RESUMEN
DSM-5 Disruptive Mood Dysregulation Disorder (DMDD) is a controversial new diagnosis. The DSM-5 conceptualizes DMDD as persistent and chronic, but the stability of the two DMDD symptoms (irritable-angry mood and temper outbursts) over time is not known. Mothers rated DMDD symptoms in a population-based sample of 376 children (54 % male) evaluated at 6-12 years (M 9) and again an average of 8 years later (M 16). Mean scores on irritable-angry mood plus temper outbursts at baseline and follow-up were below sometimes a problem, but were higher at baseline than follow-up. Irritable-angry mood and temper outbursts were both often or very often a problem for 9 % of children at baseline, 6 % at follow-up, and 3 % at baseline and follow-up. Only 29 % of children whose baseline symptoms were often or very often continued to have follow-up symptoms at this level (remission rate 71 %). Less than half (45 %) of the children whose symptoms were often or very often at follow-up had these symptoms 8 years earlier (55 % new cases). Our finding of 71 % remission and 55 % new cases indicates instability of DMDD symptoms over an 8-year period. However, the finding that 29 % still had symptoms often or very often 8 years later is clinically significant. DMDD symptoms were found in only one child who did not have symptoms of oppositional defiant disorder (ODD), conduct disorder, ADHD, anxiety, or depression. This suggests that DMDD symptoms are a feature of multiple disorders, particularly ODD, and do not occur in isolation, questioning the validity of DMDD as a unique and independent diagnosis.
Asunto(s)
Desarrollo del Adolescente/fisiología , Desarrollo Infantil/fisiología , Progresión de la Enfermedad , Genio Irritable/fisiología , Trastornos del Humor/fisiopatología , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: To explore the link between pediatric obesity and attention deficit/hyperactivity disorder (ADHD) by examining whether executive functioning (EF) and medication status are associated with body mass index (BMI) and weight status in children with ADHD. METHOD: Participants for this study included 80 children (mean age=10 years, 9 months) with a DSM-IV diagnosis of ADHD, confirmed by a comprehensive clinical diagnostic assessment. Children's EF was measured using three neuropsychological tests, and severity of ADHD symptoms and medication status were obtained from parent report. Children's height and weight were also measured during the visit using a wall-mounted stadiometer and a balance beam scale. RESULTS: Children with ADHD who performed poorly on the neuropsychological battery had greater BMI z-scores, and were more likely to be classified as overweight/obese compared with children with ADHD who performed better on the neuropsychological battery. In addition, children with ADHD who were taking a stimulant medication had significantly lower BMI z-scores compared with children with ADHD who were not taking medication or who were taking a non-stimulant medication. CONCLUSION: EF is more impaired among children with ADHD and co-occurring weight problems, highlighting the importance of self-regulation as a link between pediatric obesity and ADHD.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estimulantes del Sistema Nervioso Central/uso terapéutico , Función Ejecutiva/efectos de los fármacos , Obesidad/epidemiología , Psicotrópicos/uso terapéutico , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Estimulantes del Sistema Nervioso Central/efectos adversos , Niño , Preescolar , Comorbilidad , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Obesidad/fisiopatología , Psicotrópicos/efectos adversos , Índice de Severidad de la Enfermedad , Controles Informales de la Sociedad , Estados Unidos/epidemiologíaRESUMEN
The objective of this study was to examine psychological processes in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients in relation to measures of life stress, coping styles, social support and cognitive ability. Fifty-two SLE patients without overt neuropsychiatric symptoms, 29 RA patients and 27 healthy controls completed measures of depression, mood, disease activity, perceived health, stressful life events, coping, and social support. Variables entered into the multiple regression analysis following principal component analysis were: group, major difficult event, major life threatening event, disengaging coping, emotional coping, social support, and cognitive impairment. Depressive symptoms were associated with SLE group status (P < 0.001), major life-threatening events (P < 0.01), disengage coping (P < 0.001) and emotional coping (P < 0.05). SLE group status (P < 0.05), disengage coping (P < 0.05) and emotional coping (P < 0.05) were associated with current distressed mood. SLE patients without overt, major neuropsychiatric symptoms had greater psychological distress compared to RA and control subjects. Increased depressive symptoms and distressed mood state in SLE patients were related to use of disengaging and emotional coping styles. These findings are limited to SLE patients with no overt neuropsychiatric illness and low disease activity, suggesting the need for future studies with a greater variety of SLE patients. Interventions aimed at improving active coping and minimizing emotional response to stress may lower psychological distress in SLE patients with mild disease.
