Changes of cerebrospinal fluid Aβ<Subscript>42</Subscript>, t-tau,and p-tau in Parkinson’s disease patients with cognitive impairment relative to those with normal cognition: a meta-analysis

The cerebrospinal fluid (CSF) signature of reduced amyloid beta 1–42 (Aβ₄₂), elevated total tau (t-tau), and phosphorylated tau181 (p-tau) is important for the early diagnosis of Alzheimer’s disease (AD). Aβ₄₂, t-tau, and p-tau have been reported in numerous studies to contribute to predicting cognitive impairment in Parkinson’s disease (PDCI). However, no consistent conclusion can be drawn so far. Literatures regarding Aβ₄₂, t-tau, and p-tau in CSF were systematically reviewed, and a meta-analysis was thus performed to evaluate the changes of these biomarkers in PDCI patients, including PD with mild cognitive impairment (PDMCI) and PD dementia (PDD) patients, relative to PD with normal cognition (PDNC) patients. Databases of “PubMed,” “EBSCO,” and “Springer” were retrieved for articles concerning Aβ₄₂, t-tau, and p-tau in PDCI patients relative to those in PDNC patients published from January 1, 2000 to February 1, 2017. The following keywords were set, namely, “dementia” or “cognitive impairment” or “mild cognitive impairment” and “cerebrospinal fluid” and “Parkinson*.” Sixteen articles comprising 590 PDCI patients and 1182 PDNC patients were included. The results showed that CSF Aβ₄₂ level in PDCI cohort was lower than that in PDNC cohort (pooled Std.MD = ?0.44, 95% CI [?0.61, ?0.26], p < 0.00001). Reduced Aβ₄₂ (pooled Std.MD = ?0.60, 95% CI [?0.75, ?0.45], p < 0.00001) as well as elevated t-tau (pooled Std.MD = 0.21, 95% CI [0.06, 0.35], p = 0.006) and p-tau (pooled Std.MD = 0.36, 95% CI [0.02, 0.69], p = 0.04) could be observed in PDD cohort compared with PDNC cohort. Therefore, amyloid pathology and tauopathy may participate in the development of PDD, which is similar to AD.     

Respiratory and upper limb function as outcome measures in ambulant and non-ambulant subjects with Duchenne muscular dystrophy: A prospective multicentre study

The field of translational research in Duchenne muscular dystrophy (DMD) has been transformed in the last decade by a number of therapeutic targets, mostly studied in ambulant patients. A paucity of studies focus on measures that capture the non-ambulant stage of the disease, and the transition between the ambulant and non-ambulant phase. In this prospective natural history study, we report the results of a comprehensive assessment of respiratory, upper limb function and upper limb muscle strength in a group of 89 DMD boys followed in 3 European countries, 81 receiving corticosteroids, spanning a wide age range (5–18 years) and functional abilities, from ambulant (n?=?60) to non-ambulant (n?=?29). Respiratory decline could be detected in the early ambulatory phase using Peak Expiratory Flow percentage predicted (PEF%), despite glucocorticoid use (mean annual decline: 4.08, 95% CI [?7.44,?0.72], p?=?0.02 in ambulant; 4.81, 95% CI [?6.79,?2.82], p < 0.001 in non-ambulant). FVC% captured disease progression in non-ambulant DMD subjects, with an annual loss of 5.47% (95% CI [?6.48,?4.45], p < 0.001). Upper limb function measured with the Performance of Upper Limb (PUL 1.2) showed an annual loss of 4.13 points (95% CI [?4.79,3.47], p < 0.001) in the non-ambulant cohort. Measures of upper limb strength (MyoGrip and MyoPinch) showed a continuous decline independent of the ambulatory status, when reported as percentage predicted (grip force ?5.51%, 95% CI [?6.54,?4.48], p < 0.001 in ambulant and a slower decline ?2.86%; 95% CI ?3.29,?2.43, p < 0.001, in non-ambulant; pinch force: ?2.66%, 95% CI [?3.82,?1.51], p < 0.001 in ambulant and ?2.23%, 95% CI [?2.92,?1.53], p < 0.001 in non-ambulant). Furthermore, we also explored the novel concept of a composite endpoint by combining respiratory, upper limb function and force domains: we were able to identify clear clinical progression in patients in whom an isolated measurement of only one of these domains failed to appreciate the yearly change. Our study contributes to the field of natural history of DMD, linking the ambulant and non-ambulant phases of the disease, and suggests that composite scores should be explored further.     

