The Neuropsychiatry of Inborn Errors of Metabolism.

The neuropsychiatry of inborn errors of metabolism.

J Inherit Metab Dis. 2013 May 23;
Walterfang M, Bonnot O, Mocellin R, Velakoulis D

A number of metabolic disorders that affect the central nervous system can present in childhood, adolescence or adulthood as a phenocopy of a major psychiatric syndrome such as psychosis, depression, anxiety or mania. An understanding and awareness of secondary syndromes in metabolic disorders is of great importance as it can lead to the early diagnosis of such disorders. Many of these metabolic disorders are progressive and may have illness-modifying treatments available. Earlier diagnosis may prevent or delay damage to the central nervous system and allow for the institution of appropriate treatment and family and genetic counselling. Metabolic disorders appear to result in neuropsychiatric illness either through disruption of late neurodevelopmental processes (metachromatic leukodystrophy, adrenoleukodystrophy, GM2 gangliosidosis, Niemann-Pick type C, cerebrotendinous xanthomatosis, neuronal ceroid lipofuscinosis, and alpha mannosidosis) or via chronic or acute disruption of excitatory/inhibitory or monoaminergic neurotransmitter systems (acute intermittent porphyria, maple syrup urine disease, urea cycle disorders, phenylketonuria and disorders of homocysteine metabolism). In this manuscript we review the evidence for neuropsychiatric illness in major metabolic disorders and discuss the possible models for how these disorders result in psychiatric symptoms. Treatment considerations are discussed, including treatment resistance, the increased propensity for side-effects and the possibility of some treatments worsening the underlying disorder. HubMed – depression


The Ecology of Early Childhood Risk: A Canonical Correlation Analysis of Children’s Adjustment, Family, and Community Context in a High-Risk Sample.

J Prim Prev. 2013 May 23;
Vilsaint CL, Aiyer SM, Wilson MN, Shaw DS, Dishion TJ

The ecology of the emergence of psychopathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts. HubMed – depression


Depression and its associated factors in pediatric chronic kidney disease.

Pediatr Nephrol. 2013 May 23;
Kogon AJ, Vander Stoep A, Weiss NS, Smith J, Flynn JT, McCauley E

BACKGROUND: Few studies on the occurrence of depression in pediatric patients with chronic kidney disease (CKD) have been conducted and none have identified associated clinical and demographic factors. METHODS: This was a cross-sectional study in which we administered the Child Depression Inventory-2 (CDI-2) to 44 patients aged 9-18 years with CKD stages III-V. Criteria for depression were CDI-2 scores of ?65 or an established diagnosis of depression recorded in the medical chart. Relative risks (RR) and 95 % confidence intervals (CI) were calculated to determine associations between patient characteristics and depression status. RESULTS: Of the 44 patients enrolled in the study, 13 (30 %) met our criteria for depression, representing 18 % of patients aged <13 years and 34 % of those aged ?13 years. Although not reaching statistical significance, the adjusted risk of depression was lower for patients with CKD duration of ?3 years than for those with longer CKD duration (RR 0.19, 95 % CI 0.02, 1.53), and for those with CKD stage IV (RR 0.23, 95 % CI 0.05, 1.09) and CKD stage V (RR 0.13, 95 % CI 0.01, 1.07) compared to those with CKD stage III. CONCLUSIONS: Our results indicate that depression is common in children with CKD, particularly for those with longstanding renal disease and at CKD stage III. HubMed – depression


Autoimmune, Atopic, and Mental Health Comorbid Conditions Associated With Alopecia Areata in the United States.

JAMA Dermatol. 2013 May 22; 1-5
Huang KP, Mullangi S, Guo Y, Qureshi AA

OBJECTIVE To evaluate the prevalence of comorbid conditions among patients with alopecia areata (AA) seen at tertiary care hospitals in Boston, Massachusetts, during an 11-year period. DESIGN Retrospective cross-sectional study. SETTING Tertiary care hospitals in Boston, including Brigham and Women’s Hospital and Massachusetts General Hospital. PARTICIPANTS We identified 3568 individuals with AA seen in the Partners health care system in Boston between January 1, 2000, and January 1, 2011. We performed comprehensive searches of the Research Patient Data Repository using International Classification of Diseases, Ninth Revision code 704.01. We randomly selected 350 patients and manually reviewed their medical records to train and validate a novel artificial intelligence program. This program then used natural language processing to review free-text medical records and confirm a diagnosis of AA. To confirm the algorithm, we manually reviewed a subset of records and found 93.9% validity. MAIN OUTCOMES AND MEASURES The prevalence of comorbid conditions was assessed. RESULTS Common comorbid conditions included autoimmune diagnoses (thyroid disease in 14.6%, diabetes mellitus in 11.1%, inflammatory bowel disease in 6.3%, systemic lupus erythematosus in 4.3%, rheumatoid arthritis in 3.9%, and psoriasis and psoriatic arthritis in 2.0%), atopy (allergic rhinitis, asthma, and/or eczema in 38.2% and contact dermatitis and other eczema in 35.9%), and mental health problems (depression or anxiety in 25.5%). We also found high prevalences of hyperlipidemia (24.5%), hypertension (21.9%), and gastroesophageal reflux disease (17.3%). This profile was different from that seen in a comparison psoriasis and psoriatic arthritis group. CONCLUSIONS AND RELEVANCE We found a high prevalence of comorbid conditions among individuals with AA presenting to academic medical centers in Boston. Physicians caring for patients with AA should consider screening for comorbid conditions. HubMed – depression


Sexual dysfunction predicts depression among women on hemodialysis.

Int Urol Nephrol. 2013 May 23;
Santos PR, Capote JR, Cavalcanti JU, Vieira CB, Rocha AR, Apolônio NA, de Oliveira EB

PURPOSE: Depression is common in patients on hemodialysis (HD), and its treatment fails in many cases. Among women on HD, sexual dysfunction (SD) can be an underestimated cause of depression and an impending factor for successful therapy. We aimed to evaluate the association between SD and depression among end-stage renal disease (ESRD) women undergoing HD and to test SD as an independent predictor of depression. METHODS: We studied 55 ESRD women undergoing HD from a single renal unit. We compared sociodemographic, clinical and laboratory data and presence of SD between depressed and non-depressed participants, and tested SD as an independent predictor of depression. Demographic data, time on dialysis, underlying etiology of ESRD and laboratory results were assessed in renal unit records. Classification of economic class was according to the criteria of the Brazilian Association of Research Institutes. Each participant was assigned a low-, medium- or high-risk index based on comorbidity. Depression was classified by the 20-Item Version of the Center for Epidemiologic Studies Depression Scale using a score ?18 to classify depression. The Female Sexual Function Index was used to evaluate sexual function considering a cutoff of 26 to classify SD. RESULTS: Thirty-three (56.8 %) women were depressive and 46 (79.3 %) women presented SD. Depressed an non-depressed women did not differ in sociodemographic, clinical and laboratory results, but the prevalence of SD among depressed patients was higher compared to non-depressed women, respectively, 90.1 versus 64 % (p = 0.029). SD was an independent predictor of depression (OR = 5.62; CI 95 % 1.33-23.7; p = 0.01). CONCLUSION: SD must be discarded among women on HD classified as depressive. Treatment of depression among women with SD should include a specific approach to SD. HubMed – depression