Facial emotion processing in patients with social anxiety disorder and Williams-Beuren syndrome: an fMRI study.

BACKGROUND: Social anxiety disorder (SAD) and Williams-Beuren syndrome (WBS) are 2 conditions with major differences in terms of genetics, development and cognitive profiles. Both conditions are associated with compromised abilities in overlapping areas, including social approach, processing of social emotional cues and gaze behaviour, and to some extent they are associated with opposite behaviours in these domains. We examined common and distinct patterns of brain activation during a facial emotion processing paradigm in patients with SAD and WBS. METHODS: We examined patients with SAD and WBS and healthy controls matched by age and laterality using functional MRI during the processing of happy, fearful and angry faces. RESULTS: We included 20 patients with SAD and 20 with WBS as well as 20 matched controls in our study. Patients with SAD and WBS did not differ in the pattern of limbic activation. We observed differences in early visual areas of the face processing network in patients with WBS and differences in the cortical prefrontal regions involved in the top-down regulation of anxiety and in the fusiform gyrus for patients with SAD. Compared with those in the SAD and control groups, participants in the WBS group did not activate the right lateral inferior occipital cortex. In addition, compared with controls, patients with WBS hypoactivated the posterior primary visual cortex and showed significantly less deactivation in the right temporal operculum. Participants in the SAD group showed decreased prefrontal activation compared with those in the WBS and control groups. In addition, compared with controls, participants with SAD showed decreased fusiform activation. Participants with SAD and WBS also differed in the pattern of activation in the superior temporal gyrus, a region that has been linked to gaze processing. LIMITATIONS: The results observed in the WBS group are limited by the IQ of the WBS sample; however, the specificity of findings suggests that the pattern of brain activation observed for WBS is more likely to reflect a neurobiological substrate rather than intellectual impairment per se. CONCLUSION: Patients with SAD and WBS showed common and specific patterns of brain activation. Our results highlight the role of cortical regions during facial emotion processing in individuals with SAD and WBS.

POEMS Syndrome: A Rare Disease With A Challenging Diagnosis.

A complex conglomerate of symptoms, signs, and abnormalities are present with POEMS syndrome, making the diagnosis, management and follow-up a challenge. Recognizing the disease early on may be difficult. Many patients are initially misdiagnosed as having others disorders, for example: multiple myeloma. There is no standard treatment for patients diagnosed with POEMS syndrome.

Use of electroconvulsive therapy in Parkinson disease with residual axial symptoms partially unresponsive to L-dopa: a pilot study.

INTRODUCTION: Mental dysfunction and especially gait disorders, such as freezing and postural instability in "on phase," are partially unresponsive to dopaminergic therapy late in the course of Parkinson disease (PD). Some of them have been related to decreased sensitivity of postsynaptic dopaminergic receptors, and it is known that electroconvulsive therapy (ECT) enhances the sensitivity of these receptors. The aim of this study was to determine the efficacy and safety of ECT in patients with advanced Parkinson disease with symptoms partially unresponsive to L-dopa. METHODS: Neurologic (Parkinson's Disease Questionnaire, Unified Parkinson's Disease Rating Scale, Tinetti Scale, and the Sit-to-Stand test), psychiatric (structured interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Hamilton Depression Rating Scale) and neuropsychological (Mini Mental State Examination, executive functions, declarative and procedural memory, visual processing, and reaction time) evaluation was performed on 9 patients with a diagnosis of L-dopa-resistant PD by the Movement Disorders Working Group. This evaluation was done before and after 8 sessions of bitemporal ECT. Six patients completed the study. RESULTS: Statistically significant differences were found in the number of steps and freezing episodes in the on phase when they were compared before and after the ECT administration. However, no statistically significant differences were found in the "off" phenomena, motor fluctuations, or dyskinesias before and after ECT administration. No patient showed psychiatric symptoms before, during, or after the ECT. No statistically significant differences were observed in the neuropsychological results between the pretreatment and posttreatment evaluations. All patients showed transient amnesia after the ECT administration, which lasted for 48 hours. CONCLUSIONS: Electroconvulsive therapy could be a safe and effective therapeutic option in L-dopa-resistant patients with PD with predominantly axial "on" phenomena; nevertheless, it needs to be confirmed in later studies.

Ziprasidone versus clozapine in the treatment of psychotic symptoms in Parkinson disease: a randomized open clinical trial.

OBJECTIVE: To compare the efficacy and safety of ziprasidone versus clozapine in patients with psychotic symptoms in Parkinson disease. METHODS: A 4-week, randomized, single-blind, open-label, parallel comparison of ziprasidone and clozapine was completed. Sixteen patients with Parkinson disease were included. Psychosis was assessed using the Brief Psychiatric Rating Scale (BPRS), and the Scale for the Assessment of Positive Symptoms (SAPS). The Unified Parkinson's Disease Rating Scale and the Abnormal Involuntary Movement Scale were used to assess motor conditions during the study period. Measures of drugs' adverse effects, white blood cell count, and the Clinical Global Impression Scale-Severity Subscale were performed. Cognitive changes were assessed with the Mini-Mental State Examination. RESULTS: Fourteen patients completed the study, 8 patients on clozapine and 6 patients on ziprasidone. The final mean dosage for clozapine was 32.14 mg/d and that for ziprasidone was 35 mg/d. Throughout the study, neither the Unified Parkinson's Disease Rating Scale, the Abnormal Involuntary Movement Scale, or the Mini-Mental State Examination showed statistical differences in both groups. Psychotic symptoms, assessed with SAPS and BPRS, were reduced in both groups but with more intensity in the ziprasidone group (effect size in SAPS, 1.3, and effect size in BPRS, 1.7) than in the clozapine group (effect size in SAPS, 0.36, and effect size in BPRS, 0.53). CONCLUSIONS: Ziprasidone seems to be at least as effective as clozapine in the treatment to ameliorate psychotic symptoms in PD.

Social anxiety and negative early life events in university students.

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

Social anxiety and negative early life events in university students / Eventos negativos na infância e ansiedade social em estudantes universitários

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

INTRODUÇÃO: Existem evidências substanciais sobre o impacto de eventos negativos da vida durante a infância na etiologia dos transtornos psiquiátricos. Examinamos a associação entre os eventos negativos ocorridos na infância e a ansiedade social em uma amostra de 571 estudantes universitários espanhóis. MÉTODOS: Em um estudo transversal realizado em 2007, foram coletados os dados de variáveis sociodemográficas, história psiquiátrica pessoal e familiar e abuso de substâncias por meio de um questionário semiestruturado e avaliamos cinco eventos negativos ocorridos na infância: (i) a perda de alguém próximo, (ii) abuso emocional, (iii) abuso físico, (iv) violência familiar e (v) abuso sexual. Todos os participantes preencheram a escala de Liebowitz para ansiedade social. RESULTADOS: A média (DP) de idade foi de 21 anos (4,5); 75% eram do sexo feminino; o escore na LSAS foi 40 (DP = 22); 14,2% tinham história psiquiátrica familiar e 50,6% tiveram eventos negativos durante a infância. A análise de regressão linear, após o controle para idade, sexo e história psiquiátrica familiar, mostraram associação positiva entre violência familiar e escore de ansiedade social (p = 0,03). Nenhum dos fatores estressores restantes produziu aumento significativo no escore da LSAS (p > 0,05). CONCLUSÃO: Os estudantes universitários com altos níveis de ansiedade social apresentaram prevalência maior de eventos negativos precoces. Portanto, a violência familiar na infância pode ser um fator de risco para ansiedade social em tal população.