Pediatric Sub-specialist Controversies in the Treatment of Congenital Heart Disease in Trisomy 13 or 18

Trisomy 13 and 18 are associated with congenital heart disease. Cardiac palliation has been reported in the literature, but is not usually done in this population. Thus, a multi-disciplinary team may experience controversy in formulating a care plan that includes cardiac intervention. Our objective was to determine differences in recommendations for cardiac intervention in this population between physicians specializing in pediatric cardiac critical care, neonatology, and genetics. A web-based survey was performed between April 2007 and August 2008. This survey evaluated surgical and transcatheter cardiac palliations that had been performed for individuals with trisomy 13 or 18 at the respondent’s institution, the respondent’s recommendations for cardiac intervention in hypothetical symptomatic patients with trisomy 13 or trisomy 18 and the influence of parental preference on these recommendations. Eight hundred fifty-nine responses were obtained from a primarily academic practice setting (59%). Cardiologists were most likely to recommend intervention; low risk interventions were recommended by 32% of cardiologists, 7% of neonatologists and 20% of geneticists. Parental request to intervene resulted in a 3 fold increased in the likelihood of all specialist recommending intervention. Counseling of families frequently occurred by multiple sub specialists (50%) and there was frequently (71%) a difference in opinion. Individuals with trisomy 13 or 18 are receiving cardiac intervention at many institutions. Cardiologists were more likely than geneticists or neonatologists to recommend intervention on all heart lesions other than single ventricle palliation which no specialists recommended. Parental wishes that “everything be done” significantly influenced all specialists’ recommendations.     

Effects of Parental Soothing Behavior on Stress Levels of 2–8 Year Old Children During Voiding Cystourethrograms by Phase of Procedure

Using the example of a voiding cystourethrogram (VCUG), a painful radiological procedure, this study investigated whether parental soothing behavior (reassuring comments like “it’s almost over” or “You’re O.K.” and soothing by “sh, sh”) in one phase of the procedure influenced the child’s distress in the following phase. The sample was comprised of 68 2–8 year-old children and the accompanying parent(s). Child and parental behavior during the VCUG was coded using a standardized rating scale (CAMPIS-R). Parental reassurance during the anticipatory phase significantly increased the child’s distress of the following phase, while parental “sh, sh” significantly reduced it. Both parental behaviors showed no significant effect on the child’s distress of the following phase when applied during the procedure itself. Results underline the importance of differentiating between anticipatory and procedural phases of the VCUG. Counselling methods for parents on more appropriate strategies to assist their children during procedural phases of the VCUG are necessary.     

Parental burden associated with borderline personality disorder in female offspring

To identify aspects of parental burden associated with borderline personality disorder (BPD), an anonymous internet survey linked to BPD support websites was developed for parents to complete on their BPD offspring and unaffected siblings. The questions cover aspects of the child's life from pregnancy through young adulthood, and query about the impact of the child's BPD on six domains of the parent's life, including physical and emotional health, marriage, job, standard of living, social life, and career trajectory. Additionally, financial burden was assessed with questions pertaining to insurance and out-of pocket costs associated with the BPD disorder. BPD offspring were identified by meeting diagnostic criteria embedded within the survey and having been given a diagnosis of BPD by a professional at some point in their life. We report on 233 female offspring meeting strict criteria for BPD. Parents of daughters with BPD endorsed varying levels of impact on the six domains comprising burden with the largest impact on emotional health which was impacted in over 88% of the respondents. Over 50% of parents endorsed four or greater of the six burden items. Particular aspects of the offspring's BPD symptom profile correlated with intensity of parental burden included including problems in adolescence with acting out behavior (p < .000), property destruction (.003), delusional symptoms (.007), and hallucinatory symptoms (.008). A subgroup of respondents provided data on specific financial expenses. The average and median out-of-pocket expense was $60,087, and $10,000. Insurance costs totaled an average of $108,251 with a mean of $20,000. The average cost per year after diagnosis was $14,606 out-of-pocket and $45,573 billed to insurance. The median cost per year after diagnosis was $3,667 out-of-pocket, and $12,500 billed to insurance. After adjusting for household income, a female proband who had been raped incurred roughly $40,000 more in BPD-related costs, while a diagnosis of conduct disorder led to about $50,000 in additional costs. Parents of female offspring with BPD experience burden in multiple domains of their life and many have incurred substantial financial expense. Increasing awareness of co-morbid conditions in the BPD proband that significantly increase parental burden may be indicators for the provision of increased family support.     

