1
|
Cintra HA, Rocha DN, da Costa ACC, Tyszler LS, Freitas S, de Araujo LA, Crozoe LI, de Paula LR, Correia PS, Gomes LHF, da Cunha Guida L. Investigating the correlation between genotype and phenotype in Prader-Willi syndrome: a study of 45 cases from Brazil. Orphanet J Rare Dis 2024; 19:240. [PMID: 38902749 PMCID: PMC11188222 DOI: 10.1186/s13023-024-03157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a genetic disorder characterized by abnormalities in the 15q11-q13 region. Understanding the correlation between genotype and phenotype in PWS is crucial for improved genetic counseling and prognosis. In this study, we aimed to investigate the correlation between genotype and phenotype in 45 PWS patients who previously underwent methylation-sensitive high-resolution melting (MS-HRM) for diagnosis. RESULTS We employed methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) and Sanger sequencing, along with collecting phenotypic data from the patients for comparison. Among the 45 patients, 29 (64%) exhibited a deletion of 15q11-q13, while the remaining 16 (36%) had uniparental disomy. No statistically significant differences were found in the main signs and symptoms of PWS. However, three clinical features showed significant differences between the groups. Deletion patients had a higher prevalence of myopia than those with uniparental disomy, as well as obstructive sleep apnea and an unusual skill with puzzles. CONCLUSIONS The diagnostic tests (MS-HRM, MS-MLPA, and Sanger sequencing) yielded positive results, supporting their applicability in PWS diagnosis. The study's findings indicate a general similarity in the genotype-phenotype correlation across genetic subtypes of PWS.
Collapse
Affiliation(s)
- Hiago Azevedo Cintra
- Laboratório de Alta Complexidade, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Danielle Nascimento Rocha
- Laboratório de Alta Complexidade, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Ana Carolina Carioca da Costa
- Unidade de Pesquisa Clínica, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Latife Salomão Tyszler
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Silvia Freitas
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | | | - Lisanne Incoutto Crozoe
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Luísa Ribeiro de Paula
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Patricia Santana Correia
- Centro de Genética Médica, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Henrique Ferreira Gomes
- Laboratório de Alta Complexidade, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Letícia da Cunha Guida
- Laboratório de Alta Complexidade, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil.
| |
Collapse
|
2
|
Andrews SM, Panjwani AA, Potter SN, Hamrick LR, Wheeler AC, Kelleher BL. Specificity of Early Childhood Hyperphagia Profiles in Neurogenetic Conditions. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:175-190. [PMID: 38657964 DOI: 10.1352/1944-7558-129.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/10/2023] [Indexed: 04/26/2024]
Abstract
Hyperphagia is highly penetrant in Prader-Willi syndrome (PWS) and has increasingly been reported in other neurogenetic conditions (NGC). The Hyperphagia Questionnaire (HQ) was completed by caregivers of 4-8-year-olds with PWS (n = 17), Angelman syndrome (AS; n = 22), Williams syndrome (WS; n = 25), or low-risk controls (LRC; n = 35). All NGC groups were significantly elevated in HQ Total and Behavior scores compared to LRC. Only AS and WS were significantly elevated in the Drive domain, and only PWS in the Severity domain. After controlling for externalizing behavior, HQ Total scores were higher for PWS relative to other groups. Hyperphagic symptoms may not differentiate PWS from other NGCs in early childhood. However, hyperphagic phenotypes may be most severe in PWS. Further investigation of these profiles may inform etiology and syndrome-specific treatments.
Collapse
|
3
|
Dykens EM, Roof E, Hunt-Hawkins H. The Prader-Willi syndrome Profile: validation of a new measure of behavioral and emotional problems in Prader-Willi syndrome. Orphanet J Rare Dis 2024; 19:83. [PMID: 38395848 PMCID: PMC10885615 DOI: 10.1186/s13023-024-03045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare, neurodevelopmental disorder caused by the lack of expression of paternally imprinted genes on chromosome 15q11-13. PWS features a complex behavioral phenotype, including hyperphagia, anxiety, compulsivity, rigidity, repetitive speech, temper outbursts, aggressivity, and skin-picking. Questionnaires exist for measuring hyperphagia, but not for the aggregation of other problems that are distinctive to PWS. A PWS-specific tool is needed for phenotypic research, and to help evaluate treatment efficacy in future clinical trials aimed at attenuating PWS's hyperphagia and related problems. In this 4-phase study, we leveraged our expertise in PWS with feedback from families and specialists to validate the PWS Profile, a novel, informant-based measure of behavioral and emotional problems in this syndrome. RESULTS The authors developed a bank of 73 items that tapped both common and less frequent but clinically significant problems in PWS (Phase 1). An iterative feedback process with families and stakeholders was used to ensure content and construct validity (Phase 2). After adding, omitting, or revising items, in Phase 3, we pilot tested the measure in 112 participants. Results were reviewed by an international team of PWS specialists and revised again (Phase 3). The final, 57-item Profile was then administered to 761 participants (Phase 4). Principal component factor analyses (n = 873) revealed eight conceptually meaningful factors, accounting for 60.52% of test variance, and were readily interpretated as: Rigidity, Insistence; Aggressive Behaviors; Repetitive Questioning, Speech; Compulsive Behaviors; Depression, Anxiety; Hoarding; Negative Distorted Thinking; and Magical Distorted Thinking. Factors were internally consistent and showed good test-retest reliability and convergent validity with existent measures of behavioral problems. Profile factors were not related to IQ, BMI, or parental SES. Three Profile factors differed across PWS genetic subtypes. Age and gender differences were found in only one Profile factor, Hoarding. CONCLUSIONS The PWS Profile is a valid, psychometrically-sound questionnaire that already has shown responsivity to treatment in a previous clinical trial. The Profile can extend the reach of future clinical trials by evaluating the impact of novel agents not only on hyperphagia, but also on the emotional and behavioral problems that characterize PWS.
Collapse
Affiliation(s)
- Elisabeth M Dykens
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA.
| | - Elizabeth Roof
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA
| | - Hailee Hunt-Hawkins
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA
| |
Collapse
|
4
|
Wieting J, Deest M, Bleich S, Frieling H, Eberlein C. N-Acetylcysteine provides limited efficacy as treatment option for skin picking in Prader-Willi syndrome. Am J Med Genet A 2021; 188:828-835. [PMID: 34854203 DOI: 10.1002/ajmg.a.62589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder based on a loss of paternally expressed genes in chromosome region 15q11-13. In addition to typical characteristics such as hyperphagia, PWS is evidenced by a certain behavioral phenotype. Common indicators are repetitive behaviors, temper tantrums, and self-injurious behaviors such as skin- and/or rectal picking. N-Acetylcysteine (NAC) was previously described as a promising therapeutic option for skin picking in PWS. In this case series, we retrospectively investigated the effect of pharmacotherapy with NAC in 14 individuals with PWS suffering from skin- and/or rectal picking. Treatment success was determined using the Clinical Global Impression-Improvement scale (CGI-I). The Clinical Global Impression-Efficacy index (CGI-EI) was used to put treatment success and side effects into perspective. Six of fourteen patients, all of which were female, showed improvement in symptoms (dosage 1800-2400 mg/day), whereas six patients did not show any change during treatment. Moreover, two male patients treated for solitary rectal picking showed new onset of skin picking. Across all cases, a CGI-I of 3 (corresponding to minimal improvement) was seen after 3 months of treatment, with a CGI-EI of 1.6 (corresponding to moderate efficacy). NAC remains a reasonable therapeutic option in certain cases of skin picking in PWS but provides only limited efficacy compared to previous studies on the topic. There was a higher rate of adverse drug reactions than previously reported. The results particularly suggest caution in future treatment in individuals with solitary rectal picking and reduced efficacy when coadministered with neuroleptics.
Collapse
Affiliation(s)
- Jelte Wieting
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| | - Maximilian Deest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| | - Christian Eberlein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
| |
Collapse
|
5
|
Schwartz L, Caixàs A, Dimitropoulos A, Dykens E, Duis J, Einfeld S, Gallagher L, Holland A, Rice L, Roof E, Salehi P, Strong T, Taylor B, Woodcock K. Behavioral features in Prader-Willi syndrome (PWS): consensus paper from the International PWS Clinical Trial Consortium. J Neurodev Disord 2021; 13:25. [PMID: 34148559 PMCID: PMC8215770 DOI: 10.1186/s11689-021-09373-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder associated with a characteristic behavioral phenotype that includes severe hyperphagia and a variety of other behavioral challenges such as temper outbursts and anxiety. These behaviors have a significant and dramatic impact on the daily functioning and quality of life for the person with PWS and their families. To date, effective therapies addressing these behavioral challenges have proven elusive, but several potential treatments are on the horizon. However, a limiting factor for treatment studies in PWS is the lack of consensus in the field regarding how to best define and measure the complex and interrelated behavioral features of this syndrome. The International PWS Clinical Trials Consortium (PWS-CTC, www.pwsctc.org) includes expert PWS scientists, clinicians, and patient advocacy organization representatives focused on facilitating clinical trials in this rare disease. To address the above gap in the field, members of the PWS-CTC “Behavior Outcomes Working Group” sought to develop a unified understanding of the key behavioral features in PWS and build a consensus regarding their definition and description. The primary focus of this paper is to present consensus definitions and descriptions of key phenotypic PWS behaviors including hyperphagia, temper outbursts, anxiety, obsessive–compulsive behaviors, rigidity, and social cognition deficits. Patient vignettes are provided to illustrate the interrelatedness and impact of these behaviors. We also review some available assessment tools as well as new instruments in development which may be useful in measuring these behavioral features in PWS.
Collapse
Affiliation(s)
- Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, CA, USA. .,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Assumpta Caixàs
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Parc Taulí Research and Innovation Institute, Sabadell, Spain.,Medicine Department, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Elisabeth Dykens
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, TN, USA
| | - Jessica Duis
- Section of Genetics & Inherited Metabolic Diseases, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stewart Einfeld
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Louise Gallagher
- Trinity College Dublin Trinity Translational Medicine Institute, St. James's Hospital, Dublin, 8, Ireland
| | - Anthony Holland
- Department of Psychiatry, Cambridge Intellectual and Developmental Disabilities Research Group, University of Cambridge, Cambridge, UK
| | - Lauren Rice
- Brain and Mind Centre
- Faculty of Health Sciences, The University of Sydney, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - Elizabeth Roof
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Parisa Salehi
- Division of Endocrinology and Diabetes, Seattle Children's, University of Washington, Seattle, WA, USA
| | - Theresa Strong
- Foundation for Prader-Willi Research, Walnut, CA, USA.,Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bonnie Taylor
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kate Woodcock
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
6
|
Ed Zigler's developmental approach to intellectual disabilities: Past, present, and future contributions. Dev Psychopathol 2021; 33:453-465. [PMID: 33955339 DOI: 10.1017/s0954579420002084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Comprising two parts, Ed Zigler's developmental approach has greatly influenced how one conceptualizes children with intellectual disabilities (ID). In part one, Zigler championed a "two-group approach" concerning the cause of children's ID. He distinguished persons with a clear, organic cause of their ID from those displaying no clear cause. Members of this "organic" group often displayed IQs below 50 and co-occurring physical-medical conditions. The second, "cultural-familial" group, mostly showed IQs of 50-70, did not possess co-occurring physical or health problems, and often came from families of lower IQs and lower socioeconomic status. While the presence of these two groups has been supported, recent advances have also further differentiated the organic group, mostly in relation to behavioral phenotypes of persons with several genetic etiologies. In part two, Zigler championed the child with ID as a "whole person." Originally focused on the child's reactions to social deprivation and failure, recent studies directly examine parent-child, within-family, and wider system interactions throughout the life span. For decades a force within the ID field, Zigler's developmental approach to children with ID continues to influence researchers, interventionists, and policymakers.
