; for the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS) Consortium IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence in adulthood. There is a recognized need to assess the efficacy of psychotherapy in adult ADHD. OBJECTIVE To evaluate the efficacy of cognitive behavioral group psychotherapy (GPT) compared with individual clinical management (CM) and that of methylphenidate hydrochloride compared with placebo. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, randomized clinical trial of 18to 58-year-old outpatients with ADHD from 7 German study centers. Patients were recruited between January 2007 and August 2010, treatment was finalized in August 2011, and final follow-up assessments occurred in March 2013. INTERVENTIONS Sessions of GPT and CM were held weekly for the first 12 weeks and monthly thereafter (9 months). Patients received either methylphenidate or placebo for 1 year. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the ADHD Index of the Conners Adult ADHD Rating Scale from baseline to the end of the 3-month intensive treatment (blinded observer ratings). Secondary outcomes included ADHD ratings after 1 year, blinded observer ratings using the Clinical Global Impression Scale, and self-ratings of depression. RESULTS Among 1480 prescreened patients, 518 were assessed for eligibility, 433 were centrally randomized, and 419 were analyzed as randomized. After 3 months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for GPT and 16.5 for CM, with no significant difference between groups. Methylphenidate (adjusted mean, 16.2

There remains much scientific, clinical, and ethical controversy concerning the use of electroconvulsive therapy (ECT) for psychiatric disorders stemming from a lack of information and knowledge about how such treatment might work, given its nonspecific and spatially unfocused nature. The mode of action of ECT has even been ascribed to a "barbaric" form of placebo effect. Here we show differential, highly specific, spatially distributed effects of ECT on regional brain structure in two populations: patients with unipolar or bipolar disorder. Unipolar and bipolar disorders respond differentially to ECT and the associated local brain-volume changes, which occur in areas previously associated with these diseases, correlate with symptom severity and the therapeutic effect. Our unique evidence shows that electrophysical therapeutic effects, although applied generally, take on regional significance through interactions with brain pathophysiology.magnetic resonance imaging | voxel-based morphometry | unipolar depression | hippocampus E lectroconvulsive therapy (ECT) is the oldest well-established procedure for somatic treatment of unipolar and bipolar disorders (1); however, its precise mechanism of action is still unclear (2). Our current understanding is that the antidepressant effect of ECT is partially mediated by seizure-induced neurotrophic effects, resulting in increased rates of neurogenesis, synaptogenesis, and glial proliferation, particularly in the hippocampus (3-5). Modern neuroimaging experiments have shown a critical role for the subgenual cortex (Brodmann area 25) (6) and deep brain stimulation of this area also results in alleviation of symptoms (7,8). Concerns regarding structural brain damage caused by ECT have been largely attenuated because of a lack of experimental evidence for ECT-induced neuronal damage (9). The scarce in vivo evidence for ECT-induced structural brain plasticity comes from region-of-interest (ROI) imaging studies reporting ECT-related hippocampal volume increases (10) that correlate with clinical outcome (11,12). Limited by an ROI approach and a lack of adequate control groups, these studies may have incompletely detected the effects of right unilateral ECT and failed to distinguish them from pharmacologically induced changes or indeed the effects of disease.We decided to resolve these ambiguities by carrying out a study with drug responsive (no-ECT) and drug-resistant (ECT) patients with either uni-or bipolar depression ( Fig. 1 and Table 1). The two psychiatric conditions are considered separate from pathophysiological and nosological viewpoints. A group of normal volunteers was included to control for non-ECT-associated confounds and to provide a way of assessing ECT-associated therapeutic effects. All subjects were recruited and imaged using structural magnetic resonance at entry (time point 1, TP1). If unresponsive to drugs, patients had ECT administered unilaterally to the right hemisphere. All study participants were imaged again at 3 mo (TP2) and 6 mo (TP3). ECT was giv...

Hypercortisolemic depressed patients suffer from resistance to insulin and increased visceral fat. The fact that hypercortisolemia reverses depression-related fat loss, particularly in the visceral area, might partially explain why major depression can be considered a risk factor for cardiovascular disorders.

Attention deficit hyperactivity disorder (ADHD) is a serious mental disorder that often persists in adulthood. In a pilot study, a structured skills training group program for adult ADHD led to significant symptomatic improvements. The present study evaluated the program's effectiveness, feasibility, and patient acceptability in a multicenter setting. Seventy-two adult ADHD patients were assigned to 13 two-hour weekly sessions at 4 different therapy sites. The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms, and personal health status (p < 0.001). The factors treatment site and medication did not contribute to the overall improvement. Patients regarded the program topics "behavioral analyses," "mindfulness," and "emotion regulation" as the most helpful. In this multicenter study, the therapy program showed therapist-independent effects and seemed to be disorder-specific. This warrants the effort of organizing further controlled studies.