Psychoanalytic and neurovegetative mood depressing and elating treatment of depressions and psychoses

Summary There has been emphasized a new and original causal treatment of mild and severe depressions and psychoses by the combined psychoanalytic and neurovegetative mood depressing and elating treatment. It enables the psychoanalyst to manage in an adequate way every kind of depression and psychosis by psychoanalysis.

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Zusammenfassung Es wird über eine neue eigene causale psychoanalytische und neurovegetative, stimmungdämpfende und-fördernde Behandlung leichter und schwerer Formen von Depressionen und Psychosen berichtet. Diese Therapie ermöglicht dem Psychoanalytiker in einer adäquaten Weise bei jeder Form von Depression und Psychose erfolgreich vorzugehen.

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Résumé On décrit un nouveau traitment, original, causal, psychanalytique et neurovégétatif en cas de dépressions et psychoses légères et graves en réprimant et en encourageant la morale du malade. Cette méthode aide le psychanaliste d'une manière adéquate de traiter avec succès toutes les formes de dépressions et psychoses.

     

Pain and the relationship with mood and anxiety disorders and psychological symptoms

ObjectiveThe objective of this study was to investigate the association between pain and mood and anxiety disorders, as well as psychological symptoms, in a population-based sample of women.MethodsThis study examined the data collected from 1067 women aged 20–93 years (median 51 years) participating in the Geelong Osteoporosis Study. Mood and anxiety disorders were diagnosed using a clinical interview (SCID-I/NP) and psychological symptomatology was assessed using the General Health Questionnaire. Pain was determined using a Visual Analogue Scale (0–100 mm) and deemed present if score ≥ 40 mm.ResultsCurrent mood disorders were associated with an increased likelihood of overall (OR = 3.2, 95% CI 2.0–5.1), headache (OR = 2.8, 95% CI 1.6–4.8), back (OR = 4.0, 95% CI 2.5–6.5) and shoulder pain (OR = 2.2, 95% CI 1.2–4.2). In those with current mood disorders, the pain interfered with daily activities (OR = 3.2, 95% CI 1.9–5.5) and was present most of their time awake (OR = 2.5, 95% CI 1.5–4.1). This pattern was similarly observed for those with past mood disorders. Current anxiety disorders were associated with an increased likelihood for overall (OR = 2.2, 95% CI 1.4–3.6), headache (OR = 2.2, 95% CI 1.3–4.0), back (OR = 1.8, 95% CI 1.1–3.0) and shoulder pain (OR = 1.9, 95% CI 1.0–3.5, p = .05). In those with current anxiety disorders, the pain interfered with daily activities (OR = 2.4, 95% CI 1.4–4.1) and was present most of their time awake (OR = 1.9, 95% CI 1.2–3.2). There was no association between pain and past anxiety. Psychological symptomatology was associated with pain at each site (all p < .001).ConclusionsThis study is consistent with studies utilising clinical samples in reporting that mood and anxiety disorders, as well as psychological symptoms, are associated with higher levels of perceived pain.     

Cultural Identity and Experiences of Prejudice and Discrimination of Afghan and Iranian Immigrant Youth

In culturally diverse and immigrant receiving societies, immigrant youth can be subject to prejudice and discrimination. Such experiences can impact on immigrant youth’s cultural identity and influence their psychosocial outcomes. This paper presents findings of a study that examined cultural identity and experiences of prejudice and discrimination among Afghan (N = 9) and Iranian (N = 17) immigrant youth in Canada. The study had a prospective, comparative, longitudinal qualitative design. Data was gathered through focus groups, interviews, journals and field logs. Four main themes emerged on participants’ experiences of prejudice and discrimination: (a) societal factors influencing prejudice; (b) personal experiences of discrimination; (c) fear of disclosure and silenced cultural identity; and (d) resiliency and strength of cultural identity. Drawing from Rosenberg’s (Conceiving the self, Basic Books, New York, 1979) self-concept framework and Romero and Roberts (J. Adolesc., 21:641–656, 1998) distinction between prejudice and discrimination, results indicated that youth’s extant and presenting cultural identity were affected. Inclusive policies and practices are needed to promote youth integration in multicultural and immigrant receiving settings.

