Clinical Correlates In Patients Research Articles

Pain as a symptom of depression: Prevalence and clinical correlates in patients attending psychiatric clinics

BackgroundThe need to assess the prevalence and characteristics of painful symptoms among depressed patients attended by psychiatrists in their regular clinical practice. MethodsA multi-centre, cross-sectional study was carried out in a large sample (n=3566) of patients attending out-patient psychiatric facilities in Spain. All types of DSM-IV-TR depressive disorders were included. Data on the diagnosis, specific symptoms, intensity of depression and antidepressant and analgesic drug treatments were collected. The presence and characteristics of significant pain (visual analogue scale score>40) at the time of the study were also recorded. ResultsThe prevalence of pain in depressed patients was 59.1% (CI 95%: 57.7%; 60.7%). Factors associated independently with the existence of significant pain were: being female, presence of loss of energy and the diagnosis of dysthymia or depression induced by physical disorders. In addition, age and the intensity of depression were two risk factors, where each year of age and each point in the Hamilton scale increased the risk of having pain by 2% and 8% respectively. The presence of anhedonia and the diagnosis of depression induced by illegal drugs were factors inversely related to pain. LimitationsThe cross-sectional naturalistic characteristics of the study. ConclusionOur data show a high prevalence of pain among depressive patients attending psychiatric clinics. Painful symptoms are modulated differently depending on the type of depression and the presence of specific symptoms, such as loss of energy or anhedonia. Psychiatrists should ask their depressive patients for the presence of pain on a regular basis.

Analysis of vitamin D receptor expression and clinical correlations in patients with ovarian cancer

Objective Although the antiproliferative and differentiating properties of vitamin D have been demonstrated, its effects on cancer cells are variable. Little is known about vitamin D receptor (VDR) levels in patients with ovarian cancer. In this population we sought to determine correlations between VDR expression, clinical parameters and treatment outcome. Methods We analyzed VDR content in platelets of healthy women and of a cohort of patients with ovarian tumors and we evaluated possible correlations with clinical parameters, tumor characterization (stage, histology, nuclear grading, ascites), response to therapy and survival. Moreover receptor expression was evaluated immunohistochemically on tissue samples. Results VDR levels were markedly lower in healthy women when compared with the pathological group. In the latter a significant increase in receptor expression was observed in malignancies compared with benign cases. No correlation existed between VDR expression and clinicopathological parameters, although we observed an advantage on survival if patients had a higher level of VDR expression in platelets. A cytoplasmic localization of the protein was observed by immunohistochemistry in ovarian cancer cells. Conclusions Vitamin D receptor status measured in platelets differs significantly between healthy and pathological groups, increasing with malignancy, and there is a trend towards longer overall survival for tumors showing higher VDR levels. These data suggest that platelet VDR content could be used as a pathological marker. The meaning of this increased VDR expression in platelets needs further investigation and it is possibly linked to an inflammatory response.

Adjunctive antidepressant use and its clinical correlates in patients with schizophrenia: an East Asia multicenter comparative prescribing audit

Aims: Previous pharmacoepidemiological studies have highlighted considerable rates of adjunctive psychotropic medication prescriptions in patients with schizophrenia, including the use of adjunctive antidepressants, but this has not previously been studied in East Asia. This study examined the frequency of adjunctive antidepressant prescriptions in patients with schizophrenia and their clinical correlates in six East Asian countries and territories. Methods: Co-prescription of antidepressants for a sample of 2,136 patients with schizophrenia from six countries and territories (China, Hong Kong, Korea, Japan, Taiwan, Singapore) were evaluated in 2004 using a standardized protocol. Results: Adjunctive antidepressant prescriptions were found in 6.5% (n=139) of the patients with some intercountry differences. Co-prescription of antidepressants was significantly associated with younger age, shorter duration of index admission, electroconvulsive therapy in the past month, less likelihood of manifesting disorganized speech, and prescription of first generation antipsychotic drugs. Concomitant antidepressant prescription was associated with greater weight and increased number of adverse events including constipation, sedation and sexual dysfunction. On multivariate analysis, it was found that country, younger age and history of electroconvulsive therapy for the past month were significantly associated with adjunctive antidepressant use. Discussion: Adjunctive antidepressant use for schizophrenia in East Asia was associated with a number of demographic, clinical, and treatment variables. The association with greater weight and more adverse events reinforces the notion that prescription of adjunctive psychotropic medication is not without its costs. The challenge for the clinician is to constantly reevaluate the risk benefit ratio in the process of understanding the patient in a holistic context and to optimize the treatment regimes for patients with schizophrenia.