Accuracy and intensity of posed emotional expressions in unmedicated schizophrenia patients: vocal and facial channels

This study investigated the ability of schizophrenia patients to volitionally display various emotional expressions. Accuracy and intensity of facial and vocal emotional expression were rated in 26 unmedicated male schizophrenia patients and 20 non-patient male controls while posing emotional facial and vocal expressions. Results indicate that schizophrenia patients, compared to non-patient controls, had deficits in their ability to portray some, but not all, emotions. Accuracy and intensity of posed facial and vocal expressions were inversely correlated with negative symptoms in the patient group. We conclude that observable flattened affect in schizophrenia during posed expression is not evident across all emotions. Furthermore, substantial disruption in the ability to portray posed emotions may be largely driven by the presence of negative symptoms.     

Selective Serotonin 3 Receptor Antagonist Treatment for Schizophrenia: Meta-analysis and Systematic Review

Double-blinded, randomized, placebo-control trials of selective serotonin 3 receptor antagonists (5-HT₃R-ANTs) for schizophrenia have differed in outcome. This meta-analysis tests the hypothesis that 5-HT₃R-ANTs are effective for the treatment for schizophrenia. We searched PubMed, the Cochrane Library database, and PsycINFO up to June 15, 2013. We conducted a systematic review and meta-analysis of individual patient data from randomized controlled trials comparing 5-HT₃R-ANTs add-on therapy with placebo. The risk ratio (RR), 95 % confidence intervals (CI), and standardized mean difference (SMD) were calculated. A random-effects model was used. Six studies (total n = 311) were identified. These included one granisetron plus risperidone study, one ondansetron plus risperidone study, one ondansetron plus haloperidol, and three tropisetron plus risperidone studies. The statistically significant effects of 5-HT₃R-ANTs add-on therapy on Positive and Negative Syndrome Scale (PANSS) total scores were SMD = ?1.03, CI = ?1.70 to ?0.36, p = 0.003 (I ² = 82 %, 5 studies, n = 261); on negative scores were SMD = ?1.10, CI = ?1.82 to ?0.39, p = 0.002 (I ² = 84 %, 5 studies, n = 261); and on PANSS general scores were SMD = ?0.70, CI = ?1.23 to ?0.17, p = 0.01 (I ² = 73 %, 5 studies, n = 261). However, 5-HT₃R-ANTs add-on therapy was not superior to placebo in PANSS positive scores (SMD = ?0.12, p = 0.33). Dropout due to all cause (RR = 0.80, p = 0.50), inefficacy (RR = 0.76, p = 0.65), or adverse events (RR = 0.84, p = 0.75) was similar in both groups. Constipation occurred significantly more often with 5-HT₃R-ANTs than placebo (RR = 2.05, CI = 1.07–3.91, p = 0.03, NNH = 11, p = 0.02). 5-HT₃R-ANTs add-on therapy is more beneficial on the psychopathology (especially negative symptoms) than controls in patients with schizophrenia, and 5-HT₃R-ANTs seem to be well-tolerated treatments.     

The influence of a mindfulness-based intervention on job satisfaction and work-related stress and anxiety

