Anemisi Olmayan Yetişkin DEHB’de Serum Ferritin Düzeyinin Bozukluğun Alt Tipleri ve Belirti Şiddetiyle İlişkisi

Amaç: Anemisi olmayan, dikkat eksikliği hiperaktivite bozukluğu (DEHB) tanısı konmuş yetişkin hastaların serum ferritin düzeylerini eşleştirilmiş kontrol grubu ile karşılaştırmak, serum ferritin düzeylerinin DEHB belirtilerinin şiddeti ve DEHB alt tipleri ile ilişkisini değerlendirmek. Yöntem: DSM-5 ölçütlerine göre DEHB tanısı konan, anemik olmayan ve bilişsel olarak normal olan 91 yetişkin hasta (Grup 1: DHEB bileşik tip 31; Grup 2: Dikkat eksikliği alt tipi 30; Grup 3: Hiperaktivite-dürtüsellik alt tipi 30 hasta) ve 51 sağlıklı kontrol grubu (Grup 4) üzerinde ileriye dönük bir çalışma yapıldı. Wender-Utah Derecelendirme Ölçeği ve Erişkin Dikkat Eksikliği Hiperaktivite Değerlendirme Ölçeği kullanıldı. Serum ferritin düzeyi belirlendi. Bulgular: Hasta grubunun ferritin düzeyi, kontrol grubuna göre istatistiksel olarak anlamlı bir düzeyde düşük saptandı. DEHB bileşik tip (ort. ferritin: 23 ng/ml), dikkat eksikliği alt tipi (ort. ferritin: 37 ng/ml), hiperaktivite ve dürtüsellik alt tipinde (ort. ferritin: 46ng/ml) ferritin düzeyi, kontrol grubuna (ort. ferritin: 65 ng/ml) göre düşüktü. Serum ferritin düzeyi DEHB’nin klinik alt tipleri arasında anlamlı bir fark göstermedi, bozukluğun şiddetiyle korele değildi. Sonuç: Bulgularımız DEHB ve alt tanılı yetişkinlerde serum ferritin düşüklüğünü destekler niteliktedir. Anemi olmaksızın düşük ferritin düzeyleri, bozukluğun patofizyolojisinde rol oynayabilir. Ferritin bu bozukluğun genel değerlendirmesine alınabilir. (Anadolu Psikiyatri Derg 2020; 21(3):327-334)

The Relationship Between Serum Ferritine Levels and Subtypes and the Severity of Symptoms on Non-anemic Adult ADHD

Objective: To compare serum ferritin levels in non anemic adult patients who were diagnosed as attention deficit hyperactivity disorder (ADHD) with a matched healthy control group, and to evaluate the relationship between serum ferritin levels and the severity of ADHD symptoms and ADHD subtypes. Methods: A prospective study was performed on 91 adult non-anemic and cognitively normal ADHD patients (according to the DSM-5 criteria) and 51 healthy controls. They were divided into three subgroups according to the clinical interview and the results of the scale; Group 1, 31 patients with compound type; Group 2, 30 patients with attention deficit subtype; Group 3, 30 patients with impulsivity-hyperactivity subtype. Wender-Utah Rating Scale and Adult Attention Deficit Hyperactivity Assessment Scale were used. Serum ferritin levels were determined. Results: The ferritin levels of the patient groups were found to be significantly lower than the control group. Mean ferritin level was 23 ng/ml in ADHD compound type, 37 ng/ml in attention deficit subtype, 46 ng/ml in hyperactivity and impulsivity subtype, and 65 ng/ml in the control group. Ferritin level was not different between Group 1, Group 2, and Group 3 while the ferritin level of the patients in Group 4 (control group) was significantly higher than the other groups. Conclusion: Our findings revealed the low ferritin levels in ADHD patients. Low ferritin levels without anemia may play a role in the pathophysiology of the disorder. Testing for the ferritin levels may be considered during the general evaluation of this disorder. (Anatolian Journal of Psychiatry 2020; 21(3):327-334) ____________________________________________________________

