Stability and change of cognitive attributes in children with uneven/delayed cognitive development from preschool through childhood

As part of an ongoing clinical service program for children with developmental delay in an Asian developing country, we analyzed the cognitive attributes of 362 Taiwanese children (average age 48.5 ± 12.9 month-old) with uneven/delayed cognitive development as they were assessed repeatedly with average duration of 39.7 ± 22.6 months from preschool through early childhood. The objectives were to determine the stability and related factors in cognitive scores of these 362 children belonging to three diagnostic subgroups: 181 children with non-autistic mental retardation (MR), 95 children with autism spectrum disorder (ASD) and 64 children with mixed type developmental language disorder (DLD); and to contribute to the accumulation of data on cognitive outcome in preschool children with developmental delay. Analysis revealed that mean initial cognitive score (IQ1) was 64.9 ± 16.9 while mean cognitive measure at follow-up (IQ2) was 72.2 ± 19.7. Whole group analysis showed the correlation between IQ1 and IQ2 was moderate (r = 0.73, p < 0.001). Analysis by a general linear model showed only male gender (β = 4.95, p = 0.02, C.I. = 0.8–9.1) and IQ1 (β = 0.79, p < 0.001, C.I. = 0.68–0.90) to be significant predictors of IQ2. There were differences among three groups in IQ1 (p < 0.001), IQ2 (p < 0.001) and IQ change (p < 0.001). Correlation coefficients of IQ1 and IQ2 were 0.6 for ASD group, 0.7 for MR group and 0.4 for DLD group respectively. The greatest proportion of children remained within the same cognitive range for both assessment points, however, it is noted that a substantial minority of children changed IQ ranges drastically from preschool through early childhood. Our results suggest that measurements of cognitive function at preschool age for children with developmental delay were valid in the context of a developing country, and the observed change in cognitive scores during follow-up emphasized the need to interpret the initial results of cognitive tests with caution.     

Idiopathic normal-pressure hydrocephalus,cerebrospinal fluid biomarkers,and the cerebrospinal fluid tap test

Cerebrospinal fluid (CSF) biomarkers, including soluble amyloid β-42 (Aβ-42) and phosphorylated-tau (P-tau), reflect core pathophysiological features of Alzheimer’s disease (AD). AD is frequently a concomitant pathology in older patients with idiopathic normal-pressure hydrocephalus (iNPH), and somewhat similar altered CSF dynamics exist in both AD and iNPH. We therefore investigated relationships between lumbar CSF biomarkers Aβ-42 and P-tau and clinical parameters in iNPH patients, along with differences in these biomarkers between CSF tap test (CSFTT) responders and non-responders. Thirty-one iNPH patients (14 CSFTT responders and 17 CSFTT non-responders) were included in the final analysis. We found lower CSF Aβ-42 correlated with poor cognitive performance (r = 0.687, p < 0.001 for Korean Mini Mental State Examination; r = 0.568, p = 0.001 for Frontal Assessment Battery; r = −0.439, p = 0.014 for iNPH grading scale [iNPHGS] cognitive score; r = −0.588, p = 0.001 for Clinical Dementia Rating Scale), and lower CSF P-tau correlated with gait dysfunction (r = −0.624, p < 0.001 for Timed Up and Go Test; r = −0.652, p < 0.001 for 10 meter walking test; r = −0.578, p = 0.001 for Gait Status Scale; r = −0.543, p = 0.002 for iNPHGS gait score). In subgroup analysis, CSF P-tau/Aβ-42 ratios were significantly higher in CSFTT non-responders compared to responders (p = 0.027). Two conjectures are suggested. One, CSF biomarkers may play different and characteristic roles in relation to different iNPH symptoms such as cognition and gait. Two, comorbid AD pathology in iNPH patients may affect the response to the CSFTT. Larger studies using combinations of other biomarkers associated with AD would be necessary to evaluate these hypotheses.     

