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Biomedical subjects

Joseph Biederman

Publications and source records attributed to Joseph Biederman.

At least 127 records · Page 7Linked to original sources
PubMed2005

Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder.

OBJECTIVE: To evaluate the effects of medications used in the treatment of adults with attention-deficit/hyperactivity disorder (ADHD) on blood pressure and pulse. METHOD: Subjects were those with DSM-III-R-/DSM-IV-diagnosed ADHD enrolled in placebo-controlled studies of 5 different medications for ADHD. Cardiovascular data from these studies of both stimulants (methylphenidate, amphetamine compounds, pemoline) and nonstimulants (bupropion, desipramine) were reanalyzed for baseline-to-endpoint active-treatment or placebo effects on blood pressure and heart rate. RESULTS: There were 125 subjects with a mean +/- SD age of 39 +/- 9 years. In general, active drug treatment for ADHD compared to baseline was associated with several statistically significant changes in systolic blood pressure (bupropion: +5.9 mm Hg, p < .05 by paired t test; amphetamine: +5.4 mm Hg, p < .05), diastolic blood pressure (desipramine: +7.1 mm Hg, p < .05), and heart rate (bupropion: +6.9 mm Hg, p < .05; amphetamine: +7.3 mm Hg, p < .05; methylphenidate: +4.5 mm Hg, p < .05). New-onset cases of systolic or diastolic hypertension (blood pressure > or = 140/90) were recorded in 8% (7/89) of placebo-treated subjects and 10% (9/89) of subjects receiving active medication, regardless of the class (stimulant, nonstimulant). CONCLUSION: Both stimulant and nonstimulant catecholaminergic medications used in adults with ADHD are associated with minor, but statistically significant, changes in heart rate and blood pressure that were often observed in those receiving placebo. Given the minor pressor and chronotropic effect of these medications, adults with ADHD should have their blood pressure and heart rate checked at baseline and periodically during treatment.

Adult↗
PubMed2004

Attention-deficit/hyperactivity disorder: a selective overview.

Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial and clinically heterogeneous disorder that is associated with tremendous financial burden, stress to families, and adverse academic and vocational outcomes. Attention-deficit/hyperactivity disorder is highly prevalent in children worldwide, and the prevalence of this disorder in adults is increasingly recognized. Studies of adults with a diagnosis of childhood-onset ADHD indicate that clinical correlates--demographic, psychosocial, psychiatric, and cognitive features--mirror findings among children with ADHD. Predictors of persistence of ADHD include family history of the disorder, psychiatric comorbidity, and psychosocial adversity. Family studies of ADHD have consistently supported its strong familial nature. Psychiatric disorders comorbid with childhood ADHD include oppositional defiant and conduct disorders, whereas mood and anxiety disorders are comorbid with ADHD in both children and adults. Pregnancy and delivery complications, maternal smoking during pregnancy, and adverse family environment variables are considered important risk factors for ADHD. The etiology of ADHD has not been clearly identified, although evidence supports neurobiologic and genetic origins. Structural and functional imaging studies suggest that dysfunction in the fronto-subcortical pathways, as well as imbalances in the dopaminergic and noradrenergic systems, contribute to the pathophysiology of ADHD. Medication with dopaminergic and noradrenergic activity seems to reduce ADHD symptoms by blocking dopamine and norepinephrine reuptake. Such alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacologic treatments of ADHD.

Adult↗
PubMed2004

Does referral bias impact findings in high-risk offspring for anxiety disorders? A controlled study of high-risk children of non-referred parents with panic disorder/agoraphobia and major depression.

BACKGROUND: Previous findings in referred samples documented significant diagnostic specificity in patterns of transmission between parents with panic disorder (PD) and parents with major depression (MD) and their offspring. This study evaluated whether these patterns of transmission between parents and high-risk offspring are moderated by referral bias. METHODS: Parental PD/agoraphobia (AG) and parental MD were used to predict rates of offspring psychiatric disorders and functional outcomes using data from an opportunistic sample of parents (n = 991) and offspring (n = 734) ascertained from case-control family genetic studies of youth with and without attention-deficit hyperactivity disorder. Subjects were comprehensively assessed with structured diagnostic interview methodology to evaluate psychiatric disorders in parents and offspring. RESULTS: Parental PD/AG increased the risk for anxiety disorders in offspring, independently of parental MD while parental MD increased the risk for mood and disruptive behavior disorders in offspring, independently of parental PD/AG. Parental psychopathology was also associated with functional impairment in offspring. LIMITATIONS: The use of a sample ascertained by ADHD and control probands, and parent psychiatric diagnostic reports for children under 12. CONCLUSIONS: These results extend to non-referred samples previous findings from referred samples documenting diagnostic specificity in the familial transmission of PD/AG and MD from parents to offspring, suggesting that these patterns of transmission are not due to referral bias. These results could inform and enhance community programs aimed at screening for and treating pediatric psychopathology.

