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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes algorithms that can identify patterns of brain structure and function associated with Alzheimer's disease, schizophrenia, normal aging, and abnormal brain development based on imaging data collected in large human populations. Extraordinary information can be discovered with these techniques: dynamic brain maps reveal how the brain grows in childhood, how it changes in disease, and how it responds to medication. Genetic brain maps can reveal genetic influences on brain structure, shedding light on the nature-nurture debate, and the mechanisms underlying inherited neurobehavioral disorders. Recently, we created time-lapse movies of brain structure for a variety of diseases. These identify complex, shifting patterns of brain structural deficits, revealing where, and at what rate, the path of brain deterioration in illness deviates from normal. Statistical criteria can then identify situations in which these changes are abnormally accelerated, or when medication or other interventions slow them. In this paper, we focus on describing our approaches to map structural changes in the cortex. These methods have already been used to reveal the profile of brain anomalies in studies of dementia, epilepsy, depression, childhood- and adult-onset schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, fetal alcohol syndrome, Tourette syndrome, Williams syndrome, and in methamphetamine abusers. Specifically, we describe an image analysis pipeline known as cortical pattern matching that helps compare and pool cortical data over time and across subjects. Statistics are then defined to identify brain structural differences between groups, including localized alterations in cortical thickness, gray matter density (GMD), and asymmetries in cortical organization. Subtle features, not seen in individual brain scans, often emerge when population-based brain data are averaged in this way. Illustrative examples are presented to show the profound effects of development and various diseases on the human cortex. Dynamically spreading waves of gray matter loss are tracked in dementia and schizophrenia, and these sequences are related to normally occurring changes in healthy subjects of various ages.
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PMID:Mapping cortical change in Alzheimer's disease, brain development, and schizophrenia. 1550 Oct 91

This study examined the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS; Scahill et al., 1997). Participants were 82 children and adolescents diagnosed with obsessive-compulsive disorder (OCD). Confirmatory factor analyses of 2 previously found models (Obsessions and Compulsions; Disturbance and Severity) yielded poor fit indexes. Exploratory factor analysis supported a model of severity and disturbance with slightly different item content than found by McKay et al. (2003). The internal consistency of the factors was acceptable, and the convergent and divergent validity was supported vis-a-vis correlations with clinician ratings of impairment, self-report measures of depression and anxiety, and parent ratings of Tourette's disorder (TD) symptoms. These findings suggest that the CY-BOCS Total Score may represent an inaccurate assessment of symptom severity and supports the use of the revised Severity and Disturbance factors in assessing illness severity.
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PMID:Factor analytic study of the Children's Yale-Brown Obsessive-Compulsive Scale. 1590 Dec 31

Transdermal nicotine patches have been successfully introduced as a safe and powerful aid to smoking cessation; this has contributed to the rising interest in additional therapeutic applications for nicotine and synthetic nicotinic agonists. Nicotine and nicotinic agonists may have a therapeutic potential for a variety of disorders, including Alzheimer's and Parkinson's diseases, depression, attention deficit disorder, Tourette's syndrome and ulcerative colitis. These interests are partially fuelled by the urgent need of the tobacco industry to find new niches for nicotine in a world bound eventually to retire from cigarette smoking. At the same time, there is an increased interest in developing drugs for fighting obesity, a growing affliction of industrialised nations. This review presents data on the potential of nicotine, and in particular synthetic nicotinic agonists, for controlling body weight. Nicotinic agonists may become relatively safe, effective and inexpensive alternatives for several optional drugs currently being developed for treating human obesity, including beta-3-adrenergic agonists, leptin and its agonists, and neuropeptide Y antagonists.
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PMID:The therapeutic potential of nicotine and nicotinic agonists for weight control. 1599 28