Collapse
|
7
|
Damen L, Grootjen LN, Juriaans AF, Donze SH, Huisman TM, Visser JA, Delhanty PJ, Hokken‐Koelega AC. Oxytocin in young children with Prader-Willi syndrome: Results of a randomized, double-blind, placebo-controlled, crossover trial investigating 3 months of oxytocin. Clin Endocrinol (Oxf) 2021; 94:774-785. [PMID: 33296519 PMCID: PMC8246775 DOI: 10.1111/cen.14387] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction, hyperphagia and a typical behavioural phenotype, with characteristics of autism spectrum disorder (ASD) like stubbornness, temper tantrums and compulsivity. It has been suggested that the oxytocin system in patients with PWS is dysfunctional. In ASD, intranasal oxytocin treatment has favourable effects on behaviour. OBJECTIVE To evaluate the effects of 3 months of twice daily intranasal oxytocin (dose range 16-40 IU/day), compared to placebo, on behaviour and hyperphagia in children with PWS. DESIGN Randomized, double-blind, placebo-controlled, crossover study in the Dutch PWS Reference Center. PATIENTS Twenty-six children with PWS aged 3-11 years. MAIN OUTCOME MEASURES (Change in) behaviour and hyperphagia measured by Oxytocin Questionnaire and Dykens hyperphagia questionnaire. RESULTS In the total group, no significant effects of oxytocin on social behaviour or hyperphagia were found. However, in boys, the Oxytocin Questionnaire scores improved significantly during oxytocin treatment, compared to a deterioration during placebo (4.5 (-0.8 to 15.3) vs. -4.0 (-11.3 to 0.8), P = .025). The Dykens hyperphagia questionnaire scores remained similar during oxytocin treatment, while there was a deterioration during placebo (0.0 (-0.8 to 4.3) vs. -3.5 (-6.0 to 0.0), P = .046). Patients with a deletion had significant improvements in both questionnaire scores during oxytocin treatment, but deteriorations during placebo. Oxytocin treatment was well tolerated, and there were no serious adverse events. CONCLUSIONS Intranasal oxytocin treatment has positive effects on social and eating behaviour in 3-11 years aged boys with PWS and in children with a deletion without safety concerns. Intranasal oxytocin in children with PWS might be considered, but individual effects should be carefully evaluated and treatment discontinued if no effects are found.
Collapse
Affiliation(s)
- Layla Damen
- Dutch Growth Research FoundationRotterdamthe Netherlands
- Department of PediatricsSubdivision of EndocrinologyErasmus University Medical CenterSophia Children’s HospitalRotterdamthe Netherlands
- Dutch Reference Center for Prader‐Willi Syndromethe Netherlands
| | - Lionne N. Grootjen
- Dutch Growth Research FoundationRotterdamthe Netherlands
- Department of PediatricsSubdivision of EndocrinologyErasmus University Medical CenterSophia Children’s HospitalRotterdamthe Netherlands
- Dutch Reference Center for Prader‐Willi Syndromethe Netherlands
| | - Alicia F. Juriaans
- Dutch Growth Research FoundationRotterdamthe Netherlands
- Department of PediatricsSubdivision of EndocrinologyErasmus University Medical CenterSophia Children’s HospitalRotterdamthe Netherlands
- Dutch Reference Center for Prader‐Willi Syndromethe Netherlands
| | - Stephany H. Donze
- Dutch Growth Research FoundationRotterdamthe Netherlands
- Department of PediatricsSubdivision of EndocrinologyErasmus University Medical CenterSophia Children’s HospitalRotterdamthe Netherlands
- Dutch Reference Center for Prader‐Willi Syndromethe Netherlands
| | - T. Martin Huisman
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Jenny A. Visser
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Patric J.D. Delhanty
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Anita C.S. Hokken‐Koelega
- Dutch Growth Research FoundationRotterdamthe Netherlands
- Department of PediatricsSubdivision of EndocrinologyErasmus University Medical CenterSophia Children’s HospitalRotterdamthe Netherlands
- Dutch Reference Center for Prader‐Willi Syndromethe Netherlands
| |
Collapse
|
8
|
Kayadjanian N, Vrana-Diaz C, Bohonowych J, Strong TV, Morin J, Potvin D, Schwartz L. Characteristics and relationship between hyperphagia, anxiety, behavioral challenges and caregiver burden in Prader-Willi syndrome. PLoS One 2021; 16:e0248739. [PMID: 33765021 PMCID: PMC7993772 DOI: 10.1371/journal.pone.0248739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by maladaptive behaviors, amongst which hyperphagia is a life-long concern for individuals with PWS and their caregivers. The current study examined the contribution of hyperphagia and other factors to caregiver burden across lifespan, in 204 caregivers of individuals with PWS living in the US, using the Zarit Burden Interview (ZBI) and the hyperphagia questionnaire (HQ-CT). Results We found a strong relationship between ZBI and HQ-CT especially in individuals with PWS older than 4 y and showed that HQ-CT scores of individuals with PWS is positively correlated with ZBI scores of their caregivers. The weight status of individuals with PWS was not associated with HQ-CT and ZBI scores, except for obese individuals who had significantly higher HQ-CT scores when compared to normal weight PWS individuals. We looked at PWS symptoms and care-related issues that impacted individuals and caregivers the most. We found that care-related tasks had the biggest negative impact on caregivers of children aged 0–4 y, whereas anxiety, temper tantrums, and oppositional behaviors of older individuals with PWS had the biggest impact on their caregivers concomitant with their high caregiver burden. Finally, we assessed the variability of HQ-CT and ZBI over 6 months in a subgroup of 83 participants. Overall, neither measure differed between 6 months and baseline. Most individual’s absolute HQ-CT score changes were between 0–2 units, whereas absolute ZBI score changes were between 0–6 points. Changes in the caregiver’s or individual’s life had little or no effect on HQ-CT and ZBI scores. Conclusions This study demonstrates a relationship between hyperphagia and caregiver burden and sheds light on predominant symptoms in children and adolescents that likely underly PWS caregiver burden. The stability and relationship between HQ-CT and ZBI support ZBI as an additional outcome measure in PWS clinical trials.
Collapse
Affiliation(s)
- Nathalie Kayadjanian
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- * E-mail:
| | - Caroline Vrana-Diaz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Jessica Bohonowych
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Theresa V. Strong
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Genetics, University of Alabama, Birmingham, Alabama, United States of America
| | - Josée Morin
- Excelsus Statistics, Montreal, Quebec, Canada
| | | | - Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
9
|
Thomason MM, McCarthy J, Goin-Kochel RP, Dowell LR, Schaaf CP, Berry LN. Neurocognitive and Neurobehavioral Phenotype of Youth with Schaaf-Yang Syndrome. J Autism Dev Disord 2020; 50:2491-2500. [PMID: 30343463 DOI: 10.1007/s10803-018-3775-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Truncating variants of the MAGEL2 gene, one of the protein-coding genes within the Prader-Willi syndrome (PWS) critical region on chromosome 15q11, cause Schaaf-Yang syndrome (SYS)-a neurodevelopmental disorder that shares several clinical features with PWS. The current study sought to characterize the neurobehavioral phenotype of SYS in a sample of 9 patients with molecularly-confirmed SYS. Participants received an assessment of developmental/intellectual functioning, adaptive functioning, autism symptomatology, and behavioral/emotional functioning. Compared to individuals with PWS, patients with SYS manifested more severe cognitive deficits, no obsessions or compulsions, and increased rates of autism spectrum disorder.
Collapse
Affiliation(s)
- Molly Mishler Thomason
- Baylor College of Medicine, Houston, TX, USA.
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA.
| | - John McCarthy
- Baylor College of Medicine, Houston, TX, USA
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA
- John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Robin P Goin-Kochel
- Baylor College of Medicine, Houston, TX, USA
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA
- Institute of Human Genetics, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Lauren R Dowell
- Baylor College of Medicine, Houston, TX, USA
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA
| | - Christian P Schaaf
- Baylor College of Medicine, Houston, TX, USA
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA
- Institute of Human Genetics, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
- University of Cologne, Cologne, Germany
| | - Leandra N Berry
- Baylor College of Medicine, Houston, TX, USA
- Clinical Care Center - Psychology Service, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030-2608, USA
| |
Collapse
|
10
|
The RDoC approach for translational psychiatry: Could a genetic disorder with psychiatric symptoms help fill the matrix? the example of Prader-Willi syndrome. Transl Psychiatry 2020; 10:274. [PMID: 32772048 PMCID: PMC7415132 DOI: 10.1038/s41398-020-00964-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open
Abstract
The Research Domain Criteria project (RDoc) proposes a new classification system based on information from several fields in order to encourage translational perspectives. Nevertheless, integrating genetic markers into this classification has remained difficult because of the lack of powerful associations between targeted genes and RDoC domains. We hypothesized that genetic diseases with psychiatric manifestations would be good models for RDoC gene investigations and would thereby extend the translational approach to involve targeted gene pathways. To explore this possibility, we reviewed the current knowledge on Prader-Willi syndrome, a genetic disorder caused by the absence of expression of some of the genes of the chromosome 15q11-13 region inherited from the father. Indeed, we found that the associations between genes of the PW locus and the modification identified in the relevant behavioral, physiological, and brain imaging studies followed the structure of the RDoC matrix and its six domains (positive valence, negative valence, social processing, cognitive systems, arousal/regulatory systems, and sensorimotor systems).
Collapse
|
11
|
Food and Non-Food-Related Behavior across Settings in Children with Prader-Willi Syndrome. Genes (Basel) 2020; 11:genes11020204. [PMID: 32079283 PMCID: PMC7074075 DOI: 10.3390/genes11020204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/03/2022] Open
Abstract
This study sought to describe food- and non-food-related behaviors of children aged 3 to 18 years with Prader–Willi syndrome (PWS) in home and school settings, as assessed by 86 parents and 63 teachers using 7 subscales of the Global Assessment of Individual’s Behavior (GAIB). General Behavior Problem, Non-Food-Related Behavior Problem, and Non-Food-Related Obsessive Speech and Compulsive Behavior (OS/CB) scores did not differ significantly between parent and teacher reports. Food-Related Behavior Problem scores were higher in parent versus teacher reports when the mother had less than a college education (difference of 13.6 points, 95% Confidence Interval (CI) 5.1 to 22). Parents assigned higher Food-Related OS/CB scores than teachers (difference of 5.7 points, 95% CI 2.4 to 9.0). Although teachers reported fewer Food-Related OS/CB, they scored overall OS/CB higher for interfering with daily activities compared with parents (difference of 0.9 points, 95% CI 0.4 to 1.4). Understanding how behaviors manifest in home and school settings, and how they vary with socio-demographic and patient characteristics can help inform strategies to reduce behavior problems and improve outcomes.
