Does early intervention in infants at high risk for a developmental motor disorder improve motor and cognitive development?

Infants at high risk for developmental motor disorders are in general referred to early intervention (EI) services. It is a matter of debate to which extent EI may facilitate outcome in various developmental domains. We reviewed the effects of EI programmes aiming at promoting motor and cognitive development. With respect to motor development the data indicated that EI prior to term age probably is most effective when it aims at mimicking the intrauterine environment; after term age general developmental programmes probably are most effective. Some evidence was provided that EI prior to term age has a beneficial effect on cognitive development regardless the type of intervention which is applied. After term age only general developmental programmes seemed to have an effect on cognitive development. The review concludes with preliminary data on the effect a new intervention programme, COPCA, applied between 3 and 6 months corrected age on developmental outcome till 18 months. The results indicated that COPCA was more beneficial for the development of sitting behaviour and cognition than traditional paediatric physiotherapy.     

Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group

Background: Bipolar affective disorder (BPAD) has considerable implications for personal and social functioning. However a tendency to be over‐represented in high socio‐economic classes has been reported in earlier studies, suggesting that social disadvantage accompanying the illness is not severe. In addition, an association between affective disorders in general and increased residential mobility has been suggested, but it is unclear if such an association exists with BPAD. Objectives: (1) To investigate the suggestion made in previous studies that patients with bipolar disorder are advantaged socially. (2) To test the hypothesis that patients with bipolar disorder show greater residential mobility compared with other patients with psychiatric disorders. Method: Ninety patients with DSM IV diagnosis of bipolar disorder admitted to the acute in‐patient unit of a public‐financed district psychiatric service in Dublin were compared with a control group of 91 randomly selected patients with other psychiatric diagnoses, excluding schizophrenia. Socio‐economic, educational and employment ratings were compared, and also duration of illness, frequency of admission and residential mobility. The data were collected retrospectively from case notes and through semistructured interviews with patients or their relatives. The bipolar group was compared with the control group and to the unipolar depression subgroup. Results: The bipolar and control groups were found to have similar demographic and socio‐economic features, although the bipolar group had more years of education compared with the whole control group but not when compared with the unipolar depression group. The bipolar group showed longer duration of psychiatric disorder, more frequent hospital admissions and more frequent residential moves since the onset of the illness. Conclusion: Bipolar patients requiring in‐patient care in this service experience severe disruption to their lives over prolonged periods.     

Are patients with pituitary adenomas at an increased risk of mental disorders?

OBJECTIVE: Retrospective clinical studies suggest that patients with pituitary adenoma (PA) have an increased risk of mental disorders. However, empirical evidence for this hypothesis is deficient because of out-dated methodology. Therefore, we investigated the occurrence of mental disorders in 93 patients with PA within a limited time frame of 2 years.METHOD: Patients were subjected to a comprehensive, standardized lifetime and cross-sectional psychopathological symptom and diagnostic assessment, including an evaluation of psychosocial conditions and life events (CIDI, SCL-90) during the past years.RESULTS: We could not find an increased risk of mental disorders as compared with a representative population sample of 481 subjects matched by age and gender.CONCLUSION: As for our random sample, neither suffering from any type of PA nor the extent of the pituitary deficiency represent factors having significant effect on the risk of the subject to develop psychopathology as compared with the general population.     

Are patients with encephalocraniocutaneous lipomatosis at increased risk of developing low-grade gliomas?

Introduction  

Cancer-prone genetic disorders are responsible for brain tumors in a considerable proportion of children. Additionally, rare genetic syndromes associated to cancer development may potentially disclose genetic mechanisms related to oncogenesis.     

A pilot randomised controlled trial to compare changes in quality of life for participants with early diagnosis dementia who attend a ‘Living Well with Dementia’ group compared to waiting-list control

Objectives: The aim of this paper is to report a pilot study in which participants who had recently received a diagnosis of dementia were randomised to either a 10-week group intervention or a waiting-list control.

Method: Memory clinic staff with limited previous experience of group therapy were trained to lead a 10-week group therapy intervention called ‘Living Well with Dementia’. Fifty-eight participants, all of whom had received a diagnosis of Alzheimer's disease, vascular or Lewy body dementia within the previous 18 months, were randomised to receive either the intervention or treatment as usual (waiting-list control). Data collection occurred at baseline, within two weeks after the intervention finished and at 10-week follow-up.

Results: The study met its recruitment targets, with a relatively low attrition rate for the intervention arm. The acceptability of the intervention and research methods was examined qualitatively and will be reported on elsewhere. For the primary outcome, measure of quality of life in Alzheimer's disease (QoL-AD), and secondary outcome, self-esteem, there was some evidence of improvement in the intervention group compared to the control group. There was, also, evidence of a reduction in cognitive functioning in the treatment group compared to the control. Such reported differences should be treated with caution because they are obtained from a pilot and not a definitive study.

