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Pellikaan K, Ben Brahim Y, Rosenberg AGW, Davidse K, Poitou C, Coupaye M, Goldstone AP, Høybye C, Markovic TP, Grugni G, Crinò A, Caixàs A, Eldar-Geva T, Hirsch HJ, Gross-Tsur V, Butler MG, Miller JL, van der Kuy PHM, van den Berg SAA, Visser JA, van der Lely AJ, de Graaff LCG. Hypogonadism in Women with Prader-Willi Syndrome-Clinical Recommendations Based on a Dutch Cohort Study, Review of the Literature and an International Expert Panel Discussion. J Clin Med 2021; 10:jcm10245781. [PMID: 34945077 PMCID: PMC8707541 DOI: 10.3390/jcm10245781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 12/27/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neuroendocrine genetic syndrome. Characteristics of PWS include hyperphagia, hypotonia, and intellectual disability. Pituitary hormone deficiencies, caused by hypothalamic dysfunction, are common and hypogonadism is the most prevalent. Untreated hypogonadism can cause osteoporosis, which is already an important issue in PWS. Therefore, timely detection and treatment of hypogonadism is crucial. To increase understanding and prevent undertreatment, we (1) performed a cohort study in the Dutch PWS population, (2) thoroughly reviewed the literature on female hypogonadism in PWS and (3) provide clinical recommendations on behalf of an international expert panel. For the cohort study, we retrospectively collected results of a systematic health screening in 64 female adults with PWS, which included a medical questionnaire, medical file search, medical interview, physical examination and biochemical measurements. Our data show that hypogonadism is frequent in females with PWS (94%), but is often undiagnosed and untreated. This could be related to unfamiliarity with the syndrome, fear of behavioral changes, hygienic concerns, or drug interactions. To prevent underdiagnosis and undertreatment, we provide practical recommendations for the screening and treatment of hypogonadism in females with PWS.
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Affiliation(s)
- Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Yassine Ben Brahim
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Christine Poitou
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, F-75013 Paris, France; (C.P.); (M.C.)
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- ENDO-ERN (European Reference Network)
| | - Muriel Coupaye
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, F-75013 Paris, France; (C.P.); (M.C.)
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- ENDO-ERN (European Reference Network)
| | - Anthony P. Goldstone
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Charlotte Høybye
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- ENDO-ERN (European Reference Network)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Department of Endocrinology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Tania P. Markovic
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Graziano Grugni
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- ENDO-ERN (European Reference Network)
- Divison of Auxology, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy
| | - Antonino Crinò
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Hospital, Research Institute, 00050 Palidoro, Italy
| | - Assumpta Caixàs
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- Endocrinology and Nutrition Department, Institut d’Investigació I Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Department of Medicine, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
- Correspondence: (A.C.); (L.C.G.d.G.)
| | - Talia Eldar-Geva
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Reproductive Endocrinology and Genetics Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem 9103102, Israel
- Hebrew University School of Medicine, Jerusalem 9112102, Israel
| | - Harry J. Hirsch
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Varda Gross-Tsur
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Hebrew University School of Medicine, Jerusalem 9112102, Israel
- Neuropediatrics Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Merlin G. Butler
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jennifer L. Miller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Paul-Hugo M. van der Kuy
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Sjoerd A. A. van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Jenny A. Visser
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (J.A.V.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- International Network for Research, Management & Education on adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.)
- ENDO-ERN (European Reference Network)
- Correspondence: (A.C.); (L.C.G.d.G.)