PDF

___

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: APA, 2013.
Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attentiondeficit/hyperactivity disorder, 2007.
Lahat E, Heyman E, Livne A, Goldman M, Berkovitch M, Zachor D. Iron deficiency in children with attention deficit hyperactivity disorder. Isr Med Assoc J 2011; 13:530-533.
Mohamed WM, Unger EL, Kambhampati SK, Jones BC. Methylphenidate improves cognitive deficits produced by infantile iron deficiency in rats. Behav Brain Res 2011; 216(1):146-152.
Cortese S, Azoulay R, Castellanos FX. Brain iron levels in attention-deficit/hyperactivity disorder: a pilot MRI study. World J Biol Psychiatry 2012; 13(3):223-231.
Adisetiyo V. Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment? Radiology 2014; 272:524-532.
Doom JR, Georgieff MK. Striking while the iron is hot: Understanding the biological and neurodevelopmental effects of iron deficiency to optimize intervention in early childhood. Curr Pediatr Rep 2014; 2:291-298
Youdim MB. Nutrient deprivation and brain function: Iron. Nutrition 2000; 16:504 508.
Connor JR, Ponnuru P, Wang XS, Patton SM, Allen RP, Earley CJ. Profile of altered brain iron acquisition in restless legs syndrome. Brain 2011; 134:959-968.
Mick E, Faraone S.V. Genetcis of attention deficit hyperactivity disorder. Child Adolesc Psychatr Clin North Am 2008; 17:261-268.
Castellanos FX. Toward a pathophysiology of attention-deficit/hyperactivity disorder. Clin Pediatr (Phila) 1997; 36:381-393.
Youdim M B, Ben-Shachar D, Yehuda S. Putative biological mechanisms of the effect of iron deficiency on brain biochemistry and behavior. Am J Clin Nutr 1989; 50(Suppl.3):607-615.
Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 2006; 64:34-43.
Falkingham M, Abdelhamid A, Curtis P, Fairweather-Tait S, Dye L, Hooper L. The effects of oral iron supplementation on cognition in older children and adults: A systematic review and meta-analysis. Nutr J 2010; 9:4.
Percinel I, Yazici KU, Ustundag B. Iron deficiency parameters in children and adolescents with attention-deficit/hyperactivity disorder. Child Psychiatry Hum Dev 2016; 47:259-269.
Grantham-McGregor S, Ani CA. review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 2001; 131(2S-2):649-666.
Donfrancesco R, Parisi P, Vanacore N, Martines F, Sargentini V, Cortese S. Iron and ADHD: time to move beyond serum ferritin levels. J Atten Disord 2013; 17:347-357.
Islam K, Seth S, Saha S, Roy A, Das R, Datta AK. A study on association of iron deficiency with attention deficit hyperactivity disorder in a tertiary care center. Indian J Psychiatry 2018; 60(1):131-134.
Konofal E, Lecendreux M, Arnulf I, Mauren MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2004; 158(12):1113-1115.
Nigg JT, Tannock R, Rohde LA. What is to be the fate of ADHD subtypes? An introduction to the special section on research on the ADHD subtypes and implications for the DSM-5. J Clin Child Adolesc Psychol 2010; 39:723-725.
Willcutt EG, Nigg JT, Pennington BF, Solanto MV, Rohde LA, Tannock R, et al. Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. J Abnorm Psychol 2012; 121:991-1010.
Mahmoud MM, El-Mazary AA, Maher RM, Saber MM. Zinc, ferritin, magnesium and copper in a group of Egyptian children with attention deficit hyperactivity disorder. Ital J Pediatr 2011; 37:60.
Karakurt MN, Karabekiroğlu MK, Akbaş S, Bilgici B, Kılıç, M, Şenses A, et al. Association between symptom profiles and iron and ferritine serum levels in children with attention deficit hyperactivity disorder. Nöropsikiyatri Arşivi 2011; 48:125-128.
Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers. (Accessed September 18th 2013) http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf.
Öncü B, Ölmez Ş, Şentürk V. Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. Turk Psikiyatri Derg 2005; 16:252-259.
Turgay A. Adult Hyperactivity Assessment Scale based on DSM-IV (unpublished scale) Integrative Therapy Institute Toronto; Canada: 1995.
Juneja M, Jain R, Singh V, Mallika V. Iron deficiency in Indian children with attention deficit hyperactivity disorder. Indian Pediatr 2010; 47:955-958.
Millichap JG, Yee MM, Davidson SI. Serum ferritin in children with attention-deficit hyperactivity disorder. Pediatr Neurol 2006; 34:200-203.
Menegassi M, Mello ED, Guimarães LR, Matte BC, Driemeier F, Pedroso GL, et al. Food intake and serum levels of iron in children and adolescents with attention-deficit/hyperactivity disorder. Rev Bras Psiquiatr 2010; 32:132-138.
Calarge C, Farmer C, DiSilvestro R, Arnold LE. Serum ferritin and amphetamine response in youth with attention deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2010; 20:495-502.
Lozoff B. Early iron deficiency has brain and behavior effects consistent with dopaminergic dysfunction. J Nutr 2011; 141(4):740-746.
Wigglesworth JM, Baum H. Iron dependent enzymes in the brain. MBH Youdim (Ed.), Brain Iron: Neurochemical and Behavioral Aspects, New York, NY: Taylor and Francis, 1988, pp.25-66.
Turner CA, Xie D, Zimmermann B, Calarge CA. Iron Status in Childhood Predicts Response to Psychostimulant Treatment in Children with ADHD. American Academy of Child and Adolescent Psychiatry Annual Meeting; Honolulu, HI. 2009.
Cook JD, Finch CA. Assessing iron status of a population. Am J Clin Nutr 1979; 32:2115-2119.
Finazzi D, Arosio P. Biology of ferritin in mammals: an update on iron storage, oxidative damage and neurodegeneration. Arch Toxicol 2014; 88(10):1787-1802.
Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 2005; 5:1215-1220.
Daubner SC, Le T, Wang S. Tyrosine hydroxylase and regulation of dopamine synthesis. Arch Biochem Biophys 2011; 508(1):1-12.
Burhans MS. Iron deficiency: differential effects on monoamine transporters. Nutr Neurosci 2005; 8:31-38.
Georgieff MK. Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev 2011; 69:43-48.