Collapse
|
12
|
Holland AJ, Aman LC, Whittington JE. Defining Mental and Behavioural Disorders in Genetically Determined Neurodevelopmental Syndromes with Particular Reference to Prader-Willi Syndrome. Genes (Basel) 2019; 10:E1025. [PMID: 31835392 PMCID: PMC6947448 DOI: 10.3390/genes10121025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
Genetically determined neurodevelopmental syndromes are frequently associated with a particular developmental trajectory, and with a cognitive profile and increased propensity to specific mental and behavioural disorders that are particular to, but not necessarily unique to the syndrome. How should these mental and behavioural disorders best be conceptualised given that similar symptoms are included in the definition of different mental disorders as listed in DSM-5 and ICD-10? In addition, a different conceptual framework, that of applied behavioural analysis, has been used to inform interventions for what are termed 'challenging behaviours' in contrast to types of interventions for those conditions meeting diagnostic criteria for a 'mental disorder'. These syndrome-specific developmental profiles and associated co-morbidities must be a direct or indirect consequence of the genetic abnormality associated with that syndrome, but the genetic loci associated with the syndrome may not be involved in the aetiology of similar symptoms in the general population. This being so, should we expect underlying brain mechanisms and treatments for specific psychopathology in one group to be effective in the other? Using Prader-Willi syndrome as an example, we propose that the conceptual thinking that informed the development of the Research Domain Criteria provides a model for taxonomy of psychiatric and behavioural disorders in genetically determined neurodevelopmental syndromes. This model brings together diagnostic, psychological and developmental approaches with the aim of matching specific behaviours to identifiable neural mechanisms.
Collapse
Affiliation(s)
| | | | - Joyce E. Whittington
- Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK; (A.J.H.)
| |
Collapse
|
13
|
Adhikari A, Copping NA, Onaga B, Pride MC, Coulson RL, Yang M, Yasui DH, LaSalle JM, Silverman JL. Cognitive deficits in the Snord116 deletion mouse model for Prader-Willi syndrome. Neurobiol Learn Mem 2019; 165:106874. [PMID: 29800646 PMCID: PMC6520209 DOI: 10.1016/j.nlm.2018.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 01/12/2023]
Abstract
Prader-Willi syndrome (PWS) is an imprinted neurodevelopmental disease caused by a loss of paternal genes on chromosome 15q11-q13. It is characterized by cognitive impairments, developmental delay, sleep abnormalities, and hyperphagia often leading to obesity. Clinical research has shown that a lack of expression of SNORD116, a paternally expressed imprinted gene cluster that encodes multiple copies of a small nucleolar RNA (snoRNA) in both humans and mice, is most likely responsible for many PWS symptoms seen in humans. The majority of previous research using PWS preclinical models focused on characterization of the hyperphagic and metabolic phenotypes. However, a crucial understudied clinical phenotype is cognitive impairments and thus we investigated the learning and memory abilities using a model of PWS, with a heterozygous deletion in Snord116. We utilized the novel object recognition task, which doesn't require external motivation, or exhaustive swim training. Automated findings were further confirmed with manual scoring by a highly trained blinded investigator. We discovered deficits in Snord116+/- mutant mice in the novel object recognition, location memory and tone cue fear conditioning assays when compared to age-, sex- matched, littermate control Snord116+/+ mice. Further, we confirmed that despite physical neo-natal developmental delays, Snord116+/- mice had normal exploratory and motor abilities. These results show that the Snord116+/- deletion murine model is a valuable preclinical model for investigating learning and memory impairments in individuals with PWS without common confounding phenotypes.
Collapse
Affiliation(s)
- Anna Adhikari
- MIND Institute, University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
| | - Nycole A Copping
- MIND Institute, University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
| | - Beth Onaga
- MIND Institute, University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
| | - Michael C Pride
- MIND Institute, University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
| | - Rochelle L Coulson
- MIND Institute, Genome Center, UC Davis School of Medicine, Department of Medical Microbiology and Immunology, Davis, CA, USA
| | - Mu Yang
- Department of Psychiatry and Institute for Genomic Medicine, New York, NY, USA
| | - Dag H Yasui
- MIND Institute, Genome Center, UC Davis School of Medicine, Department of Medical Microbiology and Immunology, Davis, CA, USA
| | - Janine M LaSalle
- MIND Institute, Genome Center, UC Davis School of Medicine, Department of Medical Microbiology and Immunology, Davis, CA, USA
| | - Jill L Silverman
- MIND Institute, University of California, Davis School of Medicine, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA.
| |
Collapse
|
14
|
Babbs RK, Beierle JA, Ruan QT, Kelliher JC, Chen MM, Feng AX, Kirkpatrick SL, Benitez FA, Rodriguez FA, Pierre JJ, Anandakumar J, Kumar V, Mulligan MK, Bryant CD. Cyfip1 Haploinsufficiency Increases Compulsive-Like Behavior and Modulates Palatable Food Intake in Mice: Dependence on Cyfip2 Genetic Background, Parent-of Origin, and Sex. G3 (BETHESDA, MD.) 2019; 9:3009-3022. [PMID: 31324746 PMCID: PMC6723122 DOI: 10.1534/g3.119.400470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022]
Abstract
Binge eating (BE) is a heritable trait associated with eating disorders and involves episodes of rapid, large amounts of food consumption. We previously identified cytoplasmic FMR1-interacting protein 2 (Cyfip2) as a genetic factor underlying compulsive-like BE in mice. CYFIP2 is a homolog of CYFIP1 which is one of four paternally-deleted genes in patients with Type I Prader-Willi Syndrome (PWS), a neurodevelopmental disorder whereby 70% of cases involve paternal 15q11-q13 deletion. PWS symptoms include hyperphagia, obesity (if untreated), cognitive deficits, and obsessive-compulsive behaviors. We tested whether Cyfip1 haploinsufficiency (+/-) would enhance compulsive-like behavior and palatable food (PF) intake in a parental origin- and sex-dependent manner on two Cyfip2 genetic backgrounds, including the BE-prone C57BL/6N (Cyfip2N/N) background and the BE-resistant C57BL/6J (Cyfip2J/J) background. Cyfip1+/- mice showed increased compulsive-like behavior on both backgrounds and increased PF intake on the Cyfip2N/N background. In contrast, maternal Cyfip1 haploinsufficiency on the BE-resistant Cyfip2J/J background induced a robust escalation in PF intake in wild-type Cyfip1J/J males while having no effect in Cyfip1J/- males. Notably, induction of behavioral phenotypes in wild-type males following maternal Fmr1+/- has previously been reported. In the hypothalamus, there was a paternally-enhanced reduction in CYFIP1 protein whereas in the nucleus accumbens, there was a maternally-enhanced reduction in CYFIP1 protein. Nochange in FMR1 protein (FMRP) was observed in Cyfip1+/- mice, regardless of parental origin. To summarize, Cyfip1 haploinsufficiency increased compulsive-like behavior and induced genetic background-dependent, sex-dependent, and parent-of-origin-dependent effects on PF consumption and CYFIP1 expression that could have relevance for neurodevelopmental and neuropsychiatric disorders.
Collapse
Affiliation(s)
- Richard K Babbs
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Jacob A Beierle
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
- T32 NIGMS Training Program in Biomolecular Pharmacology
- Boston University's Transformative Training Program in Addiction Science (TTPAS), Biomedical Genetics, Boston University School of Medicine, Boston, MA 02118
| | - Qiu T Ruan
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
- T32 NIGMS Training Program in Biomolecular Pharmacology
- Boston University's Transformative Training Program in Addiction Science (TTPAS), Biomedical Genetics, Boston University School of Medicine, Boston, MA 02118
| | - Julia C Kelliher
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Melanie M Chen
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Ashley X Feng
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Stacey L Kirkpatrick
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Fabiola A Benitez
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Fred A Rodriguez
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Johanne J Pierre
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Jeya Anandakumar
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| | - Vivek Kumar
- The Jackson Laboratory, 600 Main St., Bar Harbor, ME 04609, and
| | - Megan K Mulligan
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, 71 S. Manassas St, Memphis, TN 38163
| | - Camron D Bryant
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry
| |
Collapse
|
15
|
Royston R, Oliver C, Moss J, Adams D, Berg K, Burbidge C, Howlin P, Nelson L, Stinton C, Waite J. Brief Report: Repetitive Behaviour Profiles in Williams syndrome: Cross Syndrome Comparisons with Prader-Willi and Down syndromes. J Autism Dev Disord 2019; 48:326-331. [PMID: 28980100 DOI: 10.1007/s10803-017-3319-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the profile of repetitive behaviour in individuals with Williams syndrome, utilising cross-syndrome comparisons with people with Prader-Willi and Down syndromes. The Repetitive Behaviour Questionnaire was administered to caregivers of adults with Williams (n = 96), Prader-Willi (n = 103) and Down (n = 78) syndromes. There were few group differences, although participants with Williams syndrome were more likely to show body stereotypies. Individuals with Williams syndrome also showed more hoarding and less tidying behaviours than those with Down syndrome. IQ and adaptive ability were negatively associated with repetitive questioning in people with Williams syndrome. The profile of repetitive behaviour amongst individuals with Williams syndrome was similar to the comparison syndromes. The cognitive mechanisms underlying these behaviours in genetic syndromes warrant further investigation.
Collapse
Affiliation(s)
- R Royston
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - C Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - J Moss
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Adams
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Griffith University, PO Box 3370, South Brisbane Qld 4101, Sidon Street, South Bank, QLD, Australia
| | - K Berg
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,School of Psychology, University of East London, AE 1.10, Stratford Campus, London, E15 4LZ, UK
| | - C Burbidge
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Coventry and Warwickshire Partnership NHS Trust, Wayside House, Wilsons Lane, Coventry, CV6 6NY, UK
| | - P Howlin
- Department of Psychology, King's College London, Strand, London, WC2R 2L, UK.,University of Sydney, Sydney, Australia
| | - L Nelson
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C Stinton
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,University of Warwick, Coventry, CV4 7AL, UK
| | - J Waite
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
16
|
Whittington J, Holland A. A review of psychiatric conceptions of mental and behavioural disorders in Prader-Willi syndrome. Neurosci Biobehav Rev 2018; 95:396-405. [DOI: 10.1016/j.neubiorev.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022]
|
17
|
Autistic, Aberrant, and Food-Related Behaviors in Adolescents and Young Adults with Prader-Willi Syndrome: The Effects of Age and Genotype. Behav Neurol 2018; 2017:4615451. [PMID: 29440778 PMCID: PMC5758853 DOI: 10.1155/2017/4615451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
The effects of age and genotype were examined, with regard to the severity of aberrant, autistic, and food-related behaviors in Prader-Willi syndrome (PWS), with an emphasis on the contrast between adolescents and young adults. The Aberrant Behavior Checklist Japanese version (ABC-J), the Food Related Problem Questionnaire (FRPQ), and the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) were administered to 65 PWS patients, including 20 adolescents (ages 12 to 17) and 45 young adults (ages 18 to 29). Significant differences (Mann-Whitney U tests) were found in ABC-J (p = 0.004) and PARS (p = 0.021), with lower scores in adolescents than in young adults. While DEL subgroups showed no significant differences between the two age groups in ABC-J (p = 0.063) and PARS (p = 0.134), mUPD subgroups showed a statistically significant difference in terms of ABC-J (p = 0.007). No significant differences were found between adolescents and young adults, in terms of FRPQ (p = 0.163). These results suggest that aberrant and autistic behaviors follow a marked worsening trend from around the age of 18. On the other hand, food-related behaviors give no sign of change at this transitory stage. Young adults with mUPD were found to be significantly more severe than adolescents with mUPD, in terms of aberrant behaviors.
