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Objective: To investigate total and selected region-of-interest-based gray matter volume (GMV) in older adults with ADHD. Method: Twenty-five elderly (≥65 years old) patients with ADHD and 34 healthy controls underwent 1.5-T magnetic resonance imaging (MRI). We used voxel-based morphometry to compare GMV between groups and performed a correlation analysis with ADHD symptoms and comorbidities. Results: Findings revealed a smaller total GMV in males with ADHD and a smaller GMV in the right medial frontal orbital area extending toward the medial frontal superior, the frontal superior, and the subgenual anterior cingulate cortex (ACC) besides correlations between inattentiveness and ACC (bilaterally) and left cerebellum, hyperactivity/impulsivity and the left frontal inferior orbital, depression and caudate (bilaterally), and the right inferior parietal lobule. Conclusion: Neural correlates in regions related to attention, executive control, and affective processing suggest that impairments in frontostriatal and frontoparietal-cerebellar areas observed in adults with ADHD persist into old age.
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Transtorno do Deficit de Atenção com Hiperatividade , Substância Cinzenta , Idoso , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Encéfalo/diagnóstico por imagem , Córtex Cerebral , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
The neuropsychological deficits in attention-deficit/hyperactivity disorder (ADHD) may present clinical features similar to mild and/or major neurocognitive disorder and may act as a confounding factor, making it difficult to detect cognitive decline. In this paper, we present the results of longitudinal neuropsychological evaluations in two elderly women with ADHD. Three neuropsychological assessments were performed in two women with ADHD (60 and 77 years old) between 2010 and 2013 at intervals varying from 12 to 15 months. We used structural magnetic resonance imaging to rule out significant abnormalities that could account for cognitive impairment. The results showed two different cognitive profiles with fluctuations in performance over these 2 years, sometimes with improvement and sometimes with decline of some functions such as attention, memory, inhibitory control, and reaction time. To minimize confounding aspects of these fluctuations in clinical practice, we used a longer follow-up with the application of a reliable change index and a minimum of three spaced assessments to provide a more consistent baseline cognitive profile. Our findings did not indicate a consistent cognitive decline, suggesting a less pessimistic perspective about cognitive impairments that could be a prodrome of ADHD-related dementia.
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Human behavior is influenced both by approach and avoidance automatic reactions to positive and negative stimulus, respectively, but these reactions have not been well studied in attention-deficit/hyperactivity disorder (ADHD) patients. Moreover, studies employing spatial stimulus-response compatibility tasks in ADHD and healthy control (HC) subjects are scarce and inconclusive. The present study investigated inhibitory control and emotional processing in ADHD adults with a modified stimulus-response compatibility task in which spatial and emotional features of affective stimuli had to be processed together to select the correct response. Manual responses to figures of Favorite and Rival soccer team players were measured, and compatible or incompatible responses were chosen according to the soccer team figure. Eighteen HC participants and sixteen ADHD adults performed the task. We found an ordinary spatial compatibility effect for the Favorite soccer team and a reversed one for the Rival team in the ADHD group but not in the HC group. The effects may be due to stronger approach and withdrawal reactions toward the Favorite soccer team and away from the Rival one, respectively, indicating poor inhibitory control for the ADHD group. These results show that differences between ADHD and HC subjects become prominent when response selection involves both emotional and spatial features of the stimulus.
