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Florida Agency Investigated Nikolas Cruz After Violent Social Media Posts - The New York Times

Agency investigators identified Mr. Cruz, who had turned 18 a few days earlier, as a “vulnerable adult due to mental illness.” In addition to depression, Mr. Cruz had autism and attention-deficit hyperactivity disorder, the report said. He was regularly taking medication for the A.D.H.D. It was unclear whether he was taking anything for the depression, according to the report.

12 of 14

A large dose of intravenous methamphetamine hydrochloride reproduced the amphetamine psychosis in 12 of 14 patients dependent on amphetamine sulfate and failed to produce a psychosis in two patients who were eventually found to have not used amphetamine regularly above the therapeutic dose range. The psychosis was the facsimile of the disorder observed during drug abuse—a schizophrenic-like state of paranoia in a setting of clear consciousness accompanied by auditory or visual hallucinations, or both, but without thought disorder. Since in some cases the onset of the psychosis was sudden and occurred within one hour of commencing the intravenous injection, hypotheses about depletion of catecholamines and long term metabolites may need to be reconsidered.

Frontiers | The Role of Infection and Immune Responsiveness in a Case of Treatment-Resistant Pediatric Bipolar Disorder | Psychiatry

P’s behavior appeared treatment resistant with minimal improvement despite multiple medication trials prior to and during hospitalizations.

Amid ADHD spike, doctors urge closer look at sleep issues -- ScienceDaily

D-diagnosed children whose behavior only improves after better sleep quality and duration. Occasionally, he has found that ADHD medications are the root of the sleep issues.

Long-term ADHD Med Use: No Benefit, Negative Impact on Growth

Moreover, individuals in the consistent/inconsistent groups were significantly shorter than those in the negligible group, at an average height reduction of 2.55 ± 0.73 cm (P < .0005). Those in the consistent group were on average 2.36 ± 1.13 cm shorter than those in the inconsistent group, a difference that was again significant (P = .04).

Researchers 'dismantle' mindfulness intervention to see how each component works -- ScienceDaily

As health interventions based on mindfulness have grown in popularity, some of the field's leading researchers have become concerned that the evidence base for such practices is not yet robust enough. A new study shows how a rigorous approach to studying mindfulness-based interventions can help ensure that claims are backed by science. One problem is that mindfulness-based interventions (MBIs) sometimes blend practices, which makes it difficult to measure how each of those practices affects participants. To address that issue, the researchers took a common intervention for mood disorders -- mindfulness-based cognitive therapy (MBCT) -- and created a controlled study that isolated, or dismantled, its two main ingredients. Those include open monitoring (OM) -- noticing and acknowledging negative feelings without judgment or an emotional secondary reaction to them; and focused attention (FA) -- maintaining focus on or shifting it toward a neutral sensation, such as breathing, to disengage from negative emotions or distractions. "It has long been hypothesized that focused attention practice improves attentional control while open-monitoring promotes emotional non-reactivity -- two aspects of mindfulness thought to contribute its therapeutic effects," said study lead and corresponding author Willoughby Britton, an assistant professor of psychiatry and human behavior in the Warren Alpert Medical School of Brown University. "However, because these two practices are almost always delivered in combination, it is difficult to assess their purported differential effects. By creating separate, validated, single-ingredient training programs for each practice, the current project provides researchers with a tool to test the individual contributions of each component and mechanism to clinical endpoints." In the study, the researchers randomized more than 100 individuals with mild-to-severe depression, anxiety and stress to take one of three eight-week courses: one set of classes provided a standardized MBCT that incorporated the typical blend of OM and FA. The two other classes each provided an intervention that employed only OM or only FA. In every other respect -- time spent in class, time practicing at home, instructor training and skill, participant characteristics, number of handouts -- each class was comparable by design. At the beginning and end of the classes, the researchers asked the volunteers to answer a variety of standardized questionnaires, including scales that measure their self-reported ability to achieve some of the key skills each practice is assumed to improve. If the researchers saw significant differences between the FA group and the OM group on the skills each was supposed to affect, then there would be evidence that the practices uniquely improve those skills as intervention providers often claim. Sure enough, the different practices engaged different skills and mechanisms as predicted. The FA-only group, for example, reported much greater improvement in the ability to willfully shift or focus attention than the OM-only group (but not the MBCT group, which also received FA training). Meanwhile, the OM-only group was significantly more improved than the FA-only group (but not the MBCT group) in the skill of being non-reactive to negative thoughts.

