Pediatric Stroke Initiatives and Preliminary Studies: What Is Known and What Is Needed?

Cerebrovascular disorders are increasingly recognized as important causes of mortality and morbidity in the pediatric population. However, there have been no clinical trials performed to assess the safety and tolerability of acute interventions or secondary preventative treatments. In 2002, the International Pediatric Stroke Study was launched to create a network of investigators, with an interest in developing standards of practice, as well as design and implement the first-ever clinical trials in pediatric stroke. This article reviews existing studies in pediatric stroke epidemiology, risk factors, outcomes, as well as experience with antithrombotic trials in children. From there, current and future initiatives in the development of clinical trials in pediatric stroke are evaluated.     

Migraine and Stroke: What’s the Link? What to Do?

Migraine and stroke are common, disabling neurologic disorders, with a high socioeconomic burden. A link between them has been proposed years ago, and various theories have been proposed to explain this bidirectional relation. However, the precise causes remain unclear. We briefly summarize existing hypotheses of this correlation seeking for recommendations for stroke prevention in migraineurs, if any exist. Among the strongest suggested theories of migraine–stroke association are cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, increased prevalence of vascular risk factors, shared genetic defects, cervical artery dissection, and patent foramen ovale. There is no evidence that any preventive therapy in migraineurs should be used to decrease stroke risk, even in most predisposed subset of patients. However, a woman with migraine with aura should be encouraged to cease smoking and avoid taking oral contraceptives with high estrogen doses. We need further investigation to better understand the complexity of migraine–stroke association and to make firm recommendations for the future.     

Prisms and neglect: What have we learned?

Since Rossetti et al. (1998) reported that prism adaptation (PA) can lead to a substantial reduction of neglect symptoms PA has become a hot topic in neglect-research. More than 280 articles have been published in this area. Not all of those studies investigated the therapeutic potential of this technique, many studies examined the responsiveness to PA as a way to subdivide neglect into separate subsyndromes, other studies focussed on the process of PA itself in an effort to illuminate its underlying neurobiological mechanisms. In this article we will review research in all of these three areas to determine whether and to what extent research on PA in neglect patients has fulfilled its promise as a new way to improve the treatment of neglect, enhance our understanding of this complex syndrome and provide new insights into the neurobiology of sensorimotor learning.     

Social Skills Training and ADHD—What Works?

Purpose of Review

Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy.

Recent Findings

We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date.

Summary

SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers’ impressions about youth with ADHD.

     

What is recovery? A conceptual model and explication

This paper describes a conceptual model of recovery from mental illness developed to aid the state of Wisconsin in moving toward its goal of developing a "recovery-oriented" mental health system. In the model, recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery--hope, healing, empowerment, and connection--and external conditions that facilitate recovery--implementation of the principle of human rights, a positive culture of healing, and recovery-oriented services. The aim of the model is to link the abstract concepts that define recovery with specific strategies that systems, agencies, and individuals can use to facilitate it.     

Adolescents’ Perspectives About Brief Psychiatric Hospitalization: What is Helpful and What is Not?

Significant numbers of adolescents receive inpatient psychiatric services, yet we know little about their experiences: what about hospitalization is perceived as helpful and what is counter-productive or even harmful? In this study, eighty adolescents hospitalized for the first time in a psychiatric program were interviewed within a week of discharge (using a semi-structured interview format), and asked to describe what did and did not help them. Multiple themes emerged relating to helpful experiences and these were grouped in three categories: interpersonal support, therapy and psycho-education, and environment; Unhelpful/harmful experiences were classified in four categories: rigidity and confinement, lack of treatment responsiveness, frightening/anxiety-provoking experiences, and other. Participants provided rich feedback that both reinforces existing practices and offers ways for programs to change practices to better meet adolescents’ developmental needs. Some factors noted as key therapeutic ingredients, especially the helpful role of peers, have not previously been included in hospital satisfaction surveys.     

What is schizophrenic in acute and transient psychotic disorder?

