Stress sensitivity as a putative mechanism linking childhood trauma and psychopathology in youth's daily life.

OBJECTIVE: Childhood trauma (CT) is associated with a range of psychopathologies, including psychosis. However, evidence on underlying mechanisms remains limited. The study aimed to investigate whether CT impacts on youth mental health by modifying sensitivity to stress in daily life. METHOD: The experience sampling method (ESM) was used to measure momentary stress, negative affect and psychotic experiences in 99 adolescents and young adults (43 help-seeking service users, 16 siblings and 40 controls). Before ESM assessments, CT and depressive, anxiety and psychotic symptoms were assessed. RESULTS: Stress sensitivity, that is, the association between momentary stress and (i) negative affect and (ii) psychotic experiences, was modified by physical and emotional abuse and, partially, emotional and physical neglect, but not sexual abuse in service users and controls. While there was strong evidence for increased stress sensitivity in service users when high vs. low levels of CT were compared, a pattern of resilience was evident in controls, with attenuated, or no differences in, stress sensitivity in those with high vs. low CT levels. Less consistent findings were observed in siblings. CONCLUSIONS: Stress sensitivity may be an important risk and resilience mechanism through which CT impacts on mental health in youth.

[Movement disorders in anti-N-NMDA receptor encephalitis]. / Bewegingsstoornissen bij anti-NMDA-receptorencefalitis.

BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis (anmdare) is a serious disease, that has only been known since 2007; movement disorders form part of the neuropsychiatric symptomatology. AIM: To provide an overview of movement disorders in anmdare and to emphasise the complexity of this disease with regard to diagnostics and treatment. METHOD: We searched the literature using PubMed, Medline and Cochrane and the search terms 'Anti-N-Methyl-D-Aspartate Receptor Encephalitis' OR 'anti-nmda receptor encephalitis' OR 'anti-nmdar encephalitis' AND 'movement disorders' OR 'catatonia'. RESULTS: Orofacial dyskinesia is the most characteristic movement disorder in anmdare. Dyskinesia was observed in 80% of the patients; young children (<12 years old) have movement disorders more often. CONCLUSION: Movement disorders are typical but aspecific symptoms of anmdare. More than one movement disorder is present in nearly all cases, a factor that can make early diagnosis difficult and can delay the start of appropriate treatment.

Management of pediatric delirium in critical illness: a practical update.

Pediatric delirium (PD) is an acute state of brain dysfunction and is often seen in the pediatric intensive care unit (PICU). There is a growing awareness of its clinical interdisciplinary importance. The aim of this article was to describe the three clinical presentations, to evaluate the differential diagnosis and to give a concise and practical update for the pharmacological and non-pharmacological treatment of PD at the PICU, based on recent literature and expert opinions. We discuss an interdisciplinary flow chart which helps the reader dealing with the diagnosis and management of any acute emotional and or behavioral disturbance, of which PD is a special case.

[The Kleine-Levin syndrome and the treatment with methylphenidate]. / Het syndroom van Kleine-Levin en de behandeling met methylfenidaat.

A 17-year-old man was referred to the Med-Psych-Unit because of recurrent episodes of hypersomnia, megaphagia, hypersexual behaviour and cognitive disturbances. Over the period of three years he suffered more than 10 episodes of hypersomnia each lasting 8 to 16 days. The clinical presentation was suggestive of the Kleine-Levin syndrome. The symptoms disappeared after treatment with methylphenidate, but it was not clear whether this could be attributed to the medication or to the self-limiting character of the illness. The Kleine-Levin syndrome is often clinically not recognised due to the variation in the symptoms and the lack of objective diagnostic examination.

[Anti-NMDA-receptor encephalitis: a new axis-III disorder in the differential diagnosis of childhood disintegrative disorder, early onset schizophrenia and late onset autism]. / Anti-NMDA-receptorencefalitis: een nieuwe as III-stoornis in de differentiaaldiagnose van desintegratiestoornis van de kinderleeftijd, vroeg optredende schizofrenie en laat optredend autisme.

Childhood disintegrative disorder (CDD), early onset schizophrenia (EOS), and late onset autism (LOA) often follow a similar course: initially, development is normal, then there is a sudden neuropsychiatric deterioration of social interaction and communication skills, which is combined with a decline in intelligence and reduction in daily activities. A 9-year-old boy was admitted to the paediatric ward with acute onset of secondary epileptic seizures. It was not long until the boy's symptoms resembled that of patients with cdd, eos and loa. Intensive tests led to the diagnosis of anti-NMDA-receptor encephalitis. Anti-NMDA-receptor encephalitis should be regarded as a possible organic cause underlying the syndromal presentation of CDD, EOS and LOA.

