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Ramakrishnan D, Farhat LC, Vattimo EFQ, Levine JLS, Johnson JA, Artukoglu BB, Landeros-Weisenberger A, Zangen A, Pelissolo A, de B Pereira CA, Rück C, Costa DLC, Mataix-Cols D, Shannahoff-Khalsa D, Tolin DF, Zarean E, Meyer E, Hawken ER, Storch EA, Andersson E, Miguel EC, Maina G, Leckman JF, Sarris J, March JS, Diniz JB, Kobak K, Mallet L, Vulink NCC, Amiaz R, Fernandes RY, Shavitt RG, Wilhelm S, Golshan S, Tezenas du Montcel S, Erzegovesi S, Baruah U, Greenberg WM, Kobayashi Y, Bloch MH. An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis. J Psychiatr Res 2024; 173:387-397. [PMID: 38598877 DOI: 10.1016/j.jpsychires.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. METHODS We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. RESULTS Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. CONCLUSION While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.
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Affiliation(s)
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Edoardo F Q Vattimo
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Jessica A Johnson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bekir B Artukoglu
- Department of Child and Adolescent Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Abraham Zangen
- Department of Life Sciences and the Zelman Center for Neuroscience, Ben Gurion University, Be'er Sheva, Israel
| | - Antoine Pelissolo
- Psychiatry Department, Henri-Mondor University Hospitals, Faculty of Medicine, Créteil, France
| | - Carlos A de B Pereira
- Mathematics and Statistics Institute, Statistics Department, University of São Paulo, São Paulo, Brazil
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Daniel L C Costa
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - David Shannahoff-Khalsa
- The Research Group for Mind-Body Dynamics, BioCircuits Institute and Center for Integrative Medicine, University of California San Diego, CA, USA; The Khalsa Foundation for Medical Science, Del Mar, CA, USA
| | - David F Tolin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; The Institute of Living, Hartford, CT, USA
| | - Elham Zarean
- Department of Psychiatry, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elisabeth Meyer
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - James F Leckman
- Child Study Center, Department of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jerome Sarris
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia; NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA
| | - Juliana B Diniz
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Luc Mallet
- Medical-University Department of Psychiatry and Addictology, Henri Mondor - Albert Chenevier University Hospitals, Créteil, France
| | - Nienke C C Vulink
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | | | - Rodrigo Yacubian Fernandes
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sabine Wilhelm
- OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sophie Tezenas du Montcel
- Sorbonne Universite, Institut du Cerveau Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Inria Aramis project-team, Paris, France
| | - Stefano Erzegovesi
- Department of Neurosciences, Eating Disorders Unit, IRCCS San Raffaele, Milano, Italy
| | - Upasana Baruah
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Yuki Kobayashi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Wang Y, Fasching L, Wu F, Huttner A, Berretta S, Roberts R, Leckman JF, Abyzov A, Vaccarino FM. Interneuron loss and microglia activation by transcriptome analyses in the basal ganglia of Tourette syndrome. bioRxiv 2024:2024.02.28.582504. [PMID: 38464084 PMCID: PMC10925323 DOI: 10.1101/2024.02.28.582504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Tourette syndrome (TS) is a disorder of high-order integration of sensory, motor, and cognitive functions afflicting as many as 1 in 150 children and characterized by motor hyperactivity and tics. Despite high familial recurrence rates, a few risk genes and no biomarkers have emerged as causative or predisposing factors. The syndrome is believed to originate in basal ganglia, where patterns of motor programs are encoded. Postmortem immunocytochemical analyses of brains with severe TS revealed decreases in cholinergic, fast-spiking parvalbumin, and somatostatin interneurons within the striatum (caudate and putamen nuclei). Here, we performed single cell transcriptomic and chromatin accessibility analyses of the caudate nucleus from 6 adult TS and 6 control post-mortem brains. The data reproduced the known cellular composition of the adult human striatum, including a majority of medium spiny neurons (MSN) and small populations of GABAergic and cholinergic interneurons. Comparative analysis revealed that interneurons were decreased by roughly 50% in TS brains, while no difference was observed for other cell types. Differential gene expression analysis suggested that mitochondrial function, and specifically oxidative metabolism, in MSN and synaptic function in interneurons are both impaired in TS subjects, while microglia display strong activation of immune response pathways. Our data explicitly link gene expression changes to changes in cis-regulatory activity in the corresponding cell types, suggesting de-regulation as a factor for the etiology of TS. These findings expand on previous research and suggest that impaired modulation of striatal function by interneurons may be the origin of TS symptoms.
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Morand-Beaulieu S, Crowley MJ, Grantz H, Leckman JF, Sukhodolsky DG. Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome. Psychol Med 2023; 53:7857-7864. [PMID: 37485677 PMCID: PMC10755221 DOI: 10.1017/s0033291723001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome. METHODS Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression. RESULTS Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect. CONCLUSIONS This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.
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Affiliation(s)
- Simon Morand-Beaulieu
- Department of Psychology, McGill University, Montreal, QC, Canada
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Heidi Grantz
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - James F. Leckman
- Department of Psychology, McGill University, Montreal, QC, Canada
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Jang Y, Fasching L, Bae T, Tomasini L, Schreiner J, Szekely A, Fernandez T, Leckman JF, Vaccarino FM, Abyzov A. Efficient reconstruction of cell lineage trees for cell ancestry and cancer. Nucleic Acids Res 2023; 51:e57. [PMID: 37026484 PMCID: PMC10250207 DOI: 10.1093/nar/gkad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Mosaic mutations can be used to track cell ancestries and reconstruct high-resolution lineage trees during cancer progression and during development, starting from the first cell divisions of the zygote. However, this approach requires sampling and analyzing the genomes of multiple cells, which can be redundant in lineage representation, limiting the scalability of the approach. We describe a strategy for cost- and time-efficient lineage reconstruction using clonal induced pluripotent stem cell lines from human skin fibroblasts. The approach leverages shallow sequencing coverage to assess the clonality of the lines, clusters redundant lines and sums their coverage to accurately discover mutations in the corresponding lineages. Only a fraction of lines needs to be sequenced to high coverage. We demonstrate the effectiveness of this approach for reconstructing lineage trees during development and in hematologic malignancies. We discuss and propose an optimal experimental design for reconstructing lineage trees.
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Affiliation(s)
- Yeongjun Jang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Liana Fasching
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Taejeong Bae
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Livia Tomasini
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | | | - Anna Szekely
- Department of Neurology, Yale University, New Haven, CT 06520, USA
| | - Thomas V Fernandez
- Child Study Center, Yale University, New Haven, CT 06520, USA
- Department of Psychiatry, Yale University, New Haven, CT 06511, USA
| | - James F Leckman
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Flora M Vaccarino
- Child Study Center, Yale University, New Haven, CT 06520, USA
- Department of Neuroscience, Yale University, New Haven, CT 06520, USA
- Yale Kavli Institute for Neuroscience, New Haven, CT 06520, USA
| | - Alexej Abyzov
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Morand-Beaulieu S, Wu J, Mayes LC, Grantz H, Leckman JF, Crowley MJ, Sukhodolsky DG. Increased Alpha-Band Connectivity During Tic Suppression in Children With Tourette Syndrome Revealed by Source Electroencephalography Analyses. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:241-250. [PMID: 33991741 PMCID: PMC8589865 DOI: 10.1016/j.bpsc.2021.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder involving chronic motor and phonic tics. Most individuals with TS can suppress their tics for at least a short period of time. Yet, the brain correlates of tic suppression are still poorly understood. METHODS In the current study, high-density electroencephalography was recorded during a resting-state and a tic suppression session in 72 children with TS. Functional connectivity between cortical regions was assessed in the alpha band (8-13 Hz) using an electroencephalography source connectivity method. Graph theory and network-based statistics were used to assess the global network topology and to identify brain regions showing increased connectivity during tic suppression. RESULTS Graph theoretical analyses revealed distinctive global network topology during tic suppression, relative to rest. Using network-based statistics, we found a subnetwork of increased connectivity during tic suppression (p < .001). That subnetwork encompassed many cortical areas, including the right superior frontal gyrus and the left precuneus, which are involved in the default mode network. We also found a condition-by-age interaction, suggesting age-mediated increases in connectivity during tic suppression. CONCLUSIONS These results suggest that children with TS suppress their tics through a brain circuit involving distributed cortical regions, many of which are part of the default mode network. Brain connectivity during tic suppression also increases as youths with TS mature. These results highlight a mechanism by which children with TS may control their tics, which could be relevant for future treatment studies.
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Affiliation(s)
| | - Jia Wu
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Linda C Mayes
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Heidi Grantz
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J Crowley
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.
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6
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Brady MV, Mariani J, Koca Y, Szekely A, King RA, Bloch MH, Landeros-Weisenberger A, Leckman JF, Vaccarino FM. Characterization of human basal ganglia organoids. Mol Psychiatry 2022; 27:4823. [PMID: 36536052 DOI: 10.1038/s41380-022-01914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Melanie V Brady
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | - Jessica Mariani
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | - Yildiz Koca
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | - Anna Szekely
- Department of Neurology, Yale University, New Haven, CT, 06520, USA
| | - Robert A King
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | - Michael H Bloch
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | | | - James F Leckman
- Child Study Center, Yale University, New Haven, CT, 06520, USA
| | - Flora M Vaccarino
- Child Study Center, Yale University, New Haven, CT, 06520, USA. .,Department of Neuroscience, Yale University, New Haven, CT, 06520, USA. .,Yale Stem Cell Center, Yale University, New Haven, CT, 06520, USA. .,Kavli Institute for Neuroscience at Yale, New Haven, CT, 06520, USA.
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Vitulano LA, Mitchell JT, Vitulano ML, Leckman JF, Saunders D, Davis N, Woodward D, Goodhue B, Artukoglu B, Kober H. Parental perspectives on attention-deficit/hyperactivity disorder treatments for children. Clin Child Psychol Psychiatry 2022; 27:1019-1032. [PMID: 35695509 DOI: 10.1177/13591045221108836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated parental perspectives and experiences on the evaluation and treatment process associated with attention-deficit/hyperactivity disorder (ADHD). Five hundred sixty-eight parents of youth 2-28 years-old (M = 9.37; SD = 4.11) diagnosed with ADHD responded to a 14-item online survey about their child's diagnosis and treatment. Parents reported that they had tried an average of 4.49 interventions (SD = 2.63). Parents further shared factors in treatment selection, most helpful parenting strategies, and preferences for types of treatments and treatment targets. A majority of parents reported incorporating many non-traditional strategies (e.g., exercise, healthy eating, outdoor activities) with goals of improving their child's coping skills, study habits, and anger management. The findings show that treatment choices were often selected based on trust in the provider, research support, and the child's preference. Given parental preferences for non-traditional strategies, treatment development efforts should consider these strategies as a component of a broader multimodal treatment approach to ADHD.
