Reduced platelet monoamine oxidase type B activity and lymphocyte muscarinic receptor binding in unmedicated children with attention deficit hyperactivity disorder

Several lines of evidence support the role of monoaminergic and cholinergic dysregulation in attention deficit hyperactivity disorder (ADHD) and the concept that peripheral blood neurotransmission indices may represent valuable surrogate CNS markers. We determined platelet MAO-B activity (p-MAO-B) and lymphocyte muscarinic cholinergic receptor binding (l-MR) in 44 unmedicated ADHD children (aged 9.1?±?2.87 years) and in 26 age-matched controls for comparison. Lower levels of p-MAO-B (~35%) and l-MR (~55%) in ADHD were observed compared with controls. Differences were gender-dependent: p-MAO-B was reduced in males only (5.20?±?2.99 vs 8.46?±?5.1 nmol mg^?1 protein h^?1 in ADHD and controls, respectively) and l-MR in females only (ADHD vs control: 6.63?±?1.75 and 15.30?±?8.35?fmol 10^?6 cells). The clinical significance was corroborated by the correlation between these markers and severity of specific symptoms: lower p-MAO-B associated with increased inattention scores (Conners’ teacher-rating scale); lower l-MR associated with increased score for oppositional-defiant disorder (ODD) (SNAP-IV); and trend towards correlation between increased inattention (SNAP-IV) and lower l-MR.     

What Time Periods of the Day Are Concerning for Parents of Children with Attention Deficit Hyperactivity Disorder?

Background/Aim

The questionnaire-children with difficulties (QCD) is a parent-assessed questionnaire designed to evaluate a child’s difficulties in functioning during specific time periods of the day. In this study, the QCD was applied to determine the time periods of the day that are concerning for the parents of children with attention deficit hyperactivity disorder (ADHD). The results were compared with those for a community sample.

Methods

Elementary and junior high school students with ADHD (243 boys, 55 girls) and a community sample of children (518 boys, 618 girls) were enrolled in this study. Their behaviors were assessed by the QCD, the ADHD-rating scale (ADHD-RS), and the Oppositional Defiant Behavior Inventory (ODBI). The effects of gender (boy/girl) and diagnosis (ADHD/community sample) on the total QCD score were analyzed across each school grade (elementary/junior high school). Correlation coefficients between QCD and ADHD-RS/ODBI scores were analyzed.

Results

The QCD score for the ADHD group was significantly lower than that for the community sample (P < 0.001). There were significantly strong correlations between “evening” and ADHD-RS and ODBI scores for all children with ADHD (r > 0.41, P < 0.001) and between “night” and inattention and oppositional symptoms for the girls with ADHD (r > 0.40, P < 0.001).

Conclusions

Parents reported that children with ADHD faced greater difficulties in completing basic daily activities compared with the community controls, particularly in the evening. Furthermore, these difficulties were related to the severity of ADHD symptoms. The parents’ perceptions depended on the gender, ADHD and oppositional symptoms, and the time period of the day. This study determined that children with ADHD face greater difficulties in daily functioning compared with community sample children, that these difficulties are time-dependent, and that these difficulties were particularly experienced in the evening.     

A non-interventional study of extended-release methylphenidate in the routine treatment of adolescents with ADHD: effectiveness, safety and adherence to treatment

This multi-centre, open-label, non-interventional study evaluates effectiveness, safety and adherence to treatment of a specific extended-release methylphenidate with a 50 % immediate and a 50 % extended-release component (Medikinet^® retard) in the clinical routine treatment of 381 adolescents with ADHD and a mean age of 14.0 ± 1.9 years. ADHD and associated psychiatric symptoms, medication status and dosage frequency, treatment adherence and adverse events were assessed at baseline and after a median treatment length with Medikinet^® retard of 70 days. Primary outcome criterion was the change of ADHD symptom severity from baseline to endpoint according to the ADHD–KGE (German: ADHS–Klinische Gesamteinschätzung) change score. At baseline, 4.2 % of the patients were treatment naïve, 92.7 % had previously received different methylphenidate formulations and 3.1 % had received atomoxetine or amphetamine. During the study, patients received a mean daily dose of 35.7 ± 15.1 mg Medikinet^® retard. At endpoint, in 78 % of patients, the total ADHD symptom severity was reduced, in 20.4 %, it remained unchanged and in 1.6 %, it was worsened. The mean ADHD–KGE total ADHD symptom score was reduced from 1.8 ± 0.7 (moderate) at baseline to 0.8 ± 0.5 (mild; p < 0.001) at endpoint; the mean ADHD–KGE total-associated symptom score was reduced from 1.9 ± 0.7 (moderate) at baseline to 1.0 ± 0.6 (mild; p < 0.0001) at endpoint. After the medication switch from previous methylphenidate formulation to Medikinet^® retard, multiple dosing with ≥3 daily medication intakes was reduced from 12.9 % at baseline to 3.1 % at endpoint (p < 0.001). Adherence to treatment was improved in 37 % of patients. Most frequent adverse events were loss of appetite and gastrointestinal problems. The findings suggest that pharmacologically treated adolescents with ADHD and insufficient symptom reduction and/or treatment adherence benefit from switching to Medikinet^® retard and that it is well tolerated when given in clinical routine care.     

