Case report: bipolar disorder as the first manifestation of CADASIL.

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by variable manifestations of migraine, recurrent transient ischemic attack or lacunar strokes, cognitive decline, and mood disturbances. However, manic episodes have rarely been documented as an initial symptom of CADASIL and bipolar disorder presenting as the first manifestation in CADASIL has not been reported previously from evaluations by psychiatrists or psychological testing by psychologists. CASE PRESENTATION: A 53 year old woman developed symptoms of mania in her 50s leading to a personality change involving a continuously labile mood and irritability over a number of years. Neuropsychological testing revealed an intact memory, but impairment in attention and executive function. In the Rorschach test, she showed a high level of cognitive rigidity. Magnetic resonance imaging findings were very consistent with a diagnosis of CADASIL, which was confirmed by genetic testing for NOTCH3 mutations. Atypical antipsychotics proved to be helpful in treating her manic symptoms and for behavior control. CONCLUSION: We present a novel case of CADASIL that first presented as bipolar disorder. We contend that when patients show a late onset personality change or chronically irritable mood that deteriorates over many years, an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

WISC-IV Intellectual Profiles in Korean Children and Adolescents with Attention Deficit/Hyperactivity Disorder.

OBJECTIVE: This study aimed to compare the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) profiles of children with attention deficit/hyperactivity disorder (ADHD) and typically-developing children (TC) in Korea. METHODS: The Korean version of the WISC-IV and the Advanced Test of Attention (ATA) were administered to 377 children and adolescents: 224 with ADHD (age 8.2±2.1 years, 182 boys) and 153 TC (age 8.7±2.4 years, 68 boys). Partial correlation and an analysis of covariance were used to investigate the relationship between the scores of the WISC-IV and the ATA. RESULTS: The mean score of the full-scale intelligence quotient was lower in ADHD children than in TC (p<0.001). In analyses controlling for gender and with the full-scale intelligence quotient as a covariate, the working memory index (WMI) (p<0.001) and values of the Digit span subtest (p=0.001) of the WISC-IV were lower in the ADHD group than in TC. The WMI (r=-0.26, p<0.001) and its subtest Arithmetic scores (r=-0.25, p<0.001) were negatively correlated with Commission errors on the auditory ATA. CONCLUSION: Children with ADHD have significantly lower WMI scores, which were clinically correlated with Commission errors on the auditory task of the ATA. Thus, the WMI is an indicator of attention deficit in children with ADHD.