Developing the WE BEAT Well-Being Education Programme to foster resilience and build connection in paediatric heart disease

BACKGROUND

The study of psychological well-being and related resilient outcomes is of increasing focus in cardiovascular research. Despite the critical importance of psychological well-being and related resilient outcomes in promoting optimal cardiac health, there have been very few psychological interventions directed towards children with heart disease. This paper describes the development and theoretical framework of the WE BEAT Wellbeing Education Program, a group-based psychoeducation and coping skills training intervention designed to improve psychological well-being and resilience in adolescents with paediatric heart disease.

METHODS

Program development was informed by patient and family needs and input gathered via large, international survey methods as well as qualitative investigation, a theoretical framework, and related resilience intervention research.

RESULTS

An overview of the WE BEAT intervention components and structure of the programme is provided.

CONCLUSIONS

The WE BEAT Wellbeing Education Program was developed as one of the first resiliency-focused interventions in paediatric heart disease with an overall objective to foster positive psychological well-being and resilient outcomes through a health promotion and prevention lens in an accessible format while providing access to safe, peer-to-peer community building. Feasibility pilot results are forthcoming. Future directions include mobile app-based delivery and larger-scale efficacy and implementation trials.

Resilient Hearts: Measuring Resiliency in Young People With Congenital Heart Disease

Background Congenital heart disease (CHD) is a life-long disease with long-term consequences on physical and mental health. Patients with CHD face multifaceted physical and psychosocial challenges. Resilience is an important factor that can be protective and positively impact mental health. We studied resiliency and its associated factors in teenagers and young adults with and without CHD using a social media-delivered survey. Resilience was measured using the 25-item Connor-Davidson Resilience Scale, a validated metric with a historical mean of 80.4/100 in the general adult population. Methods and Results Individuals with and without CHD, aged 10 to 25 years, were prospectively recruited on social media to complete an online survey. The survey was completed from January to February 2022. Respondents provided information on their demographics and CHD details (where applicable) and completed the Connor-Davidson Resilience Scale. As a group, participants with CHD had higher resilience scores compared with same-aged healthy individuals (65.3±16.1 versus 55.4±13.8; P<0.001). For both cohorts, sex, race, and age were not associated with differences in resilience score. For individuals with CHD, lower resilience was associated with more hospital admissions, lack of exercise, presence of a mental health diagnosis, and no participation in support groups or disease-specific camps. Conclusions Young people with CHD had higher resilience than individuals without CHD in our sample. We identified several factors, both modifiable and nonmodifiable, that are associated with higher resilience. Awareness of resiliency and its contributors in the population with CHD may assist medical teams in improving patient physical and psychological well-being.

Do antidepressants influence mood patterns? A naturalistic study in bipolar disorder

This prospective, longitudinal study compared the frequency and pattern of mood changes between outpatients receiving usual care for bipolar disorder who were either taking or not taking antidepressants. One hundred and eighty-two patients with bipolar disorder self-reported mood and psychiatric medications for 4 months using a computerized system (ChronoRecord) and returned 22,626 days of data. One hundred and four patients took antidepressants, 78 did not. Of the antidepressants taken, 95% were selective serotonin or norepinephrine reuptake inhibitors, or second-generation antidepressants. Of the patients taking an antidepressant, 91.3% were concurrently taking a mood stabilizer. The use of antidepressants did not influence the daily rate of switching from depression to mania or the rate of rapid cycling, independent of diagnosis of bipolar I or II. The primary difference in mood pattern was the time spent normal or depressed. Patients taking antidepressants frequently remained in a subsyndromal depression. In this naturalistic study using self-reported data, patients with bipolar disorder who were taking antidepressants—overwhelmingly not tricyclics and with a concurrent mood stabilizer—did not experience an increase in the rate of switches to mania or rapid cycling compared to those not taking antidepressants. Antidepressants had little impact on the mood patterns of bipolar patients taking mood stabilizers.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

Purpose:

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

Methods:

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

Results:

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

Conclusion:

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Spinal parenchymal occupation by neural stem cells after subpial delivery in adult immunodeficient rats