Co-occurrence and symptomatology of fatigue and depression

ObjectiveFatigue and depression are highly comorbid phenotypes with partially overlapping symptoms. The main aims of the present study are to: (i) identify the risk of current fatigue and depression; (ii) determine if the depression symptoms experienced by individuals who are fatigued (N = 766) and non-fatigued (N = 1849) are different; and (iii) identify if the fatigue symptoms experienced by depressed (N = 275) and non-depressed (N = 2340) individuals are different, in a community-based sample of Australian twins aged over 50 years.MethodsFatigue and depression symptom profiles and classifications were generated using the Schedule of Fatigue and Anergia (SOFA); the General Health Questionnaire; and the Delusions-Symptoms-States Inventory, States of Anxiety and Depression questionnaires. The association between co-occurring fatigue and depression was assessed using prevalence ratios. Differences in the preponderance of fatigue and depression symptoms were assessed using logistic regression modeling.ResultsIndividuals with either fatigue or depression have an approximately two-fold increased risk for comorbid presentation of both traits, compared to the general population. Logistic regression analysis indicated that fatigued individuals were significantly more likely to report all of the Diagnostic and Statistical Manual of Mental Disorders (DSM) depression symptoms assessed in the study. Similarly, depressed individuals were significantly more likely to report all SOFA fatigue symptoms.ConclusionsFatigue and depression are highly correlated traits within the community. Depression symptomatology and prevalence are significantly increased in fatigued individuals. Fatigue and especially the symptoms of insomnia and poor concentration are strong predictors of depression. Notably, the association between fatigue and depression is independent of their overlapping symptomatology. Therefore, presentation with fatigue, and in particular the symptoms of insomnia and poor concentration, should be considered as warning signs of depression in older adults.     

Hemodynamic and serum cardiac markers and risk of cognitive impairment and dementia

Introduction

Cardiac function is a key player in maintaining energy homeostasis in the brain. Heart failure is closely related to higher risk of neurocognitive disorders. Recent evidence shows that this relationship might not be limited to patients with advanced heart failure, and even suboptimal cardiac functioning is associated with accelerated brain aging. Hence, hemodynamic and serum cardiac markers may provide valuable information about the risk of dementia.

Differences in functional and structural social support among female and male veterans and civilians

Purpose

Social support is an important correlate of health behaviors and outcomes. Studies suggest that veterans have lower social support than civilians, but interpretation is hindered by methodological limitations. Furthermore, little is known about how sex influences veteran–civilian differences. Therefore, we examined veteran–civilian differences in several dimensions of social support and whether differences varied by sex.

Methods

We performed a cross-sectional analysis of the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative sample of 34,331 respondents (male veterans = 2569; female veterans = 356). We examined veteran–civilian differences in functional and structural social support using linear regression and variation by sex with interactions. We adjusted for socio-demographics, childhood experiences, and physical and mental health.

Results

Compared to civilians, veterans had lower social network diversity scores (difference [diff] = − 0.13, 95% confidence interval [CI] − 0.23, − 0.03). Among women but not men, veterans had smaller social network size (diff = − 2.27, 95% CI − 3.81, − 0.73) than civilians, attributable to differences in religious groups, volunteers, and coworkers. Among men, veterans had lower social network diversity scores than civilians (diff = − 0.13, 95% CI − 0.23, − 0.03); while among women, the difference was similar but did not reach statistical significance (diff = − 0.13, 95% CI − 0.23, 0.09). There was limited evidence of functional social support differences.

Conclusion

After accounting for factors that influence military entry and social support, veterans reported significantly lower structural social support, which may be attributable to reintegration challenges and geographic mobility. Findings suggest that veterans could benefit from programs to enhance structural social support and improve health outcomes, with female veterans potentially in greatest need.

     

Alcohol,cannabis and other drugs and subsequent suicide ideation and attempt among young Mexicans

