Neuropsychiatry Clinic Research Articles

Wechsler profiles in referred children with intellectual giftedness: Associations with trait-anxiety, emotional dysregulation, and heterogeneity of Piaget-like reasoning processes.

It is common that intellectually gifted children (IQ ≥ 130) are referred to paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school underachievement or maladjustment. Among them, those displaying developmental asynchrony - a heterogeneous developmental pattern reflected in a significant verbal-performance discrepancy (SVPD) on Wechsler's intelligence profile - are thought to be more emotionally and behaviourally impaired than others. Our purpose was to investigate this clinical dichotomy using a cognitive psychopathological approach. Trait-anxiety and emotional dysregulation were investigated in two groups of referred gifted children (n = 107 and 136, respectively), a pilot-study of reasoning processes on extensive Piaget-like tasks was also performed in an additional small group (n = 12). Compared to those with a homogenous Wechsler profile, children with a SVPD exhibited: 1) a decreased prevalence of social preoccupation-anxiety (11.1% versus 27.4%; p < 0.05); 2) an increased prevalence of emotional dysregulation (58.7% versus 41.3%; p < 0.05); and 3) an increased prevalence of pathological cognitive disharmony on Piaget-like tasks (87.5% versus 0.0%; p < 0.05). The results support a clinical dichotomy of behaviourally-impaired children with intellectual giftedness, with developmentally asynchronous ones exhibiting more severe psychopathological features. This suggests that developmental asynchrony matters when examining emotional and behavioural problems in gifted children and call for further investigation of this profile.

Myanmar’s Mental Health System Undergoes Major Modernization

Myanmar’s Mental Health System Undergoes Major Modernization

The correlation between central auditory processing in autistic children and their language processing abilities

AimTo study the auditory profile at different levels of the auditory system in children with ASD and to verify the role of (Central) auditory processing disorder as an essential pathology of the autistic disorder or as an associated co-morbidity, and to establish the correlation between CAP findings and the language delay in these cases. PatientsThe study included 30 children with definite autistic disorder according to DSM-IV-TR criteria and ADI-R among those attending the outpatient neuropsychiatry clinic of Alexandria University Children Hospital at El Shatby. An informed consent was taken from all patients in this part of the study. Confidentiality of the records was maintained. MethodsAll cases were subjected to complete history taking and examination; special assessment to language skills and evoked potentials were done. ResultsThe results concluded that (central) auditory processing disorder is an essential pathology of the autistic disorder. Autistic children possess a dysfunctioning or an immature central auditory nervous system at both the brainstem and cortical levels.

The role of a neuropsychiatry clinic in a tertiary referral teaching hospital: a 2-year study.

Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided. We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82). The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson's disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history. Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.

