Use of paracetamol during pregnancy and child neurological development

Paracetamol (acetaminophen) remains the first line for the treatment of pain and fever in pregnancy. Recently published epidemiological studies suggested a possible association between paracetamol exposure in utero and attention‐deficit–hyperactivity disorder/hyperkinetic disorder (ADHD/HKD) or adverse development issues in children. However, the effects observed are in the weak to moderate range, and limitations in the studies' design prevent inference on a causal association with ADHD/HKD or child neurological development. In parallel, recent animal data showed that cognition and behaviour may be altered following exposure to therapeutic doses of paracetamol during early development. These effects may be mediated by interference of paracetamol with brain‐derived neurotrophic factor, neurotransmitter systems (including serotonergic, dopaminergic, adrenergic, as well as the endogenous endocannabinoid systems), or cyclooxygenase‐2. However, no firm conclusion can be made on the relevance of these observations to humans. We conclude that additional well‐designed cohort studies are necessary to confirm or disprove the association. In the context of current knowledge, paracetamol is still to be considered safe in pregnancy and should remain the first‐line treatment for pain and fever.     

成人抑郁症患者儿童期受虐对神经系统软体征的影响

目的:研究抑郁症患者儿童期受虐待对神经系统软体征的影响. 方法:对103例抑郁症患者行儿童受虐问卷、神经系统软体征、汉密尔顿抑郁量表、自杀意念量表以及Beck绝望量表评定.结果:①儿童受虐患者较未受虐者额叶有更多的软体征(2.51±1.61,1.77±1.25,P＜0.01).有情感忽视患者额叶软体征也明显高于无情感忽视者(2.53±1.63,1.80±1.25,P＜0.05);有躯体忽视者额叶较无躯体忽视者软体征明显增多(2.41±1.63,1.65±1.00,P＜0.01);有性虐待患者软体征明显高于无性虐待者(6.29±1.83,4.28±2.82,P＜0.01).②受虐总分与额叶和颞叶评分呈明显正相关(r=0.29,P＜0.01;r=0.24,P＜0.05);情感受虐待、情感被忽视及躯体虐待与额叶评分呈明显正相关(r=0.284,0.345,0.218,P＜0.01或0.05).③HAMD与神经系统软体征总分及各脑叶均呈明显正相关;自杀意念量表评分与神经系统软体征总分及额叶、顶叶、颞叶软体征评分呈明显正相关. 结论:抑郁症患者儿童期受虐对大脑有不利影响,不同虐待可对不同脑区产生损害,主要在额叶.     

精神分裂症神经系统软体征的多因素分析

目的：探讨精神分鲜明症神经系统软体征的主要影响因素。方法：对１７５例精神分裂症患者的神经系统软体征进行评定,并与年龄,病程,抗精神病药剂量,受教育年限,阴性阳性症状各因子分、ＴＥＳＳ及简明智能评定量表分进行相关分析及多元逐步回归分析。结果：多因素分析显示神经系统体征的主要影响因素有情感谈漠,意志活动缺乏,社交活动缺乏,注意障碍、阳性思维形式障碍、系统软体征的主要影响因素有情感谈漠,意志活动缺乏,社     

Monoclonal gammopathy with neurological signs and symptoms

Clinical, neurophysiological and muscle biopsy findings in ten patients with monoclonal gammopathy are reported. Three patients had polyneuropathy, one had hemiparkinsonism, one migraine and radicular symptoms and one paresthesiae and radicular symptoms. Amyloidosis was not found in muscle biopsy specimens. All but one patient with neurological findings also had positive immunofluorescence staining for tissuebound immunoglobulins in muscle biopsy specimens. The tissue-bound immunoglobulins usually belonged to the same class as the M-component. None of the biopsies of patients without neurological findings were positive.     

Pseudomigraine with transient neurological signs and lymphocytic pleiocytosis

We report the case of a 32-year-old man without previous medical history of migraine, who presented with severe headache and temporary focal neurological deficits. Lumbar puncture revealed aseptic lymphocytic pleiocytosis. The patient completly recovered within 2 months. This condition was suggestive of a transient syndrome of headache with neurologic deficits and CSF pleiocytosis. The main characteristics and the physiopathology of this uncommon disorder are discussed.     

Significance and meaning of neurological signs in schizophrenia

The authors review studies of abnormal signs on clinical neurological examination of schizophrenic patients. In spite of a number of methodologic limitations, the cumulative evidence strongly argues that there are more neurological signs in schizophrenic patients than in nonpsychiatric control subjects. Although less consistent, there is considerable evidence of more neurological signs in schizophrenic patients than in patients with affective disorders or with mixed, nonpsychotic disorders. The existing literature suggests several preliminary hypotheses with respect to neuroanatomical localization of neurological signs, subtyping of schizophrenia, and utility of studies of relatives at high risk and family history studies. Directions for future research in these areas are described.     