Observational study: Matricaria chamomilla may improve some symptoms of attention-deficit hyperactivity disorder

ObjectiveNoradrenaline and serotonin reuptake inhibitors have been proven to be effective in some cases of ADHD. In this open trial, Matricaria chamomilla, a serotonin and noradrealine reuptake inhibitor, actually used as an antidepressant, has been checked for this indication.MethodThree 14–16-year-old male psychiatric outpatients, diagnosed with attention-deficit disorder (ADHD) have been rated at baseline and while taking Matricaria chamomilla to determine its efficacy as a treatment for ADHD. Improvement was valuated using comparisons of Conners’ parent ratings.ResultsPatients’ mean scores improved for Conners’ hyperactivity, inattention and immaturity factors.ConclusionsAlthough the sample size is very small and therefore generalization is very difficult, this observation indicates that Matricaria chamomilla might be a slightly effective treatment also for ADHD.     

Relationship between attention-deficit/hyperactivity disorder and sedentary behavior in adolescence: a cross-sectional study

Existing studies reveal that high levels of sedentary behavior are associated with more inattention and hyperactivity problems. Since most previous studies used screen time as an indicator of sedentary behavior and assessed symptoms of attention-deficit/hyperactivity disorder (ADHD) by short screening measures which do not allow to distinguish between subtypes of ADHD, the current study aimed to investigate association between different types of sedentary behavior and symptoms and subtypes of ADHD. The current cross-sectional study analyzed data of 913 students (46.1% girls) aged 13–17 years (M = 15.0, SD = 0.6). Using a self-administered questionnaire, screen-based and non-screen-based sedentary behavior and ADHD symptoms were assessed. Linear and logistic regression analyses were conducted. All analyses were adjusted for age, gender, moderate to vigorous physical activity and body mass index. Screen time was related to the total ADHD score (p < 0.001) as well as to the subscales inattention (p ≤ 0.016) and hyperactivity/impulsivity (p ≤ 0.008). Sedentary time without screens was virtually not associated with ADHD. As far as ADHD symptoms are considered as a correlate of sedentary behavior, the type of activity which is pursued sedentarily seems to matter: screen time, but not other non-screen-based sedentary activities should be considered as being a risk factor for ADHD.     

低温等离子射频消融术治疗小儿阻塞性呼吸暂停综合征的临床疗效观察

目的:探究低温等离子射频消融术治疗小儿阻塞性呼吸暂停综合征的临床疗效。方法:收集2014年5月到2016年5月来我院就诊的小儿阻塞性呼吸暂停综合征患者72例,根据随机数字对照表分为对照组与试验组,各36例。对照组采用传统手术治疗切除患儿肥大的扁桃体及腺样体,试验组实施低温等离子射频消融术。比较两组患者临床疗效、行为状况及VAS评分。结果:治疗后,对照组的总有效率为91.67%;试验组的总有效率为94.45%,两组比较差异无统计学意义(P0.05);治疗后,两组患儿CBCL量表总评分均较治疗前明显降低(P0.05),抑郁、社交退缩、多动、违纪及攻击各项评分均明显降低(P0.05),但是试验组各项评分及总评分与对照组相比并无明显差异(P0.05);试验组手术后VAS评分明显低于对照组(P0.05)。结论:低温等离子射频消融术对小儿阻塞性呼吸暂停综合征患者有明显的治疗效果,且对患儿损伤较小。     

