Cognitive deficits and impaired hippocampal long-term potentiation in KATP-induced DEND syndrome.

ATP-sensitive potassium (KATP) gain-of-function (GOF) mutations cause neonatal diabetes, with some individuals exhibiting developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome. Mice expressing KATP-GOF mutations pan-neuronally (nKATP-GOF) demonstrated sensorimotor and cognitive deficits, whereas hippocampus-specific hKATP-GOF mice exhibited mostly learning and memory deficiencies. Both nKATP-GOF and hKATP-GOF mice showed altered neuronal excitability and reduced hippocampal long-term potentiation (LTP). Sulfonylurea therapy, which inhibits KATP, mildly improved sensorimotor but not cognitive deficits in KATP-GOF mice. Mice expressing KATP-GOF mutations in pancreatic ß-cells developed severe diabetes but did not show learning and memory deficits, suggesting neuronal KATP-GOF as promoting these features. These findings suggest a possible origin of cognitive dysfunction in DEND and the need for novel drugs to treat neurological features induced by neuronal KATP-GOF.

Depression Severity Is Related to Less Gross Body Movement: A Motion Energy Analysis.

Psychomotor retardation is a well-known clinical phenomenon in depressed patients that can be measured in various ways. This study aimed to investigate objectively measured gross body movement (GBM) during a semi-structured clinical interview in patients with a depressive disorder and its relation with depression severity. A total of 41 patients with a diagnosis of depressive disorder were assessed both with a clinician-rated interview (Hamilton Depression Rating Scale) and a self-rating questionnaire (Beck Depression Inventory-II) for depression severity. Motion energy analysis (MEA) was applied on videos of additional semi-structured clinical interviews. We considered (partial) correlations between patients' GBM and depression scales. There was a significant, moderate negative correlation between both measures for depression severity (total scores) and GBM during the diagnostic interview. However, there was no significant correlation between the respective items assessing motor symptoms in the clinician-rated and the patient-rated depression severity scale and GBM. Findings imply that neither clinician ratings nor self-ratings of psychomotor symptoms in depressed patients are correlated with objectively measured GBM. MEA thus offers a unique insight into the embodied symptoms of depression that are not available via patients' self-ratings or clinician ratings.

Developmental Outcomes for Children at High Risk of Dyslexia and Children With Developmental Language Disorder.

We followed children at family risk of dyslexia and children with preschool language difficulties from age 3½, comparing them with controls (N = 234). At age 8, children were classified as having dyslexia or Developmental Language Disorder (DLD) and compared at earlier time points with controls. Children with dyslexia have specific difficulties with phonology and emergent reading skills in the preschool period, whereas children with DLD, with or without dyslexia, show a wider range of impairments including significant problems with executive and motor tasks. For children with both dyslexia and DLD, difficulties with phonology are generally more severe than those observed in children with dyslexia or DLD alone. Findings confirm that poor phonology is the major cognitive risk factor for dyslexia.

Melancholia as Predictor of Electroconvulsive Therapy Outcome in Later Life.

OBJECTIVES: In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms. METHODS: One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time. RESULTS: Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057). DISCUSSION: Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response.

Health-related quality of life and peer relationships in adolescents with developmental coordination disorder and attention-deficit-hyperactivity disorder.

AIM: Health-related quality of life (HRQoL) and peer relationships were investigated in adolescents with developmental coordination disorder (DCD) and attention-deficit-hyperactivity disorder (ADHD). METHOD: Adolescents with DCD (n=9), ADHD (n=9), DCD and ADHD (n=10), and typically developing adolescents (n=16) completed the following questionnaires: KIDSCREEN-52 Health-Related Quality of Life Questionnaire and Peer Relations Questionnaire for Children. Twenty-five participants took part in semi-structured interviews. RESULTS: Adolescents with DCD and ADHD had lower HRQoL on the mood and emotions, school environment, and financial resources scales of the KIDSCREEN-52 than adolescents in the DCD and typically developing groups (all p<0.05). On the Peer Relations Questionnaire for Children, the DCD and ADHD group reported significantly higher victimization compared with those in the typically developing (p=0.030) and DCD (p=0.010) groups. Qualitative interviews among young people with DCD and ADHD revealed feelings of marginalization and victimization. Descriptors such as 'misfits', 'oddballs', 'weird', and 'the rejects' were used to describe themselves. INTERPRETATION: HRQoL and peer relationships are negatively affected in adolescents with DCD and ADHD. WHAT THIS PAPER ADDS?: Children with developmental coordination disorder (DCD) do not display poorer overall health-related quality of life (HRQoL) versus typically developing controls. Having DCD and attention-deficit-hyperactivity disorder (ADHD) was associated with poorer HRQoL. Adolescents with DCD and ADHD experience significantly higher levels of peer victimization than typically developing adolescents. HRQoL and peer relationships are significantly associated in adolescent respondents.

