Differential development of learning strategies on a Pictorial Verbal Learning Test (PVLT) in primary-school children.

The aim of this study was to test the hypothesis that developmental differences exist in the use of learning strategies in primary school children. Serial and subjective clustering in a multitrial Pictorial Verbal Learning Test (PVLT) were compared in 79 children aged 6-12. Correlation analyses indicated that serial clustering yielded better performance when information was presented on the initial trials of the test. Subjective clustering was superior when information was presented repeatedly, i.e., after three or more trials. Analyses of variance indicated that subjective clustering was used more often in older children with repeated presentations. On the other hand, there was no increase in the use of serial clustering with age and with repeated presentations. The findings imply that training in the use of proper strategies could have benefit for children who use an inefficient learning strategy and/or have a learning problem. In addition, they point to the importance of the factor "age" in relation to the way information is presented to children.

Systematic review: serotonergic modulators in the treatment of irritable bowel syndrome--influence on psychiatric and gastrointestinal symptoms.

BACKGROUND: Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome. AIM: To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology. METHODS: A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points). RESULTS: Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies. CONCLUSIONS: The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.

Child psychiatric diagnoses in a population of Dutch schoolchildren aged 6 to 8 years.

OBJECTIVE: To determine the prevalence rates of child psychiatric diagnoses in a school-based population of children aged 6 to 8 years in the south of the province of Limburg (The Netherlands). METHOD: In a two-stage design 1,317 children were screened with the Child Behavior Checklist. From 403 of these children, child psychiatric information was obtained with the Amsterdam Diagnostic Interview for Children and Adolescents (ADIKA, DSM-III-R/IV). Data were generalized to the responder group (n = 1,317) and to the entire cohort (N = 2,290). For the latter procedure, a prediction model was used to generalize ADIKA results to the nonresponders (n = 973). RESULTS: Estimates of the prevalence of different ADIKA diagnoses in the responder group were quite comparable with those for the entire cohort. Twenty-four percent of the entire cohort met criteria for a single disorder, and 21.0% met criteria for two or more disorders. However, in only 5.7% of the cases parents did report a need for help. CONCLUSIONS: Where other studies generalize psychiatric diagnoses to the responder group only, this report adds new information by generalizing the prevalence to a school-based cohort of children aged 6 to 8 years. These prevalence estimates are of importance with regard to the demand for care for child psychopathology.

Psycho-education in bipolar disorder: effect on expressed emotion.

In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder, key relatives in the treatment group showed a significant change from high to low levels of expressed emotion (EE) compared with the control group. In addition, patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives. The multi-family groups were well received by the participants, and there were only a few drop-outs.

Selective serotonin reuptake inhibitors (SSRIs) in the treatment of elderly depressed patients: a qualitative analysis of the literature on their efficacy and side-effects.

A qualitative analysis of studies on the efficacy and side-effects of selective serotonin reuptake inhibitors (SSRIs) for the treatment of elderly people with depression is presented. Only placebo-controlled or comparison studies of SSRI versus other antidepressants were included. The description and methodological quality of the analysed studies were important criteria in the outcome of the analysis. Quality was assessed by means of a blinded review approach. After excluding duplicate publications, 16 studies were analysed, of which six turned out to be of good quality. The results indicated that at the end of the treatment periods (4-8 weeks) all antidepressants were equally effective. Side-effects occurred less frequently with SSRIs than with tricyclics (TCAs), and different side-effect profiles were found. Significantly fewer SSRI-treated patients than TCA-treated patients dropped out both overall and due to side-effects.

Comparison of seven sets of criteria used for the diagnosis of vascular dementia.

At least seven different sets of criteria are commonly used for the diagnosis of vascular dementia (VaD). These are the ischemic scales (IS) of Hachinski, Rosen and Loeb, the criteria from the DSM-III-R, those outlined by Erkinjuntti et al., the State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) and the international workgroup of the American National Institute of Neurological Disorders and Stroke (NINDS) and the European "Association Internationale pour la Recherche et l'Enseignement en Neurosciences'. To investigate the differences and similarities of these criteria, we applied them to a sample of 124 demented patients from the Maastricht Memory Clinic. Only 8 patients were diagnosed as having VaD by all criteria. Depending on which criteria were used, the frequencies of VaD and Alzheimer's disease (AD) ranged from 6 to 32%, and from 48 to 56%, respectively. The IS of Hachinski and Rosen resulted in the highest frequencies of VaD, whereas the criteria of Erkinjuntti and those from the ADDTC and the NINDS workgroup yielded the lowest. The number of patients with VaD was reduced substantially when neuroradiological data and the temporal relationship between stroke and dementia were taken into consideration. We conclude that the seven sets of criteria cannot be regarded as interchangeable. Differences in the criteria for VaD and AD may be an overlooked source of interstudy variance

Depression, insight, and personality changes in Alzheimer's disease and vascular dementia.