Neural precursor cells (NSCs) hold great potential to treat a variety of neurodegenerative diseases and injuries to the spinal cord. However, current delivery techniques require an invasive approach in which an injection needle is advanced into the spinal parenchyma to deliver cells of interest. As such, this approach is associated with an inherent risk of spinal injury, as well as a limited delivery of cells into multiple spinal segments. Here, we characterize the use of a novel cell delivery technique that employs single bolus cell injections into the spinal subpial space. In immunodeficient rats, two subpial injections of human NSCs were performed in the cervical and lumbar spinal cord, respectively. The survival, distribution, and phenotype of transplanted cells were assessed 6-8 months after injection. Immunofluorescence staining and mRNA sequencing analysis demonstrated a near-complete occupation of the spinal cord by injected cells, in which transplanted human NSCs (hNSCs) preferentially acquired glial phenotypes, expressing oligodendrocyte (Olig2, APC) or astrocyte (GFAP) markers. In the outermost layer of the spinal cord, injected hNSCs differentiated into glia limitans-forming astrocytes and expressed human-specific superoxide dismutase and laminin. All animals showed normal neurological function for the duration of the analysis. These data show that the subpial cell delivery technique is highly effective in populating the entire spinal cord with injected NSCs, and has a potential for clinical use in cell replacement therapies for the treatment of ALS, multiple sclerosis, or spinal cord injury.

Trajectories of adherence to mood stabilizers in patients with bipolar disorder

Background

Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes.

Methods

This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient.

Results

Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found.

Conclusion

In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.

Solar insolation in springtime influences age of onset of bipolar I disorder

OBJECTIVE

To confirm prior findings that the larger the maximum monthly increase in solar insolation in springtime, the younger the age of onset of bipolar disorder.

METHOD

Data were collected from 5536 patients at 50 sites in 32 countries on six continents. Onset occurred at 456 locations in 57 countries. Variables included solar insolation, birth-cohort, family history, polarity of first episode and country physician density.

RESULTS

There was a significant, inverse association between the maximum monthly increase in solar insolation at the onset location, and the age of onset. This effect was reduced in those without a family history of mood disorders and with a first episode of mania rather than depression. The maximum monthly increase occurred in springtime. The youngest birth-cohort had the youngest age of onset. All prior relationships were confirmed using both the entire sample, and only the youngest birth-cohort (all estimated coefficients P < 0.001).

CONCLUSION

A large increase in springtime solar insolation may impact the onset of bipolar disorder, especially with a family history of mood disorders. Recent societal changes that affect light exposure (LED lighting, mobile devices backlit with LEDs) may influence adaptability to a springtime circadian challenge.

Regularity in daily mood stabilizer dosage taken by patients with bipolar disorder

OBJECTIVE

The aim of this study was to investigate regularity in the daily mood stabilizer dosage taken by patients with bipolar disorder, and identify factors associated with irregularity.

METHODS

Self-reported daily mood and medication data were available from 206 patients who took the same mood stabilizer for ≥100 days. Approximate entropy (ApEn) was used to measure serial regularity in daily mood stabilizer dosage. Generalized estimating equations (GEE) were used to estimate if demographic or clinical variables were associated with ApEn.

RESULTS

There was a wide range of regularity in the daily mood stabilizer dosage. The mean percent of days of missing doses was 13.6%. The number of psychotropic medications (p=0.007), pill burden (p=0.004) and percent of days with depressed mood (p=0.013) were associated with more irregularity, while the percent of days euthymic (p=0.014) was associated with less irregularity. The percent of days missing doses was not associated with the number of medications, pill burden or mood ratings.

DISCUSSION

Patients may have irregularity in daily dosage in spite of a low percent of days missing doses. Psychotropic medication regimen complexity and depression are associated with increased dosage irregularity. Research is needed on how irregularity in daily dosage impacts the continuity of drug action of mood stabilizers.

Inter-subject correlation exists between morphological metrics of cerebral blood flow velocity and intracranial pressure pulses

BACKGROUND

The prototypical intracranial pressure (ICP) pulse morphology has been well known to be triphasic. Several studies suggest that the morphology of ICP pulse reflects the physiological and pathophysiological conditions of the intracranial dynamics. Recently, there has been a renaissance of studying ICP pulse using new ICP signal processing technologies in various clinical contexts. Cerebral blood flow velocity (CBFV) pulse is another important pulsatile signal originated from the complex circulatory systems of cerebral blood flow. However, CBFV pulse morphology has not been well studied mainly due to the noise level and lack of signal processing techniques.

METHODS

Our group recently developed a technique called the morphological clustering and analysis of intracranial pressure that can extract a comprehensive set of pulse morphological metrics. We extend this algorithm to extract various morphological metrics from ICP and CBFV pulses that were simultaneously recorded from 47 brain injury patients and investigate the mutual correlation between those metrics utilizing the robust percentage bend correlation analysis.

RESULTS

Our results show that CBFV pulses are also triphasic as ICP pulses and 15.2% of 128 pulse morphological metrics extracted from ICP and CBFV pulses are highly correlated (P < 0.01) in an inter-subject fashion. In addition, mean ICP does not correlate (P = 0.45) with the pulsatility index of CBFV pulses but correlates (P < 0.05) with several novel CBFV pulse morphological metrics such as the time interval between the onset of CBFV pulses and ECG QRS peak.

CONCLUSIONS

Our results suggest that characterizing CBFV pulse morphology is clinically important because it may offer a potential noninvasive alternative to assess various aspects of ICP such as mean ICP.

Intracranial pressure pulse morphological features improved detection of decreased cerebral blood flow

We investigated whether intracranial pressure (ICP) pulse morphological metrics could be used to realize continuous detection of low cerebral blood flow. Sixty-three acutely brain injured patients with ICP monitoring, daily (133)Xenon cerebral blood flow (CBF) and daily transcranial Doppler (TCD) assessments were studied. Their ICP recordings were time-aligned with the CBF and TCD measurements so that a 1 h ICP segment near the CBF and TCD measurements was obtained. Each of these recordings was processed by the Morphological Cluster and Analysis of Intracranial Pressure (MOCAIP) algorithm to extract pulse morphological metrics. Then the differential evolution algorithm was used to find the optimal combination of the metrics that provided, using the regularized linear discriminant analysis, the largest combined positive predictivity and sensitivity. At a CBF threshold of 20 ml/min/100 g, a sensitivity of 81.8 +/- 0.9% and a specificity of 50.1 +/- 0.2% were obtained using the optimal combination of conventional TCD and blood analysis metrics as input to a regularized linear classifier. However, using the optimal combination of the MOCAIP metrics alone we were able to achieve a sensitivity of 92.5 +/- 0.7% and a specificity of 84.8 +/- 0.8%. Searching the optimal combination of all available metrics, we achieved the best result that was marginally better than those from using MOCAIP alone. This study demonstrated that the potential role of ICP monitoring may be extended to provide an indicator of low global cerebral blood perfusion.

The thyroid-brain interaction in thyroid disorders and mood disorders

Thyroid hormones play a critical role in the metabolic activity of the adult brain, and neuropsychiatric manifestations of thyroid disease have long been recognised. However, it is only recently that methodology such as functional neuroimaging has been available to facilitate investigation of thyroid hormone metabolism. Although the role of thyroid hormones in the adult brain is not yet specified, it is clear that without optimal thyroid function, mood disturbance, cognitive impairment and other psychiatric symptoms can emerge. Additionally, laboratory measurements of peripheral thyroid function may not adequately characterise central thyroid metabolism. Here, we review the relationship between thyroid hormone and neuropsychiatric symptoms in patients with primary thyroid disease and primary mood disorders.

Vasospasm probability index: a combination of transcranial doppler velocities, cerebral blood flow, and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage

OBJECT

The goal in this study was to create an index (vasospasm probability index [VPI]) to improve diagnostic accuracy for vasospasm after subarachnoid hemorrhage (SAH).

METHODS

Seven hundred ninety-five patients in whom aneurysmal SAH was demonstrated by computed tomography, and in whom one or more intracranial aneurysms had been diagnosed, underwent transcranial Doppler (TCD) studies between April 1998 and January 2000. In 154 patients angiography was performed within 24 hours of the TCD examination, and in 75 133Xe cerebral blood flow (CBF) studies were obtained the same day. Seven cases were excluded because of a limited sonographic window. Forty-one women (60.3%) and 27 men (39.7%) between the ages of 35 and 84 years (58.0 +/- 13.2 years [mean +/- standard deviation]) were included. Clinical characteristics analyzed included age, sex, Hunt and Hess grade, Fisher grade, days after SAH, day of treatment, type of treatment (coil embolization, surgical clip occlusion, or conservative treatment), smoking history, and hypertension history. Lindegaard ratios and spasm indexes (TCD velocities/hemispheric CBF) were calculated bilaterally. Digital subtraction angiography images were measured at specific points of interest. Sensitivity, specificity, predictive values, and global accuracy of the different tests were calculated. Logistic regression was used to evaluate the possible predictive factors, and the coefficients of the logistic regression were integrated to create the VPI.

