Steroid-responsive Hashimoto encephalopathy mimicking Creutzfeldt�CJakob disease

Hashimoto??s encephalopathy (HE) is a rare neurological disorder with a heterogeneous group of neurological symptoms associated with high titres of anti-thyroid antibodies. Clinical manifestations may include encephalopathic features such as seizures, behavioural and psychiatric manifestations, movement disorders and coma. The objective of this presentation is to describe a patient with this rare and controversial clinical syndrome mimicking Creutzfeldt?CJakob disease, associated with a Hashimoto euthyroid thyroiditis and with a significant response to high dose intravenous prednisone. The responsiveness of this syndrome to steroids suggests that this disorder involves immune pathogenic mechanisms, as previous reviews reported.     

Soziometrie in Schulen �C 2011 noch aktuell?

Three examples of conflict-like situations in various pedagogical environments illustrate different possibilities for the application of sociometrical methods at schools. Not only the sociometrical test, the sociogram and the social atom, but also the perception test are useful techniques to give a deep insight into the deep structure, the issues and the conflicts a group is concerned with. Children and adolescents prefer these creative techniques to ??just talking??. After a continuous use of these methods a sociometrical way of thinking and acting can be slowly established at schools. The dynamics of the cooperation between teachers and psychodramatists and especially the group dynamics and the interaction among school teams and teachers/teacher teams is often ignored. But it is group dynamics which plays a vital role for the establishment and the positive development of a group.     

Redox Mechanism of Neurotoxicity by a Serotonin�CAcrolein Polymeric Melanoid

Postoperative cognitive dysfunction may be associated with the toxic products of lipid peroxidation, such as the ??,??-unsaturated aldehyde acrolein, which accumulates in aging. We previously identified an acrolein-mediated, serotonin-derived melanoid product, or SDM. This study further characterizes this putative novel neuromelanin, which is not made from catecholamines. In addition to its strong protein-binding properties, we observed that SDM binds Fe²⁺ readily and exhibits complex redox characteristics. SDM may exist as a two-dimensional network of polymers that coalesce into larger entities exhibiting electroactive properties. These observations suggest that SDM may contribute to the decline in cognition due to focal degeneration from SDM-mediated free-radical production. We know that inhalational anesthetics sequester acrolein, which is toxic to neurons, and we propose that the local increase in acrolein depletes serotonin levels and enhances neuronal vulnerability through the production of neuromelanin-like structures, such as SDM.     

PSP-Skala �C Deutsche Version der Personal and Social Performance Scale

In the treatment of schizophrenia, the domain of psychosocial functioning is an important aspect of therapeutic success that should be considered in addition to the reduction of psychopathology. Valid and standardised measures are necessary for diagnostics and the assessment of patients" personal, social and professional functioning. The German version of the Personal and Social Performance (PSP) Scale (with its four subdimensions: "socially useful activities, work and study included", "personal and social relationships", "self-care" and "disturbing and aggressive behaviour") was administered to patients with schizophrenia in previous studies. These data demonstrated this scale to be a reliable, valid and efficient tool for measuring psychosocial functioning in schizophrenia. Thus, it is argued that, for everyday clinical practice, the PSP Scale is useful for the assessment of psychosocial functioning in schizophrenia during short, medium and long-term treatment courses.     

Cognitive and functional outcome in spina bifida�CChiari II malformation

Purpose  

The long-term outcome in spina bifida–Chiari II–hydrocephalus complex is poorly understood. Traditional neurosurgical outcome measures are crude. Neuropsychological testing is increasingly important in outcome assessment. We investigated the health, disability, lifestyle and cognitive function in adults who had myelomeningocoele closure at birth.     

Prader�CWilli syndrome and autism spectrum disorders: an evolving story

Prader-Willi syndrome (PWS) is well-known for its genetic and phenotypic complexities. Caused by a lack of paternally derived imprinted material on chromosome 15q11-q13, individuals with PWS have mild to moderate intellectual disabilities, repetitive and compulsive behaviors, skin picking, tantrums, irritability, hyperphagia, and increased risks of obesity. Many individuals also have co-occurring autism spectrum disorders (ASDs), psychosis, and mood disorders. Although the PWS 15q11-q13 region confers risks for autism, relatively few studies have assessed autism symptoms in PWS or directly compared social, behavioral, and cognitive functioning across groups with autism or PWS. This article identifies areas of phenotypic overlap and difference between PWS and ASD in core autism symptoms and in such comorbidities as psychiatric disorders, and dysregulated sleep and eating. Though future studies are needed, PWS provides a promising alternative lens into specific symptoms and comorbidities of autism.     

