The Diet Factor in Attention-Deficit/Hyperactivity Disorder - State-of-the-Art Review Article in Pediatrics

Diets that were tried in attempt to reduce symptoms associated with attention-deficit/hyperactivity disorder (ADHD) include:

- sugar-restricted
- additive/preservative-free
- oligoantigenic/elimination
- fatty acid supplements

Omega−3 supplement is the latest dietary treatment with positive reports of efficacy. Interest in the additive-free diet of the 1970s is occasionally revived.

Provocative reports have drawn attention to the ADHD-associated “Western-style” diet, high in fat and refined sugars, and the ADHD-free “healthy” diet, containing fiber, folate, and omega-3 fatty acids.

Indications for dietary therapy include:

- medication failure
- parental or patient preference
- iron deficiency
- change from an ADHD-linked Western diet to an ADHD-free healthy diet, when appropriate

In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients.

Iron and zinc are supplemented in patients with known deficiencies; they may also enhance the effectiveness of stimulant therapy.

In patients failing to respond or with parents opposed to medication, omega-3 supplements may warrant a trial.

References:

The Diet Factor in Attention-Deficit/Hyperactivity Disorder. J. Gordon Millichap, MD and Michelle M. Yee, CPNP. PEDIATRICS Vol. 129 No. 2 February 1, 2012, pp. 330 -337, (doi: 10.1542/peds.2011-2199)

Image source: Olive oil, Wikipedia

Seasonal affective disorder (SAD)

What is seasonal affective disorder?

Seasonal affective disorder is a combination of biologic and mood disturbances with a seasonal pattern. It typically occurs in the autumn (fall) and winter, with remission in the spring or summer.

How common is seasonal affective disorder?

5% of the U.S. population experiences seasonal affective disorder. Because the symptoms are seasonal, they are present for 40% of the year. Although the condition is seasonally limited, patients may have associated depression which would last longer.

What is the treatment for seasonal affective disorder?

Light therapy is well tolerated. Most patients improve within 1-2 weeks. To avoid relapse, light therapy should continue through the end of the winter season until spontaneous remission of symptoms in the spring or summer.

Antidepressant medications and cognitive behavior therapy are as effective as light therapy.

How to prevent seasonal affective disorder?

Light treatment may be used as prophylaxis before the subsequent autumn and winter seasons.

There are many devices available on Amazon, for example:



References:

Seasonal affective disorder. Kurlansik SL, Ibay AD. Am Family Physician, Dec 2012.
Image sources: Record breaking snowfall March 2008 at Aubrey, Texas, Wikipedia, public domain

40% of police officers have a sleep disorder according to a JAMA study

More than a third of police officers have a sleep disorder, and those who do are more likely to experience heart disease, problems with job performance and rage toward suspects and citizens, says the NYTimes, citing a study in the JAMA. That figure is at least double the estimated 15-20% rate of sleep disorders seen in the general population.

Having a sleep disorder raised the odds of heart disease by 45%, and the odds of depression by 120%. It also raised the odds of being injured on the job by 22% and falling asleep while driving by 51%.


The JAMA report video.

The officers who had sleep disorders reported more instances of “uncontrolled anger” toward suspects and citizens and serious administrative errors. Sleep deprivation may affect the amygdala, a part of the brain where emotion is governed.

Of the 5,000 study participants, 40% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously:

- 34% screened positive for obstructive sleep apnea
- 6.5% for moderate to severe insomnia
- 5.4% for shift work disorder

Not surprisingly, the police officer who had smaller body mass indexes were far less likely to have sleep apnea. System-wide practices can have a significant impact. For example, state police officers in Massachusetts are given one hour of paid exercise time four days a week to help them stay fit. They were less liekly to have sleep apnea.

References:

Sleep Problems in Police Officers Take Heavy Toll. NYTimes.
Sleep Disorders, Health, and Safety in Police Officers. JAMA.

Comments from Twitter:

WendySueSwanson MD (@SeattleMamaDoc): Geesh.

@CrumbedOxygen: wonder if EMS similar.

Dr John Weiner @AllergyNet:  Can CPAP Cure Cops?

Martin Wilson @ChInspMWilson: what is CPAP then ...??

@DrVes CPAP (continuous positive airway pressure) is a treatment option for sleep apnea. Here is more info from the Mayo Clinic: http://www.mayoclinic.com/health/cpap/MM00716

Premenstrual syndrome and premenstrual dysphoric disorder (review)

Premenstrual syndrome

Premenstrual syndrome is defined as recurrent psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20-30% of premenopausal women.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder includes affective or somatic symptoms that cause severe dysfunction in social or occupational activity. It affects 3-8% of premenopausal women.

Proposed etiologies (causative factors) include:

- increased sensitivity to normal cycling levels of estrogen and progesterone
- increased aldosterone and plasma renin activity
- neurotransmitter abnormalities, particularly serotonin

The Daily Record of Severity of Problems is one tool with which women may self-report premenstrual symptoms.

Symptom relief is the goal, and there is limited evidence for the use of:

- calcium
- vitamin D
- vitamin B6 supplementation

Serotonergic antidepressants (SSRIs) (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.

References:

Premenstrual syndrome and premenstrual dysphoric disorder. Biggs WS, Demuth RH. Am Fam Physician. 2011 Oct 15;84(8):918-24.

Image source: OpenClipArt.org, public domain.