AACAP Updates Guidelines On Autism Spectrum Disorder

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessAACAP Updates Guidelines On Autism Spectrum DisorderAaron LevinAaron LevinSearch for more papers by this authorPublished Online:7 Mar 2014https://doi.org/10.1176/appi.pn.2014.3a18AbstractNew practice parameter for autism spectrum disorder will help clinicians coordinate treatment.A flood of new research in recent years has prompted the American Academy of Child and Adolescent Psychiatry to revise a key guideline for evaluating and treating autism.The “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder” applies that information to make the case for “multidisciplinary care, coordination of services, and advocacy for individuals and their families.”The practice parameter appeared in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry.New research creates a need for revised autism guidelines, said Yale’s Fred Volkmar, M.D.Yale University“There were about 2,800 papers published last year alone,” said lead author Fred Volkmar, M.D., a professor of psychiatry, pediatrics, and psychology at the Yale School of Medicine and director of the Yale Child Study Center. “The field is changing rapidly.”Practice parameters seek to promote effective care and move professional medical methods closer to current best practices.In all, Volkmar’s work group reviewed abstracts of 9,581 articles and selected 186 for full examination based on quality and generalizability.“This is a very comprehensive effort, based on the current evidence,” commented James Harris, M.D., a professor and director of the Developmental Neuropsychiatry Clinic in the Division of Child and Adolescent Psychiatry at Johns Hopkins. Harris was not involved in the preparation of the practice parameter.After summarizing material on the epidemiology, etiology, and clinical course of autism spectrum disorder, the document recommends routine inquiry about symptoms of autism spectrum disorder as part of the developmental assessment of young children and of the psychiatric assessment of all children. If a child has significant symptoms, clinicians should coordinate a full medical, psychological, and communication evaluation. A careful evaluation should differentiate between autism and a variety of developmental and other disorders, as well as intellectual and behavioral disabilities.“Finding children with autism spectrum disorder early and getting them into treatment helps them do better and develop workaround tools,” said Volkmar.Treatment involves a team approach, he said. Strong evidence now supports structured educational, communication, and behavioral treatments backed by family involvement. There is lesser evidence for the value of pharmacological treatments, but they can help with comorbid conditions like anxiety, depression, aggression, inattention, and other problems.James Harris, M.D., a professor of child and adolescent psychiatry at Johns Hopkins, says that psychiatrists need to ask parents if they are using any alternative/complementary therapies with their children.Aaron Levin“The role of psychiatrists is first to closely coordinate diagnosis and treatment with teachers, behavioral psychologists, and speech and language pathologists, as well as looking for co-occurring conditions like anxiety or mood dysregulation,” said Harris. “Once a treatment team is in place, the psychiatrist can evaluate whether medications can help the child make productive use of those interventions.”The practice parameter concludes with a strong recommendation that clinicians should “inquire about the use of alternative/complementary treatments and be prepared to discuss their risk, and potential benefits.”“Perhaps 90 percent of parents of children with autism use some kind of alternative or complementary therapies,” said Volkmar. “Most of them are harmless, but some, like chelation or secretin, are not, so we have to encourage a discussion with parents about the lack of evidence.”Harris agreed. “The psychiatrist has to ask what the parents are actually doing, then stick with them and educate them.” ■“Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder” can be accessed here. ISSUES NewArchived

Psychiatric adverse effects of zonisamide in patients with epilepsy and mental disorder comorbidities

Over the last few years, zonisamide has been proposed as a potentially useful medication for patients with focal seizures, with or without secondary generalization. Since psychiatric adverse effects, including mania, psychosis, and suicidal ideation, have been associated with its use, it was suggested that the presence of antecedent psychiatric disorders is an important factor associated with the discontinuation of zonisamide therapy in patients with epilepsy. We, therefore, set out to assess the tolerability profile of zonisamide in a retrospective chart review of 23 patients with epilepsy and comorbid mental disorders, recruited from two specialist pediatric (n=11) and adult (n=12) neuropsychiatry clinics. All patients had a clinical diagnosis of treatment-refractory epilepsy after extensive neurophysiological and neuroimaging investigations. The vast majority of patients (n=22/23, 95.7%) had tried previous antiepileptic medications, and most adult patients (n=9/11, 81.8%) were on concomitant medication for epilepsy. In the majority of cases, the psychiatric adverse effects of zonisamide were not severe. Four patients (17.4%) discontinued zonisamide because of lack of efficacy, whereas only one patient (4.3%) discontinued it because of the severity of psychiatric adverse effects (major depressive disorder). The low discontinuation rate of zonisamide in a selected population of patients with epilepsy and neuropsychiatric comorbidity suggests that this medication is safe and reasonably well-tolerated for use in patients with treatment-refractory epilepsy. Given the limitations of the present study, including the relatively small sample size, further research is warranted to confirm this finding.

BEHAVIOURAL PROFILE OF ZONISAMIDE IN ADULT PATIENTS WITH EPILEPSY AND NEUROPSYCHIATRIC COMORBIDITY

ObjectiveZonisamide is a newer antiepileptic drug indicated as adjunctive therapy in the treatment of adult patients with partial-onset seizures, with or without secondary generalization. Following isolated reports of zonisamide-induced mania,...