[Altered orientation and aggressiveness in an 89-year-old woman]. / Wechselnde Vigilanz und Fremdaggressivität bei einer 89­jährigen Patientin.

An 89-year-old woman with Alzheimer's dementia was admitted because of altered orientation, aggressiveness and inability to take care of herself at home. Her patient history indicated that 14 days ago the battery of the pacemaker had be renewed. During that time the patient suffered from psychomotor alterations. Therefore, melperone had been initiated. Inspection of the urine and laboratory findings pointed towards an acute exacerbation of acute intermittent porphyria as a possible cause of the delirium. After discontinuation of melperone with additional parenteral therapy with physiological fluids, the signs of delirium significantly improved.

Effect of Repetitive Transcranial Magnetic Stimulation on Psychomotor Retardation in Major Depression: A Pilot Feasibility Study.

This pilot study investigated the feasibility of a comprehensive battery of tests assessing psychomotor retardation after a 3-week protocol of repetitive transcranial magnetic stimulation for depression. In addition to the beneficial effect of this treatment on depression, the results showed positive changes in psychomotor retardation.

Psychometric evaluation of the DMSS-4 in a cohort of elderly post-operative hip fracture patients with delirium.

BACKGROUND: Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Rapid reliable identification of clinical subtypes can allow for more targeted research efforts. METHODS: We explored the concordance in attribution of motor subtypes between the Delirium Motor Subtyping Scale 4 (DMSS-4) and the original Delirium Motor Subtyping Scale (DMSS) (assessed cross-sectionally) and subtypes defined longitudinally using the Delirium Symptom Interview (DSI). RESULTS: We included 113 elderly patients developing DSM-IV delirium after hip-surgery [mean age 86.9 ± 6.6 years; range 65-102; 68.1% females; 25 (22.1%) had no previous history of cognitive impairment]. Concordance for the first measurement was high for both the DMSS-4 and original DMSS (k = 0.82), and overall for the DMSS-4 and DSI (k = 0.84). The DMSS-4 also demonstrated high internal consistency (McDonald's omega = 0.90). The DSI more often allocated an assessment to "no subtype" compared to the DMSS-4 and DMSS-11, which showed higher inclusion rates for motor subtypes. CONCLUSIONS: The DMSS-4 provides a rapid method of identifying motor-defined clinical subtypes of delirium and appears to be a reliable alternative to the more detailed and time-consuming original DMSS and DSI methods of subtype attribution. The DMSS-4, so far translated into three languages, can be readily applied to further studies of causation, treatment and outcome in delirium.

Unraveling psychomotor slowing in bipolar disorder.

BACKGROUND/AIMS: In addition to affective and cognitive symptomatology, psychomotor deficits are known to be present in bipolar disorder (BD). Psychomotor functioning includes all of the processes necessary for completing a movement, from planning to initiation and execution. While these psychomotor symptoms have been studied extensively in schizophrenia and major depressive disorder, only simple measures have been conducted in BD. The present study examines psychomotor functioning in BD. METHODS: Twenty-two euthymic BD patients and 21 healthy controls performed three computerized copying tasks varying in cognitive load. Movement times (MT), reflecting fine motor processing, and initiation times (IT), reflecting cognitive processing of visual-spatial information, were separately measured in each group. RESULTS: The BD patients had longer IT but not MT in the simplest task and the opposite pattern of longer MT but not IT in the complex task. However, when controlling for residual mood symptoms, the MT were no longer significantly slower in the BD group. CONCLUSIONS: The longer MT and IT in BD reflect overall psychomotor slowing. Specifically, the results provide evidence for cognitive slowing in BD. In addition, the longer MT in the complex task reflect a slowed motor component of movement when the cognitive load is high and when depressive symptoms are present. These findings extend the current knowledge of the nature of psychomotor slowing in BD and may have important prognostic implications for patients.

Evaluation of the psychometric properties of the Spanish version of the Denver Developmental Screening Test II.

