Constructive and Destructive Marital Conflict, Parenting, and Children's School and Social Adjustment.

This study addresses the links between destructive and constructive marital conflict and mothers' and fathers' parenting to understand associations with children's social and school adjustment. Multi-method, longitudinal assessments of 235 mothers, fathers, and children (129 girls) were collected across kindergarten, first, and second grades (ages 5-7 at Time 1; ages 7-9 at Time 3). Whereas constructive marital conflict was related to both mothers' and fathers' warm parenting, destructive marital conflict was only linked to fathers' use of inconsistent discipline. In turn, both mothers' and fathers' use of psychological control was related to children's school adjustment, and mothers' warmth was related to children's social adjustment. Reciprocal links between constructs were also explored, supporting associations between destructive marital conflict and mothers' and fathers' inconsistent discipline. The merit of examining marital conflict and parenting as multidimensional constructs is discussed in relation to understanding the processes and pathways within families that affect children's functioning.

Interparental discord and adolescent adjustment trajectories: the potentiating and protective role of intrapersonal attributes.

This prospective study of 360 adolescent-mother dyads examined whether associations between marital discord and trajectories of adolescent depressive symptoms and delinquency varied as a function of three intrapersonal attributes: temperament, childhood behavior problems, and perceived family support. Difficult temperament (i.e., dysrhythmicity, poor task orientation) potentiated the effects of marital discord on adolescent trajectories of adjustment, whereas heightened perceptions of family support protected adolescents from the adverse effects of marital discord. Adolescents with behavior problem histories were initially less vulnerable to marital discord; however, the high levels of depressive symptoms exhibited by adolescents with childhood behavior problems persisted over time only when they were exposed to elevated marital discord. The effects of the moderators differed in terms of duration and course.

Depression and heavy alcohol use among adolescents: concurrent and prospective relations.

This study of over 1,000 adolescents focused on common and distinctive correlates of four subgroups--no problem, depressed only, heavy drinking only, and mixed (depressed and heavy drinking). Correlates were evaluated from the domains of personal dispositions (e.g., temperament), interpersonal relations (e.g., parent and peer), stressful life events, and other problem behaviors (e.g., delinquency, substance use). The no-problem subgroup differed from the other three subgroups in the direction of healthier functioning on almost all measures. The mixed subgroup reported the most pervasive, low levels of functioning, with the highest levels of childhood externalizing problems and stressful life events, the lowest levels of family social support, and high levels of delinquency and substance use. The depressed-only subgroup reported a more internalized pattern characterized by childhood avoidance problems, a difficult temperament (e.g., inflexibility, withdrawal, low task orientation), interpersonal stressors, and poor coping strategies. The heavy-drinking-only subgroup was characterized by higher drinking levels by primary caregivers and lower levels of family cohesion as reported by primary caregivers. The 1-year prospective findings were generally consistent with the concurrent findings in that variables that were associated with transitions toward and away from depression and heavy drinking were associated with specific transitions (e.g., childhood externalizing problems were associated with the transition from no problem to heavy drinking).

Chronic inflammatory demyelinating polyneuropathy presenting with headache and papilledema.

Chronic inflammatory demyelinating polyneuropathy is a disorder typified clinically by motor and sensory neuropathy of at least 2 months' duration and pathologically by multifocal inflammatory demyelination. Its usual presentation is with features reflecting the polyneuropathy, namely limb weakness with hyporeflexia or areflexia and sensory symptoms of glove and stocking distribution. In this report, we detail the course of a 53-year-old man who presented to our neurological service with a severe headache in association with papilledema. The initial diagnosis considered was of possible primary intracranial pathology. Two months later, he developed limb weakness and sensory symptoms typical of chronic inflammatory demyelinating polyneuropathy. His headache, papilledema, and limb symptoms responded to oral corticosteroid therapy, the standard treatment for this type of neuropathy. We hypothesize that his headache and papilledema were due to the elevated cerebrospinal fluid protein level as a result of the polyneuropathy. To our knowledge, this is the first report of headache being a prominent and early symptom of this disorder.

Exploring children's emotional security as a mediator of the link between marital relations and child adjustment.