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Suicidality and Self-Harming Behaviors in Patients with Prader-Willi Syndrome (PWS): Case Report and Literature Review. Case Rep Psychiatry 2021; 2021:2527261. [PMID: 34671495 PMCID: PMC8523272 DOI: 10.1155/2021/2527261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder which is often associated with significant behavioral challenges and poor intellectual functioning. Research has shown that individuals with PWS are more likely to experience mental health problems, have higher relapse rates, and are at risk of self-harming behavior. Although PWS is associated with mild intellectual disability, which in itself confers a higher mortality rate, suicidality in this population is so far unreported in the literature. We present the case of an 18-year-old male patient who was admitted to our facility following exogenous insulin administration with suicidal intent. The main clinical characteristics, self-harming behaviors, and suicide risk factors of patients with PWS are discussed in this report. The article's objective is to redirect clinicians' attention to carefully screen and treat the underlying behavioral problems in PWS patients.
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Pellikaan K, Ben Brahim Y, Rosenberg AGW, Davidse K, Poitou C, Coupaye M, Goldstone AP, Høybye C, Markovic TP, Grugni G, Crinò A, Caixàs A, Eldar-Geva T, Hirsch HJ, Gross-Tsur V, Butler MG, Miller JL, van den Berg SAA, van der Lely AJ, de Graaff LCG. Hypogonadism in Adult Males with Prader-Willi Syndrome-Clinical Recommendations Based on a Dutch Cohort Study, Review of the Literature and an International Expert Panel Discussion. J Clin Med 2021; 10:jcm10194361. [PMID: 34640379 PMCID: PMC8509256 DOI: 10.3390/jcm10194361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/20/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic syndrome characterized by hyperphagia, intellectual disability, hypotonia and hypothalamic dysfunction. Adults with PWS often have hormone deficiencies, hypogonadism being the most common. Untreated male hypogonadism can aggravate PWS-related health issues including muscle weakness, obesity, osteoporosis, and fatigue. Therefore, timely diagnosis and treatment of male hypogonadism is important. In this article, we share our experience with hypogonadism and its treatment in adult males with PWS and present a review of the literature. In order to report the prevalence and type of hypogonadism, treatment regimen and behavioral issues, we retrospectively collected data on medical interviews, physical examinations, biochemical measurements and testosterone replacement therapy (TRT) in 57 Dutch men with PWS. Fifty-six (98%) of the patients had either primary, central or combined hypogonadism. Untreated hypogonadism was associated with higher body mass index and lower hemoglobin concentrations. TRT was complicated by behavioral challenges in one third of the patients. Undertreatment was common and normal serum testosterone levels were achieved in only 30% of the patients. Based on the Dutch cohort data, review of the literature and an international expert panel discussion, we provide a practical algorithm for TRT in adult males with PWS in order to prevent undertreatment and related adverse health outcomes.
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Affiliation(s)
- Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Yassine Ben Brahim
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (C.P.); (M.C.)
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- ENDO-ERN (European Reference Network)
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (C.P.); (M.C.)
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- ENDO-ERN (European Reference Network)
| | - Anthony P. Goldstone
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Hammersmith Hospital, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Charlotte Høybye
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- ENDO-ERN (European Reference Network)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Tania P. Markovic
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Graziano Grugni
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- ENDO-ERN (European Reference Network)
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy
| | - Antonino Crinò
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Hospital, Research Institute, 00050 Palidoro (Rome), Italy
| | - Assumpta Caixàs
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d’Investigació I Innovació Parc Taulí I3PT, Department of Medicine, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Talia Eldar-Geva
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Reproductive Endocrinology and Genetics Unit, Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem 9103102, Israel
- Hebrew University School of Medicine, Jerusalem 9112102, Israel
| | - Harry J. Hirsch
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Varda Gross-Tsur
- The Israel Multidisciplinary Prader-Willi Syndrome Clinic, Jerusalem 9103102, Israel; (T.E.-G.); (H.J.H.); (V.G.-T.)
- Hebrew University School of Medicine, Jerusalem 9112102, Israel
- Neuropediatrics Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Merlin G. Butler
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jennifer L. Miller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Sjoerd A. A. van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Erasmus Medical Center, Department of Clinical Chemistry, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (Y.B.B.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- International Network for Research, Management & Education on Adults with PWS (INfoRMEd-PWS); (A.P.G.); (C.H.); (T.P.M.); (G.G.); (A.C.); (A.C.)
