Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study.

BACKGROUND: Recent randomized controlled trials suggest some efficacy for focused interventions in subjects at high risk (HR) for psychosis. However, treating HR subjects within the real-world setting of prodromal services is hindered by several practical problems that can significantly make an impact on the effect of focused interventions. METHOD: All subjects referred to Outreach and Support in South London (OASIS) and diagnosed with a HR state in the period 2001-2012 were included (n = 258). Exposure to focused interventions was correlated with sociodemographic and clinical characteristics at baseline. Their association with longitudinal clinical and functional outcomes was addressed at follow-up. RESULTS: In a mean follow-up time of 6 years (s.d. = 2.5 years) a transition risk of 18% was observed. Of the sample, 33% were treated with cognitive behavioural therapy (CBT) only; 17% of subjects received antipsychotics (APs) in addition to CBT sessions. Another 17% of subjects were prescribed with antidepressants (ADs) in addition to CBT. Of the sample, 20% were exposed to a combination of interventions. Focused interventions had a significant relationship with transition to psychosis. The CBT + AD intervention was associated with a reduced risk of transition to psychosis, as compared with the CBT + AP intervention (hazards ratio = 0.129, 95% confidence interval 0.030-0.565, p = 0.007). CONCLUSIONS: There were differential associations with transition outcome for AD v. AP interventions in addition to CBT in HR subjects. These effects were not secondary to baseline differences in symptom severity.

Are we really mapping psychosis risk? Neuroanatomical signature of affective disorders in subjects at ultra high risk.

BACKGROUND: The majority of people at ultra high risk (UHR) of psychosis also present with co-morbid affective disorders such as depression or anxiety. The neuroanatomical and clinical impact of UHR co-morbidity is unknown. METHOD: We investigated group differences in grey matter volume using baseline magnetic resonance images from 121 participants in four groups: UHR with depressive or anxiety co-morbidity; UHR alone; major depressive disorder; and healthy controls. The impact of grey matter volume on baseline and longitudinal clinical/functional data was assessed with regression analyses. RESULTS: The UHR-co-morbidity group had lower grey matter volume in the anterior cingulate cortex than the UHR-alone group, with an intermediate effect between controls and patients with major depressive disorder. In the UHR-co-morbidity group, baseline anterior cingulate volume was negatively correlated with baseline suicidality/self-harm and obsessive-compulsive disorder symptoms. CONCLUSIONS: Co-morbid depression and anxiety disorders contributed distinctive grey matter volume reductions of the anterior cingulate cortex in people at UHR of psychosis. These volumetric deficits were correlated with baseline measures of depression and anxiety, suggesting that co-morbid depressive and anxiety diagnoses should be carefully considered in future clinical and imaging studies of the psychosis high-risk state.

Entrapment neuropathy in patients with spastic cerebral palsy.

OBJECTIVES: We performed nerve conduction and needle electromyographic tests in 29 patients with spastic cerebral palsy (SCP) and severe limb deformities. Nerve conduction abnormalities were detected in 32 of 400 sensory or motor nerves, while 11 of 29 patients (37.9%) showed abnormal nerve conduction, indicating one or more entrapment neuropathies. Patients with SCP develop severe joint contractures and deformities due to spastic muscle tone and limited muscle and joint use/flexibility; these contractures and deformities can, in turn, cause nerve damage, possibly as a result of the stretching, angulation or compression mechanisms in the anatomic fibro-osseous passages, where nerves are particularly susceptible.

Initial motor unit recruitment in patients with spastic hemiplegia.

Lesions of the first motor neuron provoke abnormal voluntary movements. To clarify the central nervous system mechanisms underlying these changes we analyzed the behavior of the first motor unit recruited during a minimal effort tonic contraction of the deltoid and abductor digiti minimi manus muscles in patients with hemiplegia due to cerebrovascular lesions in the distribution of the middle cerebral artery. We compared data from paretic and healthy muscles in the same subject. The onset and recruitment intervals determined for the single motor unit yielded the range of control. The first recruited motor unit had a lower baseline firing rate and the second recruited motor unit potential appeared significantly earlier (p < 0.01) in plegic than in healthy muscles. Both changes affected distal more than proximal locations. Recordings from plegic muscles, particularly at distal locations, also disclosed a lowered range of control. These findings suggest that in hemiplegic patients the central nervous system loses its ability to modulate the frequency of firing during minimal effort voluntary movements so that distal muscles tend to behave like proximal muscles.

Evoked potentials obtained with tendon percussion in hemiplegic patients.

