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Two themes have puzzled the research on developmental and learning disorders for decades. First, some of the risk and protective factors behind developmental challenges are suggested to be shared and some are suggested to be specific for a given condition. Second, language-based learning difficulties like dyslexia are suggested to result from or correlate with non-linguistic aspects of information processing as well. In the current study, we investigated how adults with developmental dyslexia or ADHD as well as healthy controls cluster across various dimensions designed to tap the prominent non-linguistic theories of dyslexia. Participants were 18–55-year-old adults with dyslexia (n = 36), ADHD (n = 22), and controls (n = 35). Non-linguistic theories investigated with experimental designs included temporal processing impairment, abnormal cerebellar functioning, procedural learning difficulties, as well as visual processing and attention deficits. Latent profile analysis (LPA) was used to investigate the emerging groups and patterns of results across these experimental designs. LPA suggested three groups: (1) a large group with average performance in the experimental designs, (2) participants predominantly from the clinical groups but with enhanced conditioning learning, and (3) participants predominantly from the dyslexia group with temporal processing as well as visual processing and attention deficits. Despite the presence of these distinct patterns, participants did not cluster very well based on their original status, nor did the LPA groups differ in their dyslexia or ADHD-related neuropsychological profiles. Remarkably, the LPA groups did differ in their intelligence. These results highlight the continuous and overlapping nature of the observed difficulties and support the multiple deficit model of developmental disorders, which suggests shared risk factors for developmental challenges. It also appears that some of the risk factors suggested by the prominent non-linguistic theories of dyslexia relate to the general level of functioning in tests of intelligence., SCOPUS: ar.j, info:eu-repo/semantics/published

Individuals with attention-deficit/hyperactivity disorder (ADHD) have difficulties navigating dynamic everyday situations that contain multiple sensory inputs that need to either be attended to or ignored. As conventional experimental tasks lack this type of everyday complexity, we administered a film-based multi-talker condition with auditory distractors in the background. ADHD-related aberrant brain responses to this naturalistic stimulus were identified using intersubject correlations (ISCs) in functional magnetic resonance imaging (fMRI) data collected from 51 adults with ADHD and 29 healthy controls. A novel permutation-based approach introducing studentized statistics and subject-wise voxel-level null-distributions revealed that several areas in cerebral attention networks and sensory cortices were desynchronized in participants with ADHD (n = 20) relative to healthy controls (n = 20). Specifically, desynchronization of the posterior parietal cortex occurred when irrelevant speech or music was presented in the background, but not when irrelevant white noise was presented, or when there were no distractors. We also show regionally distinct ISC signatures for inattention and impulsivity. Finally, post-scan recall of the film contents was associated with stronger ISCs in the default-mode network for the ADHD and in the dorsal attention network for healthy controls. The present study shows that ISCs can further our understanding of how a complex environment influences brain states in ADHD.

Modern environments are full of information, and place high demands on the attention control mechanisms that allow the selection of information from one (focused attention) or multiple (divided attention) sources, react to changes in a given situation (stimulus-driven attention), and allocate effort according to demands (task-positive and task-negative activity). We aimed to reveal how attention deficit hyperactivity disorder (ADHD) affects the brain functions associated with these attention control processes in constantly demanding tasks. Sixteen adults with ADHD and 17 controls performed adaptive visual and auditory discrimination tasks during functional magnetic resonance imaging (fMRI). Overlapping brain activity in frontoparietal saliency and default-mode networks, as well as in the somato-motor, cerebellar, and striatal areas were observed in all participants. In the ADHD participants, we observed exclusive activity enhancement in the brain areas typically considered to be primarily involved in other attention control functions: During auditory-focused attention, we observed higher activation in the sensory cortical areas of irrelevant modality and the default-mode network (DMN). DMN activity also increased during divided attention in the ADHD group, in turn decreasing during a simple button-press task. Adding irrelevant stimulation resulted in enhanced activity in the salience network. Finally, the irrelevant distractors that capture attention in a stimulus-driven manner activated dorsal attention networks and the cerebellum. Our findings suggest that attention control deficits involve the activation of irrelevant sensory modality, problems in regulating the level of attention on demand, and may encumber top-down processing in cases of irrelevant information. (C) 2018 Elsevier B.V. All rights reserved.

Objectives Few long-term studies on bipolar disorder (BD) have investigated the incidence and risk factors of suicide attempts (SAs) specifically related to illness phases. We examined the incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and bipolar II (BD-II) patients, and risk factors specifically for SAs during major depressive episodes (MDEs). Methods In the Jorvi Bipolar Study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to 5 years. The incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models. Results During the 5 years of follow-up, 90 SAs per 718 patient-years occurred. The incidence was highest, over 120-fold higher than in euthymia, during mixed states (765/1000 person-years; 95% confidence interval [CI] 461−1269 person-years), and also very high in MDEs, almost 60-fold higher than in euthymia (354/1000 person-years; 95% CI 277−451 person-years). For risk of SAs during MDEs, the duration of MDEs, severity of depression, and cluster C personality disorders were significant predictors. Conclusions We confirmed in this long-term study that the highest incidences of SAs occur in mixed and major depressive illness phases. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question “when” rather than “who” may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Previous functional connectivity studies have found both hypo‐ and hyper‐connectivity in brains of individuals having autism spectrum disorder (ASD). Here we studied abnormalities in functional brain subnetworks in high‐functioning individuals with ASD during free viewing of a movie containing social cues and interactions. Twenty‐six subjects (13 with ASD) watched a 68‐min movie during functional magnetic resonance imaging. For each subject, we computed Pearson's correlation between haemodynamic time‐courses of each pair of 6‐mm isotropic voxels. From the whole‐brain functional networks, we derived individual and group‐level subnetworks using graph theory. Scaled inclusivity was then calculated between all subject pairs to estimate intersubject similarity of connectivity structure of each subnetwork. Additional 54 individuals (27 with ASD) from the ABIDE resting‐state database were included to test the reproducibility of the results. Between‐group differences were observed in the composition of default‐mode and ventro‐temporal‐limbic (VTL) subnetworks. The VTL subnetwork included amygdala, striatum, thalamus, parahippocampal, fusiform, and inferior temporal gyri. Further, VTL subnetwork similarity between subject pairs correlated significantly with similarity of symptom gravity measured with autism quotient. This correlation was observed also within the controls, and in the reproducibility dataset with ADI‐R and ADOS scores. Our results highlight how the reorganization of functional subnetworks in individuals with ASD clarifies the mixture of hypo‐ and hyper‐connectivity findings. Importantly, only the functional organization of the VTL subnetwork emerges as a marker of inter‐individual similarities that co‐vary with behavioral measures across all participants. These findings suggest a pivotal role of ventro‐temporal and limbic systems in autism. Hum Brain Mapp 37:1066–1079, 2016. © 2015 Wiley Periodicals, Inc.

