New England Journal of Medicine – Journal Watch Psychiatry Top Stories of 2016 – ADHD is a hot topic!

fireworkNow that the year is coming to an end, we are flooded with reviews of the year. For many reasons, 2016 wasn’t a particularly good year: especially some “democratic” decisions made this year cast some doubt on the so-called “swarm intelligence” which in 2016 apparently turned into “swarm dullness”. With alt-right, fake news and the post-factual world being an imminent threat to mental sanity, we can only hope for a better 2017. Anyway – that’s not the topic of this blog post. As many other journals did, the top journal of the Medical World, NEJM has nominated their top articles in each speciality (http://www.jwatch.org/na43004/2016/12/23/nejm-journal-watch-psychiatry-top-stories-2016).

Amazingly, amongst the Top 10 papers in psychiatry, three dealt with ADHD – and even better, two of them featured IMpACT / MiND / Aggressotype / CoCA researchers in the author list! The papers are in detail:

  • the finding that the use of stimulants is safe in bipolar disorder with comorbid ADHD (Viktorin et al.; http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16040467 – also one of my favourite studies this year)(with H. Larsson, IMpACT / MiND / CoCA)
  • a meta-analysis showing that EEG-based neurofeedback does not have a significant beneficial effect in ADHD, and also suggesting that unblinding of the rater might have influenced positive reports (http://www.jaacap.com/article/S0890-8567(16)30095-8/abstract)(with Dani Brandeis, Aggressotype)
  • the equally sad as important report that young children (aged 5 to 11), who died by suicide, had more frequently symptoms of ADHD, rather than depressive features (almost 60% of 87 children). Also for this most devastating outcome, it is thus very important to adequately diagnose ADHD (http://pediatrics.aappublications.org/content/138/4/e20160436) especially considering that ADHD goes along with an increased risk for suicide life-long which can be lowered by MPH treatment.

In my opinion, the fact that the editors picked three ADHD-relevant papers for their top 10 list demonstrates that ADHD is a hot topic and that we provide cutting edge research in the field – and we will continue to do so in 2017! Watch out at this space for more news on ADHD / ASD, my personal top picks in 2016 and more exciting research in the coming year! Merry New Year and all the best for 2017 for all of you, may it bring peace, happiness and reason to this discomposed world.

How can we make sense of comorbidity?

Comorbidity, defined as the simultaneous occurrence of more than one disorder in a single patient, is commonplace in psychiatry and somatic medicine. In research, as well as in routine clinical settings.

In March 2016 the new H2020 collaborative project “CoCA” (Comorbidity in adult ADHD) was officially launched, with a 3-day kick-off meeting in Frankfurt, Germany. This ambitious project, which is coordinated by professor Andreas Reif and is co-maintaining this shared blog, will investigate multiple aspects of comorbidity in ADHD.

For instance, CoCA will “identify and validate mechanisms common to the most frequent psychiatric conditions, specifically ADHD, mood and anxiety disorders, and substance use disorders (SUD), as well as a highly prevalent somatic disorder, i.e. obesity”.

As reflected in this bold mission, most scientists trained in the biological sciences agree that studies of overlapping and concurrent phenomena may reveal some underlying common mechanisms, e.g. shared genetic or environmental risk factors.

However, particularly in psychiatry and psychology, the origins of comorbidity have been fiercely debated. Critics have argued that observed comorbidities are “artefacts” of the current diagnostic systems (Maj, Br J Psychiatry, 2005 186: 182–184).

This discussion relates to fundamental questions of how much of our scientific knowledge reflects an independent reality, or is merely a product of our own epistemological traditions. In psychiatry, the DSM and ICD classification systems have been accused of actively producing psychiatric phenomena, including artificial diagnoses and high comorbidity rates, rather than being “true” representations of underlying phenomena.  Thus, the “constructivist” tradition argues that diagnostic systems are projected onto the phenomena of psychiatry, while “realists” acknowledge the presence of an independent reality of psychiatric disorders.

In an attempt to explain these concepts and their implications, psychiatric diagnoses and terminology have been termed “systems of convenience”, rather than phenomena that can be shown to be true or false per se (van Loo and Romeijn, Theor Med Bioeth. 2015, 41-60). It remains to be seen whether such philosophical clarifications will advance the ongoing debate related to the nature of medical diagnoses and their co-occurrence.

CoCA will not resolve these controversies. Neither can we expect that our new data will convince proponents of such opposing perspectives.

It is important to acknowledge the imperfections and limitations of concepts and instruments used in (psychiatric) research.

However, it may provide some comfort that similar fundamental discussions have a long tradition in other scientific disciplines, such as physics and mathematics. Rather  than being portrayed as a weakness or peculiarity of psychiatric research, I consider that an active debate, with questioning and criticism is considered an essential part of a healthy scientific culture.

Hereby, you are invited to join this debate on this blog page!Wooden ruler vector