Chronic Paroxysmal Hemicrania: Dissociation of the Pain and Autonomic Features

The case of a woman suffering from chronic paroxysmal hemicrania is presented. Most attacks were unilateral and recurred on the same side. On a few occasions, attacks were observed on the contralateral side. In addition, the patient reported some incomplete attacks on the usually symptomatic side with autonomic phenomena, but without pain. That "partial" attacks would exist has been suspected on theoretical ground. This is, however, the first time such attacks have been reported by a patient. Therefore, a double dissociation of the symptomatology seemed to exist: (1) a side shift of attacks, and (2) incomplete("partial") attacks. These unexpected findings occurred after two indomethacin treatment withdrawals. A possible central and "midline" origin of attacks or an indomethacin after-effect or both are discussed as a likely explanation for such a dissociation of symptoms and signs.     

内分泌疾病伴发焦虑抑郁症状特征及其治疗

目的初步探索内分泌疾病伴发焦虑抑郁症状的症状学及临床用药经验。方法对入选患者于治疗前、后进行焦虑抑郁自评量表、汉密顿抑郁焦虑量表、临床疗效总评定量表及Tess副反应量表评定,并以治疗后汉密顿焦虑、抑郁量表减分率作为疗效评定指标。结果内分泌不同疾病组之间的焦虑抑郁症状无显著性差异。赛乐特治疗能有效改善患者的焦虑抑郁症状,且毒副作用较轻。结论内分泌慢性病患者常伴发焦虑抑郁症状,作为代表药物之一,赛乐特安全有效,毒副作用轻,可用于改善内分泌疾病伴发的情绪障碍患者的生活质量。     

Determinants of Weight Loss Dieting Among Adolescents: A Longitudinal Analysis

PurposeTo prospectively assess characteristics associated with dieting behaviors in adolescence.MethodsWe analyzed 1,640 adolescents evaluated at 13 and 17 years old (EPITeen cohort), Porto, Portugal. Dieting was assessed only at 17 years, as self-reported frequency of dieting to lose weight in the previous 12 months. The association between participants' characteristics and dieting was summarized using multinomial logistic regression for girls and binary logistic regression for boys.ResultsDieting at 17 years old was significantly more prevalent in girls than in boys (respectively 27.6% and 10.5% for occasional dieting and 12.2% and 2.6% for frequent dieting). In both sexes, overweight and obese adolescents were significantly more likely to engage in dieting but body dissatisfaction was the strongest determinant among girls. Furthermore, dieting frequency also increased with depressive symptomatology and among those involved in health compromising behaviors.ConclusionsBesides body mass index, body image concerns and depressive symptomatology predict dieting throughout adolescence.     

Relations between dissociative experiences,borderline personality disorder symptoms and cannabis use in adolescents and young adults

The aim of the study was to evaluate the relations between cannabis use, dissociative experiences and borderline personality disorder symptoms. A convenient sample of 212 subjects composed of high school students completed questionnaires assessing cannabis use frequency, the symptoms of dependence, the symptoms of dissociation and borderline personality disorder using the Dissociative Experience Scale (DES) completed by a subscale measuring hyper-personalization/hyper-realization experiences and the Borderline Personality Inventory (BPI), respectively; 114 (54%) were cannabis users. Multiple regression analyses showed that the frequency of cannabis use was negatively predicted by the frequency of spontaneous experiences of absorption and imaginative involvement and positively predicted by the frequency of experiences of absorption and hyper-personalization and hyper-realization linked to cannabis use. Cannabis dependence was predicted only by borderline personality symptoms. Positive dissociative experiences appear to be an important element in the understanding of cannabis use in adolescents and young adults.     

The clinical spectrum of anxiety in Parkinson's disease

Anxiety is common in Parkinson's disease (PD), and contributes to increased disability and poorer quality of life. In spite of its significant impact, the symptomatology, chronology, and neurobiology of anxiety in PD are all poorly understood, and this hinders accurate diagnosis and development of effective treatment strategies. This review investigates and updates literature related to the clinical spectrum of anxiety in PD. The reported prevalence of anxiety in PD varies considerably, with emerging interest in the frequency of the DSM‐IV residual category of “Anxiety disorder, not otherwise specified” (Anxiety disorder NOS), which is observed in up to 25% of PD patients. By design, there are no standardized diagnostic criteria for Anxiety disorder NOS, because this is the category applied to individuals who do not meet diagnostic criteria for any other current anxiety disorder. Anxiety rating scales incompletely capture anxiety symptoms that relate specifically to PD symptoms and the complications arising from PD therapy. Consequently, these scales have been deemed inappropriate for use in PD, and there remains a need for the development of a new PD‐specific anxiety scale. Research establishing accurate symptom profiles of anxiety in PD is sparse, although characterizing such symptomatology would likely improve clinical diagnosis and facilitate targeted treatment strategies. Research into the neurobiological and psychological underpinnings of anxiety in PD remains inconclusive. Anxiety can precede the onset of PD motor symptoms or can develop after a diagnosis of PD. Further investigations focused on the chronology of anxiety and its relationship to PD diagnosis are required. © 2014 International Parkinson and Movement Disorder Society     

Can autism be diagnosed accurately in children under 3 years?

This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.