The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity,phenylketonuria or neurobehavioural disorders

Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents’ socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.     

Cellular neuroanatomy of rat presubiculum

The presubiculum, at the transition from the hippocampus to the cortex, is a key area for spatial information coding but the anatomical and physiological basis of presubicular function remains unclear. Here we correlated the structural and physiological properties of single neurons of the presubiculum in vitro. Unsupervised cluster analysis based on dendritic length and form, soma location, firing pattern and action potential properties allowed us to classify principal neurons into three major cell types. Cluster 1 consisted of a population of small regular spiking principal cells in layers II/III. Cluster 2 contained intrinsically burst firing pyramidal cells of layer IV, with a resting potential close to threshold. Cluster 3 included regular spiking cells of layers V and VI, and could be divided into subgroups 3.1 and 3.2. Cells of cluster 3.1 included pyramidal, multiform and inverted pyramidal cells. Cells of cluster 3.2 contained high‐resistance pyramidal neurons that fired readily in response to somatic current injection. These data show that presubicular principal cells generally conform to neurons of the periarchicortex. However, the presence of intrinsic bursting cells in layer IV distinguishes the presubicular cortex from the neighbouring entorhinal cortex. The firing frequency adaptation was very low for principal cells of clusters 1 and 3, a property that should assist the generation of maintained head direction signals in vivo.     

The structure of the Montgomery–Åsberg depression rating scale over the course of treatment for depression

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a widely used clinician‐rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large‐scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four‐factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four‐factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients. Copyright © 2013 John Wiley & Sons, Ltd.     

Spatial scale and place field stability in a grid‐to‐place cell model of the dorsoventral axis of the hippocampus

The rodent hippocampus and entorhinal cortex contain spatially modulated cells that serve as the basis for spatial coding. Both medial entorhinal grid cells and hippocampal place cells have been shown to encode spatial information across multiple spatial scales that increase along the dorsoventral axis of these structures. Place cells near the dorsal pole possess small, stable, and spatially selective firing fields, while ventral cells have larger, less stable, and less spatially selective firing fields. One possible explanation for these dorsoventral changes in place field properties is that they arise as a result of similar dorsoventral differences in the properties of the grid cell inputs to place cells. Here, we test the alternative hypothesis that dorsoventral place field differences are due to higher amounts of nonspatial inputs to ventral hippocampal cells. We use a computational model of the entorhinal‐hippocampal network to assess the relative contributions of grid scale and nonspatial inputs in determining place field size and stability. In addition, we assess the consequences of grid node firing rate heterogeneity on place field stability. Our results suggest that dorsoventral differences in place cell properties can be better explained by changes in the amount of nonspatial inputs, rather than by changes in the scale of grid cell inputs, and that grid node heterogeneity may have important functional consequences. The observed gradient in field size may reflect a shift from processing primarily spatial information in the dorsal hippocampus to processing more nonspatial, contextual, and emotional information near the ventral hippocampus. © 2013 Wiley Periodicals, Inc.     

Which dyskinesia scale best detects treatment response?

Numerous scales assess dyskinesia in Parkinson's disease (PD), variably focusing on anatomical distribution, phenomenology, time, severity, and disability. No study has compared these scales and their relative ability to detect change related to an established treatment. We conducted a randomized placebo‐controlled trial of amantadine, assessing dyskinesia at baseline and at 4 and 8 weeks using the following scales: Unified Dyskinesia Rating Scale (UDysRS), Lang‐Fahn Activities of Daily Living Dyskinesia Rating Scale (LF), 26‐Item Parkinson's Disease Dyskinesia scale (PDD‐26), patient diaries, modified Abnormal Involuntary Movements Scale (AIMS), Rush Dyskinesia Rating Scale (RDRS), dyskinesia items from the Movement Disorder Society–sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS), and Clinical Global Impression (severity and change: CGI‐S, CGI‐C). Scale order was randomized at each visit, but raters were aware of each scale as it was administered. Sensitivity to treatment was assessed using effect size. Sixty‐one randomized dyskinetic PD subjects (31 amantadine, 30 placebo) completed the study. Four of the 8 scales (CGI‐C, LF, PDD‐26, and UDysRS) detected a significant treatment. The UDysRS Total Score showed the highest effect size (η² = 0.138) for detecting treatment‐related change, with all other scales having effect sizes < 0.1. No scale was resistant to placebo effects. This study resolves 2 major issues useful for future testing of new antidyskinesia treatments: among tested scales, the UDysRS, having both subjective and objective dyskinesia ratings, is superior for detecting treatment effects; and the magnitude of the UDysRS effect size from amantadine sets a clear standard for comparison for new agents. © 2012 Movement Disorder Society