Umbilical Cord Blood Testosterone and Childhood Internalizing and Externalizing Behavior: A Prospective Study

Antenatal testosterone exposure influences fetal neurodevelopment and gender-role behavior in postnatal life and may contribute to differences in developmental psychopathology during childhood. We prospectively measured the associations between umbilical cord blood testosterone levels at birth and childhood behavioral development in both males and females from a large population based sample. The study comprised 430 females and 429 males from the Western Australian Pregnancy Cohort (Raine) Study where umbilical cord blood had been collected. Total testosterone concentrations were determined by mass spectrometry and bioavailable testosterone (BioT) levels were calculated. At two, five, eight and ten years of age, the participants completed the Child Behavior Checklist (CBCL). Linear regression models were used to analyse the relationship between BioT concentrations (in quartiles) and CBCL scores (total, internalizing, externalizing and selected syndrome). Boys had higher mean CBCL T-scores than girls across all ages of follow-up. There was no significant relationship between cord blood BioT quartiles and CBCL total, internalizing and externalizing T-scores at age two or five to ten combined. In the syndrome score analyses, higher BioT quartiles were associated with significantly lower scores for attention problems for boys at age five, eight and ten, and greater withdrawal symptoms in pre-school girls (age five). We did not identify a consistent relationship between antenatal testosterone exposure and total, internalizing or externalizing behavioral difficulties in childhood. Higher umbilical cord BioT levels were associated with lower scores for attention problems in boys up to 10 years and more withdrawn behavior in 5-year-old girls; however, these findings were not consistent across ages and require further investigation in a larger sample.     

调任通督针刺法联合感觉统合训练对注意缺陷多动障碍患儿注意力和脑动脉血流速度的影响

摘要 目的：观察感觉统合训练联合调任通督针刺法对注意缺陷多动障碍（ADHD）患儿注意力和脑动脉血流速度的影响。方法：纳入东莞市中医院2020年1月到2021年1月期间收治的ADHD患儿100例,入组患儿按门诊号单双数分为对照组（单数,感觉统合训练）和研究组（双数,调任通督针刺法联合感觉统合训练）,各为50例,两组患儿均干预3个月。观察并对比两组疗效、中医证候总积分、注意力、脑动脉血流速度、Conners父母评症状量表（PSQ）、联合型瑞文测验 (CRT) 评分。结果：研究组的临床总有效率明显高于对照组（P<0.05）。干预3个月后,两组注意力情况：错误数、漏报数较干预前减少,反应时间较干预前缩短,且研究组的变化程度大于对照组（P<0.05）。研究组患儿干预3个月后双侧中动脉（MCA）、前动脉（ACA）、后动脉（PCA）的血流速度均较干预前增快,且高于同时期的对照组患儿（P＜0.05）。干预3个月后,两组PSQ评分、中医证候总积分下降,CRT评分升高,且研究组的变化程度大于对照组（P<0.05）。结论：调任通督针刺法联合感觉统合训练可有效改善ADHD患儿注意力,促进临床症状改善,调节脑血流速度,临床应用价值较好。     

Psychometric properties of the Japanese version of the Weiss Functional Impairment Rating Scale: Self-Report

The Weiss Functional Impairment Rating Scale Self-Report has been translated into nine languages and has been widely used in assessing functional impairment of adults with ADHD. This study is a psychometric validation of the WFIRS-S in Japanese. The WFIRS-S-J and other questionnaires were administered to 46 adults with attention-deficit–hyperactivity disorder (ADHD), 104 control adults, and 889 university students. ADHD diagnoses were made using the Japanese semi-structured diagnostic interview for adult ADHD, which is compatible with the DSM-5. All subscales of the WFIRS-S-J had Cronbach’s α values of around 0.80. Total scores on the WFIRS-S-J had high test–retest reliability after a 2-week interval. The total score, subscale scores, and 59 of the individual item scores of the 70 items in the WFIRS-S-J were significantly higher in the ADHD group than in the other two groups, although more than half of the items in subdomain G (risk) showed floor effects and did not reach significance. Generally WFIRS-S-J subdomain scores were moderately correlated with scores on the Japanese version of Conners’ Adult ADHD Rating Scales Self-Report subscales. WFIRS-S-J scores were also correlated (albeit more weakly; 0.31 ≤ r ≤ 0.55) with Beck Depression Inventory II total scores. The WFIRS-S-J showed acceptable psychometric properties, although further study is necessary.     

