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Emotional lability: its value in the differential diagnosis and treatment of ADHD
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S.28. Developmental aspects and top-down regulation in ADHD
in both ASD and OCD in dMPFC dysfunction relative to ADHD may reflect shared problems in top-down affect control. References [1] Hart H, Radua J, Mataix D, Rubia K. 2013. Meta-analysis of fMRI studies of inhibition and attention in ADHD: exploring task-specific, stimulant medication and age effects. JAMA Psychiatry 70,185−98. [2] Rubia K, Alegria, A., Brinson H. 2014. Imaging the ADHD brain: disorder-specificity, medication effects and clinical translation. Exp Rev Neurother 14, 519−38. [3] Penad´es R., Catal´an R., Rubia K, Boget T., Andr´es S., Salamero M., and Gast´o, C. 2007. Impaired response inhibition in Obsessive-compulsive disorder. Eur. Psychiatry 22, 404–410. [4] Radua J, Rubia K, Canales-Rodr´ıguez EJ, Pomarol-Clotet E, FusarPoli P, Mataix-Cols D. 2014. Anisotropic Kernels for Coordinate-Based Meta-Analyses of Neuroimaging Studies. Front Psychiatry 5,13. Disclosure statement: Katya Rubia has received speaker’s honoraria from Lilly and Shire
S.28.03 Emotional and non-emotional dimensions of top-down regulation in ADHD and emotional instability disorders P. Petrovic1 ° 1 Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden Dysfunctional regulation of information processing is a core problem in both attention deficit / hyperactivity disorder (ADHD) and borderline personality disorder (BPS). While this dysregulation is related to non-emotional processes in ADHD it is related to emotional processes in BPS. The large comorbidity between ADHD and BPS suggests a partially common underlying mechanism. Here, we propose that this top-down dysregulation constitutes a gradient extending from mostly non-emotional to mainly emotional regulation. While ADHD and BPS are on the extreme sides of this scale all variants in-between exist. Although non-emotional and emotional networks overlap, research suggest some specificity in top-down regulation: non-emotional top-down regulation appears to be more related to dorsolateral prefrontal cortex and caudal anterior cingulate cortex, while emotional topdown regulation entails orbitofrontal cortex and rostral anterior cingulate cortex. A similar distinction appears to hold for the basal ganglia and the dopamine system. We propose that there is a substantial spread of the capacity of these regulatory systems in the population. In healthy subjects this may be mirrored in sub-clinical symptoms and traits associated with low capacity to regulate emotional and non-emotional processes. Even lower capacities are related to clinical disorders including ADHD and BPS. A similar reasoning may be applied for other disorders involving emotional instability, such as conduct disorder (CD) and antisocial personality disorder (ASPD) as for BPS. Altogether, we propose a neurocognitive framework that can integrate ADHD, emotional traits in ADHD, BPS, ASPD and CD into a mechanistically related cluster of psychiatric conditions. References [1] Petrovic, P. and Castellanos, X.F., 2016. Top-down dysregulation − from ADHD to emotional instability. Frontiers in Behavioral Neuroscience. Accepted.
S.28.04 Emotional lability: its value in the differential diagnosis and treatment of ADHD J.A. Ramos-Quiroga1 ° 1 Hospital Universitari Vall d’Hebron Universitat Aut`onoma de Barcelona, Department of Psychiatry Adult ADHD Program, Barcelona, Spain Attention-deficit/hyperactivity disorder (ADHD) is a developmental neurobiological disability that can persists into adulthood. DSM-5 includes inattention and impulsivity–hyperactivity as core symptoms of ADHD. Nevertheless, DSM-5 do not include emotional lability (EL) as diagnostic criteria for ADHD. Several studies found that adults with ADHD presented higher levels of EL when compared to non-ADHD subjects or community subjects. Furthermore, regarding the discussion if whether EL is attributable to ADHD or if it could be a result of the presence of comorbidity, our group obtained similar results that other groups. We also found that EL is related to ADHD and is not explained by the presence of other comorbid disorders different from ADHD. On the other hand, the presence of comorbidity was associated with higher levels of EL. Moreover, the construct of EL is also related to some impulsivity dimensions. Future research is needed to focus on the hypothesis that EL may be related to some personality profiles and that EL could be a marker of a different subgroup of ADHD patients. EL showed a sensitivity of 87.1% in discriminating ADHD patients suggesting that EL is highly frequent in ADHD [1]. Thus, if an individual presents EL symptoms such as low frustration tolerance, irritability or difficulties in anger management, it would be appropriate to screen ADHD as a potential explanation for EL. The presence of EL does not exclude the presence of ADHD diagnosis. However, there are controversial results regarding the specificity of EL in the diagnosis of adults with ADHD [2]. References [1] Vidal R, Valero S, Nogueira M, Palomar G, Corrales M, Richarte V, Bosch R, G´omez-Barros N, Corominas M, Casas M, RamosQuiroga JA., 2014. Emotional lability: The discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Compr Psychiatry; 55:1712−9. [2] Skirrow C, Asherson P., 2013. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord; 147:80−6. Disclosure statement: J.A.R.Q was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Novartis, Shire, Lundbeck, Ferrer and Rubi´o in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Rubi´o, Ferrer, Shire and Eli-Lilly. The ADHD Program chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Shire, Rovi, Lundbeck and Rubi´o.