Demyelination and neurological signs in experimental allergic encephalomyelitis

Because of the reported absence of demyelination in some animals with neurological signs of experimental allergic encephalomyelitis (EAE), it has been suggested that these signs are not due to demyelination. The present study demonstrates that there is ample demyelination in the central nervous system (CNS) and peripheral nervous system (PNS) to account for the neurological signs in rats with myelin basic protein (MBP)-induced acute EAE as well as in rats and rabbits with whole-spinal-cord-induced acute EAE. The main reasons for failure to detect demyelination in animals with neurological signs of EAE appear to be inadequate histological techniques and incomplete examination of the nervous system, particularly the PNS and the lumbar, sacral and coccygeal segments of the spinal cord.     

精神分裂症患者神经系统软体征随访观察

目的:探讨缺陷型、非缺陷型精神分裂症患者神经系统软体征(NSS)的长期随访特点.方法:对1997年9月曾进行NSS评定、持续住院的缺陷型和非缺陷型精神分裂症患者分别23例和30例于4年后再次进行评定,同时采用简明精神病评定量表(BPRS)、阳性症状评定量表(SAPS)、阴性症状评定量表(SANS)评定其精神症状.结果:4年后精神分裂症患者NSS总分及顶叶、额叶、枕叶因子分均明显增加;非缺陷型患者仅顶叶、额叶因子分显著增加.NSS评分均与同期的SANS评分呈正相关,而与SAPS评分无显著相关性.结论:缺陷型精神分裂症患者NSS随病程进展呈加重趋势,其严重程度与阴性症状密切相关.     

Abnormal neurological signs, visual contrast sensitivity, and the deficit syndrome of schizophrenia

This study was designed to investigate the relationship between abnormal neurological signs, visual contrast sensitivity, and the deficit syndrome of schizophrenia. Visual contrast sensitivity for counterphase-modulated low spatial frequency gratings was measured in 32 non-deficit and 12 deficit schizophrenia patients and 20 healthy controls subjects. Abnormal neurological signs were evaluated with the Neurological Evaluation Scale (NES). Compared with the controls, patients with schizophrenia displayed impaired visual contrast sensitivity, which was associated with sensory integration deficits, as measured with the NES. The deficit syndrome was predicted by negative symptoms and sensory integration deficits. These results suggest that early-stage perceptual dysfunctions, which may reflect the abnormality of precortical magnocellular visual pathways, are related to a specific group of abnormal neurological signs.     

Motor impairments, neurological signs, and developmental level in individuals with Angelman syndrome

The aim of this study was to examine the character of motor dysfunction in individuals with Angelman syndrome (AS). Thirty-three children and adolescents (median age 6 years, range 18 months to 23 years) were consecutively investigated for learning disability, epilepsy, and motor dysfunction to detect suspected AS. Twenty-three individuals (13 males, 10 females; median age 5 years 6 months, range 21 months to 23 years) fulfilled international consensus criteria for AS. Clinical diagnosis was supported by a positive DNA methylation test in eleven participants. Ten participants (seven males, three females; median age six years, range 18 months to 13 years) did not comply with consensus criteria for AS and were regarded as a comparison group. There was no significant difference between the AS and the comparison group regarding age or developmental level. Median developmental quotient level was 26 months (range 8 to 63 months); median gross motor developmental level in participants with AS was 24 months (range 8 to 60 months); median fine motor developmental level was 15 months (range 6 to 60 months). Muscle strength, spasticity, tremor, and coactivation were assessed: distal lower limb spasticity, ataxic like gait, stiff lower limbs, and the presence of coactivation during locomotion were significantly more frequent in participants with AS than in the comparison group (p<0.05). Asymmetry of muscle strength and spasticity were frequent. Neurological abnormalities were insufficient for a diagnosis of cerebral palsy and impeded function less than immaturity in both AS groups. Risk of increasing impairment needs to be anticipated to prevent negative long-term effects of muscle imbalance and motor asymmetries in individuals with AS.     

Computed tomography and neurological soft signs in obsessive-compulsive disorder

Computed tomography was used to compare the following three groups: obsessive-compulsive disorder (OCD) patients with high scores on a soft neurological sign examination, OCD patients with low soft neurological sign scores, and control subjects. Neuroanatomical structures were measured using quantitative volumetric analysis. OCD patients with high soft sign scores had significantly increased ventricular volumes compared with OCD patients with low soft sign scores and control subjects. Caudate and lenticular nucleus volumes did not differ between groups.     

Motor imitation abilities and neurological signs in autistic children

Autistic children were compared with chronological and mental agematched normal children on two tests of motor imitation and on the Herzig Battery for Non-Focal Neurological Signs. The results indicated that autistic children have significant handicaps in the neurodevelopmental area, with very poor performance on motor imitation tasks and a universal and significant excess of soft signs of neurological dysfunction. Such dyspraxias may underlie the failure of these chlidren to learn to use gesture.     