Health-related quality of life in ADHD: a pooled analysis of gender differences in five atomoxetine trials

Attention-deficit/hyperactivity disorder (ADHD) is associated with considerable impairment in health-related quality of life (HR-QoL). Atomoxetine has been found to improve HR-QoL in both children and adolescents. However, there is scarcity of data on gender differences in treatment responses to ADHD medications. This pooled analysis of five atomoxetine trials aimed to evaluate treatment differences with respect to HR-QoL and ADHD symptoms across genders. Data from 5 clinical atomoxetine trials (4 from Europe and 1 from Canada) with similar inclusion and exclusion criteria and similar durations (8- to 12-week follow-up) were included in the pooled analysis. All studies included the Child Health and Illness Profile-Child Edition (CHIP-CE) Parent Report Form. In addition, correlations between HR-QoL and ADHD core symptoms were compared between girls and boys. Data from 136 girls and 658 boys (mean age: 9.6 and 9.7 years, respectively) were pooled. Boys and girls were similarly impaired at baseline with minor differences in some of the subdomains. Treatment effect of atomoxetine was significant in both groups for the Risk Avoidance domain and its subdomains. No gender effect with both clinical and statistical significance was found for treatment outcome. Correlations between ADHD Rating Scale and CHIP-CE scores were similar in both genders and were generally low at baseline and moderate at endpoint and for the change from baseline to endpoint. Atomoxetine was effective in improving some aspects of HR-QoL in both genders without any significant differences across genders. Correlations between core symptoms of ADHD and HR-QoL were low to moderate in both boys and girls.     

Assessment of effects of atomoxetine in adult patients with ADHD: consistency among three geographic regions in a response maintenance study

A previous study (Upadhyaya et al. in Eur J Psychiatry 2013b; 27:185–205) reported that adults with attention-deficit/hyperactivity disorder (ADHD) demonstrated maintenance of response for up to 25 weeks after initially responding to atomoxetine treatment. In the present report, the consistency of treatment effect across three geographic regions (Europe, United States/Canada [US/Can], and Latin America [Latin Am]) was explored. Data were analyzed from a phase 3, multicenter, randomized, double-blind, maintenance-of-response (randomized withdrawal) trial of atomoxetine versus placebo in adults with ADHD. Patients were randomized to atomoxetine (N = 266) or placebo (N = 258) for 25 weeks. Consistency assessments included the interaction test, pairwise t tests, noninferiority, and the criteria from Basic Principles on Global Clinical Trials (Ministry of Health, Labour and Welfare of Japan 2007). Atomoxetine-treated patients maintained the improved ADHD symptoms relative to placebo-treated patients on the Conners’ Adult ADHD Rating Scale Investigator-Rated: Screening Version 18-Item (CAARS-Inv:SV) total score in all three regions (atomoxetine–placebo mean difference = ?4.55, ?3.18, and ?0.07 for Europe, US/Can, and Latin Am, respectively). For the Latin Am region, the mean change in total score (0.41) was notably smaller for the placebo group than for Europe (5.87) and US/Can (4.39). Similar results were observed for the CAARS-Inv:SV hyperactivity/impulsivity and inattention subscale scores. Overall, patients maintained the response with atomoxetine treatment compared to placebo; however, the magnitude of treatment effect differed among the regions studied, being numerically higher in the EU and US/Can than Latin Am. Trial registration http://www.clinicaltrials.gov/(NCT00700427).     

Relation between internalizing behaviors,externalizing behaviors,and peer victimization among children with and without ADHD