Objectives The long-term outcome of bipolar disorder (BD) has been extensively investigated. However, previous studies may be biased towards hospitalized patients with bipolar I disorder (BD-I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary-care cohort of patients with BD. Methods In the Jorvi Bipolar Study, 191 patients with BD-I and bipolar II disorder (BD-II) were followed using a life-chart method. Interviews were conducted at six months, 18 months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and BD-I versus BD-II differences were investigated among the 151 patients remaining in follow-up. Results Nearly all subjects recovered from the index episode, but almost all (90%) had a recurrence, and most had multiple recurrences. The patients spent about one-third of their time in illness episodes and 15% of their time with subthreshold symptoms; half of the time they were euthymic. After controlling for confounders, no difference in time spent in depressive states between patients with BD-I and BD-II persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (HR) = 0.452, p = 0.040] and higher 17-item Hamilton Depression Scale score (HR = 0.951, p = 0.022) predicted longer time to remission, whereas lifetime psychotic symptoms (HR = 2.162, p = 0.016) predicted shorter time to first recurrence. Conclusions Among patients with BD, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with BD spent only half of their time euthymic. Patients with BD-I and BD-II may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome.

In this study of the project DyAdd, implicit learning was investigated through two paradigms in adults (18-55 years) with dyslexia (n = 36) or with attention deficit/hyperactivity disorder (ADHD, n = 22) and in controls (n = 35). In the serial reaction time (SRT) task, there were no group differences in learning. However, those with ADHD exhibited faster RTs compared to other groups. In the artificial grammar learning (AGL) task, the groups did not differ from each other in their learning (i.e., grammaticality accuracy or similarity choices). Further, all three groups were sensitive to fragment overlap between learning and test-phase items (i.e., similarity choices were above chance). Grammaticality performance of control participants was above chance, but that of participants with dyslexia and participants with ADHD failed to differ from chance, indicating impaired grammaticality learning in these groups. While the main indices of AGL performance, grammaticality accuracy and similarity choices did not correlate with the neuropsychological variables that reflected dyslexia-related (phonological processing, reading, spelling, arithmetic) or ADHD-related characteristics (executive functions, attention), or intelligence, the explicit knowledge for the AGL grammar (i.e., ability to freely generate grammatical strings) correlated positively with the variables of phonological processing and reading. Further, SRT reaction times correlated positively with full scale intelligence quotient (FIQ). We conclude that, in AGL, learning difficulties of the underlying rule structure (as measured by grammaticality) are associated with dyslexia and ADHD. However, learning in AGL is not related to the defining neuropsychological features of dyslexia or ADHD. Instead, the resulting explicit knowledge relates to characteristics of dyslexia.

To investigate whether there are global white matter (WM) differences between autistic and healthy adults, we performed diffusion tensor imaging (DTI) in 14 male adults with Asperger syndrome (AS) and 19 gender-, age-, and intelligence quotient-matched controls. We focused on individuals with high-functioning autism spectrum disorder (ASD), AS, to decrease heterogeneity caused by large variation in the cognitive profile. Previous DTI studies of ASD have mainly focused on finding local changes in fractional anisotropy (FA) and mean diffusivity (MD), two indexes used to characterize microstructural properties of WM. Although the local or voxel-based approaches may be able to provide detailed information in terms of location of the observed differences, such results are known to be highly sensitive to partial volume effects, registration errors, or placement of the regions of interest. Therefore, we performed global histogram analyses of (a) whole-brain tractography results and (b) skeletonized WM masks. In addition to the FA and MD, the planar diffusion coefficient (CP) was computed as it can provide more specific information of the complexity of the neural structure. Our main finding indicated that adults with AS had higher mean FA values than controls. A less complex neural structure in adults with AS could have explained the results, but no significant difference in CP was found. Our results suggest that there are global abnormalities in the WM tissue of adults with AS. Autism Res 2013, 6: 642-650. (c) 2013 International Society for Autism Research, Wiley Periodicals, Inc.

In this study of the project DyAdd, three aspects of visual attention were investigated in adults (18–55 years) with dyslexia (n = 35) or attention deficit/hyperactivity disorder (ADHD, n = 22), and in healthy controls (n = 35). Temporal characteristics of visual attention were assessed with Attentional Blink (AB), capacity of visual attention with Multiple Object Tracking (MOT), and spatial aspects of visual attention with Useful Field of View (UFOV) task. Results showed that adults with dyslexia had difficulties performing the AB and UFOV tasks, which were explained by an impaired ability to process dual targets, longer AB recovery time, and deficits in processing rapidly changing visual displays. The ADHD group did not have difficulties in any of the tasks. Further, performance in the visual attention tasks predicted variation in measures of phonological processing and reading when all of the participants were considered together. Thus, difficulties in tasks of visual attention were related to dyslexia and variation of visual attention had a role in the reading ability of the general population.

Responses to atomoxetine vary for individual patients with attention-deficit/hyperactivity disorder (ADHD). However, we do not know whether any factors can be used to reliably predict how individuals with ADHD will respond to treatment.Our objective was to evaluate background variables that facilitate early identification of those adults with ADHD who are likely to respond to treatment with atomoxetine.We pooled data for atomoxetine-treated adults with ADHD from 12 clinical trials for a short-term (10-week) analysis, and from 11 clinical trials for a long-term (24-week) analysis. Patients not meeting a response definition [≥30 % reduction in Conners' Adult ADHD Rating Scales-Investigator Rated: Screening Version (CAARS-Inv:SV) total score and Clinical Global Impressions of ADHD Severity Scale (CGI-S) score ≤3 at endpoint], or who discontinued, were defined as non-responders. Another definition of response (≥30 % reduction in CAARS-Inv:SV total score at endpoint) was also used in these analyses; only the results with the former definition are shown in this abstract, as the same conclusions were gained with both definitions. A treatment-specified subgroup detection tool (a resampling-based ensemble tree method) was used to identify predictors of response.Of 1945 adults in the long-term analysis, 548 (28.2 %) were responders to atomoxetine at week 24; 65.2 % of 1397 non-responders had discontinued. Of 4524 adults in the short-term analysis, 1490 (32.9 %) were responders at week 10; 33.2 % of 1006 non-responders had discontinued. No analyzed baseline parameters (age, sex, prior stimulant use, ADHD subtype, CAARS-Inv:SV, CGI-S) were statistically significant predictors of response. Reductions in CAARS-Inv:SV total, CAARS-Inv:SV subscores, and CGI-S at week 4 in the short-term analysis, and at weeks 4 or 10 in the long-term analysis, were statistically significant predictors of response, i.e., patients with versus without these reductions early in treatment were more likely to be clinical responders at later time points. Sensitivity ranged from 28.6 to 85.9 %, and specificity ranged from 23.8 to 86.7 %. Predictors with higher sensitivity had lower specificity, and vice versa.Reductions in CAARS-Inv:SV and CGI-S scores at weeks 4 and 10 are statistically significant predictors of response to atomoxetine at later time points in adults with ADHD. However, the predictors identified by these analyses are not reliable enough for use in clinical practice. The only currently available method to judge whether individuals with ADHD will respond to atomoxetine is to start treatment and assess the response over an extended period, sometimes longer than 10 weeks.

