Onset Of Symptoms In Adulthood Research Articles

Is age at symptom onset associated with severity of memory impairment in adults with obsessive-compulsive disorder?

Age at onset is a potentially important marker for neurobiological features of obsessive-compulsive disorder (OCD). This study examined the relationship between age at symptom onset and memory impairment in adults with OCD. The authors used the Rey-Osterrieth Complex Figure Test and the California Verbal Learning Test to compare memory functioning of 37 adult OCD patients with self-reported childhood onset of symptoms (onset at less than 18 years of age) with that of 31 patients with adult-onset symptoms. No differences were found between the two groups on any of the verbal and nonverbal memory measures. Self-reported age at symptom onset is not associated with memory performance in adult patients with OCD according to tests previously found to be sensitive to frontal-striatal system dysfunction and impairment in OCD. Such dysfunction appears to be a consistent feature of OCD in adults, regardless of age at initial symptom onset.

Surgical management of recurrent pancreatitis in children with pancreas divisum.

To analyze an institutional experience with pancreatitis in childhood to clarify the frequency of pancreas divisum in that patient population, the characteristics of pancreatitis in children with pancreas divisum, and the role of surgical management in their treatment. The role of pancreas divisum in causing acute and relapsing pancreatitis and chronic, recurring abdominal pain is controversial. Although the anatomical abnormality is present from birth, most investigators have reported cases with onset of symptoms in adulthood. The reported pediatric experience with this disorder is small, and the natural history of pancreatitis in children with pancreas divisum has not been well elucidated. A retrospective chart review of all children 18 years of age and younger with a discharge diagnosis of pancreatitis identified 135 patients treated in the authors' institution from 1978 to 1998. Ten patients were found to have anatomical variants of pancreas divisum associated with recurrent or chronic pancreatitis. The medical records of these patients were reviewed for data on the presentation, diagnostic findings, imaging studies, treatment, surgical findings, and pathologic findings in these children. Chart review and telephone calls were used to assess the current state of health in nine patients available for follow-up. Pancreas divisum was identified in 7.4% of all children with pancreatitis and 19.2% of children with relapsing or chronic pancreatitis. Patients had early onset of recurrent episodic epigastric pain and vomiting, at a mean age of 6 years. Three patients had a positive family history of pancreatitis and one was proven by DNA analysis to have hereditary pancreatitis. Pancreatitis was documented by elevated amylase or lipase levels, and endoscopic retrograde cholangiopancreatography was the method of diagnosis of pancreas divisum in all patients. Eight patients had complete pancreas divisum and two had incomplete variants. Eight patients underwent surgery to improve ductal drainage. Seven underwent transduodenal sphincteroplasty of the accessory papilla, along with sphincteroplasty of the major papilla in two (plus septoplasty in one). Three patients underwent longitudinal pancreaticojejunostomy, as a primary procedure in one patient with midductal stenosis and in two because of recurring pancreatitis after sphincteroplasty. The surgical findings and histologic examination of five patients undergoing distal pancreatectomy revealed striking changes of advanced chronic pancreatitis. Patients responding to sphincteroplasty alone showed less severe histologic changes. Overall, three of seven patients had excellent results, three were improved, and one had continued disabling attacks of pancreatitis. The mean duration of follow-up was 7.3 years, and there were no deaths. No patients had endocrine or exocrine pancreatic insufficiency, and none required chronic analgesics. Pancreas divisum is an important cause of recurrent pancreatitis in childhood and should be sought aggressively in children with more than one episode of pancreatitis or pancreatitis with a history of chronic recurrent abdominal pain. Surgical intervention is directed toward relief of ductal obstruction and may involve accessory duct sphincteroplasty alone or in combination with major sphincteroplasty and septoplasty. Patients with more distal ductal obstruction or ductal ectasia may benefit from pancreaticojejunostomy.

CNTF overproduction hastens onset of symptoms in motor neuron degeneration (mnd) mice.

Ciliary neurotrophic factor (CNTF) promotes the survival of motor neurons, in vitro and in vivo. Moreover, CNTF can block the degeneration of injured or diseased motor neurons in young rodents. Motor neuron degeneration (mnd) mutant mice display adult onset symptoms reflecting progressive motor debilitation and provide a model in which to test the hypothesis that CNTF can prevent the loss of these motor functions. We generated mnd mice that harbor a genomically integrated transgene, resulting in overexpression of the encoded CNTF protein in these mice. In contrast to the beneficial effects of CNTF in preventing motor neuron degeneration in other experimental paradigms, we report that overproduction of CNTF increased the rate of onset of motor disease symptoms in mnd mice and the presence of the transgene correlated with low adult body weight in mnd and wild-type genetic backgrounds.

Foods perceived by adults as causing adverse reactions

This study was undertaken to identify differences in offending foods reported by 45 patients with classic symptoms of food allergy and/or subjective food-related complaints not traditionally associated with food allergy. On the basis of a comprehensive clinical history, skin testing, and double-blind food challenges, patients were diagnosed as having confirmed (n = 22) or unconfirmed (n = 23) adverse reactions to foods. The majority of patients in both groups were women — 17 of those with confirmed reactions and 21 of those with unconfirmed reactions. Individuals with confirmed reactions were significantly younger, 34.8±10.9 years, than those with unconfirmed reactions, 41.5±9.6 years. The symptoms and reaction patterns of adults with confirmed reactions were generally consistent with immunoglobulin E-mediated food hypersensitivity. Individuals with unconfirmed reactions were more likely to report frequently occurring, delayed-onset symptoms of a nonspecific nature, and they had an average of five times as many foods causing adult-onset symptoms than those with confirmed reactions. Adults with confirmed reactions more often reported common food allergens such as tree nuts, legumes, and crustaceans; those with unconfirmed reactions were more apt to name foods not commonly implicated in adult food allergies confirmed by conventional diagnostic methods. The types of offending foods reported suggested that individuals with unconfirmed reactions were influenced by the popular news media and clinical ecology-oriented literature. Their use of nutrition supplements was consistent with the attitude of health activism. Such individuals may seek nontraditional health care or adopt questionable dietary practices. Individuals with adverse food reactions of a nonspecific nature pose challenging problems to dietitians.