Is ADHD really a sleep problem? -- ScienceDaily

"There is extensive research showing that people with ADHD also tend to exhibit sleep problems. What we are doing here is taking this association to the next logical step: pulling all the work together leads us to say that, based on existing evidence, it looks very much like ADHD and circadian problems are intertwined in the majority of patients. We believe this because the day and night rhythm is disturbed, the timing of several physical processes is disturbed, not only of sleep, but also of temperature, movement patterns, timing of meals, and so on. If you review the evidence, it looks more and more like ADHD and sleeplessness are 2 sides of the same physiological and mental coin."

CBT plus video games plus heart rate monitors

In a subsequent outpatient study the researchers randomized 20 youth to 10 cognitive behavior therapy sessions and videogame therapy that required them to control their heart rate, and 20 youth to CBT with the same videogame but not linked to heart rates. All the adolescents had anger or aggression problems, said Dr. Gonzalez-Heydrich, who was senior author of the study. Therapists interviewed the children’s primary caregiver before and two weeks after their last therapy session. They found the children’s ratings on aggression and opposition were reduced much more in the group that played the game with the built-in biofeedback. The ratings for anger went down about the same in both groups. The findings were presented at the American Academy of Child and Adolescent Psychiatry conference in 2015. The study is currently under review for publication.

Smarter in the sun?

Besides suppressing melatonin and warding off any residual sleepiness, recent studies suggest that bright light acts as a stimulant to the brain. Gilles Vandewalle and colleagues at the University of Liège in Belgium asked volunteers to perform various tasks in a brain scanner while exposing them to pulses of bright white light or no light. After exposure to white light, the brain was in a more active state in those areas that were involved in the task. Although they didn’t measure the volunteers’ test performances directly, if you are able to recruit a greater brain response, then your performance is likely to be better: you will be faster or more accurate, Vandewalle says.

Ad targetting at Facebook

occasionally, if used very cleverly, with lots of machine-learning iteration and systematic trial-and-error, the canny marketer can find just the right admixture of age, geography, time of day, and music or film tastes that demarcate a demographic winner of an audience.

Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon

Another reason that physicians don't report their colleagues, researcher Lisa Merlo says, is because medical schools fail to educate them about the disease of addiction. Most medical schools include only a lecture or two on addiction, she says. By contrast, the University of Florida requires all third-year students to complete a 2-week rotation in addiction medicine. "Every physician in the United States has to deliver a baby to graduate, but how many of them are ever going to deliver babies in practice?" she asks. "But every doctor is going to see addicted patients."

Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon

Access rapidly becomes an addict's top priority, he notes, and self-medicating physicians will do everything in their power to ensure it continues. "They're often described as the best workers in the hospital," he says. "They'll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They'll sign up for extra call and show up for rounds they don't have to do." Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.

Stimulant Use Exceptionally High Among Medical Students

Of 148 medical students, 145 (98%) responded to the survey. The results revealed that 20% of students reported lifetime use of stimulants, with 15% reporting stimulant use during medical school. Compared with Asian students, white students had a 9-fold increase in odds for stimulant use (P = .001). The investigators note that the sample size was not large enough to reliably compare prevalence of stimulant use in black and Hispanic medical students. The researchers report that 13 students (9%) reported a diagnosis of ADHD and had an odds ratio of 37 for stimulant use in medical school compared with those without an ADHD diagnosis (P < .001). The study also revealed that, of those who had taken stimulants, 83% used them specifically to boost cognitive performance, including improving focus while studying and staying awake longer while on clinical duty. There were no differences in stimulant use by age, marital status, or academic achievement. "Indeed, those with high standardized test scores had an almost identical use prevalence compared with those with lower test scores," the investigators report. The majority (83%) of students who reported using stimulants used them specifically to improve cognitive performance.