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Affiliation(s)
| | | | | | | | - David Saunders
- Yale Child Study Center.,5798Columbia University, New York, NY, USA
| | | | | | | | | | - Hedy Kober
- Yale University Department of Psychiatry
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Cervin M, Miguel EC, Güler AS, Ferrão YA, Erdoğdu AB, Lazaro L, Gökçe S, Geller DA, Yulaf Y, Başgül ŞS, Özcan Ö, Karabekiroğlu K, Fontenelle LF, Yazgan Y, Storch EA, Leckman JF, do Rosário MC, Mataix-Cols D. Towards a definitive symptom structure of obsessive-compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals. Psychol Med 2022; 52:3267-3279. [PMID: 33557980 PMCID: PMC9693708 DOI: 10.1017/s0033291720005437] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/18/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques. METHODS A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM). RESULTS Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables. CONCLUSIONS Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Ygor A. Ferrão
- Department of Clinical Medicine (Neurosciences), Porto Alegre Health Sciences Federal University, Porto Alegre, Brazil
| | - Ayşe Burcu Erdoğdu
- Department of Child and Adolescent Psychiatry, Marmara University, Istanbul, Turkey
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Sebla Gökçe
- Department of Child and Adolescent Psychiatry, Maltepe University, Istanbul, Turkey
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yasemin Yulaf
- Department of Psychology, Gelişim University, Istanbul, Turkey
| | | | - Özlem Özcan
- Department of Child and Adolescent Psychiatry, İnönü University, Malatya, Turkey
| | - Koray Karabekiroğlu
- Department of Child and Adolescent Psychiatry, Ondokuz Mayıs University, Samsun, Turkey
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
- D'Or Institute for Research and Education (IDOR) and Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yankı Yazgan
- Güzel Günler Clinic, Istanbul, Turkey
- Yale Child Study Center, New Haven, CT, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - James F. Leckman
- Departments of Psychiatry, Pediatrics & Psychology, Child Study Center, Yale University, New Haven, CT, USA
| | | | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Region Stockholm, Stockholm, Sweden
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Bae T, Fasching L, Wang Y, Shin JH, Suvakov M, Jang Y, Norton S, Dias C, Mariani J, Jourdon A, Wu F, Panda A, Pattni R, Chahine Y, Yeh R, Roberts RC, Huttner A, Kleinman JE, Hyde TM, Straub RE, Walsh CA, Urban AE, Leckman JF, Weinberger DR, Vaccarino FM, Abyzov A. Analysis of somatic mutations in 131 human brains reveals aging-associated hypermutability. Science 2022; 377:511-517. [PMID: 35901164 PMCID: PMC9420557 DOI: 10.1126/science.abm6222] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We analyzed 131 human brains (44 neurotypical, 19 with Tourette syndrome, 9 with schizophrenia, and 59 with autism) for somatic mutations after whole genome sequencing to a depth of more than 200×. Typically, brains had 20 to 60 detectable single-nucleotide mutations, but ~6% of brains harbored hundreds of somatic mutations. Hypermutability was associated with age and damaging mutations in genes implicated in cancers and, in some brains, reflected in vivo clonal expansions. Somatic duplications, likely arising during development, were found in ~5% of normal and diseased brains, reflecting background mutagenesis. Brains with autism were associated with mutations creating putative transcription factor binding motifs in enhancer-like regions in the developing brain. The top-ranked affected motifs corresponded to MEIS (myeloid ectopic viral integration site) transcription factors, suggesting a potential link between their involvement in gene regulation and autism.
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Affiliation(s)
- Taejeong Bae
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
| | - Liana Fasching
- Child Study Center, Yale University, New Haven, CT 06520
| | - Yifan Wang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
| | - Joo Heon Shin
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Milovan Suvakov
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
| | - Yeongjun Jang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
| | - Scott Norton
- Child Study Center, Yale University, New Haven, CT 06520
| | - Caroline Dias
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, USA
- Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | | | | | - Feinan Wu
- Child Study Center, Yale University, New Haven, CT 06520
| | - Arijit Panda
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
| | - Reenal Pattni
- Department of Psychiatry and Behavioral Sciences, Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305
| | - Yasmine Chahine
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, USA
- Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Rebecca Yeh
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, USA
- Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Rosalinda C. Roberts
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham Al, 35294
| | - Anita Huttner
- Department of Pathology, Yale University, New Haven, CT 06520
| | - Joel E. Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Thomas M. Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Richard E. Straub
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
| | - Christopher A. Walsh
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, MA, USA
- Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | | | - Alexander E. Urban
- Department of Psychiatry and Behavioral Sciences, Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305
| | | | - Daniel R. Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
| | - Flora M. Vaccarino
- Child Study Center, Yale University, New Haven, CT 06520
- Department of Neuroscience, Yale University, New Haven, CT 06520
| | - Alexej Abyzov
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905
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10
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Martino D, Leckman JF, Okun MS. Why Some Individuals With Tourette Syndrome Experience Assault and Perpetrate Criminal Behavior. JAMA Neurol 2022; 79:442-444. [PMID: 35311951 DOI: 10.1001/jamaneurol.2021.5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville.,Associate Editor, JAMA Neurology
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11
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Affiliation(s)
- James F Leckman
- Yale Child Study Center and Department of Psychiatry, Yale University, New Haven, Conn
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12
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Morand-Beaulieu S, Smith SD, Ibrahim K, Wu J, Leckman JF, Crowley MJ, Sukhodolsky DG. Electrophysiological signatures of inhibitory control in children with Tourette syndrome and attention-deficit/hyperactivity disorder. Cortex 2022; 147:157-168. [PMID: 35042055 PMCID: PMC8816877 DOI: 10.1016/j.cortex.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/29/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, especially in children. Reduced inhibitory control abilities have been suggested as a shared phenotype across both conditions but its neural underpinnings remain unclear. Here, we tested the behavioral and electrophysiological correlates of inhibitory control in children with TS, ADHD, TS+ADHD, and typically developing controls (TDC). One hundred and thirty-eight children, aged 7-14 years, performed a Go/NoGo task during dense-array EEG recording. The sample included four groups: children with TS only (n = 47), TS+ADHD (n = 32), ADHD only (n = 22), and matched TDC (n = 35). Brain activity was assessed with the means of frontal midline theta oscillations, as well as the N200 and P300 components of the event-related potentials. Our analyses revealed that both groups with TS did not differ from other groups in terms of behavioral performance, frontal midline theta oscillations, and event-related potentials. Children with ADHD-only had worse Go/NoGo task performance, decreased NoGo frontal midline theta power, and delayed N200 and P300 latencies, compared to typically developing controls. In the current study, we found that children with TS or TS+ADHD do not show differences in EEG during a Go/NoGo task compared to typically developing children. Our findings however suggest that children with ADHD-only have a distinct electrophysiological profile during the Go/NoGo task as indexed by reduced frontal midline theta power and delayed N200 and P300 latencies.
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Affiliation(s)
| | - Stephanie D. Smith
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA,School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Karim Ibrahim
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jia Wu
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - James F. Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael J. Crowley
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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13
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Schjølberg S, Shic F, Volkmar FR, Nordahl-Hansen A, Stenberg N, Torske T, Larsen K, Riley K, Sukhodolsky DG, Leckman JF, Chawarska K, Øien RA. What are we optimizing for in autism screening? Examination of algorithmic changes in the M-CHAT. Autism Res 2022; 15:296-304. [PMID: 34837355 PMCID: PMC8821132 DOI: 10.1002/aur.2643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
The present study objectives were to examine the performance of the new M-CHAT-R algorithm to the original M-CHAT algorithm. The main purpose was to examine if the algorithmic changes increase identification of children later diagnosed with ASD, and to examine if there is a trade-off when changing algorithms. We included 54,463 screened cases from the Norwegian Mother and Child Cohort Study. Children were screened using the 23 items of the M-CHAT at 18 months. Further, the performance of the M-CHAT-R algorithm was compared to the M-CHAT algorithm on the 23-items. In total, 337 individuals were later diagnosed with ASD. Using M-CHAT-R algorithm decreased the number of correctly identified ASD children by 12 compared to M-CHAT, with no children with ASD screening negative on the M-CHAT criteria subsequently screening positive utilizing the M-CHAT-R algorithm. A nonparametric McNemar's test determined a statistically significant difference in identifying ASD utilizing the M-CHAT-R algorithm. The present study examined the application of 20-item MCHAT-R scoring criterion to the 23-item MCHAT. We found that this resulted in decreased sensitivity and increased specificity for identifying children with ASD, which is a trade-off that needs further investigation in terms of cost-effectiveness. However, further research is needed to optimize screening for ASD in the early developmental period to increase identification of false negatives.
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Affiliation(s)
- Synnve Schjølberg
- a: Norwegian Institute of Public Health, University of Washington School of Medicine
| | - Frederick Shic
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | - Fred R. Volkmar
- c: Yale Child Study Center, The Arctic University of Norway,d: Southern Connecticut University, The Arctic University of Norway
| | | | - Nina Stenberg
- f: Oslo University Hospital, The Arctic University of Norway
| | - Tonje Torske
- g: Vestre Viken Hospital:, The Arctic University of Norway
| | | | - Katherine Riley
- b: Seattle Children’s Research Institute, University of Washington School of Medicine
| | | | | | | | - Roald A. Øien
- c: Yale Child Study Center, The Arctic University of Norway,h: UiT – The Arctic University of Norway,Corresponding author tel: +4793099994, PB 6070, 9037 Tromsoe, Norway
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14
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Essing J, Jakubovski E, Psathakis N, Cevirme SN, Leckman JF, Müller-Vahl KR. Premonitory Urges Reconsidered: Urge Location Corresponds to Tic Location in Patients With Primary Tic Disorders. J Mov Disord 2022; 15:43-52. [PMID: 35124958 PMCID: PMC8820883 DOI: 10.14802/jmd.21045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objective In patients with Tourette syndrome and other primary tic disorders (PTDs), tics are typically preceded by premonitory urges (PUs). To date, only a few studies have investigated the location and frequency of PUs, and contrary to clinical experience, the results suggest that PUs are not located in the same anatomic region as the tics. This study aimed to further explore PU location and frequency in detail, differentiating the kind and complexity of the corresponding tics, in a large sample of patients with PTD. Methods A total of 291 adult (≥ 18 years) patients with a confirmed diagnosis of chronic PTD were included. The study was conducted online, assement included tics and the general characterization of PUs and a sophisticated body drawing for locating PUs. Results We found that PUs were located in the same body area as, or in direct proximity to, the corresponding tic. Most frequently, PUs were located in the face and at the head (62.1%). Compared with simple tics, complex (motor and vocal) tics were more often preceded by a PU; but there was no difference in PU frequency observed between motor tics and vocal tics. PUs were more often experienced at the front than at the back of the body (73% vs. 27%), while there was no difference between the right and left sides (41.6% vs. 41.3%). Conclusion The strong association between PU and tic location further supports the hypothesis that PUs represent the core of PTD. Accordingly, future therapies should focus on treating PUs to achieve greater tic reduction.
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Affiliation(s)
- Jana Essing
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Nikolas Psathakis
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Sinan N Cevirme
- Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Corresponding author: Kirsten R Müller-Vahl, MD Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany / Tel: +49- 511-5323551 / Fax: +49-511-5323187 / E-mail:
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15
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Li F, Cui Y, Li Y, Guo L, Ke X, Liu J, Luo X, Zheng Y, Leckman JF. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals. J Child Psychol Psychiatry 2022; 63:34-46. [PMID: 34019305 DOI: 10.1111/jcpp.13445] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To date, no national-scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up-to-date systematic nationwide psychiatric epidemiological survey. METHODS We conducted a two-stage large-scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini-International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio-demographic factors. Prevalence in socio-demographic factor subgroups and overall were estimated. Rao-Scott adjusted chi-square tests were utilized to determine if between-group differences were present. Factor interactions were checked by logistic regression analyses. RESULTS A total of 73,992 participants aged 6-16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2-18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ2 (1, N = 71,929) = 223.0, p < .001], age groups [χ2 (1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ2 (1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ2 (1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity. CONCLUSIONS The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long-term negative impact of these conditions on families and the society as a whole.
