Cortney Mears

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widely diagnosed disorders: an estimated 8% to 12% of children are affected worldwide. Although many studies about treatment options have been published, the genetic components that underlie the disorder are still being discovered. A special issue of the 

American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics

, highlights recent research and includes results from the first genome-wide study of patients with ADHD. Genome-wide studies have successfully identified variants associated with obesity and such diseases as age-related macular degeneration, diabetes, and prostate cancer.

Using data from the International ADHD Multicenter Genetics project, one study examined 600,000 genetic markers from more than 900 families. Two single-nucleotide polymorphisms were found to be significant for the specified phenotype and genetic model in the analysis: Rs6565113 and Rs552655.

 Rs6565113 is found in Cadherin 13, which acts as a negative regulator of neural cell growth. Rs552655 is located in GFOD1, a protein thought to be involved in electron transport and metabolic processes. Although the authors were able to identify these “novel genetic associations as viable ADHD candidate genes,” they called for larger studies to confirm their findings and to fully understand the genetic mechanisms that underlie the disorder.

 also examined genome-wide response to treatment with methylphenidate in 187 children with ADHD (mean age, 9.2 years). These researchers examined genetic markers to predict which children would respond favorably to the medication. Although the authors found that “noradrenergic and possibly glutaminergic genes may be involved with response to methylphenidate,” they noted that their findings need to be replicated in larger samples.

 Lasky-Su J, Neale BM, Franke B, et al. Genome-wide association scan of quantitative traits for attention deficit hyperactivity disorder identifies novel associations and confirms candidate gene associations. 

 Mick E, Neale B, Middleton FA, et al. Genome-wide association study of response to methylphenidate in 187 children with attention-deficit/hyperactivity disorder. 

Articles

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widely diagnosed disorders: an estimated 8% to 12% of children are affected worldwide. Although many studies about treatment options have been published, the genetic components that underlie the disorder are still being discovered. A special issue of the American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, highlights recent research and includes results from the first genome-wide study of patients with ADHD. Genome-wide studies have successfully identified variants associated with obesity and such diseases as age-related macular degeneration, diabetes, and prostate cancer.

New Research Examines Genetics Behind ADHD

Women with bulimia nervosa (BN) respond more impulsively during psychological testing than do women without eating disorders, according to a recent article in

 Functional MRI showed differences in brain areas responsible for regulating behavior in women with and without BN.

Rachel Marsh, PhD, and colleagues at Columbia University and the New York State Psychiatric Institute compared the results of the Simon Spatial Incompatibility task in 40 women (20 with and 20 without BN) who were undergoing functional MRI. Participants were asked to indicate on a response box the direction an arrow was pointing while wearing nonmagnetic goggles, regardless of where it appeared on the screen. The act of focusing on the arrow and ignoring the rest of the screen requires regulating behavior by fighting the tendency to respond automatically and resolving conflicting messages.

Patients with BN were more impulsive than controls: they responded more quickly and made more errors in the parts of the task that required self-regulatory control. Patients with the most severe symptoms made the most errors. The frontostriatal circuits in the left inferolateral prefrontal cortex, bilateral inferior frontal gyrus, lenticular and caudate nuclei, and anterior cingulate cortex were not activated in patients with BN as they were in the control group. When patients with BN made errors, there was an increase in dorsal anterior cingulate cortex activation. In contrast, when healthy participants responded correctly there was an increase in anterior cingulate cortex activation, and when the healthy controls responded incorrectly there was an increase in striatum activation.

The authors concluded that self-regulation in women with BN is impaired because they cannot appropriately engage frontostriatal circuits. The authors noted several confounders in their study, including menstrual status; lack of inclusion of otherwise healthy but impulsive persons in the control group; and not including adolescents with BN. They called for future, larger studies that would take these factors into account.

1. Marsh R, Steinglass JE, Gerber AJ, et al. Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Arch Gen Psychiatry. 2009;66:51-63.

Women with bulimia nervosa (BN) respond more impulsively during psychological testing than do women without eating disorders, according to a recent article in Archives of General Psychiatry.1 Functional MRI showed differences in brain areas responsible for regulating behavior in women with and without BN.

Impulsivity, Brain Abnormalities Connected With Bulimia Nervosa

Just the sight of someone smoking may be enough to trigger the desire to start smoking again among those who have kicked the habit. 

Researchers from Duke University Medical Center have been trying to determine what changes in the brain lead to the desire to start smoking again. They used functional MRI to visualize changes in brain activity of persons who were trying to quit.

 Eighteen adult smokers were scanned once before quitting and 24 hours after quitting. Participants were shown photographs of people smoking during the scanning.

Joseph McClernon, associate professor in the department of psychiatry and behavioral sciences and lead author of the study that appeared online in the December issue of Psychopharmacology, noted, “Quitting smoking dramatically increased brain activity in response to seeing smoking cues, which seems to indicate that quitting smoking is actually sensitizing the brain to these smoking cues.” Greater activation was found after abstinence in the parietal, frontal, occipital, and central cortical regions and in the dorsal striatum and thalamus.