My Stimulant Use in Med School: The Good, The Bad, The Victory » in-Training, the online magazine for medical students

ADD medications are generally marketed to “unleash the potential of the student,” which is accurate. In my case, I could finally barrel through those lecture notes without stopping five times to look at some shiny thing in order to earn a slightly below average grade on an exam (I’d stop only 2 times, instead). Indeed, there is evidence to suggest that high-functioning students do not benefit from stimulant use the way lower-functioning students do. Of course, “high” and “low” functioning takes on a whole new meaning when we’re now splicing up classes of some of the highest achieving students from their colleges, but this is part of the issue in saying “ADD versus ‘normal.’” It’s really “ADD versus your potential.” The ability to synthesize complex ideas in my head had never been the issue, even through college (i.e. my intellect on its own was plenty strong). My ability to utilize this abstract synthetic ability was the issue, thus the obvious utility of Focalin.

Adderall Concentration Benefits in Doubt: New Study

The last question they asked their subjects was: "How and how much did the pill influence your performance on today's tests?" Those subjects who had been given Adderall were significantly more likely to report that the pill had caused them to do a better job on the tasks they'd been given, even though their performance did not show an improvement over that of those who had taken the placebo.

Adderall, Ritalin, Vyvanse: Do smart pills work if you don’t have ADHD?

What if Adderall turns out to be the new coffee—a ubiquitous, mostly harmless little helper that enables us to spend more time poring over spreadsheets and less time daydreaming or lolling about in bed? For those of us whose natural predilections are to spend far too little time poring and far too much daydreaming, they’re a big improvement over self-medication via caffeine or cigarettes. But those without ADHD might well ask themselves: Don’t I work enough already?

Blood Pressure and Heart Rate in the Multimodal Treatment of Attention Deficit/Hyperactivity Disorder Study Over 10 Years

Disclosures: Dr. Elliott has received research funding from Cephalon, McNeil, Shire, Sigma Tau, and Novartis; has consulted to Cephalon and McNeil; and has been on the speakers’ bureaus of Janssen, Eli Lilly, and McNeil. Dr Swanson has received research support from Alza, Richwood, Shire, Celgene, Novartis, Celltech, Gliatech, Cephalone, Watson, CIBA, Janssen, and Mcneil; has been on the advisory boards of Alza, Richwood, Shire, Celgene, Novartis, Celltech, UCB, Gliatech, Cepahlon, McNeil, and Eli Lilly; has been on the speakers’ bureaus of Alza, Shire, Novartis, Celltech, UCB, Cephalon, CIBA, Janssen, and McNeil; and has consulted to Alza, Richwood, Shire, Celgene, Novartis, Celltech, UCB, Gliatech, Cephalon, Watson,, CIBA, Janssen, McNeil, and Eli Lilly. Dr. Arnold has received research funding from Celgene, Curemark, Shire, Noven, Eli Lilly, Targacepts, Sigma Tau, Novartis, and Neuropharm; has consulted to Shire, Noven, Sigma Tau, Ross, Organon, Targacept, and Neuropharm; and has been speaker for Abbott, Shire, McNeil, Targacept, and Novartis. Dr. Hechtman has received research funding from the National Institute of Mental Health, Eli Lilly, GlaxoSmithKline, Janssen Ortho, Purdue Pharma, and Shire; has been on the speakers’ bureaus of Eli Lilly, Janssen-Ortho, Purdue Pharma, and Shire; and has been on the advisory board of Eli Lilly, Janssen-Ortho, Purdue Pharma, and Shire. Dr. Abikoff has received research funding from McNeil, Shire, Eli Lilly, and Bristol-Myers-Squibb; has consulted to McNeil, Shire, Eli Lilly, Pfizer, Celltech, Cephalon, and Novartis; and has been on the speakers’ bureaus of McNeil, Shire, and Celltech. Dr. Wigal has received research funding from Eli Lilly, Shire, Novartis, and McNeil; and has been on the spearkers’ bureaus of McNeil and Shire. Dr. Jensen has received research funding from McNeil and unrestricted grants from Pfizer; has consulted to Best Practice, Shire, Janssen, Novartis, Otsuka, and UCB; and has participated in speakers’ bureaus for Janssen,-Ortho, Alza, McNeil, UCB, CMED, CME Outfitters, and the Neuroscience Education Institute. Greenhill has received research funding from or has been a consultant to the National institute of Mental Health, National Institute on Drug Abuse, American Academy of Child and Adolescent Psychiatry, Johnson & Johnson, Otsuka, and Rhodes Pharmaceuticals. Dr. Gibbons has consulted to the US Department of Justice, Wyeth, and Pfizer. Ms. Odbert, Ms. Severe, and Drs. Hur, Kaltman, Wells, Molina, and Vitiello report no relevant financial relationships.

