Aripiprazole monotherapy in children and young adolescents with pervasive developmental disorders: a retrospective study.

BACKGROUND: Pervasive developmental disorders (PDDs) are severe psychiatric disorders characterized by impairment in social interactions, in verbal and non-verbal communication, and by restricted and stereotyped patterns of interest and behaviour, with onset in the first 3 years of life. The appropriate use of pharmacotherapy can improve some aberrant symptoms and behaviours and increase the person's response to non-pharmacological interventions. OBJECTIVE: To describe clinical outcomes, or symptom changes, and adverse effects during naturalistic treatment with aripiprazole monotherapy in children with PDDs and severe behavioural disorders (such as aggression against self and/or others, hostility, hyperactivity, severe impulsiveness). METHOD: This retrospective naturalistic study included 34 patients (23 males and 11 females, age range 4.5-15 years, mean age 10.2 +/- 3.3 years), admitted during 2006-2007, diagnosed according to DSM-IV criteria and followed up for 4-12 months (mean 7.0 +/- 3.6 months). Outcome measures were three global measures of clinical and functional impairment and improvement from baseline: the Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I) scales; the Children's Global Assessment Scale (C-GAS); and the Childhood Autism Rating Scale (CARS), a specific measure of PDD symptoms. RESULTS: The mean baseline CGI-S was 5.7 +/- 0.8 (markedly ill/severely ill). The mean final dosage of aripiprazole was 8.1 +/- 4.9 mg/day. At the endpoint, 11 patients (32.4%) were 'much improved' or 'very much improved' (CGI-I score of 1 or 2), 12 patients (35.3%) were 'minimally improved' (CGI-I score of 3) and 10 (29.4%) were 'unchanged' or 'worsened' (CGI-I score of 4 or 5). C-GAS and CARS scores significantly improved (p < 0.0001, effect sizes 0.59 and 0.62, respectively). Nine patients (26.5%) experienced moderate to severe agitation, which was associated with self-injurious behaviours in five of these patients, and five patients presented with sleep disorders. Twelve patients (35.3%) discontinued medication during the follow-up because of lack of efficacy or adverse effects. CONCLUSIONS: In these severely impaired children with PDDs, aripiprazole monotherapy was associated with a significant improvement in maladaptive behaviours in one-third of patients. Agitation and insomnia were the most frequent adverse effects. Further controlled studies in larger samples to explore possible predictors of efficacy are warranted.

Control and synchronization of laser bursting and its implications in neuroscience.

We present experimental and numerical evidence of control and synchronization of burst events in modulated CO(2) lasers. Bursts appear randomly in each laser as trains of large amplitude spikes intercalated by a small amplitude chaotic regime. Experimental data and model display the frequency locking of bursts in a suitable interval of coupling strengths. The analogy with neuronal bursting will also be discussed in view of the role of bursting synchronization in cognitive functions.

Attractor selection in a modulated laser and in the Lorenz circuit.

By tuning a control parameter, a chaotic system can either display two or more attractors (generalized multistability) or exhibit an interior crisis, whereby a chaotic attractor suddenly expands to include the region of an unstable orbit (bursting regime).Recently, control of multistability and bursting have been experimentally proved in a modulated class B laser by means of a feedback method. In a bistable regime, the method relies on the knowledge of the frequency components of the two attractors. Near an interior crisis, the method requires retrieval of the unstable orbit colliding with the chaotic attractor. We also show that a suitable parameter modulation is able to control bistability in the Lorenz system. We observe that, for every given modulation frequency, the chaotic attractor is destroyed under a boundary crisis. The threshold control amplitude depends on the control frequency and the location of the operating point in the bistable regime. Beyond the boundary crisis, the system remains in the steady state even if the control is switched off, demonstrating control of bistability.

Present and previous psychopathology of juvenile onset migraine: a pilot investigation by Child Behavior Checklist.

The objective was to describe the premorbid state of migraine with juvenile onset. Thirty subjects with migraine and 30 healthy subjects were enrolled in a case-control study. A structured questionnaire (Child Behavior Checklist, CBCL) was administered to the mothers and ratings were obtained for the past two age periods (0-3 and 4-6 years) and for the present state. CBCL scores of the migraine group (MG) were compared to those of the control group (CG) during the three periods. A longitudinal study was performed to evaluate the evolution of psychopathology comparing CBCL scores of MG in the three age periods. During the premorbid period MG showed significantly higher mean scores on total, internalising, anxious-depressive scales. In the longitudinal perspective, internalising traits were present in the premorbid period in MG. Children later diagnosed as having migraine differ from CG in several scales during different age periods. Migraine could be considered as the expression of a previous vulnerability.

Phase control of intermittency in dynamical systems.

We present a nonfeedback method to tame or enhance crisis-induced intermittency in dynamical systems. By adding a small harmonic perturbation to a parameter of the system, the intermittent behavior can be suppressed or enhanced depending on the value of the phase difference between the main driving and the perturbation. The validity of the method is shown both in the model and in an experiment with a CO2 laser. An analysis of this scheme applied to the quadratic map near crisis illustrates the role of phase control in nonlinear dynamical systems.

Synchronization of spontaneous bursting in a CO2 laser.

We present experimental and numerical evidence of synchronization of burst events in two different modulated CO2 lasers. Bursts appear randomly in each laser as trains of large amplitude spikes intercalated by a small amplitude chaotic regime. Experimental data and model show the frequency locking of bursts in a suitable interval of coupling strength. We explain the mechanism of this phenomenon and demonstrate the inhibitory properties of the implemented coupling.