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Affiliation(s)
- Fenghua Li
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yonghua Cui
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lanting Guo
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jing Liu
- Sixth hospital, Peking University, Beijing, China
| | - Xuerong Luo
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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16
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Bloch MH, Landeros-Weisenberger A, Johnson JA, Leckman JF. A Phase-2 Pilot Study of a Therapeutic Combination of Δ 9-Tetrahydracannabinol and Palmitoylethanolamide for Adults With Tourette's Syndrome. J Neuropsychiatry Clin Neurosci 2021; 33:328-336. [PMID: 34340527 DOI: 10.1176/appi.neuropsych.19080178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are few effective pharmacological treatments for Tourette's syndrome. Many patients with Tourette's syndrome experience impairing tic symptoms despite use of available evidence-based treatments. The investigators conducted a small, uncontrolled trial to examine the safety, tolerability, and dosing of THX-110, a combination of Δ9-tetrahydracannabinol (Δ9-THC) and palmitoylethanolamide (PEA), in Tourette's syndrome. METHODS A 12-week uncontrolled trial of THX-110 (maximum daily Δ9-THC dose, 10 mg, and a constant 800-mg dose of PEA) in 16 adults with Tourette's syndrome was conducted. The primary outcome was improvement on the Yale Global Tic Severity Scale (YGTSS) total tic score. Secondary outcomes included measures of comorbid conditions and the number of participants who elected to continue treatment in the 24-week extension phase. RESULTS Tic symptoms significantly improved over time with THX-110 treatment. Improvement in tic symptoms was statistically significant within 1 week of starting treatment compared with baseline. THX-110 treatment led to an average improvement in tic symptoms of more than 20%, or a 7-point decrease in the YGTSS score. Twelve of the 16 participants elected to continue to the extension phase, and only two participants dropped out early. Side effects were common but were generally managed by decreasing Δ9-THC dosing, slowing the dosing titration, and shifting dosing to nighttime. CONCLUSIONS Although the initial data from this trial in adults with refractory Tourette's syndrome are promising, future randomized double-blind placebo-controlled trials are necessary to demonstrate efficacy of THX-110 treatment. The challenges raised by the difficulty in blinding trials due to the psychoactive properties of many cannabis-derived compounds need to be further appreciated in these trial designs.
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Affiliation(s)
- Michael H Bloch
- Yale Child Study Center, New Haven, Conn. (Bloch, Landeros-Weisenberger, Johnson, Leckman); and Department of Psychiatry, Yale University, New Haven, Conn. (Bloch, Leckman)
| | - Angeli Landeros-Weisenberger
- Yale Child Study Center, New Haven, Conn. (Bloch, Landeros-Weisenberger, Johnson, Leckman); and Department of Psychiatry, Yale University, New Haven, Conn. (Bloch, Leckman)
| | - Jessica A Johnson
- Yale Child Study Center, New Haven, Conn. (Bloch, Landeros-Weisenberger, Johnson, Leckman); and Department of Psychiatry, Yale University, New Haven, Conn. (Bloch, Leckman)
| | - James F Leckman
- Yale Child Study Center, New Haven, Conn. (Bloch, Landeros-Weisenberger, Johnson, Leckman); and Department of Psychiatry, Yale University, New Haven, Conn. (Bloch, Leckman)
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17
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Leckman JF, Ponguta LA, Pavarini G, Hein SD, McCarthy MF, Staiti H, Hanöz-Penney S, Rubinstein J, Pruett KD, Yazgan MY, Fallon NS, Hartl FJ, Ziv M, Salah R, Britto PR, Fitzpatrick S, Panter-Brick C. Love and peace across generations: Biobehavioral systems and global partnerships. Compr Psychoneuroendocrinol 2021; 8:100092. [PMID: 35757671 PMCID: PMC9216554 DOI: 10.1016/j.cpnec.2021.100092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
Children's environments - especially relationships with caregivers - sculpt not only developing brains but also multiple bio-behavioral systems that influence long-term cognitive and socioemotional outcomes, including the ability to empathize with others and interact in prosocial and peaceful ways. This speaks to the importance of investing resources in effective and timely programs that work to enhance early childhood development (ECD) and, by extension, reach communities at-scale. Given the limited resources currently devoted to ECD services, and the devastating impact of COVID-19 on children and communities, there is a clear need to spur government leaders and policymakers to further invest in ECD and related issues including gender and racial equity. This essay offers concrete examples of scholarly paradigms and leadership efforts that focus on child development to build a peaceful, equitable, just, and sustainable world. As scholars and practitioners, we need to continue to design, implement, assess, and revise high-quality child development programs that generate much-needed evidence for policy and programmatic changes. We must also invest in global partnerships to foster the next generation of scholars, practitioners, and advocates dedicated to advance our understanding of the bio-behavioral systems that underlie love, sociality, and peace across generations. Especially where supported by structural interventions, ECD programs can help create more peaceful, just, and socially equitable societies.
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Affiliation(s)
- James F. Leckman
- Child Study Center, Yale University, New Haven, CT, USA
- Departments of Psychiatry, Psychology and Pediatrics, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liliana Angelica Ponguta
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Gabriela Pavarini
- Early Childhood Peace Consortium, New York, NY, USA
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sascha D. Hein
- Early Childhood Peace Consortium, New York, NY, USA
- Freie Universität, Berlin, Germany
| | - Michael F. McCarthy
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, USA
| | | | - Suna Hanöz-Penney
- Early Childhood Peace Consortium, New York, NY, USA
- Mother Child Education Foundation (AÇEV), Istanbul, Turkey
| | - Joanna Rubinstein
- Early Childhood Peace Consortium, New York, NY, USA
- United Nations Sustainable Development Solutions Network, Paris, France
| | - Kyle D. Pruett
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - M. Yanki Yazgan
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
- Güzel Günler Clinic, Istanbul, Turkey
| | - N. Shemrah Fallon
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Franz J. Hartl
- Early Childhood Peace Consortium, New York, NY, USA
- University Web Operations, Yale University, New Haven, CT, USA
| | - Margalit Ziv
- The International Networking Group on Peacebuilding with Young Children, Belfast, Northern Ireland, UK
| | - Rima Salah
- Child Study Center, Yale University, New Haven, CT, USA
- Early Childhood Peace Consortium, New York, NY, USA
| | - Pia Rebello Britto
- Early Childhood Peace Consortium, New York, NY, USA
- Country Representative, UNICEF, Lao’s People Democratic Republic (Lao PDR)
| | - Siobhán Fitzpatrick
- Early Childhood Peace Consortium, New York, NY, USA
- The International Networking Group on Peacebuilding with Young Children, Belfast, Northern Ireland, UK
- The Early Years – the Organization for Young Children, Belfast, Northern Ireland, UK
| | - Catherine Panter-Brick
- Early Childhood Peace Consortium, New York, NY, USA
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, New Haven, CT, USA
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18
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Wexler BE, Vitulano LA, Moore C, Katsovich L, Smith SD, Rush C, Grantz H, Dong J, Leckman JF. An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder. Psychol Med 2021; 51:1524-1535. [PMID: 32090720 DOI: 10.1017/s0033291720000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. METHODS Children (n = 93, mean age 7.3 +/- 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. RESULTS Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009-0.01) while non-responders improved on none (p = 0.27-0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). CONCLUSIONS Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.
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Affiliation(s)
- Bruce E Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Christina Moore
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Delaware, Newark, DE, USA
| | | | - Stephanie D Smith
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Cindy Rush
- Department of Statistics, Columbia University, New York, NY, USA
| | - Heidi Grantz
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | | | - James F Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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19
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Calhoun A, Herrington OD, Leckman JF, Martin A. Supporting Clinician-Scientist Development in Child Psychiatry: A Four-Domain Model for Individual or Programmatic Self-Reflection. Front Psychiatry 2021; 12:651722. [PMID: 33868057 PMCID: PMC8044467 DOI: 10.3389/fpsyt.2021.651722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The Albert J. Solnit Integrated Training Program (AJSP) is a novel educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders. Methods: We conducted a qualitative study to explore the impact and active components of the AJSP through hour-long individual interviews of its enrollees and graduates. We were specifically interested in identifying individual or programmatic traits for success that could be replicated elsewhere. As components of our theoretical framework, we used sources on Strength, Weakness, Opportunity, and Threat (SWOT) Analysis as applied to healthcare, and on mentorship and career development as pertaining to child and adolescent psychiatry (CAP). Results: Thirty-four individuals matriculated into the AJSP between 2004 and 2020, 33 (97%) of whom participated. Through iterative thematic analysis, we developed a model consisting of quadrants resulting from the intersection of a developmental perspective (spanning professional or personal spheres) and a reflective direction (with outward- or inward-facing vantage points). The model can be of practical utility through putative questions that trainees/program leaders could ask themselves by using the four domains as points of departure: (I) Individual: "Is becoming a clinician-scientist right for me?"/"What traits are we looking for in prospective applicants?"; (II) Program: "Is this the right program for me?"/"What is the right balance between structure and freedom for trainees to thrive in?"; (III) Mentorship: "What is the right number and constellation of mentors for me?"/"How can we optimize our experience and backgrounds toward the benefit of our trainees?"; and (IV) Charting Course: "Who do I want to become?"/"How can we help our charges embrace, find, or reconnect with their true vocation?" Conclusion: Our analytic approach can help identify, refine, and replicate programs that are urgently needed to increase the workforce of clinician-scientists dedicated to improving the well-being and mental health of children and families. The model we describe can be fruitfully applied to the self-reflection by individuals or program leaders. Although based on a single program with very specific goals, the model could also be applied to other training initiatives within psychiatry-and beyond.
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Affiliation(s)
| | | | | | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
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20
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Fasching L, Jang Y, Tomasi S, Schreiner J, Tomasini L, Brady MV, Bae T, Sarangi V, Vasmatzis N, Wang Y, Szekely A, Fernandez TV, Leckman JF, Abyzov A, Vaccarino FM. Early developmental asymmetries in cell lineage trees in living individuals. Science 2021; 371:1245-1248. [PMID: 33737484 DOI: 10.1126/science.abe0981] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
Mosaic mutations can be used to track cell lineages in humans. We used cell cloning to analyze embryonic cell lineages in two living individuals and a postmortem human specimen. Of 10 reconstructed postzygotic divisions, none resulted in balanced contributions of daughter lineages to tissues. In both living individuals, one of two lineages from the first cleavage was dominant across tissues, with 90% frequency in blood. We propose that the efficiency of DNA repair contributes to lineage imbalance. Allocation of lineages in postmortem brain correlated with anterior-posterior axis, associating lineage history with cell fate choices in embryos. We establish a minimally invasive framework for defining cell lineages in any living individual, which paves the way for studying their relevance in health and disease.