- ENDO-ERN (European Reference Network)
- Correspondence:
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Kayadjanian N, Vrana-Diaz C, Bohonowych J, Strong TV, Morin J, Potvin D, Schwartz L. Characteristics and relationship between hyperphagia, anxiety, behavioral challenges and caregiver burden in Prader-Willi syndrome. PLoS One 2021; 16:e0248739. [PMID: 33765021 PMCID: PMC7993772 DOI: 10.1371/journal.pone.0248739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by maladaptive behaviors, amongst which hyperphagia is a life-long concern for individuals with PWS and their caregivers. The current study examined the contribution of hyperphagia and other factors to caregiver burden across lifespan, in 204 caregivers of individuals with PWS living in the US, using the Zarit Burden Interview (ZBI) and the hyperphagia questionnaire (HQ-CT). Results We found a strong relationship between ZBI and HQ-CT especially in individuals with PWS older than 4 y and showed that HQ-CT scores of individuals with PWS is positively correlated with ZBI scores of their caregivers. The weight status of individuals with PWS was not associated with HQ-CT and ZBI scores, except for obese individuals who had significantly higher HQ-CT scores when compared to normal weight PWS individuals. We looked at PWS symptoms and care-related issues that impacted individuals and caregivers the most. We found that care-related tasks had the biggest negative impact on caregivers of children aged 0–4 y, whereas anxiety, temper tantrums, and oppositional behaviors of older individuals with PWS had the biggest impact on their caregivers concomitant with their high caregiver burden. Finally, we assessed the variability of HQ-CT and ZBI over 6 months in a subgroup of 83 participants. Overall, neither measure differed between 6 months and baseline. Most individual’s absolute HQ-CT score changes were between 0–2 units, whereas absolute ZBI score changes were between 0–6 points. Changes in the caregiver’s or individual’s life had little or no effect on HQ-CT and ZBI scores. Conclusions This study demonstrates a relationship between hyperphagia and caregiver burden and sheds light on predominant symptoms in children and adolescents that likely underly PWS caregiver burden. The stability and relationship between HQ-CT and ZBI support ZBI as an additional outcome measure in PWS clinical trials.
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Affiliation(s)
- Nathalie Kayadjanian
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- * E-mail:
| | - Caroline Vrana-Diaz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Jessica Bohonowych
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Theresa V. Strong
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Genetics, University of Alabama, Birmingham, Alabama, United States of America
| | - Josée Morin
- Excelsus Statistics, Montreal, Quebec, Canada
| | | | - Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
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Kayadjanian N, Schwartz L, Farrar E, Comtois KA, Strong TV. High levels of caregiver burden in Prader-Willi syndrome. PLoS One 2018; 13:e0194655. [PMID: 29579119 PMCID: PMC5868812 DOI: 10.1371/journal.pone.0194655] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder that is characterized by hyperphagia, developmental delay, incomplete sexual development, mild-to-moderate intellectual disability, and a variety of challenging behavioral and psychiatric symptoms. The characteristics of PWS can be difficult for caregivers to cope with and are likely to cause significant and long- term caregiver burden. The current study examined burden in 142 caregivers of children and adults with PWS living in the US using the Zarit Burden Interview (ZBI). The study aimed to measure the level of burden in caregivers of individuals with PWS, to explore the impact of PWS on caregiver quality of life, and to assess ZBI as an indicator of that impact. Results Caregivers participating in this study were predominantly mothers, 30–59 years old, non-Hispanic Whites, married or in a relationship, with an annual household income slightly distributed towards higher income. Nearly 90% of the caregiver`s children with PWS lived at home. Caregivers experienced high caregiver burden with an average ZBI score of 44.4 ± 15.4. ZBI scores were highest for caregivers of teenage and young adult individuals with PWS (49.2 ± 14.6 and 49.2 ± 14.1, respectively), while those caring for older adults (>30) and the youngest age group had lower scores (38.6 ±10.5 and 34.8 ±12.5, respectively). Caregivers reported that caring for a person with PWS negatively impacted their romantic relationship, ability to work, sleep, and mood. Whereas we did not find strong correlations between family income or level of help the caregiver receives and ZBI scores, the results showed significant correlations and a linear relationship between ZBI scores and caregiver depressed mood, feelings of anxiety, negative romantic relationship impact, as well as sleep and work disruption. Conclusions Our study reveals that PWS incurs high caregiver burden and impacts many aspects of the lives of caregiver. We identified the ZBI as a good predictor of that impact. Our findings draw attention to the critical unmet need for support for caregivers of individuals with PWS.
