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Attention-Deficit-Hyperactivity-Disorders (ADHD) and Autistic-Spectrum-Disorders (ASD) share overlapping clinical and cognitive features that may confuse the diagnosis. Evaluation of executive problems and planning dysfunction may aid the clinical diagnostic process and help disentangle the neurobiological process underlying these conditions. This study evaluates the planning function problems in 80 male children and adolescents diagnosed with ADHD and 23 male children and adolescents with ASD using the Zoo Map Task; both groups were comparable in terms of age and IQ. The relationship between planning function and other executive functions is also assessed. In comparison to the ADHD groups, ASD children presented more errors in the open-ended tasks; these planning function problems seem to be mediated by processing speed and motor coordination, however it does not seem to be mediated by other executive function problems, including attention, working memory or response inhibition. In the time for planning, an interaction between the specific subgroups and working memory components was observed. ADHD and ASD present with different patterns of planning function, even when other components of executive function are taken into account; clinical and educational implications are discussed.

Introduction: Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited. Objectives: This study aimed to explore the association between hypomentalizing and SA lethality. Methods: Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models. Results: Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2). Table 1. Means Comparison for low and high lethality (N=1371) Low lethality N=539 High lethality N=832 p value Effect size Age, mean (SD) 38.65 (15.65) 41.91 (15.37) ≤0.001 -0.209a Female sex, N (%) 392 (72.7) 571 (68.6) 0.116 0.044b Educational years, mean (SD) 12.45 (2.99) 12.43 (3.41) 0.890 0.0076a Employed, N (%) 220 (41.2) 332 (40) 0.692 0.012b Suicide Ideation, N (%) 475 (88.1) 742 (89.2) 0.541 0.016b Suicide Planning, N (%) 159 (39.2) 400 (58.1) ≤0.001 0.183b Number of attempts, mean (SD) 3.28 (5.48) 3.63 (5.74) 0.269 -0.169a RFQ, mean (SD) 4.68 (1.27) 4.56 (1.32) 0.087 0.095a Table 2. Logistic regression analyses for high SA lethality (N=1371). Univariate analysis Multivariate analysis OR p value OR p value Age 1.014 (1.007-1.021) ≤0.001 1.014 (1.005-1.022) 0.001 Female sex 0.820 (0.646-1.042) 0.105 Educational years 0.998 (0.965-1.031) 0.890 Employed 0.952 (0.763-1.187) 0.660 Suicide ideation 1.111 (0.790-1.562) 0.545 Suicide planning 2.150 (1.674-2.761) ≤0.001 2.183 (1.697-2.808) ≤0.001 Number SA 1.012 (0.990-1.034) 0.277 RFQ 0.929 (0.854-1.011) 0.088 Conclusions: While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

This study was designed to ascertain the associations between public and private self-focused attention and individuals’ relationships with their voices (auditory verbal hallucinations). A sample of 60 subjects with psychiatric disorders who heard voices were given a series of scales to measure their relationship with their voices, self-focused attention, depression and anxiety. A significant association was found between the relational style (dominance, intrusiveness and distance of voices) on one hand and private and public self-focused attention on the other. Voice dominance predicts the scores on the private and public self-focused attention scales. Finally, public self-focused attention mediated the relationship between voice dominance and anxiety. The theoretical and clinical implications of the results are discussed. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to adapt the 'Voice and You' Scale (VAY) (Hayward, Denney, Vaughan, & Fowler, 2008) to Spanish and explore its psychometric properties for measuring the perceived relationship with voices. A sample of 50 psychiatric patients with verbal auditory hallucinations (48 had a psychotic disorder and two a borderline personality disorder) was used. Its reliability was calculated using the Cronbach's α and test-retest, and concurrent validity by the Pearson correlation coefficient of the VAY with the Beliefs About Voices Questionnaire and the Psychotic Symptom Rating Scales. The results showed that internal consistency of the Spanish version of the VAY ranged from 0.74 to 0.84 on the various subscales, and test-retest reliability varied from 0.74 to 0.83 on three subscales (voice 'dominance', 'intrusiveness' and hearer 'dependence'), and was lower (0.68) on the hearer 'distance' subscale. Concurrent validity was acceptable as significant associations were found with the Beliefs About Voices Questionnaire and the Psychotic Symptom Rating Scales subscales. It is concluded that the Spanish version of the VAY is a reliable and valid instrument that can assist the exploration of voices within relational frameworks across research and clinical domains. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The Spanish version of the VAY is a reliable, valid instrument for evaluating the perception a person can have about his or her relationship with the voices and how the person relates to them., Voices that are perceived as relating dominantly and intrusively, and from whom distance is sought, seem to be distressing and cause disturbance., Voices that are related to dependently are perceived as having benevolent intent and are engaged with., Benevolent or neutral voices may be considered as intrusive because of the intensity and frequency with which they are experienced. [ABSTRACT FROM AUTHOR]

