Cognitive Behavioral Therapy for Depressed Adults With Mild Intellectual Disability: A Pilot Study

There is a paucity of research on psychosocial treatments for depression in adults with intellectual disability (ID). In this pilot study, we explored the efficacy of a group CBT treatment that involved a caregiver component in adults with mild ID with a depressive disorder. Sixteen adults with mild ID and a depressive disorder participated in a 10-week group CBT treatment and eight adults with mild ID with a depressive disorder served as a treatment as usual (TAU) control group. Adults with mild ID and caregivers completed measures of depressive symptoms, behavior problems, and social skills at pretreatment, posttreatment, and a 3-month follow-up. Adults with mild ID also completed a series of tasks to measure their understanding of the principles of cognitive therapy pre- and posttreatment. The CBT group demonstrated significant decreases in depressive symptoms and behavior problems from pretreatment to posttreatment and these effects were maintained at a 3-month follow-up. The CBT group demonstrated significant improvements in their ability to infer emotions and thoughts based on various situation-thought-emotion pairings from pretreatment to posttreatment. Findings indicate that adults with mild ID with a depressive disorder benefitted from a group CBT treatment with a caregiver component. Moreover, adults with mild ID appeared to benefit, at least in part, from the cognitive therapy components of the treatment, in addition to the behavior therapy components.     

Reading decoding and comprehension in children with autism spectrum disorders: Evidence from a language with regular orthography

Decoding and comprehension skills in children with autism spectrum disorders (ASD) were analysed in children native speakers of a language (Italian) with a highly regular orthography. Children with ASD were compared to children with matched intellectual functioning: a subgroup of children with ASD and borderline intellectual functioning (BIF) was compared to a subgroup of children with BIF but no signs of ASD; a subgroup of children with ASD and cognitive functioning within normal limits was compared to a group of typically developing children. Children with ASD (whether with or without BIF) showed essentially spared decoding skills in text as well as word and pseudo-word reading; this was at variance with children with BIF who, as a group, showed overall deficient decoding skills, despite considerable individual differences. By contrast, children with ASD (once again, irrespective of the presence of BIF) showed a selective impairment in reading comprehension, just like children with BIF but unlike the typically developing ones. Therefore, results are generally consistent with a profile of hyperlexia for children with ASD learning a regular orthography, as previously reported for other languages. Notably, this pattern was present irrespective of the degree of cognitive impairment, and clearly distinguished these children from those with borderline intellectual functioning but not signs of autism.     

Mental Health Problems in Adults With Down Syndrome and Their Association With Life Circumstances

This study focused on current life circumstances, previous life events, and engagement with productive and enjoyable activities. It examined the association of these variables with mental health problems and mood in a cohort of young adults with Down syndrome. Participants were 49 adults with Down syndrome (age range 20–31 years) and their parents/carers. Adults with Down syndrome completed standardized language assessments, were screened for possible mental health disorders by a psychologist using the Mini Psychiatric Assessment Schedule for Adults with a Developmental Disability, and/or were seen by a psychiatrist with expertise in dual diagnosis. Parents/carers completed measures of adaptive behavior, life events, mood, participation in activities, and psychosocial engagement with these activities. Fifteen participants (30.6%) received a psychiatric diagnosis of a mental health disorder, of which 7 were diagnosed with Depression (14.3% of the sample). Analysis of differences between 3 groups—those without a diagnosis, those with a diagnosis of Depression, and those with a mental health disorder that was not Depression—identified few differences. Although groups did not differ on the participation measure, there was a significant difference between those with no diagnosis and those with a diagnosis of Depression with respect to psychological engagement. Depressed adults were less engaged in their daily activities.     