Steroid-induced improvement of neurological signs in ataxia-telangiectasia patients

A recent clinical observation reported on a dramatic improvement of neurological symptoms following short-term betamethasone administration in a child affected with ataxia-teleangiectasia (A-T). The aim of this study was to extend this observation to additional A-T patients followed at a single Immunodeficiency Center. Six consecutive patients (three males; mean age 16.3 years, range 5–30 years) were enrolled into this monocentric before–after trial. A cycle of oral betamethasone at the dosage of 0.1 mg/kg/day was administered for 10 days. The neurological evaluation was performed through the Scale for the Assessment and Rating of Ataxia. Overall, five of the six patients exhibited a clear amelioration of the neurological performances. Only in two patients, a slight amelioration persisted 7 days after the therapy withdrawal, whilst in the other patients the score reached approximately the pre-treatment value at the end of the therapy. Twenty-eight of the 46 evaluated neurological items (60%) improved during therapy. The speech disturbance, finger chase and nose–finger test showed the more significant improvement. The clinical amelioration was inversely correlated with the level of cerebellum atrophy, as revealed by the magnetic resonance. Our data indicate that neurological signs in A-T are susceptible of beneficial pharmacological intervention even years after the disease onset.     

Abnormal neurological signs at the onset of psychosis

INTRODUCTION: The objective of this investigation was to determine whether abnormal neurological signs (ANS) are present at the onset of psychosis, prior to the initiation of antipsychotic treatment, and to examine the effect of 6 weeks of antipsychotic treatment on these signs. METHODS: We examined 29 first-episode schizophrenic patients admitted at an Army Medical Center within 10 days of psychosis onset, using the Neurological Evaluation Scale and the 18-item Brief Psychiatric Rating Scale (BPRS) and compared them to controls. RESULTS: All of the subjects had neurological signs indicating problems in sensory integration, motor coordination, and sequencing of complex motor acts. No psychotic subject had fewer than two abnormal neurological signs. When compared to age and sex matched groups of normal controls and nonpsychotic psychiatric controls, the psychotic group had a significantly higher incidence of neurological signs. At baseline, the severity of neurological signs was associated with elevated BPRS total, positive, and negative symptom scores. The change in clinical symptoms was positively correlated with a change in neurological signs. DISCUSSION: These findings indicate that some neurological signs are present at the onset of psychosis, and that these signs may be altered by treatment. These abnormal neurological signs reflect an underlying brain function abnormality and may be useful in differential diagnosis, prognosis, and treatment selection.     

The child and adolescent psychiatry trials network (CAPTN): infrastructure development and lessons learned

Background  

In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field."     

Validation and factorial structure of a standardized neurological examination assessing neurological soft signs in schizophrenia

Although neurological soft signs (NSS) have been consistently reported in patients with schizophrenia, their clinical relevance, the actual impact of treatment or their evolution during the disease are not well clarified, possibly because of methodological limitations of the available tools. We have developed a new standardized examination integrating the assessment of 23 NSS selected from the literature and the rating of well-validated scales for assessment of extra-pyramidal symptoms. We examined 161 subjects (controls, n=48; patients with schizophrenia, n=95; or recurrent mood disorder, n=18). Half of the patients were neuroleptic-free. Schizophrenic patients had significantly higher total score (14. 6+/-8) than mood disorder patients (12.0+/-7) and controls (5.0+/-2). Internal consistency (Cronbach's alpha=0.85) and inter-rater reliability were good. Principal component analysis found five consistent factors ('motor coordination', 'motor integrative function', 'sensory integration', 'involuntary movements or posture', 'quality of lateralization'). This scale thus confirmed a factorial structure in agreement with the conceptual areas of interest explored by NSS and should be a useful tool for assessment of the different dimensions of neurological dysfunction in schizophrenia.     

Correlates between neurological soft signs and saccadic parameters in schizophrenia

Objective

Neurological Soft Signs (NSS) and impairments in oculomotor saccadic paradigms are both frequent in patients with schizophrenia but their correlation has never been explored.

Methods

78 patients with DSM-IV schizophrenia (including 43 non-treated) and 41 matched healthy controls were tested for NSS, and on three saccadic tasks: prosaccades, predictive saccades and memory-guided saccades) using infrared oculometry. We analyzed correlations between NSS scores and latencies in all three tasks, rate of errors in memory-guided saccades, and rate of anticipated predictive saccades.

Results

No correlations were found in healthy controls. In the patient group, the NSS total and motor coordination scores were positively correlated with three saccadic variables: the latency of prosaccades (r = 0.36, p < 0.01 and r = 0.36, p < 0.01 respectively), of memory-guided saccades (r = 0.35, p < 0.01 and r = 0.32, p < 0.05 respectively) and, negative correlations were found, with the rate of anticipated predictive saccades (r = − 0.33, p < 0.01; r = − 0.35, p < 0.01 respectively). NSS total, motor coordination and sensory integration scores were correlated to the latency of non-anticipated predictive saccades (r = 0.34, p < 0.01; r = 0.24, p < 0.05 and r = 0.40, p < 0.001 respectively). The NSS total, motor integration and sensory integration scores were correlated with the rate of errors in memory-guided saccades (r = 0.38, p < 0.01; r = 0.37, p < 0.01 and r = 0.34, p < 0.01 respectively).

Conclusions

These results support a common pathological mechanism with partial overlapping neural substrates between NSS and saccades in schizophrenia.