Mean diffusivity: A biomarker for CSF-related disease and genetic liability effects in schizophrenia

Mean diffusivity (MD), the rotationally invariant magnitude of water diffusion that is greater in cerebrospinal fluid (CSF) and smaller in organized brain tissue, has been suggested to reflect schizophrenia-associated cortical atrophy. Regional changes, associations with CSF, and the effects of genetic predisposition towards schizophrenia, however, remain uncertain. Six-direction diffusion tensor imaging DTI and high-resolution structural images were obtained from 26 schizophrenia patients, 36 unaffected first-degree patient relatives, 20 control subjects and 32 control relatives (N = 114). Registration procedures aligned diffusion tensor imaging (DTI) data across imaging modalities. MD was averaged within lobar regions and the cingulate and superior temporal gyri. CSF volume and MD were highly correlated. Significant bilateral temporal, and superior temporal MD increases were observed in schizophrenia compared with unrelated control probands. First-degree relatives of schizophrenia probands showed larger MD measures compared with controls within bilateral superior temporal regions with CSF volume correction. Superior temporal lobe brain tissue deficits and proximal CSF enlargements are widely documented in schizophrenia. Larger MD indices in patients and their relatives may thus reflect similar pathophysiological mechanisms. However, persistence of regional MD effects after controlling for CSF volume, suggests that MD is a sensitive biological marker of disease and genetic liability, characterizing at least partially distinct aspects of brain structural integrity.     

A population‐based family study of minor depression

Background: There is a paucity of research on whether minor depression is a familial disorder. Methods: We conducted a population‐based family study of minor depression in which subjects were interviewed using the Diagnostic Interview Schedule (DIS). Minor depression only (MDO) was diagnosed if there was a lifetime history of what the DIS refers to as a depressive “spell” and no lifetime history of either Diagnostic and Statistical Manual of Mental Disorders, Third Edition, major depression or dysthymia. There were 71 probands with a lifetime history of MDO; 577 controls with no lifetime history of MDO, major depression, or dysthymia; and 1,539 first‐degree relatives (FDRs). Logistic regression was performed with the presence/absence of MDO in a proband/control as the “exposure” and MDO in an FDR as the “outcome”. Results: The odds ratio for the association between MDO in a proband and MDO in an FDR, after adjusting for age and sex of the FDR, was 1.55 (95% confidence interval: 0.93–2.58; P=.093). The study had 80% power to detect an odds ratio as small as 1.97, which is in the range of odds ratios seen for the familial aggregation of major depression. Conclusions: MDO does not appear to be a familial disorder, raising questions about the validity of “minor depression” as a distinct psychiatric syndrome. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Childhood neglect and abuse as predictors of antidepressant response in adult depression

Background: Childhood neglect and abuse are recognized as risk factors for depression, but are not often studied as predictors of treatment response in depression. Methods: Clinically depressed outpatients (n=195) were asked about childhood experiences before beginning a randomized antidepressant trial with either fluoxetine or nortriptyline. Three treatment outcomes were measured: Adequate trial, six‐week response and two months sustained recovery. Results: Patients reporting low paternal care (paternal neglect), as measured by the Parental Bonding Instrument (PBI), were less likely to complete an adequate six‐week trial of medication. Patients who reported high maternal protection (maternal overprotection) on the PBI had poorer treatment response in the short‐term at six weeks, and longer term, for two months of sustained recovery. However, abuse, whether sexual, physical, or psychological in nature, did not predict treatment response. Conclusions: The experience of having a neglectful father or an overprotective mother was more predictive of response to treatment for depression than abuse, suggesting that the quality of ongoing intra‐familial relationships has a greater impact on treatment outcomes for depression than experiences of discrete abuse in childhood. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Moving Mammogram-Reluctant Women to Screening: A Pilot Study

Background  

Effective interventions are needed for women long overdue for screening mammography.     

Whole‐brain atrophy as a measure of progression in premanifest and early Huntington's disease

Therapeutic trials in Huntington's disease (HD) are challenging as clinical progression is slow and variable and reliable biomarkers are lacking. We used magnetic resonance imaging and the brain boundary shift integral to quantify whole‐brain atrophy rates over 1 year in early and premanifest HD subjects, and controls. Early HD subjects had statistically significantly (P = 0.007) increased (threefold higher) rates of whole‐brain atrophy compared with controls. Higher atrophy rates were associated with longer CAG repeat length. MRI‐based measures of whole‐brain atrophy may have potential as a measure of progression in HD. © 2009 Movement Disorder Society     

Sudden death and the forensic evaluation of neurocutaneous syndromes

On occasion the forensic evaluation of individuals who have died suddenly and unexpectedly may reveal intracranial vascular abnormalities such as capillary, venous- and arteriovenous malformations. Such vascular abnormalities may form part of a heterogeneous group of disorders called neurocutaneous syndromes and involve the skin, nervous system and other organ systems. These unusual conditions include Sturge–Weber, Osler–Weber–Rendu, Klippel–Trenaunay, Von Hippel-Lindau, Proteus and Wyburn-Mason syndromes in addition to ataxia telangiectasia. Causes and mechanisms of unexpected death include epileptic seizures, intracranial haemorrhage and thromboses. Differentiating these conditions at autopsy is important because of variable inheritance patterns and occasionally inaccurate clinical classifications. The autopsy evaluation requires review of the medical and family histories, and full external and internal examinations with photographic documentation and histologic sampling of lesions. Formal neuropathology, storage of blood and tissues for molecular studies if required, and liaison with a medical geneticist should be considered.     

The perceptual response to exercise of progressively increasing intensity in children aged 7–8 years: Validation of a pictorial curvilinear ratings of perceived exertion scale

This study assessed the validity of the Eston-Parfitt (E-P) curvilinear Ratings of Perceived Exertion (RPE) Scale and a novel marble quantity task to provide estimates of perceived exertion during cycle ergometry. Fifteen children aged 7–8 years performed a discontinuous incremental graded-exercise test, and reported exertional ratings at the end of each minute. Significant increases in physiological and perceptual data were observed with increasing work rate. The relationship between work rate and marbles was curvilinear (mean R ²=.94), supporting the theoretical justification for the E-P Scale. Strong linear ( R ²=.93) and curvilinear ( R ²=.94) relationships between RPE from the E-P Scale and work rate confirmed the robustness of the E-P Scale. Valid exertional ratings may be obtained using the E-P Scale with young children. The novel marble quantity task offers an alternative method of deriving perceived exertion responses in children.