RESULTS

In 18 patients (26.5%) symptomatic vasospasm was diagnosed, and 33 (48.5%) had angiographic evidence of vasospasm. For TCD velocities above 120 cm/second at the middle cerebral artery, the global accuracy was 81.1% for the diagnosis of clinical vasospasm and 77.2% for angiographic vasospasm. For a Lindegaard ratio higher than 3.0, the accuracy was 85% for clinical vasospasm and 83.2% for angiographic vasospasm. A spasm index higher than 3.5 had an accuracy of 82.0% for the diagnosis of clinical vasospasm and 81.6% for angiographic vasospasm. The selected model for estimation of clinical vasospasm included Fisher grade, Hunt and Hess grade, and spasm index. The VPI had a global accuracy of 92.9% for clinical vasospasm detection. For diagnosis of angiographic vasospasm, the model included Fisher grade, Hunt and Hess grade, and Lindegaard ratio. The VPI achieved a global accuracy of 89.9% for angiographic vasospasm detection.

CONCLUSIONS

The use of TCD velocities, Lindegaard ratio, and spasm index independently is of limited value for the diagnosis of clinical and angiographic vasospasm. The combination of predictive factors associated with the development of vasospasm in the new index reported here has a significantly superior accuracy compared with the independent tests and may become a valuable tool for the clinician to evaluate the individual probability of cerebral vasospasm after aneurysmal SAH.

Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure

OBJECTIVE

To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio.

DESIGN

Prospective monitoring with retrospective data analysis.

SETTING

Single-center academic neurologic intensive care unit.

PATIENTS

Twenty-one patients with severe traumatic brain injury (Glasgow Coma Scale score 3-8).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Cerebral microdialysis was performed for the initial 7 days after traumatic brain injury. Thirteen patients had microdialysis probes in normal tissue and eight had two probes, one of which was located in pericontusional tissue. Retrospective analysis was performed to determine if microdialysis levels in pericontusional tissue demonstrates higher levels of lactate/pyruvate ratio than normal tissue and if lactate/pyruvate ratio increased with reductions in cerebral perfusion pressure. Univariate analysis revealed higher values for glutamate and lactate/pyruvate ratio in pericontusional tissue compared with normal tissue. However, based on the mixed-effects model analysis, the percent time of elevated lactate/pyruvate ratio was significantly higher in pericontusional tissue (40 +/- 59% vs. 17 +/- 37%, p < .05), and the mean lactate/pyruvate ratio values showed only a trend relationship (62 +/- 134 vs. 34 +/- 78, p < .06). When examined by cerebral perfusion pressure threshold, cerebral perfusion pressure <60 mm Hg was not associated with higher lactate/pyruvate ratio values in normal or pericontusional tissue. In addition, no single cerebral perfusion pressure threshold was associated with a significant reduction in lactate/pyruvate ratio in either pericontusional or normal tissue (p < .08).

CONCLUSIONS

Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.

Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury*

OBJECTIVE

To determine that intensive glycemic control does not reduce microdialysis glucose concentration brain metabolism of glucose.

DESIGN

Prospective monitoring followed by retrospective data analysis of cerebral microdialysis and global brain metabolism.

SETTING

Single center, academic neurointensive care unit.

PATIENTS

Forty-seven moderate to severe traumatic brain injury patients.

INTERVENTIONS

A nonrandomized, consecutive design was used for glycemic control with loose insulin (n=33) for the initial 2 yrs or intensive insulin therapy (n=14) for the last year.

MEASUREMENTS AND MAIN RESULTS

In 14 patients treated with intensive insulin therapy, there was a reduction in microdialysis glucose by 70% of baseline concentration compared with a 15% reduction in 33 patients treated with a loose insulin protocol. Despite this reduction in microdialysis glucose, the global metabolic rate of glucose did not change. However, intensive insulin therapy was associated with increased incidence of microdialysis markers of cellular distress, namely elevated glutamate (38+/-37% vs. 10+/-17%, p<.01), elevated lactate/pyruvate ratio (38+/-37% vs. 19+/-26%, p<.03) and low glucose (26+/-17% vs. 11+/-15%, p<.05, and increased global oxygen extraction fraction. Mortality was similar in the intensive and loose insulin treatment groups (14% vs. 15%, p=.9), as was 6-month clinical outcome (p=.3).