Guided by the emotional security hypothesis, this study examined whether links between marital relations and children's adjustment were mediated by children's emotional security, as evidenced by their emotional reactivity (e.g., vigilance, distress), regulation of exposure to parent affect (avoidance, involvement), and internal representations in the context of interparental relations. Multiple methods and contexts were used to assess 6- to 9-year-olds' emotional security in response to standardized, simulated conflicts involving parents. Latent variable path analysis supported a theoretical pathway whereby marital dysfunction was linked with adjustment problems as mediated by response processes indicative of emotional insecurity in relation to parental conflicts. Emotional reactivity and internal representations were most closely linked with marital relations and child adjustment, especially with regard to internalizing symptoms. The importance of understanding children's emotional security in the context of the marital subsystem is discussed.

Double-blind placebo-controlled trial of lithium in episodic cluster headache.

Lithium is widely used in the prophylaxis of episodic cluster headache without formal evidence of efficacy. Placebo-controlled clinical trials are not easy in conditions characterized by frequent severe pain. In this study, it was assumed that lithium would work quickly if at all, and placebo response would be zero. Strict diagnostic criteria excluded uncertain or atypical cases. Patients were male in so-far untreated episodes expected to last for at least 3 weeks more. In a double-blind, placebo-controlled comparison of matched parallel groups, treatment was either slow-release lithium carbonate, 800 mg/day, or placebo. After 7 days, compliance was estimated by tablet count, blood was taken for lithium assay, efficacy was assessed (attacks stopped or substantially improved) and adverse reactions were recorded. The study was stopped after planned sequential analysis of the 27th patient (13 on lithium, 14 on placebo). Estimated compliance was usually but not always good. Plasma lithium levels were mostly in the range 0.5-0.6 mmol/l on lithium, zero on placebo. Cessation of attacks within 1 week occurred in two patients in each group, substantial improvement in 6/14 (43%) on placebo, 8/13 (62%; NS) on lithium. Only minor adverse events were reported. Lithium treatment was therefore associated with a useful subjective improvement rate but the assumptions made at outset had proved wrong. The trial was stopped because superiority over placebo could not be demonstrated. There were lessons for future trials.

Gender-specific pathways between maternal depressive symptoms, family discord, and adolescent adjustment.

Relations among maternal depressive symptoms, family discord, and adolescent psychological adjustment were examined in a sample of 443 middle adolescents and their mothers. Histories of maternal depressive symptoms, gathered at 3 occasions with 6-month intervals, were related to subsequent adolescent reports of depressive symptoms, conduct problems, and academic difficulties for girls but not for boys. Mediational tests indicated that girls' greater vulnerability to family discord (e.g., marital discord, low family intimacy, parenting impairments) accounted for the impact of maternal depressive symptoms on their social and emotional adjustment. Analyses suggest that family discord is a strong mediator in the development of girls' conduct disturbances and a modest mediator of girls' depressive symptoms. Results are discussed within a framework that integrates interpersonal models of parental depressive symptoms with the gender intensification hypothesis.

Traumatic carotid and vertebral artery dissection in a professional jockey: a cautionary tale.

Jockeys accept bony fractures and soft tissue injuries as occupational hazards. An average National Hunt jockey falls once in ten races with an injury rate of 4.25%. Head injury is a common cause of morbidity and the benefit of helmets is well recognized. Neck injuries are also common and usually musculoskeletal. Although rare, trauma to the neck arteries may go unnoticed yet have catastrophic consequences. Internal tears can allow arterial blood to dissect the layers of the arterial wall and obstruct the lumen. Severe obstruction may lead to cerebral ischaemia and infarction. An appreciation of the early clinical signs caused by this process may allow effective intervention. We report a case which illustrates these points.

Marital conflict and child adjustment: an emotional security hypothesis.

An emotional security hypothesis that builds on attachment theory is proposed to account for recent empirical findings on the impact of marital conflict on children and to provide directions for future research. Children's concerns about emotional security play a role in their regulation of emotional arousal and organization and in their motivation to respond in the face of marital conflict. Over time these response processes and internalized representations of parental relations that develop have implications for children's long-term adjustment. Emotional security is seen as a product of past experiences with marital conflict and as a primary influence on future responding. The impact and interaction of other experiential histories within the family that affect children's emotional security are also examined, with a focus on parent-child relations.

Some clinical comparisons between common and classical migraine: a questionnaire-based study.