Introduction: Literature regarding efficacy of educational programs in ADHD is scarce, with important methodological flaws [1–3]. Objectives: To evaluate clinical efficacy of a specific psychoeducational program on families with ADHD children/adolescents. Methods: Double blind RCT; intervention-psychoeducation group (n = 43), and active control-group (n = 37). Parents attended 12 weekly sessions, 90 min length in groups of 8–10 families and received a structured-evidence-based psychoeducational program (intervention), the controls attended supporting groups (active control). Families were evaluated after 6-month follow-up. Results: Participant families did not differ in terms of age, gender, diagnosis or comorbidities. Parents of ADHD children in the psychoeducation group presented improvement of ADHD symptoms measured by Conners total scale and Conners index (p\0.028 and 0.001, respectively) and when compared to the control group (ES = 0.60 and 0.89). Similar differences were found at 6-month follow-up. Conclusions: Psychoeducation intervention can be regarded as a good alternative to standardized treatment on ADHD. Further studies are required in order to disentangle which ADHD groups may be benefited the most with this specific type of intervention. [ABSTRACT FROM AUTHOR]

Introduction: Iowa gambling task have been used in ADHD to study problems associated with real-life decision making [1, 2]. Method: The aim is to explore this cognitive bias in a sample of 118 children and adolescents with ADHD (DSM-IV) criteria (n = 86 combined; n = 32 inattentive) using a new paradigm (‘‘jumping to conclusion’’). This task consists of drawings of common objects displayed on a computer screen in decreasing degrees of fragmentation. Results: Five parameters were calculated: Jumping-To-Conclusions at first stage (JTC-1), Plausibility Rating at first stage (PR-1), Draws- To-Decision (DTD), Time-Response at first stage (TR-1) and Time- Response for Draw to Decision (TR-DTD). In comparison with the inattentive type, significantly more of the combined type patients made a definitive decision at the first stage (JTC-1: 44.2 vs. 15.6%, p = 0.004), showed higher levels of conviction when making a decision (higher Plausibility Rating PR-1), and needed fewer stages (lower DTD) when making a decision than the inattentive subgroup (4.54 ± 2.22 vs. 5.62 ± 1.84; p = 0.016). Conclusions: ADHD combined children make quicker decisions with a higher level of conviction and may manifest a data-gathering bias when compared to the inattentive subtype. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have compared cognitive functioning in ADHD children and adolescents with or without comorbid anxiety. Children with ADHD and anxiety have shown more impairment on some tasks (e.g. Trail Making test B, working memory), but less on others [2, 3]. Such contradictory findings may be explained by the different effects of anxiety on the processing and storage of information and motivation. The attention control theory (ACT) is an approach to anxiety and cognition that further develops the previous processing efficiency theory (PET). The ACT holds that anxiety impairs executive function efficiency by disrupting the balance between the stimulus-driven attentional system and the goal-directed attentional system [1]. Objective: To explore the effects of anxiety in cognitive function according to specific ADHD subtypes (combined or inattentive), and in relation with previous theories regarding anxiety and cognitive performance. Methods: We included 78 patients with a diagnosis of ADHD attending a Child and Adolescent Psychiatric service in Jae´n (Spain). Patients were divided according to the specific subtype (combined: n = 55, and inattentive: n = 23). Independent variables were cognitive function measured by (1) Rey Auditory Verbal Learning Test for immediate, short- and long-term auditory memories, (2) short-term visual memory and visual planning-organization ability measured by Rey-Osterreich Complex Figure, and (3) divided attention measured by Trail Making Test B. Anxiety levels were assessed using the Conners subscale for parental anxiety. Results: Mean age was 11.26 ± 2.43 years for inattention subtype, and 10.47 ± 3.27 years for the combined subtype. We found no differences between subtypes for any of the variables explored. Patients with low levels of anxiety (below median) showed similar cognitive functioning in both the combined and the inattentive subtypes. However, children with high levels of anxiety (above median) showed a different pattern of functioning according to the specific ADHD subtype. While improvement in the long-term auditory memory was seen for the inattentive subtype, the combined type showed worsening of long-term auditory memory, the differences between groups being statistically significant (p\0.05). Similarly, we obtained a positive interaction (p = 0.018) between the two groups in the multivariable analysis, the inattentive subtype with high levels of anxiety showing improvement in functioning, whereas subjects with combined subtype and high levels of anxiety worsened in function (p = 0.037). Again, a positive interaction (p = 0.026) was found for divided attention, the combined type showing more errors than the inattentive subtype (p = 0.010) when high levels of anxiety were reported. Discussion and conclusion: High levels of anxiety were seen to affect long-term auditory memory and visual planning-organising ability differently, depending on ADHD subtype. These results are in line with previous theories about anxiety and cognitive performance that suggest anxiety has a dual effect (worsening the processing and storage capacity of working memory, while increasing motivation and auxiliary processing resources), and enhances the influence of stimulus- driven attention as opposed to goal-directed attention. Our findings, while contradictory, coincide with the observations of some previous studies. [ABSTRACT FROM AUTHOR]

