Obesity-associated factors in psychiatric outpatients: A multicenter questionnaire survey.

The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self-administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD-10 F0-F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non-obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second- and first-generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity-related factors.

Gaze measurements during viewing human dialogue scenes in adults with ADHD: Preliminary findings.

AIM: Eye gaze measurement to human dialogue scenes in adults with attention deficit hyperactivity disorder (ADHD) was investigated. We examined whether eye gaze measurement might be a biological marker of ADHD. METHODS: Twenty-two individuals with ADHD (mean age, 34.5 years) attending the outpatient clinic of Showa University Karasuyama Hospital were included in the study, and 26 healthy individuals (mean age, 32.6 years) with no history of mental disorders were used as the control group. For the participants, intellectual functioning was estimated using the Japanese Adult Reading Test, and mental symptoms were assessed using the Autism Spectrum Quotient and Conner's Adult ADHD Rating Scale. We extracted human dialogue scenes from two classic movies as visual stimuli and recorded the participant's gaze while watching these scenes using Tobii's eye tracker. RESULTS: For gazing time, repeated measures analysis of variance showed no significant main effect of "group" and no significant interaction effect between "group" and areas of interest "(AOI)." In the normal group, gazing time at the eyes was significantly longer than those at the mouth, body, and background; in the ADHD group, gazing time at the eyes was significantly longer than only that at the background. CONCLUSION: Given the different results obtained in the past in ASD, these results suggest that it would be necessary to directly compare the two groups to determine whether the gaze measurement shows significant differences in ASD and ADHD.

Psychosis in adults with autism spectrum disorder and attention deficit hyperactivity disorder at acute psychiatric wards

Background and objectives Psychotic symptoms, such as delusions and hallucinations, in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) have been increasingly reported in recent literature. In the present study, the prevalence and duration of psychotic symptoms, comorbid psychotic disorders, and clinical characteristics of adults with ASD and ADHD were retrospectively examined via a chart review. Methods The participants were 98 adults (mean age, 28.5 years; 72 men) who were admitted to the psychiatric emergency wards of Showa University Karasuyama Hospital, and who were diagnosed with ASD and/or ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Results Among 69 individuals with ASD, 21 (30.4%) experienced psychotic symptoms, and among 29 individuals with ADHD, 5 (17.2%) exhibited psychosis. While all psychotic symptoms were classified as transient and none had comorbidity with schizophrenia and other psychotic disorders in adults with ADHD, 38.1% of psychosis was classified as prolonged and 10.3% had comorbidity with schizophrenia and other psychotic disorders in adults with ASD. Conclusion The results showed that a significant proportion of adults with ASD and ADHD experience psychosis during their course of illness, and provide evidence for the existence of a shared etiology between neurodevelopmental and psychotic disorders. (AU)

Effects of Gaze Cues on Distributive Behavior of the Ultimatum Game in Adults With Attention Deficit Hyperactivity Disorder.

ABSTRACT: Adults with attention deficit hyperactivity disorder (ADHD) have difficulty in social decision-making. The ultimatum game (UG) is a popular economic game used to evaluate social decision-making. This study aimed to examine the effects of schematically depicted eyes and ADHD symptoms on UG performance. Thirty adults with ADHD were recruited. The computer screen background was changed among the "eyespots," "neutral," and "flowers" conditions among 30 trials of UG. Through all trials, task performances were recorded, and then compared with 30 typical adults and 30 adults with autism spectrum disorder (ASD). The reaction time was not affected by the background in any group. Although typical adults distributed more money in the "eyespots" condition, a nonsignificant background effect was observed in adults with ADHD or ASD. These results may be associated with reduced attention to social cues in individuals with ADHD, and this ADHD characteristic might lead to difficulty in social decision-making.

ASD symptoms in adults with ADHD: a comparative study using ADOS-2.

In this study, we examined autism spectrum disorder (ASD) symptoms in adults with attention-deficit hyperactivity disorder (ADHD) in comparison with normal controls using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). Sixty-three adults with ADHD (mean age, 35.3 years; 38 men) and 31 controls (mean age, 38.7 years; 17 men) completed Module 4 of the ADOS-2, Autism Spectrum Quotient, Conners' Adult ADHD Rating Scale, and Wechsler Adult Intelligence Scale, Third Edition. Adults with ADHD were not clinically diagnosed with ASD, and their ADHD diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Between-group comparisons on the scoring patterns revealed significant ASD symptoms present in adults with ADHD, which was congruent with our previous study. Further, item level and correlation analyses showed the possibility that ASD symptoms in adult ADHD comprised of two distinct mechanisms, one qualitatively similar to ASD and the other arising from ADHD characteristics, highlighting the complex nature of ADHD-ASD symptom overlaps.