Asunto(s)
Adaptación Psicológica , Acontecimientos que Cambian la Vida , Lupus Eritematoso Sistémico/psicología , Apoyo Social , Estrés Psicológico/etiología , Adulto , Afecto , Artritis Reumatoide/psicología , Estudios de Casos y Controles , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Componente Principal , Análisis de RegresiónRESUMEN
If stereotypes function to protect people against death-related concerns, then mortality salience should increase stereotypic thinking and preferences for stereotype-confirming individuals. Study 1 demonstrated that mortality salience increased stereotyping of Germans. In Study 2, it increased participants' tendency to generate more explanations for stereotype-inconsistent than stereotype-consistent gender role behavior. In Study 3, mortality salience increased participants' liking for a stereotype-consistent African American and decreased their liking for a stereotype-inconsistent African American; control participants exhibited the opposite preference. Study 4 replicated this pattern with evaluations of stereotype-confirming or stereotype-disconfirming men and women. Study 5 showed that, among participants high in need for closure, mortality salience led to decreased liking for a stereotype-inconsistent gay man.
Asunto(s)
Actitud Frente a la Muerte , Identidad de Género , Percepción Social , Estereotipo , Violencia/etnología , Violencia/psicología , Adulto , Negro o Afroamericano/psicología , Población Negra , Estudios de Casos y Controles , Colorado , Femenino , Alemania/etnología , Homosexualidad Masculina , Humanos , Masculino , Prejuicio , Distribución AleatoriaRESUMEN
OBJECTIVE: Very little research has focused on the efficacy of Adderall (Shire-Richwood Inc, Florence, KY) in the treatment of children with attention-deficit/hyperactivity disorder (ADHD), and no studies have compared it with standardized doses of Ritalin (Novartis Pharmaceuticals, East Hanover, NJ). It is thought that Adderall has a longer half-life than Ritalin and might minimize the loss of efficacy that occurs 4 or 5 hours after Ritalin ingestion. We compared two doses of Ritalin and Adderall in the treatment of ADHD in children in an acute study and assessed the medications' time courses. DESIGN: Within-subject, double-blind, placebo-controlled, crossover design lasting 6 weeks. As in our previous work, medication changes occurred on a daily basis in random order over days. SETTING: Eight-week, weekday (9 hours daily) summer treatment program at the State University of New York at Buffalo, using an intensive behavioral treatment program including a point system and parent training. STUDY PARTICIPANTS: Twenty-five children (21 boys and 4 girls) diagnosed as ADHD using standardized structured interview and rating scales, mean age 9.6 years, 88% Caucasian, of average intelligence, with no medical conditions that would preclude a trial of stimulant medication. Thirteen were comorbid for oppositional-defiant disorder and another 8 for conduct disorder. INTERVENTIONS: Children received 10 mg of Ritalin, 17.5 mg of Ritalin, 7.5 mg of Adderall, 12.5 mg of Adderall, or placebo, twice a day (7:45 AM and 12:15 PM), in random order with conditions changing daily for 24 days. OUTCOME MEASURES: Daily rates of behaviors in recreational and classroom settings, and standardized ratings from counselors, teachers, and parents, were averaged across days within condition within child and compared. Within-subject relative sizes of the medication effects were computed by taking the placebo-minus-drug mean difference divided by the placebo standard deviation for each child, and were compared hourly between first daily ingestion (7:45 AM) and 5:00 PM to assess the time course of the two drugs. Measures were taken at 12:00 PM (recess rule violations) and at 5:00 PM (parent behavior ratings) to determine whether Adderall was still effective at times when the effects of Ritalin should have worn off. Parent ratings were also made for evening behavior to assess possible rebound, and side effects ratings were obtained from parents, counselors, and teachers. Parents, counselors, and teachers also rated their perceptions of medication status and whether they recommended the continued use of the medication given that day. Finally, a clinical team made recommendations for treatment taking into account each child's individual response. RESULTS: Both drugs were routinely superior to placebo and produced dramatic improvements in rates of negative behavior, academic productivity, and staff/parent ratings of behavior. The doses of Adderall that were assessed produced greater improvement than did the assessed doses of Ritalin, particularly the lower dose of Ritalin, on numerous but not all measures. This result suggests that the doses of Adderall used were functionally more potent than those for Ritalin. Adderall was generally superior to the low dose of Ritalin when the effects of Ritalin were wearing off at midday and late afternoon/early evening. The lower dose of Adderall produced effects comparable to those of the higher dose of Ritalin. Both drugs produced low and comparable levels of clinically significant side effects. Staff clinical recommendations for continued medication favored Adderall three to one. Almost 25% of the study participants were judged to be nonresponders by the clinical team, presumably because of their large beneficial response to the concurrent behavioral intervention and minimal incremental benefit from medication. CONCLUSIONS: This is the first investigation to assess comparable doses of Adderall and Ritalin directly. (ABSTRACT TRU