Adolescent↗
PubMed2004

Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care.

BACKGROUND: Recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults in psychiatry and primary care have faced many obstacles. METHODS: Review by 50 psychiatrists and 50 primary care practitioners (PCPs) of 537 and 317 medical records, respectively, of adults diagnosed as having ADHD. Information on other psychiatric disorders, time of onset of ADHD, source of referral, use of referrals for diagnosis, ADHD treatment, and use of drug holidays was recorded. RESULTS: Forty-five percent of the patient records reviewed by psychiatrists and 65% reviewed by PCPs indicated previous diagnoses of ADHD. Only 25% of the adults with ADHD had been first diagnosed as having the disorder in childhood or adolescence. A diagnosis of ADHD was the initial cause for referral in 80% of psychiatric patients and 60% of PCP patients. Most patients with previously diagnosed and undiagnosed ADHD were self-referred. Among patients who had not received a prior diagnosis, 56% complained about ADHD symptoms to other health professionals without being diagnosed; PCPs were the least aggressive in diagnosing ADHD. In psychiatric and PCP settings, there was a statistical difference in the use of pharmacotherapy (91% vs 78%, respectively) and the proportion of patients taking drug holidays (24% vs 17%, respectively); most drug holidays were initiated by the patient (57%). Stimulants were the treatment of choice for adult ADHD (84% treated with stimulants). CONCLUSION: Data contained within this medical record review suggest that adult ADHD is a substantial source of morbidity in both psychiatric and PCP settings.

Adult↗
PubMed2004

Moderating effects of major depression on patterns of comorbidity in patients with panic disorder.

Given the high rate of co-occurring major depression in patients with panic disorder, it is unclear whether patterns of comorbidity in individuals with panic disorder reported in the literature are associated with panic disorder or with the presence of major depression. Subjects were 231 adult subjects with panic disorder and major depression (n=102), panic disorder without comorbid major depression (n=29), major depression without comorbid panic disorder (n=39), and neither panic disorder nor major depression (n=61). Subjects were comprehensively assessed with structured diagnostic interviews that examined psychopathology across the life cycle. Panic disorder, independently of comorbidity with major depression, was significantly associated with comorbid separation anxiety disorder, simple phobia, obsessive-compulsive disorder, generalized anxiety disorder, and agoraphobia. Major depression, independently of comorbidity with panic disorder, was significantly associated with comorbidity with psychoactive substance use disorders and childhood disruptive behavior disorders. Overanxious disorder was associated with both panic disorder and major depression. Major depression has important moderating effects on patterns of comorbidity of panic disorder in referred adults.

Adult↗
PubMed2004

Gender effects on attention-deficit/hyperactivity disorder in adults, revisited.

BACKGROUND: This study reexamined gender differences in a large sample of adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: We assessed the effects of ADHD, gender, and their interaction on rates of psychiatric comorbidity and cognitive functioning in 219 adults with ADHD who were referred to an outpatient psychiatric clinic over the last 7 years compared with 215 control subjects group-matched to control subjects on age and gender, and ascertained from ongoing family genetic case control adults with ADHD. RESULTS: There was no evidence that gender moderated the association between ADHD and other psychiatric disorders. Attention-deficit/hyperactivity disorder was associated with cognitive deficits and higher rates of major depression, anxiety, substance use disorders, and antisocial personality disorder. CONCLUSIONS: Attention-deficit/hyperactivity disorder in adults is associated with psychiatric and cognitive impairment in both genders. These results bear striking similarities to findings reported in pediatric samples, supporting the validity of ADHD and stressing the importance of identifying and treating the disorder in adulthood.

Adult↗
PubMed2004

Evidence-based pharmacotherapy for attention-deficit hyperactivity disorder.

