Search PubMed⌕ Search

Biomedical subjects

P H Wender

Publications and source records attributed to P H Wender.

At least 19 recordsLinked to original sources
PubMed2003

[Reliability and validity of the Wender-Utah-Rating-Scale short form. Retrospective assessment of symptoms for attention deficit/hyperactivity disorder].

The diagnosis of adult attention deficit/hyperactivity disorder (ADHD) requires the retrospective assessment of ADHD symptoms in childhood. The Wender Utah Rating Scale (WURS) is helpful in detecting ADHD-associated symptomatology in childhood. A German short version (WURS-k) of this instrument has been made available recently. In the present study, we investigated the validity of the WURS-k. In a population of 63 adult ADHD patients (according to ICD-10 and DSM-IV criteria) and 1,303 male controls, ROC analysis indicated a sensitivity of 85% and specificity of 76% at a cutoff of 30 points. In ADHD patients, seven individual factors explained 70.3% of the variance. The highest diagnostic precision was demonstrated using the WURS-k total score. The seven extracted factors of the WURS-k did not differ in diagnostic value. Significant correlations were found between impulsivity according to Eysenck's Impulsivity Questionnaire (EIQ) and excitability, aggression, emotional lability, and satisfaction on the Freiburg Personality Inventory (FPI-R) in ADHD patients. Concerning a 30-50% persistence of ADHD symptomatology in adults, these correlations underline the diagnostic validity of the WURS-k. The scale manifested excellent internal consistency (alpha=0.91) and a split-half correlation of r(12)=0.85.

Adult↗
PubMed2002

[Wender Utah rating scale. The short-version for the assessment of the attention-deficit hyperactivity disorder in adults].

This work presents a statistical analysis of the German version of the Wender Utah rating scale (WURS) for the retrospective diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults. Data were obtained from 703 subjects. Item selection according to item-total correlation scores, frequency, and plausibility led to a short version of the scale that includes 21 items with item-total correlations from 0.19 to 0.61. Retest reliability of the WURS-k was r=0.9.

Adolescent↗
PubMed2001

Adults with ADHD. An overview.

Attention-Deficit Hyperactivity Disorder (ADHD) is a common, genetically transmitted neurological disorder, with onset in childhood, probably mediated by decreased brain dopaminergic functioning. The first author was one of the earliest to describe the persistence of symptoms into adulthood. Prevalence and natural history data suggest that of the 3 to 10% of children diagnosed with ADHD, one- to two-thirds (somewhere between 1 and 6% of the general population) continue to manifest appreciable ADHD symptoms into adult life. This paper describes how ADHD in adults can be readily diagnosed and treated, despite resembling or coexisting with other psychiatric disorders. The Wender Utah diagnostic criteria address adult characteristics of the disorder. Informant and patient interviews and rating scales are used to determine the psychiatric status of the patient as a child, make a retroactive diagnosis of childhood ADHD, and establish the current diagnosis of the adult. Stringent diagnosis is key to determining effective treatment. Dopamine agonist stimulant medications appear to be the most effective in treating ADHD. About 60% of patients receiving stimulant medication showed moderate-to-marked improvement, as compared with 10% of those receiving placebo. The core symptoms of hyperactivity, inattention, mood lability, temper, disorganization, stress sensitivity, and impulsivity have been shown to respond to treatment with stimulant medications. Non-dopaminergic medications, such as the tricyclic antidepressants and SSRIs have generally not been useful in adults with ADHD in the absence of depression or dysthymia. Pemoline is no longer approved for use in these patients, despite early favorable reports. Appropriate management of adult patients with ADHD is multimodal. Psychoeducation, counseling, supportive problem-directed therapy, behavioral intervention, coaching, cognitive remediation, and couples and family therapy are useful adjuncts to medication management. Concurrent supportive psychosocial treatment or polypharmacy may be useful in treating the adult with comorbid ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

Factors affecting return of symptoms 1 year after treatment in a 62-week controlled study of fluoxetine in major depression.

BACKGROUND: In spite of impressive results in acute studies, the long-term treatment of major depression remains problematic. To explore the return of depressive symptoms and their interaction with social factors on long-term outcome, we assessed 55 patients whose depression had been treated during a 62-week, fluoxetine maintenance study, 1 year after the study's termination. METHOD: During the year following the study termination, patients were free to select treatment options. Assessments at the 1-year follow-up included measures of depressive symptoms (using the Hamilton Rating Scale for Depression [HAM-D]), social and marital impairment (using the Weissman Social Adjustment Scale [SAS]), personal stressors (using the Holmes Social Readjustment Rating Scale), and history of treatment during the past year. RESULTS: At the time of the naturalistic follow-up, 53% of patients sustained their improvement in mood. Factors associated with return of depressive symptoms included personal stresses, marital maladjustment, personal decision to discontinue antidepressants, and medication failure. Psychosocial variables were associated with poor outcome in over 90% of impaired subjects. Development of subsyndromal symptoms during the 50-week double-blind phase was predictive of poorer outcome at the long-term follow-up. CONCLUSION: The study demonstrates that no matter how effective initial pharmacologic therapy may be, without ongoing clinical monitoring and support, particularly in dealing with issues such as marriage and handling significant life stresses, and compliance with medications, it will not be successful in the long-term treatment for a significant portion of patients with depression.

