Functional Impairment In Adults Research Articles

Postural control and trunk stability on sway parameters in adults with and without chronic low back pain

BackgroundPostural sway changes often reflect functional impairments in adults with chronic low back pain (LBP). However, there is a gap in understanding how these individuals adapt their postural strategies to maintain stability.PurposeThis study investigated postural sway distance and velocity, utilizing the center of pressure (COP) and center of gravity (COG), between adults with and without LBP during repeated unilateral standing trials.MethodsTwenty-six subjects with LBP and 39 control subjects participated in the study. Postural sway ranges, COP/COG sways, and sway velocities (computed by dividing path length by time in anteroposterior (AP) and mediolateral (ML) directions over 10 s) were analyzed across three unilateral standing trials.ResultsA significant group interaction in sway range difference was observed following repeated trials (F = 5.90, p = 0.02). For COG sway range, significant group interactions were demonstrated in both directions (F = 4.28, p = 0.04) and repeated trials (F = 5.79, p = 0.02). The LBP group demonstrated reduced ML sway velocities in the first (5.21 ± 2.43 for the control group, 4.16 ± 2.33 for the LBP group; t = 1.72, p = 0.04) and second (4.87 ± 2.62 for the control group, 3.79 ± 2.22 for the LBP group; t = 1.73, p = 0.04) trials.ConclusionThe LBP group demonstrated decreased ML sway velocities to enhance trunk stability in the initial two trials. The COG results emphasized the potential use of trunk strategies in augmenting postural stability and optimizing neuromuscular control during unilateral standing.

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

Objective: Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. Method: Articles related to the search terms “ADHD,” “adult,” and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. Results: We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. Conclusion: This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.

The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study

BackgroundThe life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA).MethodsWe enrolled 40 adults with SCD (20 younger adults aged 18–49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events.ResultsEighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80–98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s).ConclusionThe SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.

Functioning assessment short test (FAST): validity and reliability in adults with Autism Spectrum Disorder

BackgroundThe assessment of functional impairment is crucial both for the diagnosis and the therapeutic approach to autism spectrum disorder (ASD). The purpose of the present study was to evaluate whether the FAST is a reliable and valid tool to assess functional impairment in adults with Level 1 ASD and to study the differences in psychosocial functioning between younger and older adults with ASD.MethodsA case–control study was carried out in a sample of 150 participants, 71 adults with Level 1 ASD, and 79 adults without psychiatric history records.ResultsResults showed good psychometric properties in terms of validity and reliability. Cronbach’s alpha for the total scale was .91 and the area under the curve was .98. The study also showed that adults with ASD present different profiles of functional impairment depending on their age: while younger patients present greater impairment in autonomy, older patients show more difficulties in interpersonal relationships.ConclusionsOur results support the use of the FAST in the evaluation of adaptive functioning in adults with Level 1 ASD.

Adult ADHD and romantic relationships: What we know and what we can do to help

It has been widely maintained that enduring and healthy romantic relationships are critical to quality of life in adulthood, and can buffer the impact of adversity, including psychological disorder. Unfortunately, much research points toward adults with attention-deficit hyperactivity disorder (ADHD) having short-lived and discordant romantic relationships. Despite this ample evidence, relatively little research has focused on identifying specific factors that may strengthen or explain their relational difficulties, which would have obvious relationship distress prevention and intervention implications. The current study reviews the state of the literature on romantic relationships in adults with ADHD, including differences that have been established between ADHD and non-ADHD populations as well as distal and proximal factors that appear to increase risk of relationship distress of adults with ADHD. Finally, notable gaps in the literature are identified and implications are raised with regards to prevention and intervention efforts designed to address functional impairment in adults with ADHD.

Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia.

The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood (b = 2.59, P < .001) and diabetes-related distress (b = 1.40, P < .001) and lower functional outcome (b = -0.22, P < .001). Older age was associated with lower diabetes-related distress (b = -0.44, P = .040). Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.

Treatment Outcomes in an Adult Attention Deficit Hyperactivity Disorder Clinic With a Focus on Executive Functioning and Sluggish Cognitive Tempo.

AimExecutive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. MethodsWe implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data.ResultsAdults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale.ConclusionsAdult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and “tailoring” through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.