The current study explored the concurrent and longitudinal association between internalizing behaviors, externalizing behaviors, and peer victimization among children with and without ADHD. Eighty children (42 ADHD, 38 non-ADHD) ages 8–12 participated in the present study conducted over a 6-month period. During the baseline session, parents completed a structured diagnostic interview and the Vanderbilt ADHD Parent Rating Scale to determine whether their child met criteria for ADHD, and the Child Behavior Checklist (CBCL) to assess their child’s internalizing and externalizing behaviors; children completed the Perception of Peer Support Scale (PPSS) to assess experiences of peer victimization. At the 6-month follow-up session, parents completed the CBCL and children completed the PPSS. Concurrently, internalizing behaviors were associated with peer victimization among children with and without ADHD; ADHD moderated this relation, such that internalizing behaviors were more strongly related to peer victimization among children with ADHD. Longitudinally, internalizing behaviors at baseline predicted peer victimization at 6-month follow-up; however, further analyses demonstrated there was a covarying change in internalizing behaviors and peer victimization. These findings suggest internalizing behaviors are related to peer victimization concurrently, and over time, and are associated with increased risk for peer victimization in the presence of ADHD. Additionally, internalizing behaviors and peer victimization appear to share a dynamic relationship; that is, decreases in internalizing behaviors predict similar decreases in peer victimization. No significant relations were observed between externalizing behaviors and peer victimization. Implications and limitations are discussed.     

A study of the association between sleep habits and problematic behaviors in preschool children

This preliminary study examined the association between sleep habits and problematic behaviors in healthy preschool children using an internationally standardized method. Two groups of 4-6-yr-old healthy Japanese children were recruited. Children in Group A (n=68) met one or more of the following three conditions: they went out from their home with adults after 21:00 h two or more times a week, they went to bed after 23:00 h four or more times a week, and they returned home after 21:00 h three or more times a week, while those in Group B (n=67) met none of these conditions. Sleep-wake logs and the Child Behavior Checklist (CBCL)/4-18 were completed daily for two weeks. The CBCL consists of questions with 113 items categorized into eight subscale items: (I) Withdrawn, (II) Somatic complaints, (III) Anxious/depressed, (IV) Social problems, (V) Thought problems, (VI) Attention problems, (VII) Delinquent behavior, and (VIII) Aggressive behavior. Internalizing (I+II+III), externalizing (VII+VIII), and total scale scores were also derived. Generally, the higher the score, the greater the likelihood of problematic behaviors in that scale. We compared both the CBCL scores and distribution of the CBCL score-determined clinical classification of behavior (normal, borderline, and abnormal) between the groups. Correlation coefficients between CBCL scores and each of the seven indices of the studied sleep habits (wake-up times, bedtimes, nocturnal sleep duration, nap duration, total sleep duration, and range of variation in wake-up and bedtime) were also assessed. Group A children showed significantly shorter average nocturnal sleep, nap, and total sleep duration, significantly later average bedtimes and wake-up times, and a significantly greater range of variation in bedtimes and wake-up times than Group B children. The CBCL score of the total scale was significantly higher in Group A than Group B children. The distribution of the clinical classifications of behavior between the two groups showed no significant differences. Although nocturnal sleep, nap, and total sleep duration did not correlate with total CBCL score, it showed a high positive correlation with wake-up times, bedtimes, and ranges of variation in both wake-up and bed times. The distribution of the clinical classification for the total scale showed significant differences between early and late risers, and also between regular and irregular sleepers. The number of children classified as normal for the total scale score was higher in early risers and regular sleepers than in late risers and irregular sleepers. Preschool children of Group A, late risers, late sleepers, irregular risers, and irregular sleepers were likely to show problematic behaviors.     

A Study of the Association between Sleep Habits and Problematic Behaviors in Preschool Children

This preliminary study examined the association between sleep habits and problematic behaviors in healthy preschool children using an internationally standardized method. Two groups of 4–6‐yr‐old healthy Japanese children were recruited. Children in Group A (n=68) met one or more of the following three conditions: they went out from their home with adults after 21∶00 h two or more times a week, they went to bed after 23∶00 h four or more times a week, and they returned home after 21∶00 h three or more times a week, while those in Group B (n=67) met none of these conditions. Sleep‐wake logs and the Child Behavior Checklist (CBCL)/4–18 were completed daily for two weeks. The CBCL consists of questions with 113 items categorized into eight subscale items: (I) Withdrawn, (II) Somatic complaints, (III) Anxious/depressed, (IV) Social problems, (V) Thought problems, (VI) Attention problems, (VII) Delinquent behavior, and (VIII) Aggressive behavior. Internalizing (I+II+III), externalizing (VII+VIII), and total scale scores were also derived. Generally, the higher the score, the greater the likelihood of problematic behaviors in that scale. We compared both the CBCL scores and distribution of the CBCL score‐determined clinical classification of behavior (normal, borderline, and abnormal) between the groups. Correlation coefficients between CBCL scores and each of the seven indices of the studied sleep habits (wake‐up times, bedtimes, nocturnal sleep duration, nap duration, total sleep duration, and range of variation in wake‐up and bedtime) were also assessed. Group A children showed significantly shorter average nocturnal sleep, nap, and total sleep duration, significantly later average bedtimes and wake‐up times, and a significantly greater range of variation in bedtimes and wake‐up times than Group B children. The CBCL score of the total scale was significantly higher in Group A than Group B children. The distribution of the clinical classifications of behavior between the two groups showed no significant differences. Although nocturnal sleep, nap, and total sleep duration did not correlate with total CBCL score, it showed a high positive correlation with wake‐up times, bedtimes, and ranges of variation in both wake‐up and bed times. The distribution of the clinical classification for the total scale showed significant differences between early and late risers, and also between regular and irregular sleepers. The number of children classified as normal for the total scale score was higher in early risers and regular sleepers than in late risers and irregular sleepers. Preschool children of Group A, late risers, late sleepers, irregular risers, and irregular sleepers were likely to show problematic behaviors.     