Cerebellar Long-term Depression is Deficient in Niemann�CPick Type C Disease Mice

Niemann–Pick type C disease (NPC) is an autosomal recessive lipidosis characterized by progressive neurodegeneration. Although several studies have revealed unusual accumulation of unesterfied cholesterol in astrocytic lysosome of NPC, pathophysiological basis of cerebellar neuronal dysfunction remains unclear. We compared parallel fiber-Purkinje cell synaptic transmission and long-term depression (LTD) in +/+npc ^nih (npc ^+/+) and −/−npc ^nih (npc ^−/−) mice. Our data showed that adenosine A1 receptor agonists decreased parallel fiber excitatory postsynaptic current (EPSC) amplitude and mEPSC frequency while its antagonists increased EPSC amplitude and mEPSC frequency in wild type and mutant mice. Furthermore, parallel fiber LTD was deficient in npc ^−/− mice and supplement of adenosine triphosphate (ATP) rescued the impaired LTD. Taken together, these experiments suggest that synaptic strength and LTD are altered in npc ^−/− mice due to the decrease of ATP/adenosine release and deactivation of A1 receptors in parallel fiber terminals. The enhanced synaptic transmission and the decreased LTD might result in progressive neurotoxicity of Purkinje cells in npc ^−/− mice.     

Two-photon fluorescence microscopy study of cerebrovascular dynamics in ultrasound-induced blood�Cbrain barrier opening

Blood–brain barrier (BBB) disruption can be achieved with ultrasound (US) and circulating microbubble (MB) contrast agent. Using dorsal US sonication and Definity, an MB contrast agent, responses of the cortical cerebral vasculature to BBB opening were observed with varying acoustic peak negative pressure (0.071 to 0.25 MPa) under two-photon microscope. Wistar rats with a craniotomy were sonicated with a single piezoelectric transducer following the intravenous injection of Texas Red for visualization of vasculature and leakage from BBB opening. Based on time-dependent intensity change in the extravascular area, the leakage was classified into three types: fast, sustained, and slow. Fast leakage was characterized by a rapid increase to peak intensity during sonication, but a decrease afterwards, occurring at all pressures and vessels sizes analyzed in our study. Sustained leakage was indicated by a similar, immediate increase to peak intensity but one that remained elevated for the duration of imaging, occurring at low-to-intermediate pressures. Slow leakage began 5 to 15 minutes after sonication, dominating at low pressures, and was more prevalent among smaller vessels than fast and sustained leakage. Our study showed the possibility of controlling leakage type and vessel size in US-induced BBB opening through varying acoustic pressure.     

Maternal common mental disorders and malnutrition in children: a case�Ccontrol study

Background

Despite improvements in the nutritional status of Brazilian children, child malnutrition remains a public health issue. The objective of the present study was to analyse the effect of maternal common mental disorders (MCMD) on child malnutrition in a large Brazilian urban centre with low rates of child malnutrition. Furthermore, we explored the hypothesis that a reduction in the quality of maternal caregiving mediates the relationship between maternal mental health problems and child nutrition.

Methods

A case?Ccontrol study including 294 children aged between 0 and 5?years, with 147 cases and 147 age- and sex-matched controls, was conducted in the city of Salvador, northeastern Brazil. Mothers completed the Self-Report Questionnaire (SRQ-20), the family??s socio-economic status was evaluated and the Home Observation for Measurement of the Environment (HOME) Inventory was applied. Children were diagnosed as moderately or severely malnourished when the weight-for-height z-score was below ?C2?SD. Conditional logistic regression was used in the analysis, and the final model was created using the backward technique.

Results

MCMD doubled the risk of moderate or severe malnutrition in children (OR?=?2.04; 95% CI: 1.10?C3.78). Maternal caregiving can be an important factor mediating the relationship between maternal mental health and child malnutrition.

Conclusion

MCMD must be taken into account in programmes for the treatment and prevention of malnutrition, especially in areas of low malnutrition prevalence.     

Determination of the brain�Cblood partition coefficient for water in mice using MRI

Cerebral blood flow (CBF) quantification is a valuable tool in stroke research. Mice are of special interest because of the potential of genetic engineering. Magnetic resonance imaging (MRI) provides repetitive, noninvasive CBF quantification. Many MRI techniques require the knowledge of the brain–blood partition coefficient (BBPC) for water. Adopting an MRI protocol described by Roberts et al (1996) in humans, we determined the BBPC for water in 129S6/SvEv mice from proton density measurements of brain and blood, calibrated with deuterium oxide/water phantoms. The average BBPC for water was 0.89±0.03 mL/g, with little regional variation within the mouse brain.     

Chlamydia pneumoniae seropositivity in adults with acute ischemic stroke: A case�Ccontrol study

Background:

Causative role of Chlamydia pneumoniae infection in patients with acute ischemic stroke (AIS) remains unresolved till date.