Long term heart rate elevation from past stimulant use

The effect on heart rate was in large part driven by current use of medication, although at one time point (8 years) there was a significant effect of cumulative exposure regardless of current use.

The MTA at 8 Years: Prospective Follow-Up of Children Treated for Combined Type ADHD in a Multisite Study

By the next follow up, three years after enrollment (22 months after the end of the randomly assigned treatment), there were no longer significant treatment group differences in ADHD/ODD symptoms or functioning.6 That is, although the improvements over baseline for children in all four groups were maintained, the relative advantage associated with the intensive 14-month medication management in the MedMgt and Comb groups had dissipated.6

Long term ADHD meds worsen school function

Medication use during the past year, measured at each assessment and treated as a time-varying covariate, was associated with outcome over time in a pattern consistent with prior reports.1, 4, 6 It was generally associated with better functioning at 14 and 24 months, when medication use mostly reflected randomized treatment group assignment, but it was associated with worse functioning and more school services (or showed no association with other outcomes) at the later assessments.

Children’s A.D.D. Drugs Don’t Work Long-Term - The New York Times

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

Higher heart rate

Using random effects meta-analysis, we found that subjects randomized to CNS stimulant treatment demonstrated a statistically significant increased resting heart rate [+5.7 bpm (3.6, 7.8), p<0.001] and systolic blood pressure findings [+2.0 mmHg (0.8, 3.2), p=0.005] compared with subjects randomized to placebo.

ADHD as a social construct

Researchers looked at ADHD rates for 378,881 children ages 4-17 in Taiwan where the cutoff birthday for school enrollment is Aug. 31, making students born in that month the youngest in their class and those born in September the oldest. They found 1.8% of students born in September received an ADHD diagnosis compared to 2.9% of those born in August. Roughly 1.2% of those born in September received ADHD medication compared to 2.1% of those born in August.

The WHO Adult ADHD Self-Report Scale for DSM-5 | Attention Deficit/Hyperactivity Disorders | JAMA Psychiatry | The JAMA Network

adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed

Sometimes for six of these and you're ADHD?

How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly? How often do you leave your seat in meetings and other situations in which you are expected to remain seated? How often do you have difficulty unwinding and relaxing when you have time to yourself? When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to before they can finish them themselves? How often do you put things off until the last minute? How often do you depend on others to keep your life in order and attend to details?

Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review

In 2000, the number of prescriptions for amphetamine exceeded eight million, a 1600% increase over nine years. That same year, US annual manufacture of amphetamine reached 30,000 kg (40 % d-amphetamine, 60% mixed d/l salts). In addition, 1,306 kg of methamphetamine was used primarily for treatment of obesity, although it was also approved for treatment of ADHD 11.