1,721,033 research outputs found
Alexithymia and tic disorders: a study on a sample of children and their mothers
No full textTic disorders are neurodevelopmental disorders characterised by the presence of motor or phonic tics, or both. Patients with tic disorders commonly report premonitory urges of tics. Alexithymia is a psychological trait characterised by a difficulty in identifying and expressing one’s own feelings and by an externally oriented thinking. We aimed to explore alexithymia in children with tic disorders and in their mothers. Global alexithymia scores of both children with tic disorders and of their mothers did not differ from those of the participants from the control group. In the tic disorder group, however, both children and their mothers showed a cognitive style characterised by operational thinking and a lack of imaginative abilities. The mothers of children with tic disorder reported significantly higher parental stress. Alexithymia was not predictive of tic severity but was predictive of the severity of the premonitory urges. The implications of these findings are discussed
Percutaneous assist devices in acute myocardial infarction with cardiogenic shock. review, meta-analysis
Full text linkAim: To assess the impact of percutaneous cardiac support in cardiogenic shock (CS) complicating acute myocardial infarction (AMI), treated with percutaneous coronary intervention.
Methods: We selected all of the studies published from January 1(st), 1997 to May 15(st), 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization: (1) intra-aortic balloon pump (IABP) vs Medical therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs IABP; (3) complete extracorporeal life support with extracorporeal membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 mo of follow-up.
Results: One thousand two hundred and seventy-two studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was: (1) significantly higher with IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher, although not significantly, with PLVADs compared to IABP (RR = +14%, P = 0.21); and (3) significantly lower in patients treated with ECMO plus IABP vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP.
Conclusion: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IAB
Sleep, anxiety and psychiatric symptoms in children with Tourette syndrome and tic disorders
No full textObjective: The current study evaluated the relationship between tic, sleep disorders and
specific psychiatric symptoms (anxiety, depression, obsessive compulsive symptoms).
Methods: Assessment of 36 consecutive children and adolescents with tic disorders
included: the Yale Global Tic Severity Scale (YGTSS) to assess the severity of tic symptoms;
the Self-administered scale for children and adolescents (SAFA) to evaluate the psychopathological
profile; a specific sleep questionnaire consisting of 45 items to assess the
presence of sleep disorders.
An age and sex-matched control group was used for comparisons.
Results: Sleep was significantly more disturbed in patients with tic disorders than in controls.
Difficulties in initiating sleep and increased motor activity during sleep were the most
frequent sleep disturbances found in our sample. Patients showed also symptoms of
anxiety (SAFA A), depressed mood (SAFA D) and doubteindecision (SAFA O). Additionally,
difficulties in initiating sleep resulted associated with other SAFA subscales relative to
obsessiveecompulsive symptoms and depression symptoms. Furthermore, anxiety
symptoms (SAFA A) resulted associated with increased motor activity during sleep.
Conclusions: Findings confirm literature studies reporting high frequency of sleep problems,
anxiety and other psychopathological symptoms in patients with tic disorders, and support
the hypothesis that intrusive thoughts and other emotional disturbances might disrupt the
sleep onset of these patients. These results suggest the importance of a thorough assessment
of sleep and psychiatric disturbances in patients with tic disorders
Developmental motor profile in preschool children with primary stereotypic movement disorder
Full text linkAim. Different neuropsychological dysfunctions have been described in children with primary Stereotypic Movement Disorder (SMD), mainly attention or motor coordination problems. Up to now with no study has evaluated psychomotor functions in preschoolers primary SMD. The aim of this observational study was to gather information on the motor profiles of SMD patients in this age range in comparison with typically developing children. Patients and Methods. Twenty-six children (four girls) aged 36 to 76 months (mean= 53 ±10) with primary SMD were assessed by a structured evaluation including the Movement Assessment Battery for Children-Second Edition (MABC-2), the Beery-Buktenica Developmental test of Visual-Motor Integration (VMI), the Repetitive Behaviour Scale-Revised (RBS-R), the Motor Severity Stereotypy Scale (MSSS), and the Child Behaviour Checklist (CBCL). The diagnoses of Intellectual Disability or Autism Spectrum Disorder were exclusion criteria from the study. A comparison group of twenty-seven (four girls) typically developing children without stereotypies aged 36 to 59 months (mean= 48 ±7) was also examined. Results. The MABC-2 total score was lower than 15th percentile in fifteen children with SMD (58%); the worst performances were observed in Balance and Manual Dexterity subtests. The motor coordination score of VMI was lower than 15th percentile in ten children (38%). The majority of the children with low scores at MABC-2 also had low scores at the motor coordination subscale of VMI. MABC-2 standard scores of the clinical group were significantly lower than those of controls on MABC-2 Total, Balance, and Ball Skills subtests. Conclusion. The finding of widespread dysfunction of gross and fine motor abilities in preschoolers with primary SMD seems to delineate a peculiar phenotype and could provide new approaches to the management of this neurodevelopment disorder
Psychiatric disorders in adolescent and young adult patients with phenylketonuria
No full textBackground and objectives: Psychiatric symptoms are a challenging aspect in adolescent and adult early treated phenylketonuric (ETPKU) patients. To assess the occurrence of psychiatric disorders we explored the presence of symptoms requiring intervention and further investigated the link between psychiatric disorders, the quality of biochemical control and cognitive functioning.