Aim:

To investigate the role of C. pneumoniae antibodies in AIS.

Materials and Methods:

Patients with AIS and sex- and environment-matched controls were enrolled. Antibodies to C. pneumoniae (IgA, IgG and IgM) were measured using enzyme-linked immunosorbent assay (ELISA).

Results:

A total of 51 patients and 48 controls were enrolled. The IgA seropositivity was significantly associated with AIS (unadjusted odds ratio 3.1; 95% CI 1.38, 6.96; P = 0.005), whereas IgG (unadjusted OR 0.44; 95% CI 0.18, 1.09; P = 0.07) and IgM (unadjusted OR 1.1; 95% CI 0.36, 3.3; P = 0.88) were not. There was no difference in IgA or IgG positivity in different stroke subtypes. On multivariate analysis after adjusting for sex, hypertension, diabetes mellitus, smoking and alcohol, the IgA seropositivity yielded an adjusted OR for stroke (4.72; 95% CI 1.61, 13.83; P = 0.005), while IgG seropositivity did not (OR 0.25; 95% CI 0.08, 0.83; P = 0.23).

Conclusions:

An increased risk of AIS was demonstrated in patients seropositive for C. pneumoniae for IgA antibodies.     

A novel seven-octapeptide repeat insertion in the prion protein gene (PRNP) in a Dutch pedigree with Gerstmann�CStr?ussler�CScheinker disease phenotype: comparison with similar cases from the literature

Human prion diseases can be sporadic, inherited or acquired by infection and show considerable phenotypic heterogeneity. We describe the clinical, histopathological and pathological prion protein (PrP^Sc) characteristics of a Dutch family with a novel 7-octapeptide repeat insertion (7-OPRI) in PRNP, the gene encoding the prion protein (PrP). Clinical features were available in four, neuropathological features in three and biochemical characteristics in two members of this family. The clinical phenotype was characterized by slowly progressive cognitive decline, personality change, lethargy, depression with anxiety and panic attacks, apraxia and a hypokinetic-rigid syndrome. Neuropathological findings consisted of numerous multi- and unicentric amyloid plaques throughout the cerebrum and cerebellum with varying degrees of spongiform degeneration. Genetic and molecular studies were performed in two male family members. One of them was homozygous for valine and the other heterozygous for methionine and valine at codon 129 of PRNP. Sequence analysis identified a novel 168?bp insertion [R2?CR2?CR2?CR2?CR3g?CR2?CR2] in the octapeptide repeat region of PRNP. Both patients carried the mutation on the allele with valine at codon 129. Western blot analysis showed type 1 PrP^Sc in both patients and detected a smaller ~8?kDa PrP^Sc fragment in the cerebellum in one patient. The features of this Dutch kindred define an unusual neuropathological phenotype and a novel PRNP haplotype among the previously documented 7-OPRI mutations, further expanding the spectrum of genotype?Cphenotype correlations in inherited prion diseases.     

Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case�Ccontrol study

Introduction:

An inverse association between serum cholesterol and the risk of hemorrhagic stroke has been noted in epidemiological studies. We performed a case–control study to assess the relationship between primary intracerebral hemorrhage (ICH) and low serum cholesterol.

Materials and Methods:

Prospectively recruited fully evaluated patients with ICH were compared with a control group based in a primary care practice, i.e. age- and sex-matched individuals attending the routine preventive health check-up. Low cholesterol was defined by the sex-specific lowest quintile of the population.

Results:

The proportion of ICH patients with low cholesterol was significantly higher than the controls (68% vs. 43%). Mean total cholesterol was also signficantly low in ICH patients compared with controls (177 mg/dL vs. 200 mg/dl; P-value = 0.0006). Low-density lipoprotein cholesterol (LDL-c) and triglycerides were also significantly low in ICH patients compared with controls. Mean LDL-C in the ICH patient group was 114 mg/dL, whereas it was 128.5 mg/dL in the control group (P-value = 0.016). There was no significant difference in the high-density lipoprotein (HDL) levels in both groups. In a subgroup analysis, both men and women in the ICH group had a significantly low mean cholesterol compared with the control group. Although lower mean cholesterol was seen in both young and older individuals in the ICH group than in controls, the difference was significant only in the older group (age >45 years). In multivariate analysis, presence of low cholesterol remained a significant predictor of hemorrhage. The odds ratio of low cholesterol in the hemorrhage cases was 2.75 (95% CI = 1.44–5.49) unadjusted and 2.15 (1.13–4.70) adjusted for age and hypertension.

Conclusions:

This study confirms an increased risk of primary ICH associated with low cholesterol both in men and women, especially in older individuals.     

