Horner’s syndrome,Pseudo-Horner’s syndrome,and simple anisocoria

This discussion reviews the common causes of Horner’s syndrome, with emphasis on case reports from the past several years. Much of the recent literature concerns the use of apraclonidine as a diagnostic test for Horner’s syndrome, possibly as an alternative for the current gold standard of cocaine eye drops. This new literature is discussed in the context of the current standards for clinical diagnosis.     

Clinicians’ Beliefs,Observations, and Treatment Effectiveness Regarding Clients’ Sexual Addiction and Internet Pornography Use

This study addressed how sex addiction and problematic IP use present to mental health professionals (MHPs), and how MHPs conceptualize and treat these issues. MHPs (N?=?183) reported on beliefs about, experiences with, and treatment of problematic sexual behaviors (PBS). Most MHPs saw clients with PBS, but most do not feel competent to treat PBS. Specialized MHPs endorsed seeing more clients with PBS and feeling more effective than nonspecialists. Sexual addiction and problematic IP use share similarities, but differ in etiology and co-occurring problems. Diagnostic ambiguity, insufficient knowledge, and limited dissemination may hinder MHPs ability to assess and treat PBSs     

Hungarian Psychiatrists’ Recognition,Knowledge, and Treatment of Catatonia

Psychiatric Quarterly - DSM-5 introduced a number of modifications to the catatonic syndrome, which is now closer to Kahlbaum’s original concept. The aim of the present study was to assess...     

Insulin-degrading enzyme, apolipoprotein E, and Alzheimer’s disease

Insulin-degrading enzyme (IDE) is a protease that degrades insulin and the beta-amyloid (Abeta) peptide implicated in Alzheimer's disease (AD). Hence, factors that influence IDE expression or IDE activity toward Abeta are potentially relevant to the etiology of AD. Hippocampal IDE mRNA levels are lower on average in subjects with an APOE epsilon4 allele, suggesting that the genetic risk conferred by APOE epsilon4 may be mediated in part by this allele's effect on IDE expression. Other factors that influence IDE may be relevant in non-epsilon4 carriers. For example, insulin, a competitive inhibitor of IDE activity toward Abeta, may be elevated in non-epsilon4 cases. We here report IDE gene promoter region variants that are associated with AD in subjects without an epsilon4 allele. If these promoter region variants prove to affect expression levels, they may be relevant to disease as well. Further investigation of the relationship between APOE genotype, IDE genetic variants, and the expression and activity of hippocampal IDE is warranted.     

Children’s Peer Victimization,Empathy, and Emotional Symptoms

This study investigated the concurrent and longitudinal relations among children’s peer victimization, empathy, and emotional symptoms. The sample consisted of 175 children (85 girls, mean age = 6.1 years) recruited from kindergartens in Switzerland and followed for 1 year (Time 2). Parents and teachers reported on the children’s emotional symptoms, empathy, and victimization. Children reported their empathy and victimization experiences. Peer victimization was a predictor of emotional symptoms at Time 1; this association was stronger for children with average or high levels of empathy. Increases in peer victimization predicted increases in boys’ emotional symptoms, and increases in victimization were related to decreases in empathy. The results emphasize the role of negative peer relations and children’s social-emotional information processing for the development of emotional symptoms.     

Cognitive ability, neighborhood deprivation, and young children’s emotional and behavioral problems

Purpose

To examine if cognitive ability moderates the effect of area (neighborhood) deprivation on young children’s problem behavior.

Methods

Data from the first two sweeps of the Millennium Cohort Study (MCS) in the UK were used. Children were clustered in small areas in nine strata in the UK and were aged 9?months at Sweep 1 and 3?years at Sweep 2. Neighborhood deprivation was measured with the Index of Multiple Deprivation at Sweep 1. Overall and specific problem behavior was measured with the Strengths and Difficulties Questionnaire at Sweep 2. To explore moderator specificity we used three indices of ability (verbal cognitive ability, non-verbal cognitive ability, and attainment of developmental milestones). Adjustment was made for child’s age and sex, and for Sweep 1 family adversity (number of adverse life events), family structure, mother’s social class and psychological distress, and family socio-economic disadvantage.

Results

We found both support for our main hypothesis, and evidence for specificity. Neighborhood deprivation was, even after adjustment for covariates, significantly associated with children’s peer problems. However, verbal and non-verbal cognitive ability moderated this association.