The neural basis of individual differences in mate poaching

This study tested the hypothesis that individual differences in the activity of the orbitofrontal cortex, a region implicated in value-based decision-making, are associated with the preference for a person with a partner, which could lead to mate poaching. During functional magnetic resonance imaging (fMRI), male participants were presented with facial photographs of (a) attractive females with a partner, (b) attractive females without a partner, (c) unattractive females with a partner, and (d) unattractive females without a partner. The participants were asked to rate the degree to which they desired a romantic relationship with each female using an 8-point scale. The participants rated attractive females higher than unattractive females, and this effect was associated with ventral striatum activation. The participants also indicated lower ratings for females with a partner than for females without a partner, and this effect was associated with parietal cortex activation. As predicted, the participants characterized by higher orbitofrontal activity demonstrated a greater willingness to engage in a romantic relationship with females who have a partner compared with females who do not have a partner. These results are the first to provide a possible neural explanation for why certain individuals are willing to engage in mate poaching.     

Effect of glucocorticoids on ICP in patients with a cerebral tumour

Preoperative treatment with glucocorticoids in patients with an intracranial tumour has been neurosurgical practice for more than 30 years. Recently, however, a less beneficial effect in patients with a meningeoma is reported. This study included 4 patients with a glioma, 4 with a metastasis and 5 with a meningeoma. All patients had a substantial amount of oedema. The effect of methylprednisolone was monitored during 5 days by clinical examination and epidural pressure measurement. ICP reduction was found in 4 of 13 patients. All observations of decreasing pressure were in patients with a malignant tumour and an initial ICP &15 mmHg. All 4 patients improved clinically. Another 4 patients with a benign meningioma had a significant increase of ICP and none of them experienced clinical improvement. Clinical deterioration was not observed in any patient despite increasing ICP in some cases. In summary, a beneficial effect of GC was demonstrated only in patients with a malignant tumour and augmented pre-treatment ICP.     

Migraine associated with head trauma

Migraine associated with head trauma i.e. onset of migraine in close temporal relation to a head trauma was analyzed in a large population based survey of 4000 forty-year-old males and females. Of the 29 people with migraine associated with head trauma, 20 had migraine without aura associated with head trauma, six had migrainous disorder without aura associated with head trauma and three had migraine with aura associated with head trauma. Eleven had a significant head trauma (loss of consciousness or posttraumatic amnesia lasting more than 10 minutes) and 18 had a minor head trauma. The overall lifetime prevalence of migraine associated with head trauma was 1.4% with a male-female ratio of 1:2.4. The symptomatology of migraine associated and unassociated with head trauma was not different. The first degree relatives of probands with migraine associated with head trauma were blindly interviewed by a physician. The first degree relatives of probands with migraine without aura associated with head trauma had a significantly lower risk of migraine without aura than first degree relatives of probands with migraine without aura unassociated with head trauma. We conclude that migraine without aura associated and unassociated with head trauma have a different aetiology. Thus, it is very likely that a head trauma may cause migraine without aura. The mechanisms involved in trauma induced migraine without aura are unknown.     

Relationships between global motion and global form processing, practice, cognitive and visual processing in adults with dyslexia or visual discomfort

The aim of the first of two experiments was to investigate the effect of practice on sensitivity to global motion and global form in a group of adults with dyslexia, a group of normal readers with visual discomfort, a group with dyslexia and visual discomfort, and a control group. In comparison to the control group, and regardless of the effect of practice, the group with dyslexia was significantly less sensitive to global motion. No differences in global motion sensitivity were found when individuals with dyslexia, with or without visual discomfort, were compared. The normal reading group with visual discomfort was less sensitive to global motion than the control group at baseline, but not when a second estimate of motion sensitivity was obtained. About 30% of the group with dyslexia had a global motion deficit on each threshold estimate. In contrast, there were no significant effects of practice or group on sensitivity to global form. In Experiment 2, performance on a number of cognitive and visual processing tasks was measured in four groups: two with dyslexia; one with and one without a global motion deficit, a normal reading group with visual discomfort, and a control group. The group with visual discomfort had reduced visual processing speed only. Regardless of whether a global motion processing deficit was present or absent in individuals with dyslexia, reduced accuracy was found on the language and visual processing measures, and on a rapid temporal sequencing task. Individuals with dyslexia and a global motion deficit had poorer accuracy than individuals with dyslexia and no motion deficit on the phonological processing and verbal short term memory tasks. We concluded that some adults with dyslexia have a persistent deficit when processing global motion but not global form. This is consistent with reports of a magnocellular pathway deficit in this group. Individuals with visual discomfort do not have a magnocellular processing deficit, but have perceptual difficulties when performing complex visual processing tasks.     

