ADHD and psychotic disorders
With data from a systematic review and meta-analysis, Mikaïl Nourredine and colleagues assessed the risk of developing a psychotic disorder following a childhood diagnosis of attention-deficit hyperactivity disorder (ADHD). Researchers included data for participants younger than 18 years at the time of ADHD diagnosis in their review, and 12 observational studies were included in the meta-analysis. With data from 124 095 individuals with ADHD and 1 725 760 controls, their analysis suggested that having an ADHD diagnosis was associated with an increased risk of subsequently developing a psychotic disorder (pooled relative effect 4·74 [95% CI 4·11–5·46]; I 2=43% [95% CI 0–70%]).
Cognitive reserve, frailty, and mortality
With data from the Rotterdam Study, Jendé Zijlmans and colleagues examined the interplay between cognitive reserve and brain reserve with frailty and mortality in older adults. The observational, population-based cohort included data for 1490 individuals with a mean age of 74·3 (SD 5·5) years at baseline, followed up for 5·3 years (SD 1·4), during which time 214 participants died. The authors observed that there was a lower mortality risk in people with higher cognitive reserve (hazard ratio [HR] 0·87 per SD increase [95% CI 0·76–0·99], p=0·035) and higher brain reserve (0·85 [0·72–1·00], p=0·048). Results from additional analysis suggested that the protective effect of cognitive reserve on mortality risk was particularly evident in individuals with physical frailty, alluding to a link between the interplay of these two factors on life expectancy.
EMERGENT-1 clinical trial
In a phase 2, double-blind, clinical trial in people with acute exacerbation of schizophrenia, Stephen Brannan and colleagues evaluated the safety and efficacy of the fixed combination of oral agent xanomeline (a muscarinic cholinergic receptor agonist) plus trospium (a peripheral muscarinic receptor antagonist). Participants (n=182) were randomly allocated to receive placebo or intervention (xanomeline [125 mg maximum dose] plus trospium [30 mg maximum dose]) twice a day. After 5 weeks, participants in the intervention group had a greater reduction from baseline in Positive and Negative Syndrome Scale total score compared to those who received placebo (–17·4 vs –5·9 points; least-squares mean difference –11·6 points [95% CI –16·1 to –7·1], p<0·001). The authors noted that participants who received xanomeline plus trospium had a greater frequency of anticholinergic or cholinergic adverse events than those who received placebo.
Depression and anxiety in IBD
In a systematic review and meta-analysis of 77 studies, Brigida Barberio and colleagues assessed the burden of anxiety and depression in people with inflammatory bowel disease (IBD). Adults with IBD had a pooled prevalence of anxiety of 32·1% (95% CI 28·3–36·0; I 2=96·9%), with a greater risk of symptoms occurring in people with active disease than with inactive disease (odds ratio [OR] 2·5 [95% CI 1·5–4·1]; I 2=77·2%). The pooled prevalence of depressive symptoms in people with IBD was 25·2% (95% CI 22·0–28·5); I 2=97·6%), with active IBD imparting a greater risk for symptoms of depression than inactive disease (OR 3·1 [95% CI 1·9–4·9]; I 2=70·8%). Compared to male counterparts, women with IBD were more likely to have symptoms of anxiety (OR 1·7 [95% CI 1·2–2·3]; I 2=64·3%) and depression (1·3 [1·0–1·8]; I 2=57·5%).
Suicide risk in China
With prospective data for adults included in the China Kadoorie Biobank, Rongqin Yu and colleagues examined risk factors for suicide. Their study included 512 715 participants from rural and urban areas followed up for 9·9 years, during which time 520 suicide deaths occurred (102 suicides per 100 000 persons). The authors highlighted that suicide mortality rates increased with age. Of note, suicide risk was higher in rural dwellers than in individuals from urban areas (HR 2·6 [95% CI 2·1–3·3], p<0·001) and was increased in men relative to women (1·6 [1·4–2·0], p<0·001). The presence of mental health factors heightened the risk of suicide; for example, the HR for suicide in people with schizophrenia-spectrum disorders was 11·0 (95% CI 7·1–17·0, p<0·001).
Lockdown, obesity, and health
With cross-sectional UK survey data, Adrian Brown and colleagues have highlighted the effect of the first COVID-19 lockdown on health and wellbeing in adults with obesity. 299 (55%) of 543 adults with obesity (median body-mass index 37·7 kg/m2 [IQR 36·0–48·7]) included in the survey noted that their mental health had worsened during lockdown and 270 (50%) experienced moderate-to-severe depression. Physical activity had decreased in 234 (61%) of 382 respondents during lockdown, and the majority reported worsening of sleep (228 [80%] of 284). The authors observed that higher depression scores and lower wellbeing scores were associated with detrimental changes in health-related behaviours in people living with obesity during the first COVID-19 lockdown.
For more on ADHD and psychotic disorders see JAMA Psychiatry 2021; published online February 24. https://dx.doi.org/10.1001/jamapsychiatry.2020.4799
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