ObjectiveTo report results from a follow-up study of alcohol, cannabis and other drugs on suicidal behavior.MethodWe estimated prospective associations of substance use as a risk factor for incident suicide ideation and attempt, from a follow-up conducted in 2013 (n = 1071) of the original Mexican Adolescent Mental Health Survey conducted in 2005.ResultsCannabis use before age 15 (ideation risk ratio (RR) = 3.97; 95% confidence interval (CI) = 1.43–11.03; attempt RR = 5.23; 95% CI = 1.17–23.32), early onset of DSM-IV drug use disorder (DUD) among cannabis users (ideation RR = 3.30; 95% CI = 1.11–9.84; attempt RR = 4.14; 95% CI = 1.28–13.36), high frequency of cannabis use (RR for attempts = 4.60; 1.03–20.60) and recent DSM-IV-DUD among cannabis users (RR for attempts = 4.74; 1.09–20.57) increased the RR. For “other drug use”, significant results were found among those with high frequency use of other drugs such that they had a higher RR of suicide attempt (5.04; 1.03–24.64). For alcohol, only those who initiated alcohol before age 15 had higher RRs of suicide attempt (1.79; 1.00–3.20).DiscussionThose who used cannabis at an early age, early onset of DSM-IV-DUD, and those with heavy cannabis use and recent DSM-IV-DUD among cannabis users in the last 12-months had increased risk of suicide ideation and attempt. Drugs other than cannabis showed some of these associations, but to a lesser degree. Prevention of substance use and treatment of those already engaged in drug use, by decreasing suicide ideation and attempt, may help to prevent suicide in Mexico.     

MAOA and MAOB polymorphisms and anger-related traits in suicidal participants and controls

MAOA and, to a lesser extent, MAOB polymorphisms have been related to aggression traits and suicidality. We aimed to investigate the role of MAOA and MAOB in suicidal versus non-suicidal participants and interactions between genetic variation and suicidal status on aggression and anger-related traits. The sample was composed of three groups: one group of suicide attempters (n = 171, males 35.1 %), one group of suicide completers (n = 90, males 57.8 %) and a healthy control group (n = 317, males 43.8 %). We examined the following markers: MAOA rs909525, rs6323, and rs2064070, and MAOB rs1799836. Anger traits were measured with the state-trait anger expression inventory (STAXI) and aggression traits with the questionnaire for measuring factors of aggression (FAF). Associations were separately examined for males and females. Variation in the three MAOA variants was associated with higher levels of anger expressed outwards (STAXI “anger-out” subscale) in male suicidal patients compared to controls (p < 0.001). In females, the C allele of rs6323 showed higher scores on the same subscale (“anger out”) (p = 0.002). Allele frequencies of the MAOA rs909525 were associated with suicidality (p < 0.007). Our findings show an association between genetic variation in three polymorphisms of the MAOA and anger traits in suicidal males and one replication for the functional variant rs6323 in females. This relationship was stronger than a direct genetic association with suicide status. Future studies incorporating endophenotypic measures of anger and aggression in suicidal participants are warranted.     

Similarities and differences between actigraphy and parent-reported sleep in a Hispanic and non-Hispanic White sample

ObjectiveDespite concerns about the inaccuracy of parents' reports of children's sleep, it remains unclear whether the bias of parents' reports varies across racial/ethnic groups. To address this limitation, the current study systematically investigated the concordance among parent-reported sleep questionnaires, sleep diaries, and actigraphy-based sleep in a sample of Hispanic and non-Hispanic White children.MethodsParents of 51 Hispanic and 38 non-Hispanic White children (N = 89; M_age = 6.46, SD = 0.62; 50.6% male) reported their child's bedtime and wake time on school days using sleep diaries and questionnaires. Children's sleep also was assessed with actigraphy for five consecutive school days.ResultsParents reported longer sleep duration, earlier bedtime, and later wake time using sleep diaries and questionnaires compared to actigraphy-based assessments. Larger discrepancies between diaries and actigraphy of sleep duration, and between questionnaires and actigraphy of wake time were found in non-Hispanic White children, compared to Hispanic children.ConclusionsAlthough parents tended to overestimate their child's sleep as compared to actigraphy, parents of Hispanic children may be more accurate in some estimates of children's sleep than parents of non-Hispanic White children. Researchers, clinicians, and parents should be aware of the potential biases in parents' reports and estimates of their child's sleep and that the degree of bias could vary across racial/ethnic groups.     

Stalking,and Social and Romantic Functioning Among Adolescents and Adults with Autism Spectrum Disorder

We examine the nature and predictors of social and romantic functioning in adolescents and adults with ASD. Parental reports were obtained for 25 ASD adolescents and adults (13–36 years), and 38 typical adolescents and adults (13–30 years). The ASD group relied less upon peers and friends for social (OR = 52.16, p < .01) and romantic learning (OR = 38.25, p < .01). Individuals with ASD were more likely to engage in inappropriate courting behaviours (χ² _{df = 19} = 3168.74, p < .001) and were more likely to focus their attention upon celebrities, strangers, colleagues, and ex-partners (χ² _{df = 5} = 2335.40, p < .001), and to pursue their target longer than controls (t = −2.23, df = 18.79, p < .05). These results show that the diagnosis of ASD is pertinent when individuals are prosecuted under stalking legislation in various jurisdictions.     

