2012 College Address: Fifty Years as a Psychiatrist.

2012 College Address: fifty years as a psychiatrist.

Australas Psychiatry. 2013 Apr; 21(2): 111-2
Andrews G

HubMed – depression

Psychosocial aspects of invasive fetal therapy as compared to prenatal diagnosis and risk assessment.

Prenat Diagn. 2013 Apr; 33(4): 334-40
Beck V, Opdekamp S, Enzlin P, Doné E, Gucciardo L, El Handouni N, van Mieghem T, Lewi L, Deprest J

To explore the psychosocial impact of invasive fetal therapy (FT).We studied 100 consecutive patients scheduled for invasive FT. Contemporary controls were women undergoing (1) invasive prenatal diagnosis (AC/CVS) and (2) first trimester risk assessment of aneuploidy (NT), and (3) women who declined the latter (CTR). Prior to the procedure, participants completed the Beck Depression Inventory II, the State-Trait Anxiety Inventory, the Dyadic Adjustment Scale and a questionnaire specifically designed to evaluate the process preceding the intervention.Thirty-five percent of women in the FT group had mild to severe depressive symptoms, and 30% showed high levels of state anxiety. Mean state anxiety was significantly higher in women facing invasive as compared to non-invasive procedures. Trait anxiety levels and relationship scores were comparable across all groups. FT patients were more satisfied with the information and support given, whereas women in the NT group felt a greater degree of self-determination and contentedness with the choices they made.Pregnant women awaiting invasive prenatal diagnosis and FT face higher levels of state anxiety than women undergoing non-invasive procedures. Traits of depression and high state anxiety are found in at least one third of women undergoing FT. © 2013 John Wiley & Sons, Ltd. HubMed – depression

[Crossed cerebellar diaschisis. Study of a patient by magnetic resonance imaging and positron emission tomography].

Rev Neurol. 2013 Apr 16; 56(8): 425-8
Soria N, Meli F, Blumenkrantz Y, Salas E, Turjanski A

INTRODUCTION. Crossed cerebellar diaschisis is a functional deficit in an area that is remote from that of a supratentorial brain lesion, although the two are anatomically and functionally connected. Deactivation of the contralateral cerebellar hemisphere occurs and is believed to be caused by a transneuronal metabolic depression of the cortico-ponto-cerebellar pathway. A reduction in the blood flow in the brain takes place and this gives rise to a diminished oxygenation of the cerebellar hemisphere. This finding can be evaluated by different functional imaging methods. CASE REPORT. A 32-year-old female, without any relevant events in her personal history, presented an extensive supra-tentorial ischaemic lesion on the right-hand side. An MR angiography scan was performed, in which the homolateral middle cerebral artery and internal carotid artery were not identified. With no specific causation and suspecting a probable case of vasculitis (two days after the first ischaemic episode, the patient suffered another one in the left-hand occipital area, although this time it was smaller and clinically asymptomatic), a positron emission tomography/computerised tomography (PET/CT) scan was performed. The results revealed hypoenhancement of the radiotracer in the contralateral cerebellar hemisphere, which was interpreted as hypometabolism. CONCLUSIONS. Determined by a possible prognostic value in the presence of crossed cerebellar diaschisis in supratentorial vascular episodes, with respect to the final clinical outcome of the patients, it is interesting to take this possibility into account when evaluating patients with an acute cerebrovascular accident, either by means of PET/CT, MR imaging (perfusion) or CT (perfusion). HubMed – depression

[Refractory status epilepticus in children: characterisation of epilepsies, continuous electroencephalographic monitoring and response to treatment].

Rev Neurol. 2013 Apr 16; 56(8): 401-8
Cardoso I, Acevedo K, Hernandez M, Santin J, Moya P, Godoy J, Castillo A, Soto P, Mesa T

INTRODUCTION. Patients with refractory status epilepticus (RSE) have high morbidity and mortality rates, are hospitalised for longer periods of time, suffer greater neurological damage and progress to symptomatic epilepsy. Continuous electroencephalogram (cEEG) monitoring is a valuable aid in the early detection of RSE, especially in the case of non-convulsive status epilepticus (NCSE). In this study we describe the clinical characteristics, treatment and use of cEEG in paediatric patients with RSE. PATIENTS AND METHODS. A retrospective study was conducted at the Hospital Clinico de la Pontificia Universidad Catolica de Chile between November 2005 and March 2011 in patients aged between 1 month and 15 years diagnosed with RSE and cEEG. Demographic characteristics, baseline and final conditions, and therapy were recorded. RESULTS. A total of 15 patients, 12 of whom were males, with a mean age of 4 years (1.5 months-13 years) were identified. Eight patients had a history of epilepsy. The most frequent aetiologies were progressive symptomatic and acute symptomatic. Convulsive epileptic status (CSE) was present in 11 patients and NCSE in the other four. During the cEEG, six of the 11 patients with CSE later progressed to NCSE. The mean amount of time with RSE was 10.2 days. Of the 15 patients, 13 responded to anticonvulsive drugs and the main secondary complications were respiratory depression and hypotension. Patients with CSE tended to evolve in a more torpid manner than patients with NCSE. On discharge from hospital, 13 patients (86.6%) presented new neurological deficit or difficult-to-manage epilepsy, one still had RSE and one died (6%). CONCLUSIONS. The aggregate neurological morbidity and mortality rates of RSE were high. The use of cEEG monitoring should be considered for use in the management of such cases of status epilepticus. HubMed – depression