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Affiliation(s)
- Nathalie Kayadjanian
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- * E-mail:
| | - Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Evan Farrar
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Prader-Willi Syndrome Association (USA), Sarasota, Florida, United States of America
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Theresa V. Strong
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Genetics, University of Alabama, Birmingham, Alabama, United States of America
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Foti F, Menghini D, Orlandi E, Rufini C, Crinò A, Spera S, Vicari S, Petrosini L, Mandolesi L. Learning by observation and learning by doing in Prader-Willi syndrome. J Neurodev Disord 2015; 7:6. [PMID: 25914757 PMCID: PMC4409733 DOI: 10.1186/s11689-015-9102-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 01/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New competencies may be learned through active experience (learning by doing) or observation of others' experience (learning by observation). Observing another person performing a complex action accelerates the observer's acquisition of the same action, limiting the time-consuming process of learning by doing. Here, we compared learning by observation and learning by doing in individuals with Prader-Willi syndrome (PWS). It is hypothesized that PWS individuals could show more difficulties with learning by observation than learning by doing because of their specific difficulty in interpreting and using social information. METHODS The performance of 24 PWS individuals was compared with that of 28 mental age (MA)- and gender-matched typically developing (TD) children in tasks of learning a visuo-motor sequence by observation or by doing. To determine whether the performance pattern exhibited by PWS participants was specific to this population or whether it was a nonspecific intellectual disability effect, we compared the PWS performances with those of a third MA- and gender-matched group of individuals with Williams syndrome (WS). RESULTS PWS individuals were severely impaired in detecting a sequence by observation, were able to detect a sequence by doing, and became as efficient as TD children in reproducing an observed sequence after a task of learning by doing. The learning pattern of PWS children was reversed compared with that of WS individuals. CONCLUSIONS The observational learning deficit in PWS individuals may be rooted, at least partially, in their incapacity to understand and/or use social information.