Autism in community pre-schoolers: Developmental profiles

Autism is often a complex developmental disorder. The aim of the present study was to describe the developmental characteristics of 129 1-4-year-old children (102 boys, 27 girls) referred for clinical assessment (mean age 2.9 years) due to suspicion of autism spectrum disorder (ASD) after community screening at Child Health Care centers. All children were clinically assessed at the Child Neuropsychiatry Clinic (CNC) in Gothenburg by a research team (neurodevelopmental examination, structured interviews and general cognitive and language examinations). Of the 129 children, 100 met diagnostic criteria for ASD (69 with autistic disorder, and 31 with atypical autism/pervasive developmental disorder-not otherwise specified). The remaining 29 children had a variety of developmental disorders, most often attention-deficit/hyperactivity disorder (ADHD), language disorder, borderline intellectual functioning, and intellectual developmental disorder (IDD) with (n=25) or without (n=4) autistic traits (AT). IDD was found in 36% of the 100 children with ASD, and in 4% of the 25 children with AT. Of the children with ASD, 56% had language disorder with no or just a few words at the initial assessment at the CNC, many of whom in combination with IDD. Hyperactivity was found in 37% of those with ASD and in 40% of those with AT. Epilepsy was found in 6% of the total group and in 7% of those with a diagnosis of ASD. Of the latter group 11% had a history of regression, while none of the AT cases had a similar background. When results were compared with a non-screened preschool ASD group of 208 children, referred for ASD intervention at a mean age of 3.4 years, very similar developmental profiles were seen. In conclusion, early community ASD screening appears to systematically identify those children who are in need of intervention and follow-up.

산림치유프로그램이 인지기능에 미치는 영향

Objectives : The purpose of this study is to examine the effects of 3 day Forests healing programs for cognitive improvement, which consists of helpful contents of Korean medicine. Methods : This study examined the effects of forests healing for mild cognitive impairment patients, who visited a Korean medicine hospital neuropsychiatry clinic for outpatients. The Forests healing programs for cognitive improvement was run with 24 participants, in which 9 of them quit in the middle of the program, so excluded in data analysis. The Forests healing programs for cognitive improvement was consisted of 3 day helpful Korean medicine contents. The primary outcome measurement was a Computerized Neurocognitive Test (CNT), which measured the cognitive functions with computer programs. Results : The results of this study showed that CNT scores were not signi ficantly changed after 3 day forests healing. General psychological states, including depression, anxiety, and anger, were also checked. Among them, depressive mood significantly improved. Quality of life (QOL) was also enhanced after 3 day program. These results indicate that the 3 day Forests healing programs for cognitive improvement was effective for depressive mood and QOL of mild cognitive impairment patients, but not enough for cognitive functions directly. Conclusions : The 3 day Forests healing programs for cognitive improvement were shown to be an effective intervention in improving some aspects of mild cognitive impairment patients, including depressive mood, and QOL. We suggest that repeated participation of this program can enhance cognitive function of mild cognitive impairment patients.

Behavioral Profiles of Clinically Referred Children with Intellectual Giftedness

It is common that intellectually gifted children—that is, children with an IQ ≥ 130—are referred to paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school underachievement or maladjustment. These clinically-referred children with intellectual giftedness are thought to typically display internalizing problems (i.e., self-focused problems reflecting overcontrol of emotion and behavior), and to be more behaviorally impaired when “highly” gifted (IQ ≥ 145) or displaying developmental asynchrony (i.e., a heterogeneous developmental pattern, reflected in a significant verbal-performance discrepancy on IQ tests). We tested all these assumptions in 143 clinically-referred gifted children aged 8 to 12, using Wechsler's intelligence profile and the Child Behavior Checklist. Compared to a normative sample, gifted children displayed increased behavioral problems in the whole symptomatic range. Internalizing problems did not predominate over externalizing ones (i.e., acted-out problems, reflecting undercontrol of emotion and behavior), revealing a symptomatic nature of behavioral syndromes more severe than expected. “Highly gifted” children did not display more behavioral problems than the “low gifted.” Gifted children with a significant verbal-performance discrepancy displayed more externalizing problems and mixed behavioral syndromes than gifted children without such a discrepancy. These results suggest that developmental asynchrony matters when examining emotional and behavioral problems in gifted children.