Although it is generally believed that depression, retained insight, and preserved personality occur more frequently in vascular dementia than in Alzheimer's disease, there is little empiric evidence for this presumption. Most studies on this subject have been carried out with severely demented inpatients, and confounding factors such as age, sex, and severity of dementia have not been sufficiently taken into account. We compared 48 patients with relatively mild vascular dementia with 48 patients with Alzheimer's disease, matched for age, sex, and stage of dementia, to investigate if depression, lack of insight, and personality changes were related to the cause of dementia. The two groups did not differ regarding the incidence of major depression, the mean depression score, the awareness score, or the sum of scores on the items of the Blessed Dementia Scale concerning personality changes. We conclude that depression, lack of insight, and personality changes do not favor an etiology of vascular dementia over that of Alzheimer's disease. The present findings underscore the notion that the severity of the dementia should be considered in studies on the differences between vascular dementia and Alzheimer's disease.

Treatment of depression in Parkinson's disease: a meta-analysis.

Despite a 40% prevalence of depression in idiopathic Parkinson's disease (PD), an extensive literature search found only 12 controlled studies of treatment efficacy. A meta-analysis of these was performed in pursuit of guidelines for pharmacological treatment. Articles were scored on a scale from 0 to 100 on a specially adapted list of methodological criteria. Only 4 articles scored more than 50 points, and these generally did not use depression rating scales. Thus, there are virtually no empirical data on the treatment of depression in PD. Further studies are urgently needed, both for the sake of patient care and to gain a better understanding of the pathophysiological mechanisms underlying depression in PD and the interrelation between depression and cognitive decline.

Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach.

Discrepancies were examined in diagnostic outcome between a monodisciplinary approach and a multidisciplinary, criteria-based approach in patients referred to a university memory clinic. Of 278 patients not fulfilling dementia criteria, 19 had been previously diagnosed as demented (specificity: 0.93). In 60 of 152 demented patients, dementia had not been diagnosed before (sensitivity: 0.61). Underreporting was frequent for mildly demented patients and for patients with coexisting depressive symptoms. In patients referred by psychiatrists, sensitivity rates for dementia and Alzheimer's disease were low; in patients referred by neurologists, depression often went unreported. Results underscore the need for more frequent use of integrated multidisciplinary services for cognitively disturbed patients.

[Screening for dementia: validity of the Cognitive Screening Test (CST) and the Mini-Mental State Examination]. / Dementie-screening: validitiet van de Cognitieve Screeningstest (CST) en de Mini-Mental State Examination (MMSE).

The Cognitive Screening Test (CST--short version), a Dutch orientation questionnaire, and the Mini-Mental State Examination (MMSE) were compared with respect to their ability to discriminate between mildly demented, moderately demented and non-demented patients. The difference between mildly and moderately demented patients was based on the Global Deterioration Scale score. The CST and the MMSE were administered to patients who had been referred to the Memory Clinic of the University Hospital of Maastricht. Both instruments were successful in discriminating moderately and severely demented from non-demented patients. The CST and the MMSE were also successful with respect to the classification of depressive, non-demented elderly patients. The CST did not succeed in the correct classification of mildly demented patients (50% false-negative). The results of the MMSE in this group of mildly demented patients were moderate (25% false-negative). It is concluded that the value of both screening instruments, and especially the short version of the CST is limited for clinical practice.

Subjective cognitive dysfunction, eye tracking, and slow brain potentials in schizophrenic and schizoaffective patients.

The relationships between subjective cognitive dysfunction (so-called basic symptoms) and some psychophysiological measures were examined repeatedly in schizophrenic and schizoaffective patients during an acute psychotic episode, and comparisons were made with psychotic symptom ratings. Psychophysiological variables were: quality of eye tracking, amplitude measures of the contingent negative variation, and reaction time. Ratings of psychotic and basic symptoms were significantly correlated, but only the basic symptom score showed significant associations with eye tracking, contingent negative variation, and reaction time. Although this pattern was confined to the recovery phase of the psychotic episode, the results suggest that the core psychopathological correlates of these psychophysiological measures consist of basic symptoms rather than florid psychotic symptoms.

Slow potential correlates of frontal function, psychosis, and negative symptoms.

The contingent negative variation (CNV) was used to study cortical activation in frontal and central areas in psychotic and nonpsychotic patients. Psychotic patients showed a higher frontal relative to central CNV amplitude than nonpsychotic patients, a finding that was correlated with performance on a test of frontal function. Negative symptom ratings (physical anhedonia and social closeness) were correlated with relatively low frontal versus central CNV amplitude, but only in psychotic patients.