Collapse
|
18
|
Ogata H, Ihara H, Gito M, Sayama M, Murakami N, Ayabe T, Oto Y, Nagai T, Shimoda K. Aberrant, autistic, and food-related behaviors in adults with Prader-Willi syndrome. The comparison between young adults and adults. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 73:126-134. [PMID: 29324255 DOI: 10.1016/j.ridd.2017.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
This study aims to explore the differences of age as well as genotype in regards to the severity of behavioral symptoms in Prader-Willi syndrome (PWS), with emphasis on the comparison between youngadults and adults.The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version (ABC-J), and the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) were administered to 46 PWS patients, including 33 young adults (ages 18-28) and 13 adults(ages 30-45). To examine the differences between young adults and adults, Mann-Whitney U tests were conducted. Statistically significant differences were found in ABC-J (p = .027) and PARS (p = .046), with higher scores in young adults than adults. Such differences between the two age groups were still true for the subgroups having a paternal chromosome 15q deletion (DEL) for ABC-J (p = .050) and part of PARS ("Problematic behavior"; p = .007). By contrast, there was no significant differences between young adults and adults regarding FRPQ (p = .65).These results suggest that aberrant behaviors decline from around the ages of thirty, in PWS patients in general and in DEL subgroups in particular, while food-related behaviors give no indication of diminishing in spite of developmental growth.
Collapse
Affiliation(s)
- Hiroyuki Ogata
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Ihara
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Masao Gito
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan; Department of Psychiatry, Ikezawa Hospital, Hanyu, Japan
| | - Masayuki Sayama
- Department of Psychiatry, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobuyuki Murakami
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tadayuki Ayabe
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yuji Oto
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|
19
|
Viaux-Savelon S, Rosenblum O, Guedeney A, Diene G, Çabal-Berthoumieu S, Fichaux-Bourin P, Molinas C, Faye S, Valette M, Bascoul C, Cohen D, Tauber M. Dyssynchrony and perinatal psychopathology impact of child disease on parents-child interactions, the paradigm of Prader Willi syndrom. ACTA ACUST UNITED AC 2017; 110:427-433. [PMID: 28823614 DOI: 10.1016/j.jphysparis.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Infant-mother interaction is a set of bidirectional processes, where the baby is not only affected by the influences of his caregiver, but is also at the origin of considerable modifications. The recent discovery of biological correlates of synchrony during interaction validated its crucial value during child development. Here, we focus on the paradigmatic case of Prader-Willi Syndrome (PWS) where early endocrinal dysfunction is associated with severe hypotonia and early feeding disorder. As a consequence, parent-infant interaction is impaired. In a recent study (Tauber et al., 2017), OXT intranasal infusion was able to partially reverse the feeding phenotype, infant's behavior and brain connectivity. This article details the interaction profile found during feeding in these dyads and their improvement after OXT treatment. METHODS Eighteen infants (≤6months) with PWS were recruited and hospitalized 9days in a French reference center for PWS where they were treated with a short course of intranasal OXT. Social withdrawal behavior and mother-infant interaction were assessed on videos of feeding before and after treatment using the Alarm Distress Baby (ADBB) Scale and the Coding Interactive Behavior (CIB) Scale. Raters were blind to treatment status. RESULTS At baseline, infants with PWS showed hypotonia, low expressiveness of affects, fatigability and poor involvement in the relationship with severe withdrawal. Parents tended to adapt to their child difficulties, but the interaction was perturbed, tense, restricted and frequently intrusive with a forcing component during the feeding situation. After OXT treatment, infants were more alert, less fatigable, more expressive, and had less social withdrawal. They initiated mutual activities and were more engaged in relationships through gaze, behavior, and vocalizations. They had a better global tonicity with better handling. These modifications helped the parents to be more sensitive and the synchrony of the dyad was in a positive transactional spiral. CONCLUSION Dys-synchrony can be induced by children's pathology as well as parental pathology with emotional and developmental impact in the both cases. The PWS paradigm shows us the necessity to sustain early parents-child relationship to avoid establishment of a negative transactional pattern of interaction that can impact child's development.
Collapse
Affiliation(s)
- Sylvie Viaux-Savelon
- Departement of Child and Adolescent Psychiatry, AP-HP, Universtity Hospital Pitie Salpetriere, Paris, France; Institut des Systemes Intelligents et de Robotiques, CNRS, UMR 7222, University Paris 6, Pierre et Marie Curie, Paris, France.
| | - Ouriel Rosenblum
- Departement of Child and Adolescent Psychiatry, AP-HP, Universtity Hospital Pitie Salpetriere, Paris, France
| | - Antoine Guedeney
- Department of Child and Adolescent Psychiatry, University Hospital Bichat Claude Bernard, APHP, University Paris 7, Paris, France; Research Unit, INSERM U669 PSYGIAM, Paris, France
| | - Gwenaelle Diene
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; INSERM UMR 1027-Université Toulouse III Hôpital Paule de Viguier, Toulouse, France
| | - Sophie Çabal-Berthoumieu
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital des Enfants, Toulouse, France
| | - Pascale Fichaux-Bourin
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | - Catherine Molinas
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Axe Pédiatrique du CIC 9302/INSERM, Hôpital des Enfants, Toulouse, France; INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, UPS, France
| | - Sandy Faye
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Axe Pédiatrique du CIC 9302/INSERM, Hôpital des Enfants, Toulouse, France
| | - Marion Valette
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Axe Pédiatrique du CIC 9302/INSERM, Hôpital des Enfants, Toulouse, France
| | - Céline Bascoul
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital des Enfants, Toulouse, France
| | - David Cohen
- Departement of Child and Adolescent Psychiatry, AP-HP, Universtity Hospital Pitie Salpetriere, Paris, France; Institut des Systemes Intelligents et de Robotiques, CNRS, UMR 7222, University Paris 6, Pierre et Marie Curie, Paris, France
| | - Maïthé Tauber
- Unité d'Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale, Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Axe Pédiatrique du CIC 9302/INSERM, Hôpital des Enfants, Toulouse, France; INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, UPS, France
| |
Collapse
|
20
|
Dykens EM, Roof E, Hunt-Hawkins H, Dankner N, Lee EB, Shivers CM, Daniell C, Kim SJ. Diagnoses and characteristics of autism spectrum disorders in children with Prader-Willi syndrome. J Neurodev Disord 2017; 9:18. [PMID: 28592997 PMCID: PMC5458479 DOI: 10.1186/s11689-017-9200-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A small percentage of people with autism spectrum disorders (ASD) have alterations in chromosome 15q11.2-q3, the critical region for Prader-Willi syndrome (PWS). Data are limited, however, on the rates and characteristics of ASD in PWS. Previous estimates of ASD in PWS (25 to 41%) are questionable as they are based solely on autism screeners given to parents. Inaccurate diagnoses of ASD in PWS can mislead intervention and future research. METHODS One hundred forty-six children and youth with PWS aged 4 to 21 years (M = 11) were assessed with the Autism Diagnostic Observation Schedule-2 (ADOS-2). An expert clinical team-made best-estimate ASD diagnoses based on ADOS-2 videotapes, calibrated severity scores, and children's developmental histories and indices of current functioning. Children were also administered the Kaufman Brief Intelligence Test-2, and parents completed the Repetitive Behavior Scale-Revised and Vineland Adaptive Behavior Scales. Scores were compared across children with PWS + ASD versus PWS only. The performance of an ASD screener, the Social Communication Questionnaire (SCQ) and the ADOS-2 were evaluated in relation to best-estimate diagnoses. RESULTS Best-estimate diagnoses of ASD were made in 18 children, or 12.3% of the sample, and the majority of them had the maternal uniparental disomy (mUPD) PWS genetic subtype. Compared to the PWS-only group, children with PWS + ASD had lower verbal and composite IQ's and adaptive daily living and socialization skills, as well as elevated stereotypies and restricted interests. Regardless of ASD status, compulsivity and insistence on sameness in routines or events were seen in 76-100% of children and were robustly correlated with lower adaptive functioning. The SCQ yielded a 29-49% chance that screen-positive cases will indeed have ASD. The ADOS-2 had higher sensitivity, specificity and predictive values. Communication problems were seen in children who were ADOS-2 positive but deemed not to have ASD by the clinical team. CONCLUSIONS Autism screeners should not be the sole index of probable ASD in PWS; children need to be directly observed and evaluated. Compulsivity and insistence on sameness are salient in PWS and likely impede adaptive functioning. Most children with PWS only evidenced sub-threshold problems in social interactions that could signal risks for other psychopathologies.
Collapse
Affiliation(s)
- Elisabeth M Dykens
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Elizabeth Roof
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Hailee Hunt-Hawkins
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Nathan Dankner
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Evon Batey Lee
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Carolyn M Shivers
- Department of Human Development, Virginia Polytechnic Institute and State University, 366 Wallace Hall, Blacksburg, VA 24061 USA
| | - Christopher Daniell
- Departments of Psychology and Human Development, Psychiatry and Pediatrics, One Magnolia Circle, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN 37203 USA
| | - Soo-Jeong Kim
- Department of Psychiatry and Behavioral Science, University of Washington, 4909 25th Ave NE, Seattle, WA 98105 USA
| |
Collapse
|
21
|
Shriki-Tal L, Avrahamy H, Pollak Y, Gross-Tsur V, Genstil L, Hirsch HJ, Benarroch F. Psychiatric disorders in a cohort of individuals with Prader-Willi syndrome. Eur Psychiatry 2017; 44:47-52. [PMID: 28545008 DOI: 10.1016/j.eurpsy.2017.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Psychiatric manifestations in Prader-Willi Syndrome (PWS) are common and often are the most debilitating problem in these individuals. We present an epidemiological nation-wide survey of psychiatric diagnoses in the PWS population, based on full-range psychiatric interviews. METHODS We studied the distribution of psychiatric diagnoses (as opposed to a symptom-based approach) in the Israel national cohort of adolescents and adults with PWS. There was a total of 53 (32 males) ages 12 years and older. All individuals and their caretakers were interviewed using standardized psychiatric questionnaires. Demographic and clinical variables, Clinical Global Impression (CGI) score, IQ, severity of hyperphagia and quality of life (QOL) were also assessed and correlations with NPD (number of psychiatric diagnoses) calculated. RESULTS An overwhelming majority (89%) of the study participants had at least one psychiatric diagnosis. The most common were disruptive behavior disorders (DBD) (68%), obsessive compulsive disorder (OCD) (45%) and skin picking (35%). Individuals with DBD were at increased risk for OCD and skin picking. Psychotic disorders were found in 11%. NPD had a significant negative influence on QOL. There was no correlation between NPD and BMI, IQ, hyperphagia severity, hormonal profile or genetic subtypes. CONCLUSIONS Psychiatric diagnoses are very frequent in PWS and strongly influence QOL. Furthermore, characterizing the profile of psychiatric comorbidity in PWS is crucial for planning effective interventions. Precise behavioral phenotyping in PWS in combination with a well-defined genetic etiology may aid biological research linking biological correlates to behavior.
