Neuropsychological assessment of attention in adults with different subtypes of attention-deficit/hyperactivity disorder.

There is only little information about varying attention functions of adults with different DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD). In the present study groups of adult patients with ADHD - predominantly inattentive type, ADHD - predominantly hyperactive-impulsive type or ADHD - combined type and three healthy control groups were compared regarding multiple components of attention. Assessment of attention was performed using a computerized neuropsychological test battery for attentional functions. In comparison with healthy subjects, the three patient groups displayed impairments of vigilance, selective attention, divided attention, and flexibility. These impairments of attention of ADHD subgroups were primarily observed with regard to reaction time. With regard to tonic and phasic alertness no differences between patient and control groups could be found. Comparison between ADHD subgroups revealed that DSM-IV subtypes of ADHD differ in measures of divided attention, selective attention and flexibility. Differences between ADHD subgroups were primarily observed with regard to task accuracy. The results suggest that while distinct profiles of attentional functioning were observed between adult patients with ADHD and healthy adults indicating gross disturbances of various attention functions in patients with ADHD, differences between ADHD subgroups were only weak.

Methylphenidate-induced improvements of various measures of attention in adults with attention deficit hyperactivity disorder.

The present study examined the effect of the stimulant medication methylphenidate (MPH) on attentional functioning of adults with ADHD. Sixteen adults with a diagnosed ADHD without comorbidity were assessed twice, at baseline off MPH and following MPH treatment. The assessment battery consisted of reaction time tasks of low complexity, including measures of alertness--subdivided into tonic and phasic alertness, vigilance, divided attention, flexibility and such aspects of selective attention as including focused attention, inhibition and integration of sensory information. In addition, 16 healthy participants who were matched to adults with ADHD according to sex, age, education level and intellectual functions were also assessed twice using the same test battery. The results of the present study suggest that adults with ADHD off stimulant medication are seriously impaired in various components of attention including vigilance, divided attention, selective attention and flexibility. These impairments of attention were observed primarily in regard to reaction time and its variability. Treatment of adults with ADHD using individually tailored doses of MPH has a positive effect on measures of alertness, vigilance, selective attention, divided attention and flexibility. However, even on MPH adults with ADHD displayed considerable deficits in vigilance and integration of sensory information. The present findings indicate that adults with ADHD are not differentially impaired in attentional processes but may suffer from a more global deficit of attention. Although MPH treatment has been found to be effective in the treatment of the attention deficit of adults with ADHD, additional treatment appears to be necessary.

[Adult attention deficit/hyperactivity disorder]. / Aufmerksamkeitsdefizitstörung beim Erwachsenen. Wie erkennen, wie behandeln?

ADHD (attention deficit/hyperactivity disorder) in adults is a more complex pathological condition than ADHD seen in children and adolescents. The number of reports of impaired self-regulation are on the increase. Psychiatric comorbities are being found ever more frequently, and negative life experiences are coloring the clinical presentation to an ever greater extent. Therapeutic strategies involving the use of stimulants and antidepressants are often needed to pave the way for individual and group psychotherapy. Despite the fact that it is currently considered to be "fashionable", the diagnosis of ADHD is a clinically relevant and persisting psychological disorder.

[Effect of chronic pressure and volume stress on the function of the right ventricle]. / Einfluss von chronischer Druck- und Volumenbelastung auf die Funktion des rechten Ventrikels.

Biplane right ventricular angiography was performed in 36 patients with chronic pressure overload of the right ventricle; 12 patients additionally had tricuspid insufficiency (TI). There were 4 subgroups: patients with systolic pulmonary artery pressure less than or equal to 40 mm Hg without (group I, n = 10) and with TI (group II, n = 6), as well as patients with systolic pulmonary artery pressure greater than 40 mm Hg without (group III, n = 14) and with TI (group IV, n = 6). Compared with the normal volumes of groups I and III, a significant increase in end-diastolic right ventricular volumes (p less than 0.01) was found in groups II and IV with 112.2 +/- 22.3 ml/m2 and 116.3 +/- 27.4 ml/m2, respectively. In both groups II and IV end-systolic volumes were also significantly increased, with 51.0 +/- 10.3 ml/m2 in group II and 49.7 +/- 11.3 ml/m2 in group IV. Right ventricular ejection fraction was 53.8 +/- 11.9% in group II, 57.3 +/- 8.5% in group III and 57.8 +/- 7.3% in group IV. There was no significant difference between the ejection fraction of these groups in comparison to the normal ejection fraction of group I with 63.4 +/- 10.9%. The results suggest that the right ventricle can compensate for moderate chronic pressure and volume overload using the Frank-Starling mechanism. Overall right ventricular dysfunction is not determined primarily by the loading conditions alone. Local myocardial and septal involvement is suspected to be an important determinant of right ventricular function.

[Stages of postmortem formation of washerwoman's skin--results of systematic qualitative and quantitative experimental studies]. / Stadien postmortaler Waschhautbildung--Ergebnisse systematischer qualitativer und quantitativer experimenteller Untersuchungen.

The development of washerwoman's hands depends upon the length of submersion. Until now there have been no results published on the qualitative and quantitative time-related changes with regard to washer-woman's hands. The fingertips of 50 hands from 35 corpses were qualitatively examined at early postmortem (1-4 h after death). The quantitative investigations were confined to the tips of the middle fingers. Submersion of the hands in water at 37 degrees C was interrupted at intervals of 10 min, 30 min, 60 min, 2 h, 3 h, 4 h, 6 h, 10 h and 24 h for a period of 30s-1 min. The width of three adjoining ridges of the skin were measured in three defined areas of the middle fingertips and photographs were taken. Quantitative results: No relevant differences were seen in the changes of the width of the skin ridges between the right and left hand after submersion in water; there was no specific difference between the sexes. During the soaking process the skin ridges influence each other. The age of the individual corpse has no influence on the change in width of the skin ridges. Concerning the qualitative test results, six time-limited stages could be classified: stage I: physiological dry state; stage II: softened state; stage III: swollen and compressed state; stage IV: partial wrinkle covering; stage V: epidermal lysis; stage VI: loss of relief outlines.