Does EEG Predict Response to Valproate Versus Lithium in Patients with Mania?

A number of factors may suggest that a patient with mania may respond to valproate or to lithium. However, prediction of which patients will respond to either medication remains difficult. In this study nonepileptiform EEG abnormalities in responders to each medication were investigated. Six of 20 patients (30%) responsive to lithium but not to valproate had nonepileptiform EEG abnormalities while 14 of 20 patients (70%) responsive to valproate but not to lithium had nonepileptiform EEG abnormalities. Patients presenting with mania and EEG abnormalities, particularly sharp activity, are statistically more likely (₂ = 4.9, df = 1, p = .027) to respond to valproate than to lithium. Whether such a finding will also hold true for other anticonvulsants used to treat mania remains to be seen.     

Exposure to Pro-smoking Media in College Students: Does Type of Media Channel Differentially Contribute to Smoking Risk?

Background

There are almost no data on whether the different channels through which pro-smoking media appear (i.e., point-of-sale advertising, movie smoking) differently influence smoking.

Purpose

This study used ecological momentary assessment to examine whether differences in smoking risk were observed for exposures to different pro-smoking media channels.

Methods

College students (n?=?134) carried smartphones for 21 days, recording their exposures to pro-smoking media and the media channels for that exposure and responding to three randomly issued control prompts per day. Participants answered questions about their future smoking risk after each pro-smoking media exposure and random prompt.

Results

Participants had elevated future smoking risk following exposure to pro-smoking media at point of sale (p?<?0.001); smoking risk at times of exposure to smoking in movies did not differ from risk measured during control prompts (p?=?0.78).

Conclusions

There is merit to examining the relative contribution of different pro-smoking media channels to smoking behavior.     

Does Sacral Neuromodulation Lead to Relevant Reduction in the Need for Intermittent Catheterization? A Single-Center Experience on Patients With Chronic Urinary Retention

Purpose: Sacral neuromodulation (SNM) is an approved method for second‐line treatment of different therapy refractory disorders of the urinary bladder. Alongside success in overactive bladder symptoms for detrusor overactivity, SNM also was shown to succeed in chronic urinary retention (UR) of various etiology. Methods: From October 2007 to December 2010, a cohort of 20 patients received two‐stage InterStim tined‐lead® (Medtronic Inc., Minneapolis, MN, USA) SNM therapy for UR. The number of electrodes implanted was decided by surgeons on the basis of patients' clinical presentation and extent of UR. Dependent on the treatment success, patients received either implantation of the implantable pulse generator (IPG) or the electrodes were removed. Median follow‐up time was 12 months (1–38 months). Results: All 20 patients, of whom 80% were female, suffered from idiopathic or neurogenic UR for a median 60 months (7–440 months) before SNM. Median patient age was 51 years (34–68 years). Eighteen (90%) of the stimulated patients showed significant success with implantation of IPG within a median of 43 days (15–93). In the follow‐up period, postvoid residual (PVR) urine of the permanent stimulated patients was reduced from a median of 350 mL to 135 mL. While this just did not reach statistical significance (p= 0.057), the median number of intermittent catheterizations (ICs) could be reduced relevantly from four to one per day (p= 0.021). The subgroup analysis of idiopathic and neurogenic UR showed relevant improvement of the vital parameters, but the number of patients was obviously too small to yield statistically significant results. Subgroup analysis according to the number of electrodes implanted revealed statistically significant reduction of IC only after unilateral SNM. PVR of ≤400 mL was a statistically significant predictor for success of SNM treatment. In the presented treatment period, only one mild adverse event occurred that could be handled conservatively. Conclusions: SNM can be a successful and secure second‐line therapy option for patients with chronic UR. Data suggest a more success‐promising situation for idiopathic cause of disease, but the number of patients was too small to reach statistical significance. Further prospective, randomized multicenter data concerning indications and number of electrodes are necessary and highly appreciated.     

Allergic Rhinitis and Chronic Daily Headaches: Is There a Link?