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Affiliation(s)
- Liana Fasching
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Yeongjun Jang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Simone Tomasi
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | | | - Livia Tomasini
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Melanie V Brady
- Child Study Center, Yale University, New Haven, CT 06520, USA
| | - Taejeong Bae
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Vivekananda Sarangi
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Nikolaos Vasmatzis
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Yifan Wang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Anna Szekely
- Department of Neurology, Yale University, New Haven, CT 06520, USA
| | - Thomas V Fernandez
- Child Study Center, Yale University, New Haven, CT 06520, USA.,Department of Psychiatry, Yale University, New Haven, CT 06520, USA
| | - James F Leckman
- Child Study Center, Yale University, New Haven, CT 06520, USA.,Department of Psychiatry, Yale University, New Haven, CT 06520, USA
| | - Alexej Abyzov
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Flora M Vaccarino
- Child Study Center, Yale University, New Haven, CT 06520, USA. .,Department of Neuroscience, Yale University, New Haven, CT 06520, USA.,Yale Kavli Institute for Neuroscience, New Haven, CT 06520, USA
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21
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Tsetsos F, Yu D, Sul JH, Huang AY, Illmann C, Osiecki L, Darrow SM, Hirschtritt ME, Greenberg E, Muller-Vahl KR, Stuhrmann M, Dion Y, Rouleau GA, Aschauer H, Stamenkovic M, Schlögelhofer M, Sandor P, Barr CL, Grados MA, Singer HS, Nöthen MM, Hebebrand J, Hinney A, King RA, Fernandez TV, Barta C, Tarnok Z, Nagy P, Depienne C, Worbe Y, Hartmann A, Budman CL, Rizzo R, Lyon GJ, McMahon WM, Batterson JR, Cath DC, Malaty IA, Okun MS, Berlin C, Woods DW, Lee PC, Jankovic J, Robertson MM, Gilbert DL, Brown LW, Coffey BJ, Dietrich A, Hoekstra PJ, Kuperman S, Zinner SH, Wagner M, Knowles JA, Jeremy Willsey A, Tischfield JA, Heiman GA, Cox NJ, Freimer NB, Neale BM, Davis LK, Coppola G, Mathews CA, Scharf JM, Paschou P, Barr CL, Batterson JR, Berlin C, Budman CL, Cath DC, Coppola G, Cox NJ, Darrow S, Davis LK, Dion Y, Freimer NB, Grados MA, Greenberg E, Hirschtritt ME, Huang AY, Illmann C, King RA, Kurlan R, Leckman JF, Lyon GJ, Malaty IA, Mathews CA, McMahon WM, Neale BM, Okun MS, Osiecki L, Robertson MM, Rouleau GA, Sandor P, Scharf JM, Singer HS, Smit JH, Sul JH, Yu D, Aschauer HAH, Barta C, Budman CL, Cath DC, Depienne C, Hartmann A, Hebebrand J, Konstantinidis A, Mathews CA, Müller-Vahl K, Nagy P, Nöthen MM, Paschou P, Rizzo R, Rouleau GA, Sandor P, Scharf JM, Schlögelhofer M, Stamenkovic M, Stuhrmann M, Tsetsos F, Tarnok Z, Wolanczyk T, Worbe Y, Brown L, Cheon KA, Coffey BJ, Dietrich A, Fernandez TV, Garcia-Delgar B, Gilbert D, Grice DE, Hagstrøm J, Hedderly T, Heiman GA, Heyman I, Hoekstra PJ, Huyser C, Kim YK, Kim YS, King RA, Koh YJ, Kook S, Kuperman S, Leventhal BL, Madruga-Garrido M, Mir P, Morer A, Münchau A, Plessen KJ, Roessner V, Shin EY, Song DH, Song J, Tischfield JA, Willsey AJ, Zinner S, Aschauer H, Barr CL, Barta C, Batterson JR, Berlin C, Brown L, Budman CL, Cath DC, Coffey BJ, Coppola G, Cox NJ, Darrow S, Davis LK, Depienne C, Dietrich A, Dion Y, Fernandez T, Freimer NB, Gilbert D, Grados MA, Greenberg E, Hartmann A, Hebebrand J, Heiman G, Hirschtritt ME, Hoekstra P, Huang AY, Illmann C, Jankovic J, King RA, Kuperman S, Lee PC, Lyon GJ, Malaty IA, Mathews CA, McMahon WM, Müller-Vahl K, Nagy P, Neale BM, Nöthen MM, Okun MS, Osiecki L, Paschou P, Rizzo R, Robertson MM, Rouleau GA, Sandor P, Scharf JM, Schlögelhofer M, Singer HS, Stamenkovic M, Stuhrmann M, Sul JH, Tarnok Z, Tischfield J, Tsetsos F, Willsey AJ, Woods D, Worbe Y, Yu D, Zinner S. Synaptic processes and immune-related pathways implicated in Tourette syndrome. Transl Psychiatry 2021; 11:56. [PMID: 33462189 PMCID: PMC7814139 DOI: 10.1038/s41398-020-01082-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022] Open
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder of complex genetic architecture involving multiple interacting genes. Here, we sought to elucidate the pathways that underlie the neurobiology of the disorder through genome-wide analysis. We analyzed genome-wide genotypic data of 3581 individuals with TS and 7682 ancestry-matched controls and investigated associations of TS with sets of genes that are expressed in particular cell types and operate in specific neuronal and glial functions. We employed a self-contained, set-based association method (SBA) as well as a competitive gene set method (MAGMA) using individual-level genotype data to perform a comprehensive investigation of the biological background of TS. Our SBA analysis identified three significant gene sets after Bonferroni correction, implicating ligand-gated ion channel signaling, lymphocytic, and cell adhesion and transsynaptic signaling processes. MAGMA analysis further supported the involvement of the cell adhesion and trans-synaptic signaling gene set. The lymphocytic gene set was driven by variants in FLT3, raising an intriguing hypothesis for the involvement of a neuroinflammatory element in TS pathogenesis. The indications of involvement of ligand-gated ion channel signaling reinforce the role of GABA in TS, while the association of cell adhesion and trans-synaptic signaling gene set provides additional support for the role of adhesion molecules in neuropsychiatric disorders. This study reinforces previous findings but also provides new insights into the neurobiology of TS.
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Grants
- R01 NS102371 NINDS NIH HHS
- R01 NS096207 NINDS NIH HHS
- R01 NS096008 NINDS NIH HHS
- R01 NS105746 NINDS NIH HHS
- R01 MH115958 NIMH NIH HHS
- K08 MH099424 NIMH NIH HHS
- K02 NS085048 NINDS NIH HHS
- R01 MH115963 NIMH NIH HHS
- U01 HG009086 NHGRI NIH HHS
- R56 MH120736 NIMH NIH HHS
- U54 MD010722 NIMHD NIH HHS
- UL1 TR001863 NCATS NIH HHS
- R01 DC016977 NIDCD NIH HHS
- DP2 HD098859 NICHD NIH HHS
- R01 MH115961 NIMH NIH HHS
- U24 MH068457 NIMH NIH HHS
- R25 NS108939 NINDS NIH HHS
- R01 MH114927 NIMH NIH HHS
- R01 NR014852 NINR NIH HHS
- R21 HG010652 NHGRI NIH HHS
- R01 MH113362 NIMH NIH HHS
- RM1 HG009034 NHGRI NIH HHS
- FT is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers - 2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (IKY)
- KMV has received financial or material research support from the EU (FP7-HEALTH-2011 No. 278367, FP7-PEOPLE-2012-ITN No. 316978), the German Research Foundation (DFG: GZ MU 1527/3-1), the German Ministry of Education and Research (BMBF: 01KG1421), the National Institute of Mental Health (NIMH), the Tourette Gesellschaft Deutschland e.V., the Else-Kroner-Fresenius-Stiftung, and GW, Almirall, Abide Therapeutics, and Therapix Biosiences and has received consultant’s honoraria from Abide Therapeutics, Tilray, Resalo Vertrieb GmbH, and Wayland Group, speaker’s fees from Tilray and Cogitando GmbH, and royalties from Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, Elsevier, and Kohlhammer; and is a consultant for Nuvelution TS Pharma Inc., Zynerba Pharmaceuticals, Resalo Vertrieb GmbH, CannaXan GmbH, Therapix Biosiences, Syqe, Nomovo Pharma, and Columbia Care.
- MMN has received fees for memberships in Scientific Advisory Boards from the Lundbeck Foundation and the Robert-Bosch-Stiftung, and for membership in the Medical-Scientific Editorial Office of the Deutsches Ärzteblatt. MMN was reimbursed travel expenses for a conference participation by Shire Deutschland GmbH. MMN receives salary payments from Life & Brain GmbH and holds shares in Life & Brain GmbH. All this concerned activities outside the submitted work.
- IM has participated in research funded by the Parkinson Foundation, Tourette Association, Dystonia Coalition, AbbVie, Biogen, Boston Scientific, Eli Lilly, Impax, Neuroderm, Prilenia, Revance, Teva but has no owner interest in any pharmaceutical company. She has received travel compensation or honoraria from the Tourette Association of America, Parkinson Foundation, International Association of Parkinsonism and Related Disorders, Medscape, and Cleveland Clinic, and royalties for writing a book with Robert rose publishers.
- MSO serves as a consultant for the Parkinson’s Foundation, and has received research grants from NIH, Parkinson’s Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. MSO’s DBS research is supported by: NIH R01 NR014852 and R01NS096008. MSO is PI of the NIH R25NS108939 Training Grant. MSO has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford and Cambridge (movement disorders books). MSO is an associate editor for New England Journal of Medicine Journal Watch Neurology. MSO has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, QuantiaMD, WebMD/Medscape, Medicus, MedNet, Einstein, MedNet, Henry Stewart, American Academy of Neurology, Movement Disorders Society and by Vanderbilt University. The institution and not MSO receives grants from Medtronic, Abbvie, Boston Scientific, Abbott and Allergan and the PI has no financial interest in these grants. MSO has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations.
- DW receives royalties for books on Tourette Syndrome with Guilford Press, Oxford University Press, and Springer Press.
- BMN is a member of the scientific advisory board at Deep Genomics and consultant for Camp4 Therapeutics, Takeda Pharmaceutical and Biogen.
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Affiliation(s)
- Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sabrina M Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kirsten R Muller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | | | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas V Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Douglas W Woods
- Marquette University and University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Paul C Lee
- Tripler Army Medical Center and University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Donald L Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | | | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Jay A Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | | | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Roger Kurlan
- Atlantic Neuroscience Institute, Overlook Hospital, Summit, NJ, USA
| | - James F Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jan H Smit
- Department of Psychiatry, VU UniversityMedical Center, Amsterdam, The Netherlands
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Harald Aschauer Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anastasios Konstantinidis
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Center for Mental Health Muldenstrasse, BBRZMed, Linz, Austria
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, 00-001, Warsaw, Poland
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Lawrence Brown
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keun-Ah Cheon
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas V Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Blanca Garcia-Delgar
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, Barcelona, Spain
| | - Donald Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | - Dorothy E Grice
- Department of Psychiatry, Friedman Brain Institute, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- Paediatric Neurosciences, Kings College London, London, UK
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chaim Huyser
- De Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | | | - Young-Shin Kim
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yun-Joo Koh
- The Korea Institute for Children's Social Development, Rudolph Child Research Center, Seoul, South Korea
| | - Sodahm Kook
- Kangbuk Samsung Hospital, Seoul, South Korea
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bennett L Leventhal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Marcos Madruga-Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Kerstin J Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav CarusTU Dresden, Dresden, Germany
| | - Eun-Young Shin
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Dong-Ho Song
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Jungeun Song
- National Health Insurance Service Ilsan Hospital, Goyang-Si, South Korea
| | - Jay A Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Samuel Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lawrence Brown
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Thomas Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Donald Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gary Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Pieter Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Paul C Lee
- Tripler Army Medical Center and University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Jay Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Douglas Woods
- Marquette University and University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Samuel Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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22
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Ravagnani Salto AB, Santoro ML, Hoexter MQ, Jackowski AP, Pan PM, Rosário MC, Belangero SI, Alvarenga PG, Doretto VF, Fumo AMT, Batistuzzo MC, Macul Ferreira de Barros P, Timpano KR, Ota VK, Rohde LA, Miguel EC, Leckman JF, Zugman A. Obsessive-Compulsive Symptoms, Polygenic Risk Score, and Thalamic Development in Children From the Brazilian High-Risk Cohort for Mental Conditions (BHRCS). Front Psychiatry 2021; 12:673595. [PMID: 34163385 PMCID: PMC8215160 DOI: 10.3389/fpsyt.2021.673595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Thalamic volume measures have been linked to obsessive-compulsive disorder (OCD) in children and adolescents. However, it is unclear if alterations in thalamic volumes occur before or after symptom onset and if there is a relation to the presence of sub-clinical obsessive-compulsive symptoms (OCS). Here, we explore the relationship between OCS and the rate of thalamic volume change in a cohort of children and youth at high risk to develop a mental disorder. A secondary aim was to determine if there is a relationship between OCS and the individual's OCD polygenic risk score (OCD-PRS) and between the rate of thalamic volume change and the OCD-PRS. Methods: The sample included 378 children enrolled in the longitudinal Brazilian High-Risk Cohort for Mental Conditions. Participants were assessed for OCS and the symmetrized percent change (SPC) of thalamic volume across two time-points separated by 3 years, along with the OCD-PRS. Zero-altered negative binomial models were used to analyze the relationship between OCS and thalamic SPC. Multiple linear regressions were used to examine the relationship between thalamic SPC and OCD-PRS. Results: A significant relationship between OCS and the right thalamus SPC (p = 0.042) was found. There was no significant relationship between changes in thalamic volume SPC and OCD-PRS. Conclusions: The findings suggest that changes in the right thalamic volume over the course of 3 years in children may be associated to OCS. Future studies are needed to confirm these results and further characterize the specific nature of OCS symptoms associated with thalamic volumes.
