This book reviews key recent advances and new frontiers within psychiatric research and clinical practice. These advances either represent or are enabling paradigm shifts in the discipline and are influencing how we observe, derive and test hypotheses, and intervene. Progress in information technology is allowing the collection of scattered, fragmented data and the discovery of hidden meanings from stored data, and the impacts on psychiatry are fully explored. Detailed attention is also paid to the applications of artificial intelligence, machine learning, and data science technology in psychiatry and to their role in the development of new hypotheses, which in turn promise to lead to new discoveries and treatments. Emerging research methods for precision medicine are discussed, as are a variety of novel theoretical frameworks for research, such as theoretical psychiatry, the developmental approach to the definition of psychopathology, and the theory of constructed emotion. The concluding section considers novel interventions and treatment avenues, including psychobiotics, the use of neuromodulation to augment cognitive control of emotion, and the role of the telomere-telomerase system in psychopharmacological interventions.

A boy with attention deficit and hyperactivity disorder (ADHD) presented with a fetish for and the subsequent stealing of female undergarments. He was predominantly inattentive and had been a slow learner. Psychological tests showed that he had significant cognitive and inattention problems without significant hyperactivity, and was at risk of dyslexia as well as conduct disorder.

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Background Individuals with co-occurring hyperactivity disorder/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can have complex presentations that may complicate diagnosis and treatment. There are established guidelines with regard to the identification and treatment of ADHD and ASD as independent conditions. However, ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature. This has led to uncertainty among healthcare practitioners when working with children, young people and adults who present with co-existing ADHD and ASD. The United Kingdom ADHD Partnership (UKAP) therefore convened a meeting of professional experts that aimed to address this gap and reach expert consensus on the topic that will aid healthcare practitioners and allied professionals when working with this complex and vulnerable population. Method UK experts from multiple disciplines in the fields of ADHD and ASD convened in London in December 2017. The meeting provided the opportunity to address the complexities of ADHD and ASD as a co-occurring presentation from different perspectives and included presentations, discussion and group work. The authors considered the clinical challenges of working with this complex group of individuals, producing a consensus for a unified approach when working with male and female, children, adolescents and adults with co-occurring ADHD and ASD. This was written up, circulated and endorsed by all authors. Results The authors reached a consensus of practical recommendations for working across the lifespan with males and females with ADHD and ASD. Consensus was reached on topics of (1) identification and assessment using rating scales, clinical diagnostic interviews and objective supporting assessments; outcomes of assessment, including standards of clinical reporting; (2) non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training, and (3) pharmacological treatments. Conclusions The guidance and practice recommendations (Tables 1, 4, 5, 7, 8 and 10) will support healthcare practitioners and allied professionals to meet the needs of this complex group from a multidisciplinary perspective. Further research is needed to enhance our understanding of the diagnosis, treatment and management of individuals presenting with comorbid ADHD and ASD.

The invention comprises a method for treatment of ADHD or ADHD-related disorders by a pharmaceutical agent exhibiting combined serotonergic or noradrenergic reuptake transporters and monoamine receptor activity.

Abstract. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition that impairs quality of life in social, academic, and occupational contexts for both children and adults. Although a strong neurobiological basis has been demonstrated, the pathophysiology of ADHD is still poorly understood. Among the proposed mechanisms are glial activation, neuronal damage and degeneration, increased oxidative stress, reduced neurotrophic support, altered neurotransmitter metabolism, and blood-brain barrier disruption. In this way, a potential role of inflammation has been increasingly researched. However, evidence for the involvement of inflammation in ADHD is still scarce and comes mainly from (1) observational studies showing a strong comorbidity of ADHD with inflammatory and autoimmune disorders; (2) studies evaluating serum inflammatory markers; and (3) genetic studies. A co-occurrence of ADHD with inflammatory disorders has been demonstrated in a large number of subjects, suggesting a range of underlying mechanisms such as an altered immune response, common genetics, and environmental links. The evaluation of serum inflammatory markers has provided mixed results, likely due to the small sample sizes and high heterogeneity between biomarkers. However, there is evidence that increased inflammation during the early development may be a risk factor for ADHD symptoms. Although genetic studies have demonstrated a potential role for inflammation in this disorder, there is no clear evidence. To sum up, inflammation may be an important mechanism in ADHD pathophysiology, but more studies are still needed for a more precise conclusion.