Collapse
Affiliation(s)
- L Shriki-Tal
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel; Beer-Yaacov Nes-Ziona Mental Health Center, POB 1, 74100 Nes-Ziona, Israel
| | - H Avrahamy
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel
| | - Y Pollak
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel; School of Education, The Hebrew University of Jerusalem, Mount Scopus, 91905 Jerusalem, Israel
| | - V Gross-Tsur
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel; School of Education, The Hebrew University of Jerusalem, Mount Scopus, 91905 Jerusalem, Israel
| | - L Genstil
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel
| | - H J Hirsch
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel
| | - F Benarroch
- PWS Multidisciplinary Clinic, Child Neurology Unit, Shaare Zedek Medical Center, POB 3235, 9103102 Jerusalem, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, POB 24035, Mount Scopus, 91240 Jerusalem, Israel.
| |
Collapse
|
22
|
Abstract
The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoarding disorder as a distinct diagnosis in youth, and review the relationship between pediatric hoarding and other psychiatric disorders. Finally, we describe preliminary models of treatment for pediatric hoarding. We conclude that there is support for hoarding disorder as a distinct diagnosis in youth. However, more precise and developmentally appropriate assessment tools are needed to provide stronger evidence for this claim and to further our knowledge of prevalence and associated clinical characteristics. Although there is no evidence-based treatment for pediatric hoarding, preliminary evidence from case studies suggests that cognitive and behavioral methods may have promise.
Collapse
|
23
|
Salles J, Strelnikov K, Carine M, Denise T, Laurier V, Molinas C, Tauber M, Barone P. Deficits in voice and multisensory processing in patients with Prader-Willi syndrome. Neuropsychologia 2016; 85:137-47. [PMID: 26994593 DOI: 10.1016/j.neuropsychologia.2016.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental and genetic disorder that is characterized by various expression of endocrine, cognitive and behavioral problems, among which a true obsession for food and a deficit of satiety that leads to hyperphagia and severe obesity. Neuropsychological studies have reported that PWS display altered social interactions with a specific weakness in interpreting social information and in responding to them, a symptom closed to that observed in autism spectrum disorders (ASD). Based on the hypothesis that atypical multisensory integration such as face and voice interactions would contribute in PWS to social impairment we investigate the abilities of PWS to process communication signals including the human voice. Patients with PWS recruited from the national reference center for PWS performed a simple detection task of stimuli presented in an uni-o or bimodal condition, as well as a voice discrimination task. Compared to control typically developing (TD) individuals, PWS present a specific deficit in discriminating human voices from environmental sounds. Further, PWS present a much lower multisensory benefits with an absence of violation of the race model indicating that multisensory information do not converge and interact prior to the initiation of the behavioral response. All the deficits observed in PWS were stronger for the subgroup of patients suffering from Uniparental Disomy, a population known to be more sensitive to ASD. Altogether, our study suggests that the deficits in social behavior observed in PWS derive at least partly from an impairment in deciphering the social information carried by voice signals, face signals, and the combination of both. In addition, our work is in agreement with the brain imaging studies revealing an alteration in PWS of the "social brain network" including the STS region involved in processing human voices.
Collapse
Affiliation(s)
- Juliette Salles
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France; Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Service de psychiatrie et psychologie médicale, Hôpital de psychiatrie, Toulouse, France
| | - Kuzma Strelnikov
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France
| | - Mantoulan Carine
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | | | | | - Catherine Molinas
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | - Maïthé Tauber
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; INSERM, Centre de Physiopathologie de Toulouse-Purpan UMR 1043 3, Toulouse, France
| | - Pascal Barone
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France.
| |
Collapse
|
24
|
Romano A, Tempesta B, Micioni Di Bonaventura MV, Gaetani S. From Autism to Eating Disorders and More: The Role of Oxytocin in Neuropsychiatric Disorders. Front Neurosci 2016; 9:497. [PMID: 26793046 PMCID: PMC4709851 DOI: 10.3389/fnins.2015.00497] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/14/2015] [Indexed: 11/13/2022] Open
Abstract
Oxytocin (oxy) is a pituitary neuropeptide hormone synthesized from the paraventricular and supraoptic nuclei within the hypothalamus. Like other neuropeptides, oxy can modulate a wide range of neurotransmitter and neuromodulator activities. Additionally, through the neurohypophysis, oxy is secreted into the systemic circulation to act as a hormone, thereby influencing several body functions. Oxy plays a pivotal role in parturition, milk let-down and maternal behavior and has been demonstrated to be important in the formation of pair bonding between mother and infants as well as in mating pairs. Furthermore, oxy has been proven to play a key role in the regulation of several behaviors associated with neuropsychiatric disorders, including social interactions, social memory response to social stimuli, decision-making in the context of social interactions, feeding behavior, emotional reactivity, etc. An increasing body of evidence suggests that deregulations of the oxytocinergic system might be involved in the pathophysiology of certain neuropsychiatric disorders such as autism, eating disorders, schizophrenia, mood, and anxiety disorders. The potential use of oxy in these mental health disorders is attracting growing interest since numerous beneficial properties are ascribed to this neuropeptide. The present manuscript will review the existing findings on the role played by oxy in a variety of distinct physiological and behavioral functions (Figure 1) and on its role and impact in different psychiatric disorders. The aim of this review is to highlight the need of further investigations on this target that might contribute to the development of novel more efficacious therapies.
Oxytocin regulatory control of different and complex processes. ![]()
Collapse
Affiliation(s)
- Adele Romano
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome Rome, Italy
| | - Bianca Tempesta
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome Rome, Italy
| | | | - Silvana Gaetani
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome Rome, Italy
| |
Collapse
|
25
|
Griggs JL, Su XQ, Mathai ML. Caralluma Fimbriata Supplementation Improves the Appetite Behavior of Children and Adolescents with Prader-Willi Syndrome. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:509-16. [PMID: 26713299 PMCID: PMC4683806 DOI: 10.4103/1947-2714.170611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Prader-Willi syndrome (PWS) results from a deletion of the paternal genes in the region of chromosome 15q11-q13. PWS develops hyperphagia, which when left unmanaged, leads to an excessive ingestion of food. To date there is inadequate pharmacological treatment or supplementation for modification of the PWS hyperphagia and/or the associated behaviors. Therefore, the best practice is familial supervision and restriction of diet and environment. Aim: We aimed to determine if the natural supplement of Caralluma fimbriata extract (CFE) could attenuate hyperphagia or the associated appetite behaviors in children and adolescents with PWS over the 4-week pilot trial period. Materials and Methods: We conducted a placebo-controlled, double-blind, randomized crossover trial over a 10-week period to investigate the effects of CFE on hunger control, in a cohort of children and adolescents with confirmed PWS (n =15, mean age 9.27 ± 3.16 years, body weight 43.98 ± 23.99 kg). Participants from Australia and New Zealand ingested CFE or a placebo of maltodextrin/cabbage leaf over a 4-week period, with a 2-week washout before the crossover to the other treatment. Weekly comparisons in appetite behavior, severity, and drive were recorded by parents, as scaled time-point measures on a hyperphagia questionnaire validated for PWS. Results: CFE administration was found to induce a significant accumulative easing of hyperphagia (P = 0.05), with decreases evident in one-third of the participants. Furthermore due to CFE supplementation, a significant decrease (P ≤ 0.05) was recorded in the category of behavior and a decrease in hyperphagia (n = 8, P = 0.009) was observed at the highest dose 1,000 mg/day (recommended adult dose). There were no reported adverse effects at any dose. Conclusion: We demonstrate that an extract of the Indian cactus succulent Caralluma fimbriata eases hyperphagic appetite behavior within a cohort of children and adolescents (n = 15) with PWS without notable adverse effects. The outcomes of this study will have a potential positive impact on PWS management.
Collapse
Affiliation(s)
- Joanne L Griggs
- Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Xiao Q Su
- Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Michael L Mathai
- Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Griggs JL, Sinnayah P, Mathai ML. Prader–Willi syndrome: From genetics to behaviour, with special focus on appetite treatments. Neurosci Biobehav Rev 2015; 59:155-72. [DOI: 10.1016/j.neubiorev.2015.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 12/22/2022]
|
27
|
Johnson L, Manzardo AM, Miller JL, Driscoll DJ, Butler MG. Elevated plasma oxytocin levels in children with Prader-Willi syndrome compared with healthy unrelated siblings. Am J Med Genet A 2015; 170:594-601. [PMID: 26615966 DOI: 10.1002/ajmg.a.37488] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder associated with distinct abnormal behaviors including hyperphagia, profound social deficits, and obsessive-compulsive tendencies. PWS males showed reduced oxytocin receptor (OTR) gene expression and density in the hypothalamic paraventricular nucleus that may play a role in PWS psychopathology. Oxytocin is an anorexigenic neuropeptide similar to vasopressin that is associated with social cognition and obsessive-compulsive behavior. To evaluate oxytocin biology in PWS, we examined overnight fasting plasma oxytocin levels in 23 children with PWS (mean ± SD age: 8.2 ± 2.0 year) having genetic confirmation and 18 age matched healthy unrelated siblings without PWS (mean ± SD age: 8.2 ± 2.3 year) and a similar gender ratio under the same clinical assessments, specimen processing and laboratory conditions. Multiplex immune assays were carried out using the Milliplex Human Neuropeptide Magnetic panel and the Luminex system. Natural log-transformed oxytocin levels were analyzed using general linear model adjusting for diagnosis, gender, age and body mass index (BMI). Oxytocin plasma levels were significantly elevated in children with PWS (168 ± 121 pg/ml) compared with unrelated and unaffected siblings without the diagnosis of PWS (64.8 ± 83.8 pg/ml, F = 8.8, P < 0.01) and the diagnosis of PWS predicted oxytocin level (F = 9.5, P < 0.003) in controlled regression analysis with an overall model fit R(2) = 0.33 (P < 0.01). The symptoms of hyperphagia, anxiety and repetitive behaviors classically seen in PWS may be related to the disruption of oxytocin responsivity or feedback in the hypothalamic paraventricular nucleus possibly influencing vasopressin signaling. Further study is needed to characterize oxytocin function in PWS.
Collapse
Affiliation(s)
- Lisa Johnson
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Ann M Manzardo
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida Medical Center, Gainesville, Florida
| | - Daniel J Driscoll
- Department of Pediatrics, University of Florida Medical Center, Gainesville, Florida
| | - Merlin G Butler
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
28
|
Gender Differences in the Behavioral Symptom Severity of Prader-Willi Syndrome. Behav Neurol 2015; 2015:294127. [PMID: 26633919 PMCID: PMC4655018 DOI: 10.1155/2015/294127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/20/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives. This study measured gender differences in Prader-Willi syndrome (PWS) in regard to the severity of behavioral symptoms. Methods. The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version, the Childhood Routines Inventory, the Pervasive Developmental Disorders Autism Society Japan Rating Scale, and Japanese ADHD-RS were administered to PWS patients (45 males aged 6 to 58 and 37 females aged 6 to 45). To examine the effects that gender and genotype have on the severity of each symptom, two-way ANOVAs were conducted. Results. Significant interactions were found only in regard to FRPQ scores, such as FRPQ total score (F(1, 78) = 8.43, p < 0.01). The FRPQ of male deletion (DEL) individuals was higher than that of female DEL and male mUPD. The FRPQ of male maternal uniparental disomy (mUPD) was lower than that of female mUPD. Conclusions. In terms of problem behaviors, routines, autistic behaviors, and hyperactivity, no significant differences were found. Food-related behaviors in DEL were more severe in males, although those in mUPD were less severe in males.