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Affiliation(s)
| | - Marcos L Santoro
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Q Hoexter
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andrea Parolin Jackowski
- Laboratory of Integrative Neuroscience, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pedro M Pan
- Laboratory of Integrative Neuroscience, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Conceição Rosário
- Laboratory of Integrative Neuroscience, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sintia I Belangero
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil.,Laboratory of Integrative Neuroscience, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pedro Gomes Alvarenga
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Fogaça Doretto
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Afonso Mazine Tiago Fumo
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | | | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Vanessa K Ota
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- Attention-Deficit/Hyperactivity Disorder and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - James F Leckman
- Yale Child Study Centre, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - André Zugman
- Laboratory of Integrative Neuroscience, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
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23
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Szejko N, Lombroso A, Bloch MH, Landeros-Weisenberger A, Leckman JF. Refractory Gilles de la Tourette Syndrome-Many Pieces That Define the Puzzle. Front Neurol 2020; 11:589511. [PMID: 33391155 PMCID: PMC7775596 DOI: 10.3389/fneur.2020.589511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.
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Affiliation(s)
- Natalia Szejko
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, United States.,Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Adam Lombroso
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - Michael H Bloch
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - Angeli Landeros-Weisenberger
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - James F Leckman
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
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24
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Martino D, Johnson I, Leckman JF. What Does Immunology Have to Do With Normal Brain Development and the Pathophysiology Underlying Tourette Syndrome and Related Neuropsychiatric Disorders? Front Neurol 2020; 11:567407. [PMID: 33041996 PMCID: PMC7525089 DOI: 10.3389/fneur.2020.567407] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: The goal of this article is to review the past decade's literature and provide a critical commentary on the involvement of immunological mechanisms in normal brain development, as well as its role in the pathophysiology of Tourette syndrome, other Chronic tic disorders (CTD), and related neuropsychiatric disorders including Obsessive-compulsive disorder (OCD) and Attention deficit hyperactivity disorder (ADHD). Methods: We conducted a literature search using the Medline/PubMed and EMBASE electronic databases to locate relevant articles and abstracts published between 2009 and 2020, using a comprehensive list of search terms related to immune mechanisms and the diseases of interest, including both clinical and animal model studies. Results: The cellular and molecular processes that constitute our "immune system" are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that innate and adaptive systemic immune pathways, as well as neuroinflammatory mechanisms, play an important role in the pathobiology of at least a subset of individuals with Tourette syndrome and related neuropsychiatric disorders In the conceptual framework of the holobiont theory, emerging evidence points also to the importance of the "microbiota-gut-brain axis" in the pathobiology of these neurodevelopmental disorders. Conclusions: Neural development is an enormously complex and dynamic process. Immunological pathways are implicated in several early neurodevelopmental processes including the formation and refinement of neural circuits. Hyper-reactivity of systemic immune pathways and neuroinflammation may contribute to the natural fluctuations of the core behavioral features of CTD, OCD, and ADHD. There is still limited knowledge of the efficacy of direct and indirect (i.e., through environmental modifications) immune-modulatory interventions in the treatment of these disorders. Future research also needs to focus on the key molecular pathways through which dysbiosis of different tissue microbiota influence neuroimmune interactions in these disorders, and how microbiota modification could modify their natural history. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to the treatment of these disorders.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Isaac Johnson
- Child Study Center, Yale University, New Haven, CT, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - James F. Leckman
- Child Study Center, Yale University, New Haven, CT, United States
- Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
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25
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Heiman GA, Rispoli J, Seymour C, Leckman JF, King RA, Fernandez TV. Empiric Recurrence Risk Estimates for Chronic Tic Disorders: Implications for Genetic Counseling. Front Neurol 2020; 11:770. [PMID: 32849224 PMCID: PMC7432137 DOI: 10.3389/fneur.2020.00770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Tourette disorder (TD) and other chronic tic disorders are neurodevelopmental/neuropsychiatric disorders characterized by motor and/or vocal tics. Family studies indicate that TD strongly aggregates within families and that other chronic tic disorders are biologically related such that studies typically combine them into any chronic tic disorder (CTD). Because of stigma, bullying, and comorbidity with other neuropsychiatric disorders, CTDs can severely impact the quality of life of individuals with these disorders. Objectives: The genetic architecture of CTDs is complex and heterogeneous, involving a myriad of genetic variants. Thus, providing familial recurrence risks is based on empirical recurrence risk estimates rather than genetic testing. Because empiric recurrence risks for CTDs have not been published, the purpose of this study is to calculate and report these recurrence risks estimates. Methods: Based on population prevalence and increased risk to different relatives from a large population-based family study, we calculated the empiric recurrent risk estimate for each relative type (full sibling, parents, offspring, all first-degree, and all second-degree). Results: The recurrence risk estimate for CTDs in first-degree relatives is 29.9% [95% confidence interval (CI) = 23.2–38.5%]. The risk is higher in males, 33.7% (95% CI = 26.2–43.3%), than females, 24.3% (95% CI = 18.9–31.3%). Conclusions: Given the complex, heterogeneous genetic architecture of CTDs, individuals concerned about recurrence risk should be referred to genetic counseling. Such counseling should include discussion of the derivation and limitations of these empiric recurrence risk estimates, including the upper and lower limits of the range of risk.
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Affiliation(s)
- Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Jessica Rispoli
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Christine Seymour
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Robert A King
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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26
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Yoshikawa H, Wuermli AJ, Britto PR, Dreyer B, Leckman JF, Lye SJ, Ponguta LA, Richter LM, Stein A. Effects of the Global Coronavirus Disease-2019 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions. J Pediatr 2020; 223:188-193. [PMID: 32439312 PMCID: PMC7234941 DOI: 10.1016/j.jpeds.2020.05.020] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Benard Dreyer
- Division of Developmental-Behavioral Pediatrics, New York University School of Medicine, New York, NY; Department of Pediatrics, Bellevue Hospital Center, New York, NY
| | - James F Leckman
- Departments of Child Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT
| | - Stephen J Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | | | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Department of Child and Adolescent Psychiatry, University of Oxford, Oxford, UK
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27
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Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, Stoner JA, Swedo SE, Cunningham MW. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry 2020; 11:564. [PMID: 32670106 PMCID: PMC7328706 DOI: 10.3389/fpsyt.2020.00564] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Movement, behavioral, and neuropsychiatric disorders in children have been linked to infections and a group of anti-neuronal autoantibodies, implying dopamine receptor-mediated encephalitis within the basal ganglia. The purpose of this study was to determine if anti-neuronal biomarkers, when used as a group, confirmed the acute disease in Sydenham chorea (SC) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). IgG autoantibodies against four neuronal autoantigens (tubulin, lysoganglioside GM1, and dopamine receptors D1 and D2) were detected in SC sera (N=8), sera and/or cerebrospinal fluid (CSF) from two groups of PANDAS cases (N=25 first group and N=35 second group), sera from Tourette's syndrome (N=18), obsessive-compulsive disorder (N=25), attention deficit hyperactivity disorder (N=18), and healthy controls (N=28) by direct enzyme-linked immunosorbent assay (ELISA). IgG specific for neuronal autoantigens was significantly elevated during the acute symptomatic phase, and the activity of calcium/calmodulin-dependent protein kinase II (CaMKII) pathway was significantly elevated in human neuronal cells. Five assays confirmed the disease in SC and in two groups of children with PANDAS. In 35 acute onset PANDAS patients, 32 sera (91.4%) were positive for one or more of the anti-neuronal autoantibodies compared with 9 of 28 healthy controls (32.1%, p<0.0001). Importantly, CSF of 32 (91.4%) PANDAS patients had one or more detectable anti-neuronal autoantibody titers and CaMKII activation. Among healthy control subjects with elevated serum autoantibody titers for individual antigens, none (0%) were positively associated with elevated positive CaMKII activation, which was a striking contrast to the sera of PANDAS subjects, who had 76-89% positive association with elevated individual autoantibody titers and positive CaMKII activity. At 6 months follow-up, symptoms improved for more than 80% of PANDAS subjects, and serum autoantibody titers also significantly decreased. Results reported herein and previously published studies in our laboratory suggest the antibody biomarkers may be a useful adjunct to clinical diagnosis of SC, PANDAS, and related disorders and are the first known group of autoantibodies detecting dopamine receptor-mediated encephalitis in children.
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Affiliation(s)
- Jennifer L. Chain
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathy Alvarez
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adita Mascaro-Blanco
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sean Reim
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Bentley
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Hommer
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Paul Grant
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - James F. Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Ivana Kawikova
- Section of Pediatric Neurology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Kyle Williams
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Susan E. Swedo
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Madeleine W. Cunningham
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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28
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Sukhodolsky DG, Walsh C, Koller WN, Eilbott J, Rance M, Fulbright RK, Zhao Z, Bloch MH, King R, Leckman JF, Scheinost D, Pittman B, Hampson M. Randomized, Sham-Controlled Trial of Real-Time Functional Magnetic Resonance Imaging Neurofeedback for Tics in Adolescents With Tourette Syndrome. Biol Psychiatry 2020; 87:1063-1070. [PMID: 31668476 PMCID: PMC7015800 DOI: 10.1016/j.biopsych.2019.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Activity in the supplementary motor area (SMA) has been associated with tics in Tourette syndrome (TS). The aim of this study was to test a novel intervention-real-time functional magnetic resonance imaging neurofeedback from the SMA-for reduction of tics in adolescents with TS. METHODS Twenty-one adolescents with TS were enrolled in a double-blind, randomized, sham-controlled, crossover study involving two sessions of neurofeedback from their SMA. The primary outcome measure of tic severity was the Yale Global Tic Severity Scale administered by an independent evaluator before and after each arm. The secondary outcome was control over the SMA assessed in neuroimaging scans, in which subjects were cued to increase/decrease activity in SMA without receiving feedback. RESULTS All 21 subjects completed both arms of the study and all assessments. Participants had significantly greater reduction of tics on the Yale Global Tic Severity Scale after real neurofeedback as compared with the sham control (p < .05). Mean Yale Global Tic Severity Scale Total Tic score decreased from 25.2 ± 4.6 at baseline to 19.9 ± 5.7 at end point in the neurofeedback condition and from 24.8 ± 8.1 to 23.3 ± 8.5 in the sham control condition. The 3.8-point difference is clinically meaningful and corresponds to an effect size of 0.59. However, there were no differences in changes on the secondary measure of control over the SMA. CONCLUSIONS This first randomized controlled trial of real-time functional magnetic resonance imaging neurofeedback in adolescents with TS suggests that this neurofeedback intervention may be helpful for improving tic symptoms. However, no effects were found in terms of change in control over the SMA, the hypothesized mechanism of action.
