The involvement of astrocytes in early-life adversity induced programming of the brain

Early-life adversity (ELA) in the form of stress, inflammation, or malnutrition, can increase the risk of developing psychopathology or cognitive problems in adulthood. The neurobiological substrates underlying this process remain unclear. While neuronal dysfunction and microglial contribution have been studied in this context, only recently the role of astrocytes in early-life programming of the brain has been appreciated. Astrocytes serve many basic roles for brain functioning (e.g., synaptogenesis, glutamate recycling), and are unique in their capacity of sensing and integrating environmental signals, as they are the first cells to encounter signals from the blood, including hormonal changes (e.g., glucocorticoids), immune signals, and nutritional information. Integration of these signals is especially important during early development, and therefore we propose that astrocytes contribute to ELA induced changes in the brain by sensing and integrating environmental signals and by modulating neuronal development and function. Studies in rodents have already shown that ELA can impact astrocytes on the short and long term, however, a critical review of these results is currently lacking. Here, we will discuss the developmental trajectory of astrocytes, their ability to integrate stress, immune, and nutritional signals from the early environment, and we will review how different types of early adversity impact astrocytes.     

Identification of early self-injurious behaviour in young children with intellectual disability

Very little is known about the early stages of self-injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well-established SIB in older individuals. In the present initial study, teachers in special schools for children under 11 years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self-injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children's behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with 'early' SIB. The index children's skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIB, suggesting that these characteristics may be important risk markers. The index children were also observed at 3-month intervals at school over the following 18 months and self-injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child's behaviour at time 1 by the teacher, no other variables predicting increases in SIB.     

Family peer support work in an early intervention youth mental health service

This paper describes the evolution of a family peer support programme in an early intervention service in Melbourne, Australia. In response to policy directions from Federal and State governments calling for carer participation in public mental health services, and feedback from the families of young people at Orygen Youth Health, the ‘Families Helping Families’ project was developed. The positive acceptance by families of this innovative programme also warrants further exploration. The programme has overcome many organizational hurdles associated with specifically trained and employed family carers working alongside professional mental health clinicians. This article describes the change processes involved in implementing this programme and documents preliminary expressions of the benefits of family peer support. The contribution of lived experience in treatment and consumer care plans needs rigorous research and evaluation.     

全膝关节置换后的感染防治

背景：感染造成的骨缺损、骨质疏松、皮肤伤口问题以及多次清创后导致的软组织丢失和瘢痕增生使翻修变得非常困难。 目的：综述全膝关节置换后感染的预防、诊断、有效治疗及康复评价的最新进展，从而建立标准化的临床预防与治疗机制。 方法：应用计算机检索1990-01/2010-12 CNKI数据库、Pubmed数据库相关文章，检索词为“total knee arthroplasty, infection”共检索到文献2 346篇，并参阅其他相关的著作，最终纳入符合标准的文献30篇。 结果与结论：感染的预防比感染的治疗更为有效。目前在诊断上，还缺乏明确诊断的特异性指针。在治疗上，彻底清创、选择有效抗生素及翻修术能够有效地治疗感染。同时新方法的应用有望提高全膝置换后感染的成功率。康复锻炼是治疗延续，也是治疗的重要步骤。为此，在全膝关节置换的基础上应该建立置换后感染的早期预防、早期诊断、有效治疗及康复评价体系，以尽量减少感染的发生及对感染进行及时有效的治疗。     

Improving detection of first-episode psychosis by mental health-care services using a self-report questionnaire

Objective: To examine the utility of the Community Assessment of Psychic Experiences (CAPE)‐42, a self‐report questionnaire, to improve detection of first‐episode psychosis in new referrals to mental health services. Method: At first contact with mental health‐care services patients were asked to complete the CAPE‐42 and were then routinely diagnosed by a clinician. Standard diagnoses were obtained by means of the mini‐Schedule for Clinical Assessment in Neuropsychiatry. Results: Of the 246 included patients, 26 (10.6%) were diagnosed with psychosis according to the mini‐Schedule for Clinical Assessment in Neuropsychiatry. Only 10 of them were recognized by clinical routine, and 16 psychotic patients were not properly identified. Using an optimal cut‐off of 50 on the frequency or distress dimension of the positive subscale of the CAPE‐42 detected 14 of these misdiagnosed patients. The sensitivity of the CAPE‐42 at this cut‐off point was 77.5 and the specificity 70.5. Conclusion: Systematic screening of patients using a self‐report questionnaire for psychotic symptoms improves routine detection of psychotic patients when they first come into contact with mental health services.     