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Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Emoções/fisiologia , Inibição Psicológica , Campos Visuais/fisiologia , Adolescente , Adulto , Análise de Variância , Lateralidade Funcional , Humanos , Masculino , Estimulação Luminosa , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor , Tempo de Reação , Adulto JovemRESUMO
BACKGROUND: Structural brain abnormalities in schizophrenia have been repeatedly demonstrated in magnetic resonance imaging (MRI) studies, but it remains unclear whether these are static or progressive in nature. While longitudinal MRI studies have been traditionally used to assess the issue of progression of brain abnormalities in schizophrenia, information from cross-sectional neuroimaging studies directly comparing first-episode and chronic schizophrenia patients to healthy controls may also be useful to further clarify this issue. With the recent interest in multisite mega-analyses combining structural MRI data from multiple centers aiming at increased statistical power, the present multisite voxel-based morphometry (VBM) study was carried out to examine patterns of brain structural changes according to the different stages of illness and to ascertain which (if any) of such structural abnormalities would be specifically correlated to potential clinical moderators, including cumulative exposure to antipsychotics, age of onset, illness duration and overall illness severity. METHODS: We gathered a large sample of schizophrenia patients (161, being 99 chronic and 62 first-episode) and controls (151) from four previous morphometric MRI studies (1.5 T) carried out in the same geographical region of Brazil. Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8) software with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) algorithm. Group effects on regional gray matter (GM) volumes were investigated through whole-brain voxel-wise comparisons using General Linear Model Analysis of Co-variance (ANCOVA), always including total GM volume, scan protocol, age and gender as nuisance variables. Finally, correlation analyses were performed between the aforementioned clinical moderators and regional and global brain volumes. RESULTS: First-episode schizophrenia subjects displayed subtle volumetric deficits relative to controls in a circumscribed brain regional network identified only in small volume-corrected (SVC) analyses (p < 0.05, FWE-corrected), including the insula, temporolimbic structures and striatum. Chronic schizophrenia patients, on the other hand, demonstrated an extensive pattern of regional GM volume decreases relative to controls, involving bilateral superior, inferior and orbital frontal cortices, right middle frontal cortex, bilateral anterior cingulate cortices, bilateral insulae and right superior and middle temporal cortices (p < 0.05, FWE-corrected over the whole brain). GM volumes in several of those brain regions were directly correlated with age of disease onset on SVC analyses for conjoined (first-episode and chronic) schizophrenia groups. There were also widespread foci of significant negative correlation between duration of illness and relative GM volumes, but such findings remained significant only for the right dorsolateral prefrontal cortex after accounting for the influence of age of disease onset. Finally, significant negative correlations were detected between life-time cumulative exposure to antipsychotics and total GM and white matter volumes in schizophrenia patients, but no significant relationship was found between indices of antipsychotic usage and relative GM volume in any specific brain region. CONCLUSION: The above data indicate that brain changes associated with the diagnosis of schizophrenia are more widespread in chronic schizophrenia compared to first-episode patients. Our findings also suggest that relative GM volume deficits may be greater in (presumably more severe) cases with earlier age of onset, as well as varying as a function of illness duration in specific frontal brain regions. Finally, our results highlight the potentially complex effects of the continued use of antipsychotic drugs on structural brain abnormalities in schizophrenia, as we found that cumulative doses of antipsychotics affected brain volumes globally rather than selectively on frontal-temporal regions.