Allergic rhinitis and migraine remain on the list of the most common diseases affecting adults. Migraines and headaches due to allergic rhinitis are easily confused because the symptoms of both conditions often overlap. Both may occur with sinus headache, nasal congestion, and lacrimation and may worsen with weather changes and exposure to allergens. No precise clinical definition exists for what constitutes a sinus headache, which has always been a diagnostic dilemma. Contrary to popular belief, headache is not a typical symptom of rhinitis. Some studies have shown that up to 90 % of sinus headaches are actually migraines. Nevertheless, patients with self-diagnosed sinus headache self-treat or are treated by primary care physicians and/or otolaryngologists with medications for rhinosinusitis, ignoring the neurogenic causes of the symptoms when most of these patients fulfill diagnostic criteria for chronic migraine. Chronic migraine affects 2 % of the general population and has a significant socioeconomic impact on society, incurring health care costs and diminishing quality of life; therefore, the proper diagnosis and treatment of these headache patients should be a priority.     

Does Affective Theory of Mind Contribute to Proactive Aggression in Boys with Conduct Problems and Psychopathic Tendencies?

Adolescent psychopathic tendencies are associated with phenotypic increases in proactive aggression. However, the extent to which an understanding of others’ affective mental states, or affective theory of mind (ToM), contributes to proactive aggression remains unknown. We examined how performance on a well-known test of affective ToM, based on cropped images of the eye region, contributes to reactive and proactive types of aggression in a mixed ethnicity sample of 80 incarcerated adolescent boys. A hierarchical regression model showed that affective ToM predicted proactive aggression over and above the influence of clinically rated psychopathic tendencies. Importantly, affective ToM was unrelated to reactive aggression. Our results suggest that being able to recognize others’ affective mental states may be an important factor in aggressing against others for personal gain. These findings have implications for interventions designed to enhance ToM in youth with conduct problems.     

Can Latent Class Analysis Be Used to Improve the Diagnostic Process in Pediatric Patients with Chronic Ataxia?

Chronic ataxia is a relatively common symptom in children. There are numerous causes of chronic ataxia, making it difficult to derive a diagnosis in a timely manner. We hypothesized that the efficiency of the diagnostic process can be improved with systematic analysis of clinical features in pediatric patients with chronic ataxia. Our aim was to improve the efficiency of the diagnostic process in pediatric patients with chronic ataxia. A cohort of 184 patients, aged 0–16 years with chronic ataxia who received medical care at Winnipeg Children’s Hospital during 1991–2008, was ascertained retrospectively from several hospital databases. Clinical details were extracted from hospital charts. The data were compared among the more common diseases using univariate analysis to identify pertinent clinical features that could potentially improve the efficiency of the diagnostic process. Latent class analysis was then conducted to detect unique patterns of clinical features and to determine whether these patterns could be associated with chronic ataxia diagnoses. Two models each with three classes were chosen based on statistical criteria and clinical knowledge for best fit. Each class represented a specific pattern of presenting symptoms or other clinical features. The three classes corresponded to a plausible and shorter list of possible diagnoses. For example, developmental delay and hypotonia correlated best with Angelman syndrome. Specific patterns of presenting symptoms or other clinical features can potentially aid in the initial assessment and diagnosis of pediatric patients with chronic ataxia. This will likely improve the efficiency of the diagnostic process.     

Is Overparenting Associated with Adolescent/Young Adult Emotional Functioning and Clinical Outcomes Following Concussion?

Child Psychiatry & Human Development - Overparenting&nbsp;(O-P), or “helicopter” parenting, has warranted increased attention across the past decade. It is characterized as...     

Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence?

OBJECTIVE: To assess the relationships between shy-inhibited temperament in childhood and anxiety problems in early adolescence using a prospective, longitudinal data set from a large community sample. METHOD: Relationships between shyness ratings on age-appropriate temperament scales and anxiety problems were analyzed, looking both forward and backward in time from infancy to adolescence. RESULTS: Forty-two percent of children rated as shy on 6 or more occasions over 8 surveys in childhood had anxiety problems in adolescence, compared with 11% who were never shy. Persistence of shyness and its presence in middle childhood increased risk for anxiety. A highly reactive temperament added to shyness did not increase the risk for anxiety. Few children with an anxiety diagnosis in early adolescence had a history of shyness. CONCLUSIONS: Prediction from childhood shyness to adolescent anxiety disorder is modest but clinically meaningful in a community sample. However, most shy children did not develop an anxiety disorder and most adolescents with anxiety disorders had not been especially shy.     

