Bipolar disorder in children and adolescents

There is increased recognition that bipolar disorder has an early age of onset. The prevalence of bipolar disorder in prepubertal children has not been determined, however the prevalence in adolescence is approximately 1%. Bipolar disorder in children poses a diagnostic challenge since the symptoms may differ from those in late adolescence and adulthood. Comorbid disorders, such as attention-deficit/hyperactivity disorder, further complicate both the diagnosis and course of the disorder. There is increasing evidence of the chronicity and severity of this disorder in youths. Bipolar disorder significantly disrupts a child's psychosocial development including impairments in academic functioning, family functioning, and relationship with peers. Although this disorder has significant morbidity in children and adolescents, there is a paucity of controlled studies to assess the efficacy and safety of mood stabilizers in the treatment of this disorder in youths. The treatment literature consists largely of case studies, retrospective chart reviews, and open-label studies. There is a compelling need for double-blind, placebo-controlled trials to determine whether commonly used medications to treat this disorder are significantly superior to placebo. Since many children in clinical practice require more than one psychotropic medication to adequately manage this disorder, studies of combination treatments are warranted. This review will provide an overview of the literature of bipolar disorder in children and adolescents, including discussion of the prevalence, diagnosis, epidemiology, course of the illness, and treatment issues.     

Bipolar disorder: horgan on vagueness and incoherence

According to Horgans transvaluationist approach, the robustness that characterizes vague terms is inherently incoherent. He analyzes that robustness into two conceptual poles, individualistic and collectivistic, and ascribes the incoherence to the former. However, he claims vague terms remain useful nonetheless, because the collectivistic pole can be realized with a suitable non-classical logic and can quarantine the incoherence arising out of the individualistic pole. I argue, on the contrary, that the nonclassical logic fails to resolve the difficulty and that the incoherence afflicts Horgans collectivistic pole as well, consequently invalidating the entire transvaluationist approach. An alternative, coherent conception of robustness is suggested.     

Bipolar disorder and family communication: effects of a psychoeducational treatment program

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.     

Attention-deficit/hyperactivity disorder: perspectives from neuroimaging

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood behavioral disorder most often characterized by inattentiveness, impulsivity, and hyperactivity. Current etiologic theories suggest that ADHD stems from abnormalities in dopaminergic and possibly noradrenergic brainstem nuclei that act to regulate a cortico-striato-thalamo-cortical network, believed to be critical for executive functions and the regulation of behavioral responses such as arousal, attention, and inhibition. Noninvasive structural and functional neuroimaging techniques provide a new avenue for exploring the validity of these theories. Despite their limitations, neuroimaging studies have provided a unique and otherwise inaccessible, biological perspective of ADHD. Collectively, the studies reviewed here reveal that dysfunction in arousal, behavioral inhibition, and attention associated with ADHD may result from structural abnormalities in frontostriatal regions that in turn result in diminished activity essential for normal function.     

Fluent versus nonfluent primary progressive aphasia: a comparison of clinical and functional neuroimaging features

To better characterize fluent and nonfluent variants of primary progressive aphasia (PPA). Although investigators have recognized both fluent and nonfluent patients with PPA, the clinical and neuroimaging features of these variants have not been fully defined. We present clinical and neuropsychological data on 47 PPA patients comparing the fluent (n=21) and nonfluent (n=26) subjects. We further compared language features with PET/SPECT data available on 39 of these patients. Compared to the nonfluent PPA patients, those with fluent PPA had greater impairment of confrontational naming and loss of single word comprehension. They also exhibited semantic paraphasic errors and loss of single word comprehension. Patients with nonfluent PPA were more likely to be female, were more often dysarthric, and exhibited phonological speech errors in the absence of semantic errors. No significant differences were seen with regard to left hemisphere abnormalities, suggesting that both variants result from mechanisms that overlap frontal, temporal, and parietal regions. Of the language measures, only semantic paraphasias were strongly localized, in this case to the left temporal lobe. Fluent and nonfluent forms of PPA are clinically distinguishable by letter fluency, single word comprehension, object naming, and types of paraphasic errors. Nevertheless, there is a large amount of overlap between dysfunctional anatomic regions associated with these syndromes.     

抑郁障碍和焦虑障碍治疗的神经心理机制——脑成像研究的ALE元分析

抑郁障碍和焦虑障碍是两种最常见的精神障碍。使用激活似然估计(activation likelihood estimation,ALE)元分析对抑郁和焦虑障碍患者治疗后出现的一致脑区激活改变进行评估,并考察不同条件下这一改变的差异。研究共纳入25篇文献,结果发现:(1)抑郁和焦虑障碍接受治疗后,枕下回(inferior occipital gyrus,IOG)等脑区激活增加;豆状核(lentiform nucleus)等激活减少。(2)a.心理治疗产生的脑激活改变为豆状核活动的减少;药物治疗则在于扣带回(cingulate gyrus)等活动增加,而楔前叶(precuneus)等活动减少。b.任务下成像治疗后激活增加的脑区为扣带回等,减少的脑区为楔前叶等;静息下成像,治疗后枕下回等激活增加,额内侧回(medial frontal gyrus,MFG)等激活减少。c.抑郁障碍治疗后的脑激活变化为扣带回等活动增加,楔前叶等活动减少;焦虑障碍在于前扣带回/额内侧回(anterior cingulate/MFG)活动减少。研究表明治疗会给抑郁和焦虑障碍带来一致的脑区激活改变;治疗方法、成像状态和障碍类型不同,治疗后脑区激活改变也存在差异。     

Coping skills and exposure therapy in panic disorder and agoraphobia: latest advances and future directions

Although cognitive-behavioral treatments for panic disorder have demonstrated efficacy, a considerable number of patients terminate treatment prematurely or remain symtpomatic. Cognitive and biobehavioral coping skills are taught to improve exposure therapy outcomes but evidence for an additive effect is largely lacking. Current methodologies used to study the augmenting effects of coping skills test the degree to which the delivery of coping skills enhances outcomes. However, they do not assess the degree to which acquisition of coping skills and their application during exposure therapy augment outcomes. We examine the extant evidence on the role of traditional coping skills in augmenting exposure for panic disorder, discuss the limitations of existing research, and offer recommendations for methodological advances.     