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Córtex Cerebral/patologia , Substância Cinzenta/patologia , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Esquizofrenia/patologia , Adulto , Brasil/epidemiologia , Córtex Cerebral/diagnóstico por imagem , Doença Crônica , Estudos Transversais , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Masculino , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The purpose of this prospective study was to evaluate the effects of switching from oral risperidone to flexibly dosed oral paliperidone extended-release (ER) in Brazilian adults with schizophrenia because of lack of efficacy, intolerability, or nonadherence after a minimum trial of 30 days on adequate (labeled) doses of oral risperidone, according to individual clinical judgment. RESEARCH DESIGN AND METHODS: Subjects with Positive and Negative Syndrome Scale total scores above 78, and/or intolerable adverse effects, with risperidone received open-label paliperidone ER 3 to 12 mg daily for 26 (main phase) to 52 (extension phase) weeks. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01010776. RESULTS: The intent-to-treat (efficacy) populations comprised 213 subjects in the main phase and 159 in the extension phase. Of 213 subjects with baseline and post-baseline efficacy data, 154 (72.3%) switched from risperidone to paliperidone ER because of a lack of efficacy and 59 (27.7%) because of tolerability issues, according to individual clinical judgment. Paliperidone ER significantly (p < 0.0500) improved a broad spectrum of efficacy endpoints from baseline, as early as the first post-baseline visit (Visit 2; 4 weeks) and persisting through 26 to 52 weeks. On most efficacy endpoints, function improved from baseline to the first post-baseline visit (week 4) and remained significantly improved compared to baseline at each visit for paliperidone ER treatment, at weeks 8, 13, 26, 39, 26, and 52; data are reported herein mainly for 26 and 52 weeks compared to baseline. Significant improvements from baseline were observed for the Positive and Negative Syndrome Scale total score and subscale scores (each p < 0.0001 at 26 and 52 weeks vs. baseline); and personal and social functioning (p < 0.0001 at 26 and 52 weeks). Paliperidone ER also significantly improved health-related quality of life (Short-Form 36) from baseline, particularly on the Mental Component Summary (p = 0.0011 at 26 weeks and p = 0.0019 at 52 weeks). Treatment with paliperidone ER also significantly improved (vs. baseline) sleep quality (according to decreases on the Pittsburgh Sleep Quality Index; p < 0.0001 at each visit vs. baseline) and disease severity (Clinical Global Impression-Severity; p < 0.0001 at each visit vs. baseline). Paliperidone ER was well tolerated. Adverse events occurring in at least 10% of subjects in either phase were insomnia (14.9% in the main phase and 8.8% in the extension phase); increased body weight (10.7% and 12.6%, respectively); and anxiety (10.7% and 2.5%). Most of these adverse events were: 1) rated as mild or moderate; 2) did not prompt interventions such as paliperidone ER dose adjustment or interruption; and 3) decreased in frequency from the main to the extension phase. CONCLUSIONS: Oral paliperidone ER is a rational treatment alternative for patients with schizophrenia whose antipsychotic regimens are switched because of unsuccessful treatment with oral risperidone according to individual clinical judgment. Study limitations included the open-label study design, lack of placebo, and use of subjective clinical judgment to determine lack of efficacy, intolerability, or nonadherence with oral risperidone.
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Isoxazóis/administração & dosagem , Pirimidinas/administração & dosagem , Qualidade de Vida , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Administração Oral , Adulto , Preparações de Ação Retardada , Feminino , Humanos , Isoxazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona , Satisfação do Paciente , Estudos Prospectivos , Pirimidinas/efeitos adversos , Risperidona/efeitos adversos , Índice de Gravidade de DoençaRESUMO
Lack of insight is frequent in schizophrenia and usually influences negatively both patient's treatment and prognosis. This study aimed to investigate the relationship between insight, symptomatology and cognitive dysfunctions in schizophrenia using the PANSS five-factor model (modified from Gaag et al. in Schizophr Res 85:280-287, 2006). Forty patients diagnosed with chronic schizophrenia (DSM-IV) were evaluated with the scale to assess unawareness of mental disorder (SUMD), the PANSS and a neuropsychological battery. Spearman correlation and linear regression analyses were performed to investigate the relationship between clinical, neurocognitive and insight measures. The SUMD current and past awareness of symptoms score showed a correlation with WCST indices (correct answers and non-persevering errors). The negative and disorganization factor of the PANSS showed a positive correlation with current and past awareness of symptoms. However, when submitted to a linear regression model only the disorganization factor emerged as significant contributor for insight. Considering that the core items of the "disorganization factor" of the PANSS are related to cognition (e.g., poor attention, difficult in abstract thinking), insight is associated cognitive symptoms although no direct relationship between insight and neuropsychological tests was observed.