Introduction: Impairments in executive function are thought to play a key role in a variety of developmental disorders including ADHD [1]. Objective: To explore planning skills in children/adolescents with different neurodevelopmental disorders (ADHD n = 42, early onset psychosis n = 58, and ASD n = 37), and to compare them with a control group (n = 31). Methods: We used the Zoo Map task [2, 3]. The ZM assesses ability to organize and implement a plan in both non-structured and structured conditions. We registered planning time, total time for completing the task, and number of errors. Results: ADHD group needed more time for planning when compared to the rest of the groups (p < 0.05) but only for the nonstructured condition. ASD made more commission errors when compared to ADHD and controls in both the structured and nonstructured versions (p < 0.05). EOP planning function was the poorest in all variables when compared to the rest of the groups. Discussion: ADHD subjects may present with deficits in planning task, but especially in the non-structured situations. Neurodevelopmental disorders present differences in planning function when compared between them. [ABSTRACT FROM AUTHOR]

Background: One of the most relevant risk factors for suicide is the presence of previous attempts. The symptomatic profile of people who reattempt suicide deserves attention. Network analysis is a promising tool to study this field., Objective: To analyze the symptomatic network of patients who have attempted suicide recently and compare networks of people with several attempts and people with just one at baseline., Methods: 1043 adult participants from the Spanish cohort "SURVIVE" were part of this study. Participants were classified into two groups: single attempt group (n = 390) and reattempt group (n = 653). Different network analyses were carried out to study the relationships between suicidal ideation, behavior, psychiatric symptoms, diagnoses, childhood trauma, and impulsivity. A general network and one for each subgroup were estimated., Results: People with several suicide attempts at baseline scored significantly higher across all clinical scales. The symptomatic networks were equivalent in both groups of patients (p > .05). Although there were no overall differences between the networks, some nodes were more relevant according to group belonging., Conclusions: People with a history of previous attempts have greater psychiatric symptom severity but the relationships between risk factors show the same structure when compared with the single attempt group. All risk factors deserve attention regardless of the number of attempts, but assessments can be adjusted to better monitor the occurrence of reattempts.

