Dear Colleagues,
It is my pleasure to welcome you to the fifth issue of the year 2010.
I am delighted to present to you a review on Attention Deficit Hyperactivity Disorder (ADHD) in adults. Michael Rösler and colleagues have undertaken an intensive literature review of peer-reviewed English language articles on the topic and compiled an up-to-date overview on the current discussions and treatment options. In line with this review, the Editors have selected several original articles and brief reports on the topic of ADHD in this issue. As a second topic for this issue, we have chosen schizophrenia.
Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are developmental disorders that overlap in a number of domains, sometimes complicating clinical distinction between both disorders. Although there is some evidence for a genetic overlap, there are no reports on genes that could differentiate between ASD and ADHD. Furthermore, it is not known whether this genetic overlap is influenced by co-morbid Substance Use Disorders (SUD). Bram Sizoo and colleagues present a study with 110 adult patients with ASD or ADHD with or without a lifetime history of SUD. The authors concluded that serotonergic genes could prove to play an important role in differentiating between ASD and ADHD and suggest that replication studies are conducted.
In an original article by Michael Rösler and German colleagues a 24-week, double-blind, placebo-controlled study in adults with ADHD is presented which investigates treatment with methylphenidate (MPH-ER) in adults with ADHD. The focus was to assess the medium to long-term effects of extended release methylphenidate on emotional symptoms and other psychopathology frequently seen in ADHD patients. The large-scale, multicenter treatment study included 363 patients who were randomized to MPH-ER or placebo at a ratio of 2:1. The duration of the titration period was 5 weeks followed by a maintenance phase of 19 weeks. The study shows that MPH-ER appears to be an effective treatment for emotional symptoms with ADHD, also obsessive-compulsive symptoms and problems with self-concept are affected positively.
Disturbed cholesterol and phospholipid metabolism has been associated with schizophrenia. Thus protein expression analysis in cerebrospinal fluid from patients may be a potential diagnostic tool for schizophrenia. Daniel Martins-de-Souza and colleagues investigated proteins from 17 first-episode schizophrenia patients and 10 healthy controls. Their findings suggest that the protein analysis of apolipoprotein E, apolipoprotein A-I, and prostaglandin-H2 D-isomerase in cerebrospinal fluid from patients might be a potential diagnostic tool for schizophrenia.
Rebecca Schennach-Wolff and colleagues examined quality of life and subjective well-being as predictors of symptomatic treatment outcome in schizophrenia. The study included biweekly PANSS ratings of 285 inpa-tients with schizophrenia spectrum disorders within a multicenter trial by the German Research Network on Schizophrenia. The Medical Outcomes Study-Short Form 36-Item Health Survey (SF-36), the Subjective Well-being Under Neuroleptic Treatment Scale (SWN-K) and the Adjective Mood Scale (AMS) were used. The findings highlight the importance of the patient's self-perception and especially of early improvement of quality of life and subjective well-being for symptomatic treatment outcome.
The influence of infectious agents on the pathogenesis of psychiatric disorders has been discussed intensively over the past few years. Pre- and postnatal infections are risk factors for schizophrenia. This may be explained by chronic infections or an altered immune status. However most of the studies have only focused on one single pathogen and not on the impact of different infectious agents. Daniela Krause and colleagues investigated the association between schizophrenia and various neurotrophic infectious agents. The study included 31 schizophrenic patients and 30 healthy matched individuals. The results show a higher prevalence of antibodies within schizophrenic patients. The findings emphasize the possible role of infectious agents in the pathogenesis of schizophrenia and indicate that it might not be one specific agent that is responsible for schizophrenic symptoms but the resulting immune response in the central nervous system instead.
Serge Brand and colleagues from Switzerland present a study with 2231 participants which aimed at investigating the relation between burnout, depressive symptoms, satisfaction with life, and sleep complaints. As a starting hypothesis the authors indicated that people with an optimistic attitude seem to be less vulnerable to stress and burnout. Interestingly, the findings suggest that among burnout symptoms emotional and physical exhaustion, but not depressive symptoms, are related to sleep complaints. Satisfaction with life is connected with low emotional and physical exhaustion and low pessimism and also contributes to favorable sleep.
In a brief report Yuval Bloch and colleagues from Israel represent their findings which emphasize positive effects of repetitive Transcranial Magnetic Stimulation (rTMS) on attention in ADHD patients. ADHD has been suggested to involve dopaminergic prefrontal abnormalities. A total of 13 ADHD patients were enrolled and there was a specific beneficial effect on attention ten minutes after the rTMS course. The authors wish to encourage future research on the possibility of amelioration of attention difficulties in patients suffering from ADHD by using high frequency rTMS directed to the right dorsolateral prefrontal cortex.
And lastly, Peter Höfer and colleagues present a letter to the Editors which focuses on hyperprolactinaemia and acute psychosis. The authors conclude the necessity of considering medication-induced enlargement of the pituitary gland and of avoiding surgery of a medication-induced adenoma of the hyophysis, especially in patients with a psychiatric case history.
Yours sincerely,
Siegfried Kasper, MD
Chief Editor