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Conscientização/fisiologia , Transtornos Cognitivos/fisiopatologia , Esquizofrenia/fisiopatologia , Papel do Doente/fisiologia , Adolescente , Adulto , Atenção/fisiologia , Doença Crônica , Cognição/fisiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Inteligência/fisiologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/normas , Testes Neuropsicológicos/estatística & dados numéricos , Determinação da Personalidade/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Análise de Regressão , Esquizofrenia/diagnóstico , Adulto JovemRESUMO
Introdução: Através de dois estudos seqüenciais a eficácia, segurança e a tolerabilidade da ziprasidona oral foram avaliadas em pacientes brasileiros portadores de transtorno esquizofrênico ou esquizoafetivo. Métodos: Estudos prospectivos e abertos. No primeiro estudo os pacientes receberam entre 80 e 160 mg/dia de ziprasidona durante seis semanas e foram avaliados através da Positive and Negative Symptom Scale (PANSS), Impressão Clinica Global para Gravidade da doença (CGI-S), Questionário de Intensidade de Cuidados (ICQ) e Preferência do Paciente (PPS). A segurança e tolerabilidade foram avaliadas por análises clínica, eletrocardiográfica e laboratoriais, escala de Avaliação dos Sintomas Extrapiramidais (ESRS) e Avaliação de Acatisia de Barnes (BAS). Os pacientes com resposta ao tratamento poderiam ser incluídos no segundo estudo, com duração de até 12 meses. Resultados: No primeiro estudo 162 pacientes foram avaliados quanto à eficácia e 164 quanto à segurança e tolerabilidade. O tratamento reduziu o escore na escala PANSS a partir do início de 94,3 para 76,2 (P<0,0001). Também houve reduções significativas dos escores nas escalas CGI-S e ICQ. Através da PPS 64,8 dos pacientes preferiram a ziprasidona ao medicamento anterior. Não houve sintomas extrapiramidais significativos avaliados pela ESRS e BAS nem alterações eletrocardiográficas. Dos 106 pacientes incluídos no segundo estudo, 86 foram analisados quanto à eficácia. A duração mediana do tratamento foi de 5,6 meses e o escore médio na escala PANSS foi mantido. O perfil de eventos adversos ao longo dos dois estudos foi semelhante. Conclusão: A ziprasidona oral é eficaz e segura no tratamento crônico de pacientes portadores de esquizofrenia e distúrbio esquizoafetivo.
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Humanos , Antipsicóticos , Esquizofrenia , Haloperidol , Esquizofrenia/terapiaRESUMO
O tratamento farmacológico do transtorno do déficit de atenção com hiperatividade (TDAH) em adultos inclui o uso de psicoestimulantes, antidepressivos e atomoxetina, sendo o primeiro considerado a indicação de primeira escolha. A eficácia do metilfenidato foi demonstrada em adultos quando se empregavam doses maiores, proporcionalmente similares àquelas usadas em estudos em crianças. O perfil de eventos adversos do metilfenidato, incluindo aqueles relativos ao sistema cardiovascular, parece bastante seguro.
Pharmacotherapy of attention-deficit/hyperactivity disorder in adulthood includes psychostimulants, antidepressants and atomoxetine, the first of them being considered the first choice. Methylphenidate efficacy has been demonstrated in adults when higher doses were used, in a proportionate similar way to what has been described in children. Methylphenidate profile of adverse events, including cardiovascular ones, seems to be safe.
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Humanos , Adulto , Antidepressivos/uso terapêutico , Comorbidade , Metilfenidato/administração & dosagem , Metilfenidato/efeitos adversos , Metilfenidato/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Brasil , Resultado do TratamentoRESUMO
PURPOSE: To describe the social-demographic variables, including interpersonal, academic, and professional performance in adult individuals with the diagnoses of attention deficit hyperactivity disorder (ADHD). There are no reports of this kind in the Brazilian population with ADHD. The ADHD is a common disorder, which can reach up to 3% of the general population. METHOD: Descriptive study of adults with ADHD, according to the DSM-IV criteria (American Psychiatric Association). The sample was selected from a specialized outpatient service in São Paulo city. The social-demographic data was obtained by personal interviews. RESULTS: There was a predominance of males in the sample (61.2%) and a high education level (90.2% had at least a high school degree) and 52% of the 102 patients had repeated their class at a least once during their school lives. In addition, 22.5% of the population sample were unemployed at the time of the interview. CONCLUSION: The distribution of the socio-demographic variables in adult ADHD is similar to other ADHD samples reported in other countries, despite the high education level met in our sample. Similarities between child and adult ADHD could also be traced.