Collapse
|
29
|
Behavior in children with Prader-Willi syndrome before and during growth hormone treatment: a randomized controlled trial and 8-year longitudinal study. Eur Child Adolesc Psychiatry 2015; 24:1091-101. [PMID: 25522840 DOI: 10.1007/s00787-014-0662-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
Information on behavior of children with Prader-Willi syndrome (PWS) and the effect of growth hormone (GH) treatment is scarce. Parents report less problem behavior during GH treatment. Forty-two pre-pubertal children, aged 3.5-14 years were studied in a randomized controlled GH trial (RCT) during 2 years, followed by a longitudinal study during 8 years of GH treatment. Behavior was measured annually by the Developmental Behavior Checklist for children with intellectual disability (DBC) and a Dutch questionnaire to evaluate social behavioral problems in children, the Children's Social Behavior Questionnaire (CSBQ). Problem behavior measured by the DBC in children with PWS was similar compared to peers with comparable intellectual disability. Scores on 'Social disabilities' subscale were however significantly higher compared to the DBC total score (p < 0.01). A lower IQ was associated with more self-absorbed behavior, more communication problems and more problem behavior in general. Problem behavior measured by the CSBQ was similar compared to peers with a comparable intellectual disability, but children with PWS scored significantly higher on the 'Not tuned', 'Understanding', and 'Stereotyped' subscales than the CSBQ total score (p < 0.05 for all subscales and p = 0.001 for the 'Not tuned'-subscale). There were no significant effects of GH treatment during the RCT and 8 years of GH treatment. Children with PWS showed similar problem behavior as a reference population with a comparable intellectual disability. Social problems were the most pronounced within-problem behavior in PWS. In contrast to our expectations and parents reports, our study shows no improvement but also no deterioration of behavioral problems in children with PWS during long-term GH treatment.
Collapse
|
30
|
Avrahamy H, Pollak Y, Shriki-Tal L, Genstil L, Hirsch HJ, Gross-Tsur V, Benarroch F. A disease specific questionnaire for assessing behavior in individuals with Prader-Willi syndrome. Compr Psychiatry 2015; 58:189-97. [PMID: 25677112 DOI: 10.1016/j.comppsych.2014.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/05/2014] [Accepted: 12/23/2014] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Prader-Willi syndrome (PWS) is a genetic multisystem disorder with various medical, cognitive, behavioral and psychiatric problems. PWS is caused by the lack of expression of paternal genes on chromosome 15q2-q13 due to a deletion (70-75%), uniparental disomy (25-30%) or imprinting center defect (<5%). The common PWS behavioral and psychiatric characteristics are very typical in all ethnicities and were reported worldwide. Still, each individual has a specific profile of these common traits and the severity of his or her symptoms varies over time. Behavioral problems are the most important factor affecting the quality of life of both the individuals and their families. There is a need for a standardized tool to assess the specific behavioral profile of each individual and its present severity, in order to enable physicians to tailor the specific treatment needed and assist in a more accurate clinical follow up. To the best of our knowledge no such a tool has been standardized and published. We developed, based on the literature (mainly Forster and Gourash's paradigm) and our clinical experience, a 37 item disease specific questionnaire, the "PWS Behavioral Questionnaire" (PWSBQ) for assessing behavior in PWS patients. The purpose of the present study was to validate this tool in the entire adolescent and adult PWS population in Israel. METHODS The PWSBQ focuses on five major domains-abnormal emotional regulation, food-seeking related behavior, lack of flexibility, oppositional behavior and interpersonal problems and lastly body related behaviors. Caregivers of all Hebrew speaking individuals with PWS over the age of 12 years attending the Israeli national multidisciplinary PWS clinic were recruited. Of the 54 eligible individuals, 53 participated. They were interviewed with the PWSBQ and in addition filled the "Hyperphagia Questionnaire" and the "Child Behavioral Checklist" (CBCL). After verifying the questionnaire's content validity, all items on the PWSBQ were analyzed for internal reliability by calculating Cronbach's α. Criterion validity was evaluated by correlation testing with regard to the Hyperphagia Questionnaire and CBCL. In order to assess the questionnaire's interpretability, the correlation between the PWSBQ and the "Clinical Global Impression" (CGI) scores was evaluated. RESULTS The PWSBQ total score was positively correlated with both the CBCL total score and the CGI score (0.662 and 0.549, p<0.001 respectively). Of the five domains, four had acceptable internal reliability (excluding the body related behaviors domain, which was thus removed from the total score). Criterion validity was established for the four domains remaining in the statistical analysis (abnormal emotional regulation, food seeking related behavior, lack of flexibility and oppositional behavior and interpersonal problems). CONCLUSIONS Our findings suggest that the PWSBQ is a valid and reliable tool for the assessment of current behavioral problems among individuals with PWS. Although further research is needed in order to verify PWSBQ's ability to identify changes in the behavioral status of a given individual, it can now be used both in research and in a clinical setting, enabling the physician to plan the most suitable treatment based on the current behavioral status.
Collapse
Affiliation(s)
- Hamutal Avrahamy
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel.
| | - Yehuda Pollak
- School of Education, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel.
| | - Liron Shriki-Tal
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel; Beer-Yaacov Nes-Ziona Mental Health Center, POB 1, Nes-Ziona 74100, Israel.
| | - Larry Genstil
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel.
| | - Harry J Hirsch
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel.
| | - Varda Gross-Tsur
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel.
| | - Fortu Benarroch
- PWS Multidisciplinary Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem 9103102, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, POB 24035, Mount Scopus, Jerusalem 91240, Israel.
| |
Collapse
|
31
|
Foti F, Menghini D, Petrosini L, Vicari S, Valerio G, Orlandi E, Crinò A, Spera S, De Bartolo P, Mandolesi L. Explorative function in Prader-Willi syndrome analyzed through an ecological spatial task. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:97-107. [PMID: 25575283 DOI: 10.1016/j.ridd.2014.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/28/2014] [Indexed: 06/04/2023]
Abstract
This study was aimed at evaluating the spatial abilities in individuals with Prader-Willi syndrome (PWS) by using an ecological large-scale task with multiple rewards. To evaluate the extent of spatial deficit in PWS individuals, we compare their performances with those of individuals with Williams Syndrome (WS) in which the spatial deficits have been widely described. Participants had to explore an open space to search nine rewards placed in buckets arranged according to three spatial configurations: a Cross, a 3×3 Matrix and a Cluster composed by three groups of three buckets each. PWS individuals exhibited an explorative deficit in Cluster and Cross configurations, while WS participants in Matrix and Cross configurations. The findings indicate that the structural affordances of the environment influence the explorative strategies and can be related to how spatial information is processed.
Collapse
Affiliation(s)
- F Foti
- Department of Psychology, University "Sapienza", Via dei Marsi 78, 00185 Rome, Italy; IRCCS Santa Lucia Foundation (CERC), Via del Fosso di Fiorano 65, 00143 Rome, Italy
| | - D Menghini
- Child Neuropsychiatry Unit, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - L Petrosini
- Department of Psychology, University "Sapienza", Via dei Marsi 78, 00185 Rome, Italy; IRCCS Santa Lucia Foundation (CERC), Via del Fosso di Fiorano 65, 00143 Rome, Italy
| | - S Vicari
- Child Neuropsychiatry Unit, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - G Valerio
- Department of Motor Science and Wellness, University "Parthenope", Via Medina 40, 80133 Naples, Italy
| | - E Orlandi
- Child Neuropsychiatry Unit, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - A Crinò
- Pediatric and Autoimmune Endocrine Disease Unit, "Children's Hospital Bambino Gesù", Via Torre di Palidoro, 00050 Fiumicino (Rome), Italy
| | - S Spera
- Pediatric and Autoimmune Endocrine Disease Unit, "Children's Hospital Bambino Gesù", Via Torre di Palidoro, 00050 Fiumicino (Rome), Italy
| | - P De Bartolo
- IRCCS Santa Lucia Foundation (CERC), Via del Fosso di Fiorano 65, 00143 Rome, Italy; Faculty of Formation Science, University "Guglielmo Marconi", Via Plinio 44, 00193 Rome, Italy
| | - L Mandolesi
- IRCCS Santa Lucia Foundation (CERC), Via del Fosso di Fiorano 65, 00143 Rome, Italy; Department of Motor Science and Wellness, University "Parthenope", Via Medina 40, 80133 Naples, Italy.
| |
Collapse
|
32
|
Are Angelman and Prader-Willi syndromes more similar than we thought? Food-related behavior problems in Angelman, Cornelia de Lange, Fragile X, Prader-Willi and 1p36 deletion syndromes. Am J Med Genet A 2015; 167A:572-8. [DOI: 10.1002/ajmg.a.36923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/21/2014] [Indexed: 11/07/2022]
|
33
|
Dykens EM. Leisure activities in Prader-Wili syndrome: implications for health, cognition and adaptive functioning. J Autism Dev Disord 2014; 44:294-302. [PMID: 22484792 DOI: 10.1007/s10803-012-1462-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although hyperphagia and compulsivity in Prader-Willi syndrome (PWS) are well described, recreation and adaptive skills are relatively unexplored. Parents of 123 participants with PWS (4-48 years) completed measures of their child's adaptive, recreation, and problem behaviors. Offspring received cognitive testing. Watching TV was the most frequent recreational activity, and was associated with compulsivity and skin picking. BMIs were negatively correlated with physical play, and highest in those who watched TV and played computer games. Computer games and physical activities were associated with higher IQ and adaptive scores. People with PWS and other disabilities need to watch less TV and be more engaged in physical activities, games, and leisure pursuits that are fun, and may bring cognitive or adaptive advantages.