S.28. Developmental aspects and top-down regulation in ADHD
in both ASD and OCD in dMPFC dysfunction relative to ADHD may reflect shared problems in top-down affect control. References [1] Hart H, Radua J, Mataix D, Rubia K. 2013. Meta-analysis of fMRI studies of inhibition and attention in ADHD: exploring task-specific, stimulant medication and age effects. JAMA Psychiatry 70,185−98. [2] Rubia K, Alegria, A., Brinson H. 2014. Imaging the ADHD brain: disorder-specificity, medication effects and clinical translation. Exp Rev Neurother 14, 519−38. [3] Penad´es R., Catal´an R., Rubia K, Boget T., Andr´es S., Salamero M., and Gast´o, C. 2007. Impaired response inhibition in Obsessive-compulsive disorder. Eur. Psychiatry 22, 404–410. [4] Radua J, Rubia K, Canales-Rodr´ıguez EJ, Pomarol-Clotet E, FusarPoli P, Mataix-Cols D. 2014. Anisotropic Kernels for Coordinate-Based Meta-Analyses of Neuroimaging Studies. Front Psychiatry 5,13. Disclosure statement: Katya Rubia has received speaker’s honoraria from Lilly and Shire
S.28.03 Emotional and non-emotional dimensions of top-down regulation in ADHD and emotional instability disorders P. Petrovic1 ° 1 Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden Dysfunctional regulation of information processing is a core problem in both attention deficit / hyperactivity disorder (ADHD) and borderline personality disorder (BPS). While this dysregulation is related to non-emotional processes in ADHD it is related to emotional processes in BPS. The large comorbidity between ADHD and BPS suggests a partially common underlying mechanism. Here, we propose that this top-down dysregulation constitutes a gradient extending from mostly non-emotional to mainly emotional regulation. While ADHD and BPS are on the extreme sides of this scale all variants in-between exist. Although non-emotional and emotional networks overlap, research suggest some specificity in top-down regulation: non-emotional top-down regulation appears to be more related to dorsolateral prefrontal cortex and caudal anterior cingulate cortex, while emotional topdown regulation entails orbitofrontal cortex and rostral anterior cingulate cortex. A similar distinction appears to hold for the basal ganglia and the dopamine system. We propose that there is a substantial spread of the capacity of these regulatory systems in the population. In healthy subjects this may be mirrored in sub-clinical symptoms and traits associated with low capacity to regulate emotional and non-emotional processes. Even lower capacities are related to clinical disorders including ADHD and BPS. A similar reasoning may be applied for other disorders involving emotional instability, such as conduct disorder (CD) and antisocial personality disorder (ASPD) as for BPS. Altogether, we propose a neurocognitive framework that can integrate ADHD, emotional traits in ADHD, BPS, ASPD and CD into a mechanistically related cluster of psychiatric conditions. References [1] Petrovic, P. and Castellanos, X.F., 2016. Top-down dysregulation − from ADHD to emotional instability. Frontiers in Behavioral Neuroscience. Accepted.
S.28.04 Emotional lability: its value in the differential diagnosis and treatment of ADHD J.A. Ramos-Quiroga1 ° 1 Hospital Universitari Vall d’Hebron Universitat Aut`onoma de Barcelona, Department of Psychiatry Adult ADHD Program, Barcelona, Spain Attention-deficit/hyperactivity disorder (ADHD) is a developmental neurobiological disability that can persists into adulthood. DSM-5 includes inattention and impulsivity–hyperactivity as core symptoms of ADHD. Nevertheless, DSM-5 do not include emotional lability (EL) as diagnostic criteria for ADHD. Several studies found that adults with ADHD presented higher levels of EL when compared to non-ADHD subjects or community subjects. Furthermore, regarding the discussion if whether EL is attributable to ADHD or if it could be a result of the presence of comorbidity, our group obtained similar results that other groups. We also found that EL is related to ADHD and is not explained by the presence of other comorbid disorders different from ADHD. On the other hand, the presence of comorbidity was associated with higher levels of EL. Moreover, the construct of EL is also related to some impulsivity dimensions. Future research is needed to focus on the hypothesis that EL may be related to some personality profiles and that EL could be a marker of a different subgroup of ADHD patients. EL showed a sensitivity of 87.1% in discriminating ADHD patients suggesting that EL is highly frequent in ADHD [1]. Thus, if an individual presents EL symptoms such as low frustration tolerance, irritability or difficulties in anger management, it would be appropriate to screen ADHD as a potential explanation for EL. The presence of EL does not exclude the presence of ADHD diagnosis. However, there are controversial results regarding the specificity of EL in the diagnosis of adults with ADHD [2]. References [1] Vidal R, Valero S, Nogueira M, Palomar G, Corrales M, Richarte V, Bosch R, G´omez-Barros N, Corominas M, Casas M, RamosQuiroga JA., 2014. Emotional lability: The discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Compr Psychiatry; 55:1712−9. [2] Skirrow C, Asherson P., 2013. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord; 147:80−6. Disclosure statement: J.A.R.Q was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Novartis, Shire, Lundbeck, Ferrer and Rubi´o in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Rubi´o, Ferrer, Shire and Eli-Lilly. The ADHD Program chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Shire, Rovi, Lundbeck and Rubi´o.