Workplace mindfulness is a recognised tool for enhancing health and well-being of university staff and may result in better task performance and satisfaction in the workplace. The study examined the beneficial effects of mindfulness meditation on job satisfaction, mindful awareness and anxiety levels in university personnel. Mixed methods with a quasi-experiment and in-depth interviews were used. Fifteen participants engaged in a mindfulness meditation approach and five volunteers were interviewed. The findings showed a significant increase in awareness, with staying focused (t(14) = –3.09, p = .00), noticing feelings of physical tension (t(14) = –4.00, p = .00), being aware of running automatically (t(14) = –3.55, p = .00) and not being preoccupied with the future or the past (t(14) = –2.69, p = .01), respectively. Mindfulness was also effective in reducing sleep disturbance. Qualitative results demonstrated the mindfulness approach contributed to calmness and relaxation, and increased ability to handle difficult matters in the workplace. Apart from helping participants to better manage emotions, the mindfulness intervention could promote better relationships towards family members and reduce blood pressure to normal levels. Therefore, mindfulness meditation should be promoted across academic settings to enhance job performance and satisfaction and reduce work-related stress.     

Anxiety disorders in adolescence are associated with impaired facial expression recognition to negative valence

ObjectiveThe aim of the present study was to test the ability of adolescents with a current anxiety diagnosis to recognize facial affective expressions, compared to those without an anxiety disorder.MethodsForty cases and 27 controls were selected from a larger cross sectional community sample of adolescents, aged from 10 to 17 years old. Adolescent’s facial recognition of six human emotions (sadness, anger, disgust, happy, surprise and fear) and neutral faces was assessed through a facial labeling test using Ekman’s Pictures of Facial Affect (POFA).ResultsAdolescents with anxiety disorders had a higher mean number of errors in angry faces as compared to controls: 3.1 (SD = 1.13) vs. 2.5 (SD = 2.5), OR = 1.72 (CI95% 1.02 to 2.89; p = 0.040). However, they named neutral faces more accurately than adolescents without anxiety diagnosis: 15% of cases vs. 37.1% of controls presented at least one error in neutral faces, OR = 3.46 (CI95% 1.02 to 11.7; p = 0.047). No differences were found considering other human emotions or on the distribution of errors in each emotional face between the groups.ConclusionOur findings support an anxiety-mediated influence on the recognition of facial expressions in adolescence. These difficulty in recognizing angry faces and more accuracy in naming neutral faces may lead to misinterpretation of social clues and can explain some aspects of the impairment in social interactions in adolescents with anxiety disorders.     

Sibling Characteristics and Early Onset Psychoses Among the Young Adolescent Patient Population

We investigated the relationship between sibling characteristics (birth order, number of siblings and birth interval) and early onset psychosis among adolescent psychiatric inpatients and their mentally healthy controls. A short birth interval of 1–2 years to the nearest sibling was more common among adolescents with schizophrenia and schizophrenia spectrum psychoses and differed significantly from healthy controls (p = 0.037). A large family (at least 6 children in family) was more common among adolescents with psychosis NOS than among healthy controls (p = 0.035). The birth order among young adolescents with any subtype of psychosis did not differ from healthy controls. Sibling characteristics may be contributing factors in the multifactorial aetiology of schizophrenia and other psychotic disorders. Further studies are required to determine whether sibling characteristics reflect other unknown environmental factors.     

The risk stratification based on the CHA2DS2-VASc may predict the response to intravenous thrombolysis after stroke

CHA₂DS₂-VASc score influences the outcome in stroke patients with or without atrial fibrillation (AF). We assessed whether the risk stratification based on the prestroke CHA₂DS₂-VASc score may predict the response to intravenous (IV) thrombolysis in stroke patients. We conducted an analysis on prospectively collected data of 516 consecutive AF and non-AF patients treated with IV thrombolysis. Outcome measures were major improvement (NIH Stroke Scale [NIHSS] ≤8 points from baseline or NIHSS score 0) and deterioration (death or NIHSS ≥1 points from baseline) or no improvement (NIHSS score equivalent to baseline) at 24 h; excellent (modified Rankin Scale [mRS] score ≤1) and unfavorable outcome (mRS score >2) at 3 months. Multivariate analysis showed that ORs for major improvement and excellent outcome were lower in patients with intermediate risk (CHA₂DS₂-VASc = 1) (OR 0.39, 95 % CI 0.16–0.92, p = 0.032; OR 0.10, 95 % CI 0.02–0.56, p = 0.009), moderately high risk (CHA₂DS₂-VASc = 2) (OR 0.43, 95 % CI 0.19–0.96, p = 0.040; OR 0.16, 95 % CI 0.03–0.76, p = 0.022), and very high risk (CHA₂DS₂-VASc > 3) (OR 0.31, 95 % CI 0.15–0.65, p = 0.002; OR 0.17, 95 % CI 0.04–0.81, p = 0.026), whereas ORs for deterioration or no improvement and unfavorable outcome were higher only in patients with very high risk (OR 4.26, 95 % CI 1.24–14.65, p = 0.021; OR 9.26, 95 % CI 1.15–74.65, p = 0.037), compared with low risk (CHA₂DS₂-VASc = 0). Low-risk level based on the prestroke CHA₂DS₂-VASc score was predictor of effective response to IV thrombolysis. Very high-risk level was predictor of failed response, compared with low-risk level.     