Benign focal epilepsy with onset in infancy in a patient with 18q-syndrome

Case report The 18q-syndrome is sometimes associated with epilepsy. We report a child with a 18q deletion who showed the typical manifestations of the syndrome. In addition, she had benign focal epilepsy with onset in infancy characterized by complex partial seizures with a frequency from 1 to 20 per day. This type of epilepsy is a rare condition and this is the first report of benign focal epilepsy with onset in infancy in a child with 18q-syndrome. The EEGs performed during sleep showed low-voltage spikes over the fronto-central region of the left hemisphere. The magnetic resonance imaging of the brain was normal.Conclusion In conclusion, benign focal epilepsy with onset in infancy could be a condition associated with 18q-syndrome.     

Atraumatic needle reduces the incidence of post-lumbar puncture syndrome

We investigated the occurrence of the post-lumbar syndrome (PPS) in relation to the puncture technique used, in a prospective randomised double-blind study comprising 100 patients. A new atraumatic 22-gauge cannula was compared with a 20-gauge cannula with a Quincke bevel. The atraumatic cannula is a needle with a tip shaped like a closed circular cone with a lateral opening, usually used with an outer cannula (introducer). The study showed that both the frequency of PPS and of acute complaints during lumbar puncture can be dramatically reduced with the atraumatic puncture technique. A marked PPS occurred after lumbar puncture with the 20-gauge cannula in 31% of patients, whereas only 5% of patients reported marked post-puncture symptoms after lumbar puncture with the atraumatic cannula.     

Hand preference and motor functioning in children with autism

This study examined three theories that have been proposed to explain the high rates of ambiguous hand preference in young children with autism. Twenty children with autism were matched with 20 children with developmental delays and 20 normally developing children. The groups were compared on measures of hand preference and motor skills. Results indicated that the lack of development of a hand preference in children with autism was not a direct function of their cognitive delay, as the children with developmental delays showed a dissimilar pattern of hand preference. The lack of a definite hand preference in the children with autism was also not due to a lack of motor skill development, as the children with developmental delays displayed similar levels of gross and fine motor skills without the accompanying lack of a definite hand preference. The finding that children with autism with a definite hand preference displayed better performance on motor, language, and cognitive tasks than children with autism who did not display a definite hand preference, however, provided support for the bilateral brain dysfunction hypothesis.     

Malignant triton tumor of cervical spine with hemorrhage

Malignant peripheral nerve-sheath tumours (MPNST) with a rhabdomyomatous component are referred to as malignant triton tumours. Cervical tritons are rare, with only one previous report. We present a 28-year-old male patient with a malignant triton tumor involving the cervical spine with neurofibromatosis Type 1 presenting with symptoms of rapidly progressive cord compression. Radiology was suggestive of a MPNST with hemorrhage at the C2-C3 level. He underwent surgery with decompression of the intradural, and a small part of the extradural, component. To our knowledge this is the first report of a cervical triton tumor presenting with an intratumoral bleed.     

Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode

OBJECTIVE: It is unclear whether patients with late onset and patients with early onset present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of ICD-10 single depressive episodes for patients with late onset (age >65 years) and patient with early onset (age < or = 65 years) in a nationwide sample of all patients discharged from psychiatric in- or outpatient settings. METHOD: All patients who got a diagnosis of a single depressive episode in a period from 1994-2002 at the end of the first outpatient treatment or at the first discharge from psychiatric hospitalisation ever in Denmark were identified in a nationwide register. RESULTS: In total, 18.192 patients were given a diagnosis of a single depressive episode at the first outpatient contact and 8.396 patients were given a diagnosis of a single depressive episode at the first psychiatric hospitalisation ever. Patients with late onset were more often women, more often presented with a severe depressive episode and more often with psychosis than patients with early onset, in both inpatient and outpatient treatment settings. No differences were found between patients with late and patients with early onset in the prevalence of depression with or without melancholic symptoms-in either of the treatment settings. CONCLUSIONS: Patients with a late onset first depressive episode are more often women and are clinically characterised by more severe depressions and a higher prevalence of psychosis than patients with early onset.     