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Affiliation(s)
- Francesca Foti
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi 78, 00185 Rome, Italy ; IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Deny Menghini
- Child Neuropsychiatry Unit, Neuroscience Department, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Enzo Orlandi
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Cristina Rufini
- Child Neuropsychiatry Unit, Neuroscience Department, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Antonino Crinò
- Pediatric and Autoimmune Endocrine Disease Unit, "Children's Hospital Bambino Gesù", Palidoro, Via Torre di Palidoro, 00050 Fiumicino, Rome, Italy
| | - Sabrina Spera
- Pediatric and Autoimmune Endocrine Disease Unit, "Children's Hospital Bambino Gesù", Palidoro, Via Torre di Palidoro, 00050 Fiumicino, Rome, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Neuroscience Department, "Children's Hospital Bambino Gesù", Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Laura Petrosini
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi 78, 00185 Rome, Italy ; IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Laura Mandolesi
- IRCCS Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143 Rome, Italy ; Department of Motor Science and Wellness, University of Naples "Parthenope", Via Medina 40, 80133 Naples, Italy
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Ihara H, Ogata H, Sayama M, Kato A, Gito M, Murakami N, Kido Y, Nagai T. QOL in caregivers of Japanese patients with Prader-Willi syndrome with reference to age and genotype. Am J Med Genet A 2014; 164A:2226-31. [PMID: 24953026 PMCID: PMC4278419 DOI: 10.1002/ajmg.a.36634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/16/2014] [Indexed: 01/24/2023]
Abstract
This study aimed to measure quality of life (QOL) of the primary family caregivers for patients with Prader–Willi syndrome (PWS). Comparisons were made between caregivers' QOL in regard to their dependents' genotype and age group. The participants with PWS consisted of 22 children (aged from 6 to 12 years) and 23 adolescents (aged from 13 to 19 years), including 6 children and 7 adolescents with maternal uniparental disomy (mUPD) and 16 children and 16 adolescents with deletion (DEL). The QOL of the primary family caregiver for each patient was assessed using the Japanese version of the WHOQOL-BREF. To examine the effect that age (children vs. adolescents) and genotype (DEL vs. mUPD) have on the QOL of caregivers, a two-way ANOVA was conducted, followed by the Bonferroni procedure to test the simple main effects. The two age groups and the two genotypes of PWS were used as independent variables and the total QOL of caregivers as a dependent variable. The two-way ANOVA (F(1, 41) = 6.98, P < 0.05), followed by the Bonferroni procedure, showed the following: the total QOL of caregivers of DEL adolescents showed little difference from that with DEL children, but the QOL of caregivers for mUPD adolescents was shown to be lower than that with mUPD children along with that of caregivers with DEL adolescents. There is hence a growing tendency for the deterioration in the QOL of caregivers to manifest itself later in the patients' adolescence, found mainly with mUPD patients. © 2014 The Authors. American Journal of Medical Genetics Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Hiroshi Ihara
- Department of Psychiatry, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
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Tunnicliffe P, Woodcock K, Bull L, Oliver C, Penhallow J. Temper outbursts in Prader-Willi syndrome: causes, behavioural and emotional sequence and responses by carers. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:134-150. [PMID: 23374136 DOI: 10.1111/jir.12010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Temper outbursts are common in Prader-Willi syndrome but rarely described in detail. This study investigated the phenomenology of temper outbursts in terms of antecedents, sequence of behaviours and emotions and intervention strategies used. METHOD A semi-structured interview about temper outbursts was conducted with the main carers of seven children (9.5 to 16.7 years) and seven adults (24.7 to 47.10 years) with Prader-Willi syndrome (10 male, 4 female). Reliability and validity of the interview results was established. RESULTS Various setting events increased and reduced the likelihood of temper outbursts. The most common antecedent was a change to routine or expectation. There were marked similarities in the sequence of behaviours and emotions during temper outbursts, with anger rising quickly followed by expressions of remorse and distress at the end of an outburst. DISCUSSION The sequence of behaviours and emotions within outbursts was similar to that described in temper tantrums in typical development. Cognitive and emotional processes are likely to be important in the understanding of temper outbursts with implications for early intervention.
