Betaine in the Brain: Characterization of Betaine Uptake, its Influence on Other Osmolytes and its Potential Role in Neuroprotection from Osmotic Stress.

Betaine (N-trimethylglycine), a common osmolyte, has received attention because of the number of clinical reports associating betaine supplementation with improved cognition, neuroprotection and exercise physiology. However, tissue analyses report little accumulation of betaine in brain tissue despite the presence of betaine/GABA transporters (BGT1) at the blood brain barrier and in nervous tissue, calling into question whether betaine influences neuronal function directly or indirectly. Therefore, the focus of this study was to determine what capacity nervous tissue has to accumulate betaine, specifically in the hippocampus, a region of the brain associated with learning and memory and one that is particularly susceptible to damage (e.g., seizure activity). Here we report that hippocampal slices actively accumulate betaine in a time, dose and osmolality dependent manner, resulting in peak intracellular concentrations four times extracellular concentrations within 8 h. Our data also indicate that betaine uptake differentially influences the accumulation of other osmolytes. Under isosmotic conditions, betaine uptake minimally impacted some osmolytes (e.g., glycerylphosphorylcholine and glutamate) while significantly reducing others (taurine, creatine, and myo-inositol). Under osmotic stress (hyperosmotic) conditions, we observed dramatic changes in osmolytes like glycine and glutamine-key players in inhibitory neurotransmission-and little change in osmolytes such as taurine, creatine and myo-inositol when betaine was available. These data suggest that betaine may influence pathways of inhibitory neurotransmitter production/recycling in addition to serving as an osmolyte and metabolic intermediate. In sum, our data provide detailed characterization of betaine uptake in the hippocampus that implicates betaine in the modulation of hippocampal neurophysiology and neuroprotection.

Measuring outcome in child and adolescent mental health services: consumers' views of measures.

BACKGROUND: Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users. AIMS: This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services. METHOD: Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures. RESULTS: Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised. CONCLUSION: Service users support outcome measures but their implementation requires care and consultation.