In this study of the project DyAdd (Adult Dyslexia and Attention Deficit Disorder in Finland), classical eyeblink conditioning (EBC) was investigated in both delay and trace paradigms in adults (18-55 years) with dyslexia (n = 37), attention deficit-hyperactivity disorder (ADHD; n = 21), their comorbid combination (n = 8), and healthy controls (n = 35). In addition, the profiles of three participants with a rare autosomal dominant cerebellar disease were assessed (episodic ataxia type 2, EA-2). We found that participants with dyslexia were overall slower learners than controls in eyeblink conditioning. Further, they were the only group that had a reduced number of CRs in mediotemporal-dependent trace paradigm compared to the more cerebellum-dependent delay paradigm. Second, ADHD was found to be related to larger CR amplitude. Third, those with a comorbid condition learned faster and manifested CRs that were not well timed. Fourth, the cerebellar patients showed nearly no conditioning at all. Correlations between EBC and various neuropsychological domains (phonological processing, reading, spelling, arithmetic, executive functions, attention, and fine motor control) over all participants resulted in significant relations only for the delay paradigm: Increased amount of reading errors related with later peak latency and increased amount of self-corrections in fine motor control related with larger response magnitude. Within those who conditioned, relations emerged only for the trace paradigm: better spelling was related to larger response magnitude. These results do not lend support to the cerebellar hypothesis of dyslexia. On the contrary, dyslexia in its pure form seems to be related to a relative dysfunction of a larger hippocampal-cerebellar network. Further, larger responses in the ADHD group are suggested to result from their lowered responding threshold.

Background Recent brain imaging findings suggest that there are widely distributed abnormalities affecting the brain connectivity in individuals with autism spectrum disorder (ASD). Using graph theoretical analysis, it is possible to investigate both global and local properties of brain’s wiring diagram, i.e., the connectome. Methods We acquired diffusion-weighted magnetic resonance imaging data from 14 adult males with high-functioning ASD and 19 age-, gender-, and IQ-matched controls. As with diffusion tensor imaging-based tractography, it is not possible to detect complex (e.g., crossing) fiber configurations, present in 60–90 % of white matter voxels; we performed constrained spherical deconvolution-based whole brain tractography. Unweighted and weighted structural brain networks were then reconstructed from these tractography data and analyzed with graph theoretical measures. Results In subjects with ASD, global efficiency was significantly decreased both in the unweighted and the weighted networks, normalized characteristic path length was significantly increased in the unweighted networks, and strength was significantly decreased in the weighted networks. In the local analyses, betweenness centrality of the right caudate was significantly increased in the weighted networks, and the strength of the right superior temporal pole was significantly decreased in the unweighted networks in subjects with ASD. Conclusions Our findings provide new insights into understanding ASD by showing that the integration of structural brain networks is decreased and that there are abnormalities in the connectivity of the right caudate and right superior temporal pole in subjects with ASD. Electronic supplementary material The online version of this article (doi:10.1186/s13229-015-0058-4) contains supplementary material, which is available to authorized users.

BackgroundWhether temperament and character differ between bipolar disorder (BD) and major depressive disorder (MDD) patients and general population subjects, or between BD I and BD II patients, remains unclear.MethodBD patients (n=191) from the Jorvi Bipolar Study and MDD patients (n=266) from the Vantaa Depression Study (VDS) and the Vantaa Primary Care Depression Study were interviewed at baseline, at 6 and 18 months, and in the VDS at 5 years. A general population comparison group (n=264) was surveyed by mail. BD patients' scores on the Temperament and Character Inventory-Revised were compared at an index interview, when levels of depression and mania were lowest, with scores of MDD patients and controls. BD I (n=99) and BD II (n=92) patients were compared.ResultsCompared with controls, both BD and MDD patients had higher harm avoidance [odds ratio (OR) 1.027, ppp=0.006 and OR 0.968, pp=0.003), MDD patients lower reward dependence (OR 0.976, p=0.002) and self-transcendence (OR 0.966, pp=0.002) and higher in novelty seeking (OR 1.027, ppConclusionsThe patterns of temperament and character dimensions differed less between BD and MDD patients, than patients from their controls. The most pronounced difference was higher novelty seeking in BD than MDD patients. The dimensions investigated are unlikely to differ between BD I and BD II patients.

Whether levels of neuroticism or extraversion differ between patients with bipolar disorder (BD), major depressive disorder (MDD) and subjects from the general population, or between BD I and BD II patients, remains unclear.BD patients (n=191) from the Jorvi Bipolar Study, and MDD patients (n=358) from both the Vantaa Depression Study and the Vantaa Primary Care Depression Study cohorts, were interviewed at baseline and at 18 months. A general population comparison group (n=347) was surveyed by mail. BD patients' neuroticism and extraversion scores, measured by Eysenck Personality Inventory, were compared at an index interview, when the levels of depression and mania were lowest, with scores of MDD patients and general population controls. Comparisons were also made between BD I (n=99) and BD II (n=92) patients.In multinomial logistic regression, BD patients had higher neuroticism (OR=1.17, p0.001) and lower extraversion (OR=0.92, p=0.003) than the general population. When entered simultaneously into the model, the effect of extraversion disappeared. In logistic regression, the levels of neuroticism and extraversion did not differ between BD and MDD patients, or between BD I and II patients.Patients' personality scores were not pre-morbid.Levels of neuroticism and extraversion are unlikely to differ between BD and MDD patients, or between BD I and II patients. The overall level of neuroticism is moderately higher and extraversion somewhat lower in BD patients than in the general population. High neuroticism may be an indicator of vulnerability to both bipolar and unipolar mood disorders.

