Universal parent training as a supplement to inpatient psychiatric treatment for children and adolescents

Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent–child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent–child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run.     

Genetic fitness and selection intensity in a population affected with high-incidence spinocerebellar ataxia type 1

Spinocerebellar ataxia type 1 (SCA1) is the major and likely the only type of autosomal dominant cerebellar ataxia in the Sakha (Yakut) people of Eastern Siberia. The prevalence rate of SCA1 has doubled over the past 21 years peaking at 46 cases per 100,000 rural population. The age at death correlates closely with the number of CAG triplet repeats in the mutant ATXN1 gene (r = ?0.81); most patients with low-medium (39–55) repeat numbers survived until the end of reproductive age. The number of CAG repeats expands in meiosis, particularly in paternal transmissions; the average total increase in intergenerational transmissions in our cohort was estimated at 1.6 CAG repeats. The fertility rates of heterozygous carriers of 39–55 CAG repeats in women were no different from those of the general Sakha population. Overall, the survival of mutation carriers through reproductive age, unaltered fertility rates, low childhood mortality in SCA1-affected families, and intergenerational transmission of increasing numbers of CAG repeats in the ATXN1 gene indicate that SCA1 in the Sakha population will be maintained at high prevalence levels. The low (0.19) Crow’s index of total selection intensity in our SCA1 cohort implies that this mutation is unlikely to be eliminated through natural selection alone.     

The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience

The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention.     

Are speech-evoked auditory brainstem response (speech-ABR) outcomes influenced by ethnicity?

Due to its objective nature, auditory brainstem response (ABR) evoked by complex stimuli has been gaining attention lately. The present study aimed to compare the speech-evoked auditory brainstem response (speech-ABR) results between two ethnic groups: Malay and Chinese. In addition, it was also of interest to compare the speech-ABR outcomes obtained from the present study with the published Caucasian data. Thirty healthy male adults (15 Malay and 15 Chinese) were enrolled in this comparative study. Speech syllable/da/presented at 80 dBnHL was used to record speech-ABR waveforms from the right ear of each subject. Amplitudes and latencies of speech-ABR peaks (V, A, C, D, E, F and O), as well as composite onset measures (V/A duration, V/A amplitude and V/A slope) were computed and analyzed. When the two ethnic groups were compared, all speech-ABR results were not statistically different from each other (p > 0.05). When the data from the present study were compared with the published Caucasian data, most of the statistical analyses were significant (p < 0.05). That is, Asian subjects revealed significantly higher peak amplitudes, earlier peak latencies, higher V/A amplitudes and steeper V/A slopes than that of Caucasians. The speech-ABR results between Malay and Chinese were found to be essentially similar due to anatomical similarities. Nevertheless, specific normative data for Asian adults are required as their speech-ABR results are different from that of Caucasian males. This issue should be addressed before it can be applied holistically in multiracial countries.     

The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.     

Sleep disorders in patients with postural tachycardia syndrome

Objective

Patients with postural tachycardia syndrome (POTS) often describe symptoms of fatigue, sleepiness, and lack of refreshing sleep. We aimed to provide further objective measures of sleep in patients with POTS.

Methods

POTS patients (n = 18) were selected based on autonomic testing and evaluation at our center. Controls (n = 16) of similar age, gender, and BMI were selected from new patients referred to the Stanford Sleep Disorders Clinic for any sleep-related complaint. All patients underwent polysomnography and completed several sleep questionnaires and a 2-week sleep diary.

Results

POTS patients and control subjects were of similar age (27 ± 10.2 vs. 29 ± 5.4 years, p = 0.92) and Body Mass Index (21 ± 3.8 vs. 24 ± 4.1, p = 0.14). The majority of subjects in both groups were females (72 % POTS vs. 81 % controls). POTS patients scored higher on subjective fatigue scales but not sleepiness scales. POTS patients scored in the normal range on the BDI and the “evening” category on the MEQ. Their sleep diaries were not different from controls. With the exception of mild OSA, slightly reduced %REM and prolonged REM latency, their PSG data were normal and no different from controls.

Conclusions

It is unlikely that the sleep-related complaints of POTS patients are the result of a primary sleep disorder unique to POTS. We propose that a combination of factors such as body fatigue, chronic pain, and other somatic symptoms common in POTS patients might be the underlying reason for sleep-related symptoms in POTS.

     

Pathophysiologische Mechanismen genetischer Epilepsien

Epileptic seizures occur because of the increased excitability of neuronal cells in the brain that is of a mainly genetic origin in at least one third of all epilepsies. The so far identified mutations in inherited monogenic idiopathic epilepsies mainly affect ion channel genes and could be linked to both focal and generalized forms of inherited epilepsy. In a healthy brain, ion channels in the membranes of excitatory and inhibitory neurons are responsible for a neuronal balance. Disruption of this balance by changing the ion channel function can therefore lead to epileptic seizures. In this overview, we describe and discuss known epilepsy-associated mutations in ion channel genes, their functional consequences, and the resulting disease mechanisms.     

Spracherhaltende Resektion einer fokalen kortikalen Dys­plasie neben dem Broca‑Areal

We report the case of a 14-year-old male with a history of focal seizures since the age of six due to a focal cortical dysplasia located within the left frontal lobe. The patient’s seizures proved to be refractory to treatments with Oxcarbazepine, Lamotrigine, Valproate, and Clobazame. Because fMRI for language mapping suggested a close spatial relationship of the lesion and Broca’s area, invasive language mapping was performed using a subdural grid for direct cortical stimulation. This suggested a clear topographic distinction between the lesion and Broca’s area, finally enabling language retaining lesionectomy. This case illustrates some pitfalls of fMRI language mapping in preoperative workup for epilepsy surgery.     

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children’s Mental Health System: A Pilot Study

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.