Fitness-to-drive in neurological disorders

Driving-license holders with health problems are morally obliged to report this to the Driver Licensing Centre (CBR). The CBR can then further investigate the matter and either insist that technical modifications be made to the vehicle or declare the driver (temporarily) unfit to drive a vehicle. After an epileptic seizure a driver may not drive a car or ride a motorcycle for six months. Following multiple seizures this period is extended to one year after the last seizure. Exceptions can be made only if certain established criteria are fulfilled. Following cerebral infarction or cerebral haemorrhage, the driving-license holder is considered unfit to drive for at least six months. After this period fitness-to-drive is dependent on the presence of any disorders of function and the results of a CBR driving test. Persons with an intracranial tumour are assessed on the presence of any disorders of function and may be given a driving license valid for a limited period of time only. A transient ischaemic attack (TIA) or the chance discovery of an unruptured intracranial aneurysm or vascular malformation which does not need treatment, does not necessarily affect fitness to drive. Persons with syncope, progressive neurological disorders or stationary functional disorders should undergo medical assessment and, if necessary, take a CBR driving test. In the case of all neurological disorders, the rules are stricter for professional drivers of cars and motorcycles as well as holders of driving licenses for heavy-goods vehicles and buses.     

Childhood eating disorders

Eating is a sensitive barometer of emotional state and parent-child interaction. Psychosocial distortions often appear first to the health worker and are referred to the dietitian as distortions in eating. At times, the distortion is severe enough to be called an eating disorder. An eating disorder of childhood is the misuse of feeding in an attempt to solve or camouflage family problems of living that seem otherwise insoluble. The childhood eating disorder might take the form of failure to thrive, obesity, excessive finickiness, or, most commonly, vehement and protracted struggles between parent and child about eating. An eating disorder is a biopsychosocial problem. It is based on characteristics and distortions in physical, physiological, psychological, and social factors. The dietitian who is to be helpful with families referred to her for correction of eating difficulties must be able to detect the disordered situation and differentiate it from one that is simply problematic. If an eating disorder exists, it is unlikely that the situation will change without psychotherapeutic intervention into family functioning. An appropriately conducted symptom management approach to correct the eating distortion is a helpful and potentially successful adjunct to psychotherapy. Such a component should be constructed around the restoration of a positive feeding relationship.     

Role of copper in human neurological disorders

Copper is a trace element present in all tissues and is required for cellular respiration, peptide amidation, neurotransmitter biosynthesis, pigment formation, and connective tissue strength. Copper is a cofactor for numerous enzymes and plays an important role in central nervous system development; low concentrations of copper may result in incomplete development, whereas excess copper maybe injurious. Copper may be involved in free radical production, via the Haber-Weiss reaction, that results in mitochondrial damage, DNA breakage, and neuronal injury. Evidence of abnormal copper transport and aberrant copper-protein interactions in numerous human neurological disorders supports the critical importance of this trace metal for proper neurodevelopment and neurological function. The biochemical phenotypes of human disorders that involve copper homeostasis suggest possible biomarkers of copper status that may be applicable to general populations.     

Gait disorders due to neurological conditions

Gait disorders are seen frequently and often have a neurological cause. The clinical management of patients presenting with a gait disorder is often complicated due to the large number of diseases that can cause a gait disorder and to the difficulties in interpreting a specific gait disorder properly. In addition, the currently available classification systems are confusing. Gait disorders can be classified into the following categories: antalgic, paretic-hypotonic, spastic, vestibular, ataxic, hypokinetic-rigid, cautious, or functional. A correct interpretation of the gait disorder is important as this determines the diseases to be considered, the auxilliary investigations that have to be carried out, and the selection of rational therapeutic options.     