Diagnostic role of serum glypican‐3 in differentiating hepatocellular carcinoma from non‐malignant chronic liver disease and other liver cancers

The role of glypican-3 (GPC3), a novel serum marker, in differentiating hepatocellular carcinoma (HCC) from non-malignant chronic liver disease and other malignant space-occupying lesions in the liver is largely unknown. The aims of this study were to evaluate its diagnostic role and clinical correlations in patients with HCC. Six groups were studied which included 40 healthy subjects, 50 patients with chronic hepatitis (CH), 50 patients with liver cirrhosis (LC), 100 patients with HCC, 50 patients with intrahepatic cholangiocarcinoma (ICC) and 50 patients with metastatic carcinoma (MCA). Serum GPC3 levels were measured by using a sandwich enzyme-linked immunosorbent assay method. Fifty-three percent of HCC patients had elevated serum GPC3 levels with values ranging 35.5-7826.6 ng/mL. The serum marker was undetectable in other groups except one patient (2%) with LC and another patient (2%) with MCA. In most cases of HCC, elevated GPC3 values did not correlate with alpha-fetoprotein (AFP) levels. Detectable GPC3 was significantly correlated with the presence of viral hepatitis markers but was not correlated with tumor size and stage of HCC. Serum GPC3 was superior to AFP in detecting small HCC (56.3% and 31.3%, respectively). A combination of serum GPC3 and AFP yielded an improved sensitivity for detecting small HCC to 75%. Serum GPC3 is highly specific for detecting HCC. The combined use of serum GPC3 and AFP provides a potentially promising tool to better differentiate HCC from benign liver disorders, as well as from other liver cancers.

Clinical significance of V617F mutation of the JAK2 gene in patients with chronic myeloproliferative disorders

Objective: To determine the prevalence of JAK2 V617F mutation and its clinical correlation in patients with chronic myeloproliferative disorders (CMD): polycythemia vera (PV), essential thrombocythemia (ET) and idiopathic myelofibrosis (IMF).Materials and methods: Detection of JAK2 V617F mutation by allele specific-PCR.Results: One hundred and three patients with CMD were included in the study. JAK2 V617F distribution was PV 40/45 (89%), ET 30/43 (69%), and IMF 7/15 (47%). In PV and ET patients only, 18 had thrombosis at diagnosis and 12 during follow-up (these were microvascular: 11, venous: 7 and arterial: 12); of these 28/70 (40%) were JAK2pos versus 2/18 (11%) JAK2neg; P=0·02. In a median of 4 years, two patients with PV JAK2pos evolved to myelofibrosis and one patient with PV presented in leukemic transformation (JAK2pos before and after transformation); six patients died: four patients with IMF and two patients with PV.Conclusions: We found an association between JAK2 V617F and thrombotic events in patients with PV and ET.

