Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria

The cardinal mood symptoms of premenstrual dysphoria can be effectively treated by serotonin-augmenting drugs. The aim of the study was to test the serotonin hypothesis of this disorder, i.e. of an association between premenstrual decline in brain serotonin function and concomitant worsening of self-rated cardinal mood symptoms. Positron emission tomography was used to assess changes in brain trapping of 11C-labeled 5-hydroxytryptophan, the immediate precursor of serotonin, in the follicular and premenstrual phases of the menstrual cycle in eight women with premenstrual dysphoria. Changes in mood and physical symptoms were assessed from daily visual analog scale ratings. Worsening of cardinal mood symptoms showed significant inverse associations with changes in brain serotonin precursor trapping; for the symptom "irritable", r(s)=-0.83, and for "depressed mood" r(s)=-0.81. Positive mood variables showed positive associations, whereas physical symptoms generally displayed weak or no associations. The data indicate strong inverse associations between worsening of cardinal symptoms of premenstrual dysphoria and brain serotonin precursor (11C-labeled 5-hydroxytryptophan) trapping. The results may in part support a role for serotonin in premenstrual dysphoria and may provide a clue to the effectiveness of serotonin-augmenting drugs in this disorder but should, due to small sample size and methodological shortcomings, be considered preliminary.     

Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD)

OBJECTIVE: Assess the prevalence of autistic traits (AST) in pediatric obsessive-compulsive disorder (OCD) and relate them to OCD co-morbidity and compare them with published normative data. METHODS: Pediatric patients with obsessive-compulsive disorder (n=109) according to the DSM-IV were studied using parent ratings of the Autistic Symptom/Syndrome Questionnaire to assess AST symptoms as a continuous rather than categorical trait. The KSADS, a semi-structured psychiatric interview, was used for the psychiatric diagnostic evaluation. Also, the Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD severity and other clinical features. RESULTS: AST was common among our patients. Symptom scores were highest in cases with co-morbid Autistic Spectrum Disorders, but cases with other co-morbidities as tics/Tourette and attention/behavioral disorders also scored higher. All sub-groups, including OCD without these co-morbidities scored higher than the Swedish normative group. Using ANOVA, co-morbid ASD and tics/Tourette (plus a term for gender by tic interaction indicating that girls with tics scored high, otherwise low) and pathological doubt contributed (R2=.41) to the AST-traits, while OCD severity and co-morbid anxiety- and depressive disorders did not. CONCLUSION: AST traits are prevalent in OCD and seem to be intricately associated with the co-morbidities as well as the OCD syndrome itself. The findings might have implication for our nosological understanding of OCD which currently is discussed.     

Normative data for the Multidimensional Anxiety Scale for Children (MASC) in Swedish adolescents

The Swedish translation of a new scale developed for childhood and adolescent anxiety, the Multidimensional Anxiety Scale for Children (MASC), was studied regarding reliability and convergent validity and to obtain norms in a general population. Four hundred and five adolescents, reasonably representative of Swedish adolescents, were asked to rate their anxiety symptoms on the MASC. In order to study the convergent validity, they also rated their depressive symptoms on the Children's Depression Inventory (CDI), their attitude to their body on the Body Esteem Scale for Adolescents and Adults (BESAA) and filled in demographical data on themselves. The MASC showed adequate internal consistency both for the whole scale (alpha = 0.87) and for subscales (range 0.64-0.84). The scale showed convergent validity through a moderate correlation with the CDI (r=0.400, P=0.0001) and the BESAA (r= - 0.29, P=0001). Girls scored higher (mean = 38.9) than boys (mean = 31.9) on the MASC total score (t(385) = 5.14, P=0.0001) and on the subscales, except Harm avoidance. Using the MASC as a general screen for anxiety, scores of 48 for boys and 56 for girls using MASC total scores, or scores of 15 for boys and 17 for girls using the Anxiety Disorders Index could be employed (both representing the 90th percentiles). The MASC appears to be a reliable and valid scale both on the global and on the subscale level.     

Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age

Purpose  

The outcome of endoscopic third ventriculostomy (ETV) is worse in children younger than 2 years old and especially in infants, and controversies still exist whether ETV might be superior to shunt placement in this age group. We retrospectively analyzed the data of 23 patients younger than 6 months of age treated with ETV and assessed its feasibility as a first choice of treatment for hydrocephalus.