Clinical correlates of socioeconomic status in adolescent bipolar disorder

BackgroundLower socioeconomic status (SES) is associated with symptomatic severity, comorbidity, and functional impairment in adults with bipolar disorder (BD). Little is known about clinical correlates of SES in adolescents with BD. MethodsParticipants included 195 adolescents, 13–20 years old, with BD type I, II or not otherwise specified (NOS). Diagnoses were determined by standardized semi-structured interviews. Based on the Hollingshead scale, participants were divided into “low” (SES 1–3) and the “high” (SES 4–5) SES groups. Demographic and clinical correlates of SES were evaluated in univariate analyses; significant variables were evaluated in a logistic regression model. ResultsCompared to participants in the high SES group (n = 150), participants in the low SES group (n = 45) were significantly younger, less likely to be of Caucasian race and living with natural parents. In the logistic regression model, controlling for age and race, the low SES group had higher risk of police contact or arrest (OR = 2.41, 95% CI:1.14–5.11, p = 0.022), less treatment with stimulants(OR = 0.20 95% CI: 0.06–0.67, p = 0.009), and more post-traumatic stress disorder (PTSD) (OR = 4.08, 95% CI:1.33–12.46, p = 0.014) compared to the high SES group. In sensitivity analyses that further controlled for intact family, the finding of higher rates of police contact or arrest was no longer significant. LimitationsCross-sectional design; higher-skewed SES sample. ConclusionsLower SES in adolescent BD is associated with higher legal risk, increased PTSD, and under-treatment of attention-deficit/hyperactivity disorder (ADHD). Future studies are needed to evaluate the inter-relationships of these correlates, using prospective designs that can evaluate the direction of these associations. Further studies incorporating neurobiological markers are also needed to explore mechanisms underlying SES-related differences in BD.

Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD

BackgroundPrevious studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors.MethodsParticipants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses).ResultsThe results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals.ConclusionsThe ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.

Associations of intellectual ability, inhibitory control, impulsiveness, cognitive flexibility and functional impairment in adults with ADHD Symptoms

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with persistent levels of inattention, hyperactivity or impulsivity. Recommendations for ADHD diagnosis involve: six or more symptoms (or five considering adults), early childhood onset, presence of symptoms in two or more contexts and presence of functional impairment. Cognitive deficits, that affect inhibitory control, cognitive flexibility and impulsiveness, are present in ADHD and affect the course of the disorder. On the other hand, intellectual skill is a factor of protection to improve the development in people with ADHD. This article explores how traits relate to functional impairments are relevant to ADHD description in terms of behavioral expression of the cognitive profile. Method: Forty-nine adults, between 20 and 68 years old, with symptoms of inattention and hyperactivity/impulsivity compatible with ADHD, with more than 4 years of schooling and absence of chronic illness, took part of this study. We collected data using screening instruments (ASRS-18, MMSE, and WASI) and main instruments (FDT, BIS-11, and EPF-ADHD). Results: The results have shown that higher intellectual indexes were associated with lower frequencies of academic impairment, while higher impulsivity levels, cognitive flexibility difficulties and inhibitory control, were associated with academic and social impairment. Conclusion: The results show that cognitive deficits were associated to impairment, in different life areas, of people with ADHD, and that some factors, as intellectual abilities, may prevent impairment in ADHD.

Prevalence of Hospital Functional Impairment in a Colombian Elderly Population at the San Ignacio University Hospital

Introduction: Functional decline following hospitalization (FDH) is defined as the loss of the functional capacity to perform at least one basic activity of daily life (BADL) when being discharged from hospital; a situation compared to functional capacity performed in the last couple of weeks, prior the acute disease. This impairment is precipitated in the elderly by factors such as aging, architectural conditions, malnutrition, hospital routines and physical restraints. The objective of this study is determining the prevalence of functional impairment in adults over 65 years of age hospitalized in the San Ignacio University Hospital (SIUH) and its associated factors. Materials and Methods: A descriptive cross-sectional study of a hospital cohort was carried out from December 1st 2015 to December 31st 2017. Univariate and multivariate analyses were performed to identify associated variables. Results: 1055 people were included,with fdh prevalence of 41.14 %. The three main factors associated with the development of fdh in the elderly population that consulted the siuh were time of hospital stay [or 1.88, CI95% (1.41-2.49), p = &lt;0.0001], malnutrition [or 1.59, CI95 % (1.16-2.19), p = 0.004] and delirium [or 2.38, CI95 % (1.83-3.10), p = &lt;0.001]. Conclusion: FDH is a highly prevalent condition in the geriatric population hospitalized in the San Ignacio University Hospital, where length of stay, malnutrition and delirium are the factors associated with its disease onset.