Altered hemodynamic regulation and reflex control during exercise and recovery in obese boys

The aims of the present study were to assess in obese and lean boys 1) the hemodynamic responses and baroreflex sensitivity (BRS) to isometric handgrip exercise (HG) and recovery and 2) the muscle metaboreflex-induced blood pressure response and the variables that determine this response. Twenty-seven boys (14 obese and 13 lean boys, body mass index: 29.2 ± 0.9 vs. 18.9 ± 0.3 kg/m(2), respectively) participated. The testing protocol involved 3 min of baseline, 3 min of HG (30% maximum voluntary contraction), 3 min of circulatory occlusion, and 3 min of recovery. The same protocol was repeated without occlusion. At baseline, no differences were detected between groups in beat-to-beat arterial pressure (AP), heart rate (HR), and BRS; however, obese boys had higher stroke volume and lower total peripheral resistance than lean boys (P < 0.05). During HG, lean boys exhibited higher HR and lower BRS compared with their obese counterparts. In lean boys, BRS decreased during HG compared with baseline, whereas in obese boys, it was not significantly modified. In lean boys, TPR was elevated during HG and declined after exercise, whereas in obese boys, TPR did not significantly decrease after exercise cessation. In the postexercise period, BRS in lean boys returned to baseline, whereas an overshoot was observed in obese boys. Postexercise BRS was correlated with body mass index (R = 0.56, P < 0.05). Although the metaboreflex-induced increase in AP was similar between obese and lean children, it was achieved via different mechanisms: in lean children, total peripheral resistance was the main contributor to AP maintenance during the metaboreflex, whereas in obese children, stroke volume significantly contributed to AP maintenance during the metaboreflex. In conclusion, obese normotensive children demonstrated altered cardiovascular hemodynamics and reflex control during exercise and recovery.     

Effects of dietary l‐carnitine supplements on growth and body composition in beluga sturgeon (Huso huso) juveniles

The effects of dietary l ‐carnitine on growth performance, whole body composition and feed utilization were studied in beluga, Huso huso. Fish were randomly allocated in 15 tanks (30 fish per tank) and triplicate groups were fed to satiety during 84 days one of five isonitrogenous (41% CP) and isoenergetic (20 MJ kg^?1) diets, each differing in l ‐carnitine content [0 (control), 300, 600, 900 and 1200 mg kg^?1 diet]. At the end of the trial, fish grew from 19‐ to 23‐fold in weight, from 8.4 g to a maximum of 191 g. Fish fed 300–600 mg l ‐carnitine had the highest specific growth rate (SGR, 3.69 and 3.72% day^?1) and protein efficiency ratio (PER, 0.95 and 0.99), and the lowest feed conversion ratio (FCR, 1.4 and 1.3) than the other groups (P < 0.0001). SGR, PER and FCR were the poorest for fish fed 1200 mg l ‐carnitine, while fish fed the unsupplemented and 900 mg l ‐carnitine supplemented diet showed intermediate performance. Body lipid concentration decreased significantly from 5.8 to 5.1% (P < 0.0001) with dietary l ‐carnitine supplementation increasing from 0 to 300 mg. Energy content was significantly lower in fish fed the 900 and 1200 mg l ‐carnitine diet (5.8 MJ kg^?1), when compared with the other treatment groups (6.4–6.6 MJ kg^?1). The results indicated that feeding sturgeon on diets supplemented with 300 mg l ‐carnitine kg^?1 diet improved growth performance, and stimulated protein‐sparing effects from lipids.     