7113 Radiographic findings of drug-induced pneumonitis and clinical correlation in patients with advanced renal cell carcinoma treated with temsirolimus

7113 Radiographic findings of drug-induced pneumonitis and clinical correlation in patients with advanced renal cell carcinoma treated with temsirolimus

Narcoleptic Patients' Perceptions of Nicotine

Free AccessNicotineNarcoleptic Patients' Perceptions of Nicotine Lois E. Krahn, M.D., Kari A. Martin, M.D., Michael H. Silber, M.B.Ch.B. Lois E. Krahn, M.D. Dept of Psychiatry and Psychology Sleep Disorders Center, Mayo Clinic College of Medicine, Scottsdale AZ Search for more papers by this author , Kari A. Martin, M.D. Dept of Psychiatry and Psychology Search for more papers by this author , Michael H. Silber, M.B.Ch.B. Dept of Neurology Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester MN Search for more papers by this author Published Online:August 15, 2009https://doi.org/10.5664/jcsm.27554Cited by:9SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONAlthough little studied, the attitudes of narcolepsy patients towards nicotine raise several issues. Whether patients view nicotine as a useful self-management technique for EDS is unclear. Given that excessive daytime sleepiness (EDS) is the cardinal symptom of narcolepsy, patients who smoke theoretically are at higher risk of injury and property damage.Participants at the 2007 Narcolepsy Network meeting were surveyed regarding nicotine using a 25-item questionnaire developed by the authors. Seventeen anonymous responses were received, of which eight were from current or past smokers, allowing an exploration of the respondents' perceptions and experiences. No respondents used smokeless tobacco products.Nicotine was perceived to decrease EDS by all smokers. One respondent reported that nicotine also decreased cataplexy. One-third had fallen asleep at least once while smoking, with many others describing coming very close. Smoking materials had caused fires or burns for two respondents leading to injuries, damaged clothing/furniture/carpet, and total loss of a car. Nicotine cessation was viewed as challenging because of increased EDS by seven respondents.These preliminary data indicate the need for more in-depth investigation into the risks of smoking for patients with narcolepsy. Nicotine cessation efforts for patients with narcolepsy could be more effective if the perception that nicotine decreases EDS is factored into treatment.DISCLOSURE STATEMENTThe authors have indicated no conflicts of interest. Previous article Next article FiguresReferencesRelatedDetailsCited by Narcolepsy, co-morbidities and smokingDhillon N, Riha R and Dhillon B Sleep Medicine, 10.1016/j.sleep.2018.08.012, Vol. 52, , (236), Online publication date: 1-Dec-2018. Response to “smoking, co-morbidities and narcolepsy”Cohen A, Mandrekar J, St. Louis E, Silber M and Kotagal S Sleep Medicine, 10.1016/j.sleep.2018.08.009, Vol. 52, , (237), Online publication date: 1-Dec-2018. Retrospective multicenter matched case–control study on the risk factors for narcolepsy with special focus on vaccinations (including pandemic influenza vaccination) and infections in GermanyOberle D, Pavel J, Mayer G, Geisler P and Keller-Stanislawski B Sleep Medicine, 10.1016/j.sleep.2017.02.026, Vol. 34, , (71-83), Online publication date: 1-Jun-2017. Narcolepsy with cataplexy in patients aged over 60 years: a case-control studyKovalská P, Kemlink D, Nevšímalová S, Maurovich Horvat E, Jarolímová E, Topinková E and Šonka K Sleep Medicine, 10.1016/j.sleep.2016.05.011, Vol. 26, , (79-84), Online publication date: 1-Oct-2016. Smoking Prevalence and Its Clinical Correlations in Patients with Narcolepsy-cataplexyPeřinová P, Feketeová E, Kemlink D, Kovalská P, Chlebušová K, Nepožitek J, Ibarburu V, Králíková E, Nevšímalová S and Šonka K Prague Medical Report, 10.14712/23362936.2016.8, Vol. 117, No. 2-3, (81-89), . Clinical and practical considerations in the pharmacologic management of narcolepsyThorpy M and Dauvilliers Y Sleep Medicine, 10.1016/j.sleep.2014.10.002, Vol. 16, No. 1, (9-18), Online publication date: 1-Jan-2015. Treatment options in narcolepsyMayer G, Bassetti C and Dauvilliers Y Expert Opinion on Orphan Drugs, 10.1517/21678707.2013.854701, Vol. 1, No. 12, (987-999), Online publication date: 1-Dec-2013. Narcolepsy with Cataplexy Masked by the Use of NicotineEbben M and Krieger A Journal of Clinical Sleep Medicine, Vol. 08, No. 02, (195-196), Online publication date: 15-Apr-2012. Narcolepsy with Cataplexy Associated with Nocturnal Compulsive Behaviors: A Case-Control StudyPalaia V, Poli F, Pizza F, Antelmi E, Franceschini C, Moghadam K, Provini F, Pagotto U, Montagna P, Schenck C, Mignot E and Plazzi G Sleep, 10.5665/SLEEP.1280, Vol. 34, No. 10, (1365-1371), Online publication date: 1-Oct-2011., Online publication date: 1-Oct-2011. Volume 05 • Issue 04 • August 15, 2009ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationApril 1, 2009Accepted for publicationApril 1, 2009Published onlineAugust 15, 2009 Information© 2009 American Academy of Sleep MedicinePDF download

