Alcohol and drug use disorders in adult attentiondeficit/hyperactivity disorder:Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation

BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation,in adults with ADHD.METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo,Norway(2014-2018).Five-hundred and fifty-eight eligible patients diagnosed with ADHD(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria)agreed to participate.Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview(MINI).Dependence and abuse were merged into“use”disorder as in MINI version 7.0/DSM-5.Questions were related both to lifetime and the past 12-mo.ADHD severity was assessed by the Adult ADHD Self Report Scale(ASRS).Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately.Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale-Self Report.RESULTS The 12-mo prevalence was 5.3%for alcohol use disorder and 13.7%for drug use disorder.The lifetime prevalence was 12.0%for alcohol use disorder and 27.7%for drug use disorder.Men had higher rates of both alcohol use disorder and drug use disorder compared to women.The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes.The drugs most participants reported having used were(in descending order):Amphetamine(19.1%),cannabis(17.1%),cocaine or ecstasy(7.4%),benzodiazepines(7.4%),and heroin or other opioids(2.9%).Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity.Lifetime alcohol use disorder,on the other hand,was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder,which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project

Purpose:This study was aimed to analyze the associations of objectively measured physical activity(PA),sedentary time,and physical fitness with mental health in the early second trimester(16§2 gestational weeks)of pregnancy.Methods:From 229 women initially contacted,124 pregnant women participated in the present cross-sectional study.Data were collected between November 2015 and March 2017.The participants wore Actigraph GT3X+Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time.A performance-based test battery was used to measure physical fitness.Self-report questionnaires assessed psychological ill-being(i.e.,negative affect,anxiety,and depression),and psychological well-being(i.e.,emotional intelligence,resilience,and positive affect).Linear regression analyses were adjusted for age,educational level,accelerometer wear time,miscarriages,and low back pain.Results:Moderate-to-vigorous PA was negatively associated with depression(b=0.222,adjusted R2=0.050,p=0.041).Higher levels of sedentary time were negatively associated with positive affect(b=0.260,adjusted R2=0.085,p=0.017).Greater upper-body flexibility was positively associated with better emotional regulation(b=0.195,adjusted R2=0.030,p=0.047).The remaining associations were not significant(all p>0.05).Conclusion:An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women.Although previous research has focused on the benefits of cardiorespiratory exercise,the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women.If the present findings are corroborated in further experimental research,physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.

Neural correlations between cognitive deficits and emotion regulation strategies:understanding emotion dysregulation in depression from the perspective of cognitive control and cognitive biases

The link between cognitive function and emotion regulation may be helpful in better understanding the onset,maintenance,and treatment for depression.However,it remains unclear whether there are neural correlates between emotion dysregulation and cognitive deficits in depression.To address this question,we first review the neural representations of emotion dysregulation and cognitive deficits in depression(including deficits in cognitive control and cognitive biases).Based on the comparisons of neural representations of emotion dysregulation versus cognitive deficits,we propose an accessible and reasonable link between emotion dysregulation,cognitive control,and cognitive biases in depression.Specifically,cognitive control serves the whole process of emotion regulation,whereas cognitive biases are engaged in emotion regulation processes at different stages.Moreover,the abnormal implementation of different emotion regulation strategies in depression is consistently affected by cognitive control,which is involved in the dorsolateral,the dorsomedial prefrontal cortex,and the anterior cingulate cortex.Besides,the relationship between different emotion regulation strategies and cognitive biases in depression may be distinct:the orbitofrontal cortex contributes to the association between ineffective reappraisal and negative interpretation bias,while the subgenual prefrontal cortex and the posterior cingulate cortex underline the tendency of depressed individuals to ruminate and overly engage in self-referential bias.This review sheds light on the relationship between cognitive deficits and emotion dysregulation in depression and identifies directions in need of future attention.

Effects of prolonged methylphenidate treatment on amygdala reactivity and connectivity:a randomized controlled trial in stimulant treatment-naive,male participants with ADHD

Background:Problems with emotional processing are widely reported in individuals with attentiondeficit/hyperactivity disorder(ADHD).Although methylphenidate(MPH)effectively alleviates inattention and hyperactivity symptoms in ADHD,its effects on emotional processing and internalizing symptoms have remained elusive.While we previously found that acute MPH administration modulated neural mechanisms underlying emotional processing in an age-dependent manner,the effects of prolonged administration remained unknown.Objectives:Therefore,we investigated:(i)whether prolonged MPH treatment influences neural substrates(amygdala reactivity and connectivity)of emotional processing,and(ii)whether these effects are modulated by age.Methods:The“effects of Psychotropic drugs On Developing brain-MPH”(“ePOD-MPH”)randomized controlled trial was a 16-week double-blind,placebo-controlled,multi-center trial with MPH in 50 boys(10–12 years of age)and 49 men(23–40 years of age),all stimulant treatment-naive and diagnosed with ADHD.Participants performed an emotional face-matching task during functional magnetic resonance imaging.We assessed their symptoms of ADHD and internalizing symptoms at baseline,during the trial(8 weeks),and 1 week after the trial end(17 weeks).Results and Conclusions:We did not find effects of prolonged MPH treatment on emotional processing,as measured by amygdala reactivity and connectivity and internalizing symptoms in this trial with stimulant treatment-naive participants.This differs from our findings on emotional processing following acute MPH administration and the effects of prolonged MPH treatment on the dopamine system,which were both modulated by age.Interestingly,prolonged MPH treatment did improve ADHD symptoms,although depressive and anxiety symptoms showed a medication-independent decrease.Furthermore,our data indicate that baseline internalizing symptoms may be used to predict MPH treatment effects on ADHD symptoms,particularly in(male)adults with ADHD.