The Use of Brexpiprazole Combined With a Stimulant in Adults With Treatment-Resistant Attention-Deficit/Hyperactivity Disorder.

Background: This is the first controlled pharmacologic study in either adults or children with uncomplicated, treatment-resistant attention-deficit/hyperactivity disorder (ADHD). This study augmented stimulant therapy with the atypical antipsychotic brexpiprazole. The Food and Drug Administration preapproved primary outcome measure (Conners' Adult ADHD Rating Scale [CAARS]) showed no drug-placebo differences.

Psychometric data and versions of the Wender Utah Rating Scale including the WURS-25 & WURS-45.

Our associated paper presented a psychometric evaluation of the Wender Utah Rating Scale (WURS) and its abbreviated version, the WURS-25. Instead of actual factors scores, we employed "item averages" calculated by the average score of each item comprising that factor. We did not present a factor analysis of the WURS-25.

Wender Utah Rating Scale: Psychometrics, clinical utility and implications regarding the elements of ADHD.

The Wender Utah Rating Scale (WURS) is a self-report instrument completed by adults assessing a range of childhood symptoms and behaviors consistent with ADHD persisting into adulthood. Many items reflect emotional dysregulation. Although over 30 publications have examined its psychometric properties, reliance on non-clinical samples has limited conclusions from these reports, as have sub-optimal statistical approaches in most previous publications.

ADHD and Anxiety: Clinical Significance and Treatment Implications.

In comparison to the DSM formulation of ADHD, we have proposed that ADHD in adults should be divided into Inattentive and Emotional Dysregulation Presentations. Under both systems, there is potential overlap with generalized anxiety disorder (GAD). We compared data from four distinct populations: ADHD clinical trials, GAD clinical trials, an ADHD clinic, and a forensic clinic.

Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder: Attrition and Change During Long-term Treatment.

Personality disorders (PDs) are commonly found in adults with attention-deficit/hyperactivity disorder (ADHD) and are associated with increased ADHD symptoms and psychosocial impairment. To assess the impact of PDs or personality traits on retention rates in ADHD trials and whether treating ADHD affects the expression of PD, data were analyzed from 2 methylphenidate trials. Assessment of PDs and personality traits included using the Wisconsin Personality Disorders Inventory IV and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Personality Disorders.

Psychometric properties of the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale.

Background: The Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) assesses the same 7 attention-deficit/ hyperactivity disorder (ADHD) domains as the interviewer-administered WRAADDS.

Methods: A normative sample was recruited, and additional participants came from trials involving ADHD, anxiety, or depression. Using the investigator-administered WRAADDS, participants in the ADHD sample were classified as ADHD inattentive presentation or ADHD emotional dysregulation presentation.

Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects.

Background: Major depressive disorder is a prevalent, disabling, and often chronic or recurrent psychiatric condition. About 35% of patients fail to respond to conventional treatment approaches and are considered to have treatment-resistant depression (TRD).

Objective: We compared the safety and effectiveness of different stimulation levels of adjunctive vagus nerve stimulation (VNS) therapy for the treatment of TRD.

The effect of personality disorder symptoms on response to treatment with methylphenidate transdermal system in adults with attention-deficit/hyperactivity disorder.

Objective: This trial was designed to prospectively explore the relationship among personality disorder (PD) symptoms, attention-deficit/hyperactivity disorder (ADHD), and treatment response in a randomized, double-blind, crossover clinical trial of methylphenidate transdermal system (MTS) and to confirm results of a prior exploratory study.

Method: 67 adults who met the Utah and/or DSM-IV-TR criteria for ADHD were recruited with no attempt to include or exclude patients with PD. Responders were defined by a 50% improvement on the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), the primary outcome measure.

Oppositional defiant disorder in adults with ADHD.

Objective: Oppositional defiant disorder (ODD) is the most common comorbid condition in childhood ADHD. This trial was prospectively designed to explore ODD symptoms in ADHD adults.

Method: A total of 86 patients in this placebo-controlled, double-blind trial of methylphenidate transdermal system (MTS) were categorized based on the presence of ODD symptoms in childhood and adulthood, and then were compared for baseline and outcome differences.

A double-blind placebo-controlled trial of lamotrigine as an antidepressant augmentation agent in treatment-refractory unipolar depression.

Background: Previous reports have suggested that lamotrigine is effective as an antidepressant augmentation agent in patients with treatment-resistant unipolar depression. This study is the largest double-blind placebo-controlled study conducted to date of lamotrigine in this role.

Method: In this multicenter trial, conducted at 19 sites, patients aged 18-65 years with a DSM-IV/ICD-10 diagnosis of unipolar, nonpsychotic major depressive disorder (confirmed by the Mini-International Neuropsychiatric Interview) who had failed at least 1 adequate trial of an antidepressant (N = 183) were first treated for 8 weeks with open-label paroxetine or paroxetine controlled-release in dosages up to 50 mg/d or 62.

OROS methylphenidate in the treatment of adults with ADHD: a 6-month, open-label, follow-up study.

Background: This open-label trial followed a previously reported randomized, placebo-controlled trial of osmotic release oral system (OROS) methylphenidate (MPH) for the treatment of personality disorder (PD). Important findings from the double-blind phase are reexamined for long-term significance.

Methods: Of 41 patients who completed the double-blind, placebo-controlled trial, 34 continued into this open-label phase.

A pooled MADRS/IDS cross-correlation analysis: clinician and patient self-report assessment of improvement in core depressive symptoms with adjunctive aripiprazole.

Background: These analyses aimed to examine the pattern of improvement in depression symptoms with adjunctive aripiprazole.