Adult↗
PubMed2000

ADHD in adults.

Explore the source record for details and available documents.

Adult↗
PubMed1998

Attention-deficit hyperactivity disorder in adults.

Attention-deficit hyperactivity disorder (ADHD) is probably the most common chronic undiagnosed psychiatric disorder in adults. It is characterized by inattention and distractibility, restlessness, labile mood, quick temper, overactivity, disorganization, and impulsivity. It is always preceded by the childhood diagnosis, a disorder that is rarely inquired about, and usually overlooked. Treatment can be dramatically effective. Approximately two thirds of adult ADHD patients experience moderate-to-marked improvement with psychoeducational management and stimulant drug therapy.

Adoption↗
PubMed1998

Pharmacotherapy of attention-deficit/hyperactivity disorder in adults.

A history of childhood attention-deficit/hyperactivity disorder (ADHD) is a mandatory prerequisite for the diagnosis of adult type ADHD, for which no DSM criteria exists. Since the diagnosis must be made retroactively, tentative criteria have been designed to establish the presence of the childhood disorder. In the 1970s, I advanced the hypothesis that "minimal brain dysfunction" (as ADHD was called) might be produced by decreased catecholaminergic function. A total of over 300 ADHD patients have been included in treatment studies, including 224 patients who received stimulants in four double-blind, placebo-controlled trials: three of methylphenidate (N = 176) and one of pemoline (N = 48). An additional 79 patients have been included in open-label trials of pargyline, selegiline, bupropion, levodopa, phenylalanine, and tyrosine. Altogether, these studies have demonstrated the efficacy of methylphenidate, pemoline, and monoamine oxidase-B (MAO-B) inhibitors when administered to adult ADHD patients; a robust response was produced in 60% of the patients. Bupropion and selegiline were effective in the open-label studies and should be systematically evaluated. A long-term study is being conducted with methylphenidate maintenance; patients have been followed for as long as 5 years, and little, if any, drug tolerance has been observed. Treatment of adult patients who have ADHD is symptomatic, not curative, but the combination of medication and psychotherapy may offer life-changing opportunities to individuals who suffer from the disorder.

Adult↗
PubMed1995

An open trial of venlafaxine in adult patients with attention deficit hyperactivity disorder.

Stimulant medications are the most widely accepted treatment of attention deficit hyperactivity disorder (ADHD) in spite of controversy over their use. Stimulants have consistently been shown to potentiate noradrenergic brain transmission, a property also characteristic of the recently marketed antidepressant venlafaxine. Eighteen adults who met the Utah Criteria for ADHD in adults were enrolled in an open trial of venlafaxine. Progress was monitored with a recently refined rating scale designed to measure change in adult patients with ADHD. Among the 11 patients who could tolerate the medication, 8 showed a good response that was well maintained. They responded to dosages of 50 to 150 mg/day, with an average dose of 96 mg. Seven of the 18 had difficulty tolerating venlafaxine's side effects. These data suggest that controlled trials should be conducted with venlafaxine for ADHD.

Adult↗
PubMed1994

Mental illness in the biological and adoptive relatives of schizophrenic adoptees. Replication of the Copenhagen Study in the rest of Denmark.

BACKGROUND: Our previous investigation of the prevalence of mental illness among the biological and adoptive relatives of schizophrenic adoptees in Copenhagen, Denmark, showed a significant concentration of chronic schizophrenia (5.6%) and what Bleuler called "latent schizophrenia" (14.8%) in the biological relatives of chronic schizophrenic adoptees, indicating the operation of heritable factors in the liability for schizophrenic illness. METHODS: We now report the results of a replication of that study in the rest of Denmark (the "Provincial Sample"). RESULTS: In this sample, the corresponding prevalences were 4.7% and 8.2%. In the combined "National Sample" of adoptees with chronic schizophrenia, that disorder was found exclusively in their biological relatives and its prevalence overall was 10 times greater than that in the biological relatives of controls. CONCLUSIONS: This study and its confirmation of previous results in the Copenhagen Study speak for a syndrome that can be reliably recognized in which genetic factors play a significant etiologic role. These findings provide important and necessary support for the assumption often made in family studies: observed familial clustering in schizophrenia is an expression of shared genetic factors.

Adolescent↗
PubMed1993

The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder.