Mantere O, Isometsa E, Ketokivi M, Kiviruusu O, Suominen K, Valtonen HM, Arvilommi P, Leppamaki S. A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders. Bipolar Disord 2010: 12: 271–284. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective: To test two hypotheses of psychiatric comorbidity in bipolar disorder (BD): (i) comorbid disorders are independent of BD course, or (ii) comorbid disorders associate with mood. Methods: In the Jorvi Bipolar Study (JoBS), 191 secondary-care outpatients and inpatients with DSM-IV bipolar I disorder (BD-I) or bipolar II disorder (BD-II) were evaluated with the Structured Clinical Interview for DSM-IV Disorders, with psychotic screen, plus symptom scales, at intake and at 6 and 18 months. Three evaluations of comorbidity were available for 144 subjects (65 BD-I, 79 BD-II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity. A latent change model (LCM) was used to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Inventory (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM-IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM-IV-based scales of substance use and eating disorders. Results: In the SEM, depression and anxiety exhibited strong cross-sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both persisting over time. Substance use disorders covaried with manic symptoms (r = 0.16–0.20, p

Difficulties in phonological processing and reading that characterize developmental dyslexia have been suggested also to affect those with attention-deficit/hyperactivity disorder (ADHD). However, it is not known to what extent various intervening factors, such as low intelligence quotient or age, explain the observed difficulties. In this study, the authors investigated the domains of phonological processing, reading, spelling, and arithmetic in 110 adults (ages 18—55 years) in healthy control, dyslexia, and ADHD groups.The aim of the study was specifically to compare domain profiles of participants with ADHD to those in other groups.The results showed that participants with dyslexia had the most generalized difficulties. Participants with ADHD were the least affected, and their difficulties reflected less accurate performance. Furthermore, all the observed differences became nonsignificant when intelligence quotient was controlled for. This suggests that adult ADHD is not related to significant impairments in phonological processing or achievement.

The project Adult Dyslexia and Attention Deficit Disorder in Finland (Project DyAdd) compares adults ( n = 119, 18—55 years) with dyslexia, attention-deficit/hyperactivity disorder (ADHD), dyslexia together with ADHD (comorbid), and healthy controls with neuropsychological, psychophysical, and biological methods. The focus of this article is on the Wechsler Adult Intelligence Scale—Third Edition (WAIS-III). The clinical groups performed well compared to the norms, and they did not differ from each other. However, compared to the controls, all of them were slightly poorer in their Full IQ, and of the factors, processing speed was relatively difficult for all of them. In addition to the group comparisons, a cluster analysis based on subtest scores was conducted over the clinical groups. It did not suggest a solution that would differentiate between the clinical groups. Instead, four clusters emerged: above average, average, poor perceptual organization, and poor working memory. Thus, differentiating between these clinical groups with the WAIS-III was not possible. However, all of them shared a relative difficulty in processing speed, and group-independent clusters with perceptual or memory difficulties emerged.

During recent years there has been growing interestin gender differences in the clinical features andcourse of bipolar disorder (BD). Previous studieshave suggested that women are more likely to haverapid cycling course of the illness (1–7), mixedstates (3, 7–12), depressive episodes (4, 7, 13, 14),later age at onset (9), BD type II (15), comorbidthyroid disease (16), comorbid bulimia (16) andpost-traumatic stress disorder (16). Men in turnmore often have manic episodes (12, 13) andcomorbid alcoholism (17). However, not all studieshave supported these findings, and the results haveoften been conflicting. Most of these studies arebased on small sample sizes, and some haveSuominen K, Mantere O, Valtonen H, Arvilommi P, Leppa¨ma¨ki S,Isometsa¨ E. Gender differences in bipolar disorder type I and II.Objective: We investigated gender differences in bipolar disorder (BD)type I and II in a representative cohort of secondary care psychiatricin- and out-patients.Method: In the prospective, naturalistic Jorvi Bipolar Study of 191secondary care psychiatric in- and out-patients, 160 patients (85.1%)could be followed up for 18 months with a life chart.Results: After adjusting for confounders, no marked differences inillness-related characteristics were found. However, female patientswith BD had more lifetime comorbid eating disorders (P < 0.001,OR = 5.99, 95% CI 2.12–16.93) but less substance use disorders(P < 0.001, OR = 0.29, 95% CI 0.16–0.56) than males. Median timeto recurrence after remission was 3.1 months longer among men thanwomen, female gender carrying a higher hazard of recurrence(P = 0.006, HR = 2.00, 95% CI 1.22–3.27).Conclusion: MenandwomenwithtypeIandIIBDhavefairlysimilarillness-related clinical characteristics, but their profile of comorbiddisorders may differ significantly, particularly regarding substance useand eating disorders. In medium-term follow-up, females appear tohave a higher hazard of recurrence than males.

Background There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder. Methods In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in- and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated. Results There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases. Limitations The relatively small sample size in some phases. Conclusions Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.

BackgroundAtomoxetine is a well-established pharmacotherapy for adult ADHD. Long-term studies show incremental reductions in symptoms over time. However, clinical experience suggests that patients differ in their response patterns.MethodsFrom 13 Eli Lilly-sponsored studies, we pooled and analyzed data for adults with ADHD whocompletedatomoxetine treatment at long-term (24 weeks;n= 1443) and/or short-term (12 weeks;n= 2830) time-points, and had CAARS-Inv:SV total and CGI-S data up to or after these time-points and at Week 0 (i.e. at baseline, when patients first received atomoxetine). The goal was to identify and describe distinct trajectories of response to atomoxetine using hierarchical clustering methods and linear mixed modelling.ResultsBased on the homogeneity of changes in CAARS-Inv:SV total scores, 5 response clusters were identified for patients who completed long-term (24 weeks) treatment with atomoxetine, and 4 clusters were identified for patients who completed short-term (12 weeks) treatment. Four of the 5 long-term clusters (comprising 95% of completer patients) showed positive trajectories: 2 faster responding clusters (L1 and L2), and 2 more gradually responding clusters (L3 and L4). Responses (i.e. ≥ 30% reduction in CAARS-Inv:SV total score, and CGI-S score ≤ 3) were observed at 8 and 24 weeks in 80% and 95% of completers in Cluster L1, versus 5% and 48% in Cluster L4.ConclusionsWhile many adults with ADHD responded relatively rapidly to atomoxetine, others responded more gradually without a clear plateau at 24 weeks. Longer-term treatment may be associated with greater numbers of responders.