화병에 대한 산림치유프로그램의 치료 효과

Objectives : The purpose of this study is to examine the effects of a 3 day Hwa-Byung forests healing program, which consists of helpful contents of Korean medicine. Methods : This study examined the effects of forests healing for Hwa-Byung patients, visited Korean medicine hospital neuropsychiatry clinic for outpatients. The Hwa-Byung forests healing program was run with 20 participants; 4 of them quit in the middle of the program and excluded in data analysis. The Hwa-Byung forests healing program consisted of 3 day helpful Korean medicine contents. The primary outcome measurement was Hwa-Byung symptom score, which measured various symptoms of Hwa-Byung. Results : The results of this study showed that Hwa-Byung symptoms were significantly alleviated. General psychological states, including depression, anxiety, and anger, were significantly improved. Quality of life was also enhanced after 3 day program. These results indicate that the 3 day Hwa-Byung forests healing program was effective for the overall improvements of Hwa-Byung patients. Conclusions : The 3 day Hwa-Byung forests healing program were shown to be an effective intervention in improving the overall aspects of Hwa-Byung patients, including symptoms, depression, anxiety, anger, and Quality of life.

Diagnostic Challenges Revealed from a Neuropsychiatry Movement Disorders Clinic

Abnormal movements are frequently associated with psychiatric disorders. Optimized management and diagnosis of these movements depends on correct labeling. However, there is evidence of reduced accuracy in the labeling of these movements, which could result in sub-optimal care. To determine the consensus inter-rater reliability between a movement disorders neurologist and physicians referring from the community for phenomenology and diagnoses of individuals with co-existing psychiatric conditions and movement disorders. Charts of all consecutive patients seen in a combined Movement Disorders and Neuropsychiatry Clinic between 2001-2009 were reviewed retrospectively. Consensus estimates and kappa values for inter-rater reliability were determined for phenomenology and diagnostic terms for the respective referring source and movement disorders neurologist for each patient. A total of 106 charts were reviewed (62 men and 44 women). Agreement for phenomenology terms ranged from 0% (psychogenic) to 73% (tremor). Only 3 terms had kappa values that met or exceeded criteria for moderate inter-rater reliability. Agreement for diagnosis terms was highest for tardive dyskinesia (83%), drug induced tremor (33%), and drug induced parkinsonism (20%). In 18 of the 22 charts (82%), a diagnosis was made of drug induced movement disorder (DIMD) by the referring physician. In contrast, a diagnosis of DIMD was made in only 54 of 106 charts (51%) after the patients were assessed in the clinic. A movement disorders specialist frequently disagreed with referring physicians' identification of patient phenomenology and diagnosis. This suggests that clinicians would benefit from educational resources to assist in characterizing abnormal movements.

Pre-school children with suspected autism spectrum disorders: Do girls and boys have the same profiles?

The male to female ratio is raised in autism spectrum disorders (ASD). Previous studies have suggested that girls with ASD have more problems with communication than boys, but boys show more repetitive behaviours than girls. In this study, 20 girls, 1.8-3.9 years of age were matched for chronological and developmental age with 20 boys with suspected ASD. All the children were recruited after population screening and referral by Child Health Care Services to a specialised neuropsychiatry clinic, where they underwent comprehensive neuropsychiatric assessments. Comparisons were made with regard to diagnosis, developmental profiles and global disability. No significant gender differences were found. There were strong correlations between results obtained in different developmental areas. The results suggest that either (1) previous studies finding clear gender differences may have overrated discrepancies between girls and boys in ASD, or that (2) there may be girls, who will not be identified in the early years with our current screening instruments. More research with a much larger population representative study samples is required.

Role of folic acid depletion on homocysteine serum level in children and adolescents with epilepsy and different MTHFR C677T genotypes

Homocysteine (Hcy) is a sulfur-containing amino acid involved in methionine metabolism. An elevated total plasma Hcy concentration (tHcy) is a risk factor for vascular disease. The present study aimed to assess the role of antiepileptic drugs (AEDs) and C677T methylenetetrahydrofolate (MTHFR) polymorphisms on tHcy in pediatric patients with epilepsy treated for at least 6 months with various treatment regimens protocols including the newer AEDs.The study group was recruited from children and adolescents with epilepsy followed up in the Child Neuropsychiatry Clinic of the Second University of Naples, between January 2007 and March 2008. Inclusion criteria were: (1) patients with epilepsy, treated with one or more anticonvulsant drugs for at least 6 months; (2) age between 2 and 16 years. Plasma tHcy concentrations were considered elevated when they exceeded 10.4μmol/L, and folate concentrations <3ng/mL were considered deficient. Serum vitamin B12 levels were considered normal between 230 and 1200pg/mL. The study group was composed of 78 patients (35 males, 43 females), aged between 3 and 15 years (mean 8.9 years). Thirty-five patients were taking AED monotherapy, 43 polytherapy. Sixty-three healthy sex- and age-matched children and adolescents served as controls. The mean tHcy value in the patient group was higher than the mean value in the control group (12.11±7.68μmol/L vs 7.4±4.01μmol/L; p<0.01).DNA analysis for the MTHFR C677T polymorphism showed the CT genotype in 46%, CC in 35% and TT in 17.8% of cases. Decreased folic acid serum levels significantly correlated with increased tHcy levels (p<0.003). Female sex was a less significant risk factor for increased tHcy levels (p=0.039).Our study confirms the association between hyperhomocysteinemia and epilepsy. The elevation of tHcy is essentially related to low folate levels. Correction of poor folate status, through supplementation, remains the most effective approach to normalize tHcy levels in patients on AED mono- or polytherapy.

Diagnostic Instability of DSM–IV ADHD Subtypes: Effects of Informant Source, Instrumentation, and Methods for Combining Symptom Reports

Using data from 123 children (aged 6–12 years) referred consecutively to a pediatric neuropsychiatry clinic by community physicians for assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) and related problems, we investigated the effects of informant (parent, teacher), tool (interview, rating scale), and method for combining symptom reports (“and,” “or” algorithms), on the diagnosis of ADHD and its subtypes. Results indicated that as many as 50% of cases were reclassified from one subtype to another, depending on whether information was derived from one or two informants, a semistructured clinical interview and/or rating scale, and the algorithm used to combine informant reports. We conclude that the diagnosis of DSM–IV ADHD subtypes is capricious in that it is influenced by clinicians' decisions regarding informants, instrumentation, and method for aggregating information across informants and instruments.