A prospective cohort study assessing differences in cosmetic appreciation of lateralization while smiling in patients with a peripheral facial palsy*

We investigated the differences in cosmetic appreciation of patients with a left and a right peripheral facial palsy (PFP) while smiling. Smiling pictures of patients with a facial palsy with House–Brackmann II–VI were reversed as a mirror image and offered as a pair of pictures, together with the true image. Twenty-six patients with a PFP and 24 medical professionals familiar with facial palsy were asked to choose the most attractive photograph. Patients rated their own pictures. Medical professionals preferred pictures of patients with a right and left PFP in, respectively, a mean of 43.00?±?12.25% and 57.00?±?12.28% (p?=?.005). Patients with a right PFP chose their mirror and true image in 65% and 35% in smiling pictures (p?=?.01). Patients with a left PFP facial palsy chose their mirror and true image in 58% and 42% in smiling pictures (p?=?.02). The House–Brackmann score and age of the patients did not influence preferences of medical professionals and patients. We have found that medical professionals have a significant preference for pictures of patients with a left PFP. Patients with a left PFP and right PFP significantly prefer their mirror image in smiling pictures.     

The risk of affective disorders in patients with adrenocortical insufficiency

OBJECTIVE: To investigate the risk of affective disorders among patients hospitalised with adrenocortical insufficiency in the study period: 1977-1999. METHOD: Using data from Danish registers, two study cohorts were identified by their ICD diagnoses at discharge from hospital: one comprising all patients with a first hospital admission with an index diagnosis of adrenocortical insufficiency; the other a control cohort comprising all patients with a first hospital admission with an index diagnosis of osteoarthritis. Subsequent admissions to psychiatric hospital wards with discharge ICD diagnoses of affective disorders were used as events of interest. Rates of readmission were estimated using Poisson regression models in survival analyses. Age, sex, duration of time after index discharge, and calendar time were included as co-variables. The primary analysis included all patients with adrenocortical insufficiency. Thereafter, the subgroup of patients with primary adrenocortical insufficiency (Addison's disease) was investigated separately in a secondary analysis. RESULTS: A study sample of 989 patients with adrenocortical insufficiency and 124,854 patients with osteoarthritis was identified. Eight hundred and fifty-two patients were subsequently readmitted with a diagnosis of affective disorder. Patients with adrenocortical insufficiency had a 2.68 (95% CI: 1.62-4.42) times greater rate of affective disorders and a 2.12 (95% CI: 1.16-3.86) times greater rate of depressive disorder when compared with the rate for patients with osteoarthritis. Patients with Addison's disease had a 2.14 (95% CI: 1.14-4.03) times greater rate of affective disorders, and a 1.71 (95% CI: 0.81-3.63) times greater rate of depressive disorder compared with the rate of patients with osteoarthritis. CONCLUSION: Patients with adrenocortical insufficiency may be at increased risk of developing severe affective disorders. Conventional replacement therapy with hydrocortisone may not be sufficient to ensure the psychiatric well-being of these patients.     

Increased risk of developing diabetes in depressive and bipolar disorders?