Objectives Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, vocational ability and predictors of long-term work disability have rarely been studied among patients with BD. We investigated clinical predictors of work disability among patients with BD in psychiatric care. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (N = 191) representing adult (18–59 years) psychiatric inpatients and outpatients with DSM-IV bipolar I disorder (BD-I) and bipolar II disorder (BD-II) in three Finnish cities. Within the JoBS, we investigated the prevalence of disability pensions at baseline, and predictors for being granted a disability pension during an 18-month follow-up of the 151 patients in the labor force at baseline. Cox models were used to determine predictors for onset of disability pension. Results At baseline, 21% (40/191) of the patients already had a disability pension. During the follow-up, a further 38 patients (25% of the 151 followed) were granted a new disability pension. The predictors included older age, male gender, depressive index episode, higher number of psychiatric hospitalizations, generalized anxiety disorder, avoidant personality disorder, and depressive burden during follow-up. However, the predictors differed depending on bipolar subtype, age, and gender. Conclusions BD-I and BD-II are associated with a major risk of long-term work disability, the proportion of patients with a disability pension rising to 41% in the medium-term follow-up of the Finnish cohort investigated in the present study. Severe clinical course, depression, comorbidities, age, and gender are likely to be the main predictors but predictors may vary depending on the subgroup.

Background: The aim of this study was to investigate potential differences in neural structure in individuals with Asperger syndrome (AS), high-functioning individuals with autism spectrum disorder (ASD). The main symptoms of AS are severe impairments in social interactions and restricted or repetitive patterns of behaviors, interests or activities. Methods: Diffusion weighted magnetic resonance imaging data were acquired for 14 adult males with AS and 19 age, sex and IQ-matched controls. Voxelwise group differences in fractional anisotropy (FA) were studied with tract-based spatial statistics (TBSS). Based on the results of TBSS, a tract-level comparison was performed with constrained spherical deconvolution (CSD)-based tractography, which is able to detect complex (for example, crossing) fiber configurations. In addition, to investigate the relationship between the microstructural changes and the severity of symptoms, we looked for correlations between FA and the Autism Spectrum Quotient (AQ), Empathy Quotient and Systemizing Quotient. Results: TBSS revealed widely distributed local increases in FA bilaterally in individuals with AS, most prominent in the temporal part of the superior longitudinal fasciculus, corticospinal tract, splenium of corpus callosum, anterior thalamic radiation, inferior fronto-occipital fasciculus (IFO), posterior thalamic radiation, uncinate fasciculus and inferior longitudinal fasciculus (ILF). CSD-based tractography also showed increases in the FA in multiple tracts. However, only the difference in the left ILF was significant after a Bonferroni correction. These results were not explained by the complexity of microstructural organization, measured using the planar diffusion coefficient. In addition, we found a correlation between AQ and FA in the right IFO in the whole group. Conclusions: Our results suggest that there are local and tract-level abnormalities in white matter (WM) microstructure in our homogenous and carefully characterized group of adults with AS, most prominent in the left ILF.

Objective: There are few prospective studies on risk factors for attempted suicide among representative samples of psychiatric patients with bipolar I and II disorders. We conducted a prospective study to investigate risk for suicide attempts among a secondary-level sample of psychiatric in- and outpatients with bipolar disorder (BD). Methods: In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients from three Finnish cities were screened for BDs with the Mood Disorder Questionnaire (MDQ). Using the Structured Clinical Interview for DSM-IV Disorders (SCID)-I and -II, 191 patients were diagnosed with BDs (90 bipolar I and 101 bipolar II). Information on suicide attempts during the follow-up was obtained for 176 patients (92%) at the 6-month follow-up and for 160 patients (84%) at the 18-month follow-up. Results: During the 18-month follow-up 20% of patients (35/176) attempted suicide. In a Cox regression model, baseline previous suicide attempts (OR 3.8, 95% CI 1.7–8.8; p = 0.001), hopelessness (OR 1.2, 95% CI 1.1–1.3; p

Daylight saving time (DST) is widely adopted. We explored the effects of transition to daylight saving time on sleep. With the use of wrist-worn accelerometers, we monitored the rest-activity cycles on a sample of 10 healthy adults for 10 days around the transition to summer time. Identical measurement protocols were carried out twice on the same individuals during the transitions in the years of 2003 and 2004, yielding data on 200 person-days for analysis. Both sleep duration and sleep efficiency were reduced after the transition both years. After the transition sleep time was shortened by 60.14min (P

Background Season-related subsyndromal depressive symptoms during winter are common among populations at high latitudes. Both physical exercise and exposure to bright light can relieve the fatigue and downturn of mood associated with the shortening length of day. Serum cholesterol level may be related to changes in mood, but the evidence is contradictory. Our objective was to compare the effect of aerobic exercise with or without bright-light exposure on health-related quality of life, mood, and serum lipids in a sample of relatively healthy adult subjects. Method A randomized controlled trial was conducted with subjects allocated to group aerobics training in a gym with bright light (2500-4000 lux) (N = 40) or normal illumination (N = 42) or to relaxation/stretching sessions in bright light as a control group (N = 42) twice a week for a period of 8 weeks. Changes in mood were recorded using questionnaires at the beginning of the study, at weeks 4 and 8. and at follow-up 4 months after the study. A blood sample was drawn before and after the 8-week intervention to measure the concentrations of serum lipids. Results Ninety-eight subjects completed the 8-week study. Both exercise and bright light effectively relieved depressive symptoms. Bright light reduced atypical depressive symptoms more than exercise (p = .03), based on the atypical symptoms subscore of the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorders Version Self-Rating Format. There were no significant differences between the study groups in the changes in serum lipid levels. Conclusion Bright light administered twice a week, alone or combined with physical exercise, seems to be a useful intervention for relieving seasonal mood slumps.

IntroductionEarlier considered a disorder affecting only children, today worldwide adult ADHD prevalence is estimated at 2.5%. The core symptoms; inattention, hyperactivity and impulsivity, often persevere impacting many fields of life.ObjectivesTo estimate the prevalence of ADHD symptoms in the general Finnish adult population.MethodsWe started with a population based and randomly drawn sample of 3000 adults, aged 18–44 years. When contacted, participants were provided three alternative ways to participate (online, letter, telephone interview). Using the adult ADHD rating scale (ASRS) screener all participants (n = 748) were categorized into groups: possibly symptomatic (≥4 points), controls (≤2 points) and undefined (3 points). Fifty-seven possibly symptomatic consented to further evaluation by a telephone interview, together with two age- and gender matched controls each.ResultsUsing the results from the ASRS screener, we calculated a 10.96% prevalence. Analysis of the complete ASRS resulted in a 5.08% and the recommended two-step evaluation in a 3.34% prevalence, out of whom two thirds considered being moderately or severely impaired by the symptoms.ConclusionsThis study suggests that a large number of adults in the general population are negatively affected by ADHD symptoms, almost all unrecognized by health care professionals. As ADHD is a burden for the patient, his family and the society, adult ADHD deserves greater attention in the future.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background. So-called atypical depressive symptoms (carbohydrate craving, prolonged sleep, weight gain, increased appetite) frequently emerge in association with low illumination to which people are ordinarily exposed indoors, or even outdoors at extreme latitudes in wintertime. Our objective was to analyse the effect of physical exercise alone or combined with bright light on mood and the health-related quality of life during winter.Methods. We carried out a randomized controlled trial on 120 indoor employees in southern Finland between November and January. The subjects were allocated to supervised fitness training under bright (2500–4000 lx) or ordinary (400–600 lx) light conditions in a gym 2–3 times weekly for 8 weeks, or supervised relaxation training once a week over the same period as active placebo. We collected questionnaire data on the changes in mood and health-related quality of life after 4 and 8 weeks of training, and after 4 months follow-up.Results. Fitness training in bright light resulted in greater relief from atypical depressive symptoms and more vitality than in ordinary room light. Compared with relaxation alone, the former regime improved general mental health and social functioning in addition to the improvement in depressive symptoms and vitality, whereas the latter only increased vitality.Conclusions. Supervised physical exercise combined with exposure to bright light appears to be an effective intervention for improving mood and certain aspects of the health-related quality of life in wintertime. This effect appears unrelated to the history of season-dependent symptoms, being noticeable among healthy individuals.