Biogenetic temperament and character in insomnia and depression

ObjectiveWe compared the biogenetic temperaments and characters of primary insomnia patients, major depressive disorder (MDD) patients with insomnia, MDD patients without insomnia, and normal controls.MethodsA total of 417 participants were recruited from a community and a psychiatric clinic in South Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire: 1) normal controls (n = 314), 2) primary insomnia (n = 33), 3) MDD without insomnia (n = 30), and 4) MDD with insomnia (n = 40). All participants were requested to complete the Temperament and Character Inventory.ResultsThere were significant between-group differences in harm avoidance (HA)(F = 32.96, p < 0.001), reward dependence (RD)(F = 5.21, p < 0.01), self-directedness (SD)(F = 24.72, p < 0.001) and cooperativeness (CO)(F = 15.75, p < 0.001), after controlling for age and gender. Subjects with primary insomnia showed higher HA and lower SD than normal control, but lower HA and higher SD than MDD patients with insomnia. CO was lower in MDD patients, but not in subjects with primary insomnia. Lower RD was found only in MDD patients with insomnia.ConclusionThe current study suggests that high HA and low SD were related to primary insomnia, although these patterns were more prominent in patients with MDD.     

Peri- and intraoperative EEG signatures in newborns and infants

ObjectiveThe electroencephalographic derived indices have been developed for adult patients, however these monitors have not been validated for infants.MethodsFrontal EEGs were recorded in 115 infants aged <1 year [0–3-months (N = 27), 4–6-months (N = 30), 7–9-months (N = 29) and 10–12-months (N = 29)] who received general anaesthesia with sevoflurane. Total power (µV²) and relative β-, α-, θ-, δ-power (%) were analyzed. Additionally, in 20 EEGs event marker were added (baseline, loss of consciousness, intraoperative situation, extubation) to assess perioperative EEG dynamics.ResultsNewborns show a mean relative δ-power at 80% in intraoperative EEG compared to infants (10–12 months) showing 47.5%. Relative β-power and α-power are low in newborns (mean 3.2% and 4.6%; respectively), with a marked increase in the older infants (4–6 months) (mean 10.9% and 14.4%; respectively).EEG dynamic in newborns from baseline (relative δ-power of 88%) to the intraoperative situation (80.5%) are discrete. In contrast infants >6-months have a strong reduction of relative δ-power from baseline to the intraoperative situation, which corresponds to an increase of faster frequencies.ConclusionsAge dependent perioperative EEG signatures can be demonstrated in infants younger than one year.SignificanceWe demonstrate significant differences in EEG readouts between newborns and infants which questions our monitoring systems in paediatric anaesthesia.     

Validity and reliability of nerve and muscle ultrasound

Introduction: Nerve and muscle ultrasound has been studied in several conditions, but validity and reliability have not been assessed systematically. Methods: Nerve cross‐sectional area and muscle thickness were measured ultrasonographically at several sites in 4 cadavers, which were then dissected, and actual measurements were obtained. To assess intrarater and interrater reliability, between 3 and 5 ultrasonographers, with varying experience levels, made repeated measurements on healthy volunteers. Results: Correlation coefficients for nerve and muscle validity were >0.968 (P < 0.001), and for intrarater reliability were >0.901 (P < 0.001) for still and real‐time images. Correlation coefficients for interrater reliability were more varied, but for still images they were all significant at the P < 0.001 (0.542–0.998) level, and for real‐time images they were significant at the P < 0.05 level for half the sites (0.243–0.981). Conclusion: Overall, nerve and muscle ultrasound is a valid and reliable diagnostic imaging technique. Muscle Nerve, 2013     

Mental and Addictive Disorders and Medical Comorbidities

Purpose of Review

Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders.

Recent Findings

Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness.

Summary

A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.