Prospective Observational Cohort Study on Dorsal Root Ganglion Stimulation in Chronic Postsurgical Pain: Results of Patient-Reported Outcomes at Two Years

ObjectivesThis study aimed to determine the long-term effects of dorsal root ganglion (DRG) stimulation on pain, physical function, and quality of life in patients with chronic postsurgical pain. We hypothesized that the effects of DRG stimulation would be sustainable through two years of follow-up.Materials and MethodsThis prospective observational cohort will include 30 patients, at least 18 years old, scheduled to receive DRG stimulation in two Dutch hospitals. A minimum pain score of 50 mm on a 100-mm visual analog scale was required. Following written informed consent, patients completed validated questionnaires on pain, physical function, and quality of life at baseline, one year, and two years. Change over time was analyzed using mixed model statistics, with Tukey-Kramer correction. A p-value of <0.05 was considered statistically significant.ResultsFollow-up was completed by 22 of 30 enrolled patients. Pain scores decreased at one year (?38 ± 7, 95% CI [?51 to ?25], p < 0.001) and two years (?29 ± 6, 95% CI [?42 to ?17], p < 0.001) compared with those at baseline. Physical function measured with pain severity and interference decreased at one and two years (?2.5 ± 0.5, 95% CI [?3.3 to ?1.5], p < 0.001, and ?2.3 ± 0.5, 95% CI [?3.3 to ?1.3], p < 0.001, respectively). Quality of life increased over time (0.22 ± 0.05, 95% CI [11–33], p < 0.001, at one year; 0.21 ± 0.05, 95% CI [10–31], p = 0.001, at two years).ConclusionsDRG stimulation in chronic postsurgical pain is associated with a sustainable reduction in pain and an improvement in physical function and in quality of life, through two years of follow-up.     

Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials

Introduction: Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents. Method: Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD–RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively. Results: Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = ?0.13, 95% CI [?0.25, ?0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01). Conclusion: Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.     

Neutral face distractors differentiate performance between depressed and healthy adolescents during an emotional working memory task

The aim of the present study is to examine the effect of neutral and emotional facial expressions on voluntary attentional control using a working memory (WM) task in adolescents with major depressive disorder (MDD). We administered the Emotional Face n-back (EFNBACK) task, a visual WM task with neutral, happy and angry faces as distractors to 22 adolescents with MDD (mean age 15.7 years) and 21 healthy controls (HC) (mean age 14.7 years). There was a significant group by distractor type interaction (p = 0.045) for mean percent accuracy rates. Group comparisons showed that MDD youth were less accurate on neutral trials than HC (p = 0.027). The two groups did not differ on angry, happy and blank trials (p > 0.05). Reaction time did not differ across groups. In addition, when comparing the differences between accuracies on neutral trials and each of the happy and angry trials, respectively [(HAP-NEUT) and (ANG-NEUT)], there was a group effect on (HAP-NEUT) where the difference was larger in MDD than HC (p = 0.009) but not on ANG-NEUT (p > 0.05). Findings were independent of memory load. Findings indicate that attentional control to neutral faces is impaired and negatively affected performance on a WM task in adolescents with MDD. Such an impact of neutral faces on attentional control in MDD may be at the core of the social-cognitive impairment observed in this population.     