Conclusions

Neighborhood deprivation was related to peer problems even at preschool age. Although the effect of neighborhood deprivation on externalizing problems was mediated by family poverty and parental socio-economic position and although its effect on internalizing problems was mediated by parental mental health, its effect on difficulties with peers was independent of both parental and child characteristics. Cognitive ability moderated the effect of neighborhood deprivation on preschoolers’ peer relationships difficulties.     

Relationships Among Parents’ Economic Stress,Parenting, and Young Children’s Behavior Problems

In a time of economic recession, identifying how economic stress may be related to parenting stress, to the parenting behaviors used by mothers and fathers, and to young children’s behavior problems may provide insight into interventions that may best assist families through their own economic crises. As part of this study, 124 culturally diverse parents with young children who ranged in age from 2- to 6-years rated their own economic, life, and parenting stress; their parenting behaviors; and their young children’s behavior problems. Hierarchical regression analyses suggested that negative economic events and parenting stress provide unique incremental variance in predicting young children’s internalizing problems, whereas life stress and parenting stress provide unique incremental variance in predicting young children’s externalizing problems. With closer examination, parenting stress fully mediated the relationship between parents’ financial cutbacks and young children’s internalizing problems and the relationship between parents’ negative economic events and young children’s externalizing problems. These findings suggested that these variables are important to examine collectively.     

Teachers’ knowledge, beliefs and attitudes concerning schizophrenia

BACKGROUND: Mental health literacy of the general public is essential for the effective promotion of society's mental health. However, there has been no investigation of the general public's mental health literacy with Japanese and Taiwanese socio-cultural backgrounds. METHODS: A total of 129 Japanese and 150 Taiwanese elementary school teachers were surveyed about knowledge, beliefs and attitudes concerning schizophrenia by means of a questionnaire with a vignette describing a case of the disease. Identification of the case, cause of the disease, coping behavior for the case, and perception of stigmatizing and supporting attitudes by parents and neighbors of the case were investigated. RESULTS: As a common finding with the studies in Western countries, only small percentages of the Japanese and Taiwanese respondents were able to make a correct identification. A further common finding was the emphasis on psychosocial factors as a cause of schizophrenia, as was the rejection of psychotropic medication, although future study is required to determine to what extent the respondents know about therapeutic procedures utilized by psychiatrists. Significantly stronger stigma perception was shown in the Japanese respondents than in the Taiwanese, which may be attributable to the high institutionalization rate in Japan. CONCLUSIONS: Japanese and Taiwanese teachers' knowledge, beliefs and attitudes regarding schizophrenia were similar to those found in the general public in Western societies. Although the present study is limited in sampling and the components of the mental health literacy investigated, several working hypotheses have been extracted from it to be tested in future investigations on the Japanese and Taiwanese and other Asian general public's mental health literacy.     

Apolipoprotein E,amyloid-beta,and neuroinflammation in Alzheimer’s disease

Alzheimer’s disease (AD) is characterized by the accumulation and deposition of amyloid-beta (Aβ) peptides in the brain. Neuroinflammation occurs in the AD brain and plays a critical role in the neurodegenerative pathology. Particularly, Aβ evokes an inflammatory response that leads to synaptic dysfunction, neuronal death, and neurodegeneration. Apolipoprotein E (ApoE) proteins are involved in cholesterol transport, Aβ binding and clearance, and synaptic functions in the brain. The ApoE4 isoform is a key risk factor for AD, while the ApoE2 isoform has a neuroprotective effect. However, studies have reached different conclusions about the roles of the isoforms; some show that both ApoE3 and ApoE4 have anti-inflammatory effects, while others show that ApoE4 causes a predisposition to inflammation or promotes an inflammatory response following lipopolysaccharide treatment. These discrepancies may result from the differences in models, cell types, experimental conditions, and inflammatory stimuli used. Further, little was known about the role of ApoE isoforms in the Aβ-induced inflammatory response and in the neuroinflammation of AD. Our recent work showed that ApoE isoforms differentially regulate and modify the Aβ-induced inflammatory response in neural cells, with ApoE2 suppressing and ApoE4 promoting the response. In this article, we review the roles, mechanisms, and interrelations among Aβ, ApoE, and neuroinflammation in AD.     