Stereotypic movement disorder: easily missed

To expand the understanding of stereotypic movement disorder (SMD) and its differentiation from tics and autistic stereotypies. Forty-two children (31 males, mean age 6y 3mo, SD 2y 8mo; 11 females, mean age 6y 7mo, SD 1y 9mo) consecutively diagnosed with SMD, without-self-injurious behavior, intellectual disability, sensory impairment, or an autistic spectrum disorder (ASD), were assessed in a neuropsychiatry clinic. A list of probe questions on the nature of the stereotypy was administered to parents (and to children if developmentally ready). Questionnaires administered included the Stereotypy Severity Scale, Short Sensory Profile, Strengths and Difficulties Questionnaire, Repetitive Behavior Scale--Revised, and the Developmental Coordination Disorder Questionnaire. The stereotyped movement patterns were directly observed and in some cases further documented by video recordings made by parents. The probe questions were used again on follow-up at a mean age of 10 years 7 months (SD 4y 4mo). Mean age at onset was 17 months. Males exceeded females by 3:1. Family history of a pattern of SMD was reported in 13 and neuropsychiatric comorbidity in 30 (attention-deficit-hyperactivity disorder in 16, tics in 18, and developmental coordination disorder in 16). Obsessive-compulsive disorder occurred in only two. The Short Sensory Profile correlated with comorbidity (p<0.001), the Stereotypy Severity Scale (p=0.009), and the Repetitive Behavior Scale (p<0.001); the last correlated with the Stereotypy Severity Scale (p=0.001). Children (but not their parents) liked their movements, which were usually associated with excitement or imaginative play. Mean length of follow-up was 4 years 8 months (SD 2y 10mo). Of the 39 children followed for longer than 6 months, the behavior stopped or was gradually shaped so as to occur primarily privately in 25. Misdiagnosis was common: 26 were initially referred as tics, 10 as ASD, five as compulsions, and one as epilepsy. Co-occurring facial grimacing in 15 children and vocalization in 22 contributed to diagnostic confusion. SMD occurs in children without ASD or intellectual disability. The generally favorable clinical course is largely due to a gradual increase in private expression of the movements. Severity of the stereotypy is associated with sensory differences and psychopathology. Differentiation of SMD from tics and ASD is important to avoid misdiagnosis and unnecessary treatment.

Pathological Gambling Associated With Modafinil

Back to table of contents Previous article Next article LETTERFull AccessPathological Gambling Associated With ModafinilN. Tarrant,A. E. Cavanna,H. Rickards,N. TarrantSearch for more papers by this author,A. E. CavannaSearch for more papers by this author,H. RickardsSearch for more papers by this author,Published Online:1 Jan 2010https://doi.org/10.1176/jnp.2010.22.1.123.e27AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Pathological gambling is defined by the DSM-IV-TR as a clinical condition characterized by persistent and maladaptive gambling behaviors; these are severe enough to disrupt the patient’s life and relationships and are not due to a manic episode. 1 Based on gambling behavior phenomenology, comorbid psychiatric conditions, family history, and demographics, it has been proposed that pathological gambling can present in three clinical subtypes: impulsive, obsessive-compulsive, and addictive. 2 Pathological gambling has been reported in association with dopamine agonists used in Parkinson’s disease, 3 restless legs syndrome, and endocrine disorders. The European Union Pharmacovigilance Working Party recommends that summaries of product characteristics for dopamine agonists carry a warning about pathological gambling as a side effect. To the best of our knowledge, there are currently no published reports of pathological gambling associated with modafinil, and there have been no Yellow Card reports submitted to the U.K. Commission on Human Medicines.Case ReportMr. C was referred to the neuropsychiatry clinic at the age of 39 with a 12-year history of narcolepsy (HLA-DBQ1*0602 positive) and associated cataplexy. He had no significant medical or psychiatric history and was being treated with modafinil, 300 mg daily in two divided doses. Initially there was a good response, but a developing tolerance prompted the referral. The patient had a prior history of minor gambling but reported a 10-fold increase in his slot-machine use, spending £20,000–£30,000 a year, since commencing modafinil. The patient was hesitant to increase the dose in case his gambling habit worsened.It was decided to withhold modafinil for a 2-month trial. At the next review, the patient complained of increased somnolence without the medication but reported that his gambling habit had considerably decreased. His somnolence had necessitated restarting modafinil, and his gambling had increased once again. He was started on clomipramine, 50 mg at night, with a view to titrating up to 150 mg/day to alleviate his compulsive behavior.Eighteen months later, he was taking clomipramine, 40 mg at night, and had discontinued modafinil. He reported that he was no longer gambling.DiscussionModafinil is currently licensed in the United Kingdom for the symptomatic relief of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and moderate to severe chronic shift-work sleep disorder. Its use is also under study for cocaine dependence and attention-deficit/hyperactivity disorder. In this patient, we observed a clear-cut temporal relationship between modafinil treatment and a gambling habit, with an improvement after withdrawal and worsening on rechallenge. The precise mechanism of action of modafinil is still unclear. 4 Modafinil is thought to increase wakefulness by blocking dopamine clearance through inhibition of the dopamine transporter and has been shown to increase cortical and caudate dopamine concentrations. 5 The effects of modafinil on impulsive/compulsive symptoms have been poorly investigated. A recent controlled study suggested that modafinil can have bidirectional effects on pathological gambling patients. Specifically, it has been shown to increase desire to gamble, disinhibition, and risky decision-making in low impulsivity subjects, while decreasing these indexes in high impulsivity subjects. 6 Overall, reward-seeking behavior, especially pathological gambling-compulsive/addictive subtype, may represent a possible adverse effect of modafinil via potentiation of the dopaminergic system in predisposed individuals. University of Birmingham Medical School, Birmingham, UKDepartment of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK Department of Neuropsychiatry, Institute of Neurology, London, UKDepartment of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK

Patients With Dementia With Lewy Bodies Have More Impaired Quality of Life Than Patients With Alzheimer Disease

The primary aim of this study was to compare quality of life (QoL) in patients with Dementia with Lewy Bodies (DLB) and patients with Alzheimer disease (AD). The secondary aim of this study was to investigate determinants of QoL in DLB. Thirty-four patients with DLB at the Neuropsychiatry clinic, University Hospital MAS, Malmö, Sweden, were included in a cross-sectional study. These patients were matched to 34 patients with AD. Two QoL instruments, the EQ-5D instrument and the Quality of Life-Alzheimer disease (QoL-AD) instrument, were applied in this study. Both instruments were administered to both patients and caregivers. Patients with DLB in this study have significantly lower QoL than patients with AD regardless of instrument or whether patient or caregiver-reported QoL was used. Furthermore, this study shows that important determinants of QoL in DLB include Neuropsychiatric Inventory score, independency in instrumental activities of daily living, whether the patient is living with the caregiver and the presence of apathy and delusions.

Brief Report: “The Autism Epidemic”. The Registered Prevalence of Autism in a Swedish Urban Area

The objective of this study was to establish rates of diagnosed autism spectrum disorders (ASDs) in a circumscribed geographical region. The total population born in 1977-1994, living in Göteborg Sweden in 2001, was screened for ASD in registers of the Child Neuropsychiatry Clinic. The minimum registered rate of autistic disorder was 20.5 in 10,000. Other ASDs were 32.9 in 10,000, including 9.2 in 10,000 with Asperger syndrome. Males predominated. In the youngest group (7-12 years), 1.23% had a registered diagnosis of ASD. There was an increase in the rate of diagnosed registered ASD over time; the cause was not determined. The increase tended to level off in the younger age cohort, perhaps due to Asperger syndrome cases missed in screening.

Antidepressant Side Effects in Children and Adolescents

The association between antidepressant treatment and suicidality in children and adolescents has been the subject of a great deal of recent discussion and controversy. Appropriate warnings have been attached to these drugs by governing bodies in the United Kingdom and the United States. However, the data upon which these deliberations have been based derive almost exclusively from clinical trials supported by the manufacturers of the respective drugs; data that are rigorous, in some respects, but which may not capture the clinical realities of antidepressant treatment in real-world settings. Data are presented from a neuropsychiatry clinic where 128 children and adolescents were treated with modern antidepressants over the past 14 months. Behavioral side effects, including suicidal ideation and self-injurious behavior, were not an uncommon accompaniment of antidepressant treatment. The problems, however, were mild and decidedly nonlethal and easily managed in the clinic setting. Ironically, 34 of 36 patients who had developed behavioral side effects to antidepressants were subsequently managed, without further incident, either on an alternative antidepressant or on lower doses of the offending agent.