. Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis. European Psychiatry, 44,[198][199][200][201][202][203][204][205][206][207] AbstractBackground: Emotional lability (EL) is an associated feature of attentiondeficit/hyperactivity disorder (ADHD) in adults, contributing to functional impairment. Yet the effect of pharmacological treatments for ADHD on EL symptoms is unknown. We conducted a systematic review and meta-analysis to examine the effects of stimulants and atomoxetine on symptoms of EL and compare these with the effects on core ADHD symptoms. Methods:A systematic search was conducted on the databases Embase, PsychInfo, and Ovid Medline ® and the clinicaltrials.gov website. We included randomised, double-blind, placebo-controlled trials of stimulants and atomoxetine in adults aged 18-60 years, with any mental health diagnosis characterised by emotional or mood instability, with at least one outcome measure of EL. All identified trials were on adults with ADHD. A random-effects meta-analysis with standardised mean difference and 95% confidence intervals was used to investigate the effect size on EL and compare this to the effect on core ADHD symptoms.Results: Of the 3,864 publications identified, nine trials met the inclusion criteria for the meta-analysis. Stimulants and atomoxetine led to large mean weighted effect-sizes for on ADHD symptoms (n=9, SMD= -0.8, 95% CI:-1.07 to -0.53). EL outcomes showed more moderate but definite effects (n=9, SMD= -0.41, 95% CI:-0.57 to -0.25). Conclusions:In this meta-analysis, stimulants and atomoxetine were moderately effective for EL symptoms, while effect size on core ADHD symptoms was twice as large. Methodological issues may partially explain the difference in effect size. Reduced average effect size could also reflect heterogeneity of EL with ADHD pharmacotherapy responsive and non-responsive sub-types. Our findings indicate that EL may be less responsive than ADHD symptoms overall, perhaps indicating the need for adjunctive psychotherapy in some cases. To clarify these questions, our findings need replication in studies selecting subjects for high EL and targeting EL as the primary outcome. Funding: None

There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.

Background: The COVID-19 pandemic is a novel population-level stressor. As such, it is important to examine pandemic-related changes in mental health and to identify which individuals are at greatest risk of worsening symptoms.Methods: Online questionnaires were administered to 34,465 individuals in the UK, recruited from existing cohorts or via social media. Around one third (n = 12,718) with prior diagnoses of depression or anxiety completed pre-pandemic mental health assessments, allowing prospective investigation of symptom change. We examined changes in depression, anxiety and PTSD symptoms using prospective, retrospective and global ratings of change assessments. We also examined the effect of key risk factors on changes in symptoms. Research in contextEvidence before this study We conducted a literature search (PubMed, Scopus) with the terms "mental*" or "psychiatr*" and "covid*" or "coronavirus" published before 8th February 2021. This resulted in 4,573 unique references, but only 15 longitudinal studies examining changes in symptoms of mental health conditions from before to during the COVID-19 pandemic. Results to date are mixed. Some studies found increases in mental distress, some found increases in either depression or anxiety, and others saw no observable change in symptoms.Examining individual-level risk factors, heightened vulnerability to worsening mental health during the pandemic has been demonstrated among young people, females, individuals with lower incomes/financial problems and among health care or key workers. Only one previous study used a large sample with prior mental health diagnoses to examine changes in anxiety and depression. This study showed that having a prior mental health diagnosis was associated with higher levels of perceived worsening of mental health but, when examining actual prospectively measured symptoms, a prior mental health diagnosis was actually associated with a lower likelihood of symptom worsening, compared to no prior diagnosis. This discrepancy across measures requires further investigation in order to understand the nature of changing mental health during the COVID-19 pandemic. Added value of this studyThis study prospectively examined changes in symptoms of depression, anxiety and PTSD in a large UK-based sample of individuals with prior depression or anxiety. Analyses were supplemented with data from additional cohorts to examine individual difference risk factors with greater statistical power. Inclusion of both prospectively measured and retrospectively estimated changes in symptoms, as well as ratings of perceived change in mental health, allowed closer examination of discrepancies in subjective experience versus actual objective change in symptoms.people who are students or are unemployed. Additionally, discrepancies in estimated symptom change across prospective and retrospective measures highlight the importance of using prospectively collected data to examine longitudinal changes.

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