     

Calvarial dermoids and epidermoids in infants and children: sonographic spectrum and follow-up

Objective  Dermoids and epidermoids are defined as ectodermal inclusion cysts. The aim of this study was to evaluate the spontaneous natural behavior and the ultrasonographic appearance of calvarial dermoids and epidermoids. Materials and methods  The ultrasonographic image datasets of 100 consecutive children up to 4 years of age (52 females, 48 males; age range at first examination 1 week to 40 months, mean age 8.3 ± 6.9 months) presenting with a firm palpable calvarial mass (103 lesions) were studied retrospectively. All ultrasound (US) examinations were performed using a 7- to 10-MHz linear transducer including B-mode and color Doppler sonography. US follow-up studies (up to 47 months) could be achieved in 30 patients with 33 lesions. Results  At first presentation, all 103 lesions demonstrated very similar US features: a round or oval configuration (diameter 3–18 mm), hypoechogenic, and homogeneous internal structures with a marked hyperechogenic superficial capsule, which were localized adjacent to or expanded into the osseous external calvarial table. No conspicuous flow signs on color Doppler were seen. In 33 lesions with US follow-up investigations, 49% showed variable signs of regression: reduction of size, increase of internal echogenicity, and decrease of demarcation. Eight lesions (24%) remained unchanged. A slight progression up to a maximum diameter of 17 mm but without any increase in osseous destruction was observed in the remainder (27%). There was no lesion with a complete destruction of the underlying bone and no intracranial extension in any of the cases. Conclusions  Calvarial dermoids and epidermoids in infants and children show a benign natural behavior with spontaneous regression in a large number of cases. On US, they demonstrate uniform pathognomonic features enabling the correct diagnosis in any of those lesions. Thus, additional, mainly radiation burdening and sometimes misleading imaging techniques should be restricted. Surgical treatment protocols should be handled conservatively and lesions should be primarily followed-up clinically and by US. Thomas Riebel and Siegfried David contributed equally to this study.     

Relations between common and specific factors of anxiety sensitivity and distress tolerance and fear,distress, and alcohol and substance use disorders

Whereas it has been speculated that the psychopathology risk factors anxiety sensitivity (AS) and distress tolerance (DT) are highly overlapping, no studies have examined whether a core affect sensitivity construct explains this relation. It was hypothesized that, in a sample of 808 treatment-seeking individuals (M_age = 35.11, SD = 14.94), the best-fitting confirmatory factor analysis model of AS and DT would comprise a common underlying affect sensitivity factor orthogonal to DT and lower-order AS factors (physical, cognitive, and social concerns). It was also hypothesized that specific relations between the factors and fear, distress, and alcohol/substance use disorders would emerge. The best-fitting model comprised a common affect sensitivity factor orthogonal to DT and lower-order AS factors. Whereas the affect sensitivity and DT factors were associated with fear, distress, and alcohol/substance use disorders, AS cognitive concerns was only related to distress disorders and AS social concerns was only related to fear disorders.     

ApoE and cholesterol in schizophrenia and bipolar disorder: comparison of grey and white matter and relation with APOE genotype

Background

Apolipoprotein E (apoE) and cholesterol play a critical role in synapse and myelin maintenance and integrity and are thus appealing candidates in the pathogenesis of schizophrenia and bipolar disorder. To explore the role of these 2 molecules, we quantified cholesterol and apoE levels in prefrontal grey and white matter in patients with schizophrenia, bipolar disorder and healthy controls. Furthermore, we investigated the relations between apoE and cholesterol levels and the APOE genotype.

Methods

We obtained dorsolateral prefrontal grey and white matter from the Stanley Medical Research Institute Brain Collection (schizophrenia n = 35, bipolar disorder n = 35 and controls n = 35). Cholesterol levels were quantified using high-pressure liquid chromatography, whereas apoE was measured by enzyme-linked immunosorbent assay.

Results

We found no significant differences in cholesterol or apoE levels among the groups. ApoE levels were higher in grey matter than in white matter in all groups; conversely, levels of cholesterol were higher in white matter than in grey matter. We observed a significant inverse correlation between apoE and cholesterol levels in both grey and white matter. Furthermore, in grey matter, apoE levels were significantly higher in APOE ɛ2 carriers compared with APOE ɛ3 or APOE ɛ4 carriers, with cholesterol levels following the opposite trend.

Limitations

Limitations of our study include our inability to control for potential confounding variables and the small numbers of APOE ɛ2 and ɛ4 carriers in each group.