Clonal B‐cell population in a reactive lymph node in acquired immunodeficiency syndrome

A 40-year-old female, HIV positive, stage C, since 4 years, complained of a right cervical lymph node swelling. Two years before, the patient had been diagnosed with follicular B-cell non-Hodgkin lymphoma (FL); she had been treated with four cycles of multiagent chemotherapy plus rituximab, the last cycle being administered 10 months before coming to our attention. An ultrasound (US) guided fine-needle cytology (FNC) showed an atypical lymphoid cell proliferation. The phenotype evidenced by flow cytometry (FC) analysis was D5: 10%, CD19: 49%, CD23: 10%, FMC7: 0%, CD10: 40%, CD10/19: 40%, lambda light chain 40%, kappa light chain 0%. FDG-positron emission tomography (PET/CT) scan showed positivity in the corresponding cervical area. Since low LDH values and a reduced lymph node size were observed, the lymph node was therefore excised; the histology revealed a reactive hyperplastic lymph node with florid follicular pattern. A subsequent PCR analysis, performed on DNA extracted from a whole histological section, did not evidence IgH rearrangement. The patient is currently undergoing strict clinical and instrumental follow-up, including PET every 3 months; after 13 months, she is alive without recurrence of lymphoma. Clonal B-cell populations in non-lymphomatous processes have been described in mucosa-associated lymphoid cell populations and reactive lymph nodes, and are considered non-malignant, antigen driven, proliferations of B-lymphocytes determined by an abnormal response to bacterial or viral antigen stimulation. The present case occurred in an HIV patient and was clinically complex because of the patient's history of FL. This experience suggests much attention in the evaluation of radiological, cytological, and FC data and in clinical correlation in patients suffering from autoimmune or immunodeficiency syndromes.

Cerebral Vasospasm: New Strategies in Research and Treatment

Cerebral Vasospasm: New Strategies in Research and Treatment

Distinguishing affective depersonalization from anhedonia in major depression and bipolar disorder

Background Affective depersonalization has received limited attention in the literature, although its conceptualization may have implications in terms of identification of clinical endophenotypes of mood disorders. Thus, this study aims to test the hypothesis that anhedonia and affective depersonalization represent 2 distinct psychopathological dimensions and to investigate their clinical correlates in patients with major depressive disorder (MDD) and bipolar disorder (BD). Methods Using a data pool of 258 patients with mood and anxiety disorders, an item response theory–based factor analysis approach was carried out on 16 items derived from 2 clinical instruments developed in the Spectrum Project (the Structured Clinical Interview for Mood Spectrum and the Structured Clinical Interview for Derealization-Depersonalization Spectrum). Clinical correlates of these psychometrically derived dimensions were subsequently investigated in patients with BD or MDD. Results Using an item response theory–based factor analysis, a 2-factor solution was identified, accounting overall for the 47.0% of the variance. Patients with BD showed statistically significant higher affective depersonalization factor scores than those with MDD ( Z = 2.215, P = .027), whereas there was no between-groups difference in anhedonia scores ( Z = 0.825 P = .411). In patients with BD, age of onset of the disease correlated with affective depersonalization factor scores ( ρ = −0.330, P = .001) but not with anhedonia factor scores ( ρ = −0.097, P = .361). Conclusions Affective depersonalization and anhedonia seem to be 2 distinct psychopathological dimensions, although closely related, bearing the opportunity to identify patients with a specific profile for a better clinical and neurobiological definition.

