Functioning of Young Adults With ADHD in the Military.

Objective: To assess the functioning of young adults with ADHD in a military setting. Method: In all, 14,655 young adults with ADHD (mean age at first examination 17.8 ± 0.7) attending mandatory service in the Israeli military were compared with matched controls on several functioning domains. Results: Young adults with ADHD had more sessions with mental health care professionals, physician appointments, sick days, and disqualifications of professions than controls (p < .001). Young adults with ADHD were also less medically fit for combat service (odds ratio [OR] = 0.75, 95% confidence interval [CI] = [0.72, 0.79]), more medically unfit for military service in general (OR = 1.26, 95% CI = [1.13, 1.40]), and had higher rates of overweight and obesity (p < .001). In addition, they were more likely to be diagnosed with a personality disorder (OR = 1.29, 95% CI = [1.07, 1.53]) or with minor affective and anxiety disorders (OR = 1.33, 95% CI = [1.06, 1.67]) than matched controls. Conclusion: These results support a negative effect of ADHD on the functioning of young adults in a military setting.

The Impact of Adherence to Treatment for ADHD on the Quality of Military Service - The Israeli Military Experience.

INTRODUCTION: Attention deficit hyperactive disorder (ADHD) is prevalent in 5.9-7.1% of children and adolescents, and 5% of adults. It results in poor academic, occupational, and social functioning. Pharmacotherapy improves core symptoms; however, average adherence levels are low and decrease at 16-17 years of age, just before the recruitment age to Israel Defense Forces (IDF). This study evaluated the effect of adherence to ADHD pharmacotherapy on occupational performance among soldiers. MATERIALS AND METHODS: Retrospective data were collected for the study cohort, which included all soldiers serving in the IDF from 2008 through 2012 (n > 500,000). Each soldier in the cohort was categorized based on adherence to treatment, as measured by prescriptions filled monthly: (1) no treatment, (2) low adherence (<2/year), (3) medium adherence (2-6/year), and (4) high adherence (>6/year). Occupational performance was evaluated by 3 indicative parameters: (1) number of sick days, (2) number of exemptions from daily activities, and (3) military profession disqualification, including sub-analysis to military profession groups. RESULTS: ADHD pharmacotherapy adherence correlated inversely with occupational performance, as exhibited by more sick days and exemptions from daily activities. All soldiers pharmacologically treated for ADHD had higher professional disqualification rates compared with soldiers who did not require ADHD treatment. In contrast to the general trend, in the military drivers group, higher rates of ADHD adherence correlated with lower professional disqualification rates. CONCLUSIONS: Our hypothesis that greater adherence would correlate positively with better occupational performance was refuted. We speculate that increased adherence levels are indicative of more severe ADHD and thus, accompanied by lower occupational performance. The correlation between increased adherence and improved driving ability could be attributed to the nature of driving professions, which require a high level of concentration. Due to the importance of driving in both military and civilian settings, interventions designed to enhance adherence to treatment for ADHD among drivers could have a broad effect on driving consequences, and should be considered by policymakers.

Corneal temperature in schizophrenia patients.

Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs (neuroleptics or non-neuroleptics) on schizophrenic psychosis as well as the role of corneal temperature as a tool to evaluate adherence to APD treatment merit further investigation via larger samples of both medicated and drug-free schizophrenia patients compared to matched controlled subjects.

Psychopharmacology of violent behavior in adolescents.

The aim of this review is to discuss the biological basis for the pharmacotherapy of violence in adolescents. The current and updated views on the etiology, biochemistry and neuroanatomy of violence in youth are presented. Concepts in the treatment and the pharmacological agents that are used both in short and long term are discussed and we conclude with some of recent findings in the exciting field of genetics of violence. The review emphasizes that treatment should always combine a socio-psycho-biological and multi-disciplinary approach, because any single treatment for violence cannot stands on its own.

Increased corneal temperature in drug-free male schizophrenia patients.

Schizophrenia patients may exhibit altered body temperature. We hypothesized that drug-free patients may have a higher corneal temperature than normal subjects. The corneal temperature of seven remitted drug-free schizophrenia outpatients and seven healthy volunteers was evaluated with a flir thermal imaging camera. A significantly higher corneal temperature was observed in the patient group (34.60+/-1.89 vs. 33.05+/-0.58 degrees C; P=0.005) and it correlated with their BPRS score (r=0.82; P=0.024). The relevance of these preliminary findings merit further investigation.