A window into the reality of families living long term with challenging behaviours after a TBI.

Challenging behaviours are a long-term burden for people with traumatic brain injury (TBI) and their families. Families frequently shoulder the responsibility alone, but little is known about the strategies they use to manage these behaviours. This study aimed to 1) identify the coping strategies used by people with TBI living in the community and their family caregivers to manage challenging behaviours; and 2) describe the similarities and differences between strategies used by people with TBI and caregivers. In this qualitative descriptive design, individual semi-structured interviews were conducted with adults with TBI and their caregivers and were inductively analyzed. The sample included 10 dyads and two triads, totalling 12 caregivers (8 women) and 14 individuals with TBI (6 women; 21.71 ± 10.84 years post-injury). Participants' strategies were proactive (prevention), reactive (response), or retroactive (aftercare). Most strategies were described by caregivers. Some of them were effective and lasting, others not, reflecting how they adapted their approaches over time. Families put in place various strategies in their life's journey, such as giving feedback or adapting the environment. Despite these strategies supporting long-term community living, the need for ongoing support is underscored, as crises may still occur, impacting families' quality of life.

The dual reality of challenging behaviours: Overlapping and distinct perspectives of individuals with TBI and their caregivers.

Challenging behaviours significantly impact the lives of people with traumatic brain injury (TBI) and their family caregivers. However, these behaviours are rarely defined from the perspectives of both individuals, a necessary step to developing interventions targeting meaningful goals for individuals and caregivers. This study aimed to (1) explore and confirm the perspective of individuals with TBI living in the community and their family caregivers on behaviours they consider challenging and, (2) identify overlapping or distinct views on challenging behaviours. A qualitative descriptive design was used. Twelve caregivers (8 females; 59.67 ± 11.64 years old) and 14 participants with mild-severe TBI (6 females; 43.21 ± 10.98 years old; time post-injury: 21.71 ± 10.84 years) were interviewed (10 dyads and two triads). Data were analysed using inductive qualitative analysis. Challenging behaviours most frequently reported by all participants were aggressive/impulsive behaviours, inappropriate social behaviours, and behavioural manifestations of cognitive impairments. Overlapping perspectives were identified regarding aggressive behaviours. Distinctions exist as inappropriate social behaviours and cognitive difficulties were mainly reported by caregivers. Our results confirm that perspectives may vary between dyad members. Interventions should include dyad inputs to formulate goals that are significant to the person with TBI and their caregiver.

Taking organelles apart, putting them back together and creating new ones: lessons from the endoplasmic reticulum.

The endoplasmic reticulum (ER) is a highly dynamic organelle. It is composed of four subcompartments including nuclear envelope (NE), rough ER (rER), smooth ER (sER) and transitional ER (tER). The subcompartments are interconnected, can fragment and dissociate and are able to reassemble again. They coordinate with cell function by way of protein regulators in the surrounding cytosol. The activity of the many associated molecular machines of the ER as well as the fluid nature of the limiting membrane of the ER contribute extensively to the dynamics of the ER. This review examines the properties of the ER that permit its isolation and purification and the physiological conditions that permit reconstitution both in vitro and in vivo in normal and in disease conditions.

Proteomic analysis of the transitional endoplasmic reticulum in hepatocellular carcinoma: an organelle perspective on cancer.

The transitional endoplasmic reticulum (tER) is composed of both rough and smooth ER membranes and thus participates in functions attributed to both these two subcellular compartments. In this paper we have compared the protein composition of tER isolated from dissected liver tumor nodules of aflatoxin B1-treated rats with that of tER from control liver. Tandem mass spectrometry (MS), peptide counts and immunoblot validation were used to identify and determine the relative expression level of proteins. Inhibitors of apoptosis (i.e. PGRMC1, tripeptidyl peptidase II), proteins involved in ribosome biogenesis (i.e. nucleophosmin, nucleolin), proteins involved in translation (i.e. eEF-2, and subunits of eIF-3), proteins involved in ubiquitin metabolism (i.e. proteasome subunits, USP10) and proteins involved in membrane traffic (i.e. SEC13-like 1, SEC23B, dynactin 1) were found overexpressed in tumor tER. Transcription factors (i.e. Pur-beta, BTF3) and molecular targets for C-Myc and NF-kappa B were observed overexpressed in tER from tumor nodules. Down-regulated proteins included cytochrome P450 proteins and enzymes involved in fatty acid metabolism and in steroid metabolism. Unexpectedly expression of the protein folding machinery (i.e. calreticulin) and proteins of the MHC class I peptide-loading complex did not change. Proteins of unknown function were detected in association with the tER and the novel proteins showing differential expression are potential new tumor markers. In many cases differential expression of proteins in tumor tER was comparable to that of corresponding genes reported in the Oncomine human database. Thus the molecular profile of tumor tER is different and this may confer survival advantage to tumor cells in cancer.