This paper provides a review of safety and efficacy data as well as of pharmacological characteristics of atomoxetine, a new drug treatment for the Attention Deficit/Hyperactivity Disorder (ADHD). To date, the only pharmacological treatment available in France for children and adolescents diagnosed with ADHD is methylphenidate, a psychostimulant drug. However, the clinical response to methylphenidate may be absent or insufficient in about 20-30% drug-treated children while the occurrence of adverse effects with methylphenidate (sleep disturbances, loss of appetite, tics increase...) may sometimes require a dose reduction or even the discontinuation of the treatment. Atomoxetine is an alternative candidate drug for the treatment of ADHD. The drug has been developed with respect to the actual standards of investigation of drugs intended to a -pediatric use. Atomoxetine has been recently licensed in the USA for the treatment of ADHD. Atomoxetine is a potent inhibitor of the norepinephrine transporter that shows only mini-mal affinity for other neurotransmitter systems. Although pharmacokinetics of atomoxetine is influenced by the polymorphism of the CYP2D6 metabolic pathway, safety and -tolerability data reported during clinical trials did not show any difference in poor versus extensive metabolizers. In addition, atomoxetine does not inhibit nor induce the CYP2D6 enzymatic function. The major metabolite of atomoxetine is 4-hydroxyatomoxetine, a pharmacologically active metabolic found in very low plasma concentrations in pediatric patients, suggesting that it plays only a minor role in the norepinephrine reuptake inhibition. Preliminary studies were aimed to assess the effective dose range of atomoxetine and to evaluate its safety and efficacy on the reduction of ADHD symptoms in adults and children diagnosed with ADHD. Main data on the child and adolescent population were obtained in four double-blind, randomized, placebo-controlled trials: two identical pivotal trials, a multiple dose study, a once-daily dose study. The first two pivotal trials were carried out in ADHD children aged 7-13 years, treated with atomoxetine vs placebo for a duration of 9 weeks. Patients presenting comorbidities (ie conduct disorder, -anxiety, depression) as well as a history of previous treatment with methylphenidate were also eligible to participate. The primary outcome was the reduction of the score on the ADHD rating scale, ADHD-RS ; secondary criteria included the responder's rate (patients with an ADHD-RS score reduction of 25% or above), the Clinical Global Impression Scale and the Conners Parent Rating Scale. With a mean dose of 1.5 mg/kg/day, atomoxetine showed a significant reduction of mean ADHD-RS scores at endpoint (ANOVA, p<0.001) (table II). Yet, the clinical significance of both studies is limited since efficacy was scored only in a social/familial setting and not in classroom conditions. In addition, intermediate results from baseline to endpoint were not presented in the publication. The multiple dose trial showed a significant reduction of the symptom score at the 1.2 and 1.8 mg/kg/day doses. The objective of the last study was to assess the efficacy of a single daily dose of atomoxetine versus placebo during a 6 week-treatment. Patients were evaluated by parents, investigators, as well as by teachers. The superiority of atomoxetine was demonstrated as compared to the placebo and the effect size of the daily dosing was similar to that reported with multiple doses. Preliminary data on ADHD patients presenting comorbidities showed that atomoxetine alone signi-ficantly reduced the symptom scores of anxiety and depression and similarly to atomoxetine associated with fluoxetine. In ADHD children with the oppositional defiant disorder, oppositional symptoms were reduced in the group receiving atomoxetine 1.8 mg/kg/day. Preliminary results in children with ADHD and chronic tics or Tourette syndrome showed a significant reduction of ADHD symptoms and a tendency to the decrease of tics. Tolerance and safety data pooled from the child and adolescent trials were acceptable. Study discontinuations due to adverse events in the four registration studies were only 2.8%. The most frequent adverse effects reported were gastrointestinal symptoms and decreased appetite. Weight loss reported early in clinical studies tended to stabilize during the open-label extension phases lasting up to 9 months. A retrospective comparison showed that the adverse event profile of poor metabolizers was similar to that of extensive metabolizers. In summary, data presented suggest that atomoxetine is a safe and effective drug for the treatment of ADHD in children and adolescents. Further studies are expected to accurately define the place of atomoxetine in the treatment strategy of ADHD, a chronic and invalidating disorder affecting 3 to 7% of school-aged children.
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PMID:[Atomoxetine: a new treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents]. 1614 49

Individuals who exhibit motor and vocal tics are viewed as less socially acceptable than persons who do not exhibit tics. Efforts have been made to alter the negative perceptions through the use of education. However, the effectiveness of peer education and whether it need be Tourette syndrome (TS) specific remains unclear. One hundred and seventy college students were randomly assigned to view either an educational video about TS, a video about depression, or no educational video, before providing attitudinal and behavioral data on social acceptance of either an actor or actress engaging in motor and vocal tics. Those viewing the TS-specific educational video held more positive attitudes toward persons with tics than those receiving the other two interventions; however, the effect on social behavior intentions and actual social behavior was unclear. Implications of these findings and directions for future research are discussed.
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PMID:Controlled evaluation of an educational intervention used to modify peer attitudes and behavior toward persons with Tourette's Syndrome. 1620 22