Objective: This study aims to investigate the interrelationship of risk factors for suicidal behaviour and their influence on attempt severity in a sample of adolescents who have recently attempted suicide. For it a network analyse was performed., Method: Data from a sample of adolescents from 12 to 17 years of age with documented suicide attempts were collected and analysed in the context of a larger study conducted in Spain called SURVIVE. Several factors were examined including age, sex, depression, trauma, impulsivity, and substance abuse. Graph analysis was performed to identify relationships and centrality measures among these factors., Results: A total of 267 participants were enrolled: 233 females and 34 males with a mean age of 15.00 years (SD = 1.52). The results indicate that age and sex do not have a notable relationship with attempt severity in adolescents. Emotional and behavioural difficulties, measured by the Strengths and Difficulties Questionnaire (SDQ), have the greatest influence on other variables. Depression and childhood trauma show varying degrees of association with suicidal behaviour, as does motor impulsivity. Substance use does not appear to be strongly related to suicide attempt severity. The number of suicide attempts is strongly correlated with emotional and behavioural difficulties, depression, and childhood trauma. Lethality of suicide attempts and intensity of suicidal ideation do not show significant associations with the other variables., Conclusion: This study identifies significant risk factors for adolescent suicide. Emotional and behavioural symptoms, depression, and childhood trauma are strongly linked to suicidal behaviour. However, age, sex, and substance abuse show minimal correlation. Assessing emotional difficulties and depressive symptoms using specific questionnaires could be crucial in evaluating suicidal behaviour in adolescents., Competing Interests: Declarations. Conflict of interest: Pilar A. Saiz has been a consultant to and/or has received honoraria or grants from Adamed, Alter Medica, Angelini Pharma, CIBERSAM, Ethypharm Digital Therapy, European Commission, Government of the Principality of Asturias, Instituto de Salud Carlos III, Johnson & Johnson, Lundbeck, Otsuka, Pfizer, Plan Nacional Sobre Drogas, Rovi, Servier and Viatris España. Luis Jiménez Treviño has been a consultant to and/or has received honoraria or grants from Adamed, Alter Medica, Angelini Pharma, Cassen-Recordati, CIBERSAM, Eli Lilly, European Commission, Government of the Principality of Asturias, Instituto de Salud Carlos III, Johnson & Johnson, Lundbeck, Otsuka, Pfizer, and Servier outside the submitted work. Jennifer Fernandez-Fernandez has been a consultant to and/or has received honoraria or grants from Otsuka. Iria Grande has received grants and served as a consultant, advisor, or CME speaker for the following identities: Adamed, Angelini, Casen Recordati, Esteve, Ferrer, Gedeon Richter, Janssen-Cilag, Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, and Viatris outside the submitted work. She also receives royalties from Oxford University Press, Elsevier, and Editorial Médica Panamericana. Ethical approval: The current proposal complies with the national (code of ethics of the national board of medicine) and international (Declaration of Helsinki, Fortaleza, Brasil, Octubre 2013) guidelines, and with the national regulations: Ley 14/2007, 3rd of July of Investigación Biomédica, and Ley Orgánica 3/2018, 5th of December, regarding Protección de Datos Personales y Garantía de Derechos Digitales. Data protection will be assured following EU regulations (General Data Protection Regulation 2016/679 and the Council of 27 April 2016). Individuals who attempted suicide will be screed by a psychiatrist at the emergency ward. After discharge, the participant will be asked verbally, whether he/she consents to be called by a study team member to inform he/she about the study. If the patient consents, a study team member will contact the patient within the first 24 h to explain the study aims, and to arrange an appointment. Participants who agreed will be given the Patient Information Sheet and Informed Consent. Participation will be voluntarily, and participants will be allowed to abandon the study at any time. The same procedure will be conducted to recruit the youth sample. The adolescent’s consent will also be obtained through the provision of age-appropriate information. Adolescents will be included in the study only if consent from both (the adolescent and his/her legal representative) is obtained. The project was evaluated at the Ethical Committees of each one of the participating sites., (© 2024. The Author(s).)