A longitudinal study of neurocognitive function in individuals at-risk for psychosis

IntroductionClinically defined prodromal diagnostic criteria identify at-risk individuals with a 35–40% likelihood of developing a psychotic disorder within a year. The time course and predictive value of cognitive deficits in the development of psychosis has not been established.MethodsA comprehensive neurocognitive battery and clinical assessments were administered to 37 subjects meeting Criteria of Prodromal States (COPS) criteria for being at risk for psychosis, and two comparison groups: 59 first episode and 47 healthy subjects. Subjects were also evaluated at 6-month and 1-year follow-up periods. Primary analyses used a neurocognitive composite score derived from individual neurocognitive measures, including measures of vigilance, verbal memory, working memory, and processing speed.ResultsAt-risk subjects performed more poorly than healthy subjects (t = 2.93, P = 0.01), but better than first episode subjects (t = 4.72, p < 0.0001). At-risk subjects were particularly impaired on measures of vigilance and processing speed. Cognitive composite scores were significantly lower in at-risk subjects who progressed to psychosis (N = 11; z = − 1.2), while those at-risk subjects who did not progress to psychosis (N = 17) performed better (z = − 0.5), and not significantly different from controls. Poor CPT performance combined with better WAIS-R digit symbol performance predicted progression to psychosis. Severity of neurocognitive deficits was not related to duration of prodrome or to time to development of psychosis and neurocognitive function improved in all subjects except those who progressed to psychosis.ConclusionNeurocognitive impairment emerges early in the course of psychotic illness. Performance on tests of neurocognition may prove to be an early risk predictor for subsequent development of psychotic disorders.     

Assessment of COVID-19 trauma responses. Who has been more traumatized during the pandemic?

Background and ObjectiveTo evaluate the effect of cognitive and sociodemographic characteristics of healthcare and non-healthcare workers on their traumatic responses to the COVID-19 pandemic.MethodsData were collected using an online survey between August-September 2020. The survey included the following scales: Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), and Impact of Event Scale-Revised (IES-R). Traumatic responses were categorized into three types: avoidance (IES-R_A), intrusion (IES-R_I), and hyperarousal (IES-R_H).ResultsThe study included a total of 672 participants, comprised of 399 (59.4%) men, and 273 (40.6%) women with a mean age of 39.25 ± 933 years. The results indicated that women had higher IES-R_I (r = .5.78, p < 0.001), IES-R_A (r = 4.47, p < 0.001), and IES-R_H (r = .5.20, p < 0.001) scores compared to men. Patients with a history of psychiatric diseases had significantly higher IES-R_I (r = ?3.82, p < 0.001), IES-R_A (r = ?2.00, p < 0.05), and IES-R_H (r = ?4.06, p < 0.001) scores compared to patients with no history of psychiatric diseases. Non-healthcare workers had significantly higher IES-R_A (r = ?2.69, p < 0.01) scores compared to healthcare workers.ConclusionFemale gender and a positive history of psychiatric diseases were found to lead to an increase in the frequency of all three traumatic responses to COVID-19. Contrary to expectation, being a healthcare worker was not found as a factor facilitating trauma response formation in our study.     

The neurocognitive consequences of sleep restriction: A meta-analytic review

The current meta-analytic review evaluated the effects of experimentally manipulated sleep restriction on neurocognitive functioning. Random-effects models were employed to estimate the overall effect size and the differential effect size across cognitive domains. Age, time of day, age-adjusted sleep deficit, cumulative days of restricted sleep, sleep latency, subjective sleepiness, and biological sex were examined as potential moderators of the effect. Based on a sample of 61 studies, from 71 different populations, findings revealed a significant negative effect of sleep restriction on cognitive processing across cognitive domains (g = −0.383, p < 0.001). This effect held for executive functioning (g = −0.324, p < 0.001), sustained attention (g = −0.409, p < 0.001), and long-term memory (g = −0.192, p = 0.002). There was insufficient evidence to detect an effect within the domains of attention, multitask, impulsive decision-making or intelligence. Age group, time of day, cumulative days of restricted sleep, sleep latency, subjective sleepiness, and biological sex were all significant moderators of the overall effect. In conclusion, the current meta-analysis is the first comprehensive review to provide evidence that short-term sleep restriction significantly impairs waking neurocognitive functioning.     

Infectious diseases,IL6 −174G > C polymorphism,and human development

Interleukin-6 (IL6) is a pro-inflammatory cytokine that is required for resistance against many pathogens. However, sustained IL6 activity can cause tissue damage in the periphery and brain. Previous studies have shown that populations in disease-endemic regions adapt by selecting the high-producing G-allele at the −174G > C (rs1800795) polymorphism, while others have linked increased IL6 to cognitive impairments. The present study sought to determine whether up-regulation of IL6 by the G-allele at rs1800795 polymorphism in disease-endemic regions was associated with increased cognitive deficits and corollary reductions in social, economic, and political development.We tested these hypotheses in a global sample of 189 nations with World Health Organization ratings for infectious diseases. We also included the Historical Pathogen Prevalence index, a measure of national average intelligence (IQ), and the United Nation Human Development Index (HDI) including per capita income, life expectancy, child mortality, and fertility rate. IL6 −174G > C allele frequencies were obtained from 171,168 individuals spanning 84 nations.The high-producing G-allele frequency was positively correlated with infectious disease ranking (r = 0.745, P < 0.001) and negatively with IQ (r = −0.524, P < 0.001) and HDI (r = −0.671, P < 0.001). These robust findings suggest that in regions with a high pathogen burden the need for a strong IL6 response is accompanied by cognitive deficits and reduced HDI ranking.     