Cognitive and emotional processes during dreaming: a neuroimaging view

Dream is a state of consciousness characterized by internally-generated sensory, cognitive and emotional experiences occurring during sleep. Dream reports tend to be particularly abundant, with complex, emotional, and perceptually vivid experiences after awakenings from rapid eye movement (REM) sleep. This is why our current knowledge of the cerebral correlates of dreaming, mainly derives from studies of REM sleep. Neuroimaging results show that REM sleep is characterized by a specific pattern of regional brain activity. We demonstrate that this heterogeneous distribution of brain activity during sleep explains many typical features in dreams. Reciprocally, specific dream characteristics suggest the activation of selective brain regions during sleep. Such an integration of neuroimaging data of human sleep, mental imagery, and the content of dreams is critical for current models of dreaming; it also provides neurobiological support for an implication of sleep and dreaming in some important functions such as emotional regulation.     

A review of adult ADHD: a neuropsychological and neuroimaging perspective

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder which effects an estimated 3% to 5% of children. Despite estimates that ADHD persists in 30% to 70% of adults having had the disorder in childhood, ADHD in adulthood remains controversial. This report summarizes current thinking in the diagnosis and etiology of adult ADHD. Most theories posit that ADHD is related to anomalies in frontal lobe function and dopaminergic transmission. However, there is debate as to whether ADHD is a unitary disorder with different manifestations, a syndrome, or multiple disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifies ADHD into inattention, hyperactivity-impulsivity, and combined subtypes. Although problems with cognition are core ADHD symptoms, self-reporting has not been a reliable predictor of neuropsychological test performance. Nevertheless, we suggest that a performance-based diagnosis, including empirically derived, age-sensitive neuropsychological tests, provides the best hope of dissociating ADHD from psychiatric disorders with similar symptoms. We also describe the promise of new neuroimaging technologies, such as functional magnetic resonance imaging, in elucidating the pathophysiology of ADHD and similar psychiatric disorders.     

Match making and match breaking: The nature of match within and around job design

We explore the notion of ‘match’. In the context of job design, this is congruence or correspondence between two or more job characteristics (e.g. cognitive demands and cognitive control). This congruence is thought to benefit health, well‐being, and performance. The origins of the match concept lie in buffering models of work stress, where resources such as workplace social support and job control are thought to attenuate deleterious effects of adverse job characteristics like excessive job demands. We outline the historical developments in work stress research that has led to notions of match, contrast match with the related concept of person‐environment fit, explore current conceptualizations and operationalizations of match, and outline how the concept of match can be developed.     

Apathy in frontotemporal dementia: behavioral and neuroimaging correlates

We investigated the occurrence of goal-directed motivational change in the form of apathy in patients with frontotemporal dementia (FTD), particularly those with behavioral variant social and executive deficits (bvFTD). Standardized behavioral inventory was employed to survey and compare apathy ratings from patients and caregivers. In cases of bvFTD, apathy ratings were further related to measures of social cognition, executive function, and atrophy on brain MRI. Results indicated that caregivers rated bvFTD patients as having significantly elevated apathy scores though patient self-ratings were normal. Caregiver and self-ratings of FTD samples with progressive nonfluent aphasia and semantic dementia did not differ from healthy controls and their informants. In the bvFTD sample, caregiver apathy scores were not correlated with general cognitive screening or depression scores, but were significantly correlated with social cognition and executive function measures. Voxel-based morphometry revealed that apathy ratings in bvFTD were related to prominent atrophy in the right caudate (including the ventral striatum), the right temporo-parietal junction, right posterior inferior and middle temporal gyri, and left frontal operculum- anterior insula region. Findings suggest that bvFTD is associated with a significant breakdown in goal-directed motivated behavior involving disruption of cortical-basal ganglia circuits that is also related to social and executive function deficits.     

Interference resolution: Insights from a meta-analysis of neuroimaging tasks

A quantitative meta-analysis was performed on 47 neuroimaging studies involving tasks purported to require the resolution of interference. The tasks included the Stroop, flanker, go/no-go, stimulus-response compatibility, Simon, and stop signal tasks. Peak density-based analyses of these combined tasks reveal that the anterior cingulate cortex, dorsolateral prefrontal cortex, inferior frontal gyrus, posterior parietal cortex, and anterior insula may be important sites for the detection and/or resolution of interference. Individual task analyses reveal differential patterns of activation among the tasks. We propose that the drawing of distinctions among the processing stages at which interference may be resolved may explain regional activation differences. Our analyses suggest that resolution processes acting upon stimulus encoding, response selection, and response execution may recruit different neural regions.     

The patient-analyst match and the outcome of psychoanalysis: a pilot study

This paper presents a pilot study in which we explore the possibility that the match between analyst and analysand is a factor of central importance in the analytic situation. It is an attempt to look at the issue of match across a large number of patients. The data we used were not collected for studying this topic; thus, the study has serious limitations. Nevertheless, certain patterns emerged which support our thesis that patient-analyst match plays a significant role in the outcome of psychoanalysis. We present this work as a first step in developing concepts and methods which will be pursued in a more systematic and rigorous fashion in a later study.