Factors predicting the Montreal cognitive assessment (MoCA) applicability and performances in a stroke unit

The evaluation of cognitive status is not routine in the acute stroke setting. We aimed to investigate feasibility, applicability, and performances of the Montreal cognitive assessment (MoCA) in acute stroke patients. Consecutive stroke patients (ischemic or hemorrhagic) admitted to one stroke unit were evaluated 5–9 days after stroke with MoCA (score range: 0–30; higher scores indicate better cognitive performance). Pre-morbid functional and cognitive status was assessed by a structured interview to caregivers. Neuroimaging data regarding index stroke and pre-existing lesions were collected. From December 2009 to December 2010, out of 207 patients with stroke, 137 (66 %) were enrolled [mean age 69.2 ± 14.8 years; males 62 %; mean National Institute of Health and Stroke Scale (NIHSS) score 5.9 ± 7.9]. The most common reason for non-enrolment was unfitting the time window inclusion criteria. MoCA was entirely applicable to 113/137 (82.5 %) patients and the mean score was 17.8 ± 7.1. Multivariate analyses showed that non-applicability was associated with higher NIHSS scores [OR (95 % CI) = 1.4 (1.2–1.7) for each point], left sided lesions [OR (95 % CI) = 18.8 (2.3–155.2)], and worse pre-morbid functional status [OR (95 % CI) = 0.7 (0.6–0.9) for each point of the instrumental activity of daily living scale]. Factors influencing MoCA performance were low education (β = 0.264, p < 0.01), higher NIHSS scores (β = ?0.277, p < 0.01) and worse pre-morbid functional status (β = 0.504, p < 0.001). MoCA administration is feasible in acute patients with mild-to-moderate stroke, with lesion location, stroke severity, and pre-morbid functional status as major determinants of its applicability and performance. MoCA seems to reveal some degree of cognitive deficit even in patients with mild stroke.     

Driving Behaviors in Adults with Autism Spectrum Disorders

This pilot study investigated driving history and driving behaviors between adults diagnosed with autism spectrum disorders (ASD) as compared to non-ASD adult drivers. Seventy-eight licensed drivers with ASD and 94 non-ASD comparison participants completed the Driver Behavior Questionnaire. Drivers with ASD endorsed significantly lower ratings of their ability to drive, and higher numbers of traffic accidents and citations relative to non-ASD drivers. Drivers with ASD also endorsed significantly greater numbers of difficulties on the following subscales: intentional violations, F(1, 162) = 6.15, p = .01, η _p ²  = .04; mistakes, F(1, 162) = 10.15, p = .002, η _p ²  = .06; and slips/lapses, F(1, 162) = 11.33, p = .001, η _p ²  = .07. These findings suggest that individuals with ASD who are current drivers may experience more difficulties in driving behaviors and engage in more problematic driving behaviors relative to non-ASD drivers.     

Long-range gamma phase synchronization as a compensatory strategy during working memory in high-performing patients with schizophrenia

Working memory deficits in schizophrenia may be associated with impairments in the integration of neural activity across a distributed network of cortical areas. However, evaluation of the contribution of this integration to working memory impairments in patients is severely confounded by behavioral performance. In the present multidimensional-neuroimaging study, measures of neural oscillations at baseline and during a working memory task, baseline gamma-aminobutyric acid (GABA) level in the left dorsolateral prefrontal cortex (DLPFC), and behavioral performance were obtained. Controlling behavioral performance by recruiting only “high-performing” patients with schizophrenia, we investigated whether the strength of cross-area communications differs between patients with schizophrenia and healthy participants under accurate and equivalent behavioral performance. Results of phase-locking value indicated that these high-performing patients recruited significantly more between frontal and occipital regions in the left hemisphere, t(13) = ?2.16, p = .05, Cohen’s d = ?1.20, and between frontal and temporal regions in the right hemisphere, t(13) = ?2.63, p = .02, Cohen’s d = ?1.46. These cross-area communication patterns may be associated with visuoverbal and visuospatial working memory networks of the left and right hemispheres, respectively. Moreover, correlations of patient’s cross-area communication with in vivo GABA levels of the left DLPFC revealed a significant positive relationship (r = .77, p = .04), demonstrating that the critical role of GABA functions in gamma band oscillations may go beyond local neuronal assemblies in the left DLPFC. Altogether, these exploratory findings point to the heterogeneity among schizophrenia patients and highlight the notion that high-performing patients may engage in potential compensatory mechanisms and may represent a subgroup of patients that may be categorically or dimensionally divergent in psychopathology.     

Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices

Background

Patients with traumatic brain injuries (TBIs) have an increased risk of developing a deep vein thrombosis (DVT), but the risk of hemorrhage expansion with intracranial monitoring devices remains unknown. We sought to determine the safety of chemical DVT prophylaxis in severe TBI patients with invasive intracranial pressure monitors.

Methods

We retrospectively reviewed all patients with severe TBI admitted to the neurosurgical intensive care unit of a large tertiary care center over a three-year period.

Results

155 patients were included with an incidence of DVT of 12 %. The median length of time to a stable head CT was 2 days, and the median time to initiation of chemical DVT prophylaxis was 3.6 days. The odds of DVT increased with intraparenchymal hemorrhage [OR 7.21, 95 % CI (1.43–36.47), p = 0.0169], non-White ethnicity [OR 7.86, 95 % CI (1.23–50.35), p = 0.0295], female gender [OR 13.93, 95 % CI (2.47–78.73), p = 0.0029], smoking [OR 4.32, 95 % CI (1.07–17.51), p = 0.0405], no anticoagulation [OR 25.39, 95 % CI (4.26–151.48), p < 0.001], and an IVC filter [OR 15.82, 95 % CI (3.14–79.76), p < 0.001]. Twenty-eight (18 %) of these subjects experienced in-hospital mortality. The risk of in-hospital death was significantly increased among those who did not receive anticoagulation. This study found no association between DVT formation, hemorrhage expansion, or increased risk from invasive monitoring devices between various doses of unfractionated heparin (UH) and low-molecular-weight heparin (LMWH).

Conclusion

We conclude that DVT prophylaxis with either LMWH or UH is safe with intracranial pressure monitors in place.

     

Dissociation between facial and bodily expressions in emotion recognition: A case study

Objective: Existing single-case studies have reported deficit in recognizing basic emotions through facial expression and unaffected performance with body expressions, but not the opposite pattern. The aim of this paper is to present a case study with impaired emotion recognition through body expressions and intact performance with facial expressions. Methods: In this single-case study we assessed a 30-year-old patient with autism spectrum disorder, without intellectual disability, and a healthy control group (n = 30) with four tasks of basic and complex emotion recognition through face and body movements, and two non-emotional control tasks. To analyze the dissociation between facial and body expressions, we used Crawford and Garthwaite’s operational criteria, and we compared the patient and the control group performance with a modified one-tailed t-test designed specifically for single-case studies. Results: There were no statistically significant differences between the patient’s and the control group’s performances on the non-emotional body movement task or the facial perception task. For both kinds of emotions (basic and complex) when the patient’s performance was compared to the control group’s, statistically significant differences were only observed for the recognition of body expressions. There were no significant differences between the patient’s and the control group’s correct answers for emotional facial stimuli. Conclusions: Our results showed a profile of impaired emotion recognition through body expressions and intact performance with facial expressions. This is the first case study that describes the existence of this kind of dissociation pattern between facial and body expressions of basic and complex emotions.     

Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis

We performed this systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan, a selective serotonin agonist, compared to placebo or other migraine therapeutics for the treatment of acute migraine attacks. We searched PubMed, SCOPUS, Embase, and Cochrane CENTRAL for relevant randomized controlled trials (RCTs). Data were extracted from eligible studies and pooled as risk ratios (RR), using RevMan software. We performed subgroup and meta-regression analyses for different doses and treatment endpoints. Sixteen RCTs (n = 5925 patients) matched our inclusion criteria. The overall effect-estimate showed that intranasal sumatriptan was superior to placebo in terms of pain relief (RR = 1.70, 95% CI [1.31, 2.21], p < 0.0001) and headache relief (RR = 1.58, 95% CI [1.35, 1.84], p < 0.00001) at 2 h. Although sumatriptan was superior to placebo in terms of headache relief at 30 min (RR = 1.31, 95% CI [1.08, 1.59], p = 0.005), no significant difference was found between both groups in terms of the frequency of pain-free participants at 30 min (RR = 1.18, 95% CI [0.49, 2.88], p = 0.71). Subgroup analysis and meta-regression models showed that increasing the dose of sumatriptan reduced the time needed for headache relief; however, this clinical improvement with higher doses was associated with more frequent adverse events in comparison to smaller doses. In conclusion, intranasal sumatriptan is effective for the treatment of acute migraine attacks. However, it was associated with a six-fold increase in the risk of taste disturbance, compared to the placebo. Future RCTs are recommended to provide head-to-head comparison of different administration routes and drug formulations of sumatriptan.     

Impairment in face processing in autism spectrum disorder: a developmental perspective

Findings on face identity and facial emotion recognition in autism spectrum disorder (ASD) are inconclusive. Moreover, little is known about the developmental trajectory of face processing skills in ASD. Taking a developmental perspective, the aim of this study was to extend previous findings on face processing skills in a sample of adolescents and adults with ASD. N = 38 adolescents and adults (13–49 years) with high-functioning ASD and n = 37 typically developing (TD) control subjects matched for age and IQ participated in the study. Moreover, n = 18 TD children between the ages of 8 and 12 were included to address the question whether face processing skills in ASD follow a delayed developmental pattern. Face processing skills were assessed using computerized tasks of face identity recognition (FR) and identification of facial emotions (IFE). ASD subjects showed impaired performance on several parameters of the FR and IFE task compared to TD control adolescents and adults. Whereas TD adolescents and adults outperformed TD children in both tasks, performance in ASD adolescents and adults was similar to the group of TD children. Within the groups of ASD and control adolescents and adults, no age-related changes in performance were found. Our findings corroborate and extend previous studies showing that ASD is characterised by broad impairments in the ability to process faces. These impairments seem to reflect a developmentally delayed pattern that remains stable throughout adolescence and adulthood.     

Changes in cortical thickness in the frontal lobes in schizophrenia are a result of thinning of pyramidal cell layers

Decreased cortical thickness and reduced activity as measured by fMRI in the grey matter of the subgenual cingulate cortex have been reported in schizophrenia and bipolar disorder, and cortical grey matter loss has been reliably reported in the frontal and temporal lobes in schizophrenia. The aim of this study was to examine the thickness of each of the six cortical layers in the subgenual cingulate cortex, five frontal lobe and four temporal lobe gyri. We examined two separate cohorts. Cohort 1 examines the subgenual cingulate cortex (SCC) in schizophrenia (n = 10), bipolar disorder (n = 15) and major depressive disorder (n = 20) against control subjects (n = 19). Cohort two examines frontal and temporal gyri in schizophrenia (n = 16), major depressive disorder (n = 6) against matched controls (n = 32). The cohorts were selected with identical clinical criteria, but underwent different tissue processing to contrast the effect of chemical treatment on tissue shrinkage. Measurements of layer I-VI thickness were taken from cresyl-violet- and haematoxylin-stained sections in cohort one and from cresyl-violet- and H&E-stained sections in cohort two. SCC cortical thickness decreased in male subjects with bipolar disorder (p = 0.048), and male schizophrenia cases showed a specific decrease in the absolute thickness of layer V (p = 0.003). Compared to controls, the relative thickness of layer V in the crown of the SCC decreased in schizophrenia (p < 0.001). A significant decrease in total cortical thickness was observed across the frontal lobe in schizophrenia (p < 0.0001), with specific pyramidal layer thinning in layers III (p = 0.0001) and V (p = 0.005). There was no effect of lateralization. No changes were noted in temporal lobe cortical thickness. This study demonstrates diminished pyramidal layer thickness resulting in decreased frontal lobe thickness in schizophrenia.