Collapse
Affiliation(s)
- Elisabeth M Dykens
- Departments of Psychology and Human Development, Pediatrics and Psychiatry, Vanderbilt Kennedy Center, Vanderbilt University, 230 Appleton Place, Peabody Box 40, Nashville, TN, 37203, USA,
| |
Collapse
|
34
|
Song DK, Sawada M, Yokota S, Kuroda K, Uenishi H, Kanazawa T, Ogata H, Ihara H, Nagai T, Shimoda K. Comparative analysis of autistic traits and behavioral disorders in Prader-Willi syndrome and Asperger disorder. Am J Med Genet A 2014; 167A:64-8. [DOI: 10.1002/ajmg.a.36787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 08/22/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Dae Kwang Song
- Department of Psychiatry; Dokkyo Medical University, School of Medicine; Tochigi Japan
- Hannan Hospital; Osaka Japan
| | | | | | | | - Hiroyuki Uenishi
- Clinical Psychology Counseling Room; Kansai University; Osaka Japan
| | | | - Hiroyuki Ogata
- Department of Psychiatry; Dokkyo Medical University, Koshigaya Hospital; Saitama Japan
| | - Hiroshi Ihara
- Department of Psychiatry; Dokkyo Medical University, Koshigaya Hospital; Saitama Japan
| | - Toshiro Nagai
- Department of Pediatrics; Dokkyo Medical University, Koshigaya Hospital; Saitama Japan
| | - Kazutaka Shimoda
- Department of Psychiatry; Dokkyo Medical University, School of Medicine; Tochigi Japan
| |
Collapse
|
35
|
Einfeld SL, Smith E, McGregor IS, Steinbeck K, Taffe J, Rice LJ, Horstead SK, Rogers N, Hodge MA, Guastella AJ. A double-blind randomized controlled trial of oxytocin nasal spray in Prader Willi syndrome. Am J Med Genet A 2014; 164A:2232-9. [DOI: 10.1002/ajmg.a.36653] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/28/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Stewart L. Einfeld
- Centre for Disability Research and Policy; University of Sydney; Sydney New South Wales Australia
- Faculty of Health Sciences; University of Sydney; Sydney New South Wales Australia
- Brain and Mind Research Institute; University of Sydney; Sydney New South Wales Australia
| | - Ellie Smith
- Children's Hospital at Westmead Clinical School; University of Sydney; Sydney New South Wales Australia
| | - Iain S. McGregor
- School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Kate Steinbeck
- The Discipline of Pediatrics and Child Health University of Sydney; Sydney New South Wales Australia
- The Academic Department of Adolescent Medicine; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - John Taffe
- Centre for Developmental Psychiatry and Psychology; Department of Psychiatry; School of Clinical Sciences; Monash University; Melbourne Victoria Australia
| | - Lauren J. Rice
- Faculty of Health Sciences; University of Sydney; Sydney New South Wales Australia
- Brain and Mind Research Institute; University of Sydney; Sydney New South Wales Australia
| | - Siân K. Horstead
- Faculty of Health Sciences; University of Sydney; Sydney New South Wales Australia
- Brain and Mind Research Institute; University of Sydney; Sydney New South Wales Australia
| | - Naomi Rogers
- Concord Centre for Cardiometabolic Health in Psychosis, Concord Medical School; University of Sydney; Sydney New South Wales Australia
| | - M. Antoinette Hodge
- Children's Hospital at Westmead Clinical School; University of Sydney; Sydney New South Wales Australia
| | - Adam J. Guastella
- Brain and Mind Research Institute; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
36
|
Miller JL, Angulo M. An open-label pilot study of N-acetylcysteine for skin-picking in Prader-Willi syndrome. Am J Med Genet A 2013; 164A:421-4. [PMID: 24311388 DOI: 10.1002/ajmg.a.36306] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/26/2013] [Indexed: 12/22/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder caused by an abnormality on the long arm of chromosome 15 (q11-q13) that results in a host of behavioral characteristics including excessive interest in food, skin picking, difficulty with a change in routine, and obsessive and compulsive behaviors. Skin-picking can result in serious and potentially life-threatening infections. Recent evidence suggests that the excitatory neurotransmitter glutamate is dysregulated in obsessive-compulsive behaviors, and modulation of the glutaminergic pathway may decrease compulsive behaviors, such as recurrent hair pulling or skin-picking behaviors. N-acetylcysteine (NAC), a derivative of the amino acid cysteine, is thought to act either via modulation of NMDA glutamate receptors or by increasing glutathione in pilot studies. Thirty-five individuals with confirmed PWS (ages 5-39 years, 23 females/12 males) and skin-picking behavior for more than 1 year were treated with N-acetylcysteine (Pharma-NAC®) at a dose of 450-1,200 mg/day. Skin-picking symptoms and open lesions were assessed after 12 weeks of treatment by counting and measuring lesions before and after the medication. All 35 individuals had improvement in skin-picking behaviors. Ten (29%) individuals (six males and four females) did not have complete resolution of skin-picking behavior, but had significant reduction in the number of active lesions. Longer-term, placebo-controlled trials are needed to further assess the potential benefit of this treatment.
Collapse
Affiliation(s)
- Jennifer L Miller
- Department of Pediatrics-Endocrinology, University of Florida, Gainsville, Florida
| | | |
Collapse
|
37
|
Hustyi KM, Hammond JL, Rezvani AB, Hall SS. An analysis of the topography, severity, potential sources of reinforcement, and treatments utilized for skin picking in Prader-Willi syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2890-2899. [PMID: 23810929 DOI: 10.1016/j.ridd.2013.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 06/02/2023]
Abstract
We examined the topography, severity, potential sources of reinforcement, and treatments utilized for skin-picking behavior shown by individuals with Prader-Willi syndrome (PWS). The parents of 55 individuals with PWS, aged 6-25 years, were interviewed about their child's skin-picking behavior using the Self-Injury Trauma Scale (SIT; Iwata, Pace, Kissel, Nau, & Farber, 1990) and the Functional Analysis Screening Tool (FAST; Iwata, DeLeon, & Roscoe, 2013). Results showed that skin picking in PWS occurred on the extremities (i.e., arms, legs, hands, and feet) for 75% of cases and resulted in bodily injury for 83.7% cases. Skin picking posed a high risk to the individual concerned in 41.8% of cases. Automatic sensory stimulation was identified as a potential source of reinforcement in the majority of cases (52.7%) followed by access to social attention or preferred items (36.4%). Treatments utilized by parents were primarily behavioral strategies (56.3%) followed by basic first aid (54.5%). There were no differences in the topography, severity or potential source of reinforcement between those with the deletion (DEL) subtype and those with the uniparental disomy (UPD) subtype. Taken together, these data indicate that skin picking shown by individuals with PWS is a particularly severe and intractable behavioral issue that may be maintained by (as yet unknown) sensory consequences. Further studies to identify the determinants of skin picking in PWS are therefore needed. The implications for interventions are discussed.
Collapse
Affiliation(s)
- Kristin M Hustyi
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, United States
| | | | | | | |
Collapse
|
38
|
Pignatti R, Mori I, Bertella L, Grugni G, Giardino D, Molinari E. Exploring Patterns of Unwanted Behaviours in Adults with Prader-Willi Syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:568-77. [PMID: 23613474 DOI: 10.1111/jar.12047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Riccardo Pignatti
- Psychology Laboratory; IRCCS Istituto Auxologico Italiano; Piancavallo Italy
| | - Ileana Mori
- Psychology Laboratory; IRCCS Istituto Auxologico Italiano; Piancavallo Italy
| | | | - Graziano Grugni
- Division of Auxology; IRCCS Istituto Auxologico Italiano; Piancavallo Italy
| | - Daniela Giardino
- Laboratory of Medical Cytogenetics; IRCCS Istituto Auxologico Italiano; Milan Italy
| | - Enrico Molinari
- Psychology Laboratory; IRCCS Istituto Auxologico Italiano; Piancavallo Italy
- Psychology Faculty; Università Cattolica del Sacro Cuore; Milan Italy
| |
Collapse
|
39
|
Social Responsiveness and Competence in Prader-Willi Syndrome: Direct Comparison to Autism Spectrum Disorder. J Autism Dev Disord 2012; 43:103-13. [DOI: 10.1007/s10803-012-1547-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
40
|
Muehlmann AM, Lewis MH. Abnormal repetitive behaviours: shared phenomenology and pathophysiology. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:427-440. [PMID: 22283923 DOI: 10.1111/j.1365-2788.2011.01519.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) is a devastating problem observed in individuals with various neurodevelopmental disorders, including specific genetic syndromes as well as idiopathic intellectual and developmental disability. Although an increased prevalence of SIB has been documented in specific genetic mutations, little is known about the neurobiological basis of SIB. This makes vulnerability assessment and pharmacological treatment incredibly challenging. METHOD Here we review evidence that SIB and other repetitive, invariant behaviours, such as stereotypy, compulsions and tics, share many phenotypic similarities, are often co-morbidly expressed and have common inducing conditions. This argues for shared or overlapping pathophysiology. As much more is known about the neurobiology of these related disorders, this should make the neurobiology of SIB a more tractable problem. RESULTS Stereotypy, compulsions and tics are diagnostic for disorders that have received focused neurobiological investigation (autism, obsessive compulsive disorder, Tourette syndrome, respectively). In addition, animal models of these repetitive behaviours have been well characterised. Collectively, these studies have found that cortical basal ganglia circuitry dysfunction mediates repetitive behaviour. Moreover, these studies provide more detailed information and potentially testable hypotheses about specific aspects of the circuitry that may be operative in SIB. CONCLUSIONS We can use available information from clinical and animal models to make more precise hypotheses regarding the particular pathophysiology driving SIB. The results of testing such hypotheses should generate pharmacological strategies that may prove efficacious in reducing SIB.
Collapse
Affiliation(s)
- A M Muehlmann
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA.
| | | |
Collapse
|
41
|
Affiliation(s)
- Randy O. Frost
- Department of Psychology, Smith College, Northampton, Massachusetts 01063;
| | - Gail Steketee
- School of Social Work, Boston University, Boston, Massachusetts 02215
| | - David F. Tolin
- The Institute of Living and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520
| |
Collapse
|
42
|
Green T, Avda S, Dotan I, Zarchi O, Basel-Vanagaite L, Zalsman G, Weizman A, Gothelf D. Phenotypic psychiatric characterization of children with Williams syndrome and response of those with ADHD to methylphenidate treatment. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:13-20. [PMID: 22052570 DOI: 10.1002/ajmg.b.31247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/29/2011] [Indexed: 11/10/2022]
Abstract
Williams syndrome (WS) is associated with cognitive deficits, special behavioral phenotype, and high rates of psychiatric disorders. The aims of the present study were: (1) To compare the rates of psychiatric disorders and repetitive behaviors in children with WS to children with idiopathic developmental disability (DDs); (2) To longitudinally assess the change in psychiatric disorders during adolescence in WS; (3) To assess retrospectively the effectiveness and safety of methylphenidate (MPH) treatment in WS children with ADHD. The study consisted of a cohort of 38 children and adolescents (age 13.1 ± 5.2 years) with WS and a sample of age-matched DDs (age 15.0 ± 3.1 years). A current follow-up evaluation was conducted after 5.6 ± 1.6 years for 25 subjects (65.8%) of the WS cohort. The rate of most psychiatric disorders was found similar in children with WS and DD controls. Specific phobia, especially from noises, obsessive-compulsive symptoms (e.g., aggressive obsessions and repetitive questions), and stereotypic behaviors (e.g., glancing), were more common in WS than DDs. In a longitudinal follow-up of the WS children, we found a decrease in the rate of anxiety disorders. In addition, a clinically significant improvement was reported in 72.2% of WS children with ADHD following MPH treatment. Sadness/unhappiness was the most common side effect associated with MPH treatment in WS, occurring in 2/3 of treated individuals. The present study further elucidates the neuropsychiatric phenotype of WS. Our results also suggest that MPH treatment for ADHD in WS warrants future prospective controlled trials.