Several studies show great heterogeneity in the type of genetic test requested and in the clinicopathological characteristics of patients with ASD. The following study aims, firstly, to explore the factors that might influence professionals' decisions about the appropriateness of requesting genetic testing for their patients with ASD and, secondly, to determine the prevalence of genetic alterations in a representative sample of children with a diagnosis of ASD. Methods: We studied the clinical factors associated with the request for genetic testing in a sample of 440 children with ASD and the clinical factors of present genetic alterations. Even though the main guidelines recommend genetic testing all children with an ASD diagnosis, only 56% of children with an ASD diagnosis were genetically tested. The prevalence of genetic alterations was 17.5%. These alterations were more often associated with intellectual disability and dysmorphic features. There are no objective data to explicitly justify the request for genetic testing, nor are there objective data to justify requesting one genetic study versus multiple studies. Remarkably, only 28% of males were genetically tested with the recommended tests (fragile X and CMA). Children with dysmorphic features and organic comorbidities were more likely to be genetic tested than those without. Previous diagnosis of ASD (family history of ASD) and attendance at specialist services were also associated with Genetically tested Autism Spectrum Disorder GTASD. Our findings emphasize the importance of establishing algorithms to facilitate targeted genetic consultation for individuals with ASD who are likely to benefit, considering clinical phenotypes, efficiency, ethics, and benefits., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Suicidal behavior constitutes a multi-cause phenomenon that may also be present in people without a mental disorder. This study aims to analyze suicidal behavior outcomes in a sample of attempters, from a symptom-based approach., Methods: The sample comprised 673 patients (72% female; M  = 40.9 years) who attended a hospital emergency department due to a suicide attempt. A wide range of clinical factors (e.g., psychopathology symptoms, psychiatric diagnoses, impulsivity, acquired capability), was administered within 15 days after the index attempt. Nine psychopathology domains were explored to identify the profile of symptoms, using latent profile analysis. The relationship between the profile membership and suicide outcome (i.e., intensity of suicidal ideation, number of suicide behaviors, and medical injury derived from index attempt) was also studied, using linear and logistic regression., Results: Three psychopathology profiles were identified: high-symptom profile (45.02% of participants), moderate-symptom profile (42.50%), and low-symptom profile (12.48%). High-symptom profile members were more likely to show higher risk of non-suicidal self-injury, acquired capability for suicide, and more severe suicide behavior and ideation. On the other hand, a more severe physical injury was associated with low-symptom profile membership in comparison to membership from the other profiles ( OR  < 0.45, p  < .05)., Conclusions: A symptom-based approach may be useful to monitor patients and determine the risk of attempt repetition in the future and potential medical injury, and to optimize prevention and intervention strategies.

Tobacco smoking is the leading cause of disability and preventable deaths worldwide, but it should be differentiated from tobacco use disorder, which is, according to the Diagnostic and Statistical Manual of Mental Disorders, a bona fide mental disorder. The rapid delivery of nicotine to the brain activates acetylcholine receptors and stimulates the release of dopamine, both systems implicated in other mental disorders. Rates of tobacco use disorder are much higher among people suffering from other mental disorders and these patients find it more difficult to quit. Dual disorders, from a transdiagnostic perspective, identify patients with substance use disorder, in this case tobacco use disorder, and other mental disorders. A dual disorder is a complex clinical condition that is often underdiagnosed, undertreated, and difficult to manage. Appropriate and integrated tobacco use disorder treatment programs for people also suffering from other mental disorders could improve outcomes. Bio-psycho-social approaches to tobacco use disorder include specific biological treatments (e.g., bupropion, varenicline, cytisine, nicotine replacement therapy or deep trans-magnetic stimulation). However, these treatments don't have the same outcomes in patients with dual disorders. Therefore, as in other dual disorders, harm reduction measures, such as vaping nicotine through electronic cigarettes or tobacco replacement therapies should be considered as alternative tools for dual tobacco use disorder management. These clinical considerations emerge from a narrative literature review and expert consensus and will specifically address considerations for changes in clinical practice to improve the treatment of tobacco use disorder and other mental disorders., Competing Interests: NS reports receiving honoraria/expenses from Viatris, Gedeon Richter/Recordati and Lundbeck. CP has served as a consultant or received fees for collaborative activities within the last 5 years from Lundbeck, Janssen, MSD, Esteve, and Casen Recordati. PV has received honoraria/expenses from Camurus and Gilead, and his research has been funded by Exeltis, Casen Recordati, and Lundbeck. IB-V has been involved in collaborative activities with Lundbeck, Janssen, and Casen Recordati over the past 5 years. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Szerman, Parro, Vega, Basurte-Villamor and Ruiz-Veguilla.)