OBJECTIVE: In an attempt to surmount the problem of retrospectively establishing the childhood diagnosis of attention deficit hyperactivity disorder, the authors constructed the 61-item Wender Utah Rating Scale (WURS) for adults to use to describe their own childhood behavior. In this paper they present their initial data collection and evaluation of the instrument's validity. METHOD: The scale was administered to 81 adult outpatients with attention deficit hyperactivity disorder, 100 "normal" adults, and 70 psychiatric adult outpatients with unipolar depression. The authors analyzed data from the 25 items of the scale that showed the greatest difference between the patients with attention deficit hyperactivity disorder and the normal comparison subjects and the relationship between the WURS and the patients' parents' judgment of childhood activity as measured by the Parents' Rating Scale. RESULTS: The patients with attention deficit hyperactivity disorder had significantly higher mean scores on all 25 items than did the two comparison groups. The difference between the mean total scores of the patients with attention deficit hyperactivity disorder and the normal subjects was also highly significant. A cutoff score of 46 or higher correctly identified 86% of the patients with attention deficit hyperactivity disorder, 99% of the normal subjects, and 81% of the depressed subjects. Correlations obtained between WURS scores and Parents' Rating Scale scores were moderate but impressive. The ability of WURS scores to predict response to methylphenidate replicated the authors' finding regarding the ability of Parents' Rating Scale scores to predict response to pemoline. CONCLUSIONS: The WURS is sensitive in identifying childhood attention deficit hyperactivity disorder and may be useful in recognizing attention deficit hyperactivity disorder in patients with ambiguous adult psychopathology.

Adult↗
PubMed1992

Risk for affective disorder and alcohol and other drug abuse in the relatives of affectively ill adoptees.

We investigated the risk for substance abuse in the biological relatives of adoptees with affective illness, controlling for potential confounds, and additionally assessed risk by probands' and relatives' gender. Our sample consisted of 67 index adoptees with affective illness, matched control adoptees, and their biological and adoptive relatives. Both affective illness and substance abuse were more common in the biological relatives of affectively ill adoptees than in controls' relatives. Affective illness was more common than substance abuse among female index biological relatives, with the opposite pattern observed among male relatives.

Adoption↗
PubMed1991

Spontaneous selective attention in schizophrenia.

A visual word identification task was used to measure the type of selective attention that occurs spontaneously when there are multiple stimuli, all potentially relevant, and insufficient time to process each of them fully. This task presents two words simultaneously, one above the other, for 200 ms, and periodically requires the subject to identify either the upper or the lower word. We tested schizophrenic patients, manic-depressive patients, and normal controls under a baseline divided attention condition with no predictability and then introduced a degree of predictability into the upper location that normally results in selective attention to the lower nonpredictable location. In both the divided attention and the selective attention conditions, the schizophrenic group was just as accurate in identifying words as the other two groups, indicating no deficit in the rate of information processing. However, spontaneous selective attention under conditions of predictability was abnormal in the schizophrenic patients: They paid more attention to the predictable than to the nonpredictable source of information, consequently processing different, not less, information than normal subjects. Abnormal values on a ratio measure of selective attention occurred in 85% of the schizophrenic patients compared with only 30% of the manic-depressives and 20% of the normal subjects.

Adult↗
PubMed1990

Bupropion treatment of attention-deficit hyperactivity disorder in adults.

The authors treated 19 adults with attention-deficit hyperactivity disorder with an open trial of bupropion. These patients had received maintenance stimulant medication or monoamine oxidase inhibitors for an average of 3.7 years. Fourteen of the patients experienced moderate to marked benefit from bupropion; ten of these patients chose to continue bupropion rather than their former medication. These results suggest that bupropion may be an alternative to stimulants in treating some adults with attention-deficit hyperactivity disorder.

Adult↗
PubMed1987

An open trial of L-tyrosine in the treatment of attention deficit disorder, residual type.

To elucidate the role of catecholamines in attention deficit disorder, the authors conducted an open 8-week trial of L-tyrosine in 12 adults with attention deficit disorder, residual type. Eight showed marked to moderate clinical response in 2 weeks; at 6 weeks these eight developed tolerance, suggesting that L-tyrosine is not useful in attention deficit disorder, residual type.

Adult↗
PubMed1986

Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorders.

To investigate the contribution of genetic and environmental factors in the etiology of mood disorders, a study was initiated to examine the frequency of psychiatric disorders in the biological and adoptive relatives of adult adoptees with mood disorders and in matched normal adoptees. Psychiatric evaluations of the relatives were made on the basis of independent blind diagnoses based on mental hospital and other official records. Analysis of the data showed an eightfold increase in unipolar depression among the biological relatives of the index cases and a 15-fold increase in suicide among the biological relatives of the index cases. These data demonstrate a significant genetic contribution to unipolar depression and suicide. They fail to disclose a significant contribution of family-associated transmission in the genesis of the mood disorders.

Adjustment Disorders↗