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Affiliation(s)
- P Tunnicliffe
- School of Psychology, University of Birmingham, Birmingham, UK
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9
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Jauregi J, Laurier V, Copet P, Tauber M, Thuilleaux D. Behavioral profile of adults with Prader-Willi syndrome: correlations with individual and environmental variables. J Neurodev Disord 2013; 5:18. [PMID: 23919902 PMCID: PMC3751283 DOI: 10.1186/1866-1955-5-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background Maladaptive behavior has been reported as a phenotypical feature in Prader–Willi syndrome (PWS). It severely limits social adaptation and the quality of life of children and adults with the syndrome. Different factors have been linked with the intensity and form of these behavioral disturbances but there is no consensus about the cause. Consequently, there is still controversy regarding management strategies and there is a need for new data. Methods The behavior of 100 adults with PWS attending a dedicated center was assessed using the Developmental Behavior Checklist for Adults (DBC-A) and the PWS-specific Hyperphagia Questionnaire. The DBC-A was completed separately by trained caregivers at the center and relatives or caregivers in a natural setting. Genotype, gender, age, degree of obesity and cognitive impairment were analyzed as variables with a hypothetical influence on behavioral features. Results Patients showed a relatively high rate of behavioral disturbances other than hyperphagia. Disruptive and social relating were the highest scoring DBC-A subscales whereas anxiety/antisocial and self-absorbed were the lowest. When hospital caregiver and natural caregiver scores were compared, scores for the latter were higher for all subscales except for disruptive and anxiety/antisocial. These effects of institutional management were underlined. In the DBC-A, 22 items have descriptive indications of PWS behavior and were used for further comparisons and correlation analysis. In contrast to previous reports, rates of disturbed behavior were lower in patients with a deletion genotype. However, the behavioral profile was similar for both genotypes. No differences were found in any measurement when comparing type I and type II deletions. The other analyzed variables showed little relevance. Conclusions Significant rates of behavioral disorders were highlighted and their typology described in a large cohort of adults with PWS. The deletion genotype was related to a lower severity of symptoms. Some major behavioral problems, such as hyperphagia, may be well controlled if living circumstances are adapted to the specific requirements of individuals with PWS.
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Affiliation(s)
- Joseba Jauregi
- Centre de Référence Prader-Willi, Hôpital Marin AP-HP, Hendaye, France.
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10
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Spendelow JS. Assessment of Behavioral and Psychiatric Problems in People With Prader–Willi Syndrome: A Review of the Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00296.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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PET scan perfusion imaging in the Prader-Willi syndrome: new insights into the psychiatric and social disturbances. J Cereb Blood Flow Metab 2011; 31:275-82. [PMID: 20588317 PMCID: PMC3049491 DOI: 10.1038/jcbfm.2010.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Prader-Willi syndrome (PWS), a rare multisystem genetic disease, leads to severe disabilities, such as morbid obesity, endocrine dysfunctions, psychiatric disorders, and social disturbances. We explored the whole brain of patients with PWS to detect abnormalities that might explain the behavioral and social disturbances, as well as the psychiatric disorders of these patients. Nine patients with PWS (six males, three females; mean age 16.4 years) underwent a positron emission tomography (PET) scan with H(2)(15)O as a tracer to measure regional cerebral blood flow (rCBF). The images were compared with those acquired from nine controls (six males, three females; mean age 21.2 years). A morphologic magnetic resonance imaging (MRI) was also performed in PWS patients, and their cognitive and behavioral skills were assessed with Wechsler Intelligence Scale for Children III and the Child Behavior Check List (CBCL). The MRI images showed no evident anatomic abnormalities, whereas PET scans revealed hypoperfused brain regions in PWS patients compared with controls, particularly in the anterior cingulum and superior temporal regions. We observed a significant relationship (P<0.05) between rCBF in the hypoperfused regions and CBCL scores. The functional consequences of these perfusion abnormalities in specific brain regions might explain the behavioral and social problems observed in these individuals.
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Zhang YW, Jia HY, Hong J, Ge Y, Zhang HJ, Shen CF, Ye L, Cui B, Li XY, Gu WQ, Zhang YF, Wang WQ, Ning G. Clinical and genetic analysis for four Chinese families with Prader-Willi syndrome. Endocrine 2009; 36:37-44. [PMID: 19421899 DOI: 10.1007/s12020-009-9203-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 03/23/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex, genetic, multisystem disorder. Its major clinical features include neonatal hypotonia and failure to thrive, mental retardation, hypogonadism, short hands and feet, hyperphagia-caused obesity, and characteristic appearance. The genetic basis of PWS is also complex. It is caused by the absence of expression of the active paternal genes such as the SNRPN, NDN, and possibly others in the PWS critical region on 15q11-13. PWS is in effect a contiguous gene syndrome resulting from deletion of the paternal copies of the imprinted. Consensus in clinical diagnostic criteria was established in 1993. However, identifying relevant patients for tests remains a challenge for most practitioners, as many features of the disorder are nonspecific, and others can be subtle or evolved over time. Consequently, molecular genetic tests can be used to diagnose PWS accurately, allowing early diagnosis of the syndrome. High resolution G-banding, high resolution cytogenetic methylation-specific PCR (MS-PCR), and fluorescence in situ hybridization (FISH) are routinely used to diagnose PWS. In this study, four Chinese patients, with typical PWS features, were detected by MS-PCR and FISH. Three were cytogenetically normal, but lacked paternal expression of proximal chromosome 15q because of maternal uniparental disomy (UPD). The other one, however, demonstrated an unbalanced de novo translocation 46, XX, t (7; 15).
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Affiliation(s)
- Yu-wen Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
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13
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The prevalence and phenomenology of repetitive behavior in genetic syndromes. J Autism Dev Disord 2008; 39:572-88. [PMID: 19037716 DOI: 10.1007/s10803-008-0655-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
We investigated the prevalence and phenomenology of repetitive behavior in genetic syndromes to detail profiles of behavior. The Repetitive Behaviour Questionnaire (RBQ) provides fine-grained identification of repetitive behaviors. The RBQ was employed to examine repetitive behavior in Angelman (N = 104), Cornelia de Lange (N = 101), Cri-du-Chat (N = 58), Fragile X (N = 191), Prader-Willi (N = 189), Lowe (N = 56) and Smith-Magenis (N = 42) syndromes and individuals with intellectual disability of heterogeneous aetiology (N = 56). Repetitive behavior was variable across syndromes. Fragile X syndrome scored highly on all subscales. Angelman syndrome demonstrated a significantly lowered probability for most behaviors. Prader-Willi, Cri-du-Chat and Smith-Magenis syndrome evidenced unique profiles of repetitive behavior. There is extreme heterogeneity of repetitive behavior across genetic syndromes, highlighting syndrome specific profiles.
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Abstract
Prader-Willi syndrome (PWS) is a highly variable genetic disorder affecting multiple body systems whose most consistent major manifestations include hypotonia with poor suck and poor weight gain in infancy; mild mental retardation, hypogonadism, growth hormone insufficiency causing short stature for the family, early childhood-onset hyperphagia and obesity, characteristic appearance, and behavioral and sometimes psychiatric disturbance. Many more minor characteristics can be helpful in diagnosis and important in management. PWS is an example of a genetic condition involving genomic imprinting. It can occur by three main mechanisms, which lead to absence of expression of paternally inherited genes in the 15q11.2-q13 region: paternal microdeletion, maternal uniparental disomy, and imprinting defect.
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Abstract
Mental retardation (MR) is a manifestation of a heterogeneous set of impairments and conditions that result in cognitive limitation. It is a condition of medical, educational, and social importance. Physicians identify profound, severe, and moderate MR but rarely diagnose mild MR unless it is associated with a genetic or medical syndrome. From a medical perspective, the quest for etiology and the possibility of medical or surgical intervention to minimize deterioration are paramount. Educators, on the other hand are less concerned with causation than with academic achievement and school success. The majority of cases of mild MR is identified in school settings. Finally, the public uses the label to describe poor adaptive skills. Adults with MR who hold jobs, live independently, and participate in society are not always described as having MR. Thus some individuals characterized in childhood or adolescence as having mild MR become indistinguishable from the general population in adulthood.