ASD symptoms in adults with ADHD: a preliminary study using the ADOS-2.

Attention-deficit/hyperactivity disorder (ADHD) has long been regarded as disparate and mutually exclusive to autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. However, this idea has become obsolete due to a growing body of evidence suggesting numerous phenotypic and genetic similarities between ADHD and ASD. ASD symptoms or autistic traits in individuals with ADHD have been examined; however, most studies were conducted on children and relied on self- or parent- reports. ASD symptoms assessed with more direct, objective measures, such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in adults with ADHD, remain understudied. In the present study, we used the ADOS-2 to evaluate ASD symptoms in adults with ADHD who were not clinically diagnosed with ASD. Fifty-six adults (mean age 33.9 years, 35 males, intelligence quotient ≥ 85), who were diagnosed with ADHD based on the DSM-5 criteria, completed Module 4 of the ADOS-2. Autism Spectrum Quotient (AQ), Conners' Adult ADHD Rating Scale (CAARS), and Wechsler Adult Intelligence Scale (WAIS)-III were also administered to assess self-rated ASD symptoms, ADHD symptoms, and intelligence, respectively. Overall, 23.3% of participants met the ASD diagnostic classification on the ADOS-2. Social reciprocal interaction scores tended to be higher, while restricted and repetitive behavior scores were low. The scoring patterns and possible overlapping and differing phenotypic characteristics of ADHD and ASD are discussed.

Mind wandering in adults with attention deficit hyperactivity disorder: Preliminary evaluation using the Mind Excessively Wandering Scale in a Japanese clinical population.

Aim: Mind wandering (MW) has been closely associated with attention deficit hyperactivity disorder (ADHD); however, the field remains understudied in Japan. The present study examined MW in adults with ADHD using the Mind Excessively Wandering Scale (MEWS) in a Japanese clinical population. Methods: Fifty-two adults with ADHD (mean age, 33.0 years; 33 men), diagnosed per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, completed the MEWS, Mind Wandering Questionnaire, Conners' Adult ADHD Rating Scale (CAARS), Autism Spectrum Quotient (AQ), and Japanese Adult Reading Test-25. Results: The mean MEWS score was 18.8 (standard deviation, 7.6). MEWS scores showed significant correlations with the CAARS Inattention/Memory Problems, Problems with Self-Concept, DSM-IV ADHD Symptoms Total, ADHD Index, and AQ scores. Higher MEWS scores were associated with greater ADHD and autism spectrum disorder symptoms in patients with ADHD. Conclusion: Our results not only provide supporting evidence of the presence of excessive MW in adults with ADHD, but also indicate the heterogeneous nature of MW in ADHD.

Similarity of subjective symptoms between autism spectrum disorder and attention-deficit/hyperactivity disorder in adults: Preliminary findings.

AIM: The purpose of this study was to examine the symptoms of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in the adult clinical population using the Autism-Spectrum Quotient (AQ) and the Adult ADHD Rating Scales self-report screening version (CAARS-S:SV). METHODS: We included 50 adults with ASD and 52 with ADHD diagnosed using the DSM-5 criteria. Clinical symptoms were evaluated using the AQ and CAARS-S:SV. RESULTS: The AQ score was elevated in the ADHD group and the CAARS scores were increased in the ASD group. Specifically, the total AQ score in adults with ADHD was lower than that in the ASD group, but was higher than that in controls. Similarly, the CAARS scores in adults with ASD were lower than in those with ADHD, but were higher than those in controls. No significant correlations were found between AQ, CAARS Inattention/Memory Problems, and CAARS Hyperactivity/Restlessness scores in both the ASD and ADHD groups. CONCLUSION: While adults with ASD and ADHD exhibited similar clinical symptoms, the absence of AQ-CAARS correlations suggests the need for examining factors other than the apparent similarity of clinical symptoms of the two disorders.

Neuropsychological characteristics of adults with attention-deficit/hyperactivity disorder without intellectual disability.