Entwicklung station?rer psychiatrischer Aufnahmen ��ber 10 Jahre (2000�C2009)

Die Aufnahmen von Patienten aus der Stadt Linz in der O? LNK Wagner-Jauregg wurden über einen Zeitraum von 10 Jahren (2000–2009) untersucht. Dabei zeigtesich eine Zunahme der Aufnahmen um 15 %, allerdings betrug die Auslastung bereits am Beginn des Untersuchungszeitraumes 99 %. Entsprechend der beschr?nkten Aufnahmekapazit?tkam es zu einer starken Zunahme ambulanter Kontakte, um Patienten mit Aufnahmewunsch ambulant zubehandeln (2001: 216 Kontakte; 2009: 1509 Kontakte). Die Zahl der Erstaufnahmen erh?hte sich nur geringfügig. Bei der Aufschlüsselung nach Diagnosen fand sich eine sehr ausgepr?gte Zunahme der Aufnahmen von Patienten mit affektiven St?rungen (F3: +136 %), was vorwiegend auf Patienten mit depressiven Episoden zurückzuführen war, w?hrend die Anzahl von Patienten mit manischen Episoden gering abnahm. Aufnahmen von Patienten mit St?rungen durch psychotrope Substanzen gingen deutlich zurück (-23 %). Keine wesentlichen Ver?nderungen fanden sich in den Diagnosegruppen F2 und F4 – F6. Der Anteil von M?nnern unter den behandelten Patienten betrug im Jahr 2000 54,8 % und sank bis zum Jahr 2009 auf 47,4 % ab. Ein Teil der Mehraufnahmen von Patientenmit depressiven St?rungen l?sst sich damit erkl?ren, dass weniger Patienten dieser Diagnosen in anderen, nicht-psychiatrischen Abteilungen Linzer Spit?ler behandelt wordensind.     

?Basiscurriculum in psychotherapeutischer Medizin��: Psychotherapeutische Ausbildung in der Psychiatrie �C ein Beginn

Die Ausbildung zum/zur Fach?rztIn für Psychiatrie und Psychotherapeutische Medizin sieht eine Einführung in Theorie und praktische Umsetzung der 4 wichtigsten psychotherapeutischen Traditionen (psychoanalytische, verhaltenstherapeutische, systemische und humanistische Tradition) vor. Die Experten-Arbeitsgruppe Psychotherapeutische Ausbildung in der Psychiatrie erarbeitete im Auftrag der ?GPP das Basiscurriculum Psychotherapeutische Medizin im Rahmen der Facharztausbildung, deren Inhalte hier im überblick vorgestellt werden. Der Unterricht wurde in Wien im M?rz 2010 gestartet. Eine besondere St?rke der Ausbildung ist die Vernetzung und Einbettung des Basiscurriculums in die laufende Ausbildung, sodass neu erworbene Inhalte direkt in den Arbeitsalltag der AusbildungskandidatInnen einflie?en k?nnen, somit weiter gefestigt und erweitert werden k?nnen. Der Unterricht legt überlegungen zur Didaktik nahe, die eine moderne interaktive, affektiv involvierende Gestaltung erm?glichen und eine hochqualitative Vermittlung der Lernziele gew?hrleisten.     

Deficit and defence �C Ged?chtnisst?rungen nach Sch?del-Hirn-Trauma unter Folter

Die Komplexit?t von Ged?chtnisst?rungen posttraumatischer Natur ist ein zentrales diagnostisches und forensisches Problem im Umgang mit traumatisierten Menschen. Folterüberlebende stellen dabei eine besondere Patientenpopulation mit einer Reihe von psychischen und somatischen Symptomen unterschiedlicher Spezifit?t dar. Differentialdiagnostische überlegungen anhand der ICD-10 und DSM-IV Kriterien demonstrieren die Notwendigkeit einer sorgf?ltigen klinischen Untersuchung von Folterüberlebenden, einschlie?lich bildgebender und testpsychologischer Verfahren. Ged?chtnisst?rungen bei Folterüberlebenden sind h?ufig und komplex: Traumatische Erinnerungsfragmente k?nnen innerhalb des Zeitraums der posttraumatischen Amnesie vorkommen. Dabei gibt es Hinweise für einen potentiell protektiven Effekt der posttraumatischen Amnesie für die Entstehung einer posttraumatischen Belastungsst?rung. Durch unstrukturierte Befragungen und Untersuchungen eines Folterüberlebenden kann eine Retraumatisierung stattfinden. Anhand des Istanbul-Protokolls werden Empfehlungen für den Umgang mit schwer traumatisierten Menschen dargelegt, zudem wird das gro?e forensische Dilemma der Glaubwürdigkeit des Erfahrungsberichts eines Folterüberlebenden thematisiert.