The role of disturbed sleep in the early recognition of bipolar disorder: a systematic review

Ritter PS, Marx C, Bauer M, Lepold K, Pfennig A. The role of disturbed sleep in the early recognition of bipolar disorder: a systematic review.
Bipolar Disord 2011: 13: 227–237. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S. Objectives: Severely disturbed sleep is known to occur during and shortly prior to the onset of mood episodes in bipolar disorder. Whether alterations in sleep occur parallel and as part of the disease process or whether they represent a trait existent before the onset of the disorder itself remains unclear. Methods: A systematic review evaluating all published data on the occurrence of disordered sleep prior to the onset of the first mood episode was conducted. Results: The evidence cited within this paper suggests that sleep disturbances frequently precede bipolar disorder by several years and convey an elevated long‐term risk for developing any kind of mood disorder. Disordered sleep appears to emerge about the time of puberty and remains persistently elevated in individuals at high risk. Conclusion: Disturbed sleep appears to be an early symptom of bipolar disorder but further research, especially longitudinal studies in individuals at high risk, will be required to characterize the type and patterns more precisely.     

Childhood violence exposure and social deprivation are linked to adolescent threat and reward neural function

BackgroundChildhood adversity is, unfortunately, highly prevalent and strongly associated with later psychopathology. Recent theories posit that two dimensions of early adversity, threat and deprivation, have distinct effects on brain development. The current study evaluated whether violence exposure (threat) and social deprivation (deprivation) were associated with adolescent amygdala and ventral striatum activation, respectively, in a prospective, well-sampled, longitudinal cohort using a pre-registered, open science approach.MethodsOne hundred and sixty-seven adolescents from the Fragile Families and Child Wellbeing Study completed functional magnetic resonance imaging (fMRI) scanning. Prospective longitudinal data from ages 3, 5 and 9 years were used to create indices of childhood violence exposure and social deprivation. We evaluated whether these dimensions were associated with adolescent brain function in response to threatening and rewarding faces.ResultsChildhood violence exposure was associated with decreased amygdala habituation (i.e. more sustained activation) and activation to angry faces in adolescence, whereas childhood social deprivation was associated with decreased ventral striatum activation to happy faces in adolescence. These associations held when adjusting for the other dimension of adversity (e.g., adjusting for social deprivation when examining associations with violence exposure), the interaction of the two dimensions of adversity, gender, internalizing psychopathology, and current life stress.ConclusionsConsistent with recent theories, different forms of early adversity were associated with region-specific differences in brain activation.     

An investigation of the association between seizures,autism symptomology,and developmental functioning in young children

ABSTRACT

Objective: The aim of the present study was to explore whether a history of seizures was associated with autism symptom severity and developmental functioning in young children.

Methods: Autism symptom severity and developmental functioning were compared between children with and without a history or seizures who either had atypical development or met criteria for autism spectrum disorder (ASD) based on review of records by a licensed clinical psychologist.

Results: Parents of children who met criteria for ASD reported lower levels of autism symptomology when the child had a history of seizures, while the opposite trend was found for children with atypical development. Participants without ASD or seizures had greater developmental functioning than the other groups.

Conclusion: The present study emphasizes the need for early identification and diagnosis of both ASD and seizure disorders, as timely intervention for these two conditions may be related to improved outcomes for young children.     

‘Programma2000’: a multi-modal pilot programme on early intervention in psychosis underway in Italy since 1999

Aim: The aim of this study was to describe a service operating in Milan, Italy, that provides early intervention for young people aged 17–30 years at the onset and at high risk of psychosis. Method: Following 2 years of preliminary study and organization, Programma2000 was launched in Milan in 1999. This programme was targeted at early detection and intervention in subjects at the onset of, at risk of, or showing ‘prodromal’ signs of psychosis. This paper contains data on the organization and activities of Programma2000. Results: The service has been active since its launch and has received 378 referrals as of March 2009, 342 of which were thoroughly evaluated. At entry, patients undergo a detailed evaluation of their psychopathology, personal and social role functioning, and cognitive status, with repeated testing over time in order to multidimensionally assess outcome. Treatment involves cognitive–behavioural psychotherapy, structured and unstructured psychosocial interventions, and pharmacotherapy when deemed necessary. Treatment appears effective in reducing morbidity and improving social functioning. Conclusion: A team dedicated to the early identification and treatment of young people with early psychosis is a feasible and sustainable extension of the traditional methods of care for people with mental disorders in Italy.