CONCLUSIONS

Intensive insulin therapy results in a net reduction in microdialysis glucose and an increase in microdialysis glutamate and lactate/pyruvate without conveying a functional outcome advantage.

Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report

AIMS/OBJECTIVES

To evaluate lamotrigine in a woman with a 30-year history of treatment-resistant menstrually-entrained rapid cycling bipolar II disorder with follicular phase depressive and luteal phase mood elevation symptoms.

METHODS

Lamotrigine was started at 5 mg/day and gradually increased up to 300 mg/day, while venlafaxine was tapered gradually and discontinued, and divalproex sodium 500 mg/day and levothyroxine 175 mcgm/day were continued. Daily self-reported mood ratings were obtained from the patient, using ChronoRecord software.

RESULTS

As lamotrigine was increased gradually, mood cycle amplitude attenuated. There was notable decrease in the severity and duration of depressive symptoms specifically during the follicular phase of the menstrual cycle. At the time of submission of this paper, the subject had remained euthymic for a total of 12 months.

CONCLUSION

This case suggests the potential utility of lamotrigine in treatment-resistant menstrually-related rapid cycling bipolar disorder, and raises the possibility that lamotrigine might be able to treat pathological entrainment of mood with the menstrual cycle. Both of these issues merit systematic assessment.

The Electronic Assessment of the Longitudinal Course of Bipolar Disorder: The ChronoRecord Software

Longitudinal studies are the optimal approach when investigating the highly variable course of bipolar disorder, but such studies are expensive, prone to reporting errors and to missing data. Automation of data collection may reduce such errors and improve data quality. The ChronoRecord, validated software that patients can install on a home computer to report mood, medications, sleep, life events, weight and menstrual data, has been designed to achieve such automation. In the trial of the ChronoRecord reported here, 80 of 96 (83 %) patients with bipolar disorder showed high acceptance of this computer-based system for self-report, entering daily recordings for a period of 3-months. This new technology, in addition to providing an accurate longitudinal record for research purposes, also facilitates on-going patient feedback and accurate study monitoring.

Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study

Disturbed glucose brain metabolism after brain trauma is reflected by changes in extracellular glucose levels. The authors hypothesized that posttraumatic reductions in extracellular glucose levels are not due to ischemia and are associated with poor outcome. Intracerebral microdialysis, electroencephalography, and measurements of brain tissue oxygen levels and jugular venous oxygen saturation were performed in 30 patients with traumatic brain injury. Levels of glucose, lactate, pyruvate, glutamate, and urea were analyzed hourly. The 6-month Glasgow Outcome Scale extended (GOSe6) score was assessed for each patient. In regions of increased glucose utilization defined by positron emission tomography, the extracellular glucose concentration was less than 0.2 mmol/l. Extracellular glucose values were less than 0.2 mmol during postinjury days 0 to 7 in 19% to 30% of hourly samples on each day. Transient decreases in glucose levels occurred with electrographic seizures and nonischemic reductions in cerebral perfusion pressure and jugular venous oxygen saturation. Glutamate levels were elevated in the majority of low-glucose samples, but the lactate/pyruvate ratio did not indicate focal ischemia. Terminal herniation resulted in reductions in glucose with increases in the lactate/pyruvate ratio but not in lactate concentration alone. GOSe6 scores correlated with persistently low glucose levels, combined early low glucose levels and low lactate/glucose ratio, and with the overall lactate/glucose ratio. These results suggest that the level of extracellular glucose is typically reduced after traumatic brain injury and associated with poor outcome, but is not associated with ischemia.

Delayed increase in extracellular glycerol with post-traumatic electrographic epileptic activity: support for the theory that seizures induce secondary injury

Early post-traumatic seizures occur commonly and may have adverse clinical consequences. In order to determine the significance of post-traumatic seizures, we performed a prospective assessment of the consequences of epileptic activity by assessing the change in extracellular glycerol levels. Glycerol is a marker of cellular membrane breakdown. Thirteen patients underwent combined electroencephalography (EEG) and cerebral microdialysis monitoring. Two patients had seizures on EEG with associated delayed elevations of glycerol associated with the seizure activity. Higher mean levels of glycerol were present in those patients with seizures compared to those without seizures (p < 0.001). Preliminary evidence suggests that post-traumatic seizures lead to additional membrane injury as reflected by elevated extracellular glycerol levels.

