November 2015

Nov
2015
Vol. 27. No. 4

ORIGINAL RESEARCH

Psychometric properties of the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale

Barrie K. Marchant, MS | Frederick W. Reimherr, MD | Paul H. Wender, MD | Thomas E. Gift, MD

BACKGROUND: The Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) assesses the same 7 attention-deficit/ hyperactivity disorder (ADHD) domains as the interviewer-administered WRAADDS.


METHODS: A normative sample was recruited, and additional participants came from trials involving ADHD, anxiety, or depression. Using the investigator-administered WRAADDS, participants in the ADHD sample were classified as ADHD inattentive presentation or ADHD emotional dysregulation presentation.


RESULTS: In the ADHD sample, the SR-WRAADDS correlated with the investigator-rated version WRAADDS (P < .001). In comparing adults with ADHD with normal controls, all SR-WRAADDS domains demonstrated discriminate validity (P < .001); a cut point was identified yielding sensitivity of 97% and specificity of 89%. In comparison, in screening for ADHD in depression or anxiety disorders, sensitivity was 87% and specificity, 49%. Internal consistency was satisfactory (Cronbach α = 0.78; split-half reliability r = 0.92). Factor analysis yielded a 2-factor solution: one reflected emotional dysregulation; the other, inattention and disorganization. Detecting ADHD emotional dysregulation presentation within the ADHD sample, as the “disorder-of-interest,” SR-WRAADDS and the investigatorrated WRAADDS agreement was 72% (sensitivity, 87%; specificity, 49%). The SR-WRAADDS detected a methylphenidate vs placebo treatment effect (P < .001).


CONCLUSIONS: The psychometric properties of the SR-WRAADDS support its use in research and clinical practice. Emotional domains are integral to its assessment of adult ADHD.

MORE

Rapid adipose deposition with mood disorders

Jess G. Fiedorowicz, MD, PhD | Lorick E. Andersen, BA | Jane E. Persons, MS | Chadi Calarge, MD

BACKGROUND: Persons with bipolar disorder represent a high-risk group for obesity, but little is known about the time course by which weight gain occurs in bipolar disorder.


METHODS: We prospectively studied changes in fat distribution using dual-energy x-ray absorptiometry in relationship to medication exposure and mood symptom burden in 36 participants with bipolar disorder. We assessed the relationship between prior medication exposure and course of illness with adiposity measures at baseline (N = 36) and at 6-month follow-up (N = 22).


RESULTS: At baseline, greater adiposity was associated with advanced age and female sex, not retrospectively assessed symptom course or medication exposure (past 2 years). Over 6 months of prospective follow-up, participants developed greater adiposity (fat mass index +0.82 kg/m2, P = .007; visceral fat area +8.6 cm2, P = .02; total percent fat +1.6%, P = .02). Manic symptomatology, not antipsychotic exposure, was related to the increased adiposity.


CONCLUSIONS: Acute exacerbations of mood disorders appear to represent high-risk periods for adipose deposition. Obesity prevention efforts may be necessary during acute exacerbations.

MORE

A meta-analysis of placebo-controlled trials of omega-3 fatty acid augmentation in schizophrenia: Possible stage-specific effects

Alexander T. Chen, BA | John T. Chibnall, PhD | Henry A. Nasrallah, MD

BACKGROUND: Omega-3 fatty acids have shown promise as an adjunctive treatment for schizophrenia. However, efficacy across studies has been inconsistent. We conducted a meta-analysis of published controlled studies with the goal of detecting different efficacy profiles at various stages of schizophrenia.


METHODS: An online search was conducted for randomized, double-blind, placebo-controlled clinical trials, and a meta-analysis was conducted.


RESULTS: Ten studies met the criteria for inclusion. Among patients in the prodromal phase of schizophrenia, omega-3 supplementation reduced psychotic symptom severity and lowered conversion rates to first-episode psychosis. In patients with first-episode schizophrenia, omega-3 decreased nonpsychotic symptoms, required lower antipsychotic medication dosages, and improved early treatment response rates. Omega-3 had mixed results in patients with stable chronic schizophrenia, with only some patients experiencing significant benefits. Among patients with chronic schizophrenia, use of omega-3 fatty acids both by those experiencing acute exacerbations and those who had discontinued antipsychotic medications resulted in worsening of psychotic symptoms.


CONCLUSIONS: The data suggest that omega-3 fatty acids may be efficacious in reducing clinical symptoms for patients in the earlier stages of schizophrenia (prodrome and first episode), while producing mixed results for patients in the chronic stages. Based on these results, omega-3 fatty acids would not be recommended for acute exacerbations in patients with chronic schizophrenia nor for relapse prevention after discontinuation of antipsychotics.

MORE

REVIEW ARTICLES

Making psychotherapy for borderline personality disorder accessible

Joel Paris, MD

BACKGROUND: Psychotherapies specifically designed for borderline personality disorder (BPD) are the most effective form of treatment for this population, but these modalities are not easily accessible.


METHOD: Narrative review.


RESULTS: Although research shows that such therapies are effective, the best-known methods are lengthy, expensive, and difficult for patients to access.


CONCLUSIONS: This review recommends that interventions for patients with BPD should be briefer, less costly, and more accessible.

MORE

LETTERS TO THE EDITOR

Topiramate in dextromethorphan abuse

Sriram Ramaswamy, MD

TO THE EDITOR: This article describes a 31-year-old patient with posttraumatic stress disorder (PTSD) who presented with
hallucinogen (dextromethorphan [DXM]) use disorder because he abused NyQuil, an over-the-counter cough remedy. NyQuil contains DXM, which exerts its antitussive effect by activating sigma-1 opioid receptors in the medullary cough center. It has minimal psychoactive effects at recommended dosages; however, powerful dissociative effects have been reported with high dosages. In 2005, the FDA issued a warning regarding DXM abuse…

MORE