Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents

ObjectiveThis study aimed to evaluate the predictive factors of the emergence of complete PTSD and subsyndromal PTSD (defined as individuals exposed to a traumatic event with at least one psychopathological impact, such as hyperarousal, avoidance or persistent re-experiencing) following a motor vehicle accident (MVA).MethodsWe recruited 155 adult MVA patients, physically injured and admitted to trauma service, over two years. In the week following the accident, patients were asked to complete questionnaires assessing their social situation (sex, age, marital and employment status, prior MVA or trauma), comorbidity (MINI), distress (PDI) and dissociation (PDEQ) experienced during and immediately after the trauma. An evaluation using the CAPS was conducted six months after the trauma to assess a possible PTSD.ResultsAt six months, 25.8% of the participants developed subsyndromal symptoms and 7.74% developed complete PTSD. The three symptoms that best discriminated the groups were dysphoric emotion, perceived life threat and dissociation. Logistic regression results showed that the strongest predictor of PTSD was the perceived life threat.In addition, a dimensional approach to the results revealed significant correlations between (1) peritraumatic distress and persistent re-experiencing or hyperarousal and (2) dissociation score and avoidance strategy. The presence of a prior traumatic event reinforces avoidance strategies.ConclusionsOur results stress that peritraumatic factors (especially the perception of a life threat) are good predictors of PTSD development. A dimensional perspective allows better identification of psychological complications following an MVA.     

Seizure frequency in pregnant women treated with lamotrigine monotherapy

Previous studies have demonstrated that the pharmacokinetics of the new antiepileptic drug (AED) lamotrigine (LTG) are substantially influenced by pregnancy and are more likely to be associated with seizure deterioration in pregnancy compared to other AEDs. This is of great concern, as LTG has developed into a first-line AED for women of childbearing age. In this study we evaluated the risk of seizure deterioration in a cohort of women treated with LTG monotherapy (n = 42) who were closely monitored with frequent dose adjustments based on monthly routine plasma level determinations. It was demonstrated that with this close monitoring set-up, the risk of increased seizure frequency (19%) was not higher than that reported for other AED treatment regimens.     

A novel ultrasonic method for evaluation of blood clotting parameters

Purpose

For long time, blood clot retraction was measured only by thromboelastographic or platelet contractile force measurement techniques. The purpose of the present study was development of a novel ultrasonic method based on simultaneous monitoring of variations in the ultrasound velocity and the frequency spectrum of the signal propagating in clotting blood and its application for automatic evaluation of blood clotting parameters.

Methods

Simultaneous measurement of ultrasound velocity and variations in the frequency spectrum of wideband ultrasonic signals in clotting blood samples was performed. All measurements were performed in pulse-echo mode. Standard clinical data were obtained using routine clinical laboratory methods.

Results

The amplitudes of ultrasonic signals during native blood coagulation varied up to ten times for different frequencies. The measurement results of the start and duration of blood clot retraction differed between patient samples: different components of the blood coagulation system had significant impact on the blood clot retraction process.

Conclusions

Our results showed that during blood clotting, the ultrasound velocity and variations in frequency spectrum should be used simultaneously to determine the beginning and duration of blood clot retraction. Our results also showed that blood clot retraction is controlled by the activity of factor XIII.

     

The impact of discontinuing methylphenidate on weight and eating behavior

Chronic administration of the amphetamine‐derivative methylphenidate (MPH) may induce appetite reduction and weight loss. By contrast, the effects that stopping chronic MPH may exert on eating behavior and body weight are poorly known. We report the case of a male patient with childhood attention deficit/hyperactivity disorder (ADHD), who discontinued MPH treatment at the age of 11 years and was lost to follow‐up until the age of 16. The patient's body mass index increased by five points within 1 year of MPH cessation while the symptoms of ADHD were re‐emerging. The patient secondarily developed DSM‐5 criteria for eating disorders. Discontinuing chronic MPH can significantly affect weight and eating behavior. Such risks should warrant further studies, as they could be particularly increased in patients with ADHD, who share common vulnerability factors with both obesity and eating disorders. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:345–348)     

Interbirth interval is associated with childhood type 1 diabetes risk

Short interbirth interval has been associated with maternal complications and childhood autism and leukemia, possibly due to deficiencies in maternal micronutrients at conception or increased exposure to sibling infections. A possible association between interbirth interval and subsequent risk of childhood type 1 diabetes has not been investigated. A secondary analysis of 14 published observational studies of perinatal risk factors for type 1 diabetes was conducted. Risk estimates of diabetes by category of interbirth interval were calculated for each study. Random effects models were used to calculate pooled odds ratios (ORs) and investigate heterogeneity between studies. Overall, 2,787 children with type 1 diabetes were included. There was a reduction in the risk of childhood type 1 diabetes in children born to mothers after interbirth intervals <3 years compared with longer interbirth intervals (OR 0.82 [95% CI 0.72-0.93]). Adjustments for various potential confounders little altered this estimate. In conclusion, there was evidence of a 20% reduction in the risk of childhood diabetes in children born to mothers after interbirth intervals <3 years.     

Delusional melancholia and multiple lacunar infarcts of the basal ganglia

A 72 years-old man presented with melancholia with delusions, possibly resulting from multiple lacunar infarcts in the basal ganglia. This case is akin to the syndrome of psychic akinesia and compulsive activity, resulting from lenticular nucleus lesions or frontal lobe lesions. We suggest that melancholia could be a consequence of a certain type of stereotyped mental activity and we would compare this stereotyped mental activity to stereotyped verbal activity in aphasia. Cognitive impairment might then be a cause of depression.