An Application of Differential Reinforcement of Other Behavior and Self-Monitoring to Address Repetitive Behavior

Differential reinforcement of other behavior (DRO) and self-monitoring was used to reduce repetitive challenging behavior in the form of eyelash, eyebrow, and hair pulling exhibited by a 19-year-old woman with an autism spectrum disorder. Treatment evaluation included DRO with competing and non-competing stimuli in a private therapy room. Once the DRO interval exceeded 10 min, treatment was conducted in the participant’s classroom. Results of the study suggested DRO was successful in both environments and across both stimulus types.     

Routine diagnostics for neural antibodies,clinical correlates,treatment and functional outcome

Objective

To determine frequencies, interlaboratory reproducibility, clinical ratings, and prognostic implications of neural antibodies in a routine laboratory setting in patients with suspected neuropsychiatric autoimmune conditions.

Methods

Earliest available samples from 10,919 patients were tested for a broad panel of neural antibodies. Sera that reacted with leucine-rich glioma-inactivated protein 1 (LGI1), contactin-associated protein-2 (CASPR2), or the voltage-gated potassium channel (VGKC) complex were retested for LGI1 and CASPR2 antibodies by another laboratory. Physicians in charge of patients with positive antibody results retrospectively reported on clinical, treatment, and outcome parameters.

Results

Positive results were obtained for 576 patients (5.3%). Median disease duration was 6 months (interquartile range 0.6–46 months). In most patients, antibodies were detected both in CSF and serum. However, in 16 (28%) patients with N-methyl-d-aspartate receptor (NMDAR) antibodies, this diagnosis could be made only in cerebrospinal fluid (CSF). The two laboratories agreed largely on LGI1 and CASPR2 antibody diagnoses (κ = 0.95). The clinicians (413 responses, 71.7%) rated two-thirds of the antibody-positive patients as autoimmune. Antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), NMDAR (CSF or high serum titer), γ-aminobutyric acid-B receptor (GABABR), and LGI1 had ≥ 90% positive ratings, whereas antibodies against the glycine receptor, VGKC complex, or otherwise unspecified neuropil had ≤ 40% positive ratings. Of the patients with surface antibodies, 64% improved after ≥ 3 months, mostly with ≥ 1 immunotherapy intervention.

Conclusions

This novel approach starting from routine diagnostics in a dedicated laboratory provides reliable and useful results with therapeutic implications. Counseling should consider clinical presentation, demographic features, and antibody titers of the individual patient.

     

Rationale and design of the Kidney Precision Medicine Project

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Effects of Ethanol on Mature Offspring of Mice Given Ethanol during Pregnancy

Male offspring of mice maintained on isocaloric liquid diets containing either 20% ethanol or sucrose derived calories during pregnancy were tested on their ability to discriminate different ethanol doses as adults. They were trained to lever-press for a food reward on each of two levers in an operant chamber, and were then maintained on an FR20 reinforcement schedule. After response rates stabilized, ethanol discrimination training was initiated by reinforcing only responses made on the drug appropriate-lever after i.p. injections of ethanol (1.0 g/kg) or water. After learning to discriminate the 1.0 g dose, the animals' ability to discriminate doses of 0.25, 0.50, 0.75, 1.0, and 1.5 g/kg was assessed by determining the percentage of responses made on the drug lever during a 2-min test period. Compared to sucrose controls, mice exposed to alcohol in utero learned the lever response more slowly and were less responsive to injected ethanol as evidenced by a reduced effect of the drug on response rates and by a reduction in their ability to discriminate the presence of injected ethanol. The results indicate that prenatal ethanol exposure can have long term consequences which reduce the effects of ethanol in fully mature animals.