There is a substantial body of literature documenting the efficacy of multiple unrelated pharmacological agents in attention-deficit hyperactivity disorder (ADHD) individuals throughout the life-cycle. The available literature indicates the important role of psychopharmacological agents in the reduction of the core symptoms of ADHD and associated impairments. The literature documents that stimulants not only improve abnormal behaviours of ADHD, but also improves self-esteem, cognition, and social and family function. However, response varied in different age groups and with certain comorbidities. In addition there is a large body of literature documenting the efficacy of atomoxetine which shows improvement in these same domains. More research is needed on alternative pharmacological treatments and to further evaluate established therapeutics beyond school-aged Caucasian boys. Further, more research is needed on the efficacy of treatment for comorbid ADHD, use of combined medications, and the combination of medication and psychosocial treatment.

Adrenergic Uptake Inhibitors↗
PubMed2004

Joint analysis of the DRD5 marker concludes association with attention-deficit/hyperactivity disorder confined to the predominantly inattentive and combined subtypes.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable, heterogeneous disorder of early onset, consisting of a triad of symptoms: inattention, hyperactivity, and impulsivity. The disorder has a significant genetic component, and theories of etiology include abnormalities in the dopaminergic system, with DRD4, DAT1, SNAP25, and DRD5 being implicated as major susceptibility genes. An initial report of association between ADHD and the common 148-bp allele of a microsatellite marker located 18.5 kb from the DRD5 gene has been followed by several studies showing nonsignificant trends toward association with the same allele. To establish the postulated association of the (CA)(n) repeat with ADHD, we collected genotypic information from 14 independent samples of probands and their parents, analyzed them individually and, in the absence of heterogeneity, analyzed them as a joint sample. The joint analysis showed association with the DRD5 locus (P=.00005; odds ratio 1.24; 95% confidence interval 1.12-1.38). This association appears to be confined to the predominantly inattentive and combined clinical subtypes.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Pregnancy complications associated with childhood anxiety disorders.

To determine whether perinatal complications predict childhood anxiety disorders independently of parental psychopathology, we systematically assessed pregnancy and delivery complications and psychopathology in a sample of children (mean age=6.8 years) at high risk for anxiety disorders whose parents had panic disorder with (n=138) or without (n=26) major depression, and in contrast groups of offspring of parents with major depression alone (n=47), or no mood or anxiety disorders (n=95; total N=306). Psychopathology in the children was assessed by structured diagnostic interviews (K-SADS), and pregnancy and delivery complications were assessed using the developmental history module of the DICA-P. Number of pregnancy complications predicted multiple childhood anxiety disorders independently of parental diagnosis (odds ratio=1.6 [1.4-2.0]). This effect was accounted for by heavy bleeding requiring bed-rest, hypertension, illness requiring medical attention, and serious family problems. Associations remained significant when lifetime child mood and disruptive behavior disorders were covaried. Results suggest that prenatal stressors may increase a child's risk for anxiety disorders beyond the risk conferred by parental psychopathology alone.

Anxiety Disorders↗
PubMed2004

A prospective follow-up study of pediatric bipolar disorder in boys with attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine patterns of persistence and remission in pediatric bipolar disorder attending to syndromatic, symptomatic, functional and affective definitions of remission of bipolar symptomatology in a longitudinal sample of ADHD children with comorbid bipolar disorder. METHODS: ADHD boys (128) were followed over 1- and 4-year follow-up assessments with structured diagnostic interviews to assess the persistence of psychiatric comorbidity. The course and duration of bipolar disorder was estimated by calculating the time from age at onset and the age at remission reported at either the 1- or 4-year follow-up assessments. RESULTS: Twenty-two (17%, Prevalent Cases) subjects met criteria for bipolar disorder at the baseline assessment. The average age of these subjects was 10.5+/-3.0 (range: 6 to 17 years) at baseline and 14.4+/-3.1 years of age at follow-up. The rate of remission was heavily dependent on the definition used. The rate of functional remission was the lowest and the rate of syndromatic remission was the highest. Regardless of the definition used, however, the disorder was chronic and lasted many years. LIMITATIONS: These data should be considered preliminary due to the sample size and the absence of mood symptom rating scales. CONCLUSIONS: That less than 20% of subjects attained functional remission or euthymia over the entire time period evaluated provides further evidence that pediatric bipolar disorder is a chronic mood disorder with a poor prognosis.

Adolescent↗
PubMed2004

The clinical characteristics of unipolar vs. bipolar major depression in ADHD youth.