On the relations between distinct aspects of psychological distance: An ecological basis of construal-level theory

Construal-level theory's basic assumption of a positive relationship between psychological distance and abstractness of mental representations presupposes a unitary distance construct. Although prior research testifies to convergent influences of temporal, spatial, social and reality (probability) distance, there is no direct evidence for the integration function of all four major distance aspects assessed within the same study with reference to the same target objects. Does high (low) distance in any aspect imply high (low) distance in all other aspects, or are discounting effects (e.g., high temporal distance rendering high personal distance obsolete) sometimes apparent in negative correlations? In pursuing this question, we obtained strong and regular positive correlations between all four distance aspects, across judges and judgment targets, regardless of whether freely construed future episodes or really experienced past episodes were judged. Existing ecological correlations seem to account for the positive relationship between time, space, probability and temporal distance.     

Steigerung des ?empowerment“ bei Angeh?rigen von schizophren Erkrankten

Objective

Enhancing empowerment is one of the aims of psychoeducational family interventions but it has never been examined in psychoeducational groups for relatives led by professionals. This study investigated the knowledge gain and the increase of empowerment of psychoeducational group programs for relatives in a naturalistic setting.

Methods

A total of 54 relatives of persons with schizophrenia or schizoaffective disorders took part in a psychoeducational group program of 8 sessions. A short questionnaire was used to assess the empowerment before and after the group programs. Knowledge gain was measured with the knowledge of illness about schizophrenia questionnaire (WFB).

Results

Among the participants of the psychoeducational groups the level of empowerment was significantly enhanced and the knowledge was significantly increased (p?<?0.01). The improvement of empowerment was independent of the knowledge gain and did not correlate with gender, age, education or group attendance.

Conclusions

Psychoeducational groups for family members not only reduce the rehospitalization rates of the ill relatives but also have additional positive effects on the family members themselves: better knowledge of the illness and enhanced empowerment. The findings emphasize the importance of psychoeducational groups for the relatives of persons with schizophrenia.     

Representation of unattended material in memory

The current study addresses how information whose processing was not part of task requirement (unattended) is represented in memory. Using a novel measure, recognition memory for unattended material was assessed twice, once when it appeared with the same (old) attended study target and once with a new target. The data reveal memory for unattended study information only in the old target condition. Results suggest that the entire study event is encoded and represented in a memory trace, which contains both attended target information along with unattended context information. In conclusion, manifestation of unattended memory may be dependent on the presence of old target information at test.     

Attenuated response to methamphetamine sensitization and deficits in motor learning and memory after selective deletion of β-catenin in dopamine neurons

In the present study, we analyzed mice with a targeted deletion of β-catenin in DA neurons (DA-βcat KO mice) to address the functional significance of this molecule in the shaping of synaptic responses associated with motor learning and following exposure to drugs of abuse. Relative to controls, DA-βcat KO mice showed significant deficits in their ability to form long-term memories and displayed reduced expression of methamphetamine-induced behavioral sensitization after subsequent challenge doses with this drug, suggesting that motor learning and drug-induced learning plasticity are altered in these mice. Morphological analyses showed no changes in the number or distribution of tyrosine hydroxylase-labeled neurons in the ventral midbrain. While electrochemical measurements in the striatum determined no changes in acute DA release and uptake, a small but significant decrease in DA release was detected in mutant animals after prolonged repetitive stimulation, suggesting a possible deficit in the DA neurotransmitter vesicle reserve pool. However, electron microscopy analyses did not reveal significant differences in the content of synaptic vesicles per terminal, and striatal DA levels were unchanged in DA-βcat KO animals. In contrast, striatal mRNA levels for several markers known to regulate synaptic plasticity and DA neurotransmission were altered in DA-βcat KO mice. This study demonstrates that ablation of β-catenin in DA neurons leads to alterations of motor and reward-associated memories and to adaptations of the DA neurotransmitter system and suggests that β-catenin signaling in DA neurons is required to facilitate the synaptic remodeling underlying the consolidation of long-term memories.