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Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Adolescente , Adulto , Brasil , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
PURPOSE: To describe the social-demographic variables, including interpersonal, academic, and professional performance in adult individuals with the diagnoses of attention deficit hyperactivity disorder (ADHD). There are no reports of this kind in the Brazilian population with ADHD. The ADHD is a common disorder, which can reach up to 3 percent of the general population. METHOD: Descriptive study of adults with ADHD, according to the DSM-IV criteria (American Psychiatric Association). The sample was selected from a specialized outpatient service in São Paulo city. The social-demographic data was obtained by personal interviews. RESULTS: There was a predominance of males in the sample (61.2 percent) and a high education level (90.2 percent had at least a high school degree) and 52 percent of the 102 patients had repeated their class at a least once during their school lives. In addition, 22.5 percent of the population sample were unemployed at the time of the interview. CONCLUSION: The distribution of the socio-demographic variables in adult ADHD is similar to other ADHD samples reported in other countries, despite the high education level met in our sample. Similarities between child and adult ADHD could also be traced.
OBJETIVO: Descrever as variáveis sócio-demográficas incluindo desempenho acadêmico, profissional e interpessoal em uma população adulta com diagnóstico de transtorno de déficit de atenção e hiperatividade (TDAH). Até o momento não há relato na literatura do perfil desses pacientes na população brasileira. O TDAH é comum na população geral, podendo chegar a 3 por cento das pessoas. MÉTODO: Foram avaliados adultos que tomaram conhecimento do serviço de atendimento especializado em TDAH através da mídia. O diagnóstico de TDAH foi realizado utilizando-se os critérios da Associação Psiquiátrica Americana (DSM-IV). Os dados sócio-demográficos foram obtidos através de entrevista pessoal com cada paciente. RESULTADOS: 102 indivíduos preencheram critérios para TDAH. Houve predomínio do sexo masculino (61,2 por cento) com alto nível de escolaridade (90,2 por cento tinham no mínimo 2° grau completo). Cinquenta e três pacientes (52 por cento) foram reprovados pelo menos uma vez durante vida estudantil. No momento da entrevista, 22,5 por cento encontravam-se desempregados. CONCLUSÃO: Observou-se uma semelhança da distribuição das variáveis sócio-demográficas com os indivíduos adultos com TDAH de outros países, apesar da escolaridade ser acima da média nacional. Além disso, pode-se também observar semelhanças entre as populações infantil e adulta com TDAH.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Brasil , Manual Diagnóstico e Estatístico de Transtornos Mentais , Hospitais Universitários , Fatores SocioeconômicosRESUMO
In a double-blind, placebo controlled study, conjugated estrogens (CE) (0.625 mg/day) were added to a fixed dosage of haloperidol (5 mg daily). Forty-four female inpatients with acute schizophrenia were included in the study and randomized to one of the groups; 40 patients completed the trial. They were followed for 28 days and evaluated periodically with the BPRS, Negative Symptoms Rating Scale, Simpson Angus Extrapyramidal Rating Scale and UKU rating scale. Hormonal concentrations (estradiol, estrone, progesterone, FSH, LH and prolactine) were measured at baseline and weekly throughout the trial. Both groups showed similar clinical improvement during the evaluation, although there was a trend for the CE group to show a better improvement than the placebo group (p < 0.10). Side effects and the use of anticholinergics were similar in both groups. Conjugated estrogens caused elevation only of estrone levels in the CE group; estradiol and prolactin showed a similar profile for both groups. Our negative findings regarding the antipsychotic effect of conjugated estrogens does not preclude, however, a possible efficacy of other estrogens, such as 17-beta-estradiol, in schizophrenia.