Psychiatric disturbances in CADASIL: a brief review.

Acta Neurol Scand. 2008 Mar 31 [Epub ahead of print]

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Psychiatric disturbances in CADASIL: a brief review.

Valenti R, Poggesi A, Pescini F, Inzitari D, Pantoni L.

Department of Neurological and Psychiatric Sciences, University of Florence, Italy.

Background - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by a variable combination of migraine, recurrent transient ischemic attack (TIA) or lacunar strokes, cognitive decline, and mood disturbances. However, the assessment of psychiatric disturbances in this disease has never been carried out systematically. Methods - This paper presents a brief review of the literature regarding the occurrence of psychiatric disorders in CADASIL patients. Results - The prevalence of psychiatric disorders in CADASIL patients is reported to range from 20% to 41%. The psychiatric disturbances reported with the highest frequency are mood disturbances (9-41%). Pooling together the studies and considering a total of 454 CADASIL patients reported in the literature, 106 of these were affected by mood disturbances (24%). The majority of studies however did not use any defined criteria to assess the presence of psychiatric disorders and diagnoses were mainly based on history or review of clinical records. Conclusions - The review of CADASIL literature suggests the need for a more structured approach to the investigation of these disturbances that are highly prevalent and may greatly impact quality of life in these patients.

PMID: 18384453 [PubMed - as supplied by publisher]

Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth

Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth

Geeta K. Swamy, MD; Truls Østbye, MD, PhD; Rolv Skjærven, PhD

JAMA. 2008;299(12):1429-1436.

Context Preterm birth is a major cause of infant morbidity and mortality. Less is known about long-term health among persons born preterm.

Objective To determine the long-term effects of preterm birth on survival, reproduction, and next-generation preterm birth.

Design, Setting, and Participants Population-based, observational, longitudinal study using registry data from 1 167 506 singleton births in the Medical Birth Registry of Norway in 1967-1988. The cohort was followed up through 2002 for survival. The cohort was truncated to births from 1967-1976 for assessment of educational achievement and reproductive outcomes through 2004.

Main Outcome Measures In relation to sex and gestational age at birth, absolute mortality, risk of fetal, infant, child, and adolescent mortality, and incidence and risk of reproduction and next-generation preterm birth. Singleton term (37-42 weeks) fetal deaths and live births, stratified by sex, served as the reference group for all analyses.

Results The percentage who were born preterm was higher among boys (5.6%) than among girls (4.7%). Preterm participants had an increased risk of mortality throughout childhood. For boys born at 22 to 27 weeks, mortality rates were 1.33% and 1.01% for early and late childhood death, with relative risks (RRs) of 5.3 (95% confidence interval [CI], 2.0-14.2) and 7.0 (95% CI, 2.3-22.0), respectively. The mortality rate for girls born at 22 to 27 weeks was 1.71% for early childhood death, with an RR of 9.7 (95% CI, 4.0-23.7); there were no late childhood deaths. For 28 to 32 weeks, the early and late childhood mortality rates among boys were 0.73% and 0.37%, with RRs of 2.5 (95% CI, 1.6-3.7) and 2.3 (95% CI, 1.3-4.1), respectively. Girls born at 28 to 32 weeks did not have a significantly increased risk of childhood mortality. Reproduction was diminished for index participants born preterm. For men and women born at 22 to 27 weeks, absolute reproduction was 13.9% and 25%, with RRs of 0.24 (95% CI, 0.17-0.32) and 0.33 (95% CI, 0.26-0.42), respectively. For 28 to 32 weeks, absolute reproduction was 38.6% and 59.2% for men and women, with RRs of 0.7 (95% CI, 0.66-0.74) and 0.81 (95% CI, 0.78-0.85), respectively. Preterm women but not men were at increased risk of having preterm offspring.

Conclusion In persons born in Norway in 1967-1988, preterm birth was associated with diminished long-term survival and reproduction.

Author Affiliations: Departments of Obstetrics and Gynecology (Dr Swamy) and Community and Family Medicine (Dr Østbye), Duke University Medical Center, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore (Dr Østbye); Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen (Dr Skjærven), and Medical Birth Registry of Norway, Norwegian Institute of Public Health (Dr Skjærven), Bergen, Norway.

Childhood physical abuse in outpatients with psychosomatic symptoms.

Biopsychosoc Med. 2008 Mar 21;2(1):8 [Epub ahead of print]

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Childhood physical abuse in outpatients with psychosomatic symptoms.

Handa M, Nukina H, Hosoi M, Kubo C.

ABSTRACT: BACKGROUND: In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. METHODS: We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. RESULTS: A history of childhood physical abuse was reported by patients with depressive disorders(12.7%), anxiety disorders(16.7%) , eating disorders (16.3%), pain disorders (10.8%), irritable bowel syndrome (12.5%), and functional dyspepsia(7.5%). In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety) and STAI-II (trait anxiety) were higher in the abused group than in the non-abused group (p<0.05). In the patients with depressive disorders, the abused group was younger than the non-abused group (p<0.05). The prevalence of self-injurious behavior of the patients with depressive disorders, anxiety disorders and pain disorders was higher in the abused groups than in the non-abused groups (p<0.005). CONCLUSIONS: A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.

PMID: 18358076 [PubMed - as supplied by publisher]