Brain activation associated with motor skill practice in children with developmental coordination disorder: an fMRI study

Children with developmental coordination disorder (DCD) have difficulty in learning new motor skills. At present, it is not known whether these children employ a different set of brain regions than typically developing (TD) children during skilled motor practice. Using functional magnetic resonance imaging, we mapped brain activity associated with skilled motor practice of a trail-tracing task in 7 children with DCD and 7 age-matched controls (aged 8-12 years). We indexed change in motor performance as a reduction in tracing error from early practice to retention. Children with DCD showed less blood-oxygen-level-dependent signal as compared to TD children in a network of brain regions associated with skilled motor practice: bilateral inferior parietal lobules (Brodmann Area (BA) 40), right lingual gyrus (BA 18), right middle frontal gyrus (BA 9), left fusiform gyrus (BA 37), right cerebellar crus I, left cerebellar lobule VI, and left cerebellar lobule IX. While no statistically significant differences were detected, effect size testing revealed that children with DCD demonstrated poorer tracing accuracy than TD children at retention (d = 0.48). Our results suggest that, compared to TD peers, children with DCD demonstrate under-activation in cerebellar-parietal and cerebellar-prefrontal networks and in brain regions associated with visual-spatial learning. These data suggest a neurobiological correlation with impaired learning of motor skills in children with DCD, which will need to be confirmed with a larger sample.     

Psychotic disorders in Argentine patients with refractory temporal lobe epilepsy: A case–control study

The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.     

Intersexuality and the diagnosis of gender identity disorder

Problems of gender identity development are the core concern in the psychosocial management of medical conditions involving ambiguous genitalia. This report discusses the difficulties encountered in applying the DSM category and criteria of Gender Identity Disorder (GID) to such patients. Data on prevalence, age of onset or presentation, sex ratio, and associated or predictive factors also suggest marked differences between intersex patients with gender identity problems and nonintersex patients with GID. Patients with intersexuality or similar medical conditions should be excluded from the GID diagnosis.     

Identifying bipolar disorders in individuals with intellectual disability

Objective The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM‐IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses. Methods A retrospective chart review was done of a convenience sample of adult patients seen over a 3‐year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM‐IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups. Results Subjects with clinical symptoms of BPD had significantly more DSM‐IV mood‐related and non‐mood‐related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups. Conclusions Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM‐IV criteria can be useful in the diagnosis of BPD.     

Women’s Views of their Sexual Difficulties: Agreement and Disagreement with Clinical Diagnoses

There is controversy about how to conceptualize sexual problems in women. Our purpose in this study was to compare ICD-10 diagnoses of sexual dysfunction in women with whether or not the woman perceived she had a sexual problem, her views on its origins, and its impact on her life. Participants (N = 401, M age, 37.8 years) were consecutive attendees to general practices in London, England. Our main measures were an ICD-10 diagnosis of sexual dysfunction and the woman’s own perception of a sexual problem. Based on reported symptoms and behavior, 38% of women had at least one ICD-10 diagnosis of sexual dysfunction. Prevalence fell to 18% in women who also perceived they had a problem and to 6% in women who regarded the problem as moderate or severe. A total of 73 (18%) women were assigned an ICD-10 diagnosis and agreed that they had a problem, 80 (20%) were assigned a diagnosis but reported no problem, 78 (19%) had no diagnosis but reported a sexual problem, and 170 (42%) had no diagnosis and reported no problem. For women with sexual partners, reported sexual satisfaction was lowest in those assigned an ICD-10 diagnosis who also perceived they had a problem and highest in those with no diagnosis and no perceived problem. Relationship and emotional difficulties were the most common perceived causes of sexual difficulties, whether or not an ICD-10 diagnosis was assigned. There were three aspects to sexual difficulties in women. The first concerned symptoms and behavior that clinicians used to make a diagnosis, the second was the woman’s own perception that she had a sexual difficulty, and the third was her level of sexual satisfaction. All three appear to be important and may explain why published prevalence rates of sexual dysfunction and associated factors are so conflicting.     

Multiaxiales System des Kapitels V (F) der ICD-10 Erste Ergebnisse der multizentrischen Praktikabilitäts- und Reliabilitätsstudie*,**

Zusammenfassung Mit der Einführung der operationalisierten psychiatrischen Diagnostik kam der multiaxiale Ansatz zu neuer Beachtung. Der Entwurf des multiaxialen Systems der ICD-10 umfa?t auf Achse I psychiatrische und somatische Diagnosen. Mit der Achse II (disability diagnostic scale, DDS) werden Beeintr?chtigungen der psychosozialen Funktionsf?higkeit abgebildet, w?hrend auf der Achse III Belastungsfaktoren eingesch?tzt werden. Als Teil der internationalen WHO-Anwendungsstudie wurden in 7 deutschsprachigen Zentren die Anwendbarkeit und Interraterreliabilit?t des Systems untersucht. Weiterhin wurde die Achse II mit der entsprechenden Achse des DSM-III-R (global assessment of functioning scale) verglichen. 45 deutschsprachige Kliniker beurteilten 12 englischsprachige, von der WHO bereitgestellte Fallgeschichten in insgesamt 488 diagnostischen Einsch?tzungen. Die Diagnosen der Achse I zeigten eine mittlere prozentuale übereinstimmung von 65,6 % und einen ϰ-Wert von 0,50, der damit in einem mittleren Reliabilit?tsbereich liegt. Für die Achse II wurde aufgrund der Skalenqualit?t als Ma? der Interraterreliabilit?t der Intraclasskoeffizient berechnet, der für diese Achse (0,62) und auch für die GAF-Skala (0,65) in einem mittleren Bereich lag. Zwischen den Subskalen und der Globaleinsch?tzung der Achse II wurde eine hohe Korrelation gefunden. Auf der Achse III gab es nur eine geringe übereinstimmung für die benannten Belastungsfaktoren, der ϰ-Wert lag hier im Mittel bei 0,16. In der Diskussion werden Anmerkungen für den Revisionsproze? des multiaxialen Systems der ICD-10 gemacht.      