Complex Post-Traumatic Stress Disorder in Patients with Somatization Disorder

Given the association between severe childhood trauma, adult somatization and complex post-traumatic stress disorder (cPTSD), the purpose of the present paper was to assess this syndrome and its clinical correlates in patients with somatization disorder (SD). A total of 28 patients (82% women, mean age = 41.7+/-10.1 years) meeting DSM-IV criteria for SD as confirmed by the Structured Clinical Interview for DSM-IV, Axis I were compared to 28 age- and gender-matched patients with major depression, but without a lifetime diagnosis of SD. They completed the Structured Interview for Disorders of Extreme Stress, the Brief Symptom Inventory, the Inventory of Interpersonal Problems-Circumplex Scales, and the SF-36 Health Survey. Compared to the control group, SD patients had higher risks for current and lifetime diagnoses of cPTSD (odds ratio (OR) = 15.0, 95% confidence interval (CI) = 1.76-127.54; and OR = 8.33, 95%CI = 2.04-34.07, respectively). SD subjects with cPTSD had more psychological distress, more interpersonal problems and worse psychosocial functioning than those without the syndrome. The concept of complex PTSD may hold clinical utility when applied to SD patients because it identifies a distinct subgroup characterized by severe psychosocial impairment. The diagnostic and therapeutic implications of the present findings are discussed.

Who responds to aripiprazole in clinical practice? An observational study of combination versus monotherapy

We aimed to study aripiprazole, as monotherapy and combined with other antipsychotics, in routine clinical practice, to identify patients who had a favourable clinical response. We retrospectively identified all secondary care psychiatric patient records started on aripiprazole (n = 85). We assigned Clinical Global Impression scores to measure effectiveness. We examined demographic and clinical correlates of patients who improved (CGI Improvement scores < 5) versus those who did not improve (CGI > or = 5). 56 patients (66%) received aripiprazole as monotherapy, 29 patients (34%) in combination with other antipsychotics. 52 patients (62%) received a CGI 1-4 (minimally to very much improved), 32 patients (38%) a CGI > or = 5 (no change to very much worse). Patients who improved were less likely to have had previous or subsequent treatment with clozapine (p = 0.04). Discontinuation was due to agitation (35%), inefficacy (21%), nausea (18%) and worsening psychosis (12%). Combination with other antipsychotics resulted in less discontinuation and a lower maximum dose of aripiprazole. Aripiprazole was combined with other regular additional antipsychotics in 1/3rd of patients. Combination and monotherapy were clinically effective in around 60% of patients. Favourable response was associated with lack of treatment resistance. Agitation was the commonest reason for discontinuation.

Clinical correlates of patients with rapid-cycling bipolar disorder and a recent history of substance use disorder: a subtype comparison from baseline data of 2 randomized, placebo-controlled trials.