The executive profile of children with Benign Epilepsy of Childhood with Centrotemporal Spikes and Temporal Lobe Epilepsy

RationaleBenign Epilepsy of Childhood with Centrotemporal Spikes (BECTS) and temporal lobe epilepsy (TLE) represent two distinct models of focal epilepsy of childhood. In both, there is evidence of executive dysfunction. The purpose of the present study was to identify particular deficits in the executive function that would distinguish children with BECTS from children with TLE.MethodsWe prospectively evaluated 19 consecutive children and adolescents with TLE with hippocampal sclerosis (HS) (57.9% male; mean 11.74 years [SD 2.05]; mean IQ 95.21 [SD 15.09]), 19 with BECTS (36.8% male; mean 10.95 years [SD 2.33]; mean IQ 107.40 [SD 16.01]), and 21 age and gender-matched controls (33.3% male; mean 11.86 years [SD 2.25]; mean IQ 108.67 [15.05]). All participants underwent a neuropsychological assessment with a comprehensive battery for executive and attentional functions. We used ANOVA and chi-square to evaluate differences on demographic aspects among groups (BECTS, TLE-HS, and control groups). Group comparisons on continuous variables were complemented by MANOVA and Bonferroni posthoc comparisons.ResultsPatients with BECTS had worse performance than controls in: Matching Familiar Figures Test, time (p = 0.001); Matching Familiar Figures Test, time × errors index (p < 0.001); Verbal Fluency for foods (p = 0.038); Trail Making Test, part B time (p = 0.030); Trail Making Test, part B number of errors (p = 0.030); and WCST, number of categories achieved (p = 0.043). Patients with BECTS had worse performance than patients with TLE-HS on Matching Familiar Figures Test, time (p = 0.004), and Matching Familiar Figures Test, time × errors index (p < 0.001). Patients with TLE-HS had worse performance than controls on the following tests: Verbal Fluency for foods (p = 0.004); Wisconsin Card Sorting Test, the number of categories achieved (p < 0.001); and Wisconsin Card Sorting Test, the number of perseverative errors (p = 0.028). Patients with TLE-HS had worse performance than patients with BECTS on Digit Backward (p = 0.002); and the Wisconsin Card Sorting Test, the number of perseverative errors (p < 0.001).ConclusionsPatients with TLE and BECTS present distinct cognitive profiles. Patients with TLE-HS had worse performance in mental flexibility, concept formation, and working memory compared to BECTS. Patients with BECTS had worse inhibitory control compared to children with TLE-HS. Both TLE-HS and BECTS had a higher number of errors on an inhibitory control test. However, patients with BECTS had a slower mental processing even when compared to patients with TLE-HS. Rehabilitation programs for children with epilepsy must include children with benign epilepsies and must take into account the epileptic syndrome and its particular neurocognitive phenotype.     

Impaired theory of mind and symptoms of Autism Spectrum Disorder in children with Prader–Willi syndrome

In order to evaluate the social cognitive functioning in children with Prader–Willi syndrome (PWS), Theory of Mind (ToM) and symptoms of Autism Spectrum Disorder were evaluated. Sixty-six children with PWS aged 7–17 years were tested using the Theory of Mind test-R and the Diagnostic Interview for Social Communication disorders. We tested the correlation between Total ToM Standard Deviation Score (Total ToM SDS) and genetic subtype of paternal deletion or maternal uniparental disomy, and total IQ, verbal IQ and performal IQ. Prevalence and symptoms of Autism Spectrum Disorder were assessed. Median (interquartile range) of total ToM SDS of those aged 7–17 years was ?3.84 (?5.73, ?1.57). Their Total ToM SDS correlated with total IQ (β = 0.662, p < 0.001, adj.R² = 0.407), in particular with verbal IQ (β = 0.502, p = 0.001, adj.R² = 0.409), but not with performal IQ (β = 0.241, p > 0.05, adj.R² = 0.259). No difference in Total ToM SDS was found between children with deletion and maternal uniparental disomy (β = ?0.143, p > 0.05, adj.R² = ?0.016). Compared to the reference group of healthy children aged 7–12 years, children with PWS in the same age group had a median ToM developmental delay of 4 (3–5) years. One third of children with PWS scored positive for Autism Spectrum Disorder. Most prominent aberrations in Autism Spectrum Disorder were focused on maladaptive behavior. Our findings demonstrate a markedly reduced level of social cognitive functioning, which has consequences for the approach of children with PWS, i.e. adjustment to the child's level of social cognitive functioning.     