Validation of the French Version of the Weiss Functional Impairment Rating Scale–Self-Report in a Large Cohort of Adult Patients With ADHD

Objective: To analyze the psychometric properties of the French version of the Weiss Functional Impairment Rating Scale–Self Report (WFIRS-S) in a large clinical sample of adults with ADHD. Method: Patients (N = 363) were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria. Psychometric properties of the French version of the WFIRS-S were tested including construct validity with a confirmatory factor analysis, internal structural validity with Cronbach’s alpha coefficient, external validity by correlations with the Beck Depression Inventory–II (BDI-II), and the EuroQol five-dimension (EQ-5D) questionnaire. Results: The confirmatory factor analysis found the following: root mean square error of approximation (RMSEA) = 0.061, 90% confidence interval (CI) = [0.058, 0.063]; comparative fit index (CFI) = 0.67. Cronbach’s alpha coefficient was .91. Correlations with EQ-5D descriptive index, visual analogue scale (VAS) scores, and BDI-II scores were –0.48, –0.55, and 0.53, respectively. Conclusion: The French version of the WFIRS-S is a psychometrically acceptable self-reported questionnaire for the multi-domain evaluation of functional impairments in adults with ADHD, for research and clinical purposes.

Consecutive Isoproterenol and Adenosine Treatment Confers Marked Protection against Reperfusion Injury in Adult but Not in Immature Heart: A Role for Glycogen.

Consecutive treatment of adult rat heart with isoproterenol and adenosine (Iso/Aden), known to consecutively activate PKA/PKC signaling, is cardioprotective against ischemia and reperfusion (I/R). Whether this is cardioprotective in an immature heart is unknown. Langendorff–perfused hearts from adult and immature (60 and 14 days old) male Wistar rats were exposed to 30 min ischemia and 120 min reperfusion, with or without prior perfusion with 5 nM Iso for 3 min followed by 30 μM Aden for 5 min. Changes in hemodynamics (developed pressure and coronary flow) and cardiac injury (Lactate Dehydrogenase (LDH) release and infarct size) were measured. Additional hearts were used to measure glycogen content. Iso induced a similar inotropic response in both age groups. Treatment with Iso/Aden resulted in a significant reduction in time to the onset of ischemic contracture in both age groups whilst time to peak contracture was significantly shorter only in immature hearts. Upon reperfusion, the intervention reduced cardiac injury and functional impairment in adults with no protection of immature heart. Immature hearts have significantly less glycogen content compared to adult. This work shows that Iso/Aden perfusion confers protection in an adult heart but not in an immature heart. It is likely that metabolic differences including glycogen content contribute to this difference.

Quick Delay Questionnaire: Reliability, validity, and relations to functional impairments in adults with attention-deficit/hyperactivity disorder (ADHD).

The Quick Delay Questionnaire (QDQ) is a self-report measure of delay-related behaviors in adults, and the present study aimed at investigating the psychometric properties of QDQ scores, how well they can discriminate between ADHD adults and both clinical and nonclinical controls, as well as their relations to measures of functional impairments. In the present study, QDQ ratings, a laboratory measure of delay discounting, and ratings of functional impairments were collected from adults diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 51), a clinical control group with other psychiatric disorders (n = 46), and a nonclinical control group (n = 105). Results showed that the QDQ scores showed adequate reliability. Adults with ADHD had higher scores compared with normal controls on both QDQ subscales, and they also reported higher levels of delay aversion than the clinical controls. Logistic regression analyses showed high specificity but low sensitivity when trying to discriminate between adults with ADHD and nonclinical controls. QDQ scores were not associated with a laboratory measure of delay discounting, but with functional impairments such as substance use, criminality, and money management. Our findings indicate that QDQ scores are reliable, but this instrument should be regarded as a complement rather than as a replacement for laboratory measures. The relatively low sensitivity of QDQ scores is in line with current models of heterogeneity stating that only a subgroup of individuals with ADHD has high levels of delay-related behaviors. Our findings further indicate that this subgroup may be at particularly high risk for problems in everyday life. (PsycINFO Database Record

Effects of levomilnacipran ER on noradrenergic symptoms, anxiety symptoms, and functional impairment in adults with major depressive disorder: Post hoc analysis of 5 clinical trials