Conclusion

Although large amounts of cholesterol are present in white matter, apoE expression is limited. The APOE genotype may play a role in the regulation of both cholesterol and apoE levels in grey matter. The impact of APOE polymorphisms on lipid homeostasis in people with psychiatric disorders warrants further investigation.     

Social Anxiety and Empathy: A Systematic Review and Meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE).Methods1442 studies from PsycINFO, Medline, and EMBASE (inception-January 2020) were systematically reviewed. Included studies (N = 48) either predicted variance in empathy using social anxiety scores or compared empathy scores between socially anxious individuals and a control group.ResultsSocial anxiety and AE were statistically significantly positively associated, k = 14, r = .103 (95%CI [.003, .203]), z = 2.03, p = .043. Sex (Q_M (2) = 18.79, p < .0001), and type of measures (Q_M (1 = 7.34, p = .007) moderated the association. Correlations were significant for male samples (r_male = .316, (95%CI [.200, .432])) and studies using self-report measures (r_self-report = .162 (95%CI [.070, .254])). Overall, social anxiety and CE were not significantly associated, k = 52, r =-.021 (95%CI [-.075, .034]), z= -0.74, p = .459. Sample type moderated the association (Q_M (1) = 5.03, p < .0001). For clinical samples the association was negative (r_clinical= -.112, (95%CI [-.201, -.017]).ConclusionThere was evidence for a positive association between social anxiety and AE, but future studies are needed to verify the moderating roles of sex and type of measure. Besides, low CE might only hold for patients with SAD.     

Holoprosencephaly: antenatal and postnatal diagnosis and outcome

Objectives

The objectives of this study are to ascertain the clinical outcome and overall survival of holoprosencephaly (HPE) patients diagnosed antenatally and postnatally, to determine the accuracy of antenatal diagnosis and to determine the role of neurosurgical intervention in HPE.

Design

This is a retrospective review over a 10-year period.

Patients

Sixty-three patients were included in the study, 45 were diagnosed by antenatal radiological imaging and 18 were diagnosed by postnatal radiological imaging. Patient data was drawn from Temple Street Children’s University Hospital (the national paediatric neurosurgery centre), the National Maternity Hospital in Holle’s Street, Dublin, and Our Lady of Sick Children Hospital, Dublin.

Methods

The study was carried out through a review of antenatal and postnatal radiological imaging and reports, clinical charts, GP letters from patient follow-up and telephone conversations with parents of HPE patients.

Results

Four patients in the antenatal diagnosis group had follow-up foetal MRI confirming HPE. Twelve in this group had radiological follow-up postnatally, and in five of these, HPE was confirmed. The remaining seven were identified as false positive. Alobar HPE constituted 55 % (21/38) of patients with 95 % mortality. Fifty-one percent had a normal karyotype. The overall survival in the antenatal diagnosis group was 13 %.In the postnatal group, 18 patients were identified, 67 % (12/18) lobar and 33 % (6/18) semilobar. Normal karyotype was found in 72 % (13/18), with an overall survival rate of 56 % (10/18). Neurosurgical intervention in both groups mainly consisted of CSF diversion in the form of ventriculoperitoneal (VP) or cystoperitoneal shunt (CP) (13/67).

Conclusion

Foetal MRI should be routinely performed in suspected cases of HPE, and reliance on ultrasound alone in the antenatal period may not be sufficient. In our study, there is a high early mortality noted in severe cases of HPE, while milder forms of HPE in children tend to survive beyond infancy albeit with associated complications that required neurosurgical intervention and medical management for other associated systemic anomalies.

     

Untangling PTSD and TBI: Challenges and Strategies in Clinical Care and Research

Purpose of Review

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) can result from similar injuries and can result in similar symptoms, such as problems with sleep, concentration, memory, and mood. Although PTSD and persistent sequelae due to a TBI (PST) have generally been viewed as pragmatically confounded but conceptually separable entities, we examine emerging evidence emphasizing the breadth of overlap in both clinical presentation and underlying pathophysiology between PST and PTSD.

Recent Findings

New evidence underscores the poor specificity of symptoms to etiology and emphasizes the potential, after both physical brain injury and traumatic stress, for changes in each of the three interacting systems that coordinate the body’s response to the experience or expectation of major injury—the immune, endocrine, and neuromodulatory neurotransmitter systems.

Summary

A view of PTSD and PST sharing common pathophysiologic elements related to the CNS response to acute injury or threat carries important implications for research and clinical care.