Evaluation of the efficacy and effectiveness of a structured disorder tailored psychotherapy in ADHD in adults: study protocol of a randomized controlled multicentre trial

ADHD is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Previous trials on psychotherapeutic concepts for adult ADHD are based on behavioural (cognitive behavioural and dialectical behavioural) psychotherapeutic approaches and showed significant effects. The aim of our study group (COMPAS) is to carry out a first randomized and controlled multicentre study to evaluate the effects of a disorder tailored psychotherapy in adult ADHD compared to clinical management in combination with psychopharmacological treatment or placebo. A total of 448 adults with ADHD according to DSM-IV will be treated at seven university sites in Germany. In a four-arm design, patients are randomized to a manualized dialectical behavioural therapy (DBT) based group programme plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the first 12 weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult Rating Scale) is rated by interviewers blind to the treatment allocation. Intention-to-treat analysis will be performed within a linear regression model (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET).     

The effect of mental rotation on changes in plasma testosterone and cortisol levels

Testosterone level has an influence on cognitive functions, especially spatial abilities. The relationship is, however, bidirectional and brain activity also affects testosterone levels. The aim of this study was to analyze the effects of an intensive 3D mental rotation task on testosterone levels in young healthy men and women. In the mental rotation task, men reached a higher top score (P=0.027) and total score (P=0.004) compared to women. In 8 out of 9 women (P=0.008) but not in men (P=0.129) testosterone levels decreased after one hour of mental rotation testing. A significant gender difference was shown (P<0.0001). In all women, plasma cortisol levels was significantly lower after testing (P=0.004). In men cortisol levels decreased in 7 out of 9 subjects (P=0.039). A significant gender difference was not found (P=0.19). No association was found in women between baseline testosterone levels and mental rotation total score (P=0.810). In men there was a positive correlation between baseline testosterone and mental rotation total score (P=0.015). A significant difference gender difference was seen in the association between testosterone and mental rotation score (P<0.05). Mental rotation stimuli caused significant changes in hormonal levels of testosterone and cortisol. A gender-specific response was detected in testosterone fluctuation.     

Glucose ingestion and substrate utilization during exercise in boys with IDDM.

This study was intended to compare exogenous [(13)C]glucose (Glu(exo)) oxidation in boys with insulin-dependent diabetes mellitus (IDDM) and healthy boys of similar age, weight, and maximal O(2) uptake. In a control trial with water intake (CT) and in a (13)C-enriched glucose trial (GT), subjects cycled for 60 min (58.8 +/- 0.9% maximal O(2) uptake) while the utilization of total glucose, total fat, and Glu(exo) was assessed. In CT, total glucose was 84.7 +/- 9.2 vs. 91.3 +/- 6.6 g/60 min (not significantly different) and total fat was 13.3 +/- 2.2 vs. 11.1 +/- 1.7 g/60 min (not significantly different) in IDDM vs. healthy boys, respectively. In GT, Glu(exo) was 10.4 +/- 1.7 vs. 14.8 +/- 1.1 g/60 min, corresponding to 9.0 +/- 1.0 vs. 12.4 +/- 0.5% of the total energy supply in IDDM and healthy boys, respectively (P < 0.05). Endogenous glucose was spared in both groups by 12.6 +/- 3.5% (P < 0.05). Blood glucose and plasma insulin concentrations were two- to threefold higher in IDDM vs. healthy boys in both trials. In conclusion, Glu(exo) is impaired in exercising boys with IDDM, even when plasma insulin levels are elevated.     

Competence and behavioral/emotional problems in Croatian children--parents' and teachers' reports: pilot study

Achenbach's Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) were administered to school children aged between 7-11 comprising a non-referred sample (n = 349) drawn from the whole country. Those were the first data on the CBCL and TRF in Croatia. Both in the CBCL and TRF boys had higher scores compared to girls in the Externalizing and Total Problems scale (p < 0.01 and p < 0.05). Parents rated higher scores to the Internalizing and Externalizing scales and the Total Problems scale in both sexes (p < 0.01 and p < 0.05), with the exception of the Internalizing scale in boys. Parents are very important observers of mental health problems in children.