The purpose of this research was to verify in a group of hemiplegic subjects the usefulness of potentials obtained with tendon tap by evaluating the integrity of the proprioceptive area in relation to lesions in the middle cerebral artery territory. The healthy and paretic sides in 10 subjects affected by hemiplegia have been studied using the cerebral potential evoked by tendon tap. Two sets of 150 stimuli for each lower limb were applied at a standard repetition rate of 1 stimulus per 16 seconds. Data obtained shows a reduction of the amplitude of the P1-N1 cortical complex derived from the paretic side. This effect appears to be related to the entity of the kinaesthetic sensitivity impairment.

Tension type headache: a neuropsychological and neurophysiological study.

Characteristic personality profiles of patients suffering from either migraine headache (MH) or tension type headache (TTH) have been described in the light of Minnesota Multiphasic Personality Inventory (MMPI). In the present study we evaluated personality profile changes following modifications of the painful symptoms after treatment, through the administration of the MMPI to MH and TTH patients. In TTH patients with no clinical improvement the depression scale scores were higher after 6 months of treatment, whereas in MH patients similar scores were observed before and after therapy, thus suggesting a primary role of depression in the onset of pain in the latter patients. Computerized EMG recording of the neck muscle activity showed different patterns of muscle contraction in resting condition and during stress or maximal muscular activity in patients suffering from TTH as compared to MH patients and normal subjects.

Chronic damage after spinal trauma in rat: neurophysiological and ultrastructural investigations.

A group of 10 rats underwent spinal trauma by epidural spinal compression according to Tator's procedure. After 4 months from injury cortical and spinal SEP were recorded, and the spinal injured tract was examined by electronic microscope. We studied morphologic and functional changes showed after some months behind the trauma. This report demonstrates and compares the varying sensitivity of cortical and spinal SEP for revealing functional spinal damage; ultrastructural investigations testify to the existence of reparative processes of the nervous tissue.

EMG computerized analysis of localized fatigue in Duchenne muscular dystrophy.

EMG power spectra obtained during a sustained isometric contraction were analyzed in a group of 10 children affected by Duchenne muscular dystrophy (DMD) and compared with those obtained in a control group of 5 normal children. In myopathic subjects the isometric contraction caused an increase of the total power, a progressive increase of power of the lower frequencies, a decrease of that of the higher frequencies, and a shift downward of the median frequency. In normal children an increase of the total power without a significant median frequency shift was noted. The modifications observed in DMD children were explained by a decrement of the firing rate of the more damaged fast twitch motor units. This decrease was probably induced by a relative predominance of activity of the slow twitch motor units, which are less damaged by the pathological process.

Effects of carnitine administration in patients with chronic renal failure undergoing periodic dialysis, evaluated by computerized electromyography.

The effects of chronic administration of L-carnitine were evaluated by EMG analysis in 20 uraemic patients undergoing periodical haemodialysis (mean duration of dialysis 34.7 months). No important changes in motor conduction velocity or distal latency of the external popliteal nerve were found after the treatment, while a reduction in the number of polyphasic muscle action potentials was observed. After carnitine administration, an increase of total EMG power was noted and the spectral array showed a progressive shift towards lower frequencies in 8 patients who had shown higher values. These results suggest that carnitine has a prevalent "myotrophic" effect.

[Changes in the monosynaptic reflex during wakefulness and sleep of children with cerebral paralysis]. / Considerazioni sulle variazioni del riflesso monosinaptico nella veglia e nel sonno di bambini affetti da paralisi cerebrale.

Changes of the H reflex during sleep were studied in 13 children with cerebral palsy (8 with spastic tetraplegia, 2 with a mixed form of cerebral palsy without spasticity, 3 with hypotonic diplegia or tetraplegia). These modifications were compared with those of 5 normal children of the same age. During repeated night recordings, responses in the calf muscle elicited by electrical stimuli to the posterior tibial nerve were studied at the same time as the EEG, EOG and EMG of the mental muscles. The results show that:--in normal children the max H reflex progressively decreases in amplitude from wakefulness to REM sleep; -- in spastic patients there is only a slight decrease in the H reflex in NREM sleep and no significant change in REM sleep; the amplitude of the H reflex is always greater than that in the control group; -- in the dystonic and hypotonic group the results obtained are similar to those of the control group. From these results one may draw the conclusion that in spastic patients as opposed to the control, dystonic and hypotonic groups, normal balance between the function of supraspinal systems regulating the amplitude of the spinal reflexes is alterated probably through the scarce functionality of the supraspinal inhibitory structures.