OBJECTIVE: To investigate the characteristics of unipolar vs. bipolar depression in youth using a sample of children referred for a study on attention deficit hyperactivity disorder (ADHD). METHODS: We compared children with unipolar depression (N=109) to those with bipolar depression (N=43) using boys and girls (N=280) referred for a study on ADHD. Comparisons were made in characteristics of depression, comorbidity and family history. All diagnoses were made using the KSADS-E. RESULTS: In comparison to children with unipolar depression, children with bipolar depression were more likely to have met criteria for depression due to both "sad" and "mad" mood states as stated in the KSADS-E, have severe depression with suicidality, anhedonia and hopelessness. Children with bipolar depression were more likely to have comorbid conduct disorder, severe oppositional defiant disorder, agoraphobia, obsessive compulsive disorder and alcohol abuse, compared to children with unipolar depression. Bipolar depressed children had lower GAF scores and higher rates of hospitalization. Bipolar depression is associated with higher levels of psychiatric disorders in first-degree relatives. CONCLUSIONS: In youth, bipolar depression is distinct from unipolar depression in quality and severity of symptoms, comorbidity and family history. This presentation can aid clinicians in identifying children and adolescents with bipolar disorder.

Adolescent↗
PubMed2004

Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: findings from a large sample of clinically referred preadolescent children assessed over the last 7 years.

BACKGROUND: A comparison of the prevalence, clinical correlates, and patterns of comorbidity among children with bipolar disorder (BPD) assessed in the early 1990s (1st cohort) with those evaluated over the last 7 years (2nd cohort). METHOD: Subjects in both cohorts were children aged <or=12 years referred to a child psychiatry service and evaluated with identical assessment methods. Children with a DSM-III-R BPD diagnosis (1st cohort, n=43; 2nd cohort, n=129) were identified. For comparison purposes, we used attention-deficit/hyperactivity disorder (ADHD) children without BPD referred to the same clinic during the same time period (1st cohort, n=164; 2nd cohort, n=450). RESULTS: Analogous to 1st cohort findings, 2nd cohort results showed that (1) mania was identified in 17% of subjects; (2) the clinical picture was predominantly irritable and mixed, and the course was chronic; (3) BPD children frequently met criteria for major depression, ADHD, psychosis, and anxiety disorders; and (4) BPD children had high rates of psychiatric hospitalization and had evidence of severely impaired psychosocial functioning. CONCLUSION: These findings confirm that pediatric BPD is a severe clinical disorder afflicting a sizable number of referred preadolescent children. Its unique phenotypic features and patterns of comorbidity support the hypothesis that clinically referred pediatric bipolar disorder represents a very severe developmental subtype of bipolar disorder.

Age of Onset↗
PubMed2004

Absence of gender differences in pediatric bipolar disorder: findings from a large sample of referred youth.

BACKGROUND: Because little is known about gender differences in pediatric bipolar disorder, we evaluated whether gender moderates the expression of pediatric bipolar disorder in a large clinical sample. METHODS: Subjects were consecutively referred youth aged 18 years or less who met full criteria for DSM-III-R bipolar disorder (BPD) (females, n=74; BD males, n=224). All subjects were assessed with a structured diagnostic interview and measures of psychosocial and family functioning. RESULTS: Most of the bipolar subjects (91% of males, 70% of females) also had ADHD. Bipolar disorder was equally prevalent in both genders. Among females and males, severe irritability (83% and 80%, respectively), mixed presentation (87% and 84%, respectively), chronic course (84% and 77%, respectively) and prepubertal onset (78% and 93%, respectively) predominated the clinical picture. We found no meaningful differences between genders in the number of BPD symptoms, type of treatment for BPD (counseling, medication, hospitalization), severity of educational deficits, severity of family and interpersonal functioning or patterns of psychiatric comorbidity. CONCLUSIONS: Because gender does not moderate the clinical expression of pediatric bipolar disorder, our data does not suggest that gender specific criteria for the disorder are warranted.

Adolescent↗
PubMed2004

Nonstimulant treatment of adult attention-deficit/hyperactivity disorder.

