Pathways to (specialized) care: patient costs and contacts en route to a first-episode psychosis clinic.

AIM: To estimate the public health costs of specific help-seeking pathways into an early intervention psychosis clinic. METHODS: The sequence of police, emergency and mental health contacts utilized by 50 patients up to 1 year prior to admission was characterized using chart reviews and structured interviews. Cost estimates for contacts were obtained from provincial health/public service cost reports. RESULTS: A high-cost inpatient pathway and a low-cost outpatient pathway were identified, with the former exceeding the latter by a factor of 18.5 in cost. This discrepancy was attributable to both the high cost of inpatient services and the long duration of inpatient admissions, as well as more frequent inpatient use of high-cost urgent services (e.g. police, emergency services). CONCLUSION: Given the substantial cost differential between inpatient and outpatient routes, additional clarification of modifiable factors that determine pathways to care could have significant implications to health service delivery costs for this population.

Scaling the primate lateral geniculate nucleus: niche and neurodevelopment in the regulation of magnocellular and parvocellular cell number and nucleus volume.

New stereological assessments of lateral geniculate nucleus (LGN) neuron numbers and volumes in five New World primates (Cebus apella, Saguinus midas niger, Alouatta caraya, Aotus azarae, and Callicebus moloch) and compiled LGN volumes for an additional 26 mammals were analyzed for a better understanding of visual system evolution. Both the magnocellular (M)- and the parvocellular (P)-cell populations scale allometrically with brain volume in primates, P cells with a significantly higher slope such that, for every increase in M neuron number, P neuron numbers more than double (ln scale; y = 0.89x + 2.42R(2) = 0.664). In diurnal primates, the ratio of P to M cells was slightly but significantly higher than in nocturnal primates. For all mammals, including primates, LGN volume was unrelated to nocturnal or diurnal niche but showed marked differences in slope and intercept depending on taxonomic group. The allometric scaling of M and P cells can be related to the order of neurogenesis, with late-generated P cells increasing with positive allometry compared with the earlier-generated M cells. This developmental regularity links relative foveal representation to relative isocortex enlargement, which is also generated late. The small increase in the P/M cell ratio in diurnal primates may result from increased developmental neuron loss in the M-cell population as it competes for limited termination zones in primary visual cortex.

Increased sensitivity to perceptual interference in adults with attention deficit hyperactivity disorder.

Difficulty with selective attention is a frequent complaint of adult patients with ADHD, but selective attention tasks have not provided robust evidence of attentional dysfunction in this group. Two experiments examine this puzzle by distinguishing between failures of spatial selection and problems due to sensitivity to perceptual interference. In Experiment 1, we measured the level of perceptual interference generated by targets in crowded displays with nearby distractors by comparing luminance thresholds in both distractor-present (noise) and distractor-absent (clean) displays. ADHD and control participants had comparable thresholds for clean displays, but ADHD individuals had elevated thresholds to crowded displays. These effects could be explained in two distinct ways. Deficits may have arisen from amplified visual interference in the noise condition, or from abnormalities in top-down attentional processes that reduce visual interference. Experiment 2 adjusted for individual perceptual differences with clean and noise displays, before measuring visual interference resolution at attended versus unattended locations. ADHD and control groups had comparable interference resolution at attended locations. These results suggest that perceptual interference rather than spatial attention deficits may account for some deficits in ADHD. This putative deficit in sensory function highlights a potential early-stage perceptual processing deficit in ADHD distinct from selective attention.

Scaling of neuron number and volume of the pulvinar complex in New World primates: comparisons with humans, other primates, and mammals.

The lateral posterior nucleus and pulvinar (LP-pulvinar complex) are the principal thalamic nuclei associated with the elaborate development of the dorsal and ventral streams of the parietal cortex in primates. In humans, a novel site of origin for a subpopulation of pulvinar neurons has been observed, the ganglionic eminence of the telencephalon. This additional site of neuron origin has been proposed to contribute to the pulvinar's evolutionary expansion (Letinic and Rakic [2001] Nat Neurosci 4:930-936). Studies of neuron number in the LP-pulvinar complex in gibbon, chimpanzee, and gorilla compared to humans, however, did not show that the human LP-pulvinar was unexpectedly large (Armstrong [1981] Am J Phys Anthropol 55:369-383). Here we enlarge the allometric basis for comparison by determining neuron number in the LP-pulvinar complex of six New World primates (Cebus apella, Saimiri ustius, Saguinus midas niger, Alouatta caraya, Aotus azarae, and Callicebus moloch) as well as measuring LP-pulvinar volume in a further set of 24 species including additional primates, carnivores, and rodents. The volume of the LP-pulvinar complex scaled with positive allometry with respect to brain volume across all species examined. The scaling of the number of neurons in the LP-pulvinar complex was extremely similar in New World primates and anthropoid apes, with the human LP-pulvinar value close to the regression line. Comparison of the relative volumes of the LP-pulvinar in the larger sample confirmed this observation, and further demonstrated that both primates and carnivores showed a "grade shift" in its size compared to rodents, with the pulvinar comprising a greater proportion of total brain volume across the board. Diurnal, nocturnal, or crepuscular niche did not discriminate LP-pulvinar size across taxa.