Depression--augmentation or switch after initial SSRI treatment.
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Depressive Disorder↗
Biomedical subjects
Bernd Hesslinger
Publications and source records attributed to Bernd Hesslinger.
Sleep in adults with attention-deficit/hyperactivity disorder: a controlled polysomnographic study including spectral analysis of the sleep EEG.
STUDY OBJECTIVES: Previous studies in children with attention-deficit/hyperactivity disorder and attention deficit disorder (ADHD/ADD) have shown impaired sleep quality with increased nocturnal motor activity. However, polysomnographic findings are not unequivocal. Up to now, in adults with ADHD, only 1 case-control polysomnographic study with small sample size has been performed. We investigated objective and subjective sleep quality in adultADHD, including an electroencephalogram spectral power analysis. DESIGN: Single-blind comparative study. SETTING: University medical center. PARTICIPANTS: Twenty adult unmedicated ADHD patients without current comorbid major depression, drug abuse, or comorbid axis-II disorder and 20 sex- and age-matched control subjects. INTERVENTIONS: N/A. MEASUREMENTS: Conventional polysomnographic parameters and sleep electroencephalogram spectral power analysis was calculated for the 2 laboratory nights. Subjective sleep parameters were estimated by sleep questionnaires to assess the relationship between objective and subjective sleep measurements. RESULTS: Adult ADHD patients showed increased nocturnal motor activity (as indicated by heightened indexes of periodic leg movements in sleep), which was significantly inversely correlated with subjective total sleep time. Although ADHD patients displayed significantly increased objective total sleep time, the subjective ratings documented impaired sleep quality in those with ADHD. Other polysomnographic sleep patterns and spectral electroencephalogram parameters did not differ between ADHD patients and normal controls. CONCLUSIONS: Similar to children, adults with ADHD show increased nocturnal motor activity. Otherwise, sleep does not seem to be impaired in ADHD patients. However, the dissociation between objective and subjective sleep parameters points to a misinterpretation of sleep quality in patients with ADHD.
Adult↗
Attention deficit hyperactivity disorder in adults-early vs. late onset in a retrospective study.
Attention deficit hyperactivity disorder (ADHD) is a severe and often debilitating mental disorder, which begins in childhood and can persist into adulthood. Both major classificatory systems, ICD-10 and DSM-IV, include the age-of-onset criterion (AOC) requiring clinically relevant symptoms before the age of 7 years. In clinical practice, particularly in adult psychiatry, it is often difficult to establish this AOC when ADHD remained unrecognized in childhood. In the literature, there is controversy about the validity of this criterion. In order to explore the validity of the AOC, we performed a retrospective study in adult patients with ADHD. Fifty consecutively diagnosed patients were subjected to a standardized diagnostic procedure. Depending on the onset of clinical symptoms, patients were divided in an early onset and in a late onset ADHD subgroup. Fourteen patients (28%) described late onset ADHD. In four of these patients (8% of the total sample), this assessment was confirmed by parent ratings. There was no difference between early onset and late onset ADHD groups in terms of psychopathology or psychiatric comorbidity.
Adult↗
Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study.
BACKGROUND: Dual frontolimbic brain pathology has been suggested as a possible correlate of impulsivity and aggressive behavior. One previous study reported volume loss of the hippocampus and the amygdala in patients with borderline personality disorder. We measured limbic and prefrontal brain volumes to test the hypothesis that frontolimbic brain pathology might be associated with borderline personality disorder. METHODS: Eight unmedicated female patients with borderline personality disorder and eight matched healthy controls were studied. The volumes of the hippocampus, amygdala, and orbitofrontal, dorsolateral prefrontal, and anterior cingulate cortex were measured in the patients using magnetic resonance imaging volumetry and compared to those obtained in the controls. RESULTS: We found a significant reduction of hippocampal and amygdala volumes in borderline personality disorder. There was a significant 24% reduction of the left orbitofrontal and a 26% reduction of the right anterior cingulate cortex in borderline personality disorder. Only left orbitofrontal volumes correlated significantly with amygdala volumes. CONCLUSIONS: While volume loss of a single brain structure like the hippocampus is quite an unspecific finding in neuropsychiatry, the patterns of volume loss of the amygdala, hippocampus, and left orbitofrontal and right anterior cingulate cortex might differentiate borderline personality disorder from other neuropsychiatric conditions.
Adult↗
Psychotherapy of attention deficit hyperactivity disorder in adults--a pilot study using a structured skills training program.
In clinical practice many adult patients with attention deficit hyperactivity disorder (ADHD) ask for an additional psychotherapeutic intervention besides the medical therapy. In this paper we present a structured skill training program particularly tailored for adult patients with ADHD. The program is based on the principles of cognitive-behavioral treatment for borderline personality disorder developed by M. Linehan. It was modified to suit the special needs of adult patients with ADHD. In this exploratory pilot study we tested this program in a group setting. The following elements were presented: neurobiology of ADHD, mindfulness, chaos and control, behavior analysis, emotion regulation, depression, medication in ADHD, impulse control, stress management, dependency, ADHD in relationship and self respect. In an open study design patients were assessed clinically using psychometric scales (Attention Deficit Hyperactivity Disorder Checklist according to DSM-IV, 16 items of the SCL-90-R, Beck-Depression Inventory, visual analogue scale) prior to and following group therapy. This treatment resulted in positive outcomes in that patients improved on all psychometric scales.
Adult↗