Joint trajectory analysis of treated adolescents' alcohol use and symptoms over 1 year

OBJECTIVE: This study characterized treated adolescents' alcohol use and symptom trajectories over 1 year to describe the form of use trajectories and symptom trajectories, and the joint probability of membership in alcohol use and symptom trajectory groups. METHOD: 109 teens (age 14-18, 66% male, 94% white), recruited from addictions treatment, with a lifetime DSM-IV alcohol diagnosis, reported on daily alcohol use and symptoms in monthly phone contacts using the Time Line Follow-Back method. A group-based modeling method jointly estimated trajectories of use and symptoms. RESULTS: Four alcohol use trajectories were identified: "Abstinent" (31%), Low (36%), Increasing (28%), and High Use (5%). Three alcohol symptom trajectories were identified: Very Low severity (44%), Mild (44%), and High severity (12%). The most frequent joint outcome was "Abstinent" and Very Low symptom severity (32%). CONCLUSIONS: Symptom severity was moderately related to alcohol use pattern over 1 year. Findings have implications for moving beyond relapse defined as a return to "any use" to consideration of treatment outcome in terms of a broader pattern of alcohol use and problems.     

Low birth weight and psychiatric morbidity; stability and change between adolescence and young adulthood

Background

Being born with low birth weight is a risk factor for psychiatric morbidity.Few longitudinal studies have included diagnostic assessment and followed subjects into adulthood.

Aim

To assess stability and change in psychiatric morbidity between adolescence and young adulthood in low birth weight subjects, and explore whether screening in adolescence can predict subsequent psychopathology in these groups.

Study design

Prospective geographically based follow-up study of two low birth weight groups and a control group born between 1986 and 1988, assessed at 14 (T1) and 20 (T2) years of age.

Subjects

Thirty eight subjects born preterm with very low birth weight (VLBW: ≤ 1500 g), 43 born at term but small for gestational age (SGA: < 10th percentile) and 64 controls with normal birth weight participated.

Outcome measures

Mental health was assessed using diagnostic psychiatric interview at both study points supplemented with the Achenbach System of Empirically Based Assessment and Children's Global Assessment Scale at T1.

Results

There was a trend towards increasing morbidity from T1 among VLBW (p = 0.086) and a significant increase among SGA (p = 0.003) participants. Supplementary assessment at T1 discriminated satisfactory between persons with and without psychiatric disorders at T2 (area under ROC curve: 0.66 to 0.89), but was most effective in the VLBW group.

Conclusion

High psychiatric morbidity continued into young adulthood in the VLBW group and increased significantly in the SGA group. Screening in adolescence can be used to detect individuals at risk especially among those born at very low birth weight.     

Measuring Liability for Substance Use Disorder among College Students: Implications for Screening and Early Intervention

Background: Heavy drinking and illicit drug use among college students has been a longstanding public health concern. Current methods to screen and identify college students at-risk for the development of substance use disorders (SUD) are somewhat limited. Objectives: This study aimed to cross-validate the work by Kirisci et al. (), who developed the Transmissible Liability Index (TLI), by deriving a set of items that would be potentially useful for characterizing SUD risk across multiple dimensions among college students. We examined: 1) variations in the TLI-College Version (TLI-CV) by race, sex, SES, religiosity, and family history of substance use problems; 2) the association between the TLI-CV and alcohol and/or marijuana dependence, both cross-sectionally and prospectively, by race and sex; and, 3) the sensitivity and specificity of the TLI-CV for identifying cases of marijuana and/or alcohol dependence. Methods: Data from an ongoing longitudinal study of college students (n = 1,253) was used to conduct item response theory (IRT) analyses; the resulting TLI-CV consisted of 33 items. Results: The TLI-CV was significantly associated with baseline dependence and significantly higher for non-dependent individuals who later became dependent during the subsequent three years of college. These associations were observed for both sexes, Whites, Blacks/African-Americans, Asians, and other racial minorities. The sensitivity and specificity were suboptimal. Conclusions and Scientific Significance: The TLI-CV advances prior research to identify college students at risk for SUD. This approach holds potential promise to identify and ultimately modify the trajectories of college students who may be at risk for the development of SUD.     

Health care service utilization and associated factors among heroin users in northern Taiwan

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit.