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1.
BMC Neurol ; 20(1): 44, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013931

RESUMO

BACKGROUND: Autoimmune encephalitis is characterized by neuropsychiatric symptoms associated with brain inflammation. The differential is usually broad and Psychiatry often collaborates with Neurology in diagnostic clarification and symptom management. At least 40% of neuroencephalitis cases are of unknown etiology which adds to difficulties in making the right diagnosis and deciding on the appropriate treatment (Granerod et al., Lancet Infect Dis 10:835-44, 2010). The aim of this case series was to present four cases with complicated psychiatric symptomatology and isolated neurologic signs and symptoms, evaluated at a large tertiary medical center and treated for suspected autoimmune encephalitis, demonstrating the complexity of diagnosis and treatment. CASE PRESENTATION: Four diagnostically challenging and heterogeneous cases displayed clinical symptomatology suggestive of autoimmune encephalitis. All cases presented with neurologic and psychiatric symptoms, but had negative autoantibody panels, normal or inconclusive magnetic resonance imaging results and non-specific cerebrospinal fluid changes. All were challenged with immunosuppressive/immunomodulatory treatments with overall poor response rates. CONCLUSIONS: There is a heterogeneous presentation of autoimmune encephalitis in pediatric populations. In the absence of positive findings on testing, individuals who do not meet proposed criteria for seronegative encephalitis may be misdiagnosed, and/or may not respond adequately to treatment. In those cases, comprehensive evaluation and stringent application of consensus guidelines is necessary.

2.
Front Psychiatry ; 10: 677, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31620029

RESUMO

As many as one in four preschool-aged children are estimated to struggle with psychosocial stress and social-emotional issues; yet, interventions are often postponed until older ages when change is actually more difficult. Reasons for this include limited interventions, paucity of FDA approved medications for young children, as well as the dearth of clinicians adequately trained in psychotherapeutic approaches for young children. This commentary outlines indications of the four most commonly used evidence-based dyadic psychotherapies for young children: Child-Parent Psychotherapy (CPP) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), used primarily for young children with trauma, and Parent-Child Interaction Therapy (PCIT) and Child Parent Relationship Therapy (CPRT), used mostly for children with behavioral issues. Rooted in attachment theory and further supported by the premise that the quality of the child-caregiver dyad is paramount to psychological wellbeing, these therapies focus on strengthening this relationship. Literature indicates that insecure or disorganized early attachments adversely affect an individual's lifelong trajectory. These therapies have demonstrated efficacy leading to positive behavioral changes and improved parent-child interactions. The major challenges of clinical practice focused on young children and their families include proper diagnosis and determining the best therapeutic strategy, especially for families who have not benefited from prior interventions. At this time, it is still unclear which therapy is best indicated for which type of patients and it mostly has been driven by convenience and provider preference or training. Further research is required to tailor treatments more successfully to the child's needs.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31424700

RESUMO

Background: Opioid use is a significant national crisis impacting individuals struggling with addiction and their families. The majority of individuals who abuse opioids are of child-rearing age, and critical knowledge gaps remain regarding how this abuse impacts their offspring. Fortunately, treatment for opioid use disorders is available. The primary goal of this study was to evaluate both physical and psychiatric diagnoses of children who have at least 1 parent participating in a buprenorphine-assisted treatment program. Methods: This retrospective study is based on chart review (January 1, 2010, through June 30, 2018). Children with parents receiving care in a buprenorphine clinic were identified and matched on sex, race, and age in a ratio of 1:5 with controls from the general pediatric clinic population. Data related to health outcomes were extracted from the medical records. Results: Compared to controls (n = 120), children of parents receiving buprenorphine-assisted treatment (n = 24) were more likely to have been born premature (odds ratio [OR] = 3.3, P = .035), had jaundice after birth (OR = 2.7, P = .034), had enuresis/encopresis (P < .001), and had been the victims of abuse or neglect (OR = 19.7, P = .0005). Children of parents with opioid use disorders were also more likely to utilize emergency services (ie, being seen in the emergency department for fussiness; OR = 4.0, P = .046) and were less likely to be covered by private insurance compared to state-funded insurance (OR = 0.2, P = .0013). Conclusions: Parental opioid use disorder impacts children. More research is needed to better describe long-term effects of treatment of parental opioid use on their offspring and to help design addiction treatment programs to support whole family units.

4.
Artigo em Inglês | MEDLINE | ID: mdl-30651753

RESUMO

Background: Between 2009 and 2014, nearly 3% of US children (age ≤ 17 years) lived in households with at least 1 parent with substance use disorder. The present systematic review aimed to evaluate effects of parental opioid use disorder on the parent-child relationship and child developmental and behavioral outcomes. Methods: Several databases were comprehensively searched for studies published from January 1980 through February 2018 that reviewed effects of parental opioid addiction on parent-child relationships and outcomes of children (age, 0-16 years). Results: Of 304 unique studies, 12 evaluated effects of parental opioid addiction on the parent-child relationship as the primary outcome and on children's outcomes, including behaviors and development. Observation of mother-child interaction showed that mothers with opioid use disorders are more irritable, ambivalent, and disinterested while showing greater difficulty interpreting children's cues compared with the control group. Children of parents with opioid use disorders showed greater disorganized attachment; they were less likely to seek contact and more avoidant than children in the control group. The children also had increased risk of emotional and behavioral issues, poor academic performance, and poor social skills. Younger children had increased risk of abuse or neglect, or both, that later in life may lead to such difficulties as unemployment, legal issues, and substance abuse. Conclusions: Current evidence shows association between parental opioid addiction and poorer mother-child attachment and suboptimal child developmental and behavioral outcomes. Further research and treatment targeting children and families with parental opioid use are needed to prevent difficulties later in life.

5.
Psychiatry Res Neuroimaging ; 279: 60-63, 2018 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-29886088

RESUMO

Connectivity features based on resting-state (RS) functional magnetic resonance imaging (fMRI) demonstrate great promise as biomarkers to guide diagnosis and treatment in major depressive disorder (MDD). However, there is a pressing need for valid, reliable biomarkers closer to the bedside for clinical research and practice. This study directly compared RS-fMRI connectivity features with transcranial magnetic stimulation (TMS) neurophysiological measures, long interval cortical inhibition (LICI) and cortical silent period (CSP), in female adolescents with MDD. LICI-200 showed the most significant associations with RS functional connectivity features, demonstrating its potential to evaluate the neurochemical underpinnings of network features in MDD.


Assuntos
Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/metabolismo , Imagem por Ressonância Magnética/métodos , Descanso/fisiologia , Ácido gama-Aminobutírico/metabolismo , Adolescente , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Projetos Piloto , Descanso/psicologia , Estimulação Magnética Transcraniana/métodos
6.
J Clin Psychiatry ; 78(9): e1276-e1283, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29188907

RESUMO

OBJECTIVE: The aim of this study was to examine the pattern of psychopharmacologic interventions in a psychiatrically referred sample of youth with autism spectrum disorder (ASD). METHODS: This retrospective chart review aimed at collecting demographic and clinical information, including data on DSM-IV-TR criteria-based psychiatric disorders and related current medication treatment and response. Data were collected in December 2011. Clinicians identified the target disorder for each medication and any adverse events. Level of psychopathology and therapeutic response was assessed by the clinician-rated Clinical Global Impressions scale (CGI). RESULTS: Psychiatrically referred youth with ASD (n = 54) suffered from multiple psychopathologies (mean = 2.3) and had a marked level of morbidity (range of baseline CGI-Severity of Illness mean scores, 4.3-5.6). The most prevalent psychopathology was ADHD (83%), anxiety disorders (67%), bipolar spectrum disorder (43%), and mood disorder not otherwise specified (44%). The majority (80%) of the subjects received combination therapy (mean ± SD number of psychotropic medications = 3 ± 1.5). Forty percent of the participants responded on all treatment target symptoms (CGI-Improvement scale score ≤ 2), and an additional 10% experienced response versus nonresponse on a relatively greater number of target symptoms. Half of the subjects reported an adverse event, most commonly weight gain (28%) and sedation (12%), both from antipsychotic medication use. CONCLUSIONS: Psychiatrically referred youth with ASD suffer from multiple highly impairing psychiatric disorders that require combination pharmacotherapy. These findings highlight the need for further research to guide clinical decision-making and treatment.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adolescente , Transtorno do Espectro Autista/complicações , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto Jovem
7.
J Dev Behav Pediatr ; 38 Suppl 1: S76-S78, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28141729

RESUMO

CASE: Susan was a 9-year-old girl living with her mother; she had never met her father. Her mother returned one evening from her job as a cocktail waitress and Susan met her at the apartment door to let her know they had run out of cat food. Her mother said she would go and buy some the next morning because it was late and she was tired, but Susan insisted she go out that evening because the cat had not eaten all day. Her mother was fatally shot in the parking lot of the convenience store shortly thereafter; since there was no robbery involved, the police suspected it was someone that she knew. Susan's extended family had her move out of the apartment that evening and relocate to live with her aunt and uncle out-of-state. The transition happened quickly. Susan was unable to return to her apartment to pick up any additional belongings and never returned to say goodbye to her friends. The family decided she was too young to attend the funeral.Susan had trouble fitting in with her aunt and uncle's family; they had 2 children who were 8 and 6 years old, and Susan felt she was being treated like a baby. She resented having a bedtime (her mother allowed her to stay up as late as she wished), and she complained that the work at school was boring and her classmates were childish. When the family went to a festival in town, she left abruptly without telling them, which frightened Susan's aunt and uncle. They wanted to be supportive but felt that she needed more structure than her mother had provided her. Susan's aunt and uncle sought bereavement support for Susan from her pediatrician and parenting advice for themselves.


Assuntos
Comportamento Infantil/psicologia , Relações Familiares/psicologia , Homicídio/psicologia , Morte Parental/psicologia , Criança , Feminino , Humanos , Mães
8.
J Dev Behav Pediatr ; 37(2): 172-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26760376

RESUMO

CASE: Susan was a 9-year-old girl living with her mother; she had never met her father. Her mother returned one evening from her job as a cocktail waitress and Susan met her at the apartment door to let her know they had run out of cat food. Her mother said she would go and buy some the next morning because it was late and she was tired, but Susan insisted she go out that evening because the cat had not eaten all day. Her mother was fatally shot in the parking lot of the convenience store shortly thereafter; since there was no robbery involved, the police suspected it was someone that she knew. Susan's extended family had her move out of the apartment that evening and relocate to live with her aunt and uncle out-of-state. The transition happened quickly. Susan was unable to return to her apartment to pick up any additional belongings and never returned to say goodbye to her friends. The family decided she was too young to attend the funeral. Susan had trouble fitting in with her aunt and uncle's family; they had 2 children who were 8 and 6 years old, and Susan felt she was being treated like a baby. She resented having a bedtime (her mother allowed her to stay up as late as she wished), and she complained that the work at school was boring and her classmates were childish. When the family went to a festival in town, she left abruptly without telling them, which frightened Susan's aunt and uncle. They wanted to be supportive but felt that she needed more structure than her mother had provided her. Susan's aunt and uncle sought bereavement support for Susan from her pediatrician and parenting advice for themselves.


Assuntos
Homicídio/psicologia , Criança , Feminino , Rituais Fúnebres/psicologia , Culpa , Humanos , Relações Mãe-Filho , Pais/psicologia , Psicologia da Criança
9.
Gen Hosp Psychiatry ; 35(4): 423-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23597876

RESUMO

OBJECTIVE: To describe a medical center's 12-year experience with medically or surgically hospitalized suicide attempters, with the goal of extending the limited literature on this sentinel event. PATIENTS AND METHODS: Eight Mayo Clinic Rochester patients' self-inflicting injuries serious enough to trigger mandatory reporting while hospitalized on a medical/surgical unit from January 1, 1998 to December 31, 2010 were matched with four same-sex and same-age controls, admitted to the same unit within 2 months. Cases were identified from Sentinel Event Tracking System and Minnesota Adverse Events Statute records. Data were analyzed with conditional logistic regression. RESULTS: Eight of 777,404 medical/surgical inpatients admitted during 12 years attempted suicide, with significantly more non-Caucasian patients among cases than controls (P=.020). Of 8 attempts, 1 was fatal. More cases than controls had undergone inpatient psychiatric evaluation prior to attempt (P=.020), and elevated risk of attempt was significantly associated with increased number of prior attempts (0.049). Near their attempts, each attempter had an identifiable stressor including inadequately controlled pain in 3, agitation and anxiety in 2 each, and acute delirium, insomnia and psychosocial difficulties in 1 each. CONCLUSION: First, this study's findings underscore the rarity of reported inpatient medical/surgical suicidal behavior. In this sample, suicide attempters were distinct from nonattempters by the increased likelihood of prior suicide attempts as well as inpatient psychiatric consultations before their attempts. When patients have these characteristics, medical teams should take particular notice and initiate heightened watchfulness for suicidal behavior.


Assuntos
Pacientes Internados/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Ansiedade/complicações , Estudos de Casos e Controles , Delírio/complicações , Unidades Hospitalares , Tempo de Internação , Modelos Logísticos , Dor/complicações , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Comportamento Autodestrutivo/complicações
10.
J AAPOS ; 15(4): 356-61, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21907119

RESUMO

PURPOSE: Hereditary hyperferritinemia cataract syndrome (HHCS), an autosomal-dominant disorder characterized by hyperferritinemia and bilateral cataracts, is caused by mutations in the iron-responsive element of the ferritin light chain (FTL) gene. The purpose of this study is to describe the genotypic and phenotypic manifestations of HHCS observed in 2 large sets of unrelated American families. METHODS: Forty-five patients were recruited from 2 unrelated families. Each underwent ophthalmological and general physical evaluation as well as laboratory testing of serum ferritin, iron, transferrin saturation, and total iron binding capacity. Serum DNA was evaluated for mutations by DNA amplification and sequencing of the FTL gene. RESULTS: Numerous cortical and nuclear white opacities in a stellate pattern occurred in 22 affected individuals and were the only clinical manifestation of HHCS. Of the 22, 16 (73%) demonstrated >1.00 D of astigmatism. Genetic analysis revealed mutation G32A in Pedigree 1 and mutation G32T in Pedigree 2, both heterozygous and located in the iron-responsive element of the ferritin light chain mRNA. Serum ferritin levels of affected subjects ranged from 555 to 2,453 µg/L (normal range, 24-336 µg/L male, 11-307 µg/L female), with greater ferritin levels and more severe cataracts associated with mutation G32A. CONCLUSIONS: Most clinical and genetic findings from these families are consistent with previous reports of HHCS. Astigmatism, previously not associated with HHCS, was present in the majority. Ferritin levels and age of cataract surgery varied among subjects with both FTL gene mutations, suggesting that phenotypic variability is modulated by other genetic or environmental factors.


Assuntos
Apoferritinas/genética , Astigmatismo/genética , Astigmatismo/patologia , Catarata/congênito , Distúrbios do Metabolismo do Ferro/congênito , Mutação Puntual , Adolescente , Adulto , Idade de Início , Idoso , Catarata/genética , Catarata/patologia , Criança , Saúde da Família , Feminino , Genótipo , Humanos , Distúrbios do Metabolismo do Ferro/genética , Distúrbios do Metabolismo do Ferro/patologia , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Estados Unidos , Adulto Jovem
11.
J AAPOS ; 14(5): 417-20, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21035068

RESUMO

OBJECTIVE: To report the prevalence, clinical findings, and outcomes in children diagnosed with congenital dacryocystocele in a well-defined population during a 20-year period. METHODS: The medical records of all Olmsted County, Minnesota, patients diagnosed with congenital dacryocystocele from January 1, 1988, through December 31, 2007, were retrospectively reviewed. RESULTS: A total of 9 children were diagnosed with dacryocystocele during the 20-year period, yielding a birth prevalence of 1 in 3,884 live births. The median age at diagnosis was 12 days (range, birth to 40 days); 7 (78%) were female. Eight patients (89%) had unilateral disease. Clinical findings included a cystic mass in all 9, dacryocystitis in 3 (33%), intranasal cysts in 3 (33%), and 1 (11%) each with facial cellulitis and dacryocystocele-induced astigmatism. Conservative treatment resolved the obstruction in 3 (33%), whereas the remaining 6 (67%) each underwent one surgery. Complete resolution was observed in all 9 patients. CONCLUSIONS: Congenital dacryocystocele is an uncommon unilateral condition of predominantly neonatal females. Clinical findings support a relatively high incidence of complications such as dacryocystitis and intranasal cysts as well as a less common finding of astigmatism that resolved without evidence of amblyopia. One-third of the cases were successfully managed with conservative treatment alone; most patients required surgical intervention.


Assuntos
Cistos/epidemiologia , Dacriocistite/epidemiologia , Doenças do Aparelho Lacrimal/epidemiologia , Ducto Nasolacrimal/anormalidades , Celulite Orbitária/epidemiologia , Astigmatismo/congênito , Astigmatismo/epidemiologia , Astigmatismo/cirurgia , Cistos/congênito , Cistos/cirurgia , Dacriocistite/congênito , Dacriocistite/cirurgia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Aparelho Lacrimal/congênito , Doenças do Aparelho Lacrimal/cirurgia , Masculino , Minnesota/epidemiologia , Celulite Orbitária/congênito , Celulite Orbitária/cirurgia , Prevalência , Estudos Retrospectivos
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