg/dL or treatment for plasma hyper-triglyceride value; HDL-C < 40 mg/dL in men and < 50 mg/dL in women or if under therapy for reduced HDL-C levels and waist circumference of > or = 102 cm in men and > or = 88 cm in women. Besides important change of lifestyle, often drug therapy is needed (diuretics and ACE inhibitors, cholesterol drugs and weight loss medications). The value of physical activity and diet in prevention and treatment of the syndrome is supported by numerous studies. Association of metabolic syndrome and cardiovascular risk is still a matter of controversy, in what concerns the lack of significant cardiovascular risk in the case of obesity itself without metabolic syndrome.

Autism, an overwhelming condition: history, etiopathogenesis, types, diagnosis, therapy and prognosis.

Autism is defined as a neurologic developmental disorder affecting brain and behavior, becoming usually apparent before 3 years of age, with stable evolution and no remission. No neurologic morphologic abnormality was associated with the disease. Several types of disease being described, autism is part of a larger spectrum known as autism spectrum disorders (ASD), or pervasive developmental disorders (PDD). The disease was first described long before it was defined and it has received its modern name. Main cause in the development of autism is considered to be genetic, up to 90 %. However, environmental factors could be incriminated, sometimes. The five types included in ASD are: Asperger syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), typical autism, Rett syndrome and childhood disintegrative disorder (CDD). The classical triad of symptoms includes: social interaction impairments, communication impairments and repetitive, stereotype behavior. Diagnosis is based on interview of the parents and specialized observation of the suspected children. Main tools used in therapy are the family and the educational system. Well established, specialized programs of therapy were developed in time. Prognosis of autism is severe, since no cure is possible; nevertheless spontaneous recoveries do occur, in some cases.

Alzheimer--certitudes and hypotheses.

Alzheimer's disease is a degenerative, progressive and irreversible condition, which affects cognitive functions. It was first described in 1907, by the German physician Alois Alzheimer. Although at the time, it was considered a rare disease, in 2010 in the world were estimated 35.6 million cases of dementia, most of these with the diagnosis of Alzheimer's disease. Typical neuropathologic lesions are represented by the amyloid plaques, neurofibrilar tangles and synapses and neurons losses. It was hypothesized that the amyloid protein has prion-like properties. Even from the first descriptions of the disease, atypical features were observed - the second case described by the physician Alois Alzheimer, had only plaques, the tangles were missing. About 19 % of the healthy old subjects present in the brain the same lesions as Alzheimer's cases, while in 10 % of the cases of disease, in necropsy are present only the plaques or only the tangles. These aspects are even more paradoxical, as the certain diagnosis is established only at necropsy, on anatomopathological lesions. Even so, the international diagnosis criteria, based on clinical aspects, can establish a certain, probable or a possible diagnosis. It exist an early-onset form, as well as a late-onset form of disease (which appears after 80-85 years of life); genes are involved in the genesis of the disease. A lot of money are spent to find an efficient medication in the treatment of the disease (tramiprosate--an amyloid-antagonist, Dimebon, gamma-secretase inhibitors or a vaccine--a synthetic form of the amyloid protein); for the moment the used medication may at its best only to temporary improve the symptoms. Some scientists believe that approx. 30 % of the cases are wrongly diagnosed with Alzheimer, being in fact other forms of dementia, or that we deal with several biologic processes, generating rather an Alzheimer's syndrome, meanwhile others are unsatisfied by a poor diagnosed disease and its popular receipt as a part of the normal aging process.

Posttraumatic stress disorder: neuroendocrine and pharmacotherapeutic approach.

Posttraumatic stress disorder (PTSD) is represented by the development of characteristic symptoms, that appear following direct/indirect exposure to a traumatic event in which physical harm was threatened, witnessed or experienced. PTSD can also occur after the unexpected death of a family member or close friend, following a serious harm or threat of death or injury to a loved one, or in case of divorce or unemplyoement. It occurs in 1%-4% of the population. As neuroendocrine pattern, PTSD is characterized by abnormal low cortisol levels and higher than normal epinephrine and norepinephrine levels. In chronique forms a total decrease of the hippocampal volume, was found, region of the brain involved in processing memories and in the memorization process. Symptoms are grouped in three main categories: re-experiencing the event, accompanied by anxiety, nightmares and flashbacks; persistent avoidance of any reminders of the event, feeling detached or estranged from others; persistent anxiety and/or physical reactivity. As treatment, besides various psychotherapy techniques, various classes of psychotropic drugs are used, such as morphine, antipsychotics, usual or atypical antidepressants, anticonvulsants, to reduce anxiety, avoidance, nightmares and hyperexcitability.

Main neuroendocrine features and therapy in primary sleep troubles.

Insomnia is a sleep trouble in which the patient has difficulties in falling or in staying asleep. There are patients who fall asleep easily, but wake up too early; others have troubles in falling asleep and a third category has troubles with both falling and staying asleep. Independent of the type of insomnia, the final result is a poor-quality sleep, responsible for depressive or irritable mood, loss in concentration, learning and memory capacities. Sleep is essential to emotional and physical health. Inadequate sleep over a period of time is increasing the risks for obesity, diabetes, heart disease and depression. People suffering of chronic insomnia show an increased predisposition for psychiatric problems. People who had sleep troubles reported impaired ability to fulfill tasks involving memory, learning, logical reasoning and mathematical operations. New studies show that insomnia might be a result of the decrease of gamma-aminobutyric acid (GABA), a neurochemical responsible for the decrease of activity in many brain areas. Lower brain GABA levels were also found in people with major depressive disorder and anxiety disorders. Hypnotics, such as benzodiazepines are acting increasing the activity of the GABA neurons. Exposure to stress is associated with a greater risk for insomnia, with individual differences. Stress activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Increased activity of HPA axis is stimulating the secretion of corticotropin-releasing hormone, further inducing sleep disruption. Insomnia is also associated with depression and anxiety disorders, in which the HPA axis is characteristically overactive. People who show predisposition to sleep troubles have a hyperactive sympathetic nervous system, they are usually suffering from hyperarousal and they have a more intense response to stressful events. Primary sleep troubles (insomnia) has no apparent causes, is lasting more than one month, and is affecting approximately a quarter of the adult population. Secondary insomnia is associated with chronic heart and/or lung diseases, medication which interfere with onset or duration of sleep, constant change of the sleep habits, restless leg syndrome, etc. Besides lifestyle changes and cogn itive-behavioral therapy, in the treatment of insomnia are used hypnotic medicines, advised to be prescribed on short-term cures of one or two weeks. Benzodiazepines are inducing and maintaining sleep. Longer use is responsible for severe side effects--dependency and withdrawal syndrome, daytime drowsiness and dizziness, low blood pressure, memory troubles and change in the melatonin secretion during night-time period. For these reasons were created non-benzodiazepines hypnotics--zolpidem, zaleplon, which are as effective as benzodiazepines, but have fewer side effects. Nevertheless the use of these hypnotics is also restricted to 7-10 days. Zopiclone (Imovane) another short-acting non-benzodiazepine hypnotic has a different chemical structure, but a pharmacologic profile similar to that of the benzod iazepines; the treatment should be of maximum four weeks. Besides generally known concerns related to the use of hypnotics (residual sedative effects, memory impairment, rebound insomnia, abuse, dose escalation, dependency and withdrawal problems) it was signaled a risk of death associated with the use of current hypnotic medications.