Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD.

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

We studied the relationship between cortisol and cognition in adolescents with ADHD.Hair cortisol concentrations (HCCs) were determined.We explored the moderating effects of sex and childhood trauma.Sex moderated the relationship between HCCs and attention and memory.Childhood trauma did not moderate the relationship between HCCs and cognition.

Internalizing and externalizing personality and subjective effects in a sample of adolescent cannabis users. / Personalidad internalizante y externalizante y efectos subjetivos en una muestra de adolescentes consumidores de cánnabis.

Cannabis is the illicit substance most widely used by adolescents. Certain personality traits such as impulsivity and sensation seeking, and the subjective effects experienced after substance use (e.g. euphoria or relaxation) have been identified as some of the main etiological factors of consumption. This study aims to categorize a sample of adolescent cannabis users based on their most dominant personality traits (internalizing and externalizing profile). Then, to make a comparison of both profiles considering a set of variables related to consumption, clinical severity and subjective effects experienced. From a cross-sectional design, 173 adolescents (104 men and 69 women) aged 13 to 18 asking for treatment for cannabis use disorder in an Addictive Behavior Unit (UCAD) from the hospital were recruited. For the assessment, an ad hoc protocol was employed to register consumption, the Millon Adolescent Clinical Inventory (MACI) and the Addiction Research Center Inventory (ARCI) 49-item short form were also administered. Factor analysis suggested a two-profile solution: Introverted, Inhibited, Doleful, Dramatizing (-), Egotistic (-), Self-demeaning and Borderline tendency scales composed the internalizing profile, and Submissive (-), Unruly, Forceful, Conforming (-) and Oppositional scales composed the externalizing profile. The comparative analysis showed that the internalizing profile has higher levels of clinical severity and more subjective effects reported than the externalizing profile. These results suggest the need to design specific intervention strategies for each profile.

El cánnabis es la sustancia ilícita más consumida por los adolescentes. Determinados rasgos de personalidad, como la impulsividad y la búsqueda de sensaciones, así como los efectos subjetivos experimentados tras el consumo (p.e. euforia o relajación), se han identificado como algunos de los principales factores etiológicos de consumo. Este estudio tiene por objetivo categorizar a una muestra de adolescentes consumidores de cánnabis en función de sus rasgos de personalidad más predominantes (perfil internalizante y externalizante) para, posteriormente, realizar una comparación de ambos perfiles a partir de un conjunto de variables asociadas al consumo, la gravedad clínica y los efectos subjetivos experimentados. A partir de un diseño transversal, se reclutaron 173 adolescentes (104 hombres y 69 mujeres) de 13 a 18 años, que demandaron tratamiento por Trastorno por Uso de Cánnabis en la Unidad de Conductas Adictivas (UCAD) del Hospital. Para la evaluación se utilizó un protocolo ad hoc para registrar el consumo, el Inventario Clínico para Adolescentes de Millon (MACI) y la versión abreviada del Addiction Research Center Inventory (ARCI)-49. El análisis factorial sugirió una solución en 2 perfiles: las escalas Introvertido, Inhibido, Pesimista, Histriónico (-), Egocéntrico (-), Autopunitivo y Tendencia límite forman el perfil internalizante, y las escalas Sumiso (-), Rebelde, Rudo, Conformista (-) y Oposicionista el externalizante. El análisis comparativo mostró que el perfil internalizante presenta mayores niveles de gravedad clínica y reporta más efectos subjetivos que el externalizante. Estos resultados sugieren la necesidad de diseñar estrategias de intervención específicas para cada perfil.

Adolescents with Internet Gaming Disorder (IGD): profiles and treatment response. / Adolescentes con Trastorno por juego en Internet (IGD): perfiles y respuesta al tratamiento.

Demand for treatment for problems related to the use of video games have increased significantly in adolescents. Most cases have a comorbid mental disorder that jeopardises both pathologies. The aim of this study is to describe profiles of adolescents with Internet Gaming Disorder (IGD) according to comorbidity and analyze treatment response at 3 and 6 months. A sample of 86 patients which consulted in the Addictive Behavior Unit of a hospital was assessed with diagnostic criteria for IGD, the interview K-SADS-PL for mental disorders and the Clinical Global Impression (CGI) to treatment progress. Of the initial sample, 68,6% (n = 59) met diagnostic criteria for IGD. Of these, the 45,76% matched an internalizing profile, presenting comorbidity with Mood Disorders (44,4%), Anxiety Disorders (44,4%) and Personality Disorders (11,1%). The externalizing profile would comprise 52,54% of the sample presenting Disruptive Behavior Disorder (48,4%=, ADHD (29%) and Disruptive Behavior Disorders not otherwise specified (22,6%). Unlike externalizing, the internalizing patients had a family history of psychiatric problems (63%), difficulties in social relationships (77,8%) and seemed to use video games preferably to escape discomfort (66,7%). After 3 months the externalizing profile showed improvements. Comorbid disorders allow the discrimination of two IGD profiles in adolescents and these could influence treatment response. Therefore, it is important to assess comorbidities to design a more accurate intervention focused on the specificities of each profile.