Background Poor treatment adherence among patients with bipolar disorder (BD) is a common clinical problem. However, whether adherence is mostly determined by patient characteristics or attitudes, type of treatment or treatment side-effects remains poorly known. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities. During the 18-month follow-up we investigated the continuity of, attitudes towards and adherence to various types of psychopharmacological and psychosocial treatments among 168 psychiatric in- and outpatients with BD I or II. Results One-quarter of the patients using mood stabilizers or atypical antipsychotics discontinued medication during at least one treatment phase of the follow-up autonomously, mostly during depression. When pharmacotherapy continued, adherence was compromised in one-third. Rates of non-adherence to mood stabilizers or antipsychotics did not differ, but the predictors did. One-quarter of the patients receiving psychosocial treatments were non-adherent to them. Limitations Serum concentrations were not estimated. Conclusions More than one-half of BD patients either discontinue pharmacotherapy or use it irregularly. Autonomous discontinuation takes place mostly in depression. Although rates of non-adherence do not necessarily differ between mood-stabilizing medications, the predictors for nonadherence do. Moreover, adherence to one medication does not guarantee adherence to another, nor does adherence at one time-point ensure later adherence. Attitudes towards treatments affect adherence to medications as well as to psychosocial treatments and should be repeatedly monitored. Non-adherence to psychosocial treatment should be given more attention.

Multifaceted and idiosyncratic aberrancies in social cognition characterize autism spectrum disorders (ASDs). To advance understanding of underlying neural mechanisms, we measured brain hemodynamic activity with functional magnetic resonance imaging (fMRI) in individuals with ASD and matched-pair neurotypical (NT) controls while they were viewing a feature film portraying social interactions. Pearson's correlation coefficient was used as a measure of voxelwise similarity of brain activity (InterSubject Correlations—ISCs). Individuals with ASD showed lower ISC than NT controls in brain regions implicated in processing social information including the insula, posterior and anterior cingulate cortex, caudate nucleus, precuneus, lateral occipital cortex, and supramarginal gyrus. Curiously, also within NT group, autism-quotient scores predicted ISC in overlapping areas, including, e.g., supramarginal gyrus and precuneus. In ASD participants, functional connectivity was decreased between the frontal pole and the superior frontal gyrus, angular gyrus, superior parietal lobule, precentral gyrus, precuneus, and anterior/posterior cingulate gyrus. Taken together these results suggest that ISC and functional connectivity measure distinct features of atypical brain function in high-functioning autistic individuals during free viewing of acted social interactions. Our ISC results suggest that the minds of ASD individuals do not ‘tick together’ with others while perceiving identical dynamic social interactions., Highlights • We studied brain function in autism during free viewing of social interactions. • The brains of individuals with autism do not ‘tick together’ with others. • Long-range functional connectivity is altered in individuals with autism. • Link between autistic traits and social brain synchrony extends to normal population.

Objective: To examine the discriminatory validity of the Wender Utah Rating Scale (WURS) and its five suggested subscales (Conduct Problems, Impulsivity Problems, Mood Difficulties, Inattention/Anxiety, Academic Concerns) in a Finnish sample. Method: WURS was administered to 114 adults, aged 18 to 55 years. Participants with ADHD ( n = 37) and dyslexia ( n = 36) were compared with healthy controls ( n = 41). Results: The ADHD group scored significantly higher than the control group on all subscales. Compared with the dyslexia group, the ADHD group did not differ in Mood Difficulties or Academic Concerns. Using the total score, the positive predictive value was .53 in this sample and only .21 when the prevalence of ADHD was taken into account. Conclusion: Three out of five domains of WURS are reliable indicators of ADHD. Domains with low discriminatory power, low general prevalence of ADHD, and other developmental disorders within the population decrease the accuracy.

BACKGROUND: Suicidal ideation indicates risk for suicidal acts. How different definitions and measures for suicidal ideation influence its prevalence, correlates and predictive validity among bipolar disorder (BD) patients is unknown. METHODS: Among the 191 BD patients in the Jorvi Bipolar Study (JoBS), suicidal ideation at baseline was measured using the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9 and by asking whether patients had seriously considered suicide. The predictive value of different definitions of ideation on suicide attempts during a six-month follow-up was investigated. RESULTS: Altogether 74% of patients had suicidal ideation as defined in at least one of the above-mentioned ways, but only 29% met the criteria for all ways; agreement between definitions ranged from low to moderate (kappa coefficient 0.15 to 0.70). The correlates of suicidal ideation overlapped, but were not identical. Of the measures investigated, a baseline SSI score >/=8 had the best combination of sensitivity (0.81) and specificity (0.69) and a positive predictive value (PPV) of 32% for an attempted suicide during follow-up. LIMITATIONS: All plausible measures for suicidal ideation could not be investigated. CONCLUSIONS: Who is classified as having suicidal ideation depends strongly on the definition and means of measurement among BD patients. Different measures for ideation have the potential to cause inconsistency when correlates of suicidal ideation are investigated. For clinically predicting suicide attempts during the next few months, an SSI score >/=8 may best combine sensitivity and specificity. Language: en

Background We investigated the adequacy of maintenance phase pharmacotherapy received by psychiatric in- and outpatients with bipolar I or II disorder, including patients both with and without a clinical diagnosis of bipolar disorder (BD). Methods In the Jorvi Bipolar Study (JoBS), a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities, we studied the adequacy of pharmacological treatment received by 154 patients during the first maintenance phase after index episode. Information on treatments prescribed during the follow-up was gathered in interviews and from psychiatric records. Results Of the patients with a maintenance phase in follow-up, adequate maintenance treatment was received by 75.3% for some time, but by only 61.0% throughout the maintenance phase and for 69.3% of the time (783/1129 patient months) indicated. Uninterrupted adequate maintenance treatment received was most strongly independently associated with having a clinical diagnosis of BD; other associations included inpatient treatment, rapid cycling and not having a personality disorder. Limitations Adequacy of dosage, duration or serum concentrations were not estimated. Findings represent an upper limit for adequate treatment within the cohort. Conclusions Provision or continuity of maintenance treatment was found to be compromised in more than one-third of BD patients during their first follow-up maintenance phase. As expected, clinical diagnosis of BD has a decisive role in determining adequacy of maintenance treatments. However, also rapid cycling may facilitate provision of adequate maintenance treatment, whereas outpatients and those with comorbid personality disorders may be disadvantaged subgroups.

