Alternative splicing and gene co-expression network-based analysis of dizygotic twins with autism-spectrum disorder and their parents

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with high heritability, however, understanding the complexity of the underlying genetic basis has proven to be a challenging task. We hypothesized that dissecting the aberrations in alternative splicing (AS) and their effects on expression networks might provide insight. Therefore, we performed AS and co-expression analyses of total RNA isolated from Peripheral Blood Mononuclear Cells (PBMCs) of two pairs of dizygotic (DZ) twins with non-syndromic autism and their parents. We identified 183 differential AS events in 146 genes, seven of them being Simons Foundation Autism Research Initiative (SFARI) Category 1-3 genes, three of which had previously been reported to be alternatively spliced in ASD post-mortem brains. Gene co-expression analysis identified 7 modules with 513 genes, 5 of which were SFARI Category 1 or Category 2 genes. Among differentially AS genes within the modules, ZNF322 and NR4A1 could be potentially interesting targets for further investigations.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate

AIM

To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-^99m] TRODAT-1SPECT in a sample of treatment-naïve adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10-repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability.

METHODS

Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-^99m] TRODAT-1 at baseline and two months after starting OROS-MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI-S) and DuPaul ADHD Rating Scale-Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS-MPH treatment.

RESULTS

Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ± 33.77, post-treatment DAT binding: 208.86 ± 28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 ± 55.24, post-treatment DAT binding: 285.66 ± 39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability.

CONCLUSION

Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc-^99m] TRODAT-1SPECT.

Technetium-99m HMPAO brain SPECT in autistic children and their families

The purpose of the study was to investigate perfusion patterns in autistic children (AC) and their families. Ten AC (9 boys, 1 girl; mean age: 6.9+/-1.7 years) with autistic disorder defined by DSM-III-R criteria, five age-matched children (3 boys, 2 girls) as a control group, and the immediate family members of eight AC (8 mothers, 8 fathers, 7 siblings; mean ages: 39+/-4 years, 36+/-5 years and 13+/-5 years, respectively) were included in the study. Age- and sex-matched control groups for both the parents and the siblings were also included in the study. Brain perfusion images were obtained 1 h after the intravenous injection of an adjusted dose of Tc-99m HMPAO to children and the adults. Visual and semiquantitative evaluations were performed. Hypoperfusion was seen in the right posterior parietal cortex in three AC, in bilateral parietal cortex in one AC, bilateral frontal cortex in two AC, left parietal and temporal cortex in one AC, and right parietal and temporal cortex in one AC. Asymmetric perfusion was observed in the caudate nucleus in four AC. In semiquantitative analyses, statistically significant hypoperfusion was found in the right inferior and superior frontal, left superior frontal, right parietal, right mesial temporal and right caudate nucleus. In parents of AC, significant hypoperfusion was noted in the right parietal and bilateral inferior frontal cortex. In siblings of AC, perfusion in the right frontal cortex, right nucleus caudate and left parietal cortex was significantly decreased. This preliminary study suggests the existence of regional brain perfusion alterations in frontal, temporal, and parietal cortex and in caudate nucleus in AC and in their first-degree family members.

A case series of Turkish children and adolescents with bipolar spectrum disorder: a naturalistic clinical phenomenological follow-up

AIM

The main objectives of this a naturalistic, prospective follow-up study were to describe the clinical presentation and predictors of treatment response in Turkish children and adolescents with bipolar disorder (BD) and to document their response to available treatment regimes.

METHODS

The study sample consisted of 27 consecutive admissions to the Child and Adolescent Psychiatry Clinic between 2002 and 2006. Washington University at St. Louis -Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) was administered to mothers for an assessment of the problem of their children and to children about themselves. Subjects were phenomenologically re-examined to ascertain whether they met the Leibenluft criteria for the narrow, intermediate, or broad phenotypes of juvenile mania. All patients were also rated with Children Global Assessment Scale (CGAS) and Young Mania Rating Scale (YMRS). Treatment response was documented using the Clinical Global Impression (CGI) and the YMRS.

RESULTS

The mean age was 12.95+/-3.8 years and the mean follow-up period was 24+/-9.2 months. Nineteen (70.3%) patients continued their treatment for 20.6+/-12.47 months. A large number of patients responded to mood stabilizers and antipsychotic agents (89.5%). When treatment endpoint scores of CGAS were compared between patients with age at onset =or>13 and <13, functionality of group with age at onset =or>13 was significantly greater than early onset group at the end of the treatment(z:-2.014, P=0.044).

CONCLUSION

Compared to non-episodic patients, episodic patients were more likely to have psychotic features and to have a later age of onset. Mood stabilizers and atypical antipsychotic combination was required in many cases (73.7%). Long term follow-up clinical phenomenological and treatment efficacy studies are needed in the future.

[Neurocognitive features of the frontal lobe in parents of autistic children]

OBJECTIVE

The aim of this study was to examine the neurocognitive functions of the frontal lobe in parents of autistic children.

METHOD

The study group included 64 parents of children (aged 4-18 years) diagnosed with autism, according to DSM-IV criteria, that were followed-up at the child and adolescent psychiatry outpatient clinic. Parents of children with Down syndrome (n = 60) were selected as the control group. We administered the Wisconsin Card Sorting Test (WCST), Stroop Test, and Wechsler Adult Intelligence Test (WAIS) to both groups in order to evaluate executive functions, attention, inhibition, and intelligence.

