Preliminary evidence for an association between a dopamine D3 receptor gene variant and obsessive-compulsive personality disorder in patients with major depression.

We have previously reported that the Ser9Gly dopamine D3 receptor (DRD3) polymorphism was associated with increased rates of obsessive-compulsive personality disorder (OCPD) symptomology. We tested the replicability of this association within a further two independent groups of individuals with a history of depression, from a clinical sample (n = 149) and a family study (n = 213). The data from the replication samples and the original sample, within which the association was found, were compiled within a meta-analysis. Although the independent samples did not replicate the original finding, the meta-analysis elucidated significant evidence supporting the association. An individual with Gly/Gly genotype is 2.4 (P = 0.017) times more likely to be diagnosed with OCPD. Male gender was also found to be a significant predictor of OCPD diagnosis (OR = 2.82, P = 0.001). An exploration of an association of DRD3 with Axis I anxiety disorder diagnoses and Temperament and Character Inventory (TCI) traits, in particular persistence, revealed no support for an association. We conclude that DRD3 may contribute to the development of OCPD.     

Children's color trails.

Color Trails for Children was developed in response to the need for instruments which minimize cultural bias in neuropsychological testing. The test, similar in format to Trail Making, was designed to provide an evaluation of speeded visuomotor tracking while minimizing the influence of language. The present research involves two exploratory studies which examine the relationship between Color Trails for Children and Trail Making, factors that may affect performance times, and discriminant validity. Results indicate that the tests appear to measure the same neuropsychological domains, and administration of Trail Making did not significantly alter performance times on Color Trails. Increasing age and IQ were related to quicker completion time for both tests. Females were found to complete Color Trails 2 and Trail Making Part B more quickly than males in this sample. Comparison between children diagnosed with learning disabilities, attention deficits, or mild neurological conditions and a preliminary standardization sample supported the discriminant validity of Color Traits to distinguish between normal controls and children with altered neuropsychological functioning. Comparison between clinical conditions indicated that Color Trails 2 was particularly sensitive in discriminating among the groups. Although further research is needed, results suggest that Color Trails has the potential to be an effective research and clinical tool in child neuropsychological assessment.     

Late Diagnosis of Neurodegenerative Disease in Children: Anosognosia by Proxy

Anosognosia is a term now generally defined as a failure to recognize the existence of disease processes, particularly those with a neurological basis. Denial of illness has been recognized in a large number of disorders, and is generally thought to have not only a central nervous system basis, but to also be influenced by the psychological processes of denial. This disorder has been reported in the adult population, and there are initial suggestions that it exists in children/adolescents.We propose to extend the concept of anosognosia to the caregivers of children who suffer significant dementia, and extended degeneration in neuro-psychological and neurological functioning. We term this syndrome anosognosia by proxy. Three case examples are presented in which parents, teachers, and health care professionals observed extended deterioration in a child/adolescent’s level of functioning prior to seeking appropriate diagnostic evaluations. Possible explanations for this process are advanced, including a combination of insidious onset coupled with the intimate nature of the child/parent relationship. The need for professional, teacher, and parent education on the nature of childhood degenerative neurological disorders is emphasized.     

Psoriatic arthritis – what the dermatologist needs to know

Psoriasis is commonly associated with a co‐existent arthritis known as psoriatic arthritis (PsA). Although there is some treatment overlap for psoriasis and psoriatic arthritis, it is possible that dermatologists may not diagnose or treat appropriately patients who are developing psoriatic arthritis at an early stage of the disease process when joint damage may be preventable. In this article we review the criteria for diagnosis of this sero‐negative arthritis, look at the clinical indications for referral to a rheumatologist and discuss evolving treatment options relevant to both conditions.     

Instructing facilitators to support the communication of people who use augmentative communication systems.

A single-subject multiple-baseline design, replicated across three dyads, was used to examine the efficacy of instructing facilitators (i.e, significant others) to promote communication with people who use augmentative and alternative communication (AAC) systems. Facilitators were instructed in four 1-hour sessions to decrease their conversational control and provide more opportunities for the participants using AAC systems to communicate. Following instruction, facilitators decreased their rates of turn-taking and initiations and increased the proportion of turns that were responsive. Participants using AAC systems increased the frequency of their initiations. Following intervention, turn-taking and initiation patterns in the dyads were more reciprocal. Generalization occurred to the natural environment. Results suggest that facilitator instruction is an effective and efficient means of promoting greater participation in daily interactions by people who use AAC systems.     

Management of chronic sinusitis in cystic fibrosis

Chronic rhinosinusitis is extremely common in patients with cystic fibrosis. It causes numerous problems in these patients and can put them at risk for life-threatening illness. Potential problems include nasal obstruction, congestion, sinus pain and pressure, infection (usually with Pseudomonas organisms), hyposmia or anosmia, and the seeding of bacteria into the lower respiratory tract. Cystic fibrosis patients with chronically infected sinuses are at increased risk for pneumonia following lung transplantation. A prophylactic protocol has been developed for the management of chronic sinusitis in patients with cystic fibrosis. These patients are fully evaluated at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. Based on the results of the evaluation, they are treated with endoscopic sinus surgery, partial middle turbinectomy, septoplasty, and a large middle meatal maxillary antrostomy. Surgery is followed by a rigorous regimen of pulsatile hypotonic saline nasal irrigation to wash away tenacious cystic secretions. Tobramycin (Nebcin®) is given once daily in the nasal irrigant to inhibit the growth of Pseudomonas organisms. At the USCD Nasal Dysfunction Clinic, this prepulmonary transplantation protocol is now used in all cystic fibrosis patients with chronic sinusitis.