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Affiliation(s)
| | - Christopher Walsh
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - William N Koller
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | | | - Mariela Rance
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Zhiying Zhao
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Robert King
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - James F Leckman
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Dustin Scheinost
- Child Study Center, Yale School of Medicine, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Statistics and Data Science, Yale University, New Haven, Connecticut
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michelle Hampson
- Child Study Center, Yale School of Medicine, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
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29
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Ponguta LA, Issa G, Aoudeh L, Maalouf C, Hein SD, Zonderman AL, Katsovich L, Khoshnood K, Bick J, Awar A, Nourallah S, Householder S, Moore CC, Salah R, Britto PR, Leckman JF. Effects of the Mother-Child Education Program on Parenting Stress and Disciplinary Practices Among Refugee and Other Marginalized Communities in Lebanon: A Pilot Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2020; 59:727-738. [PMID: 32014538 DOI: 10.1016/j.jaac.2019.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Few randomized controlled trials (RCTs) have explored the implementation and impact of early childhood parenting education programs in very fragile contexts and humanitarian settings. We tested the effects of a group-based intervention, the Mother-Child Education Program (MOCEP), on parenting stress and practices among two refugee communities and one other marginalized community in Beirut, Lebanon. METHOD A pilot wait-list RCT was conducted to assess the program's impact on maternal, child (average age: 4 years), and dyadic outcomes. A total of 106 mother-child dyads were randomly assigned to either the intervention group (n = 53) or the wait-list control group (n = 53). Analysis was conducted by modified intention-to-treat and supplemental analyses through multiple imputation of missing post-intervention data. RESULTS Forty families (38%) withdrew early from the study. After completing the program, mothers in the intervention group showed a reduction in their harsh parenting practices, as indexed by the Disciplinary Style Questionnaire (Cohen's d = -0.76, 95% CI = -1.24, -0.27) and in their level of parenting stress, as indexed by the Parenting Stress Index-Short Form (PSI-SF; Cohen's d = -0.90, 95% CI = -1.39, -0.40). Exploratory but underpowered analyses of dyadic interactions revealed reductions in the PSI were associated with a reduction in harsh parenting after the intervention. However, we did not detect any positive impact on behavioral or emotional outcomes among the children. CONCLUSION Our analyses suggest that MOCEP had a positive impact on disciplinary practices and parenting stress in a context of high fragility, but that broader effects on maternal and child outcomes may be dependent on program attendance and the availability of other services. We discuss implications of this pilot study for practice and research of a largely unexplored area of program evaluation. CLINICAL TRIAL REGISTRATION INFORMATION Mother and Child Education Program in Palestinian Refugee Camps; https://clinicaltrials.gov; NCT02402556.
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Affiliation(s)
- Liliana A Ponguta
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut.
| | | | | | | | | | - Anna L Zonderman
- Ms. Zonderman is with the Section of Hospital Medicine, Biological Sciences Division, The University of Chicago, Illinois
| | - Liliya Katsovich
- Dr. Khoshnood and Ms. Katsovich are with the School of Public Health, Yale University, New Haven, Connecticut
| | - Kaveh Khoshnood
- Dr. Khoshnood and Ms. Katsovich are with the School of Public Health, Yale University, New Haven, Connecticut
| | - Johanna Bick
- Dr. Bick is with The University of Houston, Texas
| | - Abir Awar
- Arab Resource Collective, Beirut, Lebanon
| | | | - Sarah Householder
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Rima Salah
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - James F Leckman
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
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30
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Calhoun A, Bloch MH, Stubbe D, Leckman JF, Martin A. Integrating clinical and research training in child psychiatry: fifteen-year outcomes of a federally supported program. Child Adolesc Psychiatry Ment Health 2020; 14:21. [PMID: 32467724 PMCID: PMC7227282 DOI: 10.1186/s13034-020-00328-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Albert J. Solnit Integrated Training Program (AJSP) is an educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders. METHODS We compared fifteen cohorts (each representing a consecutive year of matriculation) of AJSP trainees and graduates (n = 30) to peers who were comparably ranked in our original match lists but ultimately pursued residency programs elsewhere (n = 60). Outcomes of interest between the two groups included professional affiliation, as measured by: (1) membership in the American Academy of Child and Adolescent Psychiatry (AACAP); and (2) certification by the American Board of Psychiatry and Neurology (ABPN), as well as three domains of research productivity: (1) Competitive awards received from AACAP; (2) Publication-related metrics derived from the National Library of Medicine (NLM); and (3) Federal grant funding from the National Institutes of Health (NIH). RESULTS AJSP participants were more commonly affiliated with AACAP and board certified in CAP. AJSP graduates and trainees outperformed their control group peers in several research outcomes: (1) Receipt of AACAP awards and number of awards per recipient were higher, and time to first award shorter in the AJSP than in the control group; (2) AJSP participants had more publications in PubMed, more first-authored publications, a higher h-index, and a shorter time to first publication than participants in the control group; and (3) NIH K- or R-series funding success rate was higher among AJSP participants (p < 0.05 for all comparisons). CONCLUSIONS A program designed to support the development of clinician-scientists specifically dedicated to childhood mental health needs has been successful in fostering scientific creativity, productivity and independence. The expansion and replication of similar training initiatives will be an in important step forward to address the high level of morbidity and mortality associated with child and adolescent psychiatric disorders.
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Affiliation(s)
- Amanda Calhoun
- The Child Study Center, Yale School of Medicine, New Haven, CT USA
| | - Michael H. Bloch
- The Child Study Center, Yale School of Medicine, New Haven, CT USA
| | - Dorothy Stubbe
- The Child Study Center, Yale School of Medicine, New Haven, CT USA
| | - James F. Leckman
- The Child Study Center, Yale School of Medicine, New Haven, CT USA
| | - Andrés Martin
- The Child Study Center, Yale School of Medicine, New Haven, CT USA
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31
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Hein S, Bick J, Issa G, Aoude L, Maalouf C, Awar A, Nourallah S, Zonderman AL, Householder S, Katsovich L, Khoshnood K, Moore C, Salah R, Britto PR, Leckman JF, Ponguta LA. Maternal perceptions of father involvement among refugee and disadvantaged families in Beirut, Lebanon. PLoS One 2020; 15:e0229670. [PMID: 32134961 PMCID: PMC7058288 DOI: 10.1371/journal.pone.0229670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
The role of fathers in (co-)parenting their children among refugee and disadvantaged families in low and middle-income countries (LMICs) remains poorly understood. This study sought to examine the associations among mothers' perceptions of their husband's involvement (hereafter referred to as paternal involvement), and her perceptions of her own well-being and a number of other variables, as well as observed mother-child interactions in families living in refugee and disadvantaged communities in Beirut, Lebanon. We analyzed baseline data from 104 mother-child dyads (mean age of children = 4.34 years; range = 2.05 to 7.93 years of age) who participated in a randomized controlled trial aimed at evaluating the impact of the Mother-Child Education Program in Beirut. In addition to the mother's perception of paternal involvement and the videotaped mother-child interactions, data were collected concerning the mother's well-being and her level of social support, as well as her level of stress as a parent and the way her children were disciplined in the family. Mother-child pairs were videotaped while completing a puzzle together and dyadic interactions were coded. Path analysis showed that paternal involvement was significantly associated with a higher level of maternal well-being and lower distress levels. In addition, higher levels of maternal distress were associated with higher levels of harsh discipline and parenting stress. Correlation analysis showed that higher perceptions of paternal involvement were associated with more positive affect displayed by the child, more positive regard for the child, and better mother-child synchrony during the dyadic interactions. Limitations include the cross-sectional design and the modest sample size, which hinder causal inferences and generalizability of the findings. These preliminary findings suggest that higher levels of paternal involvement may have an impact on markers of maternal mental health and positive mother-child interactions in families living in disadvantaged communities or humanitarian settings. Paternal involvement should be considered when designing and implementing parenting programs in LMICs.
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Affiliation(s)
- Sascha Hein
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, Texas, United States of America
| | | | - Lara Aoude
- Arab Resource Collective, Beirut, Lebanon
| | | | - Abir Awar
- Arab Resource Collective, Beirut, Lebanon
| | | | - Anna L. Zonderman
- UChicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Sarah Householder
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Liliya Katsovich
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Kaveh Khoshnood
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Christina Moore
- Department of Psychology, University of Delaware, Newark, Delaware, United States of America
| | - Rima Salah
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Pia R. Britto
- UNICEF, New York, New York, United States of America
| | - James F. Leckman
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
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Smith SD, Vitulano LA, Katsovich L, Li S, Moore C, Li F, Grantz H, Zheng X, Eicher V, Guloksuz SA, Zheng Y, Dong J, Sukhodolsky DG, Leckman JF. A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD. J Atten Disord 2020; 24:780-794. [PMID: 27178060 PMCID: PMC5107355 DOI: 10.1177/1087054716647490] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.
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Affiliation(s)
- Stephanie D. Smith
- Yale School of Medicine, New Haven, CT, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Shuaixing Li
- Beijing Physical Education & Skill College, People’s Republic of China
| | - Christina Moore
- Yale School of Medicine, New Haven, CT, USA
- University of Delaware, Newark, DE, USA
| | - Fenghua Li
- Chinese Academy of Sciences, Beijing, People’s Republic of China
| | | | - Xixi Zheng
- Peking Union Medical College, Beijing, People’s Republic of China
| | | | | | - Yi Zheng
- Capital Medical University, Beijing, People’s Republic of China
| | - Jinxia Dong
- Peking University, Beijing, People’s Republic of China
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Leckman JF, Rubinstein J. Not just in Philadelphia - But across the globe. Depress Anxiety 2019; 36:584-585. [PMID: 31099452 DOI: 10.1002/da.22905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- James F Leckman
- Child Study Center and the Departments of Psychiatry, Pediatrics, and Psychology, Yale University, Yale University School of Medicine, New Haven,, Connecticut
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34
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Blanco-Vieira T, Santos M, Ferrão YA, Torres AR, Miguel EC, Bloch MH, Leckman JF, do Rosario MC. The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects. Depress Anxiety 2019; 36:533-542. [PMID: 30990937 DOI: 10.1002/da.22898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. METHODS A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests. Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. RESULTS The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts. CONCLUSION Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Matheus Santos
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ygor A Ferrão
- Department od Psychiatry, Porto Alegre Health Science Federal University, Porto Alegre, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil
| | - Albina R Torres
- Brazilian OCD Research Consortium (CTOC), Brazil.,Department of Psychiatry, Faculty of Medicine of Botucatu, State University of São Paulo, São Paulo, Brazil
| | - Eurípedes C Miguel
- Brazilian OCD Research Consortium (CTOC), Brazil.,Psychiatry Institute, Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria C do Rosario
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil.,Child Study Center, Yale University, New Haven, Connecticut
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35
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Tillman R, Gordon I, Naples A, Rolison M, Leckman JF, Feldman R, Pelphrey KA, McPartland JC. Oxytocin Enhances the Neural Efficiency of Social Perception. Front Hum Neurosci 2019; 13:71. [PMID: 30914935 PMCID: PMC6421852 DOI: 10.3389/fnhum.2019.00071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
Abstract
Face perception is a highly conserved process that directs our attention from infancy and is supported by specialized neural circuitry. Oxytocin (OT) can increase accuracy and detection of emotional faces, but these effects are mediated by valence, individual differences, and context. We investigated the temporal dynamics of OT’s influence on the neural substrates of face perception using event related potentials (ERPs). In a double blind, placebo controlled within-subject design, 21 healthy male adults inhaled OT or placebo and underwent ERP imaging during two face processing tasks. Experiment 1 investigated effects of OT on neural correlates of fearful vs. neutral facial expressions, and Experiment 2 manipulated point-of-gaze to neutral faces. In Experiment 1, we found that OT reduced N170 latency to fearful faces. In Experiment 2, N170 latency was decreased when participant gaze was directed to the eyes of neutral faces; however, there were no OT-associated effects in response to different facial features. Findings suggest OT modulates early stages of social perception for socially complex information such as emotional faces relative to neutral. These results are consistent with models suggesting OT impacts the salience of socially informative cues during processing, which leads to downstream effects in behavior. Future work should examine how OT affects neural processes underlying basic components of social behavior (such as, face perception) while varying emotional expression of stimuli or comparing different characteristics of participants (e.g., gender, personality traits).