Mastery motivation in adolescents with cerebral palsy

The aim of this study is to describe motivation in adolescents with cerebral palsy (CP) and factors associated with motivation level. The Dimensions of Mastery Questionnaire (DMQ) measures motivation in mastering challenging tasks and expressive elements. It was completed by 153 parents and 112 adolescents with CP. Adolescents (GMFCS in n = 146 – I:50, II:43, III:13, IV:15, V:25) were assessed using the Leiter IQ and Gross Motor Function Measure. Parents completed the Vineland Adaptive Behavior Scale and the Strengths and Difficulties Questionnaire. Motivation scores were highest for mastery pleasure and social persistence with adults and lowest for gross motor and object-oriented persistence. Socio-demographic factors were not strongly correlated with DMQ. Higher gross motor ability (r = 0.24–0.52) and fewer activity limitations (r = 0.30–0.64, p < .001) were associated with persistence in cognitive, motor and social tasks, but not mastery pleasure. Higher IQ was associated with persistence in object-oriented tasks (r = 0.42, p < .001). Prosocial behaviors correlated with high motivation (r = 0.39–0.53, p < .001). Adolescents’ motivation scores were higher than parents’ scores. Adolescents with CP express high mastery pleasure, not related to abilities. High motivation was associated with fewer activity limitations and prosocial behaviors and aspects of family environment. Findings elucidate those at-risk for low motivation, which can influence treatment adherence and participation in challenging but meaningful activities.     

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

ObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.     

Neurocognitive disturbances associated with acute infectious mononucleosis,Ross River fever and Q fever: A preliminary investigation of inflammatory and genetic correlates

Disturbances in neurocognitive performance are a core feature of the acute sickness response to infection; however the underlying mechanisms remain unclear. The current study used a computerised battery to assess neurocognitive functioning in subjects enrolled in the Dubbo Infection Outcomes Study (n = 107) – a prospective cohort of subjects followed from documented acute infection with Epstein Barr virus, Ross River virus, or Coxiella burnetii until recovery. Subjects were assessed when ill, and a subset again after complete recovery. Associations between sickness-related cognitive disturbances and single nucleotide polymorphisms (SNPs) in cytokine (interleukin [IL]-6, IL-10, tumor necrosis factor-α and interferon-γ) and neurobehavioral genes (serotonin transporter and catechol-O-methyltransferase) were explored.During acute infection, subjects exhibited slower matching-to-sample responses (p = 0.03), poorer working memory capacity (p = 0.014), mental planning (p = 0.045), and dual attention task performance (p = 0.02), and required longer to complete discordant Stroop trials (p = 0.01) compared to recovery. Objective impairments correlated significantly with self-reported symptoms (p < 0.05) as well as levels of the inflammation marker, C-reactive protein (p = 0.001). Linear regression analysis identified an association between neurocognitive disturbance during acute illness and functional polymorphisms in inflammatory cytokine genes. Specifically, the high cytokine producing G allele of the IL-6-174G/C SNP was associated with poorer neurocognitive performance when subjects were ill (p = 0.027).These findings confirm that acute infection impacts on neurocognitive performance, manifesting as slowed responses and impaired performance on complex tasks requiring higher-order functioning which has important real-world implications. The data provide the first preliminary evidence for a role of a genetic predisposition to more intense inflammatory responses in objective neurocognitive disturbances during acute infections. These associations require replication in a larger sample size.     