Detection of critical oligemia in patients with traumatic intracerebral hemorrhage using continuous quantitative electroencephalography and cerebral microdialysis

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Introduction: Serial changes in cerebral blood flow after intracerebral hemorrhage may influence tissue viability in regions surrounding the hematoma. Non invasive monitoring may assist titration of systolic blood pressure. Purpose: To determine if continuous quantitative electroencephalography percent alpha variability(EEGPAV)can discriminate areas of critically reduced cerebral blood flow (CBF). Methods: Ten patients with traumatic intracerebral hemorrhage underwent combined monitoring of cerebral microdialysis, EEGPAV, and intermittent xenon-computerized tomograhpy to determine if EEGPAV monitoring could determine and monitor cellular distress in the context of oligemia. Critical oligemia was defined as CBF < 25. Time and regional matched samples of EEG, microdialysis and CBF were used to correlate across modalities. Regions adjacent to the hematoma only were studied. Results: Six patients had regional CBF < 25 and 4 > 30 cc/100gm/min. In the low CBF group, the mean regional EEGPAV was 0.11 ± 0.4 compared to 0.22 ± 0.3 in the high-normal CBF group(p < 0.01). The low CBF group had lower extracellular levels of glucose (0.33±0.27) compared to the high-normal CBF group (1.9±1.0) (p < 0.001). Extracellular glutamate levels were higher in the low CBF group (14.5 ±23 uM) compared to the high-normal CBF group (1.34±0.8) (p < 0.001). Lactate and glycerol levels were not statistically different between groups (p < 0.8) Conclusion: EEGPAV can discriminate brain regions that have critical oligemia and neurochemichal evidence of cellular distress.

Development of a computerized psychiatric diagnostic interview for use by mental health and primary care clinicians

A diagnostic screening tool was developed to simulate a clinical psychiatrist intake interview including DSM-IV Axis I and II differential diagnosis plus evaluation of dangerousness, and optionally psychiatric medication history, family history, developmental history, and treatment goals (PsychDiagnoser software). The performance of the software as a diagnostic screening tool was evaluated in a private practice outpatient setting with 62 new patients. The software was well accepted with 60 patients receiving a computer diagnosis. The computer diagnosis for Axis I, Axis II, and dangerousness was compared with the definitive clinical diagnosis from a psychiatrist. Sensitivity and specificity calculations showed PsychDiagnoser software to be an affective screening tool for the Axis I and II disorders prevalent to this population (major depression, bipolar I and II, alcohol and drug abuse, no personality disorder, borderline personality disorder) and for dangerousness.

Comparison of the effects of rootstock on crop, juice and wine composition in a replanted nematode-infested Barossa Valley vineyard

Shiraz grapevine scions grafted to Ramsey, Dog Ridge, Harmony, Schwarzmann and 1613 rootstocks outyielded Shiraz on their own roots in a replanted, nematode-infested vineyard in the Barossa Valley. The cultivar Ramsey gave the largest cumulative yield (44 kg/vine) over three years in comparison with 16 kg/vine for own-rooted vines. The observed yield increases could be attributed to both more bunches per vine and increased bunch weight. Juice from the fruit of ungrafted vines had lower pH than that from rootstocks. Wine made from this juice had higher colour density and ionized anthocyanins and the lowest wine colour hue. The ranked performance of individual rootstocks was not consistent from season to season as shown by significant rootstock x year interactions for 15 of 20 variables measured.

Folie á deux in a child

Folie a deux is the transference of delusional ideas and behaviors from one person to another with whom there has been a close association. Its occurence in children has been rarely described in the literature, which was reviewed for case reports, diagnostic criteria, and etiological theories. A detailed case history of a 10-year-old girl who had delusions of special powers and delusions of persecution as well as hypochondriacal and hysterical symptoms is presented as an example of folie a deux between child and parent. This girl had developed a symbiotic incestuous relationship with her stepfather, a paranoid schizophrenic patient. Six criteria for making the diagnosis of folie a deux in a child were applied to the case studied. General and specific aspects of treating this disorder were discussed.