Acute and transient psychotic disorder (ATPD) is supposed to differ from schizophrenia, but little research has been done on the subject. In a prospective longitudinal case control study we compared all inpatients with ATPD (ICD-10 F23) treated at Halle University Hospital during a 5-year period with matched controls with "positive" schizophrenia (PS) and with mentally healthy controls. Followup investigations were performed at a mean of 2.2 years after the index episode or 8.2 years after the first episode. Female preponderance in ATPD was marked (78.6%). ATPD and PS patients were similar to each other (but different from healthy controls) in the prevalence of a "broken home" situation and a family history for mental disorders. Compared with PS patients, ATPD patients showed better premorbid social adaptation, and they more often displayed rapidly changing symptoms in the index episode and a negative life event preceding the episode. Despite comparable relapse rates, at followup ATPD patients showed better social adaptation, less psychological impairment, and better global functioning than PS patients. These data support the delineation of ATPD from schizophrenia.     

What about the mental time travel and age-related effects?

According to Tulving, episodic memory allows humans to travel mentally through subjective time into either the past or the future, this ability being at the origin of adaptation, organization and planning of future behavior. The main aim of this review is to present a state of art of episodic mental time travel and a lifespan perspective from children to elderly people. We examine the numerous similarities between remembering the past and envisioning the future which have been highlighted in cognitive, neuroimaging, and neuropsychological studies. We also present studies that have given evidence that remembering the past and imagining the future differ somewhat. We focus on demonstrating that hippocampal dysfunction is associated with disturbances in the recall of episodic autobiographical details in past memories, but also in the imagining of episodic detailed future events. More specifically, we discuss that the future seems to involve higher semantic processes mediated by the inferior frontal and lateral temporal gyri. We propose that the study of mental travel in personal time could be undertaken in line with the distinction between the memory of (episodic) experiences and (semantic) personal knowledge of one's life, which constitutes a major part of the self and constraints what we have been, what we are now, and what we might yet become.     

What is a psychosis and where is it located?

Kraepelin's dichotomy, manic-depressive insanity and dementia praecox, are contrasting and true endogenous disease entities which affect excitability, the fundamental property of the CNS. Kraepelin wanted to establish a valid classification and hit the extremes in brain structure and function at a time when we had no knowledge of brain dysfunction in "functional" psychoses. The aetiology is now known: the psychoses are part of human growth and maturation and might be classified according to their brain dysfunction, which is exactly what Kraepelin wanted. However, presumably to reduce the stigma attached to the word "psychosis", there is currently a strong initiative to eliminate the concept. But knowledge of what is happening in the brain in a psychosis might be more helpful in reducing stigma. It is suggested that psychosis is due to an affection of the supplementary motor area (SMA), located at the centre of the Medial Frontal Lobe network. The SMA is one of the rare universally connected areas of the brain, as should be the case for such a key structure that makes decisions as to the right moment for action. This important network, which partly has continuous neurogenesis, has sufficiently widespread connections. The SMA, a premotor area located on the medial side of the frontal lobes, is one of the last regions to reach a concurrence of synaptogenesis. An affection of the SMA, a deficient or abolished Delayed Response Task, seriously disturbs our relation and adaptation to the surroundings. We usually master the Delayed Response Task around the age of 7 months, a time at which the second CNS regressive event takes place, which proceeds from the posterior to the anterior of the brain. In very late maturation, a persistent affection of the SMA might occur. We experience a chronic psychosis: infantile autism (IA), a chronic inability to act consciously, which contrasts with the episodic SMA affection post-puberty, when excitation is reduced due to excessive pruning of excitatory synapses. Silent spots are the result of insufficient fill-in mechanisms following a breakdown of circuitry. They may affect the SMA in the case of very late puberty. An acute reduction in excitation and concomitantly a marked increase in silent spots might lead to an acute psychosis. A frontal preference is likely, given that a reduction might occur anywhere in the cortex, but particularly in the areas maturing latest. The varying localisations probably explain the difficulty in accepting schizophrenia as a disease entity. The multifactorial inheritance of the dichotomy implies that the genetics are not fate, a psychotic development might be prevented given enough epigenetic factors: brain food (omega 3). Might the present dietary adversity, with its lack of brain food, be responsible for a rising incidence in psychosis? A psychosis is an understandable and preventable dysfunction of the brain, and its mechanisms are known. Primarily a disorder of reduced excitation in an attenuated CNS, this explains why all the neuroleptics are convulsants, raising excitation, in contrast to all antidepressives, which are anti-epileptic.