Background Hopelessness, a key risk factor for suicidal behaviour overall, has been studied little among bipolar disorder (BD) patients. For purposes of prevention, it is important to know whether it is predominantly a patient's permanent trait or merely reflects the highly variable illness states. We investigated the degree to which hopelessness is trait- or state-related during the course of BD. Methods The Jorvi Bipolar Study (JoBS) is a naturalistic prospective study representing psychiatric in- and outpatients with DSM-IV BD I and II. Repeated measurements with the Beck Hopelessness Scale of 188 patients at baseline, 6 months and 18 months were analysed using a linear regression model with general estimation equations. Factors covarying with hopelessness during follow-up were investigated. Results Levels of hopelessness varied markedly between illness phases, being highest in depressive and mixed phases, and lowest in euthymia, hypomania or mania. Hopelessness was independently associated with concurrent severity of depression (estimate 0.231, p

Background Combining bright light exposure and physical exercise may be an effective way of relieving depressive symptoms. However, relatively little is known about individual factors predicting either a good response or treatment failure. We explored background variables possibly explaining the individual variation in treatment response or failure in a randomised trial. Methods Participants were volunteers of working-age, free from prior mental disorders and recruited via occupational health centres. The intervention was a randomised 8-week trial with three groups: aerobics in bright light, aerobics in normal room lighting, and relaxation/stretching in bright light. Good response was defined as a 50% decrease in the symptom score on either the Hamilton Depression Rating Scale (HDRS) or 8-item scale of atypical symptoms. Background variables for the analysis included sex, age, body-mass index, general health habits, seasonal pattern, and sleep disturbances. Results Complete data were received from 98 subjects (11 men, 87 women). Of them, 42 (5 men, 37 women) were classified as responders on the HDRS. Overall, light had a significant effect on the number of responders, as assessed with the HDRS (X2 = .02). The number needed to treat (NNT) for light was 3.8. Conclusions We investigated the effect of bright light and exercise on depressive symptoms. Problems with sleep, especially initial insomnia, may predict a good response to treatment using combined light and exercise. Bright light exposure and physical exercise, even in combination, seem to be well tolerated and effective on depressive symptoms.

Background Morning light exposure administered as simulated dawn looks a promising method to treat Seasonal Affective Disorder, but it may moreover help with resetting the inaccurate organisation of body clock functions relative to sleep occurring in winter among people in general. Disturbances in sleep patterns are common and may compromise wellbeing even in the short term. Our hypothesis was that simulated dawn could improve the subjective quality of sleep during winter. Methods A community-based trial with 100 volunteer subjects provided with dawn simulators. Study period lasted for eight weeks, and subjects used the dawn simulators for two weeks at a time, each subject acting as his own control (ABAB-design). Main outcome measure was subjective quality of sleep recorded each morning with Groningen Sleep Quality Scale. Results 77 subjects completed the trial. Quality of sleep improved while subjects were using dawn simulator-devices (p = 0.001). The treatment became beneficial after six days' use of dawn simulator, but the effect did not last after the use was ceased. Conclusion Dawn simulation may help to improve the subjective quality of sleep, but the benefits are modest. Further research is needed to verify these findings and to elucidate the mechanism by which dawn simulation acts on the sleep-wake pattern.

Background: Physical exercise alleviates depressive symptoms, as does exposure to bright light, especially in those with seasonal variation. Our objective was to compare the effect of exercise alone or combined with morning bright light on mood and the health-related quality of life in healthy subjects. Methods: Study subjects were working-age adults, randomized in two groups ( n =80): exercise in bright light (group A), or exercise in normal indoor illumination (group B). Intervention lasted for 8 weeks and questionnaire data on mood and the health-related quality of life were collected at study entry, and at weeks 4 and 8. Results: Physical exercise both in normal indoor illumination and in bright light was effective at alleviating depressive symptoms. The exercise was significantly more effective at alleviating so-called atypical depressive symptoms when combined with bright-light exposure. Limitations: There was no active placebo condition, but a comparative, randomized trial was executed. Conclusions: Physical exercise in bright light had a positive effect on mood and health-related quality of life in a sample of healthy, working-age people. Further research is needed to explore the mechanisms of the apparent additive effect of exercise and light.

Introduction In studies of adult patients with attention deficit hyperactivity disorder (ADHD) atomoxetine (ATX) has demonstrated substantial improvements in ADHD symptomatology using Conners’ Adult ADHD Rating Scales (CAARS). The pattern suggests incremental response over time with no clear plateau of response. Objectives To identify patterns of response to ATX in adult ADHD patients and to describe those trajectories over time Aims To determine if patients have distinct response trajectories using CAARS in two populations, short term (12 weeks) and long term (24 weeks) treatment data. Methods Data from 2502 ATX patients, who had an investigator-rated CAARS total score at ≥ short or long term time point, The numbers of trajectory clusters for short term (n=2502) and long term (n=1139) data were identified using hierarchical clustering methods. Linear mixed modelling was used to describe those different trajectories over time. Results Using CAARS total, 4 trajectory clusters were identified in short term treated patients and 5 in long term. Three out of 4 short term trajectory clusters (representing 84% of patients) and 4 out 5 long term (representing 96%) showed more successful trajectories. In general clusters with less improvement were those with the worst baseline CAARS and minimal initial improvement. Distinct trajectory patterns of response were found that were incremental over time in all clusters. Conclusions Adult ADHD patients receiving atomoxetine have individual trajectories of response that can be divided into 4 short term trajectories and 5 long term trajectories. Further analysis is ongoing to describe these cohorts.