Apolipoprotein E,Receptors, and Modulation of Alzheimer’s Disease

Apolipoprotein E (apoE) is a lipid carrier in both the peripheral and the central nervous systems. Lipid-loaded apoE lipoprotein particles bind to several cell surface receptors to support membrane homeostasis and injury repair in the brain. Considering prevalence and relative risk magnitude, the ε4 allele of the APOE gene is the strongest genetic risk factor for late-onset Alzheimer’s disease (AD). ApoE4 contributes to AD pathogenesis by modulating multiple pathways, including but not limited to the metabolism, aggregation, and toxicity of amyloid-β peptide, tauopathy, synaptic plasticity, lipid transport, glucose metabolism, mitochondrial function, vascular integrity, and neuroinflammation. Emerging knowledge on apoE-related pathways in the pathophysiology of AD presents new opportunities for AD therapy. We describe the biochemical and biological features of apoE and apoE receptors in the central nervous system. We also discuss the evidence and mechanisms addressing differential effects of apoE isoforms and the role of apoE receptors in AD pathogenesis, with a particular emphasis on the clinical and preclinical studies related to amyloid-β pathology. Finally, we summarize the current strategies of AD therapy targeting apoE, and postulate that effective strategies require an apoE isoform–specific approach.     

Levetiracetam,lamotrigine, and phenobarbital in patients with epileptic seizures and Alzheimer’s disease

The objective of the study described here was to evaluate the efficacy, tolerability, and cognitive effects of levetiracetam (LEV) in patients with seizures and Alzheimer’s disease (AD). This was a prospective, randomized, three-arm parallel-group, case–control study of 95 patients taking LEV (n = 38), phenobarbital (PB) (n = 28), and lamotrigine (LTG) (n = 29). A 4-week dose adjustment was followed by a 12-month evaluation period. The three groups were compared to a control group (n = 68) to evaluate cognitive effects of the antiepileptic drugs. We examined drug effects cross-sectionally at baseline, 6 months, and 12 months. There were no significant differences in efficacy among the three AEDs. LEV caused fewer adverse events than the other AEDs. PB produced persistent negative cognitive side effects. LEV was associated with improved cognitive performance, specifically attention level and oral fluency items. LTG had a better effect on mood. LEV had a benign neuropsychological side effect profile, making it a cognitively safe drug to use for controlling established seizures in elderly patients with Alzheimer’s disease.     

Managing Gait,Balance, and Posture in Parkinson’s Disease

Purpose of Review

Postural instability and gait difficulties inexorably worsen with Parkinson’s disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies.

Recent Findings

It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients’ condition.

Summary

Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients’ management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.

     

Biomarker discovery for Alzheimer’s disease, frontotemporal lobar degeneration, and Parkinson’s disease

Ante-mortem diagnosis of neurodegenerative disorders based on clinical features alone is associated with variable sensitivity and specificity, and biomarkers can potentially improve the accuracy of clinical diagnosis. In patients suspected of having Alzheimer’s disease (AD), alterations in cerebrospinal fluid (CSF) biomarkers that reflect the neuropathologic changes of AD strongly support the diagnosis, although there is a trade-off between sensitivity and specificity due to similar changes in cognitively healthy subjects. Here, we review the current approaches in using CSF AD biomarkers (total tau, p-tau₁₈₁, and Aβ42) to predict the presence of AD pathology, and our recent work using multi-analyte profiling to derive novel biomarkers for biofluid-based AD diagnosis. We also review our use of the multi-analyte profiling strategy to identify novel biomarkers that can distinguish between subtypes of frontotemporal lobar degeneration, and those at risk of developing cognitive impairment in Parkinson’s disease. Multi-analyte profiling is a powerful tool for biomarker discovery in complex neurodegenerative disorders, and analytes associated with one or more diseases may shed light on relevant biological pathways and potential targets for intervention.     

Physical,occupational, speech and swallowing therapies and physical exercise in Parkinson’s disease

Former studies on the effects of physical exercise, physical and occupational therapy (PT, OT) and speech and swallowing therapy (ST, SwT) in Parkinson’s disease (PD) have demonstrated little or uncertain effects. New pathophysiological concepts have been developed. Recent controlled high-level studies demonstrate improvement of mobility and balance after training of muscular strength and endurance, trunk control, and amplitude and rhythmicity of movements (treadmill). Attentional and cognitive strategies were found to enforce body awareness and improve movement sequences. Dance, sensory (auditory, visual, tactile) and cognitive cueing are effective for problems of gait and balance. Whether PT and OT reduce the risk of falls remains uncertain. ST including Lee Silverman Voice Treatment has been shown to relieve speech problems. SwT and OT are frequently applied, however, further studies are necessary. Therapeutic interventions need to be evaluated with regard to consistency, intensity, frequency, duration, side effects, home versus institution based and standardized versus individualized training, quality standards, practicability in real life, and cost-effectiveness. Parkinson patients should resume or continue physical exercise as long as possible. There is hope that regular sport may modify PD risk and progression.     