Las demandas de tratamiento de adolescentes con problemas relacionados con el uso de videojuegos han incrementado significativamente. La mayoría de casos presentan un trastorno mental comórbido que compromete ambas patologías. El objetivo del presente estudio es describir los perfiles de adolescentes con Trastorno por Juego en Internet (IGD) según la comorbilidad y analizar la respuesta al tratamiento a los 3 y 6 meses. Se ha valorado una muestra de 86 pacientes que han consultado en la Unidad de Conductas Adictivas de un hospitalmediante los criterios del IGD, la entrevista semiestructurada K-SADS-PL para los trastornos mentales y la Impresión Clínica Global (ICG) para la evolución del tratamiento. Del total de pacientes, un 68,6% (n = 59) cumplían criterios para el IGD. De estos, el 45,76% corresponderían a un perfil internalizante, presentando comorbilidades con Trastornos Afectivos (44,4%), Trastornos de Ansiedad (44,4%) y Trastornos de Personalidad (11,1%). El perfil externalizante englobaría al 52,54% de la muestra, presentando Trastorno del Comportamiento Perturbador (48,4%), TDAH (29%) y Trastorno del Comportamiento Perturbador no especificado (22,6%). A diferencia de los externalizantes, los pacientes internalizantes tienen más antecedentes psiquiátricos familiares (63%), dificultades con las relaciones sociales (77,8%) y parecen utilizar los videojuegos preferentemente para escapar del malestar (66,7%). A los 3 meses el perfil externalizante muestra mejorías. Se pueden discriminar dos perfiles de adolescentes con IGD en función de los trastornos comórbidos y esto puede influir en la respuesta al tratamiento. Por ello, resulta clave valorar las comorbilidades para realizar un planteamiento más eficaz del abordaje psicoterapéutico enfocado a las especificidades de cada perfil.

Doctors admitted to a Physicians' Health Program: a comparison of self-referrals versus directed referrals.

OBJECTIVE: To compare the profile of doctors with mental disorders admitted to a Physicians' Health Program (PHP) depending on their type of referral. DESIGN: Retrospective chart review. METHOD: We analysed 1545 medical records of doctors admitted to the Barcelona PHP (PAIMM) from 1 February 1998 to 31 December 2012. RESULTS: Most doctors (83.2%) were self-referred to the programme. Patients non-self-referred were older ([Formula: see text]=55 vs [Formula: see text]=49.6 years; t=6.96, p<0.01) than those self-referred and there were more men (68.3%) than women (45.8%; OR=0.39; 95% CI 0.29 to 0.52). Self-referrals were more frequent among patients with non-addictive disorders (84.6% vs 15.4%; OR=4.52; 95% CI 3.23 to 28.45). Self-referred patients needed less inpatient admissions (16.8% vs30.9%; OR=2.22; 95% CI 1.63 to 3.01) and the length of their treatment episodes was shorter ([Formula: see text]=24.3 vs [Formula: see text] = 32.4 months; t=3.34; p<0.01). Logistic regression showed a significant model (χ(2)=67.52; df=3; p<0.001). Age, gender and diagnosis were statistically associated with type of referral to the programme. CONCLUSIONS: Type of referral to a PHP may be influenced not only by sick doctors' personal traits but also by each programme's design and how it is perceived by service users. Our findings should be taken into account when designing treatment and preventive interventions for this professional group.

Promoting voluntary help-seeking among doctors with mental disorders.

OBJECTIVES: To explore if the Barcelona Integral Care Program for Doctors with mental disorders (PAIMM, in Catalan) has achieved its goal of enhancing earlier and voluntary help-seeking amongst sick doctors. MATERIAL AND METHODS: We conducted a retrospective chart review of 1363 medical records of physicians admitted to the inpatient and outpatient units of the PAIMM from February 1st, 1998 until December 31st, 2011. The sample was divided into 3 time periods: 1998-2004, 2005-2007 and 2008-2011 (477, 497, and 389 cases, respectively). RESULTS: The mean age at admission decreased (F = 77.57, p < 0.001) from the first period (x = 54.18; SD = 10.28 years) to the last period (x = 44.81; SD = 10.65 years), while voluntary referrals increased from 81.3% to 91.5% (Chi(2) = 17.85, p < 0.001). Mental disorders other than substance use disorders grew from 71% during the 1998-2003 period, to 87.4% (2004-2007), and 83.9% in the last period (Chi2 = 29.01, p < 0.001). Adjustment disorders increased their prevalence, while inpatient treatment progressively represented less of the overall clinical activity. CONCLUSIONS: Sick doctors may feel encouraged to seek help in non-punitive programs specially designed for them and where treatment becomes mandatory only when there is risk or evidence of malpractice.

Cocaine use in Europe - a multi-centre study. Methodology and prevalence estimates.

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Cocaine use in Europe - a multi-centre study: patterns of use in different groups.

AIM: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. DESIGN, SETTING, PARTICIPANTS: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. MEASUREMENTS: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. FINDINGS: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. CONCLUSIONS: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.