Of particular interest was the fact that greater activation was found in the dorsal striatum-the area involved in learning habits. McClernon notes: “That means quitting smoking may not be a matter of conscious control. So, if we’re really going to help people quit, this emphasizes the need to do more than tell people to resist temptation. We also have to help them break that habitual response.”

1. McClernon FJ, Kozink RV, Lutz AM, Rose JE. 24-H smoking abstinence potentiates fMRI-BOLD activation to smoking cues in cerebral cortex and dorsal striatum. Psychopharmacology (Berl). 2008 Dec 24; [Epub ahead of print].

Just the sight of someone smoking may be enough to trigger the desire to start smoking again among those who have kicked the habit. Researchers from Duke University Medical Center have been trying to determine what changes in the brain lead to the desire to start smoking again. They used functional MRI to visualize changes in brain activity of persons who were trying to quit.1 Eighteen adult smokers were scanned once before quitting and 24 hours after quitting. Participants were shown photographs of people smoking during the scanning.

Watching Others Smoke May Trigger Relapse

A combination of cognitive-behavioral therapy (CBT) and antidepressants to treat anxiety disorders in youngsters has yielded positive results in a government-funded study that was published online by the 

John T. Walkup, MD, and colleagues conducted a randomized, controlled trial of 488 children aged 7 to 17 years for whom a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia had been made. Participants received 14 sessions of CBT, sertraline, a combination of sertraline and CBT, or placebo for 12 weeks. The researchers assessed categorical and dimensional ratings of anxiety severity and impairment at baseline and again at 4, 8, and 12 weeks.

Children were rated using the Clinician Global Impression–Improvement scale; 80.7% of those who received combination therapy were much or very much improved. Only 59.7% of children who received CBT and 54.9% of children who were treated with sertraline showed such improvement. All therapies were superior to placebo.

Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. There was less insomnia, fatigue, sedation, and restlessness associated with CBT than with sertraline treatment.

A combination of cognitive-behavioral therapy (CBT) and antidepressants to treat anxiety disorders in youngsters has yielded positive results in a government-funded study that was published online by the New England Journal of Medicine.1

Combined Therapy Eases Anxiety in Children

Imagine seeing a patient in your office and being able to test for dozens or even hundreds of diseases with just the swipe of a card that contains microscopic samples of the patient’s blood, saliva, or urine. This technology may not be far off.

Scientists from the University of Utah, Iowa State University, and NVE Corp have created a prototype of a device that could ultimately be used to test for a multitude of diseases right in the doctor’s office. Test results would be available in minutes. Details about the development of this device were reported in the November issue of 

The creators of this device estimate that the sensor could hold 1900 different samples for testing and may be able to scan for cancers, including prostate cancer, heart disease, herpesvirus infection, and other disorders.

The device uses giant magnetoresistance (GMR), which was discovered by Albert Fert and Peter Grnberg, who received the Nobel Prize in Physics in 2007 for their discovery. GMR uses the same technology that is used to read data on computer hard drives and on MP3 players.

Although the device is currently the size of a personal computer, when it is developed commercially it will look much like a credit card reader. The researchers expect that a more advanced version of the device will be used to test farm animals for diseases in about 2 years; a version for humans might begin evaluation in about 5 years.


1. Alper J. Microsized “giant” drives new rapid-screening device. Anal Chem. 2008;80:7905. http://pubs.acs.org/cgi-bin/sample.cgi/ancham/2008/80/i21/html/ac801967k.html. Accessed November 20, 2008.

New Technology Could Lead to Card-Swipe Medical Tests

Persons who live in rural areas in this country often lack access to adequate mental health care. Psychiatrists from Michigan State University (MSU) are tackling their state’s lack of resources by providing counseling via videocon

ference for patients with psychiatric disorders who live in remote areas.

To cope with the growing number of psychiatric cases in Michigan’s rural areas, particularly among children and adolescents, doctors at MSU’s department of psychiatry may “see” up to 10 patients on any given morning via a video connection without ever having to leave their office.

Psychiatrist Paul Quinlan, who regularly holds videoconferences with patients, noted, “We do take a slightly different approach to establishing rapport, but we’re finding patients respond well and are very comfortable.” To participate, patients visit their county’s community mental health center where they are electronically connected with an MSU psychiatrist. The program, which began 3 years ago, is now at capacity and has become one of the most active programs in the Midwest.

Jed Magen, chairperson of MSU’s department of psychiatry, said that the center was developed “in response to a shortage in psychiatrists-a problem seen not only in Michigan but nationwide. The problem is especially acute in child psychiatry. This is the only viable solution.”

Persons who live in rural areas in this country often lack access to adequate mental health care. Psychiatrists from Michigan State University (MSU) are tackling their state’s lack of resources by providing counseling via videoconference for patients with psychiatric disorders who live in remote areas.