A few studies have suggested that the prevalence of diabetes is increased for patients with depression and for patients with bipolar disorder compared with the general population. However, no study has been published comparing the risk of getting a diagnosis of diabetes for patients with affective disorders with the risk for patients with other medical illnesses. It was the aim of the present study to investigate whether patients hospitalised for depressive or bipolar disorders are at increased risk of getting a diagnosis of diabetes at readmission compared to patients previously admitted for osteoarthritis. In a nationwide case register study, all patients who got a discharge diagnosis of depression, mania/bipolar disorder or osteoarthritis at first admission in a period from 1977 to 1997 were identified. The probability of getting readmitted and discharged with a diagnosis of diabetes was estimated with competing risks models in survival analysis. In total, 29,035 patients with a diagnosis of depression at first discharge, 6683 patients with mania/mixed episode and 108,525 patients with a diagnosis of osteoarthritis were identified. The risk of getting readmitted with diabetes was not increased for patients who had previously been admitted with depression or mania/bipolar disorder compared to patients with osteoarthritis. There was no difference in the risks of developing Type 1 and Type 2 diabetes.     

Stupor: a review of 25 cases

ABSTRACT– Twenty-five cases of stupor referred to a psychiatric teaching hospital over 15 years are reviewed. Ten cases presented with a depressive syndrome, four cases with catatonic phenomena and a further 10 cases with established organic aetiology; one case was considered to be psychogenic in origin. The overall mortality was high (16%), attributable to the basic pathology. Compared with earlier series there was a reduction in cases with catatonic features with a corresponding increase in the proportion of organic cases.     

Validation of the deCODE Migraine Questionnaire (DMQ3) for use in genetic studies

We assessed the reliability of the diagnosis of migraine with aura (MA) and migraine without aura (MO) based on the third edition of the deCODE Migraine Questionnaire (DMQ3) using a physician-conducted interview as an empirical index of validity. Amongst Danish migraine families recruited from specialist practice we selected 200 cases diagnosed according to the International Classification of Headache Disorders 2nd Edition in a validated physician-conducted telephone interview: 50 patients with exclusively MA, 50 with both MA and MO, 50 with exclusively MO and 50 controls. A written copy of the DMQ3 was mailed to the participant. The DMQ3-based diagnosis was compared with the interview-based diagnosis. Overall, the DMQ3 diagnosed migraine (MA, MO or both) with a sensitivity of 99% (109/110), a specificity of 86% (32/37) and a kappa statistic of 0.89. The most reliable subtype of migraine was MA (with or without co-occurring attacks of MO) which was diagnosed with a sensitivity of 92% (71/77), a specificity of 93% (65/70) and a kappa statistic of 0.85. Exclusively MO was diagnosed with a sensitivity of 91% (30/33), a specificity of 93% (106/114) and a kappa statistic of 0.80. Weakest was the diagnosis of both MO and MA which was diagnosed with a sensitivity of 63% (24/38), a specificity of 92% (100/109) and a kappa statistic of 0.57. In conclusion, the DMQ3 is a valid tool for diagnosing patients with migraine for genetic studies.     

Tumefactive multiple sclerosis requiring emergency craniotomy: Case report and literature review

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or “tumefactive”/“pseudotumoral” presentation) has been described before with a certain frequency; it consists of a large single plaque (>2 cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before.     

Re-visiting "semantic facilitation" of word retrieval for people with aphasia: facilitation yes but semantic no

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic mechanisms in word retrieval? The first experiment shows that word-to-picture matching with unrelated distractors improves naming at short (2-3 minutes) and long (up to 25 minute) lags. There was no effect of being made aware of the relationship between word-to-picture matching and picture naming. People who have a semantic impairment improve only with a short lag between word-to-picture matching and naming. Participants with less semantic impairment show larger priming effects that are equal at short and long lags between word-to-picture matching and naming. The second experiment shows that the facilitation effect is just as large for word-to-picture matching with unrelated distractors as with semantically-related distractors. Furthermore, overall there was no difference between matching with coordinate items and with associated items. The results of these experiments show that facilitation of naming by word-to-picture matching in people with aphasia cannot be a result of the priming of semantic representations. Instead they are consistent with two effects: word-to-picture matching results in priming at a lemma level for aphasic people with a semantic impairment that is only found with a short lag between word-to-picture matching and naming. Word-to-picture matching causes priming of the lemma to output lexicon entry mapping that benefits participants with less semantic impairment that is evident at both a short and long lag between word-to-picture matching and naming. These findings fit well with previous research on repetition priming of naming with normal subjects.