A substantial literature supports the viability of nonstimulant treatments for ADHD. Despite their chemical differences, the various compounds with documented anti-ADHD activity share a common noradrenergic/dopaminergic activity. Although TCAs are established alternative treatments forADHD, particularly the more noradrenergic secondary amines (DMI and nortriptyline), their narrow therapeutic index and potential for cardiovascular toxicity have limited their use. The atypical mixed noradrenergic/dopaminergic antidepressant bupropion also has been documented to be effective in treating adults with ADHD in a controlled clinical trial. Recent work with the novel noradrenergic specific agent, atomoxetine, has produced convincing evidence of substantial efficacy, tolerability, and safety in children and adults. Despite these advances, more work is needed to further document the short- and long-term safety and efficacy of stimulants and alternative agents for treating adults with ADHD. It also is hoped that advances in the understanding of the underlying neurobiology of ADHDwill lead to the development of a new generation of safe and effective treatments for this disorder. Such developments have the promise of improving the quality of life of the millions of affected patients and their families worldwide.

Adolescent↗
PubMed2004

Stimulant treatment of adult attention-deficit/hyperactivity disorder.

Though only recently recognized as a valid disorder in adults, the clinical picture of adult ADHD is highly reminiscent of childhood ADHD,with continued associated occupational failure and academic deficits. Similarly, many adults with ADHD suffer from antisocial, depressive, and anxiety disorders. Recent work clearly documents that when therapeutic doses of MPH and amphetamine treatment are used in the treatment of adults with ADHD, they can lead to a robust clinical response that is highly consistent with that observed in pediatric studies using equipotent daily doses. As in childhood ADHD, medication remains a key component of treatment for adults with ADHD. More studies are needed to evaluate the efficacy and safety of stimulants over the long-term and their impact on quality of life.

Adult↗
PubMed2004

The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives.

With the single exception of SUDs, no statistically significant gender-by ADHD interactions were identified in the multiple, outcomes evaluated. These results suggest that with the exception of SUDs, ADHD expresses itself similarly in boys and girls relative to comparison subjects of the same gender, indicating that ADHD-associated impairments are correlates of ADHD in both genders. Gender differences, such as the higher prevalence of symptoms of inattention and lower rates of comorbidity with disruptive behavior disorders, major depression, and learning disability, were identified among the ADHD subjects. Because these differences were caused by the main effects of gender rather than effect modification of ADHD by gender, these findings indicate that girls were at the same relative risk for these adverse outcomes as boys, but that female gender resulted in a different clinical presentation than that affecting boys. The single statistically significant gender-by-ADHD interaction identified was the association between ADHD and SUDs (alcohol or drug abuse or dependence). ADHD in females was a more serious risk factor for SUDsthan it was in males was an unanticipated and surprising finding. In light of ongoing concerns regarding ADHD as a putative risk factor of SUDs [12],this finding may indicate that girls are particularly at risk in early adolescence. Considering that the age of onset of ADHD and SUDs are separated by at least a decade [13.14], this finding would support targeting of substance abuse prevention programs to girls with ADHD.Furthermore, results show that although the combined type of ADHDwas the predominant type in both genders, girls with ADHD were twice as likely as boys with ADHD to manifest the predominantly inattentive type of the disorder. Because symptoms of inattention are more covert than those of hyperactivity and impulsivity, their higher prevalence in girls with ADHDrelative to boys also may explain partially the markedly higher male-to-female ratios in referred versus nonreferred samples of children withADHD. This work also showed that the pattern of transmission of ADHD and comorbid disorders is not influenced by the proband's gender. This is true for the type of disorder transmitted and the degree of risk to relatives. The finding of no interactions between proband ADHD diagnosis and pro-band gender clearly rejects the idea that gender differences in comorbid disorders can be attributed to genes or other familial causes. Prior work had shown this to be true for the diagnosis of ADHD in relatives [15-20].Thus, gender and ADHD appear to be independent risk factors for comorbid psychopathology and for the familial transmission of comorbid psychopathology. In summary, these results suggest that gender was a limited effect modifier of ADHD as a risk factor for ADHD-associated dysfunction in referred children and adolescents. Gender, however, did impact the clinical presentation of the disorder. This was largely because girls with ADHDwere less likely than boys to have comorbid disruptive behavior problems and higher prevalence of symptoms of inattention. Because these features could result in gender-based referral bias unfavorable to girls, more work is needed in referred and nonreferred samples of youth with ADHD to more fully assess this issue. These results also showed similar patterns in the familial transmission of comorbid disorders in families of boys and girls with ADHD. Thus, although ADHD is associated with the familial trans-mission of comorbid disorders, the pattern of transmission is not influenced by the proband's gender. These similar patterns provide further evidence for the idea that, when ADHD is diagnosed in girls it corresponds to the same disorder diagnosed in boys.

Adolescent↗