Fathers’ parenting, adverse life events, and adolescents’ emotional and eating disorder symptoms: the role of emotion regulation

Purpose  To investigate the role of emotion regulation in the relation between fathers’ parenting (specifically warmth, behavioral control and psychological control) and adolescents’ emotional and eating disorder symptoms, after adjustment for controls. Methods  A total of 203 11–18 year-old students from a school in a socio-economically disadvantaged area in North-East London completed questionnaires assessing emotional symptoms (measured with the Strengths and Difficulties Questionnaire’s (SDQ) Emotional Symptoms Scale), eating disorder symptoms (measured with the Eating Attitudes Test (EAT-26)), difficulties in emotion regulation (measured with the Difficulties in Emotion Regulation Scale (DERS)), and fathers’ overprotection and warmth, measured with the Parental Bonding Instrument (PBI), as well as behavioral and psychological control. The confounding variables considered were number of proximal (i.e., during the last year) adverse life events experienced, gender, age, and socio-economic status (eligibility for free school meals). Results  Adolescents’ difficulties in emotion regulation mediated the link between fathers’ psychological control and adolescents’ emotional symptoms, but not the link between fathers’ parenting and adolescents’ eating disorder symptoms, which appeared to be more directly linked to fathers’ psychological control and number of proximal adverse life events experienced. Proximal adverse life events experienced were also strongly associated with difficulties in emotion regulation. Conclusions  The study findings have implications for intervention programs which may prove more fruitful in addressing adolescent emotional problems by targeting underlying emotion regulation abilities, and in addressing adolescent eating disorder symptoms by protecting adolescents with a recent experience of multiple adverse life events. Parenting programs also stand to benefit from the evidence presented in this study that paternal psychological control may have uniquely harmful consequences for adolescent development through the hampering or atrophying of emotion regulation abilities and the encouragement of eating disorders.     

Mothers’ Temperament and Personality: Their Relationship to Parenting Behaviors,Locus of Control,and Young Children’s Functioning

There appears to be a lack of construct clarity and a dearth of studies that have examined both mothers’ temperament and personality in conjunction with parenting behaviors when predicting young children’s functioning. As a result, this study examined these constructs jointly so that a further understanding of how mothers’ temperament and personality may work together to predict young children’s functioning could be gained. As part of this study, 214 diverse mothers with young children who ranged in age from 2- to 6-years rated their own temperament and personality, their parenting characteristics, and their young children’s functioning (i.e., temperament and emotional and behavioral functioning). Based on the findings of hierarchical regression analyses completed in this study, both mothers’ temperament and personality may be important individual predictors of young children’s temperament but may be important joint predictors, along with parenting behaviors, of young children’s behavior problems. Consequently, future research should examine the role that mothers’ temperament and personality characteristics may play in conjunction with their parenting behaviors when trying to understand young children’s functioning. These findings will be particularly helpful for professionals providing parenting interventions to families with young children who have difficult temperament styles and/or emotional and behavioral problems.     

General practitioners’ knowledge,practices, and obstacles in the diagnosis and management of dementia

Objectives: To identify general practitioners’ (GPs) knowledge, practices, and obstacles with regard to the diagnosis and management of dementia.

Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a purposive sample of GPs in Kathmandu, Nepal. Three hundred and eighty GPs responded (response rate = 89%).

Results: Knowledge of practitioners’ with regard to the diagnosis and management of dementia was unsatisfactory (<50%). Diagnosis and management barriers are presented with regard to GP, patient, and carer factors. Specifically, the results address the following issues: communicating the diagnosis, negative views of dementia, difficulty diagnosing early-stage dementia, acceptability of specialists, responsibility for extra issues, knowledge of dementia and aging, less awareness of declining abilities, diminished resources to handle care, lack of specific guidelines, and poor awareness of epidemiology.

Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with diagnosis, care, and management of dementia.     

Adolescents with Diabetes and Their Parents’ Perceptions of Mental Health Screening,Assessment, and Feedback

This study examined adolescents with diabetes and their parents’ reactions to mental health screenings, assessments, and feedback. Most parents and adolescents did not report negative affect, but 15- and 16-year olds and referred adolescents showed greater levels of concern with assessment outcomes. Among those referred to mental health services, parents anticipated barriers in costs, insurance, and lack of qualified providers. Adolescents reported scheduling conflicts, time, and confidentiality concerns. Respondents perceived feedback as an important component of the clinical process and findings indicated a need for clinicians to incorporate psychosocial screenings and feedback in healthcare visits for adolescents with diabetes.