AIMS: While several studies have reported various cognitive impairments in children with attention-deficit/hyperactivity disorder, the neuropsychological profiles of adults with this disorder are understudied. Here, the intelligence and memory functions of adults with attention-deficit/hyperactivity disorder without intellectual disability were evaluated. METHODS: The Wechsler Adult Intelligence Scale-Third Edition and Wechsler Memory Scale-Revised were administered to 30 adults with attention-deficit/hyperactivity disorder whose full-scale intelligence quotients were >85. Diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Conners' Adult ADHD Rating Scales-Self-Report-screening version and the Autism Spectrum Quotient were also evaluated. RESULTS: In the Wechsler Adult Intelligence Scale-Third Edition, the verbal intelligence quotient was significantly higher than the performance intelligence quotient and the verbal comprehension score was the highest among the secondary indices. In the Wechsler Memory Scale-Revised, the visual memory score was the highest measure. Although the verbal intelligence quotient had no correlation with any Wechsler Memory Scale-Revised measures, the performance intelligence quotient was significantly correlated with the visual memory and attention scores of the Wechsler Memory Scale-Revised. Conners' Adult ADHD Rating Scales hyperactive-impulsive score was significantly correlated with the verbal intelligence quotient, whereas the inattention score was not correlated with any measures of the Wechsler Adult Intelligence Scale-Third Edition or Wechsler Memory Scale-Revised. CONCLUSIONS: The results suggest that while adults with normal-intelligence attention-deficit/hyperactivity disorder have comparatively high verbal comprehension and social knowledge, their ability of information processing and visual-motor coordination are relatively weak.

Spontaneous theory of mind in adults with attention-deficit/hyperactivity disorder.

Spontaneous theory of mind (ToM) is an unconscious and automatic understanding of others' mental states. Recently, individuals with attention-deficit hyperactivity disorder (ADHD) have been shown to have social and communication difficulties, and ToM in ADHD has come under scrutiny. Although some studies have employed explicit ToM tasks to this end with contradictory results, none, to our knowledge, has investigated spontaneous ToM in individuals with ADHD. Therefore, we performed this study to examine implicit mentalizing in adults with ADHD using the anticipatory-looking paradigm designed by Senju et al. (2009) with a sample of 24 adults with ADHD and 18 neurotypical adults. The total fixation times to three areas of interest, i.e., the actor and the false-belief congruent and incongruent sides of the scene were measured. We found that neither group showed looking bias toward either the false-belief congruent or incongruent side. We interpret that this similar gaze pattern and the absence of looking bias to the false-belief incongruent side in both groups is indicative of intact implicit ToM in adults with ADHD. Adults with ADHD looked significantly less at the actor than did neurotypical individuals, possibly due to inattention and further experimental modifications should be considered.

Clinical Characteristics of Women with ADHD in Japan.

PURPOSE: Although gender differences have been reported in various aspects of adult attention-deficit hyperactivity disorder (ADHD), such as prevalence, comorbidities, and social functioning, there have been few such studies conducted in Japan. Our research investigated gender differences in sociodemographic and clinical characteristics of adults with ADHD in a Japanese clinical sample. Due to unique Japanese cultural ideals and expectations of women's behavior that are in opposition to ADHD symptoms, we hypothesized that women with ADHD experience more difficulties and present more dysfunctions than men. We tested the following hypotheses: first, women with ADHD have more comorbidities than men with ADHD; second, women with ADHD experience more social hardships than men, such as having less full-time employment and being more likely to be divorced. PATIENTS AND METHODS: The subjects were 335 outpatients with a DSM-5 ADHD diagnosis, who visited our ADHD specialty clinic at Showa University Karasuyama Hospital in central Tokyo between April 2015 and March 2016. Sociodemographic and clinical characteristics were collected, and gender differences were compared. RESULTS: Results fully supported our hypotheses: women had a significantly higher psychiatric comorbidity rate, were significantly less likely to be a full-time employee, and were significantly more likely to be divorced than men with ADHD. CONCLUSION: Consistent with research in other countries, women with ADHD have greater impairments than men with ADHD in Japan. The importance of understanding gender differences of ADHD-diagnosed adults within a sociocultural context is highlighted.

[Biological Mechanisms of ADHD].

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inappropriate levels of inattention, hyperactivity and impulsivity. Recent developments in neuroimaging and functional brain studies have revealed volumetric reductions and decreased neural activities in the frontal lobe, basal ganglia, limbic system, and cerebellum. Based on these findings, impairment of executive function and the reward system, reffered to as the dual pathway model, and dysfunction of the default mode network have been proposed as biological changes underlying ADHD. Bio-pharmacological studies have shown dysfunctions in catecholamine- regulated neurotransmission, especially dysfunction of dopamine transporters, which the therapeutic drug of methylphenidate is thought to modulate. Agrowing body of genetic research suggests the high heritability of ADHD and several candidate genes relating to dopamine synthesis and transmission have been identified. Epigenetic modification is also garnering much attention in ADHD research and the mutual effects of environmental factors and genetic polymorphism have been reported. Despite such accumulative findings, how genes, the environment, and brain functioning interact and relate to create the symptoms of ADHD are still unknown and more research is needed to uncover the biological mechanisms of ADHD.