One in six college students misuse ADHD stimulant drugs

March 12, 2015 by  
Filed under Research

Getting into trouble with drugs is one way to derail a promising future, and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses. A recent literature review published by researchers at the University of South Carolina shows that one in six college students misuse common stimulant medications prescribed for attention deficit hyperactivity disorder (ADHD). Given that Ritalin, Adderall and their ilk are Schedule II controlled substances — the same as cocaine and methamphetamine — a lot of young adults are flirting with potentially serious legal jeopardy.

Senior psychology major Kari Benson has seen that firsthand with fellow students. As a sophomore, she had started working with associate professor Kate Flory in the University of South Carolina’s Parenting and Family Research Center, studying social impairment in children with ADHD.

Friends would ask her what she was up to, and once word got around that she was doing ADHD research, a few acquaintances that didn’t know her very well started making requests.

“People would ask me if I could get them Adderall or Ritalin,” Benson says. “I realized that this was a pretty prevalent issue on campus, and I wanted to see what I could do about it.”

She set out to analyze collegiate misuse of stimulant ADHD drugs, earning a grant as a Magellan Scholar from the Office of Undergraduate Research to help put together a survey of Carolina students. To familiarize herself with previous work in the area, she prepared a literature review that Flory thought merited publication, particularly because it highlighted how much uncertainty there was in the field.

“If you looked at individual studies, the rates of college student misuse were all over the place,” says Flory. “They ranged from 2 percent to 43 percent. So when we submitted this for publication, the journal was really interested in us doing a meta-review of all the existing studies.”

That involved standardizing and pooling data from 30 articles, which Benson and Flory did in collaboration with Kathryn Humphreys of the Tulane University School of Medicine and Steve Lee of UCLA. They recently published their results in the journal Clinical Child and Family Psychology Review.

Because the meta-analysis comprises a much larger sample size than any individual study, it provides greater statistical certainty in conclusions. One result is the finding that 17 percent of college students misuse stimulant medications prescribed for ADHD. Misuse includes taking more than prescribed or taking the medication without a prescription.

College students misuse the drugs primarily because they think they bolster academic performance, although there is no study showing stimulant medication does so, Flory says. In fact, the meta-analysis suggested the opposite may be true, correlating poor academic performance with stimulant misuse.

Recreational use of the drugs, such as taking them with alcohol to prolong the amount of time a student can party, is less prevalent but extremely dangerous. “It makes it possible to drink beyond the normal limit,” Benson says. “So instead of passing out drunk, you might end up in the hospital having to get your stomach pumped.”

The review also concluded that the most common source of stimulant drugs was among friends, meaning there’s an informal network of students sharing Schedule II controlled substances on most college campuses. Each individual in the network carries legal risks not just for possession and trafficking, but also potentially for the consequences of someone else’s highly hazardous — and possibly fatal — recreational abuse of the drugs.

Benson and Flory are using the meta-analysis and the results of their student survey, which involves more than a thousand Carolina students, to examine specific characteristics that are associated with misuse of the drugs. They hope that will help identify students for intervention programs on college campuses.

“That’s something we’re hoping to do here,” says Flory. “We have a substance abuse prevention and education office, and they have a group that’s focused on prescription medications. We’ve pulled together an interdisciplinary group of researchers here at USC to apply for a grant from the National Institute of Drug Abuse, which would enable us to actually do an intervention on campus.”

SOURCE: University of South Carolina via EurekAlert

Boredom and frustration trigger skin-picking and other compulsive behaviors

March 12, 2015 by  
Filed under Research

An interesting news release from the University of Montreal:

Individuals who get easily bored, frustrated or impatient are more inclined to develop skin-picking and other body-focused repetitive behaviors, say researchers at the Institut universitaire en santé mentale de Montréal and the University of Montreal. “Chronic hair-pulling, skin-picking disorder and nail-biting and various other habits are known as body-focused repetitive behaviors. Although these behaviours can induce important distress, they also seem to satisfy an urge and deliver some form of reward”, says principal investigator Kieron O’Connor. Chronic hair-pulling is also known as trichotillomania. “We believe that individuals with these repetitive behaviours maybe perfectionistic, meaning that they are unable to relax and to perform task at a ‘normal’ pace.  They are therefore prone to frustration, impatience, and dissatisfaction when they do not reach their goals. They also experience greater levels of boredom.”

O’Connor and his colleagues came to these conclusions by working with 48 study participants, half of whom suffered these repetitive behaviours and half of whom didn’t (acting therefore as the controls.) The participants were referred to a clinical evaluator for a telephone screening interview and completed questionnaires at home. The questionnaires included a scale that evaluates emotions, including boredom, anger, guilt, irritability, anxiety. The participants were then individually exposed to four experimental situations at the research centre, each one designed to provoke a different feeling: stress, relaxation, frustration and boredom. The first two involved the screening of videos (a plane crash and the waves on a beach.) Frustration was elicited by asking the participants to complete a task that was supposedly easy and quick (it wasn’t) and boredom was caused by… leaving the participant alone in a room for six minutes!

Individuals with a history of body-focussed repetitive behaviours reported a greater urge to engage in these behaviours than controls during the boredom and frustration phases of the experiment, but not in the relaxation situation. “These results partially support our hypothesis in that participants were more likely to engage in body-focussed repetitive behaviours when they felt bored, frustrated, and dissatisfied than when they felt relaxed. Moreover, they do engage in these behaviours when they are under stress. This means that condition is not simply due to “nervous” habits,” added Sarah Roberts, first author of the study. “The findings suggest that individuals suffering from body-focussed repetitive behaviours could benefit from treatments designed to reduce frustration and boredom and to modify perfectionist beliefs.”