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Affiliation(s)
- Rachael Tillman
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Ilanit Gordon
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Adam Naples
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - Max Rolison
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - James F Leckman
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
| | - Ruth Feldman
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States.,Department of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Kevin A Pelphrey
- Harrison-Wood Jefferson Scholars Foundation Professor, University of Virginia, Charlottesville, VA, United States
| | - James C McPartland
- Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, United States
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Barzilay R, Patrick A, Calkins ME, Moore TM, Wolf DH, Benton TD, Leckman JF, Gur RC, Gur RE. Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? J Am Acad Child Adolesc Psychiatry 2019; 58:277-286.e4. [PMID: 30738554 DOI: 10.1016/j.jaac.2018.06.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/13/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Obsessive-compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a "red flag" that merits psychiatric evaluation. METHOD Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N = 7,054, aged 11-21 years, 54% female). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive-compulsive disorder (OCD), depressive episode, psychosis, and suicide ideation. RESULTS OCS were common in non-mental health-seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in female participants and postpuberty. Factor analyses resulted in 4 factors: F1 - Bad Thoughts; F2 - Repeating/Checking; F3 - Symmetry; F4 - Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis, and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions. CONCLUSION OCS are common in community youth. Although for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help to identify youth at risk for serious psychopathology.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Ariana Patrick
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - Monica E Calkins
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tyler M Moore
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel H Wolf
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tami D Benton
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - James F Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Ruben C Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raquel E Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Shannahoff-Khalsa D, Fernandes RY, Pereira CADB, March JS, Leckman JF, Golshan S, Vieira MSR, Polanczyk GV, Miguel EC, Shavitt RG. Kundalini Yoga Meditation Versus the Relaxation Response Meditation for Treating Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial. Front Psychiatry 2019; 10:793. [PMID: 31780963 PMCID: PMC6859828 DOI: 10.3389/fpsyt.2019.00793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is often a life-long disorder with high psychosocial impairment. Serotonin reuptake inhibitors (SRIs) are the only FDA approved drugs, and approximately 50% of patients are non-responders when using a criterion of 25% to 35% improvement with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). About 30% are non-responders to combined first-line therapies (SRIs and exposure and response prevention). Previous research (one open, one randomized clinical trial) has demonstrated that Kundalini Yoga (KY) meditation can lead to an improvement in symptoms of obsessive-compulsive severity. We expand here with a larger trial. Design: This trial compared two parallel run groups [KY vs. Relaxation Response meditation (RR)]. Patients were randomly allocated based on gender and Y-BOCS scores. They were told two different (unnamed) types of meditation would be compared, and informed if one showed greater benefits, the groups would merge for 12 months using the more effective intervention. Raters were blind in Phase One (0-4.5 months) to patient assignments, but not in Phase Two. Main Outcome Measures: Primary outcome variable, clinician-administered Y-BOCS. Secondary scales: Dimensional Yale-Brown Obsessive Compulsive Scale (clinician-administered), Profile of Mood Scales, Beck Anxiety Inventory, Beck Depression Inventory, Clinical Global Impression, Short Form 36 Health Survey. Results: Phase One: Baseline Y-BOCS scores: KY mean = 26.46 (SD 5.124; N = 24), RR mean = 26.79 (SD = 4.578; N = 24). An intent-to-treat analysis with the last observation carried forward for dropouts showed statistically greater improvement with KY compared to RR on the Y-BOCS, and statistically greater improvement on five of six secondary measures. For completers, the Y-BOCS showed 40.4% improvement for KY (N = 16), 17.9% for RR (N = 11); 31.3% in KY were judged to be in remission compared to 9.1% in RR. KY completers showed greater improvement on five of six secondary measures. At the end of Phase Two (12 months), patients, drawn from the initial groups, who elected to receive KY continued to show improvement in their Y-BOCS scores. Conclusion: KY shows promise as an add-on option for OCD patients unresponsive to first line therapies. Future studies will establish KY's relative efficacy compared to Exposure and Response Prevention and/or medications, and the most effective treatment schedule. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01833442.
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Affiliation(s)
- David Shannahoff-Khalsa
- BioCircuits Institute, University of California, San Diego, La Jolla, CA, United States.,Center for Integrative Medicine, University of California, San Diego, La Jolla, CA, United States.,The Khalsa Foundation for Medical Science, Del Mar, CA, United States
| | - Rodrigo Yacubian Fernandes
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos A de B Pereira
- Mathematics and Statistics Institute, Statistics Department, University of São Paulo, São Paulo, Brazil
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, United States
| | - James F Leckman
- Child Study Center, Department of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Shahrokh Golshan
- Center for Integrative Medicine, University of California, San Diego, La Jolla, CA, United States.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | | | - Guilherme V Polanczyk
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Euripedes C Miguel
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
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38
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Bikic A, Leckman JF, Christensen TØ, Bilenberg N, Dalsgaard S. Attention and executive functions computer training for attention-deficit/hyperactivity disorder (ADHD): results from a randomized, controlled trial. Eur Child Adolesc Psychiatry 2018; 27:1563-1574. [PMID: 29644473 DOI: 10.1007/s00787-018-1151-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/27/2018] [Indexed: 01/26/2023]
Abstract
Multicenter randomized clinical superiority single-blind trial investigated the effect of a computer training program targeting multiple cognitive functions. Seventy children with ADHD, aged 6-13, were randomized to intervention or control group. The intervention group used ACTIVATE™ for 8 weeks and both groups received treatment as usual and were assessed in regard to cognitive functions, symptoms, behavioral and functional outcome measures after 8, 12 and 24 weeks. There was no significant effect on the primary outcome, sustained attention (β = - 0.047; CI - 0.247 to 0.153) or the secondary outcomes [parent-rated ADHD-RS, β = - 0.037; CI (- 0.224 to 0.150); teacher-rated-ADHD-RS, β = 0.093; CI (- 0.107 to 0.294); parent-rated-BRIEF, β = - 0.119; CI (- 0.307 to 0.069); and teacher-rated-BRIEF, β = 0.136; CI (- 0.048 to 0.322)]. This multicenter randomized clinical trial found no significant beneficial effects of cognitive training using the computer program ACTIVATE on the primary or secondary outcome measures in children with ADHD. Nevertheless, our study was likely underpowered to detect small to moderate changes.Trial registration ClinicalTrials.gov: NCT01752530, date of registration: December 10, 2012.
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Affiliation(s)
- Aida Bikic
- Department of Child and Adolescent Mental Health Services Southern Jutland, Region of Southern Denmark, Kresten Phillipsens Vej 15, Aabenraa, Denmark. .,Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, Odense, Denmark.
| | - James F Leckman
- Yale Child Study Centre, Yale University, 230 South Frontage Road, New Haven, USA
| | - Torben Ø Christensen
- Psychiatric Department, Region Nordjylland, Klinik Psykiatri Nord Hjørringvej 180, Brønderslev, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, Odense, Denmark.,Department of Child and Adolescent Mental Health Services Odense, Psychiatric Hospital Region of Southern, Odense, Denmark
| | - Søren Dalsgaard
- Department of Economics and Business, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department for Child and Adolescent Psychiatry, Hospital of Telemark, Kragerø, Norway
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Leckman JF, Britto PR. Steps Toward Peace and Violence Prevention Across Generations: The Potential of Early Child Development in the Context of the 2030 Sustainable Development Goals. New Dir Child Adolesc Dev 2018. [PMID: 29537184 DOI: 10.1002/cad.20227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This special issue of New Directions in Child and Adolescent Development features four review articles from authoritative leaders in the field. These articles highlight how far our field has come over the past five decades, as well as how much further effort is needed to refine, adapt, and implement - in a sustainable fashion - responsive parenting and nurturing care programs of proven value across the globe.
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Abstract
Obsessive-compulsive disorder (OCD) is present in 1.5-2.5% of the population and can result in substantial lifelong disability. It is characterized by intrusive thoughts, sensations, and urges and by repetitive behaviors that are difficult to control despite, in most cases, preserved insight as to their excessive or irrational nature. The causes and underlying pathophysiology of OCD are not well understood, which has limited the development of new treatments and interventions. Despite evidence for a substantial genetic contribution to disease risk, identification and replication of genetic variants associated with OCD have been challenging. Decades of candidate gene association studies have provided little insight. They are now being supplanted by modern genomewide approaches to discover both common and rare sequence and structural variants. Studies to date suggest potential novel therapeutic avenues such as modulators of glutamatergic and immune pathways; however, individual genetic findings are not yet statistically robust or replicated. Further efforts are clearly needed to identify specific risk variants and to confirm vulnerable pathways by studying much larger cohorts of patients with comprehensive variant discovery approaches. Mouse knockout models have already made notable inroads into our understanding of OCD pathology; their utility will only increase as specific risk alleles are identified.
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Affiliation(s)
- Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University School of Medicine, New Haven, CT, United States; Integrated Neuroscience Research Program, Yale University School of Medicine, New Haven, CT, United States
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41
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Fatori D, de Bragança Pereira CA, Asbahr FR, Requena G, Alvarenga PG, de Mathis MA, Rohde LA, Leckman JF, March JS, Polanczyk GV, Miguel EC, Shavitt RG. Adaptive treatment strategies for children and adolescents with Obsessive-Compulsive Disorder: A sequential multiple assignment randomized trial. J Anxiety Disord 2018; 58:42-50. [PMID: 30025255 DOI: 10.1016/j.janxdis.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/19/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This sequential multiple assignment randomized trial (SMART) tested the effect of beginning treatment of childhood OCD with fluoxetine (FLX) or group cognitive-behavioral therapy (GCBT) accounting for treatment failures over time. METHODS A two-stage, 28-week SMART was conducted with 83 children and adolescents with OCD. Participants were randomly allocated to GCBT or FLX for 14 weeks. Responders to the initial treatment remained in the same regimen for additional 14 weeks. Non-responders, defined by less than 50% reduction in baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, were re-randomized to either switch to or add the other treatment. Assessments were performed at baseline, 7, 14, 21, and 28 weeks. RESULTS Among the 43 children randomized to FLX who completed the first stage, 15 (41.7%) responded to treatment and 21 non-responders were randomized to switch to (N = 9) or add GCBT (N = 12). Among the 40 children randomized to GCBT who completed the first stage, 18 (51.4%) responded to treatment and 17 non-responders were randomized to switch to (N = 9) or add FLX (N = 8). Primary analysis showed that significant improvement occurred in children initially treated with either FLX or GCBT. Each time point was statistically significant, showing a linear trend of symptom reduction. Effect sizes were large within (0.76-0.78) and small between (-0.05) groups. CONCLUSIONS Fluoxetine and GCBT are similarly effective initial treatments for childhood OCD considering treatment failures over time. Consequently, provision of treatment for childhood OCD could be tailored according to the availability of local resources.
