Assessment of central adrenal insufficiency in children and adolescents with Prader-Willi syndrome

Objective A recent study evidenced by metyrapone test a central adrenal insufficiency (CAI) in 60% of Prader–Willi syndrome (PWS) children. These results were not confirmed in investigations with low [Low‐Dose Tetracosactrin Stimulation Test (LDTST), 1 μg] or standard‐dose tetracosactrin stimulation tests. We extended the research by LDTST in paediatric patients with PWS. Design Cross‐sectional evaluation of adrenal stress response to LDTST in a PWS cohort of a tertiary care referral centre. Patients Eighty‐four children with PWS. Measurements Assessment of adrenal response by morning cortisol and ACTH dosage, and 1‐μg tetracosactrin test. Response was considered appropriate when cortisol reached 500 nm ; below this threshold, patients were submitted to a second test. Responses were correlated with the patients’ clinical and molecular characteristics to assess genotype–phenotype correlation. Results Pathological cortisol peak responses to the LDTST were registered in 12 patients (14·3%) who had reduced basal (169·4 ± 83·3 nm ) and stimulated (428·1 ± 69·6 nm ) cortisol levels compared to patients with normal responses (367·1 ± 170·6 and 775·9 ± 191·3 nm , P < 0·001). Body mass index standard deviation score was negatively correlated with basal and peak cortisol levels (both P < 0·001), and the patients’ ages (P < 0·001). In patients with deletion on chromosome 15, the cortisol peak was significantly lower than that in uniparental disomy (UPD) cases (P = 0·030). At multiple regression analysis, the predictors of peak response were basal cortisol, age, and UPD subclass (r² = 0·353, P < 0·001). Standard‐dose (250 μg) tetracosactrin test confirmed CAI in 4/12 patients (4·8% of the cohort). Conclusions Our results support the hypothesis that, albeit rare, CAI may be part of the PWS in childhood.     

Specialist Palliative Care is More Than Drugs: A Retrospective Study of ILD Patients

Background  

This study aimed to assess the palliative care needs of progressive idiopathic fibrotic interstitial lung disease (PIF-ILD) populations in two London ILD centres.     

Brain microstructure of subclinical apathy phenomenology in healthy individuals

Although apathy has been extensively studied in relation to neuropsychiatric disorders, it is still unclear whether, in healthy people, it should be considered as a physiological phenomenon or whether it is a risk factor for progression to clinical disturbances. Here, we investigated subclinical apathy phenomenology and its brain microstructural correlates in healthy individuals. We submitted 72 participants to a comprehensive clinical assessment, a high‐resolution structural MRI and a diffusion tensor imaging scan protocol. Data of individual microstructural (mean diffusivity and fractional anisotropy) variations were processed across genders in relation to the Apathy Rating Scale score. In females, subclinical apathy phenomenology was associated with microstructural variation of the bilateral thalami, the anterior thalamic radiation, the forceps major, and the corona radiate. These are white matter areas mostly connecting the thalami to the frontal and occipital cortices, regions that are known to be implicated in the expression of apathy in clinical samples. No significant relationship with brain microstructure was found in males who showed a positive correlation between subclinical apathy and somatic phenomenology of depression. In conclusion, our results show that in healthy individuals subclinical apathy phenomenology is associated with different mechanisms across genders, and raise the issue about whether brain microstructural changes associated with subclinical apathy in healthy females could be a precocious marker useful in the prediction of progression to more severe apathetic conditions. Hum Brain Mapp 34:3193–3203, 2013. © 2012 Wiley Periodicals, Inc.     

A naturalistic study on the criteria of choice of second-generation antidepressants: A comparison of venlafaxine and SSRIs in depressed inpatients

INTRODUCTION: The objective of this study was to compare, in a naturalistic setting, the efficacy and tolerability of selective serotonin reuptake inhibitors (paroxetine, sertraline, citalopram) and venlafaxine, in 120 depressed inpatients. This paper attempts to review which variables may influence a physician's choice of a specific antidepressant for a specific patient. METHOD: Patients were assessed using the Hamilton Psychiatric Rating Scale for Depression (HAM-D), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Clinical Global Impression (CGI) and the Symptoms Check List (SCL-90). The two groups under assessment were comparable in all socio-demographic characteristics. We used logistic regression analyses to identify variables that differentiate the two groups at baseline. This, in turn, would represent those variables with the potential to influence a physician's selection of an antidepressant. RESULTS: Venlafaxine patients reported significantly worse scores on MADRS at baseline, but any difference was no longer present at discharge. We found no significant variation in the efficacy of the antidepressants under study and there were no differences in the incidence and profiles of adverse events between the groups of patients. CONCLUSION: The degree of severity of the actual depressive picture appears to influence choice in favour of venlafaxine. However, it appears that the choice of SSRIs is more closely linked to patients who present a previous history of non-mood psychiatric symptoms.