RESULTS

Mothers of children with autism performed better than the control group mothers on the executive function measures of WCST. There were no group differences in Stroop Test measures of attention and inhibition, or in the verbal and performance intelligence subtests of WAIS. Fathers of children with severe autistic symptoms performed better on some WAIS subtests compared to other; however, there were no significant differences in IQ between the parents in both groups.

CONCLUSION

The results suggest that parents of autistic children could display different cognitive styles, but we did not observe any distinctive cognitive profile pertaining to frontal lobe functions. The cognitive ability of parents of autistic children and its neurobiological basis should be further investigated.

Assessment of child neurology outpatients with headache, dizziness, and fainting

Neurologic symptoms such as headache, vertigo, dizziness, and fainting can create a diagnostic problem in pediatric neurology practice because they are also the most common presenting symptoms of psychiatric disorders. Children, especially adolescents, who are often admitted with such autonomic symptoms, are frequently misdiagnosed. In this study, we aimed to investigate the psychiatric morbidity and comorbidity rate in children and adolescents presenting with neurologic symptoms such as headache, vertigo, and syncope. We investigated 31 children who presented with these symptoms. All children were evaluated for their medical history and had a physical and neurologic examination. We attempted to rule out a possible organic etiology. All patients received a complete laboratory examination (blood count, electroencephalography), pediatric cardiology and otorhinolaryngology consultations, and a caloric test. All patients were assessed according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The majority of the patients (93.5%) received a psychiatric diagnosis according to the DSM-IV criteria. Most of these patients were adolescents and female. Psychosocial stressors such as academic problems, familial dysfunction, parental psychopathology, and child sexual abuse were associated with somatic symptoms. The results of this study demonstrated the importance of differential diagnosis and psychiatric comorbidity in a pediatric neurologic outpatient population. Treatment should be directed at biopsychosocial integrity, and a multidisciplinary treatment approach should be applied.

Technetium-99m HMPAO brain SPECT in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobehavioral syndrome with an onset in childhood. The aim of this study was to investigate the existence of regional perfusion changes in ADHD by means of Tc-99m HMPAO brain SPECT. Thirteen children with a diagnosis of ADHD and 7 healthy, age-matched controls were included in this study. Hypoperfusion was observed on the right temporal cortex in 9, and on the left temporal cortex in 3 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. Asymmetric perfusion was seen on the caudate nucleus in 4, on the thalamus in 3 and on the frontal cortex in 6 children. There was a significant difference between children with ADHD and controls in right medial temporal cortex: cerebellum and right lateral temporal cortex: cerebellum ratios. Hypoperfusion in the right medial temporal cortex was significantly and inversely correlated with Du Paul teachers' questionnaire rating scale (r = -0.71, p = 0.006). It has been postulated that difficulty in self regulating response to stimuli in ADHD is mediated by underfunctioning of the orbital frontal cortex and subsequent connection to the limbic system. Decreased temporal cortex perfusion may dysfunction of the limbic system or the orbito-frontal-limbic axis.

Child abuse in Turkey: an experience in overcoming denial and a description of 50 cases

OBJECTIVE

To share the experiences of the first clinical multidisciplinary child abuse and neglect (CAN) team in Turkey with international child abuse community.

METHODS

The authors established the first Turkish CAN follow-up team at Dr. Behcet Uz Children's Hospital. Following a training program in five teaching hospitals in Izmir, the authors kept a record of every case diagnosed with CAN from these hospitals between 1996 and 1998. The demographic, epidemiologic, and medical features of this case series are summarized.

RESULTS

Fifty cases were diagnosed and followed-up. Seventy-six percent of patients were reported from Dr. Behcet Uz Children's Hospital. Age and sex distribution was 9.2 +/- 6.7 years and 46% male, 54% female, respectively. The offenders were only father in 38%, only mother in 28%, and multiple in 34%. More than three CAN risk factors were present in 94%. Of the children reported 44% survived, 14% died, and 42% were lost to follow-up. Sixteen percent were free of reabuse, and 42% survived with handicaps.

CONCLUSIONS

Child abuse and neglect is a reality in Turkey. The team's work increased pediatricians' awareness of CAN. Reporting these cases to Social Affairs Bureau was established for the first time in Turkey. Physicians in Turkey need training to diagnose and properly report CAN. The implemen tation of a national CAN prevention program is an urgent need for Turkey.

A multicenter child maltreatment study: twenty-eight cases followed-up on a multidisciplinary basis

Twenty-eight maltreated cases were presented in this multicenter study. Hospital distribution was as follows: Dr. Behçet Uz Children's Hospital, 54 percent; Dokuz Eylül University Hospital, 21 percent; Ege University Hospital, 14 percent; Tepecik Social Security Hospital, 7 percent; Atatürk State Hospital, 4 percent. Age and sex distribution was two months to 25 years and 43 percent male, 57 percent female. The offender was the father in 71 percent, the mother in 32 percent and multiple in 25 percent of the cases. More than three child maltreatment risk factors were present in 93 percent. Nineteen patients (68%), nine of which were effectively followed-up were reported to the Social Affairs Bureau. Sixty-four percent gained acceptable health with the support of our team, 14 percent died, and 21 percent failed to comply with follow-up. A multidisciplinary group may interfere both medically and socially with these cases to interrupt the course of maltreatment. Every children's hospital needs such a team to increase diagnosis establishment necessary to initiate social support.