To compare clinical variables in patients with rapid-cycling bipolar I or II disorder and a recent history of substance use disorder (SUD). Cross-sectional data from 2 studies of patients with rapid-cycling bipolar I disorder or rapid-cycling bipolar II disorder and a recent history of SUD were used to retrospectively assess the differences in clinical variables between the subtypes. The studies were conducted from November 1997 to February 2007 at University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Extensive clinical interview and the Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV diagnoses of rapid-cycling bipolar disorder, SUDs, and other Axis I disorders and to collect clinical variables. The Addiction Severity Index (ASI), Global Assessment Scale (GAS), and the Medical Outcomes Study 36-Item Short-Form Health Survey were used to measure the severity of impairment at the initial assessment. One-way analysis of variance or chi(2) was used for significance tests. A Bonferroni adjustment was applied for multiple comparisons. Of 245 patients with rapid-cycling bipolar disorder (rapid-cycling bipolar I disorder, N = 191; rapid-cycling bipolar II disorder, N = 54) and a recent history of SUD, the demographics were similar. A significantly higher rate of panic disorder was observed in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder (odds ratio = 3.72, 95% CI = 1.66 to 8.32, p = .008). A significantly higher psychiatric composite score on the ASI was also found in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder even after Bonferroni adjustment (p = .0007). There were no significant differences between the subtypes in the rates of previous hospitalization or suicide attempt, early childhood verbal, physical, or sexual abuse, lifetime substance abuse or dependence, the number of SUDs or mood episodes in the last 12 months, and total or other subscale scores on ASI and GAS. Except for the significantly higher rate of comorbid panic disorder and higher psychiatric composite scores on the ASI in patients with rapid-cycling bipolar I disorder than in those with rapid-cycling bipolar II disorder, the other clinical variables were similar between the 2 groups.

Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury

Abusive head trauma (AHT) in young children usually has a severe outcome when associated with hypoxic-ischemic encephalopathy (HIE), which is best characterized by MRI in the acute or subacute phase utilizing diffusion-weighted imaging (DWI). HIE in this setting has been hypothesized to result from stretching of the spinal cord, brainstem, or vasculature. To provide clinical correlation in patients with unilateral HIE and to postulate a mechanism in the setting of suspected AHT. IRB approval was obtained. Over a 5-year period, the medical records and images were reviewed of the 53 children < or = 3 years of age who presented with acute head trauma according to the hospital registry. The children were subselected in order to determine how many suffered either HIE or AHT, and to detect those with unilateral HIE. In 11 of the 53 children, the etiology of the head trauma was highly suspicious for abuse. In 38 the head trauma was accidental and in 4 the trauma was of unknown etiology and at the time of this report was unresolved legally. Of the 53, 4 suffered HIE confirmed by CT or MRI. In three of these four with HIE the trauma was considered highly suspicious for AHT. Two of these three were the only patients with unilateral HIE, and both (7 months and 14 months of age) presented with early subacute phase HIE seen on DW MRI (range 4-7 days) and are described in detail with clinical correlation. The third child with AHT and HIE had bilateral findings. In the fourth patient the HIE was bilateral and was considered accidental. The work-up for both patients with unilateral HIE included head CT, craniocervical MRI, and craniocervical MR angiography (MRA). In both, there was mostly unilateral, deep white matter restricted diffusion, with subdural hematomas that were small compared to the extent of hypoxic-ischemic insult, and no skull fracture. Craniocervical MRA and axial thin-section fat-saturation images were negative for dissection, brainstem, or cord injury. Legal authorities obtained a confession of inflicted injury in one and a partial confession in the second (which did not fit the extent of injury). Five other children with HIE (based on DWI) were found during this period who had not suffered head trauma; all were bilateral insults. HIE associated with AHT might present with largely unilateral white matter injury on DWI following extensive cortical infarction. We propose that unilateral HIE in a young child might be a sign of AHT and might result from cervical vascular compression, whether from kinking during hyperflexion/hyperextension or from direct strangulation.

Shuttle walking versus maximal cycle testing: Clinical correlates in patients with kyphoscoliosis

A cross-sectional prospective design was used to compare the effectiveness of the shuttle walking test (SWT) and the maximal cycle ergometry test (CET) to assess the functional capacity of patients with chronic hypercapnic respiratory failure due to severe kyphoscoliosis. Twenty-four patients completed both the SWT and CET. Heart rate, blood pressure, leg fatigue, chest pain and dyspnea (Borg's scale) were measured immediately after each test. Correlation coefficients and Bland-Altman analysis were used to compare the two methods. Borg's dyspnea, leg and chest pain after exercise were not significantly different between tests. Only heart rate (SWT 130[20.7] versus CET 116[28.75]; p = 0.048) and diastolic blood pressure (SWT: 85.5[13.75] versus CET 95[17.5]; p = 0.021) were slightly but significantly different between the two protocols. There was a good positive correlation between the distance walked in SWT and maximal oxygen consumption (r = 0.675; p < 0.001). SWT and CET testing elicited similar clinical and hemodynamic responses. SWT is a feasible measure of functional capacity in this patient group.

Whole-Brain Histogram and Voxel-Based Analyses of Diffusion Tensor Imaging in Patients with Leukoaraiosis: Correlation with Motor and Cognitive Impairment

Cerebral white matter changes, termed leukoaraiosis (LA), appearing as areas of increased signal intensity in T2-weighted MR images, are common in elderly subjects, but the possible correlation of LA with cognitive or motor deficit has not been established. We hypothesized that histogram and voxel-based analyses of whole-brain mean diffusivity (MD) and fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) could be more sensitive tools than visual scales to investigate the clinical correlates of LA. Thirty-six patients of the Leukoaraiosis and Disability Study were evaluated with fluid-attenuated inversion recovery for LA extension, T1-weighted images for volume, and DTI for MD and FA. The extent of LA was rated visually. The normalized total, gray, and white matter brain volumes were computed, as well as the 25th percentile, 50th percentile, kurtosis, and skewness of the MD and FA maps of the whole brain. Finally, voxel-based analysis on the maps of gray and white matter volume, MD, and FA was performed with SPM2 software. Correlation analyses between visual or computerized data and motor or neuropsychologic scale scores were performed using the Spearman rank test and the SPM2 software. The visual score correlated with some MD and FA histogram metrics (P<.01). However, only the 25th and 50th percentiles, kurtosis, and skewness of the MD and FA histograms correlated with motor or neuropsychologic deficits. Voxel-based analysis revealed a correlation (P<.05 corrected for multiple comparisons) between a large cluster of increased MD in the corpus callosum and pericallosal white matter and motor deficit. These results are consistent with the hypothesis that histogram and voxel-based analyses of the whole-brain MD and FA maps are more sensitive tools than the visual evaluation for clinical correlation in patients with LA.

Who responds to aripiprazole? An observational study

Background:Aripiprazole is a new antipsychotic with a different mode of action to established second generation antipsychotics. We aimed to study patients who were prescribed aripiprazole in routine clinical practice, to identify patients who had a good clinical response.Methods:From a data set of 21,000 electronic patient records (starting in 2002), we retrospectively identified all secondary care psychiatric patients started on aripiprazole (n=180). We assigned an improvement score of Clinical Global Impression to these records to measure the effectiveness of aripiprazole. We examined demographic and clinical correlates of patients who improved (CGI scores 80% psychosis), duration of contact with services, or initial dose of aripiprazole (10mg). Patients who improved with aripiprazole were less likely (p<0.01) to be treatment resistant (previous or subsequent treatment with clozapine). Discontinuation was primarily due to agitation (29%) followed by inefficacy (23%) and worsening psychosis (10%).Conclusions:Aripiprazole was clinically effective in around two-third of patients. Favourable response was associated with lack of treatment resistance. Agitation followed by inefficacy were the commonest reasons for discontinuation.

Aberrant learning in individuals who perform repetitive skilled hand movements: Focal hand dystonia—Part 2