Does Exposure to Stressors Predict Changes in Physiological Dysregulation?

Background

The allostatic load framework implies that cumulative exposure to stressors results in multi-system physiological dysregulation.

Purpose

The purpose of this study was to investigate the effect of stress burden on subsequent changes (2000–2006) in physiological dysregulation.

Methods

Data came from a population-based cohort study in Taiwan (n?=?521, aged 54+ in 2000, re-examined in 2006). Measures of stressful events and chronic strain were based on questions asked in 1996, 1999, and 2000. A measure of trauma was based on exposure to the 1999 earthquake. Dysregulation was based on 17 biomarkers (e.g., metabolic, inflammatory, neuroendocrine).

Results

There were some small effects among men: chronic strain was associated with subsequent increases in dysregulation (standardized β?=?0.08, 95 % CI?=?0.01 to 0.20), particularly inflammation; life events were also associated with increased inflammation (β?=?0.10, CI?=?0.01 to 0.26). There were no significant effects in women.

Conclusions

We found weak evidence that stress burden is associated with changes in dysregulation.     

What Factors Contribute to Headache-Related Disability in Teens?

BackgroundOur aim was to describe the relationship between risk factors, such as stress, depression, and anxiety, and potentially protective factors against pediatric headache-related disability, such as mindfulness, resilience, and self-compassion, and to determine teens' interest in mind-body skills training to help reduce headache-related disability.MethodsThis was a cross-sectional survey among adolescents seen in an academic neurology clinic reporting four or more headaches monthly using standardized instruments to determine the relationship between putative risk and protective factors as well as physiologic markers of inflammation and vagal tone and headache-related disability.ResultsAmong the 29 participants, 31% were male, the average age was 14.8 years, average headache frequency was 11.6 per month, and the most commonly reported trigger was stress (86%). The only risk or protective factor significantly associated with headache-related disability was depression (r = 0.52, P = 0.004). Depression was negatively correlated with mindfulness, resilience, and self-compassion (P < 0.01 each) and positively correlated with stress, sleep disturbance, and anxiety (P < 0.01 each). Biomarkers of vagal tone and inflammation were correlated with each other but not with headache-related disability or depression. There was strong interest in learning skills like slow, deep breathing practices supported by a smart phone application to reduce stress and the negative impact of headaches on daily life.DiscussionAmong teens with frequent migraine headaches, depression is the strongest risk factor for headache-related disability. Stress is viewed as a headache trigger, and teens reported wanting to learn simple stress management strategies supported by a smart phone application to help reduce headache-related disability.     

Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke?

Background: Although perturbation-based balance training (PBT) may be effective in improving reactive balance control and/or reducing fall risk in individuals with stroke, the characteristics of reactive balance responses that improve following PBT have not yet been identified. This study aimed to determine if reactive stepping characteristics and timing in response to support-surface perturbations improved to a greater extent following PBT, compared to traditional balance training. Materials and methods: This study represents a substudy of a multisite randomized controlled trial. Sixteen individuals with chronic stroke were randomly assigned to either perturbation-based or traditional balance training, and underwent 6-weeks of training as a part of the randomized controlled trial. Responses to support-surface perturbation were evaluated pre- and post-training, and 6-months post-training. Reactive stepping characteristics and timing were compared between sessions within each group, and between groups at post-training and 6-months post-training while controlling for each measure at the pre-training session. Results: The frequency of extra steps in response to perturbations decreased from pre-training to post-training for the PBT group, but not for the control group. Conclusions: Improvements in reactive balance control were identified after PBT in individuals with chronic stroke. Findings provide insight into the mechanism by which PBT improves reactive balance control poststroke, and support the use of PBT in balance rehabilitation programs poststroke.