Patients and methods: Forty-six ETPKU patients (aged 12 to 44) and 30 age-matched healthy controls were sub- jected to cognitive and psychiatric assessment by means of self-report questionnaires and psychiatric interview. Psychiatric diagnoses, if detected, were made according to DSM-5 criteria. Concomitant IQ, historical and concur- rent biochemical metabolic controls were included in the statistical analysis.
Results: Twenty-five out of 46 ETPKUs showed clinical scores on at least one scale of the psychiatric assessment (7/30 in controls); anxiety and withdrawal were the most frequent self-reported symptoms. Seventeen patients (and no controls) met criteria for a psychiatric diagnosis, most of them belonging to the Anxiety Disorders cate- gory. The occurrence of psychiatric symptoms was not associated with the life-long and concurrent quality of metabolic control but patients with good metabolic control (≤ 500 μM) in the first 11 years of life showed higher frequency of psychiatric diagnosis (Fisher's exact p = .0300).
Discussion/conclusion: ETPKUs show a higher than normal vulnerability to psychiatric disorders, which cannot be explained by the usual biochemical alterations influencing intellectual outcome. Our data support the hypothesis that the burden of the disease acts as psychological stress for children and their families. Possible involvement of neuromediators in the pathogenesis of these complex symptoms requires further investigation
Neurocognitive and neuroimaging outcome of early treated young adult PKU patients: A longitudinal study
No full textThe aim of the study was to explore the outcome of neurocognitive deficits and neuroimaging correlates in young adult early treated phenylketonuric (PKU) patients. We conducted a longitudinal study of 14 PKU patients that were assessed for IQ and neuropsychological functioning including executive functions (EF) over 14years of follow-up (age range at 1st and 2nd assessments were 7.8-13.5 and 22.2-27.7years, respectively). The IQ of all 14 PKU patients was within the normal range. With respect to the 1st assessment, mean IQ at follow-up did not decrease significantly. Compared to control subjects (n=14), mean IQ of patients was significantly lower (p=.0005). Throughout adolescence and early adulthood there was an improvement of neuropsychological functioning of PKU patients in spite of the relaxation of diet, however some deficits were still detectable when compared to controls. All patients that underwent a second MRI scan showed white matter alterations ranging from mild to severe which was correlated neither with IQ nor with EF scoring. Cognitive, neuropsychological and neuroimaging outcome was influenced from life-long and/or second decade of life metabolic control. Nevertheless patients' developmental trajectories were in some cases independent from metabolic control. Our results support the hypothesis of an individual vulnerability to phenylalanine. However, as long as individual factors that account for the vulnerability to Phe are not recognized, strict dietary control is recommended for all the patients also in the second decade of life
Predicting susceptibility and resilience in an animal model of post-traumatic stress disorder (PTSD)
Full text linkPost-Traumatic Stress Disorder (PTSD) is a psychiatric disorder whose pathogenesis relies on a maladaptive expression of the memory for a life-threatening experience, characterized by over-consolidation, generalization and impaired extinction, which are responsible of dramatic changes in arousal, mood, anxiety and social behavior. Even if subjects experiencing a traumatic event during lifetime all show an acute response to the trauma, only a subset of them (susceptible) ultimately develops PTSD, meanwhile the others (resilient) fully recover after the first acute response. However, the dynamic relationships between the interacting brain circuits that might potentially link trauma-related experiences to the emergence of susceptible and resilient PTSD phenotypes in individuals is not well understood. Toward the first step to reach this goal, we have implemented our experimental PTSD model previously developed, making it suitable to differentiate between susceptible (high responders, HR) and resilient (low responders, LR) rats in terms of over-consolidation, impaired extinction, and social impairment long after trauma. Rats were exposed to five footshocks paired with social isolation. One week after trauma but before extinction, animals were tested in the Open Field and Social Interaction tasks for the identification of a predictive variable to identify susceptible and resilient animals before the possible appearance of a PTSD-like phenotype. Our findings show that exploratory activity after trauma in a novel environment is a very robust variable to predict susceptibility towards a PTSD-like phenotype. This experimental model is thus able to screen and differentiate, before extinction learning and potential therapeutic intervention, susceptible and resilient PTSD-like rats