ADHD in Adults - March 2011

For decades, psychostimulants have been the gold standard pharmaceutical treatment for attention-deficit/hyperactivity disorder (ADHD). In the United States, an astounding 9% of all boys and 4% of girls will be prescribed stimulant drugs at some point during their childhood. Recent meta-analyses have revealed that individuals with ADHD have reduced brain volume loss later in life (>60 y.o.) compared to the normal aging brain, which suggests that either ADHD or its treatment may be neuroprotective. Crucially, these neuroprotective effects were significant in brain regions (e.g., hippocampus, amygdala) where severe volume loss is linked to cognitive impairment and Alzheimer’s disease. Historically, the ADHD diagnosis and its pharmacotherapy came about nearly simultaneously, making it difficult to evaluate their effects in isolation. Certain evidence suggests that psychostimulants may normalize structural brain changes typically observed in the ADHD brain. If ADHD itself is neuroprotective, perhaps exercising the brain, then psychostimulants may not be recommended across the lifespan. Alternatively, if stimulant drugs are neuroprotective, then this class of medications may warrant further investigation for their therapeutic effects. Here, we take a bottom-up holistic approach to review the psychopharmacology of ADHD in the context of recent models of attention. We suggest that future studies are greatly needed to better appreciate the interactions amongst an ADHD diagnosis, s...

“A lively, approachable way to befriend your ADHD and thrive!” —Melissa Orlov, author of award-winning The ADHD Effect on Marriage May We Have Your Attention Please? will help you to conquer your adult ADHD — in a way that’s right for you. This practical and engaging workbook uses cutting-edge research and lessons from working with thousands of adults with ADHD, as shared by specialists with extensive professional — and sometimes personal — experience managing the disorder. Through digestible chapters and practical exercises you will: - Learn how your brain works to leverage your ADHD for strength. - Discover practical, hands-on activities to separate yourself from your symptoms. - Find an approach to treatment that works for you. You’ll share your journey with Jason, Candace, Tim and Amy: four characters embarking on different journeys through ADHD. Each will inspire you to see past mental health symptoms and boldly take ownership of your personal wellbeing. They represent resilience, growth, optimism and strength. Life is not linear: neither is working through ADHD. May We Have Your Attention Please? will lead you to a place of clarity and purpose, to live with, not in spite of, your ADHD. May We Have Your Attention Please? is brought to you by Springboard Clinic: offering innovative approaches to ADHD care since 2009. Looking to stay on track or enhance your reading experience? We're creating online courses to accompany readers through this process! Visit springboardclinic.com to find out more.

Attention deficit hyperactivity disorder (ADHD) is a debilitating psychiatric illness affecting approximately 4% to 12% of the population. Characterized by persistent problems with distractibility, impulsivity, and/or hyperactivity, ADHD has a significant effect on day-to-day functioning and quality of life. Unfortunately, ADHD often goes unrecognized. Patients may hesitate to disclose their symptoms, and physicians unfamiliar with this disorder may confuse its manifestations with other psychiatric illnesses. Common comorbidities can further cloud the diagnosis. This course will cover the epidemiology, diagnostic criteria, pathophysiology, and differential diagnosis of ADHD. It will review the first-line treatments, recommended duration of therapy, and options for patients who do not respond to initial therapy. Finally, it will address the roles of other therapeutic options, such as behavioral therapy.

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Abstract. One of the greatest challenges that parents confront in raising children involves monitoring their health and managing to obtain the proper treatment

Abstract. One of the greatest challenges that parents confront in raising children involves monitoring their health and managing to obtain the proper treatment

Attention deficit hyperactivity disorder (ADHD) is a clinical and diagnostic heterogeneous picture. This study analysed the association of functional polymorphisms in DAT1 VNTR 3’ UTR and DRD4 VNTR Exon III candidate genes, and the neuropsychological characterisation of attention and executive functions of a group of children with ADHD vs. controls. 32 patients and 51 controls were selected. The DAT1 10-repeat allele appeared more frequently in the two groups (cases: 0.93/control: 0.82), showing an OR: 2.5 (IC 95%: 0.684-9.133; p: 0.158). In DRD4, the 4-repeat allele shows the highest occurrence (cases: 0.62/controls: 0.60). None of the markers presented a significant association after a direct analysis, but the DRD4 7-repeat marker showed a positive risk when performing a Bayesian logistic analysis (coefficient: −1.69; OR: 5.39 CI 95%: 1.167-40.97). On the other hand, when considering association with cognitive performance, a positive risk for processing speed and attention tasks was identified.

A guide to answers emerging questions about stimulants issues in their communities.

Traumatic brain injury (TBI) is commonly defined as an insult to the brain from an external force that causes temporary or permanent impairment in functional, psychosocial, or physical abilities.1 It is a significant cause of morbidity and mortality, and the leading cause of death and disability among young adults.

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. Objective: The primary aim of this study was to collate health care professionals’ perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. Methods: A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. Results: Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. Conclusions: This study has managed to elucidate health care professionals’ perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates.