Etiology Of Symptoms Research Articles

Gene-environment interaction: New insights into perceived parenting and social anxiety among adolescents.

Social anxiety symptoms (SAS) are among the most common mental health problems during adolescence, and it has been shown that parenting influences the adolescent's level of social anxiety. In addition, it is now widely assumed that most mental health problems, including social anxiety, originate from a complex interplay between genes and environment. However, to date, gene-environment (G × E) interactions studies in the field of social anxiety remain limited. In this study, we have examined how 274 genes involved in different neurotransmission pathways interact with five aspects of perceived parenting as environmental exposure (i.e., support, proactive control, psychological control, punitive control, and harsh punitive control) to affect SAS during adolescence. We have applied an analytical technique that allows studying genetic information at the gene level, by aggregating data from multiple single-nucleotide-polymorphisms within the same gene and by taking into account the linkage disequilibrium structure of the gene. All participants were part of the STRATEGIES cohort of 948 Flemish adolescents (mean age = 13.7), a population-based study on the development of problem behaviors in adolescence. Relevant genes were preselected based on prior findings and neurotransmitter-related functional protein networks. The results suggest that genes involved in glutamate (SLC1A1), glutathione neurotransmission (GSTZ1), and oxidative stress (CALCRL), in association with harsh punitive parenting, may contribute to social anxiety in adolescence. Isolated polymorphisms in these genes have been related to anxiety and related disorders in earlier work.Conclusions: Taken together, these findings provide new insights into possible biological pathways and environmental risk factors involved in the etiology of social anxiety symptoms' development. Taken together, these findings provide new insights into possible biological pathways and environmental risk factors involved in the etiology of social anxiety symptoms' development.

Gastrointestinal peptides and small-bowel hypomotility are possible causes for fasting and postprandial symptoms in active Crohn’s disease

Crohn's disease (CD) patients suffer postprandial aversive symptoms, which can lead to anorexia and malnutrition. Changes in the regulation of gut hormones and gut dysmotility are believed to play a role. This study aimed to investigate small-bowel motility and gut peptide responses to a standard test meal in CD by using MRI. We studied 15 CD patients with active disease (age 36±3 y; BMI 26±1 kg/m 2) and 20 healthy volunteers (HVs; age 31±3 years; BMI 24±1 kg/m 2). They underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling following a 400-g soup meal (204 kcal). Small-bowel motility, other MRI parameters, and glucagon-like peptide-1 (GLP-1), polypeptide YY (PYY), and cholecystokinin peptides were measured. Data are presented as means±SEMs. HVs had significantly higher fasting motility indexes [106±13 arbitrary units (a.u.)], compared with CD participants (70±8 a.u.; P≤0.05). Postprandial small-bowel water content showed a significant time by group interaction (P<0.05), with CD participants showing higher levels from 210 min postprandially. Fasting concentrations of GLP-1 and PYY were significantly greater in CD participants, compared with HVs [GLP-1, CD 50±8 µg/mL versus HV 13±3 µg/mL (P≤0.0001); PYY, CD 236±16 pg/mL versus HV 118±12 pg/mL (P≤0.0001)]. The meal challenge induced a significant postprandial increase in aversive symptom scores (fullness, distention, bloating, abdominal pain, and sickness) in CD participants compared with HVs (P≤0.05). The decrease in fasting small-bowel motility noted in CD participants can be ascribed to the increased fasting gut peptides. A better understanding of the etiology of aversive symptoms in CD will facilitate identification of better therapeutic targets to improve nutritional status. This trial was registered at clinicaltrials.gov as NCT03052465.

Лимфаденопатии в педиатрической практике

The purpose — to present the information on the main causes of lymphadenopathies in children and the stages of differential-diagnostic search which complicate diagnosing and determining the treatment tactics. Material and methods. Analysis of literature data on lymphadenopathies in children, features of clinical manifestations under tumorous and non-tumorous etiology of the disease, and approaches to differential diagnostics. Results. The article presents the general information on etiology and classification of the characteristic clinical symptoms of lymphadenopathies in children, which are necessary for a pediatrician to determining the treatment tactics of a patient with this pathology. Conclusion. For duly diagnosing a child with lymphadenopathy, a pediatrician should be aware of a wide range of nosologies and be attentive to any detail of the case history, clinical picture and laboratory examination data, as it may influence not only the treatment efficiency but even life forecast for the patient.

Evaluation of concordance between degenerative changes on neck X-ray and symptomatic cervical disc herniation

ObjectivesRadiographic assessment of cervical spine can help find the etiology of neck symptoms, however association between these findings is debatable. The aim of this study was to investigate the association between degenerative changes of the cervical spine and symptomatic cervical disc herniation. Patients and MethodsThis cross-sectional retrospective study included 160 patients who underwent anterior cervical discectomy and fusion between February 2012 and June 2017 for cervical disc herniation. Demographic data, patients' symptoms and radiographic findings and indices were evaluated. The Chi-Square (X2) and one-way ANOVA were used to compare the observed data. ResultsA total of 160 patients were studied. Among them, 83(52%) were male and 77(48%) were female. The patients were classified into four groups on the basis of imaging findings: 89(55.6%) with degenerative changes and symptomatic disc herniation at the same level (group 1), 40(25%) with degenerative changes at a level adjacent to symptomatic level (group 2), 23(14.3%) with symptomatic herniation both at the degenerated level and at level immediately adjacent to it (group 3), and 8(5%) symptomatic herniation and degenerative changes at non-adjacent levels (group 4). There were no significant differences among the four groups from the viewpoint of gender, age, symptoms, smoking and sedentary life style. The study also showed no significant differences between groups with respect to Ishihara index, disc height and posterior osteophyte length. ConclusionDegenerative changes visible on neck X-ray can be useful clues to the symptomatic disc herniation, but disc herniation may also develop at adjacent and non-adjacent levels.

Defining Mental and Behavioural Disorders in Genetically Determined Neurodevelopmental Syndromes with Particular Reference to Prader-Willi Syndrome.

Genetically determined neurodevelopmental syndromes are frequently associated with a particular developmental trajectory, and with a cognitive profile and increased propensity to specific mental and behavioural disorders that are particular to, but not necessarily unique to the syndrome. How should these mental and behavioural disorders best be conceptualised given that similar symptoms are included in the definition of different mental disorders as listed in DSM-5 and ICD-10? In addition, a different conceptual framework, that of applied behavioural analysis, has been used to inform interventions for what are termed ‘challenging behaviours’ in contrast to types of interventions for those conditions meeting diagnostic criteria for a ‘mental disorder’. These syndrome-specific developmental profiles and associated co-morbidities must be a direct or indirect consequence of the genetic abnormality associated with that syndrome, but the genetic loci associated with the syndrome may not be involved in the aetiology of similar symptoms in the general population. This being so, should we expect underlying brain mechanisms and treatments for specific psychopathology in one group to be effective in the other? Using Prader-Willi syndrome as an example, we propose that the conceptual thinking that informed the development of the Research Domain Criteria provides a model for taxonomy of psychiatric and behavioural disorders in genetically determined neurodevelopmental syndromes. This model brings together diagnostic, psychological and developmental approaches with the aim of matching specific behaviours to identifiable neural mechanisms.

P.011 Role of microRNA in the vulnerability or resilience to stress-related disorders: novel target for preventive strategies

Anti-NMDAR encephalitis is increasingly recognized as one etiology of psychiatric symptoms, but there is not enough evidence on patients with mood disorder. We assayed anti-NR1/NR2B IgG antibodies in serum and/or cerebrospinal fluid of 62 patients initially diagnosed with mood disorder by a cell-based assay. We also investigated the specific patient characteristics and psychotic symptoms. At first admission, the patients showed only psychiatric symptoms without typical neurological signs or abnormal examination findings. Four of the 62 patients had anti-NR1/NR2B IgG antibodies. The anti-NR1/NR2B IgG antibody-positive patients showed more super- or abnormal sensitivity (P = 0.00088), catatonia (P = 0.049), and more conceptual disorganization (P < 0.0001), hostility (P = 0.0010), suspiciousness (P < 0.0001), and less emotional withdrawal (P < 0.0001) and motor retardation (P < 0.0001) on the Brief Psychiatric Rating Scale than the antibody-negative patients. During the clinical course, anti-NR1/NR2B IgG antibody-positive patients showed more catatonia (P = 0.0042) and met Graus's criteria for diagnosis of anti-NMDAR encephalitis, but negative patients did not. Immunotherapy was effective for anti-NR1/NR2B IgG antibody-positive patients, and there was the weak relationship (R² = 0.318) between the anti-NR1/NR2B IgG antibody titer in the cerebrospinal fluid and the Brief Psychiatric Rating Scale score.

Postoperative Pullthrough Obstruction in Hirschsprung Disease: Etiologies and Diagnosis.

Some patients continue to have obstructive symptoms and/or incontinence after pullthrough surgery for Hirschsprung disease. Incontinence can be due to injury to the anal sphincter and/or dentate line, abnormal colonic motility (nonretentive), or a chronic large stool burden (retentive). A diagnostic algorithm based on clinical and pathological evaluations can be applied to distinguish potential etiologies for obstructive symptoms, which segregate into anatomic (mechanical or histopathological) or physiologic subgroups. Valuable clinical information may be obtained by anorectal examination under anesthesia, radiographic studies, and anorectal or colonic manometry. In addition, histopathological review of a patient's original resection specimen(s) as well as postoperative biopsies of the neorectum usually are an important component of the diagnostic workup. Goals for the surgical pathologist are to exclude incomplete resection of the aganglionic segment or transition zone and to identify other neuromuscular pathology that might explain the patient's dysmotility. Diagnoses established from a combination of clinical and pathological data dramatically alter management strategies. In rare instances, reoperative pullthrough surgery is required, in which case the pathologist must be aware of histopathological features specific to redo pullthrough resection specimens.

Cardiovascular Autonomic Dysfunction Is the Most Common Cause of Syncope in Paced Patients.

Introduction: Syncope and orthostatic intolerance in paced patients constitute a common clinical dilemma. We, thus, aimed to determine the etiology of syncope and/or symptoms of orthostatic intolerance in paced patients.Methods: Among 1,705 patients with unexplained syncope and/or orthostatic intolerance that were investigated by cardiovascular autonomic tests, including Valsalva maneuver, active standing, carotid sinus massage, and tilt-testing, 39 patients (2.3%; age 65.6 years; 39% women) had a cardiac implantable electronic device (CIED). We explored past medical history, diagnoses found during cardiovascular autonomic tests, and the further clinical workup, in case of negative initial evaluation.Results: An etiology was identified during cardiovascular autonomic tests in 36 of the 39 patients. Orthostatic hypotension (n = 16; 41%) and vasovagal syncope (n = 12; 31%) were the most common diagnoses. There were no cases of pacemaker dysfunction. The original pacing indications followed guidelines (sick-sinus-syndrome in 16, atrioventricular block in 16, atrial fibrillation with bradycardia in five). Twenty-two of the 39 patients (56%) had experienced syncope prior to the original CIED implantation. Orthostatic hypotension was diagnosed in seven (32%) and vasovagal syncope in nine (41%) of these patients. Of the 17 patients that had not experienced syncope prior to the original CIED implantation, nine patients (53%) were diagnosed with orthostatic hypotension and vasovagal syncope was diagnosed in three (18%). Of the 39 patients, two had implantable cardioverter-defibrillators to treat malignant ventricular arrhythmias diagnosed after syncopal episodes.Conclusion: Cardiovascular autonomic tests reveal the etiology of syncope and/or orthostatic intolerance in the majority of paced patients. The most common diagnosis was orthostatic hypotension (40%) followed by vasovagal syncope (30%), whereas there were no cases of pacemaker dysfunction. Our results emphasize the importance of a complete diagnostic work-up, including cardiovascular autonomic tests, in paced patients that present with syncope and/or orthostatic intolerance.

Prefrontal Regulation of Threat-Elicited Behaviors: A Pathway to Translation.

Regions of the prefrontal and cingulate cortices play important roles in the regulation of behaviors elicited by threat. Dissecting out their differential involvement will greatly increase our understanding of the varied etiology of symptoms of anxiety. I review evidence for altered activity within the major divisions of the prefrontal cortex, including orbitofrontal, ventrolateral, dorsolateral, and ventromedial sectors, along with the anterior cingulate cortex in patients with clinical anxiety. This review is integrated with a discussion of current knowledge about the causal role of these different prefrontal and cingulate regions in threat-elicited behaviors from experimental studies in rodents and monkeys. I highlight commonalities and inconsistencies between species and discuss the current state of our translational success in relating findings across species. Finally, I identify key issues that, if addressed, may improve that success in the future.

The demotivating effect of social exclusion: An experimental test of a psychosocial model on the development of negative symptoms in psychosis

The impairment in social functioning of patients with psychotic disorders is mainly driven by motivational negative symptoms with a widely unknown etiology. Building on the well-confirmed link between specific social risk factors and psychosis, the current study tested the postulated effect of immediate social exclusion on the development of motivational negative symptoms and the association of repeated social exclusion experiences with demotivating beliefs in a community sample (N = 84). Repeated social exclusion experiences and demotivating beliefs were assessed at baseline. We randomized the participants to either an exclusion or an inclusion condition of a virtual ball tossing game. Motivation and anticipatory pleasure were measured before and after the manipulation via self-report and via a behavioral effort paradigm. We found a significant multivariate effect of social exclusion on self-reported motivation (F(4,79) = 4.25, p < .01, η2 = .18), but not on behavioral effort (F(1,82) = 1.24, p = .27, η2 = .02). Repeated social exclusion was significantly associated with demotivating beliefs (r = .58, p < .01) and negative symptoms (r = .43, p < .001). Our findings support the notion that reduced motivation, anticipatory anhedonia and demotivating beliefs can be understood as motivational and cognitive consequences of social exclusion. We also discuss the implications for psychological interventions and for further research on the etiology of negative symptoms.

A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral strictures done under spinal anesthesia and local anesthesia.

This study is a randomized controlled study comparing the effectiveness and outcomes of direct visual inter urethrotomy (DVIU) for short segment anterior urethral strictures performed under local anesthesia versus spinal anesthesia. Patients presenting with an anterior urethral stricture up to 2 cm were randomized into two interventional groups: Group I-DVIU done under spinal anesthesia and Group II-DVIU performed under local anesthesia. Procedural discomfort was analyzed with a visual analog scale (VAS) immediately postoperatively and after one hour of the procedure. The changes in the vital parameters (systolic blood pressure and pulse rate) were recorded. The success of the procedure was defined as the absence of symptoms of recurrent stricture along with the ability of self-urethral calibration with an 18Fr catheter on follow-up. One hundred and twenty patients, between December 2015 and February 2017, were randomized into the two above-mentioned groups with 60 patients each. The demographic profile, the stricture characteristics (etiology, length, and duration of symptoms), and the preoperative parameters (Qmax, preoperative pulse rate, and systolic blood pressures) were comparable in both the groups. The mean (±SD) intraoperative and one-hour postoperative VAS scores were 1.96 (±1.04) and 1.20 (±0.73), respectively, for Group I, which were significantly less (p<0.05) than the VAS scores 4.26 (± 1.98) and 2.13 (±1.71), respectively, for Group II. The intraoperative mean increases in pulse rate and systolic blood pressure were also significantly lower in Group I (p<0.05). The change in postoperative Qmax (mL/sec) was comparable in both the groups (mean of 20.75±4.31 vs. 19.041 4.88) and so is the stricture free rate at a one-year follow-up. No significant differences in complication rates were observed in both the groups. Although perioperative procedural parameters seem to be in favor of spinal anesthesia, the outcome of DVIU is independent of the type of anesthesia used.

498 Objective Evidence of Gastrointestinal Disorders in Patients With 22q11.2 Deletion Syndrome

INTRODUCTION: 22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion syndrome (1:3000-6000 live births) and the most common cause of DiGeorge Syndrome (congenital heart disease, parathyroid hypoplasia, thymic hypoplasia). However, the 22q11.2DS phenotype varies markedly among patients. We previously studied a smaller subset of patients with 22q11.2DS (n = 72) and found that chronic gastrointestinal (GI) symptoms were common. Here we expand our previous observations to a larger cohort (n = 175) and also present objective study data in an effort to characterize these GI problems as structural versus functional. METHODS: Adult patients with 22q11.2DS were retrospectively assessed from our cohort of &gt;1400 patients with a confirmed 22q11.2 deletion followed in the 22q and You Center at the Children's Hospital of Philadelphia. Included patients had at least one problem list, medication list, review of systems, and outpatient physician evaluation at ≥17 years of age. Broad clinical data were abstracted, including results of relevant imaging and laboratory studies. All available imaging studies were reviewed for radiologic and pathologic abnormalities. All routine laboratory studies were reviewed, and the lowest value was recorded for each test. RESULTS: 672 consecutive charts were reviewed, of which 175 met inclusion criteria. Included patients (45% F) ranged from 17 to 59 years of age (mean 26.1; SD 8.1). Chronic GI symptoms were common from childhood through adulthood (Figure 1), but congenital GI malformations were rare (4%). Additionally, autoimmune GI disorders occurred at the frequency of the general population [celiac disease (1%); inflammatory bowel disease (0.6%)]. However, motility disorders were common and accounted for the vast majority of GI symptoms (Figure 2). Pertinent laboratory results were also reported and showed a high rate of anemia (Figure 3). CONCLUSION: Specialized GI studies were performed commonly in our study population, reinforcing our prior observation that GI disorders place a significant burden on patients with 22q11.2DS. In addition to the well-described palatal abnormalities affecting this population, these studies revealed a wide range of non-structural GI problems. We conclude that a large burden of GI illness in 22q11.2DS is functional. Finally, the known chromosomal microdeletions present in patients with 22q11.2DS may provide an explanatory framework for understanding the etiology of functional GI symptoms in the general population.

476 Pelvic Floor Dysfunction Is Associated With Reduced Urinary Flow Rate in Younger Men

INTRODUCTION: In younger men, in whom organic prostate disease is uncommon, the etiology of lower urinary tract symptoms (LUTS) is frequently unclear. Studies suggest that in this young cohort voiding phase dysfunction is more common than storage phase dysfunction or normal urodynamics. Abnormal pelvic floor muscle relaxation, which can result in constipation, could potentially result in voiding dysfunction also. To date, no studies have investigated the relationship between posterior pelvic floor dysfunction and LUTS in young men. METHODS: Men who had undergone both anorectal manometry and uroflowmetry (i.e. had lower gastrointestinal and urinary symptoms) between October 2012 and September 2018 were identified. Patients &gt;40 years old were excluded to reduce the likelihood of prostate disease. Clinical data was extracted from the electronic health records. Descriptive and comparative analyses were performed. RESULTS: Of 47 identified patients, 13 were excluded due to a history of neurogenic bowel/bladder, urethral/anal surgery or significant neurological disease. The mean age and standard deviation (SD) of the 34 men analyzed was 30 ± 6 years. Twenty patients demonstrated an abnormal balloon expulsion test (BET). The median (and interquartile range [IQR]) number of LUTS was 1.5 (1-2). An abnormal BET was not associated with symptoms of nocturia, hesitancy, incomplete emptying or the total number of LUTS (2 vs 1, P = 0.6). An abnormal balloon expulsion test was associated with a lower maximum urinary flow rate (Qmax, 14 vs 29 mls/sec, P &lt; 0.001) but not flow duration (34 vs. 27 seconds, P = 0.2), residual urine volume (55 vs. 43 mls, P = 0.7) or urine volume (300 vs. 301 mls, P = 0.5). No correlation was seen between anal pressures at rest or during simulated evacuation and maximum urinary flow rate. No correlation was found between functional constipation and Qmax, LUTS or abnormal uroflow. No relationship between rectal sensory thresholds and urinary symptoms was identified. CONCLUSION: In this study of young men undergoing both anorectal manometry and uroflow, pelvic floor dysfunction was not associated with specific LUTS but was associated with a clinically significant reduction in maximum urinary flow rate. However an objective diagnosis of functional constipation was not associated with urologic abnormalities. Further studies will be needed to prospectively characterize this cohort and to identify whether PFD-associated LUTS and reduced flow respond to biofeedback therapy.

1456 A Case of Syphilitic Proctitis in a Newly Diagnosed Patient With HIV

INTRODUCTION: Rectal pain and hematochezia are common symptoms of anorectal pathology. Sexually transmitted infections such as gonorrhea, chlamydia and syphilis are often implicated as infectious etiologies of such symptoms in men who have sex with men. We report a case of young male who presented with rectal pain, hematochezia and weight loss and was concomitantly diagnosed with syphilitic proctitis and HIV. CASE DESCRIPTION/METHODS: A 35-year-old bisexual male presented with a 9 months history of rectal pain, hematochezia and involuntary 30 pounds weight loss. Initial laboratory tests revealed normocytic anemia with a hemoglobin of 9.2 gm/dl, ferritin of 81.1 ng/ml, a positive HIV test with CD4 count of 50 cells/microL. Colonoscopy demonstrated large, semi-circumferential ulcers around 10 cm from the anal verge (Figure 1). Biopsy of the ulcerated lesions revealed chronic active colitis with cryptitis, crypt abscess and destruction. Numerous spirochetes were identified on Warthin-Starry and Steiner stains in the ulcerated mucosa and random biopsies of colon (Figure 2). Enzyme immunoassay (EIA) and rapid plasma reagin (RPR) for syphilis were positive with a RPR titer of 1:256. He was treated with benzathine penicillin 2.4 million units intramuscularly once a week for 3 weeks for syphilits proctitis along with anti-retroviral medications. He had resolvement of symptoms on subsequent follow up visit at 6 months with a repeat RPR of 1:64 suggesting an adequate serological response. DISCUSSION: Anorectal syphilis can either present as a chancer in primary infection or proctocolitis as a manifestation of secondary infection. Establishing a diagnosis often requires endoscopy for visualization of colonic inflammation, histopathology for documentation of spirochetes and serological test such as EIA and RPR to identify Treponema palladium. The histopathological features of syphilitic proctitis can mimic that of inflammatory bowel disease in which case the microbiological stains such as Warthin-Starry and Steiner aid in diagnosis. As proctocolitis is a manifestation of secondary syphilis, treatment includes Penicillin G benzathine 2.4 million units IM once. With the rise in the MSM population, cases of syphilis are more frequently being encountered and therefore syphilitic proctitis should be a common differential in such patients presenting with lower gastrointestinal symptoms.

Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag.

We aimed to determine the incidence of all vestibular symptoms in a large interdisciplinary tertiary emergency department (ED) and to assess stroke prevalence, and frequency of other life-threatening aetiologies. In this 1-year retrospective study, we manually screened all medical records of 23,608 ED visits for descriptions of vestibular symptoms. Symptoms were classified according to the International Classification of Vestibular Disorders of the Bárány Society. We evaluated all patients older than 16years in whom vestibular symptoms were the main or accompanying complaint. We extracted clinical, radiological, and laboratory findings as well as aetiologies from medical records. We identified a total of 2596 visits by 2464 patients (11% of ED visits) who reported at least one vestibular symptom. In 1677/2596 visits (64.6%), vestibular symptoms were the main reason for the ED consultation. Vestibular symptoms were classified as dizziness (43.8%), vertigo (33.9%), postural symptoms (6.5%), or more than one symptom (15.8%). In 324/2596 visits (12.5%), cerebrovascular events were the aetiology of vestibular symptoms, and in 355/2596 visits (13.7%), no diagnosis could be established. In 23.8% of visits with vestibular symptoms as the main complaint, the underlying condition was life-threatening. Frequency and impact of vestibular symptoms in patients visiting the ED were higher than previously reported, and life-threatening aetiologies such as strokes are common. Therefore, awareness among physicians regarding the importance of vestibular symptoms has to be improved.

Role of astrocytic GABAergic system on inflammatory cytokine-induced anxiety-like behavior

Recent studies have shown that not only neurons but astrocytes contain a considerable amount of γ-aminobutyric acid (GABA), which can be released and activate the receptors responsive to GABA. The purpose of this study is to test whether gliotransmitters from astrocytes may play a role in etiology of anxiety symptoms. Intracerebroventricular (i.c.v.) infusion of interleukin-1β (IL-1β), one of potent inflammatory cytokines, induced anxiety-like behaviors and activated the glial fibrillary acidic protein (GFAP) in the paraventricular nucleus (PVN) of the hypothalamus. Pretreatment with astrocytes toxin, l-α-aminoadipate (L-AAA) reduced anxiety-like behaviors and the GFAP expression in the PVN. Intraparaventricular nucleus (iPVN) infusion of IL-1β produced markedly anxiety-like behaviors and increased release of GABA from astrocytes. However, treatment of glial cell inhibitor, L-AAA or blocker of Bestrophin-1 (Best1), 5-Nitro-2-(3-phenylpropylamino) benzoic acid (NPPB) markedly inactivated astrocytes and also reduced the anxiety-like behaviors. Treatment of L-AAA or NPPB decreased IL-1β-induced gliotransmitter GABA release measured by in vivo microdialysis. These results suggest that selective inhibition of astrocytes or astocytic GABA release in the PVN may serve as an effective therapeutic strategy for treating anxiety and affective disorders.

A Systematic Review of Taste Differences Among People With Eating Disorders.

Background:Eating disorders are a significant cause of morbidity and mortality. The etiology and maintenance of eating-disorder symptoms are not well understood. Evidence suggests that there may be gustatory alterations in patients with eating disorders.Objective:This article systematically reviews research assessing gustatory differences in patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).Method:A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, examining taste and eating disorders. We reviewed electronic databases and identified 1,490 peer-reviewed English-language studies. Of these, 49 met inclusion criteria.Results:Studies employed psychophysical measures (n = 27), self-reported questionnaires (n = 5), and neuroimaging techniques (i.e., electroencephalography, functional magnetic resonance imaging; n = 17). Psychophysical studies showed that individuals with BN, in general, had greater preference for sweetness than healthy controls, and those with AN had a greater aversion for fat than controls. In neuroimaging studies, findings suggested that predictable administration of sweet-taste stimuli was associated with reduced activation in taste-reward regions of the brain among individuals with AN (e.g., insula, ventral, and dorsal striatum) but increased activation in BN and BED.Discussion:To our knowledge, this systematic review is the first to synthesize literature on taste differences in AN, BN, and BED. The inconsistency and variability in methods used across studies increased difficulties in comparing studies and disease processes. Further studies with well-defined population parameters are warranted to better understand how taste varies in patients with eating disorders.

The relationship between independent and dependent life events and depression symptoms in Sri Lanka: a twin and singleton study

PurposeLife events have been associated with a variety of mental health conditions including depression. There is a scarcity of research in South Asia exploring the aetiology of independent and dependent life events and their relationship with depression symptoms. This study aimed, in a Sri Lankan population, to identify the socio-demographic correlates and genetic and environmental influences on independent and dependent life events and their relationship with depression.MethodsQuestionnaire data came from the Colombo Twin and Singleton Follow-up Study, CoTaSS-2 (N = 3969), a population study of Sri Lankan twins and singletons. Lifetime-ever independent and dependent life events were measured using a questionnaire and depressive symptoms using the Revised Beck’s Depression Inventory. Structural Equation Model-fitting analyses explored the genetic and environmental influences on life events and depression.ResultsLiving in a rural environment and financial hardship were associated with greater reporting of independent and dependent life events. Sex differences were evident in the aetiology of life events and depression symptoms. Independent and dependent life events, but not depression symptoms, were heritable in males. Independent life events and depression symptoms, but not dependent life events, were heritable in females. Non-shared environmental influences explained phenotypic associations between independent life events and depression symptoms in both males and females. Genetic and non-shared environmental influences explained the phenotypic associations between dependent life events and depression symptoms in males. Only non-shared environment explained the covariation between dependent life events and depression symptoms in females.ConclusionsSocio-demographic correlates of independent and dependent life events were similar to those reported in Western populations. Life events were associated with increased depression symptoms. Contrary to research in Western populations, we found that non-shared environmental, rather than genetic, influences explained much of the covariation between life events and depression symptoms. This suggests that whilst independent LEs may be heritable, the relationship is unlikely to be confounded by genetic influences and has significant implications for possible interventions for depression.

Metacognitive and motivation deficits, exposure to trauma, and high parental demands characterize adolescents with late-onset ADHD.

The objective of this study is to evaluate support for three hypotheses about the etiology of adolescent-onset ADHD symptoms: (1) a "cool" cognitive load hypothesis, (2) a "hot" rewards processing hypothesis, and (3) a trauma exposure hypothesis. Participants (N = 50) were drawn from two public high schools in a culturally diverse metropolitan area. A detailed procedure for identifying and confirming late-onset ADHD cases is described. Adolescents with late-onset ADHD (n = 15) were identified and compared to childhood-onset (n = 17) and non-ADHD classmates (n = 18). Adolescents and parents completed measures of neurocognition, rewards' processing, clinical profile, and environmental demands. Late-onset cases were clinically and neurocognitively indistinguishable from childhood-onset cases; however, they experienced higher demands from parents (d = 1.09). Compared to the non-ADHD group, late-onset cases showed significant deficits in metacognition (d = 1.25) and academic motivation (d = 0.80), as well as a pronounced history of multiple trauma exposure (OR 11.82). At 1-year follow-up, ADHD persisted in 67.7% of late-onset cases. Late-onset cases (26.7%) were more likely than childhood-onset cases (0.0%) to transfer to alternative schools by 1-year follow-up. Multiple factors may contribute to adolescent-onset ADHD. Adolescents with metacognition and motivation deficits may be at greatest risk for the late-onset ADHD phenotype, particularly in highly demanding environments. Exposure to traumatic stress may play a key role in the exacerbation of existing deficits or onset of new symptoms. Late-onset ADHD was persistent in most cases and associated with higher risk for school disengagement than childhood-onset ADHD. Further work is needed to better understand the etiologies of late-onset ADHD symptoms.

The Clinical Use of Nonimaging Exercise Stress Testing

Exercise stress testing is an exceptionally useful cardiovascular test providing a wealth of information that can be used in patient management. It can be used in the diagnosis and/or management of chest pain, hypertension, arrhythmia, and heart failure. Non-imaging exercise stress testing not only helps evaluate the etiology of clinical symptoms but also provides an opportunity to evaluate ECG changes with exercise, total exercise capacity, heart rate response or chronotropic index, blood pressure response, heart rate recovery, and to make estimates of the risk of coronary artery disease using tools such as the Duke Treadmill Score. These parameters, individually and collectively, provide valuable information on the likelihood of disease and an individual’s prognosis. In addition, exercise testing is inexpensive, quick and widely available compared to imaging studies. This review contains 6 figures, 5 tables, and 68 references. Keywords: blood pressure response, chronotropic incompetence, coronary artery disease, Duke Treadmill Score, exercise physiology metabolic equivalents (METs), exercise stress test, exercise treadmill test, exercise-induced hypertension, heart rate recovery, maximal exercise capacity, ST-segment deviation