Predictors of intellectual functioning after epilepsy surgery in childhood: The role of socioeconomic status

ObjectiveThe objective of this study was to evaluate the association between socioeconomic status and intellectual functioning in children with medically refractory epilepsy, before and after resective epilepsy surgery. Family environment is a strong contributor to cognitive development in children and has been recently shown to play a significant role in intellectual outcome after surgery in children with epilepsy.MethodsOne hundred children who had undergone resective epilepsy surgery and completed preoperative and postoperative assessments of IQ as part of clinical care were included in the study. We evaluated the impact of epilepsy-related variables, income quintile, and residence location on IQ.ResultsGreater improvements in IQ after surgery were associated with an older age at surgery (β = .235, p = .018). Higher IQ scores at follow-up were associated with an older age of seizure onset (β = .371, p < .001), older age at surgery (β = .356, p < .001), unilobar epileptogenic focus (β = .394, p < .001), and mesial temporal sclerosis (β = .338, p = .001) or tumor (β = .457, p < .001) in comparison with malformation of cortical development; age at seizure onset did not remain as a significant predictor in multivariable regression analysis. Income quintile, residence location, seizure control, and antiepileptic medication use were not significant predictors.ConclusionsEpilepsy-related variables were the strongest predictors of IQ and postoperative change in IQ. We were unable to identify a significant association between IQ and socioeconomic status. Future research should evaluate the impact of multiple aspects of family environment.     

Muscle ultrasound measurements and functional muscle parameters in non-dystrophic myotonias suggest structural muscle changes

Patients with non-dystrophic myotonias, including chloride (myotonia congenita) and sodium channelopathies (paramyotonia congenita/potassium aggravated myotonias), may show muscular hypertrophy in combination with some histopathological abnormalities. However, the extent of muscle changes has never been assessed objectively in a large group genetically confirmed patients. This study quantitatively determines echo intensities, thicknesses, ranges-of-motion and force of four skeletal muscles in 63 genetically confirmed patients. The main findings revealed elevated echo intensities in all muscles except the rectus femoris (+1.3–2.2 SD, p < 0.0001), and hypertrophy in the arms (+0.5–0.9 SD, p < 0.01). Muscle echo intensities were inversely correlated to the corresponding ranges-of-motion (biceps brachii: r = ?0.43; p < 0.001, forearm flexors: r = ?0.47; p < 0.001, rectus femoris: r = ?0.40; p = 0.001, and tibial anterior: r = ?0.27; p = 0.04) and correlated positively to age (r = 0.22; p = 0.05). The echo intensity of the forearm flexors was inversely correlated to their muscles’ force (r = ?0.30; p = 0.02). Together, these data suggest that non-dystrophic myotonias may lead to structural muscle changes.     

Assessment of physical fitness and exercise tolerance in children with developmental coordination disorder

Children with developmental coordination disorder (DCD) have been shown to be less physically fit when compared to their typically developing peers. The purpose of the present study was to examine the relationships among body composition, physical fitness and exercise tolerance in children with and without DCD. Thirty-seven children between the ages of 7 and 9 years participated in this study. Participants were classified according to results obtained on the Movement Assessment Battery for Children (MABC) and were divided in 2 groups: 19 children with DCD and 18 children without DCD. All children performed the following physical fitness tests: The five-jump test (5JT), the triple-hop distance (THD) and the modified agility test (MAT). Walking distance was assessed using the 6-min walking test (6MWT). Children with DCD showed higher scores than children without DCD in all MABC subscale scores, as well as in the total score (p < 0.001). Participants with DCD were found to perform significantly worse on the MAT (p < 0.001), the THD (p < 0.001) and 5JT (p < 0.05). Moreover, children with DCD had poorer performance on the 6MWT than children without DCD (p < 0.01). Our results found significant correlations among body mass index (BMI), THD (r = 0.553, p < 0.05), 5JT (r = 0.480, p < 0.05) and 6MWT (r = 0.544, p < 0.05) only in DCD group. A significant correlation between MAT and 5JT (r = −0.493, p < 0.05) was found. Similarly, THD and 5JT (r = 0.611, p < 0.01) was found to be correlated in children with DCD. We also found relationships among 6MWT and MAT (r = −0.522, p < 0.05) and the 6MWT and 5JT (r = 0.472, p < 0.05) in DCD group. In addition, we found gender specific patterns in the relationship between exercise tolerance, explosive strength, power, DCD, and BMI. In conclusion, the present study revealed that BMI was indicative of poorer explosive strength, power and exercise tolerance in children with DCD compared to children without DCD probably due to a limited coordination on motor control.     

The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.     