Objective Few studies have investigated the prevalence of and risk factors for suicidal ideation and attempts among representative samples of psychiatric patients with bipolar I and II disorders. Method In the Jorvi Bipolar Study (JoBS), psychiatric inpatients and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire from January 1, 2002, to February 28, 2003. According to Structured Clinical Interviews for DSM-IV Axis I and II Disorders, 191 patients were diagnosed with bipolar disorders (bipolar I, N = 90; bipolar II, N = 101). Suicidal ideation was measured using the Scale for Suicidal Ideation. Prevalence of and risk factors for ideation and attempts were investigated. Results During the current episode, 39 (20%) of the patients had attempted suicide and 116 (61%) had suicidal ideation; all attempters also reported ideation. During their lifetime, 80% of patients (N = 152) had had suicidal behavior and 51% (N = 98) had attempted suicide. In nominal regression models, severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, and hopelessness, comorbid personality disorder, and previous suicide attempt were independent risk factors for suicide attempts. There were no differences in prevalence of suicidal behavior between bipolar I and II disorder; the risk factors were overlapping but not identical. Conclusion Over their lifetime, the vast majority (80%) of psychiatric patients with bipolar disorders have either suicidal ideation or ideation plus suicide attempts. Depression and hopelessness, comorbidity, and preceding suicidal behavior are key indicators of risk. The prevalence of suicidal behavior in bipolar I and II disorders is similar, but the risk factors for it may differ somewhat between the two.

Objective: Our aim was to obtain a comprehensive view of differences between bipolar disorder (BD) patients with onset at early versus adult age in a representative study cohort. Methods: In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients were systematically screened for BD using the Mood Disorder Questionnaire (MDQ). A total of 191 bipolar I and II patients with a current DSM-IV episode were interviewed to obtain information about age at onset of mood symptoms, clinical course, treatment, comorbidity, and functional status. The patients were classified as either early onset (

Objective: To obtain a comprehensive view of differences in current comorbidity between bipolar I and II disorders (BD) and (unipolar) major depressive disorder (MDD), and Axis I and II comorbidity in BD in secondary-care psychiatric settings. Method: The psychiatric comorbidity of 90 bipolar I and 101 bipolar II patients from the Jorvi Bipolar Study and 269 MDD patients from the Vantaa Depression Study were compared. We used DSM-IV criteria assessed by semistructured interviews. Patients were inpatients and outpatients from secondary-care psychiatric units. Comparable information was collected on clinical history, index episode, symptom status, and patient characteristics. Results: Bipolar disorder and MDD differed in prevalences of current comorbid disorders, MDD patients having significantly more Axis I comorbidity (69.1% vs. 57.1%), specifically anxiety disorders (56.5% vs. 44.5%) and cluster A (19.0% vs. 9.9%) and C (31.6% vs. 23.0%) personality disorders. In contrast, BD had more single cluster B personality disorders (30.9% vs. 24.6%). Bipolar I and bipolar II were similar in current overall comorbidity, but the prevalence of comorbidity was strongly associated with the current illness phase. Conclusions: Major depressive disorder and BD have somewhat different patterns in the prevalences of comorbid disorders at the time of an illness episode, with differences particularly in the prevalences of anxiety and personality disorders. Current illness phase explains differences in psychiatric comorbidity of BD patients better than type of disorder.

Background We investigated our translation of The Mood Disorder Questionnaire (MDQ) as a screening instrument for bipolar disorder in a psychiatric setting in Finland. Methods In a pilot study for the Jorvi Bipolar Study (JoBS), 109 consecutive non-schizophrenic psychiatric out- and inpatients in Espoo, Finland, were screened for bipolar disorder using the Finnish translation of the MDQ, and 38 of them diagnostically interviewed with the SCID. Results Forty subjects (37%) were positive in the MDQ screen. In the SCID interview, twenty patients were found to suffer from bipolar disorder, of whom seven (70%) of ten patients with bipolar I but only two (20%) of ten with bipolar II disorder had been previously clinically correctly diagnosed. The translated MDQ was found internally consistent (alpha 0.79) and a feasible screening tool. Conclusions Bipolar disorder, particularly type II, remains commonly unrecognized in psychiatric settings. The Mood Disorder Questionnaire is a feasible screen for bipolar disorder, which could well be integrated into psychiatric routine practice.

Objectives: To investigate whether the course of bipolar disorder (BD) type II is more depressive than that of BD I, and, if so, to explore the underlying factors that cause this difference. Methods: In a prospective, naturalistic study of 191 secondary care psychiatric in- and outpatients diagnosed in an acute phase of BD I or II, 160 patients (85.1%) were followed for 18 months. Using a life chart, the exact timing of symptom states in follow-up was examined. Differences between BD I (n = 75) and II (n = 85) in duration of index phase and episode, time to full remission and recurrence, and time in any mood episode were investigated. Results: Patients with BD II spent a higher proportion of time ill (47.5% versus 37.7%; p = 0.02) and in depressive symptom states (58.0% versus 41.7%; p = 0.003) than BD I patients. This was a result of the higher proportion (61.7% versus 48.6%; p = 0.03) and mean number (1.69 versus 1.11; p = 0.006) of depressive illness phases in BD II, rather than of differences in the duration of depressive phases. Type of index phase strongly predicted the outcome. In linear regression models, both BD II and type of index phase predicted more time spent in depressive symptom states. Conclusions: In medium-term follow-up, BD II patients spend about 40% more time in depressive symptom states than BD I patients because a higher proportion of BD II patients have depressive phases and the frequency of these is higher. Differences in type of index phase may markedly confound differences in outcome between BD I and II.

Background: Differences in the incidence of suicide attempts during various phases of bipolar disorder (BD), or the relative importance of static versus time-varying risk factors for overall risk for suicide attempts, are unknown. Methods: We investigated the incidence of suicide attempts in different phases of BD as a part of the Jorvi Bipolar Study (JoBS), a naturalistic, prospective, 18-month study representing psychiatric in- and outpatients with DSM-IV BD in three Finnish cities. Life charts were used to classify time spent in follow-up in the different phases of illness among the 81 BD I and 95 BD II patients. Results: Compared to the other phases of the illness, the incidence of suicide attempts was 37-fold higher [95% confidence interval (CI) for relative risk (RR): 11.8–120.3] during combined mixed and depressive mixed states, and 18-fold higher (95% CI: 6.5–50.8) during major depressive phases. In Cox’s proportional hazards regression models, combined mixed (mixed or depressive mixed) or major depressive phases and prior suicide attempts independently predicted suicide attempts. No other factor significantly modified the risks related to these time-varying risk factors; their population-attributable fraction was 86%. Conclusions: The incidence of suicide attempts varies remarkably between illness phases, with mixed and depressive phases involving the highest risk by time. Time spent in high-risk illness phases is likely the major determinant of overall risk for suicide attempts among BD patients. Studies of suicidal behavior should investigate the role of both static and time-varying risk factors in overall risk; clinically, management of mixed and depressive phases may be crucial in reducing risk.