In a questionnaire-based study we compared the clinical features of migraine with aura (classical migraine) and migraine without aura (common migraine) in 354 and 397 patients, respectively, attending The Princess Margaret Migraine Clinic. Other than those related to the aura, no significant differences were seen in any clinical features of the attack (e.g. frequency or duration of attacks, time of day at onset, location of headache at onset, severity of headache, or nausea and vomiting). Common migraine attacks were significantly more likely to occur at weekends (p = 0.002). Dietary triggers tended to be more troublesome in classical migraineurs while pregnancy and the menstrual cycle affected both migraine types equally. Classical migraine patients were twice as likely to have a history of hypertension (p less than 0.05) and showed a slightly but not significantly greater tendency to depression. Family histories of migraine were similar in each migraine type. We conclude that classical and common migraine are fundamentally similar in their clinical characteristics and that the occurrence of focal neurological symptoms during a migraine attack has little influence on the rest of the attack.

Kinetics of platelet 5-hydroxytryptamine uptake in headache patients.

Platelet 5-hydroxytryptamine (5-HT) uptake was measured in asymptomatic headache patients attending a specialist migraine clinic, and in hospital staff who did not suffer from regular or severe headache. Current levels of anxiety and depression were assessed in all subjects using the Hospital Anxiety and Depression (HAD) scale and their possible influence on the uptake kinetics taken into account during the analysis of results. The Michaelis-Menten constant (Km) was significantly raised in common migraine and tension headache compared with controls (p less than 0.001 and p less than 0.01, respectively), but not in classical migraine or cluster headache. The increase remained significant after adjusting for differences in age, sex, presence of anxiety or depression (HAD sub-scale score greater than or equal to 8), drug intake during the week before testing, time elapsed since last attack and time of assay (am or pm). No differences were observed between patients and controls in the maximal rate of uptake (Vmax) or platelet count, and previous reports of a reduction in Vmax in patients experiencing attack within 5 days prior to testing could not be confirmed. The cause and significance of an increased Km are not clear, but plasma factors acting as competitive inhibitors for the uptake site or an alteration in the configuration of the uptake site are possible explanations. If confirmed, the shared biochemical abnormality may suggest that common migraine and tension headache have a common pathogenesis.

Wildervanck or cervico-oculo-acoustic syndrome and MRI findings.

In 1952, Wildervanck described the first case of what he styled the cervico-oculo-acoustic (COA) syndrome. This comprises Klippel Feil's (KF) anomaly (congenitally fused cervical vertebrae), congenital sensorineural deafness and Duane's retraction syndrome (deficient abduction with retraction on adduction). Since that original paper, there have been further reports describing this triad, either completely or incompletely. A further case of this syndrome is reported and the first report of MRI head scan findings in this condition is presented. In addition, the origin of mirror movements observed as part of the KF syndrome are discussed.

Chocolate is a migraine-provoking agent.

Patients with migraine who believed that chocolate could provoke their attacks were challenged with either chocolate or a closely matching placebo. In a double-blind parallel group study, chocolate ingestion was followed by a typical migraine episode in 5 out of 12 patients, while none of the 8 patients challenged with placebo had an attack (p = 0.051). The median time to the onset of the attack was 22 h. This brief study provides some objective evidence that chocolate is able to provoke a migraine attack in certain patients who believe themselves sensitive to it.

Platelet [3H]imipramine binding in migraine and tension headache in relation to depression.

Platelet [3H]imipramine binding was measured in 40 migrainous (7 classical and 33 common) and 17 tension headache patients and in 28 normal controls. A significant reduction in Bmax was found in migraine compared with controls (p less than 0.05) but not in tension headache. In migraine, there was no significant relationship between Bmax and depression or anxiety score on the self-rating Hospital Anxiety and Depression (HAD) Scale, suggesting that the reduction in Bmax is a concomitant of migraine itself rather than a manifestation of associated depression. Preliminary evaluation using the Schedule of Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) tended to confirm this conclusion.

Urinary output of endogenous monoamine oxidase inhibitor and isatin during acute migraine attacks.

Urinary output of endogenous monoamine oxidase (MAO) inhibitory activity, was significantly raised in serial samples collected across a migraine attack compared with collections during attack-free periods and in healthy controls, which did not differ from each other. There was a highly significant correlation in output between isatin, a major fraction of the MAO inhibitory activity, and output of the MAO inhibitory activity itself. However, although there was a tendency towards increased isatin excretion during migraine attacks, it failed to reach statistical significance.