Ten-Year Follow-up of the OPUS Specialized Early Intervention Trial for Patients With a First Episode of Psychosis

Introduction : Specialized early intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 and 5 years. Few studies have examined long-term outcomes of these interventions. Aim : To examine the effect of 2 years of OPUS vs treatment as usual (TAU) within an FEP cohort, 10 years after inclusion into the OPUS trial. Methods : From 1998 to 2000, participants were randomized to OPUS or TAU. Ten years later, we conducted comprehensive interviews and performed register-based follow-up on all participants in national Danish registers. We analyzed participants according to the intention-to-treat principle. Results : Of the 547 participants included in the study, 347 (63.4%) took part in this follow-up. While there was evidence of a differential 10-year course in the development of negative symptoms, psychiatric bed days, and possibly psychotic symptoms in favor of OPUS treatment, differences were driven by effects at earlier follow-ups and had diminished over time. Statistically significant differences in the course of use of supported housing were present even after 8–10 years. There were no differences between OPUS and TAU regarding income, work-related outcomes, or marital status. Conclusion: Most of the positive short-term effects of the OPUS intervention had diminished or vanished at this long-term follow-up. We observed a clear tendency that OPUS treatment leads to fewer days in supported housing. There is a need for further studies investigating if extending the intervention will improve outcomes more markedly at long-term follow-ups.Key words: schizophrenia, randomized trial, long-term outcomes, early intervention     

Surveillance of Patients in the Waiting Area of the Department of Emergency Medicine

Many patients visiting an emergency department are in reduced general condition of health and at risk of suffering further deterioration during their stay. We wanted to test the feasibility of a new monitoring system in a waiting area of an emergency department.In an observational cross-sectional single-center study, patients with acute cardiac or pulmonary symptoms or in potentially life-threatening conditions were enrolled. Monitoring devices providing vital signs via short range radio (SRR) at certain time points and compliance evaluation forms were used.Out of 230 patients, 4 wanted to terminate their participation prematurely. No data was lost due to technical difficulties. Over a median monitoring period of 178 (118–258) min per patient, 684 h of vital sign data were collected and used to assist managing those patients. Linear regression analysis between clinical symptom category groups of patients showed significant differences in the respiratory rate and noninvasive blood pressure courses. Feedback from patients and users via questionnaires showed overall very good acceptance and patients felt that they were given better care.To assist medical staff of an emergency department waiting area to rapidly response to potentially life-threatening situations of its patients, a new monitoring system proved to be feasible and safe.     

Maturational Trajectory of Processing Speed Performance in Pediatric Multiple Sclerosis

Processing speed is a frequently affected cognitive domain in pediatric multiple sclerosis (MS) and is commonly assessed using the Symbol Digit Modalities Test (SDMT). The objective of this study was to determine maturational trajectories in SDMT performance and baseline factors affecting trajectories in a sample of 82 pediatric MS individuals. Performance on the SDMT increased with age in patients with pediatric MS followed by a subsequent decline. Furthermore, patients who were older at disease onset and had a higher IQ showed greater gains with age, suggesting that these factors may be protective with respect to cognitive maturation in pediatric MS.     

A DTI‐based tractography study of effects on brain structure associated with prenatal alcohol exposure in newborns

Prenatal alcohol exposure (PAE) is known to have severe, long‐term consequences for brain and behavioral development already detectable in infancy and childhood. Resulting features of fetal alcohol spectrum disorders include cognitive and behavioral effects, as well as facial anomalies and growth deficits. Diffusion tensor imaging (DTI) and tractography were used to analyze white matter (WM) development in 11 newborns (age since conception <45 weeks) whose mothers were recruited during pregnancy. Comparisons were made with nine age‐matched controls born to abstainers or light drinkers from the same Cape Coloured (mixed ancestry) community near Cape Town, South Africa. DTI parameters, T1 relaxation time, proton density and volumes were used to quantify and investigate group differences in WM in the newborn brains. Probabilistic tractography was used to estimate and to delineate similar tract locations among the subjects for transcallosal pathways, cortico‐spinal projection fibers, and cortico‐cortical association fibers. In each of these WM networks, the axial diffusivity was the parameter that showed the strongest association with maternal drinking. The strongest relations were observed in medial and inferior WM, regions in which the myelination process typically begins. In contrast to studies of older individuals with PAE, fractional anisotropy did not exhibit a consistent and significant relation with alcohol exposure. To our knowledge, this is the first DTI‐tractography study of prenatally alcohol exposed newborns. Hum Brain Mapp, 36:170–186, 2015. © 2014 Wiley Periodicals, Inc.     

Acute and chronic pseudo‐obstruction: a current update

Acute colonic pseudo‐obstruction (ACPO) and chronic intestinal pseudo‐obstruction (CIPO) are distinct clinical entities in which patients present similarly with symptoms of a mechanical obstruction without an occlusive lesion. Unfortunately, they also share the issues related to a delay in diagnosis, including inappropriate management and poor outcomes. Advancements have been made in our understanding of the aetiologies of both conditions. Several predisposing factors linked to critical illness have been implicated in ACPO. CIPO is a functional motility disorder, historically misdiagnosed, with unnecessary surgery being performed in many patients with dire consequences. This review discusses the pathophysiology, clinical and diagnostic features, and treatment of each. For ACPO, a safer pharmacological approach to treatment is presented in a modified up‐to‐date algorithm. The importance of CIPO as a differential diagnosis when seeing patients with recurrent admissions for abdominal pain and distention is also discussed, as well as specific indications for surgery. While surgery is often a last resort, the role of the surgeon in the management of both ACPO and CIPO cannot be undervalued. By characterizing each condition in a common review, the knowledge gleaned aims to optimize outcomes for these frequently complex patients.     

Spatial and temporal analyses of posture in strabismic children

Purpose

To analyse postural performances of strabismic children, both in the spatial and the temporal domains, by wavelet transformation, comparing both stable and unstable situations.

Methods

Twenty-six strabismic children aged from 4 to 11 years old and 26 age-matched normal children participated in the study. Postural performances were evaluated using the Framiral® platform. Posture was recorded in the following conditions: eyes open fixating a target and eyes closed on stable and unstable platforms.

Results

For both strabismic and non-strabismic children, the surface and the mean velocity of the center of pressure (CoP) were significantly larger in the eyes closed on unstable platform condition, but this was much more pronounced in case of strabismus. Spectral power index and cancelling time were also found to be altered in strabismic children compared to non-strabismic children.

Conclusions

This data demonstrates poor postural stability for both groups on an unstable platform with the eyes closed. However, strabismic children had significantly worse performance than non-strabismic children. Strabismic children also engage more energy to stabilize their posture by using visuo-vestibular sensory inputs to compensate their altered vision due to strabismus, in comparison to non-strabismic children.