Premenstrual Psychosis in an Adolescent: A Case Report.

Premenstrual psychosis is a rare phenomenon initiating during or preceding menses, often lasting one to two weeks after the onset of menses. Previous literature shows links between the estrogen decline of the menstrual cycle's late luteal phase and the worsening of preexisting symptomatology in psychosis. There is thought to be a similar etiology in premenstrual psychosis. Current literature describes mostly clinical cases showing successful treatment using oral contraceptives and/or atypical antipsychotics. We present an adolescent who suffered from a new episode of psychosis beginning just before the onset of menses. Her symptoms abated after the completion of menses and with the initiation of combined oral contraceptives and olanzapine.

Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression.

Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder.

Cost implications, deprivation and geodemographic segmentation analysis of non-attenders (DNA) in an established diabetic retinopathy screening programme.

AIM: To ascertain the relationship between socioeconomic status and non attendance alongside the role of geodemographic analysis in identifying reasons for non attendance. To also ascertain the financial implications of non attendance on the service. METHODS: Retrospective analysis of DNA patients between April 2009 and March 2010. Cost to the service was calculated based on Devon Primary Care Trust tariffs. Deprivation Analysis was based on the Indices of Multiple Deprivation 2007 for England. Geodemographic analysis was done using a commercially available software (MOSAIC Public Sector, Experian Information Solutions Inc.). RESULTS: 22,651 patients were invited for screening with 20,514 screened and 2137 (9.4%) DNA's. Of these, 1757 (82.2%) were DNA 1's while 380 (17.7%) were DNA 2's. Mean age of screened patients was 68 (SD ±14.2), DNA 1's was 62 (SD ±17.3) and DNA 2's was 57 (SD ±18.7).1269 (59%) of DNA's were males and 868 (41%) were females. Cost to the service as calculated by lost earnings from missed appointments came to £78,259. Deprivation analysis showed increasing non attendance rates with increasing deprivation. Geodemographic segmentation analysis revealed that the lowest DNA rates were seen in successful professionals and active retired communities and the highest rates were seen in areas of social housing. CONCLUSIONS: The study demonstrates an association between non attendance and socioeconomic deprivation. The use of geodemographic analysis programmes can help identify groups that do not respond to traditional postal reminders. More focused and customised strategies can then be developed for these groups to eliminate nonattendance.

Serotonin transporter polyadenylation polymorphism modulates the retention of fear extinction memory.

Growing evidence suggests serotonin's role in anxiety and depression is mediated by its effects on learned fear associations. Pharmacological and genetic manipulations of serotonin signaling in mice alter the retention of fear extinction learning, which is inversely associated with anxious temperament in mice and humans. Here, we test whether genetic variation in serotonin signaling in the form of a common human serotonin transporter polyadenylation polymorphism (STPP/rs3813034) is associated with spontaneous fear recovery after extinction. We show that the risk allele of this polymorphism is associated with impaired retention of fear extinction memory and heightened anxiety and depressive symptoms. These STPP associations in humans mirror the phenotypic effects of serotonin transporter knockout in mice, highlighting the STPP as a potential genetic locus underlying interindividual differences in serotonin transporter function in humans. Furthermore, we show that the serotonin transporter polyadenylation profile associated with the STPP risk allele is altered through the chronic administration of fluoxetine, a treatment that also facilitates retention of extinction learning. The propensity to form persistent fear associations due to poor extinction recall may be an intermediate phenotype mediating the effects of genetic variation in serotonergic function on anxiety and depression. The consistency and specificity of these data across species provide robust support for this hypothesis and suggest that the little-studied STPP may be an important risk factor for mood and anxiety disorders in humans.

Ophthalmic manifestations of giant cell arteritis.

This article reviews the ophthalmic manifestations of giant cell arteritis. An overview of giant cell arteritis as a disease spectrum is presented with special emphasis on the ophthalmic involvement.