About the study

Source : Roberts S, O’Connor K, Aardema F, Bélanger C. The impact of emotions on body-Focused repetitive behaviors: evidence from a non-treatment-seeking sample.  J Behav Ther Exp Psychiatry. 2015 Mar;46:189-97. PubMed PMID: 25460266.

Kieron O’Connor is researcher and director of the Obsessive-Compulsive Disorder and Tic Disorder Studies Centre at the Institut universitaire en santé mentale de Montréal and a full Professor at the Department of Psychiatry at the University of Montreal.

Sarah Roberts is a psychologist in private practice at the MindSpace Clinic in Montreal.

Frederick Aardema is researcher at the Institut universitaire en santé mentale de Montréal and assistant professor at the Department of Psychiatry at the University of Montreal.

Claude Bélanger is full professor at the Université du Québec à Montréal

This research was partially funded by a Quebec Health Research Fund (Fonds de Recherche en Santé du Québec) grant no. 20573 awarded to Dr. Kieron O’Connor.

The University of Montreal is officially known as Université de Montréal.

Elimination diets for ADHD: beyond the media hype

March 5, 2015 by  
Filed under Commentary, Tips

I am often asked by parents about whether their child’s diet could be causing their ADHD or worsening it. My answer is that yes, there is some controlled research demonstrating that foods or additives can produce the symptoms of ADHD or exacerbate them, but let’s not jump to an elimination diet.

One of the most well-known studies on diet and ADHD was conducted by Dr. Lidy Pelsser and her colleagues, and was published in Lancet in 2011. That study – and an earlier study by Feingold – are the ones that seem to have attracted a lot of parental interest in the topic.

Dr. Pelsser and her colleagues randomly assigned 100 children aged 4-8 years who were diagnosed with ADHD to either a 5 -weeks restricted elimination diet or to a control group who were simply given instructions for a healthy diet. In the ADHD restricted diet group, 41 of 50 children finished the first phase. In that group of 41 children, 32, or 78%, responded favorably by having fewer symptoms. Overall, 32 of 50, or 64%, had decreased ADHD symptoms while on the diet. Associated symptoms such as oppositional behavior and tantrums also decreased. Most parents hear that over 60% improved on the diet and think, “Wow, that sounds great!” But not so fast, because the methodology was seriously confounded by relying on the reports of parents who were not blind to the child’s experimental condition, which can introduce a bias or placebo effect into their reports of improvement.
Children who showed a significant improvement in their ADHD symptoms while on the restricted elimination diet were then assigned to one of two food-challenge groups based on their individual immunoglobulins (IgG) blood tests. Significantly, two-thirds of the children displayed a relapse in their symptoms when challenge foods were re-introduced to their diet.

More recently, Joel T. Nigg, PhD and  Kathleen Holton, PhD, MPH reviewed the literature on research on foods and additives. Their full article is well worth attempting to read if you are considering undertaking an elimination diet for your child, as they point out that adequately controlled experiments generally do not provide evidence of dramatic effects in symptom reduction for the majority of children with ADHD:

The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children.

Of course, every parent hopes their child will be in that subset who do respond to diet changes, but if you are not sure whether foods or additives are causing or exacerbating your child’s ADHD-like symptoms, speak with your pediatrician about whether an elimination diet might be in order as a 5-week trial or test. Maintaining a restricted diet is difficult, time-consuming, costly, and unlikely to work if you do not have pretty much total control over what your child eats both outside of the home and in your home. It is also important to ensure that the elimination diet does not deprive the child of important nutrients, so don’t just start removing everything from your child’s diet. Reading Drs. Nigg and Holton’s detailed review of studies may help you understand what to consider and what to ask your child’s physician.

About 7% of Kids Worldwide Have ADHD: Study

March 3, 2015 by  
Filed under Research

Dennis Thompson reports:

About 7 percent of children worldwide have attention-deficit/hyperactivity disorder (ADHD), new research concludes.

This estimate — which differs significantly from other recent appraisals — is based on data from 175 prior studies conducted over nearly four decades.

The approximation could help public health officials determine whether ADHD is overdiagnosed or underdiagnosed in their nation, state or community, said lead author Rae Thomas, of Bond University in Australia.

Read more on HealthDay.

Comorbidity in Tourette Syndrome: lifetime prevalence and risks

March 3, 2015 by  
Filed under Featured, Research

Finally we have a study that provides us with some analysis of comorbidity in Tourette Syndrome (TS)  based on a large sample size.

The Tourette Syndrome Association International Consortium for Genetics has published a report that looked at lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity in 1,374 individuals with TS who were compared to 1,142 TS-unaffected family members.

Some of the key findings include:

  • The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%;
  • 57.7% of individuals with TS had 2 or more psychiatric disorders.
  • 72.1% of individuals with TS met DSM-IV-TR diagnostic criteria for OCD or ADHD.
  • Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants.
  • The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence.
  • TS was associated with increased risk of anxiety and decreased risk of substance use disorders  independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%) may be accounted for by comorbid OCD.
  • Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders.
  • Genetic correlations between TS and mood, anxiety, and disruptive behavior disorders may be accounted for by ADHD and, for mood disorders, by OCD.

Looking at their findings, there’s really nothing surprising in the rates of comorbidity nor the possibility that some comorbidity may be better accounted for by the presence of ADHD or OCD than by TS itself.

Referencce:
Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, King RA, Sandor P, McMahon WM, Lyon GJ, Cath DC, Kurlan R, Robertson MM, Osiecki L, Scharf JM, Mathews CA; for the Tourette Syndrome Association International Consortium for Genetics. Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry. 2015 Feb 11. doi: 10.1001/jamapsychiatry.2014.2650. [Epub ahead of print]

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