Early post-cooling brain magnetic resonance for the prediction of neurodevelopmental outcome in newborns with hypoxic-ischemic encephalopathy
Full text linkAim and objectives: This study aimed to evaluate the predictive role of early post-cooling brain magnetic resonance for developmental outcome in newborns with hypoxic-ischemic encephalopathy. Materials and methods: A retrospective cohort study was performed on 29 consecutive patients through magnetic resonance evaluation (visual analysis of the images and scoring of the detected lesions; mean diffusivity of semioval centre and lenticular nuclei; and area under the curve of basal ganglia N-acetylaspartate at proton magnetic resonance spectroscopic imaging) and Griffiths Mental Development Scales-third edition at 12 and 24 months. Results: Brain magnetic resonance was performed at a mean age of 5.7 ± 3.7 days. Newborns with no/minor magnetic resonance abnormalities had a better developmental outcome than patients with moderate or severe lesions. Structural and spectroscopic abnormalities in basal ganglia resulted in the most significant predictors for an unfavorable outcome.
Conclusion: Normal magnetic resonance in early post-cooling phases is strongly associated with a favorable developmental outcome
The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position
No full textPurpose: To compare the occurrence rate of hypotensive and bradycardic events (HBEs) during arthroscopic rotator cuff
repair performed with interscalene brachial plexus block anesthesia in the sitting position in 2 groups of patients who
underwent the procedure with norepinephrine or epinephrine added to the irrigation fluid. The secondary objective was
to evaluate the efficacy of norepinephrine in comparison with epinephrine in controlling intraoperative bleeding and
maintaining adequate visualization of the arthroscopic field of view during the procedure. We hypothesized that
norepinephrine added to the irrigation fluid during shoulder arthroscopy in the sitting position would reduce the
occurrence of HBEs, allowing optimal intraoperative bleeding control. Methods: One hundred twenty patients underwent
an arthroscopic rotator cuff repair performed under peripheral anesthesia and in the beach-chair position. Patients
were randomly divided into 2 groups of 60 cases each: Norepinephrine (0.66 mg/L) and epinephrine (0.33 mg/L) were
added to irrigation bags in group N and group E, respectively. The primary outcome was the occurrence rate of HBEs
during surgery. The secondary outcomes were timing of onset of HBEs, accompanying symptoms, and intraoperative
bleeding that impaired arthroscopic visualization. The clarity of the visual field was rated postoperatively by the surgeon
using a visual analog scale. Comparison between groups for all baseline variables and outcome measurements was performed
with the c2 or Fisher exact test, as appropriate, for categorical variables and the Student t test or Mann-Whitney U
test, as appropriate, for continuous variables. Significance was set at P < .05. Results: One patient was excluded from
group E because of block failure; therefore 119 patients were finally included in the study. Comparison between groups
showed no significant differences in baseline characteristics. The occurrence rate of HBEs was significantly greater in group
E (n 1⁄4 15) than in group N (n 1⁄4 5) (P 1⁄4 .02). No differences between groups were found in the average time of onset of
HBEs, accompanying symptoms, and clarity of the visual field. Conclusions: Continuous administration of norepinephrine,
0.66 mg/L, diluted in irrigation fluid during arthroscopic rotator cuff repair with the patient in the beach-chair
position reduces the incidence of HBEs and is as effective as epinephrine in controlling intraoperative bleeding and
maintaining the visual clarity of the surgical field. Level of Evidence: Level I, randomized clinical stud
Anticoagulant therapy with rivaroxaban in a young patient with paroxysmal nocturnal hemoglobinuria
No full textThe new direct oral anticoagulants such us rivaroxaban, could play an important role in the anticoagulant treatment of patients with paroxysmal nocturnal hemoglobinuria where anticoagulant treatment is complex to run, since they have shown a reduction in serious bleeding complications compared to antithrombotic therapy with classical vitamin k antagonist
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