Electrophysiological manifestations of stimulus evaluation, response inhibition and motor processing in Tourette syndrome patients.

Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder with childhood onset presenting with multiple fluctuating motor tics and one or more phonic tics. A significant proportion of people suffering from GTS are still symptomatic in adulthood and present other emotional and cognitive difficulties, along with motor problems that often accompany these comorbid conditions. The nature of these difficulties is still poorly understood and multiple comorbidities are often inadequately controlled. The current study investigates both stimulus evaluation and motor processing in GTS while controlling for comorbidity. Fifteen adults with GTS and 20 control participants were matched on gender, laterality and intelligence. The P300 component, the no-go anteriorization (NGA) as well as the stimulus and response-locked lateralized-readiness potentials (S-LRP, R-LRP) were elicited during a stimulus-response compatibility (SRC) paradigm. The standard version of the Stroop Color-Word Test (SCWT) was also administered. Reaction times showed that participants with GTS processed both the SRC and the SCWT more rapidly than the control group, while producing a delayed P300 peak latency. The GTS group also showed faster S-LRP onset in response to the incompatible and faster processing of interference in the SCWT. There was also a tendency toward a greater frontal shift of the NGA in the GTS group. The P300 latency showed that with GTS patients, stimulus evaluation occurs later whereas the overlapping pre-motor response selection processes occur faster. Our findings are congruent with a probable cortical motor over-activation hypothesis of GTS involving faster motor program selection in processing conflicting SR configuration.

Influence of comorbid obsessive-compulsive symptoms on brain event-related potentials in Gilles de la Tourette syndrome.

Approximately 30 to 50% of people suffering from Gilles de la Tourette Syndrome (GTS) also fulfill diagnostic criteria for obsessive-compulsive disorder (OCD). Despite this high degree of comorbidity, very few studies have addressed the question of obsessive-compulsive symptoms (OCS) in GTS patients using specific brain event-related potentials (ERP) responses. The aim of the current study was to quantify neurocognitive aspects of comorbidity, using ERPs. Fourteen adults with GTS (without OCD) were compared to a group of 12 participants with GTS and comorbid obsessive-compulsive symptoms (GTS+OCS), to a group of 15 participants with OCD and to a group of 14 control participants without neurological or psychiatric problems. The P200 and P300 components were recorded during a visual counting oddball task. Results showed intact P200 amplitude in all groups, whilst the P300 amplitude was affected differentially across groups. The P300 oddball effect was reduced in participants in both OCD and GTS+OCS groups in the anterior region. However, the P300 oddball effect was significantly larger in participants of the GTS group compared to all other groups, mostly in the parietal region. These findings suggest that adults with GTS are characterized by enhanced working memory updating processes and that the superimposition of OCS can lead to a reduction of these processes. The discrepancy between our findings and results obtained in previous studies on GTS could reflect the modulating effect of OCS on late ERP components.

Memory and executive functions in adults with Gilles de la Tourette syndrome and chronic tic disorder.

INTRODUCTION: The main aim of the current study was to assess whether adults with either Tourette syndrome (TS) or chronic tic disorder (CTD) show a similar neuropsychological profile. Neuropsychological investigations of tic disorders have been mostly focused on children, mainly because symptoms peak during that period. Little has been carried out on adults, even if a significant proportion of the tic population experience moderate or marked levels of tic frequency throughout adulthood. Still, it is not clear whether neuropsychological performances are affected to the same degree in adults with TS and CTD. METHOD: Patients diagnosed with TS were compared with a CTD group and a control group free of psychiatric or neurological diagnosis, comparable in terms of age, gender, and intelligence. All participants completed two tests of memory (Rey-Osterreich Complex Figure, California Verbal Learning Test), one test of motor dexterity (Purdue pegboard), and four tasks of executive function (Stroop, Color Trail Test, Tower of London, Wisconsin Card Sorting Test). RESULTS: TS and CTD patients showed nonverbal memory impairments while verbal memory and executive functioning remained intact. Results also indicated that nonverbal memory performances decrease as a function of tic severity. CONCLUSION: Both TS and CTD patients present a specific nonverbal deficit whilst the executive and motor functions are relatively intact. The two tic disorder subgroups might be part of a spectrum implicating mainly nonverbal memory.