[Pathological hoarding by children and adolescents]. / Pathologisch verzamelen bij kinderen en jeugdigen.

BACKGROUND: There is a dearth of knowledge and understanding concerning hoarding by children and adolescents. Psychiatrists need to know more about the phenomenon of hoarding since it can be a marker of psychopathology and it sometimes is symptomatic of a psychiatric disorder. AIM: To review hoarding from an epidemiological and psychopathological perspective and to discuss it in relation to the developmental aspect of the first object acquisition: the transitional object. METHOD: We conducted a literature search in PubMed, Medline, PsycINFO and the Cochranedatabase using primarily the search term 'hoarding', but also in combination with the terms: primates, child, adolescent, psych*, klepto*, transitional object, obsessive-compulsive disorder, collecting and attachment. RESULTS: Both animals and humans engage frequently in collecting and hoarding. Up to 60% of normally functioning children and adolescents are involved in collecting. A strong emotional attachment to possessions may be a response to an attachment problem. Hoarding combined with psychopathology is seen in persons of all ages but the prevalence rates for children and adults are unknown. CONCLUSION: Hoarding is a worrisome type of behaviour which must be regarded as an indication of serious comorbid psychopathology. It can occur either as a symptom of an existing disorder or as a separate disorder. Finally we recommend that hoarding be included in the diagnostic criteria of the dsm and icd.

Post-hoc revision of the pediatric anesthesia emergence delirium rating scale: clinical improvement of a bedside-tool?

BACKGROUND: Pediatric delirium (PD) is a severe neuropsychiatric disorder often seen at the pediatric intensive care unit (PICU). The Pediatric Anesthesia Emergence Delirium (PAED) scale assesses five behavioral items on a five-level severity scale, and is easily applicable in children. However, the five-level severity scales are rather arbitrarily anchored and subjective. This study aimed to pilot a practical and clinical improvement of the PAED by condensing the five-level scales of the five behavioral items to a more objectively anchored two- and three-point scale. METHODS: Post-hoc analysis of routine data in an eight-bed PICU in a tertiary university hospital. 144 critically ill, non-electively admitted patients, aged 1-18 years, were included between November 2006 and February 2010. Scales of the five PAED-items were condensed post-hoc from five to two- and three levels of severity. Five scale properties were analyzed: 1) internal consistency; 2) item-total score correlations; 3) inter-rater agreement; 4) sensitivity and specificity; and 5) discriminative diagnostic ability. RESULTS: Three-level PAED-items post-hoc displayed Cronbach's alpha of 0.86, and mean item-total score correlation was 0.71 (range 0.60 to 0.79). Inter-rater agreement was high (0.90). The most optimal cut-off was 8 (sensitivity=100%, specificity=96.7%) with an area under the curve (AUC) of 0.98. Likelihood ratio for a positive test result (LR+) was 30.3. CONCLUSION: A three-level severity scale for the five PAED-items may be optimal to diagnose PD. Further prospective research is required to determine whether a revised PAED has adequate psychometric properties and is applicable across different clinical settings.

Pediatric delirium in the pediatric intensive care unit: a systematic review and an update on key issues and research questions.

There was a dearth in awareness and knowledge regarding pediatric delirium (PD) at the pediatric intensive care unit (PICU). The aim of this study is to highlight the most recent and up-to-date findings of current literature -by means of a systematic review (SR) method-, and to present the key issues and research questions. A SR of the literature published between 24 March 2009 and 10 March 2011. Eight new articles were identified which included (literature) reviews, journal commentaries, and observational studies. There still is a dearth of literature on PD, with also a variable level of evidence (1b - 5), especially in relation to critical illness. To be able to further clarify PD in the PICU, additional research questions are provided for future research.

[Delirium in critically ill children in a paediatric intensive care unit]. / Delier bij kritisch zieke jonge kinderen op een pediatrische intensivecareafdeling.

Two critically ill girls, aged 2.3 years and 3.5 years respectively, developed delirium in the Paediatric Intensive Care Unit (PICU). The first child, admitted with meningococcal meningitis and septic shock with respiratory failure, suffered from hyperactive delirium which started 2 hours post-extubation. The second child, admitted due to an exacerbation of cystic fibrosis with the threat of respiratory failure, suffered from hypoactive delirium with regression, inconsolability, dyspraxia and dysphasia. Both patients responded well to a single intravenous dose of haloperidol. Although delirium occurs in critically ill children, it often goes unrecognized, particularly in its hypoactive form. It should nevertheless be considered as a medical emergency, particularly in a PICU setting, and should be treated accordingly. Physicians are generally reluctant to consider psychopharmacological treatment of childhood delirium. Haloperidol is considered as the drug of choice, but risperidone can also be used successfully.