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Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.
| | | | - Fernando R Asbahr
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Guaraci Requena
- Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro G Alvarenga
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Luis A Rohde
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil; Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - James F Leckman
- Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - John S March
- Division of Neurosciences Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Guilherme V Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes C Miguel
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Mataix-Cols D, Frans E, Pérez-Vigil A, Kuja-Halkola R, Gromark C, Isomura K, Fernández de la Cruz L, Serlachius E, Leckman JF, Crowley JJ, Rück C, Almqvist C, Lichtenstein P, Larsson H. A total-population multigenerational family clustering study of autoimmune diseases in obsessive-compulsive disorder and Tourette's/chronic tic disorders. Mol Psychiatry 2018; 23:1652-1658. [PMID: 29133949 PMCID: PMC5951741 DOI: 10.1038/mp.2017.215] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/19/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022]
Abstract
The association between obsessive-compulsive disorder (OCD) and Tourette's/chronic tic disorders (TD/CTD) with autoimmune diseases (ADs) is uncertain. In this nationwide study, we sought to clarify the patterns of comorbidity and familial clustering of a broad range of ADs in individuals with OCD, individuals with TD/CTD and their biological relatives. From a birth cohort of 7 465 455 individuals born in Sweden between 1940 and 2007, we identified 30 082 OCD and 7279 TD/CTD cases in the National Patient Register and followed them up to 31 December 2013. The risk of 40 ADs was evaluated in individuals with OCD, individuals with TD/CTD and their first- (siblings, mothers, fathers), second- (half siblings) and third-degree (cousins) relatives, compared with population controls. Individuals with OCD and TD/CTD had increased comorbidity with any AD (43% and 36%, respectively) and many individual ADs. The risk of any AD and several individual ADs was consistently higher among first-degree relatives than among second- and third-degree relatives of OCD and TD/CTD probands. The risk of ADs was very similar in mothers, fathers and siblings of OCD probands, whereas it tended to be higher in mothers and fathers of TD/CTD probands (compared with siblings). The results suggest a familial link between ADs in general (that is, not limited to Streptococcus-related conditions) and both OCD and TD/CTD. Additional mother-specific factors, such as the placental transmission of antibodies, cannot be fully ruled out, particularly in TD/CTD.
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Affiliation(s)
- D Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - E Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Pérez-Vigil
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - R Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Gromark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - K Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - L Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - J F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - J J Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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43
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McGuire JF, Piacentini J, Storch EA, Murphy TK, Ricketts EJ, Woods DW, Walkup JW, Peterson AL, Wilhelm S, Lewin AB, McCracken JT, Leckman JF, Scahill L. A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale. Neurology 2018; 90:e1711-e1719. [PMID: 29653992 DOI: 10.1212/wnl.0000000000005474] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/16/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure. METHODS This cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points. RESULTS Children and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference. CONCLUSIONS The YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed.
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Affiliation(s)
- Joseph F McGuire
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
| | - John Piacentini
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Eric A Storch
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Tanya K Murphy
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Emily J Ricketts
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Douglas W Woods
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - John W Walkup
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Alan L Peterson
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Sabine Wilhelm
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Adam B Lewin
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James T McCracken
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James F Leckman
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Lawrence Scahill
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
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Frick L, Rapanelli M, Jindachomthong K, Grant P, Leckman JF, Swedo S, Williams K, Pittenger C. Differential binding of antibodies in PANDAS patients to cholinergic interneurons in the striatum. Brain Behav Immun 2018; 69:304-311. [PMID: 29233751 PMCID: PMC5857467 DOI: 10.1016/j.bbi.2017.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus, or PANDAS, is a syndrome of acute childhood onset of obsessive-compulsive disorder and other neuropsychiatric symptoms in the aftermath of an infection with Group A beta-hemolytic Streptococcus (GABHS). Its pathophysiology remains unclear. PANDAS has been proposed to result from cross-reactivity of antibodies raised against GABHS with brain antigens, but the targets of these antibodies are unclear and may be heterogeneous. We developed an in vivo assay in mice to characterize the cellular targets of antibodies in serum from individuals with PANDAS. We focus on striatal interneurons, which have been implicated in the pathogenesis of tic disorders. Sera from children with well-characterized PANDAS (n = 5) from a previously described clinical trial (NCT01281969), and matched controls, were infused into the striatum of mice; antibody binding to interneurons was characterized using immunofluorescence and confocal microscopy. Antibodies from children with PANDAS bound to ∼80% of cholinergic interneurons, significantly higher than the <50% binding seen with matched healthy controls. There was no elevated binding to two different populations of GABAergic interneurons (PV and nNOS-positive), confirming the specificity of this phenomenon. Elevated binding to cholinergic interneurons resolved in parallel with symptom improvement after treatment with intravenous immunoglobulin. Antibody-mediated dysregulation of striatal cholinergic interneurons may be a locus of pathology in PANDAS. Future clarification of the functional consequences of this specific binding may identify new opportunities for intervention in children with this condition.
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Affiliation(s)
| | | | | | - Paul Grant
- Pediatrics and Developmental Neuroscience Branch, National Institute
of Mental Health
| | - James F. Leckman
- Department of Psychology, Yale University,Child Study Center, Yale University
| | - Susan Swedo
- Pediatrics and Developmental Neuroscience Branch, National Institute
of Mental Health
| | - Kyle Williams
- Department of Psychiatry, Yale University, United States; Child Study Center, Yale University, United States; Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, United States.
| | - Christopher Pittenger
- Department of Psychiatry, Yale University, United States; Department of Psychology, Yale University, United States; Child Study Center, Yale University, United States; Interdepartmental Neuroscience Program, Yale University, United States.
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Leckman JF, Britto PR. Issue Information. New Dir Child Adolesc Dev 2018. [DOI: 10.1002/cad.20210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Leckman JF. What Are the Transgenerational Consequences of Maternal Childhood Adversity and Maternal Stress During Pregnancy? J Am Acad Child Adolesc Psychiatry 2017; 56:914-915. [PMID: 29096770 DOI: 10.1016/j.jaac.2017.09.421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 11/27/2022]
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Bikic A, Christensen TØ, Leckman JF, Bilenberg N, Dalsgaard S. A double-blind randomized pilot trial comparing computerized cognitive exercises to Tetris in adolescents with attention-deficit/hyperactivity disorder. Nord J Psychiatry 2017; 71:455-464. [PMID: 28598701 DOI: 10.1080/08039488.2017.1328070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this trial was to examine the feasibility and efficacy of computerized cognitive exercises from Scientific Brain Training (SBT), compared to the computer game Tetris as an active placebo, in a pilot study of adolescents with attention-deficit/hyperactivity disorder (ADHD). METHOD Eighteen adolescents with ADHD were randomized to treatment or control intervention for 7 weeks. Outcome measures were cognitive test, symptom, and motivation questionnaires. RESULTS SBT and Tetris were feasible as home-based interventions, and participants' compliance was high, but participants perceived both interventions as not very interesting or helpful. There were no significant group differences on cognitive and ADHD-symptom measures after intervention. Pre-post intra-group measurement showed that the SBT had a significant beneficial effect on sustained attention, while the active placebo had significant beneficial effects on working memory, both with large effect sizes. CONCLUSION Although no significant differences were found between groups on any measure, there were significant intra-group changes for each group.
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Affiliation(s)
- Aida Bikic
- a Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,b Department for Child and Adolescent Psychiatry , Aabenraa , Denmark
| | | | - James F Leckman
- d The Child Study Center , Yale School of Medicine , New Haven , CT , USA
| | - Niels Bilenberg
- a Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,e Department for Child and Adolescent Psychiatry , Odense , Denmark
| | - Søren Dalsgaard
- a Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,f National Centre for Register-based Research, Department of Economics and Business , Aarhus University , Aarhus , Denmark.,g Department for Child and Adolescent Psychiatry , Hospital of Telemark , Kragerø , Norway
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Stuckelman ZD, Mulqueen JM, Ferracioli-Oda E, Cohen SC, Coughlin CG, Leckman JF, Bloch MH. Risk of Irritability With Psychostimulant Treatment in Children With ADHD: A Meta-Analysis. J Clin Psychiatry 2017; 78:e648-e655. [PMID: 28682529 DOI: 10.4088/jcp.15r10601] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 10/04/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Irritability is listed as a common side effect of psychostimulant medications. However, psychostimulants have been demonstrated as an effective treatment in reducing irritability and aggression in children with attention-deficit/hyperactivity disorder (ADHD). The goal of this study was to quantify the risk of irritability as a side effect of psychostimulant treatment for ADHD. DATA SOURCES AND STUDY SELECTION A PubMed search was conducted on August 18, 2013, to identify all double-blind, randomized, placebo-controlled trials published in English examining the efficacy of psychostimulant medications in the treatment of children with ADHD. Trials were excluded if (1) they required additional psychiatric or medical comorbidity in addition to ADHD, (2) they involved fewer than 20 subjects (parallel group trials), or (3) children received psychostimulant medication for less than 1 week. DATA EXTRACTION A fixed-effects meta-analysis was used to examine the risk ratio of irritability reported as a side effect in children treated with psychostimulants compared to placebo. Stratified subgroup analysis and meta-regression were used to examine the effects of stimulant type, dosage, duration of use, and trial design on the measured risk of irritability. RESULTS From 92 potentially eligible trials, the meta-analysis identified 32 trials involving 3,664 children with ADHD that reported data on irritability as a side effect. The relative risk of irritability significantly differed between psychostimulant classes (test for subgroup differences χ²₁ = 7.6, P = .006). Methylphenidate derivatives were associated with a significantly decreased risk of irritability compared to placebo (risk ratio [RR] = 0.89 [95% CI, 0.82 to 0.96], z = -2.87, P = .004, k = 32, I² = 50%), whereas amphetamine derivatives were associated with a significantly increased risk of irritability (RR = 2.90 [95% CI, 1.26 to 6.71], z = 2.5, P = .01, k = 5, I² = 0%). CONCLUSIONS This meta-analysis suggests an increased risk of irritability may be confined to amphetamine-derived psychostimulants. Future meta-analyses examining the effects of amphetamine and methylphenidate derivatives on irritability as a continuous measure, as well as head-to-head trials between methylphenidate and amphetamine derivatives examining effects on irritability, will be important to replicate the findings of this meta-analysis.
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Affiliation(s)
| | | | | | | | | | | | - Michael H Bloch
- Child Study Center, Yale University School of Medicine, PO Box 207900, New Haven, CT 06520. .,Yale Child Study Center, New Haven, Connecticut, USA.,Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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49
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Saad LO, do Rosario MC, Cesar RC, Batistuzzo MC, Hoexter MQ, Manfro GG, Shavitt RG, Leckman JF, Miguel EC, Alvarenga PG. The Child Behavior Checklist-Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children. J Child Adolesc Psychopharmacol 2017; 27:342-348. [PMID: 28151703 PMCID: PMC5439443 DOI: 10.1089/cap.2016.0125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ("at-risk for OCD") using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD. METHODS Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales. RESULTS A total of 2512 (mean age: 8.86 ± 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an "at-risk for OCD" subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%. CONCLUSIONS The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The "at-risk for OCD" group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.
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Affiliation(s)
- Laura O. Saad
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Maria C. do Rosario
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Raony C. Cesar
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Gisele G. Manfro
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - James F. Leckman
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Eurípedes C. Miguel
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Pedro G. Alvarenga
- Department of Psychiatry, University of São Paulo Medical School (USP), São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
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50
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Meier SM, Dalsgaard S, Mortensen PB, Leckman JF, Plessen KJ. Mortality risk in a nationwide cohort of individuals with tic disorders and with tourette syndrome. Mov Disord 2017; 32:605-609. [DOI: 10.1002/mds.26939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sandra M. Meier
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- Child and Adolescent Mental Health Centre - Mental Health Services Capital Region; Copenhagen Region Denmark
| | - Søren Dalsgaard
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
| | - Preben B. Mortensen
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- CIRRAU - Centre for Integrated Register-based Research; Aarhus University; Aarhus V Denmark
| | - James F. Leckman
- Yale Child Study Center; Yale University; New Haven Connecticut USA
| | - Kerstin J. Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- Child and Adolescent Mental Health Centre - Mental Health Services Capital Region; Copenhagen Region Denmark
- Department of Clinical Medicine; Faculty of Health Sciences, University of Copenhagen; Copenhagen Denmark
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