UNLABELLED: The objective of this study was to examine the psychometric properties of the Spanish version of the Denver Developmental Screening Test II in a population of Spanish children. Two hundred children ranging from 9 month to 6 years were grouped into two samples (healthy/with psychomotor delay) and screened in order to check whether they suffered from psychomotor delay. Children from three Early Intervention Centres and three schools participated in this study. Criterion validity was calculated by the method of extreme groups, comparing healthy children to those with development delay. Interobserver and intraobserver reliability were calculated using Cohen Kappa coefficient, and internal consistency was calculated via the Kuder-Richardson coefficient. The scale demonstrated 89% sensitivity, 92% specificity, a positive predicted value of 91% and a negative predicted value of 89%, whereas the positive and negative likelihood ratio was 11.12 and 0.12, respectively. Intraobserver reliability ranged from 0.662 to 1, and interobserver reliability ranged from 0.886 to 1. The Kuder-Richardson coefficient values ranged from 87.5 to 97.6%. CONCLUSION: The Spanish version of the Denver Developmental Screening Test II was found to have a good criterion validity, reliability and internal consistency and is a suitable screening test for use in a population of Spanish children.

[Postural control characteristics in elderly women with fallers].

Using computer posturografic (stabilometric) complex a study of postural control peculiarities was carried out in 108 women aged 65-74 years who had experienced two or more falls during the year (fallers). These tests were: Sensory Organization Test, Motor Control Test, Rhythmic Weight Shift. It was found that elderly women with fallers had a decrease of sensory information (somatosensory - by 1,8 %, of the visual - by 6 %, and of the vestibular - by 10,1 %), the neurophysiological mechanisms of postural control (by 5,7 points), violation of adaptation possibilities of sensory and motor components of the legs to respond quickly to changes in the center of gravity within the support base of its footing (7,3 ms), as well as reducing balance control in the frontal (by 7,2 %) and sagittal (by 23,2 % ) planes compared with the women of the same age without fallers.

[Is emotional dysregulation a component of attention-deficit/hyperactivity disorder (ADHD)?]. / La dysrégulation émotionnelle est-elle une des composantes du trouble déficit d'attention/hyperactivité ?

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. It is characterized by age-inappropriate inattention/impulsiveness and/or hyperactivity symptoms. ADHD shows a high comorbidity with oppositional defiant disorder (ODD), a disorder that features symptoms of emotional lability. Due to this comorbidity, emotional lability was long considered a secondary consequence of ADHD, which could arise under the influence of environmental factors such as inefficient parenting practices, as part of an ODD diagnosis. In this model of heterotypic continuity, emotional lability was considered not to play any causal role regarding ADHD symptomatology. LITERATURE FINDINGS: As opposed to this view, it is now well established that a large number of children with ADHD and without any comorbid disorder exhibit symptoms of emotional lability. Furthermore, recent studies have found that negative emotionality accounts for significant unique variance in ADHD symptom severity, along with motor-perceptual and executive function deficits. Barkley proposed that ADHD is characterized by deficits of executive functions, and that a deficiency in the executive control of emotions is a necessary component of ADHD. According to this theory, the extent to which an individual with ADHD displays a deficiency in behavioral inhibition is the extent to which he or she will automatically display an equivalent degree of deficiency in emotional inhibition. However, not all children with ADHD exhibit symptoms of emotional lability, and studies have found that the association between emotional lability and ADHD was not mediated by executive function or motivational deficits. Task-based and resting state neuroimaging studies have disclosed an altered effective connectivity between regions dedicated to emotional regulation in children with ADHD when compared to typically developing children, notably between the amygdala, the prefrontal cortex, the hippocampus and the ventral striatum. Morphological alterations of the amygdala have also been reported in previous structural studies in children with ADHD. DISCUSSION: Emotional lability can result from different neurobiological mechanisms. In particular, bottom-up and top-down processes can be opposed. Bottom-up related emotional dysregulation involves an increased emotional reactivity, and is thought to be linked to the automatic evaluative activity of the amygdala. Top-down mechanisms are associated with the regulation of such activity, and rely on a prefrontal network including the lateral prefrontal cortex, the anterior cingulate cortex and the orbitofrontal cortex. Since various neuropsychological impairments and alterations in multiple brain networks have been implicated in the etiology of ADHD, contemporary models emphasize its neuropsychological heterogeneity. It is therefore likely that some but not all children with ADHD will exhibit neurobiological alterations in circuits dedicated to emotional regulation, possibly at different levels. Future research will have to identify the different causal pathways and to decide whether emotional lability represents a criterion to subtype ADHD diagnoses. CONCLUSION: Emotional dysregulation is now known to play a causal role regarding ADHD symptomatology. Along with executive functioning, reaction time variability and potentially delay aversion, emotional dysregulation should therefore be included in future theoretical models of ADHD, as well as in clinical practice when identifying the major impairments in this diagnostic group and when deciding therapeutic strategies.