Lifetime presence of psychotic symptoms in bipolar disorder is associated with less favorable socio-demographic and certain clinical features

BackgroundThe presence of psychotic symptoms in bipolar disorder (BD) is considered a feature of higher severity of illness and, in particular, of manic episodes in bipolar I disorder (BD I). However, the possibility to apply the “with psychotic features” specifier to major depressive episodes in either bipolar II disorder (BD II) or BD I highlights the need for additional research in this area.MethodsThe present study assessed the lifetime presence of psychotic symptoms and related socio-demographic and clinical features in a large sample of BD patients (N = 360), with (BDPs, N = 207) and without a lifetime history of psychosis (BDNPs, N = 153).ResultsAn overall less favorable socio-demographic profile was observed in BDPs vs BDNPs. In terms of clinical variables, BDPs vs BDNPs had: earlier age at onset (27.7 ± 10.5 vs 30.1 ± 12.3 years; p = 0.02), higher rates of BD I diagnosis (95.7% vs 45.8%; p < 0.001), more elevated (manic/hypomanic/mixed) polarity of first (55.2% vs 24.4%; p < 0.001) and most recent episode (69.8% vs 35.6%; p < 0.001), more comorbid alcohol/substance use disorder (38.1% vs 21.9%; p = 0.002), more lifetime hospitalizations (3.8 ± 6.1 vs 2 ± 3; p = 0.002) and involuntary commitments (1 ± 1.9 vs 0.1 ± 0.4; p < 0.001), more history of psychosocial rehabilitation (17.9% vs 5.7%; p = 0.001), more current antipsychotic use (90.1% vs 70.9%; p < 0.001), and lower GAF (62.3 ± 14.2 vs 69.3 ± 12.5; p < 0.001), but shorter duration of most recent episode (34.1 ± 45.4 vs 50.3 ± 65.7 days; p = 0.04), lower rates of comorbid anxiety disorders (23.9% vs 38.2%; p = 0.005), and antidepressant use (19.4% vs 56.6%; p < 0.001).ConclusionsThe present findings indicate an overall worse profile of socio-demographic and certain clinical characteristics associated with the lifetime presence of psychotic symptoms in bipolar patients.     

The correlation between central and peripheral oxytocin concentrations: A systematic review and meta-analysis

There is growing interest in the role of the oxytocin system in social cognition and behavior. Peripheral oxytocin concentrations are regularly used to approximate central concentrations in psychiatric research, however, the validity of this approach is unclear. Here we conducted a pre-registered systematic search and meta-analysis of correlations between central and peripheral oxytocin concentrations. A search of databases yielded 17 eligible studies, resulting in a total sample size of 516 participants and subjects. Overall, a positive association between central and peripheral oxytocin concentrations was revealed [r = 0.29, 95% CI (0.14, 0.42), p < 0.0001]. This association was moderated by experimental context [Q_b(4), p = 0.003]. While no association was observed under basal conditions (r = 0.08, p = 0.31), significant associations were observed after intranasal oxytocin administration (r = 0.66, p < 0.0001), and after experimentally induced stress (r = 0.49, p = 0.001). These results indicate a coordination of central and peripheral oxytocin release after stress and after intranasal administration. Although popular, the approach of using peripheral oxytocin levels to approximate central levels under basal conditions is not supported by the present results.     

Perfusion CT investigation of chronic internal carotid artery occlusion: comparison with SPECT

This study investigated the usefulness of perfusion computed tomography (CT) for the evaluation of patients with chronic internal carotid artery (ICA) occlusion by comparing the findings with those of iodine-123 iodoamphetamine ([¹²³I]IMP) single photon emission computed tomography (SPECT). Twenty five patients with chronic ICA occlusion were investigated on the same day by perfusion CT to measure the cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transient time (MTT), and [¹²³I]IMP SPECT to measure the regional CBF, significant correlations were observed between regional CBF measured by SPECT and CBF measured by perfusion CT (r = 0.659, R² = 0.434, p < 0.001), regional CBF and CBV (r = −0.406, R² = 0.165, p < 0.001) and regional CBF and MTT (r = −0.592, R² = 0.350, p < 0.001). Significant correlations were also observed between CBF and CBV (r = −0.153, R² = 0.023, p < 0.001), CBF and MTT (r = −0.580, R² = 0.337, p < 0.001) and MTT and CBV (r = 0.763, R² = 0.582, p < 0.001). Perfusion CT is useful to evaluate the hemodynamic state of patients with chronic major cerebral artery occlusive disorders.     

The validity of self-rated psychotic symptoms in depressed inpatients

BackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P < 0.001) and with the BDI total score (0.64, P < 0.001). Moderate correlations were found for the MADRS (0.34, P < 0.001), HAMD (0.37, P < 0.001) and AMDP depression score (0.33, P < 0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P < 0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P < 0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.