ObjectiveTo evaluate the effects of levomilnacipran extended-release (LVM-ER; 40–120mg/day) on noradrenergic (NA) and anxiety-related symptoms in adults with major depressive disorder (MDD) and explore the relationship between these symptoms and functional impairment. MethodsData were pooled from 5 randomized, double-blind, placebo-controlled trials (N=2598). Anxiety and NA Cluster scores were developed by adding selected item scores from the Montgomery-Åsberg Depression Rating Scale (MADRS) and 17-item Hamilton Depression Rating Scale (HAMD17). A path analysis was conducted to estimate the direct effects of LVM-ER on functional impairment (Sheehan Disability Scale [SDS] total score) and the indirect effects through changes in NA and Anxiety Cluster scores. ResultsMean improvements from baseline in NA and Anxiety Cluster scores were significantly greater with LVM-ER versus placebo (both P<0.001), as were the response rates (≥50% score improvement): NA Cluster (44% vs 34%; odds ratio=1.56; P<0.0001); Anxiety Cluster (39% vs 36%; odds ratio=1.19; P=0.041). Mean improvement in SDS total score was also significantly greater with LVM-ER versus placebo (−7.3 vs −5.6; P<0.0001). LVM-ER had an indirect effect on change in SDS total score that was mediated more strongly through NA Cluster score change (86%) than Anxiety Cluster score change (18%); the direct effect was negligible. LimitationsNA and Anxiety Cluster scores, developed based on the face validity of individual MADRS and HAMD17 items, were not predefined as efficacy outcomes in any of the studies. ConclusionIn adults with MDD, LVM-ER indirectly improved functional impairment mainly through improvements in NA symptoms and less so via anxiety symptoms.

Emotional symptoms and their contribution to functional impairment in adults with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a severe neurodevelopmental disorder beginning in childhood and consisting of the core symptoms of inattention, hyperactivity, and impulsivity. The disorder is often accompanied by functional impairment in daily life. Research showed that severe impairment cannot be fully explained by the core symptoms of ADHD. Accordingly, emotional symptoms in ADHD and their influence on functional impairment have increasingly become the focus of research in recent years. The aim of the current study was to investigate the relationship between ADHD core symptoms, emotional symptoms, and functional impairment. We assumed that emotional symptoms might form part of adult ADHD and that the connection between ADHD core symptoms and functional impairment may be partly mediated by emotional symptoms. Data of 176 participants from an ADHD Special Consultations Unit were included. Of these participants, 146 were diagnosed with ADHD, while 30 received no such diagnosis. We developed a structural equation model which included core symptoms, emotional symptoms, and four domains of daily impairment (family life, social life, work, and organization). As predicted, results indicate that emotional symptoms are directly linked to adult ADHD and bear a strong negative influence on different domains of daily life. The results of different analyses showed a mediation of the relationship between ADHD core symptoms and impairment through emotional symptoms: While the connection between inattention and work and organization was partly mediated, the connections between impulsivity and family life and between inattention and social life were shown to be fully mediated through emotional symptoms.

The effects of a Self-Alert Training (SAT) program in adults with ADHD.

Attention-Deficit/Hyperactivity Disorder (ADHD), a neuropsychiatric condition characterized by attention and impulsivity problems, is one of the most common behavioral disorders. The first line of treatment for ADHD is psychostimulant medication, but this has limited effectiveness, particularly in adults, and is often associated with adverse side-effects. Thus, it is imperative that new non-pharmaceutical approaches to treatment are developed. This study aims to evaluate the impact of a non-pharmacological Self-Alert Training (SAT) intervention on ADHD symptom prevalence, psychological and cognitive functioning, and on everyday functional impairment in adults with ADHD. Fifty-one adult participants with a current diagnosis of ADHD were randomized to either SAT or a Control Training (CT) program. They were assessed at baseline, immediately following the 5-week training period, and after 3-months using ADHD symptoms scales, as well as a series of neuropsychological tests and psychological questionnaires. Subjective ratings of everyday life attention and memory problems were also collected. The SAT group showed significant improvements in ADHD inattentive and impulsive symptoms, depressive symptoms and in self-efficacy ratings compared to the CT group at both post-training and at the 3-month assessment. Pre-post improvements in SAT participants on untrained cognitive tasks measuring selective attention and executive functions were also observed. Finally, the SAT group reported improved subjective ratings of everyday life attention at both assessment points. This pattern of results suggests that SAT may be beneficial in treating ADHD symptoms as well as psychological and cognitive impairments in adult ADHD. A large-scale randomized controlled trial (RCT) is needed.

