Autism may result from abnormalities in specific brain regions and a global lack of integration due to brain enlargement. Inconsistencies in the literature partly relate to differences in the age and IQ of study populations. Some regions may show abnormal growth trajectories.
Difficulties experienced by some young people with mild and borderline intellectual disability are associated with enhanced liability to schizophrenia. Clinical methods can both identify those with this extended phenotype and predict those in whom psychosis will occur.
Controversy around the association between celiac disease (CeD) and attention deficit hyperactive disorder (ADHD) was addressed by a systematic review in 2015, ultimately showing no association. Since 2015, there have been several studies showing an association between celiac disease and attention deficit hyperactive disorder. This is an updated systematic review. Background: Most experts agree on the recommendation to not screen as part of the standard of care for ADHD in persons with CeD or vice versa. Simultaneously, they propose that untreated patients with CeD and neurological symptoms such as chronic fatigue, inattention, pain, and headache could be predisposed to ADHD-like behavior, namely inattention (which may be alleviated by following a gluten-free diet). The inattentive subtype of ADHD that encompasses the symptoms of inattention is phenotypically heterogeneous, as it includes the clinical construct of sluggish cognitive tempo (SCT). SCT symptoms overlap with the neurological manifestations of CeD. Methods: A systematic search (PRISMA) of PubMed, Google Scholar, EMBASE, Web of Science, Stanford Lane, SCOPUS, and Ovid was conducted for articles up to 21 February 2022. Of these, 23 studies met the criteria. Results: Out of the 23 studies, 13 showed a positive association between ADHD and CeD. Most studies that showed a positive association had been published in the last five years. Inconsistencies in the results remain due to the heterogeneous methodology used, specifically for ADHD and the outcome questionnaires, as well as a lack of reporting on ADHD subtypes. Conclusion: There is an association between ADHD and celiac disease. The current methodological limitations will be lessened if we examine the subtypes of ADHD.
Multiple inpatient psychiatric hospitalizations can be due to system issues, patient complexity, family dynamics, and misdiagnoses to name a few. This study highlights a diagnostically challenging case and how that, in itself, contributed to hospital admissions. Although 18 months elapsed from the time of the initial presentation to the diagnosis of non-epileptic seizures (NES), the suspicion of the diagnosis may have been made earlier by clinicians. The evidence for seizures of post-ictal confusion followed by lethargy, amnesia for the event, and response to an anti-seizure medication only could have provided a higher index of suspicion for NES. Many health care providers will argue that this will create over-diagnoses of NES and usage of anti-epileptic medications. While reviewing the literature on NES, it was noted that frontal lobe epilepsy (FLE) causing psychiatric comorbidities has been poorly studied. Furthermore, this case highlights that within the field of child psychiatry, the same clinical presentation can be interpreted differently. This case helps us understand how eliciting clinical information to enable the timely ordering of imaging could help in diagnoses. This may help set up clinical guidelines for NES for the mental health providers to facilitate improvement in diagnoses and treatment.
Executive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. Methods We implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data. Results Adults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale. Conclusions Adult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and "tailoring" through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.
ResumenAntecedentes.En pacientes con autismo se han descrito anomalías estructurales cerebrales, pero los estudios realizados son de pequeño tamaño y contradictorios. Quisimos identificar qué regiones cerebrales de los pacientes con autismo pueden considerarse diferentes de las de los controles sanos.Métodos.Se realizó una búsqueda sistemática de estudios de resonancia magnética del tamaño de diversas regiones cerebrales. Se recogieron datos y se combinaron por medio de un metaanálisis de efectos aleatorios. Se investigaron los efectos sobre la variabilidad de la edad y del CI por medio de meta-regresión.Resultados.El cerebro completo, los hemisferios cerebrales, el cerebelo y el núcleo caudado tenían mayor volumen, pero el área del cuerpo calloso estaba reducida. La edad y el CI modificaron los lóbulos del vérmix cerebeloso VI-VII, y la edad, la amígdala.Conclusiones.El autismo podría deberse a anomalías de regiones específicas del cerebro y a una falta de integración global debida al aumento de tamaño del cerebro. Los resultados contradictorios en la literatura se deben en parte a la edad y al CI de las poblaciones del estudio. Algunas regiones muestran alteraciones de las trayectorias de crecimiento.
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