[Do psychomotor symptoms predict the treatment response of patients with depressive disorders?]. / Voorspellen psychomotore symptomen de behandelrespons bij depressieve stoornissen?

BACKGROUND: Patients with depressive disorders may present with typical psychomotor symptoms such as retardation and/or agitation. So far, however,the prognostic significance of these symptoms is unclear. AIM: To present an overview in which we assess to what extent psychomotor symptoms can predict the effect of the type of treatment that patients with depressive disorders receive. METHOD: We searched the literature using Medline. RESULTS: Psychomotor symptoms might predict that the patient will respond more favourably to treatment with dopaminergic antidepressants and broad-spectrum antidepressants (TCAs) and particularly to electroconvulsive therapy than to 'single-acting serotonergic antidepressants' - but, so far, the scientific evidence for the foregoing is limited. CONCLUSION: In our view psychomotor symptoms do have a predictive value with regard to treatment response, but further research is needed.

[Visual perceptual abilities of children with low motor abilities--a pilot study]. / Visuelle Wahrnehmungsleistungen bei motorisch auffälligen Kindern--eine Pilotstudie.

The results of many studies show visual perceptual deficits in children with low motor abilities. This study aims to indicate the correlation between visual-perceptual and motor abilities. The correlation of visual-perceptual and motor abilities of 41 children is measured by using the German versions of the Developmental Test of Visual Perception--Adolescent and Adult (DTVP-A) and the Movement Assessment Battery for Children--Second Edition (M-ABC-2). The visual-perceptual abilities of children with low motor abilities (n=21) are also compared to the visual-perceptual abilities of children with normal motor abilities (the control group, n=20). High correlations between the visual-perceptual and motor abilities are found. The perceptual abilities of the groups differ significantly. Nearly half of the children with low motor abilities show visual-perceptual deficits. Visual perceptual abilities of children suffering coordination disorders should always be assessed. The DTVP-A is useful, because it provides the possibilities to compare motor-reduced visual-perceptual abilities and visualmotor integration abilities and to estimate the deficit's degree.

Sleep disturbances in children, adolescents, and young adults with severe psychomotor impairment: impact on parental quality of life and sleep.

AIM: In childhood, severe psychomotor impairment (SPMI) is associated with profound sleep disturbances. With the help of newly developed and validated measures, we systematically assessed how much a child's sleep disturbance affects parental sleep and quality of life (QoL) in this specific patient group. METHOD: Parents and their children with SPMI were enrolled from three outpatient centers and one in-patient center in Germany. We administered a set of questionnaires to the parents that addressed their child's sleep quality, the sleep disturbance-related parental burden, and the impact on both parental sleep and QoL. Additional questionnaires were used to gather data describing our sample group to allow for comparison with published norms. RESULTS: Parents of 214 children, adolescents, and young adults with SPMI (114 males, 100 females; mean age 10y 5mo, SD 5y 6mo, range 0.1-25y) responded to the questionnaire set (response rate of 66%). We found severe impairment of parental health status and QoL. More than 50% of the parents suffered from a sleep disorder (e.g. prolonged sleep latency, shortened sleep duration). Sleep disturbances in children, adolescents, and young adults correlated strongly with parental sleep disturbances, parental impairment of physical and mental functioning, parental social functioning, and parental working ability. INTERPRETATION: Sleep-related difficulties have a significant sociomedical impact on the parents of children, adolescents, and young adults with complex neurological diseases. Typically, parents are severely affected in various aspects of daily living. There is a need for novel diagnostic and therapeutic approaches that match the complex sociomedical needs of these patients and their families.

Motor impairment in very preterm-born children: links with other developmental deficits at 5 years of age.

AIM: To elucidate the relation between motor impairment and other developmental deficits in very preterm-born children without disabling cerebral palsy and term-born comparison children at 5 years of (corrected) age. METHOD: In a prospective cohort study, 165 children (81 very preterm-born and 84 term-born)were assessed with the Movement Assessment Battery for Children - 2nd edition, Touwen's neurological examination, the Wechsler Preschool and Primary Scale of Intelligence, processing speed and visuomotor coordination tasks of the Amsterdam Neuropsychological Tasks, and the Strengths and Difficulties Questionnaire. RESULTS: Motor impairment (≤15th centile) occurred in 32% of the very preterm-born children compared with 11% of their term-born peers (p=0.001). Of the very preterm-born children with motor impairment, 58% had complex minor neurological dysfunctions, 54% had low IQ, 69% had slow processing speed, 58% had visuomotor coordination problems, and 27%, 50%,and 46% had conduct, emotional, and hyperactivity problems respectively. Neurological outcome (odds ratio [OR]=41.7, 95% confidence intervals [CI] 7.5­232.5) and Full-scale IQ(OR=7.3, 95% CI 1.9­27.3) were significantly and independently associated with motor impairment. Processing speed (OR=4.6, 95% CI 1.8­11.6) and attention (OR=3.2, 95% CI1.3­7.9) were additional variables associated with impaired manual dexterity. These four developmental deficits mediated the relation between preterm birth and motor impairment. INTERPRETATION: Complex minor neurological dysfunctions, low IQ, slow processing speed,and hyperactivity/inattention should be taken into account when very preterm-born children are referred for motor impairment.

Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4).

BACKGROUND: Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings. METHODS: A multi-site database, including motor symptom assessments conducted in 487 patients from palliative care, adult and old age consultation-liaison psychiatry services was used to document motor activity disturbances as per the Delirium Motor Checklist (DMC). Latent class analysis (LCA) was used to identify the class structure underpinning DMC data and also items for a brief subtyping scale. The concordance of the abbreviated scale was then compared with the original Delirium Motor Subtype Scale (DMSS) in 375 patients having delirium as per the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition) criteria. RESULTS: Latent class analysis identified four classes that corresponded closely with the four recognized motor subtypes of delirium. Further, LCA of items (n = 15) that loaded >60% to the model identified four features that reliably identified the classes/subtypes, and these were combined as a brief motor subtyping scale (DMSS-4). There was good concordance for subtype attribution between the original DMSS and the DMSS-4 (κ = 0.63). CONCLUSIONS: The DMSS-4 allows for rapid assessment of clinical subtypes in delirium and has high concordance with the longer and well-validated DMSS. More consistent clinical subtyping in delirium can facilitate better delirium management and more focused research effort.

Latent Bipolarity In Unipolar Depression: Experimental Findings, Conceptual Analysis And Implications For Treatment Strategies.

INTRODUCTION: Previous studies have suggested that the two opposite poles of psychomotor disturbances in unipolar depression (UD) - retardation and agitation - require different treatment strategies as the psychomotor overactivation requires an augmentation of the antidepressant therapy with mood stabilizers and/or atypical antipsychotics. OBJECTIVE: The aim of the present study was to objectively identify and measure the psycho-motor disturbances in UD using differentiation between activity and reactivity. MATERIAL AND METHODS: An equilibriometric movement pattern analysis system that allows differentiation between psychomotor activity and reactivity was applied in 58 unipolar depressive patients and 76 healthy controls. RESULTS: Compared to controls, the patients as a group were significantly slower in their psychomotor reactivity. However, the subsequent subgrouping according to the direction of deviation of their objective psychomotor parameters revealed a disinhibition of psychomotor activity and/or reactivity in about one half of them. Such a contradictory combination of clinically manifested depressive mood and subclinically detected manic-like psychomotor overactivation might be regarded as belonging to the bipolar spectrum, since it was admitted that manic psychomotor disinhibition in unipolar depressive patients uncovers a latent bipolarity. CONCLUSION: Not only prototypical depressive inhibition, but also prototypical manic-like disinhibition may underlie clinically manifested UD. Since the combination between depressive mood and psychomotor overactivation multiplies the suicidal risk, we may presume that the timely detection of this combination at a subclinical level would contribute to an earlier and more effective suicidal prevention by an objectively-guided optimization of pharmacological treatment.

[The development of the body schema]. / Le développement du schéma corporel.

The body schema as an acquired structure enables individuals to gain a representation of the different parts of their body without relying on external stimulations. When its development is disrupted a certain number of disorders can arise which have significant repercussions on the patients' daily lives. These dysfunctions can be managed in the framework of psychomotor rehabilitation.

Inverse relationship between task complexity and performance deficit in 5 m water immersion.

Previous research on cognitive deficits during shallow water immersion led to inconsistent results: some authors observed deficits at 5 m, but others only at depths well beyond 5 m. The present study evaluates whether this discrepancy could be related to different levels of difficulty. Forty-eight subjects participated in a mental rotation task and in a color-word task, both having multiple levels of difficulty. The two tasks were administered once 5 m below the water's surface and once on dry land. Compared to land, subjects' reaction time increased in 5 m depth when task difficulty was low, but it did not increase when task difficulty was high. Thus, performance deficits in 5 m depth were inversely related to task complexity. We interpret this counter-intuitive finding within the framework of a multiple-channel parallel processing model, with channels that are differentially sensitive to immersion. This model correctly predicts performance deficits on simple, but not on complex skills at smaller depths, and deficits on simple as well as complex skills at larger depths, in accordance with the present findings and data from literature.