Childhood abuse and risk of eating disorders in women

BACKGROUND: Eating disorders are one of the most common psychiatric disorders among women. Little is known about underlying causes. METHODS: To assess the association between childhood violence victimization and eating disorders, we performed a case-control study of women participating in the Harvard Study of Moods and Cycles, a population-based sample of women 36 to 44 years of age. Cases were women who met the diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder after a structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). A self-administered questionnaire was used to assess a history of abuse as a child. RESULTS: Compared with women who reported no abuse, women who reported childhood physical abuse had twice the odds of suffering from subclinical eating disorder symptoms (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.3-3.3) or meeting DSM-IV criteria for an eating disorder (2.1; 1.1-4.2). Women who reported both physical and sexual abuse during childhood had 3 times the odds of developing eating disorder symptoms (3.0; 1.3-6.8) and nearly 4 times the odds of meeting DSM-IV criteria for an eating disorder (3.9; 1.3-11.5). These associations persisted within the subgroup of women with no depression antecedent to first onset of an eating disorder. CONCLUSIONS: The present study provides additional evidence of an association between preadolescent trauma and psychiatric morbidity.     

Efficacy of BCG vaccine in animal models of neurological disorders

The Bacillus Calmette-Guerin (BCG) vaccine can modulate the immune response via antigen-specific immune response, but also it can confer nonspecific protection and therapeutic benefits in several neurological conditions through different heterologous effects of vaccination. However, the precise mechanism of action of BCG remains unclear. In this review, different mechanisms underlying BCG-mediated immunity will be explained in animal models that reflects characteristic feature of neuroinflammatory and neurodegenerative disorders such as multiple sclerosis, Alzheimer’s and Parkinson’s diseases. Furthermore, evidence for a beneficial effect of the BCG on neuropsychiatric disorders, will be also discussed.     

Childhood abuse and eating disorders in gay and bisexual men

OBJECTIVE: This study examines the association between eating disorders and a history of childhood abuse in gay and bisexual men, and how substance abuse and depression might impact this relationship. METHOD: 193 white, black, Latino gay, and bisexual men were sampled from community venues. DSM-IV diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview. RESULTS: Men with a history of childhood sexual abuse are significantly more likely to have subclinical bulimia or any current full-syndrome or subclinical eating disorder compared with men who do not have a history of childhood sexual abuse. A history of depression and/or substance use disorders did not mediate this relationship. CONCLUSION: Researchers should study other potential explanations of the relationship between a history of childhood abuse and eating disorders in gay and bisexual men. Clinicians working with gay and bisexual men who have a history of childhood abuse should assess for disordered eating as a potential mechanism to cope with the emotional sequelae associated with abuse.     

Childhood maltreatment in adult female psychiatric outpatients with eating disorders

To explore possible relations between maltreatment in childhood and subsequent eating disorders in adult life, 107 consecutive adult psychiatric female outpatients were screened for eating disorders. They also completed questionnaires about harassment by adults and bullying by peers in childhood. The Childhood Trauma Questionnaire measured childhood abuse by parents or other adults, and the Parental Bonding Instrument captured parental coldness and overprotection. Bullying by peers was measured by an inventory used in schools. Outpatients who met the criteria for bulimia nervosa reported far more bullying by peers, more coldness and overprotection from fathers, and more childhood emotional, physical and sexual abuse. The findings suggest associations between childhood maltreatment, especially bullying by peers, and bulimia nervosa.     

Impact of COVID-19 lockdown in children with neurological disorders in Italy

BackgroundThe costs and benefits of full lockdown measures are debated. Neurologically impaired children are a vulnerable population with specific needs in terms of protection against infection and access to health services.ObjectivesWe investigated the effects of lockdown on the health of children with neurological disorders and on their access to care during lockdown.MethodsData from 514 children (282 males – 232 females) were collected through physician-administered interviews to investigate: the occurrence of viral-like physical symptoms, the correlation between the risk of developing such symptoms and several demographic and clinical variables, the occurrence of any worsening of the children's neurological conditions during lockdown, and their access to care services during this period.Results49.1% experienced at least one symptom during the study period, but no child developed severe complications. The prevalence of symptoms was significantly lower during lockdown than during the previous two months. The underlying neurological condition worsened in 11.5% of the patients. Children who regularly left the home during lockdown were greater risk of exhibiting symptoms. During lockdown, 67.7% had a specialist appointment cancelled, 52.6% contacted their paediatrician, and 30.9% contacted their child neuropsychiatrist. Among patients who usually receive rehabilitation, 49.5% continued remotely.ConclusionLockdown protected children from infections. Telemedicine and telerehabilitation constituted a valid alternative for the care and treatment of these children, but they should not become a widespread and definitive model of care. COVID-19 and other emergency response plans must take into account the specific needs of children with disabilities.