Methods: Data were pooled (724 subjects: n = 356 placebo, n = 368 aripiprazole) from 2 double-blind, 6-week aripiprazole studies. Pearson correlation coefficients (r) were calculated between changes on the Montgomery-Asberg Depression Rating Scale (MADRS) line items and selected Inventory of Depressive Symptomatology (IDS) line items using last observation carried forward.

Personality disorders in ADHD Part 3: Personality disorder, social adjustment, and their relation to dimensions of adult ADHD.

Background: This study explored the relationship between the dimensions of adult attention-deficit/hyperactivity disorder (ADHD), personality disorder (PD), and adverse social adjustment.

Methods: In a controlled trial of osmotic release oral system methylphenidate, PD was assessed using the Wisconsin Personality Disorders Inventory IV (WISPI-IV), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and a final consensus diagnosis. Participants were categorized 2 ways: (1) ADHD alone, ADHD with emotional dysregulation (ADHD + ED), and ADHD plus emotional dysregulation plus oppositional symptoms (ADHD + ED + ODD); and (2) those with no PD (PD-negative), 1 (PD-positive), and 2 or more (PD-plus) PDs.

Personality disorders in ADHD Part 2: The effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD.

Background: This study explored the relationship between personality disorder (PD) and treatment response in a randomized, double-blind, clinical trial of osmotic release oral system (OROS) methylphenidate (MPH).

Methods: Forty-seven patients entered a crossover trial using the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) to assess outcome. A final personality diagnosis was made using staff consensus and information from the Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).

Personality disorder in ADHD Part 1: Assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate.

Background: Comorbidity of personality disorder (PD) and attention-deficit/hyperactivity disorder (ADHD) has been suggested in several reports. However, assessment of PD is problematic, and studies have over-relied on baseline evaluations.

Methods: Forty-seven patients entered a double-blind trial of osmotic release oral system (OROS) methylphenidate (MPH).

Methylphenidate transdermal system in adult ADHD and impact on emotional and oppositional symptoms.

Objective: This trial evaluated the effect of methylphenidate transdermal system (MTS) on the full spectrum of adult symptoms (attention-disorganization, hyperactivity-impulsivity, emotional dysregulation [ED], and oppositional-defiant disorder [ODD]) found in this disorder.

Method: This placebo-controlled, double-blind, flexible-dose, crossover trial employed the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and Connor's Adult ADHD Rating Scale (CAARS) and two measures of adult ODD. Treatment responses of all participants and four subgroups (ADHDalone, ADHD + ED, ADHD + ODD, and ADHD + ED + ODD) were assessed.

A one year trial of methylphenidate in the treatment of ADHD.

Objective: To determine the effects of long-term methylphenidate treatment on symptom severity and social adjustment in adult ADHD.

Method: Adults (n = 116) meeting operational diagnostic criteria for ADHD (the "Utah Criteria") entered a randomized double-blind crossover trial of methylphenidate and placebo. Participants who improved on immediate-release methylphenidate entered a 12-month, open-label trial.

Tachyphylaxis after repeated antidepressant drug exposure in patients with recurrent major depressive disorder.

Objective: The aim of this post hoc analysis was to examine whether tachyphylaxis occurs after repeated courses of antidepressant drug therapy.

Method: 276 patients with major depressive disorder (MDD) were treated with sertraline (150-200 mg daily) for 8 weeks. Patients with persistent MDD after sertraline therapy were randomized to continuation therapy with either sertraline plus atomoxetine (n = 72) or sertraline plus placebo (n = 74) for 8 additional weeks.

Narrow-band blue-light treatment of seasonal affective disorder in adults and the influence of additional nonseasonal symptoms.

Background: Bright visible-spectrum light therapy has proven effective in the treatment of seasonal affective disorder (SAD) and recent basic research suggests that blue wavelengths approximately 470 nm account for that effectiveness. To more stringently test the importance of these wavelengths, bright red-light was used for the placebo (control) condition.

Methods: Thirty subjects meeting DSM-IV criteria for SAD were randomized to narrow-band light-emitting diode panels emitting blue- or red-light in this 3-week, parallel, double-blind trial.

Bupropion SR in adults with ADHD: a short-term, placebo-controlled trial.

Increased attention has been given to the alternatives to stimulants in the treatment of attention deficit hyperactivity disorder (ADHD) in both adults and children. This short-term, double-blind trial was designed to evaluate the extended-release form of bupropion in adult subjects meeting DSM-IV and the Utah Diagnostic Criteria for ADHD. Outcome measures were the Clinical Global Impressions-Improvement (CGI-I) and the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), which assesses adult ADHD symptoms.

Gender differences in 2 clinical trials of adults with attention-deficit/hyperactivity disorder: a retrospective data analysis.

Introduction: Studies show that, in childhood attention-deficit/hyperactivity disorder (ADHD), boys have the combined type with externalizing behaviors more frequently, and girls have the inattentive type with increased internalizing disorders more frequently.

Method: This study explored gender differences in adults with ADHD in 2 large, placebo-controlled, multicenter studies conducted from 2000 to 2001. Information collected included 2 measures of ADHD, multiple psychological measures, general physical symptoms, and treatment response.

The reliability and validity of self- and investigator ratings of ADHD in adults.

Objective: Little information is available comparing self- versus investigator ratings of symptoms in adult ADHD. The authors compared the reliability, validity, and utility in a sample of adults with ADHD and also as an index of clinical improvement during treatment of self- and investigator ratings of ADHD symptoms via the Conners Adult ADHD Rating Scale (CAARS).

Method: We analyzed data from two double-blind, parallel-design studies of 536 adult ADHD patients, randomized to 10-week treatment with atomoxetine or placebo.