Although motor tics and/or vocal tics are the defining features of chronic tic disorder (CTD) and Tourette syndrome (TS), older youths and adults often report their tics to be preceded by an unpleasant sensation or "premonitory urge." While premonitory urge phenomena may play an important role in behavioral interventions for CTD/TS, standardized assessments for premonitory urges do not exist. The current study of 42 youths with TS or CTD presents initial psychometric data for a new, brief self-report scale designed to measure tic-related premonitory urges. Results showed that the Premonitory Urge for Tics Scale (PUTS) was internally consistent (alpha = .81) and temporally stable at 1 (r = 0.79, p < .01) and 2 (r = 0.86, p < .01) weeks. PUTS scores were also correlated with overall tic severity as measured by the Yale Global Tic Severity Scale (YGTSS; r = 0.31, p < .05) and the YGTSS number (r = 0.35, p < .05), complexity (r = 0.49, p < .01), and interference (r = 0.36, p < .05) subscales. Finally, an examination of the psychiatric correlates of the premonitory urge phenomenon yielded significant correlations between the PUTS and the Child Behavior Checklist (CBCL) anxiety/depression (r = 0.33, p < .05), and withdrawal (r = 0.38, p < .05) subscales as well as the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS; r = 0.31, p < .05). However, a cross-sectional examination of the data showed that the psychometric properties of the PUTS were not acceptable for youths 10 years of age and younger. Likewise, significant correlations found between the YGTSS subscales, CBCL subscales, CYBOCS, and the PUTS did not emerge in this younger age group. The clinical and theoretical implications of these findings are discussed.
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PMID:Premonitory Urge for Tics Scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. 1634 54

To investigate the reliability and validity of the Yale Global Tic Severity Scale (YGTSS), 28 youth aged 6 to 17 years with Tourette's syndrome (TS) participated in the study. Data included clinician reports of tics and obsessive-compulsive disorder (OCD) severity, parent reports of tics, internalizing and externalizing problems, and child reports of depression and anxiety. All children participated in a 2nd YGTSS administration by the same rater 48 days later. Good internal consistency and stability were found for the YGTSS scores. YGTSS scores demonstrated strong correlations with parent-rated tic severity (r = .58-.68). YGTSS scores were not significantly related to measures of clinician ratings of OCD severity (r = .01-.15), parent ratings of externalizing and internalizing behavior (r = -.07-.20), and child ratings of depression (r = .02-.26) and anxiety (r = -.06 -.28). Findings suggest that the YGTSS is a reliable and valid instrument for the assessment of pediatric TS.
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PMID:Reliability and validity of the Yale Global Tic Severity Scale. 1639 16

This study determined the prevalence of and factors associated with comorbid major depressive disorder (MDD) in patients with Gilles de la Tourette syndrome (GTS). How a simple self-report instrument, the Beck Depression Inventory (BDI), correlates with clinical assessment of comorbid MDD in this population was assessed. In a continuous sample of 114 adult patients with GTS, assessed clinically using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria, 26 (23%) patients met criteria for MDD; more severe tics as measured with the Yale Global Tic Severity Scale, conduct disorder in childhood or higher age at the time of assessment were associated with MDD. The BDI score had a high negative predictive value for diagnosis of MDD, but a low positive predictive value. Using the BDI as a screening tool for comorbid MDD in patients with GTS is suggested.
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PMID:Beck Depression Inventory is a useful screening tool for major depressive disorder in Gilles de la Tourette syndrome. 1650 Sep 43

Over the past two decades, deep brain stimulation (DBS) has supplanted lesioning techniques for the treatment of movement disorders, and has been shown to be safe and efficacious. The primary therapeutic indications for DBS are essential tremor, dystonia and Parkinson's disease. In the case of Parkinson's disease, DBS is effective for treating the primary symptoms--tremor, bradykinesia and rigidity--as well as the motor complications of drug treatment. Progress has been made in understanding the effects of stimulation at the neuronal level, and this knowledge should eventually improve the effectiveness of this therapy. Preliminary studies also indicate that DBS might be used to treat Tourette's syndrome, obsessive-compulsive disorder, depression and epilepsy. As we will discuss in this review, the success of DBS depends on an appropriate rationale for the procedure, and on collaborations between neurologists and neurosurgeons in defining outcomes.
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PMID:Surgery insight: Deep brain stimulation for movement disorders. 1693 75

Gilles de la Tourette's syndrome (GTS) consists of multiple motor tics and one or more phonic tics. Psychopathology occurs in approximately 90% of GTS patients, with attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) being common. Depression is common, with a lifetime risk of 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of GTS patients attending specialist clinics, respectively. In controlled studies embracing over 700 GTS patients, the patients were significantly more depressed than controls in all but one instance. In community and epidemiological studies, depression in GTS individuals was evident in two of five investigations. Clinical correlates of depression in people with GTS appear to be: tic severity and duration, the presence of echophenomena and coprophenomena, premonitory sensations, sleep disturbances, obsessive-compulsive behaviors/OCD, self-injurious behaviors, aggression, conduct disorder (CD) in childhood, and, possibly, ADHD. Depression in people with GTS has been shown to result in a lower quality of life, potentially leading to hospitalization and suicide. The etiology of depression appears to be multifactorial. Bipolar affective disorder (BAD) and GTS may be related in some individuals. However, it is noted that sample sizes in most of these studies were small, and it is unclear at the present time as to why BAD may be overrepresented among GTS patients.
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PMID:Mood disorders and Gilles de la Tourette's syndrome: An update on prevalence, etiology, comorbidity, clinical associations, and implications. 1693 13


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