Collapse
Affiliation(s)
- Tamar Green
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Elena G, Bruna C, Benedetta M, Stefania DC, Giuseppe C. Prader-willi syndrome: clinical aspects. J Obes 2012; 2012:473941. [PMID: 23133744 PMCID: PMC3486015 DOI: 10.1155/2012/473941] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/21/2012] [Indexed: 11/18/2022] Open
Abstract
Prader-Willi Syndrome (PWS) is a complex multisystem genetic disorder that shows great variability, with changing clinical features during a patient's life. The syndrome is due to the loss of expression of several genes encoded on the proximal long arm of chromosome 15 (15q11.2-q13). The complex phenotype is most probably caused by a hypothalamic dysfunction that is responsible for hormonal dysfunctions and for absence of the sense of satiety. For this reason a Prader-Willi (PW) child develops hyperphagia during the initial stage of infancy that can lead to obesity and its complications. During infancy many PW child display a range of behavioural problems that become more noticeable in adolescence and adulthood and interfere mostly with quality of life. Early diagnosis of PWS is important for effective long-term management, and a precocious multidisciplinary approach is fundamental to improve quality of life, prevent complications, and prolong life expectancy.
Collapse
|
44
|
Reid JM, Arnold E, Rosen S, Mason G, Larson MJ, Murphy TK, Storch EA. Hoarding behaviors among nonclinical elderly adults: correlations with hoarding cognitions, obsessive-compulsive symptoms, and measures of general psychopathology. J Anxiety Disord 2011; 25:1116-22. [PMID: 21889875 DOI: 10.1016/j.janxdis.2011.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 07/31/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
This study examines correlates of hoarding behaviors among nonclinical elderly adults, focusing upon hoarding cognitions, obsessive-compulsive symptoms, and measures of general psychopathology. Two hundred and sixty-nine adults aged 56-93 years (M=72.49 years) completed the Saving Inventory-Revised, Savings Cognitions Inventory-Revised, Obsessive Compulsive Inventory-Revised, Social Interaction Anxiety Scale, Penn State Worry Questionnaire, and Beck Depression Inventory. Our geriatric sample evidenced significantly greater severity of hoarding behaviors than did a younger community sample (24-72 years; M=44.4 years; Frost, Steketee, & Grishman, 2004). Within our sample, moderate correlations were found between hoarding behaviors and hoarding cognitions; however, controlling for obsessive-compulsive and depressive symptoms resulted in reduced-magnitude associations. As well, relationships between obsessive-compulsive symptoms and both hoarding behaviors and hoarding cognitions were generally strong, with most relationships diminishing after controlling for depressive symptoms. Associations between hoarding symptoms and symptoms of social anxiety, general worry, and depression were generally moderate. A significant regression model showed depressive symptoms explaining the most unique variance in hoarding behaviors. Findings confirm a relatively greater severity of hoarding behaviors in older adults (as compared to younger adults) and suggest that related psychopathology plays a critical role in hoarding expression among older adults. As well, the current study contributes to the ongoing investigation of the diagnostic categorization of compulsive hoarding.
Collapse
Affiliation(s)
- Jeannette M Reid
- Department of Pediatrics, University of South Florida, FL, United States.
| | | | | | | | | | | | | |
Collapse
|
45
|
Di Nuovo S, Buono S. Behavioral phenotypes of genetic syndromes with intellectual disability: comparison of adaptive profiles. Psychiatry Res 2011; 189:440-5. [PMID: 21507490 DOI: 10.1016/j.psychres.2011.03.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 10/18/2010] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
Abstract
The study of distinctive and consistent behaviors in the most common genetic syndromes with intellectual disability is useful to explain abnormalities or associated psychiatric disorders. The behavioral phenotypes revealed outcomes totally or partially specific for each syndrome. The aim of our study was to compare similarities and differences in the adaptive profiles of the five most frequent genetic syndromes, i.e. Down syndrome, Williams syndrome, Angelman syndrome, Prader-Willi syndrome, and Fragile-X syndrome (fully mutated), taking into account the relation with chronological age and the overall IQ level. The research was carried out using the Vineland Adaptive Behavior Scale (beside the Wechsler Intelligence scales to obtain IQ) with a sample of 181 persons (107 males and 74 females) showing genetic syndromes and mental retardation. Syndrome-based groups were matched for chronological age and mental age (excluding the Angelman group, presenting with severe mental retardation). Similarities and differences in the adaptive profiles are described, relating them to IQs and maladaptive behaviors. The results might be useful in obtaining a global index of adjustment for the assessment of intellectual disability level as well as for educational guidance and rehabilitative plans.
Collapse
|
46
|
Repetitive behavior profiles: Consistency across autism spectrum disorder cohorts and divergence from Prader-Willi syndrome. J Neurodev Disord 2011; 3:316-24. [PMID: 21881965 PMCID: PMC3261264 DOI: 10.1007/s11689-011-9094-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/14/2011] [Indexed: 11/05/2022] Open
Abstract
Restricted and repetitive behavior (RRB) is a group of heterogeneous maladaptive behaviors. RRB is one of the key diagnostic features of autism spectrum disorders (ASDs) and also commonly observed in Prader–Willi syndrome (PWS). In this study, we assessed RRB using the Repetitive Behavior Scale-Revised (RBS-R) in two ASD samples (University of Illinois at Chicago [UIC] and University of Florida [UF]) and one PWS sample. We compared the RBS-R item endorsements across three ASD cohorts (UIC, UF and an ASD sample from Lam, The Repetitive Behavior Scale-Revised: independent validation and the effect of subject variables, PhD thesis, 2004), and a PWS sample. We also compared the mean RBS-R subscale/sum scores across the UIC, UF and PWS samples; across the combined ASD (UIC + UF), PWS-deletion and PWS-disomy groups; and across the combined ASD sample, PWS subgroup with a Social Communication Questionnaire (SCQ) score ≥15, and PWS subgroup with a SCQ score <15. Despite the highly heterogeneous nature, the three ASD samples (UIC, UF and Lam’s) showed a similar pattern of the RBS-R endorsements, and the mean RBS-R scores were not different between the UIC and UF samples. However, higher RRB was noted in the ASD sample compared with the PWS sample, as well as in the PWS subgroup with a SCQ score ≥15 compared with the PWS subgroup with a SCQ score <15. Study limitations include a small sample size, a wide age range of our participants, and not controlling for potential covariates. A future replication study using a larger sample and further investigation into the genetic bases of overlapping ASD and RRB phenomenology are needed, given the higher RRB in the PWS subgroup with a SCQ score ≥15.
Collapse
|
47
|
Dykens EM, Lee E, Roof E. Prader-Willi syndrome and autism spectrum disorders: an evolving story. J Neurodev Disord 2011; 3:225-37. [PMID: 21858456 PMCID: PMC3261277 DOI: 10.1007/s11689-011-9092-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 07/26/2011] [Indexed: 11/04/2022] Open
Abstract
Prader-Willi syndrome (PWS) is well-known for its genetic and phenotypic complexities. Caused by a lack of paternally derived imprinted material on chromosome 15q11-q13, individuals with PWS have mild to moderate intellectual disabilities, repetitive and compulsive behaviors, skin picking, tantrums, irritability, hyperphagia, and increased risks of obesity. Many individuals also have co-occurring autism spectrum disorders (ASDs), psychosis, and mood disorders. Although the PWS 15q11-q13 region confers risks for autism, relatively few studies have assessed autism symptoms in PWS or directly compared social, behavioral, and cognitive functioning across groups with autism or PWS. This article identifies areas of phenotypic overlap and difference between PWS and ASD in core autism symptoms and in such comorbidities as psychiatric disorders, and dysregulated sleep and eating. Though future studies are needed, PWS provides a promising alternative lens into specific symptoms and comorbidities of autism.
Collapse
Affiliation(s)
- Elisabeth M Dykens
- Departments of Psychology and Human Development, Pediatrics and Psychiatry, Vanderbilt University, Vanderbilt Kennedy Center, Nashville, TN, USA,
| | | | | |
Collapse
|
48
|
Siegel MS, Smith WE. Psychiatric features in children with genetic syndromes: toward functional phenotypes. Pediatr Clin North Am 2011; 58:833-64, x. [PMID: 21855710 DOI: 10.1016/j.pcl.2011.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurodevelopmental disorders with identified genetic etiologies present a unique opportunity to study gene-brain-behavior connections in child psychiatry. Parsing complex human behavior into dissociable components is facilitated by examining a relatively homogenous genetic population. As children with developmental delay carry a greater burden of mental illness than the general population, familiarity with the most common genetic disorders will serve practitioners seeing a general child population. In this article, basic genetic testing and 11 of the most common genetic disorders are reviewed, including the evidence base for treatment. Based on their training in child development, family systems, and multimodal treatment, child psychiatrists are well positioned to integrate cognitive, behavioral, social, psychiatric, and physical phenotypes, with a focus on functional impairment.
Collapse
Affiliation(s)
- Matthew S Siegel
- Department of Psychiatry, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110, USA.
| | | |
Collapse
|
49
|
Spendelow JS. Assessment of Behavioral and Psychiatric Problems in People With Prader–Willi Syndrome: A Review of the Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00296.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
50
|
Dykens EM, Roof E, Bittel D, Butler MG. TPH2 G/T polymorphism is associated with hyperphagia, IQ, and internalizing problems in Prader-Willi syndrome. J Child Psychol Psychiatry 2011; 52:580-7. [PMID: 21418060 PMCID: PMC3353323 DOI: 10.1111/j.1469-7610.2011.02365.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a genetic, neurodevelopmental disorder characterized by intellectual disabilities, growth hormone dysregulation, hyperphagia, increased risks of morbid obesity, compulsive behaviors, and irritability. As aberrant serotonergic functioning is strongly implicated in PWS, we examined associations between the PWS phenotype and polymorphisms in tryptophan hydroxylase 2 (TPH2), the rate-limiting enzyme in the biosynthesis of serotonin in the brain. METHODS Ninety-two individuals with PWS aged 4 to 50 years (M = 21.97) were genotyped for the TPH2 G703-T polymorphism. IQ testing was conducted in offspring, and parents completed questionnaires that tapped their child's compulsivity, hyperphagia, and other behavior problems. RESULTS As expected, the frequency of G/T or T/T polymorphisms in participants with PWS (39%) was similar to rates found in the general population (38%). Compared to those with a homozygous (G/G) genotype, individuals with a T allele had significantly higher hyperphagic behavior, drive, and severity scores, and they also had a younger age of onset of hyperphagia. Those with a T allele also had higher IQ scores than their counterparts. Females with a T allele had significantly higher internalizing symptoms, primarily anxiety and depression, than all others. CONCLUSIONS TPH2 G/T polymorphisms, and presumed loss of enzyme function, were associated with specific aspects of the PWS phenotype. Aberrant serotonergic functioning is strongly implicated in hyperphagia in PWS, and females with TPH2 T alleles may be at higher risk for affective or mood disorders. Findings hold promise for examining other serotonin-altering genes in PWS, and for future serotonin-altering treatment trials.
Collapse
Affiliation(s)
- Elisabeth M. Dykens
- Vanderbilt Kennedy Center for Research on Human Development, Departments of Psychology and Human Development, Psychiatry, and Pediatrics Vanderbilt University, Nashville, TN
| | - Elizabeth Roof
- Vanderbilt Kennedy Center for Research on Human Development, Departments of Psychology and Human Development, Psychiatry, and Pediatrics Vanderbilt University, Nashville, TN
| | - Douglas Bittel
- Children’s Mercy Hospital and University of Missouri – Kansas City School of Medicine, Department of Pediatrics, Kansas City, MO
| | - Merlin G. Butler
- Kansas University Medical Center, Departments of Psychiatry & Behavioral Sciences and Pediatrics, Kansas City, KS
| |
Collapse
|