Conclusion: This pilot study succeeded in collecting data to inform a future definitive cost effectiveness clinical trial of Living Well with Dementia group therapy.     

Assessment of early mother–child relation in infants with oesophageal atresia

Fifteen one-year old infants with oesophageal atresia and their parents were used to demonstrate how the Parent–Child Early Relational Assessment (PCERA) can be used to explore the mother–child interaction in a clinical sample of children. The infants and their mothers were videotaped for 5-min episodes during feeding and free play, and the quality of the mother–infant interactions was assessed by PCERA. The results showed areas of strength regarding most of the maternal, infant and dyadic components. There was concern about maternal positive physical contact, maternal quality of verbalizations to or about the child, maternal social initiative, infant's communicative competence and infant's visual contact with mother. This concern of social proximity between infants and their mothers was most prominent in the feeding situation. The present study indicates that oesophageal atresia in infants may constitute stressors impinging on the parent–infant relationship. PCERA was found to be an adequate assessment tool with acceptable reliability to evaluate the mother–infant interaction.     

Asymmetrical motor behaviour as a window to early leg preference: a longitudinal study in infants 7–12 months of age

This longitudinal study explored leg preference in infancy during half-kneel pulling-to-stand (PTS) and asymmetrical four-point kneeling, which is part of the typical motor repertoire of infants. The special characteristics of the half-kneel PTS as a discrete task, performed in a bilateral context provide the opportunity to explore leg preference during an asymmetrical behaviour. Twenty-seven infants were observed in their homes, every 3 weeks between the ages of 7–12 months. Leg preference was determined by the “lead-out” limb used as the infants pulled to stand from the half-kneeling position (half-kneel PTS). As a complementary measure, the leading leg during asymmetrical four-point kneeling and crawling (“asymmetrical four-point patterns”) was used in the 10 infants who developed these patterns. The infants studied showed a general preference for using a leading leg during half-kneel PTS, which was mostly consistent over the study period. A strong correlation was found between leg preferences during half-kneel PTS and asymmetrical four-point patterns. The findings documented functional asymmetry in infant lower limbs during half-kneel PTS and asymmetrical four-point patterns, highlighting the importance of the tasks used to define leg preference.     

Out of the group,out of control? The brain responds to social exclusion with changes in cognitive control

The effects of social exclusion are far-reaching, both on an emotional and behavioral level. The present study investigates whether social exclusion also directly influences basic cognitive functions, specifically the ability to exert cognitive control. Participants were either excluded or included while playing an online game. To test whether exclusion altered cognitive control, we measured the electrophysiological responses to a Go/No Go task. In this task participants had to withhold a response (No Go) on a small number of trials while the predominant tendency was to make an overt (Go) response. Compared to Go trials the event-related potential evoked by No Go trials elicited an increased N2, reflecting the detection of the response conflict, followed by an increased P3, reflecting the inhibition of the predominant response. The N2 effect was larger for participants who had experienced exclusion, while the P3 effect was smaller. This indicates that exclusion leads to an increased ability to detect response conflicts, while at the same time exclusion decreases the neural processes that underlie the inhibition of unwanted behavior.     

The Kløve-Matthews static steadiness test compared with the DPD TREMOR. Comparison of a fine motor control task with measures of tremor in smokers and manganese-exposed workers

The aim of this study was to compare two tests for tremor/fine motor control as regards their sensitivity in relation to effects on tremor of exposure to manganese and cigarette smoke. One hundred manganese-exposed workers were compared with 100 age-matched referents. The subjects were tested with the Kl?ve-Matthews static steadiness test (hole tremormeter) and the DPD TREMOR (accelerometer). The manganese-exposed subjects showed increased postural tremor compared to the referents. The tremor had a larger frequency dispersion among the exposed subjects than among the referents as assessed by the TREMOR 7.0 test system, indicating that the tremor had a pattern where the power was burned at a wider spectre of frequencies among the exposed subjects than among the referents. The two tests differed in their ability to demonstrate tremor, depending of the type of exposure (manganese or cigarette smoke). The static steadiness test was better than the TREMOR at discriminating between manganese-exposed subjects and referents while the TREMOR was better at discriminating between smokers and non-smokers than the static steadiness test. The tests also differed in their ability to demonstrate tremor depending on the frequency of tremor. The Tremor Intensity I was higher for subjects with higher tremor frequency, while no such effect was found for the static steadiness test parameters. When studying the effects of exposures where the quality of the tremor is unknown, it is suggested to include at least two tremor tests, one based on acceleration and the other on displacement.     