Psychometric evaluation of the Sheehan Disability Scale in adult patients with attention-deficit/hyperactivity disorder.

Inattention and impulsivity symptoms are common among adults with attention-deficit/hyperactivity disorder (ADHD), which can lead to difficulty concentrating, restlessness, difficulty completing tasks, disorganization, impatience, and impulsiveness. Many adults with ADHD find it difficult to focus and prioritize. Resulting outcomes, such as missed deadlines and forgotten engagements, may ultimately impact the ability to function at work, school, home, or in a social environment. The European Medicines Agency guidelines for evaluating medicinal products for ADHD recommend inclusion of both functional outcomes, such as school, social, or work functioning, and outcomes related to symptoms of ADHD in clinical studies of novel medication primary efficacy endpoints. Due to its performance in other disease areas and the relevance of its items as evidenced by content validity analyses, the Sheehan Disability Scale (SDS) was chosen to assess functional impairment in ADHD. The aim of this study was to investigate the psychometric properties of the SDS, used as a brief measure of functional impairment in a number of psychiatric disorders, in adult patients with ADHD. To the authors’ knowledge, this is the first study to evaluate the reliability of the SDS (based on Cronbach’s coefficient alpha and test-retest reliability), its validity (construct and known-groups validity), and its ability to detect change in this patient population. This study also established a preliminary responder definition for the SDS in this study population to determine when change can be considered clinically beneficial in a clinical trial setting. The psychometric results support the use of the SDS subscales (items 1–3) and total score (sum of items 1–3) in an ADHD population. In addition, the evaluation provides evidence for a three-point preliminary responder definition for the SDS and further evidence of its responsiveness in adults with ADHD. Altogether, the results indicate that the SDS is a simple and easy-to-score scale that would have great utility in future clinical trials for monitoring functional impairment in adults with ADHD.

Mediators and moderators of functional impairment in adults with obsessive–compulsive disorder

The current study examined correlates, moderators, and mediators of functional impairment in 98 treatment-seeking adults with obsessive–compulsive disorder (OCD). Participants completed or were administered measures assessing obsessive–compulsive symptom severity, functional impairment, resistance against symptoms, interference due to obsessive–compulsive symptoms, depressive symptoms, insight, and anxiety sensitivity. Results indicated that all factors, except insight into symptoms, were significantly correlated with functional impairment. The relationship between obsessive–compulsive symptom severity and functional impairment was not moderated by patient insight, resistance against obsessive–compulsive symptoms, or anxiety sensitivity. Mediational analyses indicated that obsessive–compulsive symptom severity mediated the relationship between anxiety sensitivity and obsessive–compulsive related impairment. Indeed, anxiety sensitivity may play an important contributory role in exacerbating impairment through increases in obsessive–compulsive symptom severity. Depressive symptoms mediated the relationship between obsessive–compulsive symptom severity and obsessive–compulsive related impairment. Implications for assessment and treatment are discussed.

Correlates of Irritability in College Students With Depressive Symptoms

Depression is a prevalent psychiatric disorder associated with significant personal and societal burden. There is accumulating evidence for the presence of a subtype of depression characterized by the presence of irritability that is associated with increased morbidity, risk for suicidal ideation, and functional impairments in adults. Little is known about the features of depressive symptoms with and without irritability among young adults in college. The primary aim of this study was to characterize the presentation of college students with depressive symptoms and irritability. Two-hundred eighty-seven undergraduate college students with depressive symptoms with and without irritability were compared across several psychiatric and functional outcome variables. Independent samples t-tests or logistic regressions were conducted for each outcome variable using the irritability item of the Beck Depression Inventory as a dichotomous grouping variable. Analyses were conducted separately for the men and the women. Both male and female students with depressive symptoms and severe irritability reported a greater severity of depressive symptoms compared with their peers with no or mild irritability. In the women, the presence of irritability was associated with greater symptoms of anxiety, whereas in the men, it was associated with increased likelihood of engaging in risky behaviors, including compulsive use of alcohol, illicit drugs, and prescription drugs. The male and female college students with depressive symptoms with and without irritability did not differ on severity of suicidal ideation, hopelessness, or cognitive functioning. The findings from this study suggest that depressive symptoms and irritability may characterize a subtype of college students who have a greater symptom burden and with the potential need for more aggressive and prompt treatment.