Byl et al. carried out a variety of clinical studies to gather more evidence to support the presence of sensory discrimination problems in patients with focal hand dystonia and the effectiveness of sensorimotor learning based training for FHd. ( Byl and McKenzie, 2000 Byl N.N. McKenzie A. Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study. Journal of Hand Therapy. 2000; 13: 289-301 Abstract Full Text PDF PubMed Scopus (112) Google Scholar ; Byl and McKenzie et al., 2000 Byl N.N. McKenzie A. et al. Differences in somatosensory hand organization in a healthy flutist and a flutist with focal hand dystonia: a case report. Journal of Hand Therapy. 2000; 13: 302-309 Abstract Full Text PDF PubMed Scopus (57) Google Scholar , Byl et al., 2003 Byl N. Nagarajan S.S. McKenzie A.A. Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: three case studies. Archives of Physical Medicine and Rehabilitation. 2003; PubMed Google Scholar ; McKenzie and Nargarjuna et al., 2003 McKenzie A.L. Nargarjuna S.S. et al. Somatosensory representation of the digits and clinical performance in patients with focal hand dystonia. American Journal of Physical Medicine and Rehabilitation. 2003; 82: 737-749 Crossref PubMed Scopus (59) Google Scholar ) The goals of this series of experiments were to: (1)describe the neurophysiological and clinical correlates of patients with focal hand dystonia (Experiments I); (2)outline the differences in sensorimotor function by severity of focal hand dystonia (Experiment II); (3)evaluate the effectiveness of learning based sensorimotor training on the remediation of focal hand dystonia (Experiment III); (4)relate change in clinical function with change in cortical structure following a learning based sensorimotor retraining program (Experiments IV and V).

Functional response to active and passive ankle movements with clinical correlations in patients with primary progressive multiple sclerosis

Patients with multiple sclerosis (MS) activate a more diffuse cortical network than do healthy subjects when they perform motor tasks. This brain functional reorganisation might contribute to the limiting of disability, but it is unclear whether there is a loss of regional activation in more advanced disease. The aim of this study was to assess whether functional reorganisation diminishes in more disabled patients with primary progressive (PP) MS. The differences in the fMRI response to active and passive movements of the dominant ankle of 13 patients and 16 controls were assessed. The relationships between functional activation and disability and brain lesion load and atrophy were investigated.Patients showed greater fMRI activation than controls with passive movements in the superior temporal gyrus, rolandic operculum, and putamen. The fMRI response to active and passive movements in the ipsilateral inferior frontal gyrus was lower in patients with greater disability and greater brain T2 lesion load, respectively. Furthermore, the fMRI activation with active movements in the contralateral cerebellum was lower in patients with worse mobility. The increased activity with passive movements in regions that participate in sensori-motor integration, such as the putamen, reflects true functional reorganisation, since passive movements induce brain activation through sensory afferents only. The inverse correlation between the fMRI response in regions that are associated with motor control, and clinical or MRI measures of disease progression, suggests that there is a loss of distributed activation in more disabled patients. This may inform future treatment strategies.

Persistent T-cell activation and clinical correlations in patients with ANCA-associated systemic vasculitis

Although in antineutrophil cytoplasmic autoantibodies (ANCA)-associated systemic vasculitis (AASV) patients, activation of T-cells has been described, persistence of these alterations has not been well characterized. This study was conducted to define persistent T-cell activation (PTA) in AASV patients and to assess whether this correlates with disease activity, disease severity, age or therapy. The expression of CD4, CD45RO, CD25, CD26, CD28, CCR7 and HLA-DR was examined longitudinally in 38 consecutive AASV patients. Clinical parameters were compared by univariate and multiple analysis and Kaplan-Meier curves for relapse-free survival were calculated. PTA could be defined as either of two activation phenotypes, i.e. a low percentage of CD4+ CD45RO- T-cells or a high percentage of CD25 in the naïve CD4+ population (n = 26), since only these phenotypes were stable over time and were not associated with active disease. In patients with PTA, major organ involvement was significantly more often found than in patients without PTA. Moreover, the cumulative cyclophosphamide dose (26.86 vs 8.53 P < 0.01) was significantly increased in these patients, suggesting that PTA was associated with disease severity. In general, patients with PTA were older than those without (62.92 +/- 9.4 years vs 48.42 +/- 16.9 years respectively, P < 0.01). PTA was independent of disease duration. Interestingly, patients with a low percentage of CD4+CD45RO- T-cells were significantly more often diagnosed as microscopic polyangiitis (P < 0.01). We identified two independent phenotypes of T-cell activation in AASV patients. These phenotypes are persistent and do not reflect disease activity. PTA predominantly occurs in patients with severe disease. This might explain the higher cumulative cyclophosphamide dose found in these patients.