Depressed preschoolers with bipolar family history: a group at high risk for later switching to mania?

Earlier age of onset of an episode of depression and family history of bipolar disorder (FHBPD) are well known to be associated with increased rates of switching to mania in childhood major depressive disorder (MDD). These findings suggest that the youngest samples of depressed children who have FHBPD might be at very high risk for switching. The finding of a valid depressive syndrome in preschool children has raised the question of whether mania could also manifest at this early stage. We investigated FHBPD among three preschool study groups: a depressed group and two nondepressed comparison groups (attention deficit hyperactivity disorder/oppositional defiant disorder, no disorder). Increased FHBPD was found among the depressed group. Based on this, we explored whether the depressed subgroup with FHBPD (MDD + FHBPD) had a unique constellation of depressive symptoms compared to the depressed subgroup without FHBPD (MDD with no FHBPD). The MDD + FHBPD group was found to have an increased frequency of the MDD symptom of "restlessness and moves around a lot" as compared with the MDD with no FHBPD group. The question of whether this symptom could be an early precursor of later mania was explored. These findings taken together suggest that early risk factors for switching to mania may be present in a subgroup of depressed preschoolers. Longitudinal follow-up of depressed preschool samples to determine rates of switching to mania later in development is critical to determine whether such findings represent early risk factors. Future studies that directly investigate age-appropriate mania manifestations in preschool samples are now warranted.     

School refusal behaviour: Are children and adolescents with autism spectrum disorder at a higher risk?

School refusal behaviour in students with autism spectrum disorder (ASD) is poorly studied despite being considered a serious problem. This study assessed the frequency, duration, and expression of school refusal behaviour in students with ASD, aged 9–16 years, without intellectual disability. Further, the associations between school refusal behaviour and sociodemographic factors were explored. Teachers and parents assessed this behaviour over 20 days in a cross-sectional study of 216 students, including 78 students with ASD and 138 typically developing (TD) students. School refusal behaviour was significantly higher in students with ASD as compared to TD students. Significant associations were found between school refusal behaviour and illness of other family members. The study concludes that school refusal behaviour is pervasive in students with ASD.     

Rotigotine transdermal system for control of early morning motor impairment and sleep disturbances in patients with Parkinson’s disease

This open-label study (NCT00243945) investigated the efficacy of rotigotine transdermal system in 54 Parkinson’s disease (PD) patients with unsatisfactory control of early morning motor impairment and sleep disturbances. Rotigotine dose was up titrated for 8 weeks and maintained for 4 weeks. Mean rotigotine dose at end of maintenance was 11.83 mg/24 h (SD 3.86). Patients had two overnight hospital stays at baseline and end of treatment during which early morning motor performance was assessed, prior to first morning dose of regular oral antiparkinsonian medication. Rotigotine improved mean Unified Parkinson’s Disease Rating Scale (UPDRS) part III score by −9.3 points, mean Timed Up and Go test duration by −1.4 s and mean morning finger tapping by 26.5 taps/min; 46% of patients were considered responders (≥30% improvement of UPDRS III). Mean Nocturnal Akinesia, Dystonia and Cramps Sum Score was reduced by 61%; mean number of nocturias decreased by 32%. Rotigotine also improved sleep quality. These results suggest a role for rotigotine in treatment of nocturnal and early morning motor disabilities in PD patients.     

Are children and adolescents with food allergies at increased risk for psychopathology?

ObjectiveLiving with food allergy is a unique and potentially life-threatening stressor that requires constant vigilance to food-related stimuli, but little is known about whether adolescents with food allergies are at increased risk for psychopathology—concurrently and over time.MethodsData came from the prospective-longitudinal Great Smoky Mountains Study. Adolescents (N = 1420) were recruited from the community, and interviewed up to six times between ages 10 and 16 for the purpose of the present analyses. At each assessment, adolescents and one parent were interviewed using the Child and Adolescent Psychiatric Assessment, resulting in N = 5165 pairs of interviews.ResultsCross-sectionally, food allergies were associated with more symptoms of separation and generalized anxiety, disorder, attention deficit and hyperactivity disorder, and anorexia nervosa. Longitudinally, adolescents with food allergy experienced increases in symptoms of generalized anxiety disorder and depression from one assessment to the next. Food allergies were not, however, associated with a higher likelihood of meeting diagnostic criteria for a psychiatric disorder.ConclusionThe unique constellation of adolescents' increased symptoms of psychopathology in the context of food allergy likely reflects an adaptive increase in vigilance rather than cohesive syndromes of psychopathology. Support and guidance from health care providers is needed to help adolescents with food allergies and their caregivers achieve an optimal balance between necessary vigilance and hypervigilance and unnecessary restriction.