Recognition and treatment of Asperger syndrome in the community.

SOURCES OF DATA: We conducted a systematic review of the current literature for this review, but as there are many gaps in the research literature, we have supplemented this by our own clinical experience. AREAS OF AGREEMENT: There is a general agreement that Asperger syndrome (AS) is one of the autistic spectrum disorders, that it is a developmental disorder which is either present at birth or develops shortly after and that there is a strong hereditary component. AREAS OF CONTROVERSY: The fundamental impairment of AS is in the social arena, but what causes this is disputed. We propose that it is a disorder of non-verbal communication. Another important area of controversy is the extent to which AS may remit. GROWING POINTS: Many people with AS develop secondary psychiatric disorders in adolescence and adulthood, some of which may be linked genetically, notably bipolar disorder [DeLong R, Nohria C (1994) Psychiatric family history and neurological disease in autistic spectrum disorders. Dev Med Child Neurol, 36, 441-448] or be explicable by some other association, but many patients and carers attribute their anxiety and low mood to bullying. The prevalence, treatment and prevention of co-morbid mental health problems are rapidly developing areas of interest. Some people with AS are known to commit offences, and when they commit they are more likely to be violent offences against strangers. How much of a risk that is presented by people with AS, and how to assess this risk, is another growing area of concern. AREAS TIMELY FOR DEVELOPING RESEARCH: The social impairments of people with AS include deficits in empathy, self-awareness and executive function. Many of these are quintessentially human characteristics, and the study of people with AS provides opportunities for using neuroimaging to compare people with AS and controls and identify which areas of the brain are concerned with these 'higher functions'. The study of AS, like that of other fronto-striatal disorders, is also throwing light on the role of networks in the brain and on how networks are formed during embryogenesis.

QTc-interval abnormalities in a forensic population.

BACKGROUND: Antipsychotic drugs have been linked to sudden death among psychiatric patients, with a suggestion that prolongation of the QT-interval detectable on a standard electrocardiogram may be linked to fatal cardiac arrhythmias in these circumstances. Patients in secure forensic psychiatric facilities may be particularly likely to be on high-dose antipsychotic medication, and yet, as far as the authors are aware, no study of QT-intervals among such patients has been reported. AIM: To investigate the prevalence of QT-interval abnormalities and associated known risk factors for fatal cardiac arrhythmias in a sample of forensic patients. METHOD: Participants had a 12-lead electrocardiogram taken at 50 mm/s. Information was collected on their age, gender, psychiatric diagnosis, history of cardiovascular, liver and kidney diseases, and smoking, on all medications and on history of seclusion over the previous 12 months. Analysis was carried out using binary logistic regression. RESULTS: Lower rates of QT-interval abnormalities than might be expected for this population were found. It was also found that a high dose of antipsychotics was associated with QTc prolongation (Adjusted OR = 9.5, 95% CI 2.6-34.2), a result consistent with previous literature. CONCLUSION: Forensic patients need not be at increased risk of QTc abnormality provided risk factors are properly managed. A high dose of antipsychotic medication increases the risk of QTc prolongation.

Response of pyromania to biological treatment in a homeless person.

Pyromania has been associated with abnormalities of impulsivity, social estrangement, cognitive flexibility, and executive function. We aim to investigate whether psychopharmacological interventions increase cognitive test performance and decrease frequency of serious clinical incidents during inpatient admission for pyromania. This is a case study of a 20-year-old homeless male who met DSM-IV criteria for pyromania. Neuropsychological testing was administered on psychiatric admission and repeated 5-months later following psychopharmacological treatment with olanzapine and sodium valproate. Baseline neuropsychological assessment revealed impairments in attention, verbal/visual memory, and executive functions, whereas visuospatial skills were intact. Five-month follow-up neuropsychological assessment showed substantial improvement on cognitive tests, while visuospatial skills remained within the normal range. A decrease in frequency of serious clinical incidents occurred during the course of inpatient admission. Fire-setting behavior abated. Psychopharmacological treatment may have facilitated improvement in cognitive test performance, social-adaptive functioning, and decreased aggressive behavior. It might have a more specific role in the treatment of mental disorders characterized by impulsive dangerousness.