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Brinkley J, Nations L, Abramson RK, Hall A, Wright HH, Gabriels R, Gilbert JR, Pericak-Vance MAO, Cuccaro ML. Factor analysis of the aberrant behavior checklist in individuals with autism spectrum disorders. J Autism Dev Disord 2006; 37:1949-59. [PMID: 17186368 DOI: 10.1007/s10803-006-0327-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 11/10/2006] [Indexed: 10/23/2022]
Abstract
Exploratory factor analysis (varimax and promax rotations) of the aberrant behavior checklist-community version (ABC) in 275 individuals with Autism spectrum disorder (ASD) identified four- and five-factor solutions which accounted for >70% of the variance. Confirmatory factor analysis (Lisrel 8.7) revealed indices of moderate fit for the five-factor solution. Our results suggest that the factor structure of the ABC is robust within an ASD sample. Both solutions yielded a three items self-injury factor. Stratifying on this factor, we identified significant differences between the high- and low-self injury groups on ABC subscales. The emergence of a self-injury factor, while not suggestive of a new subscale, warrants further exploration as a tool that could help dissect relevant neurobiobehavioral groups in ASD.
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Affiliation(s)
- Jason Brinkley
- Center for Human Genetics, Duke University Medical Center, DUMC Box 3445, Durham, NC 27710, USA
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Hartley SL, Maclean WE, Butler MG, Zarcone J, Thompson T. Maladaptive behaviors and risk factors among the genetic subtypes of Prader-Willi syndrome. Am J Med Genet A 2005; 136:140-5. [PMID: 15940679 PMCID: PMC1896317 DOI: 10.1002/ajmg.a.30771] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Maladaptive behaviors among 65 people with Prader-Willi syndrome were assessed using the Reiss Screen for maladaptive behaviors. Young adults in their twenties were more likely to display aggressive behavior than adolescents and older adults. Differences in maladaptive behaviors between the typical deletion and uniparental disomy (UPD) subtypes were evaluated. The typical deletion subtype had higher self-injury and stealing scores than the UPD subtype. Subject characteristics were differentially related to maladaptive behavior among the typical deletion and UPD subtypes. Differences in maladaptive behavior were also examined between the typical deletion type I and type II subtypes. The type I deletion subtype had greater physical depression scores than the type II deletion subtype. The Reiss Screen cut-off scores were used to determine whether differences occurred between the subtypes at a clinically significant level. These findings offer insight into the health care needs of people with PWS.
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Affiliation(s)
- Sigan L Hartley
- Department of Psychology, University of Wyoming, Laramie, 82070, USA.
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Walley RM, Donaldson MDC. An investigation of executive function abilities in adults with Prader-Willi syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:613-25. [PMID: 16011554 DOI: 10.1111/j.1365-2788.2005.00717.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a genetic disorder caused by the absence of expression of maternally imprinted genes on the long arm of chromosome 15 (15q 11-13). There are two main genetic sub-types: (1) deletion, caused by the absence of paternally derived genetic material; and (2) uniparental disomy (UPD), where two copies of maternally derived chromosome 15 are present. In addition to generally mild/borderline intellectual disability (ID) and the almost universal feature of hyperphagia, PWS is associated with high rates of behaviour problems including temper tantrums, compulsive behaviour, perseverative speech, skin picking and rigid thinking. The present study seeks to explore whether these behaviours are associated with relative deficits in executive function (EF), which comprises the set of non-automatic processes utilized by an individual when faced with a novel situation. METHODS Eighteen adult participants with a clinical diagnosis of PWS (12 with deletion sub-type, 6 with UPD) were recruited from a UK Health Service PWS clinic, and compared with 15 participants of similar age and verbal ability on a series of EF tasks and also Digit Span Forwards. An informant completed two ratings of behaviour, the Aberrant Behavior Checklist (ABC) and the Dysexecutive Questionnaire (DEX). RESULTS The PWS group had significantly higher scores on the ABC but not on the DEX. There were no significant differences between the whole PWS group and the comparison group on any of the EF tasks. The deletion sub-type group was significantly poorer at a non-executive task, Digit Span Forwards. There was an unexpected trend for the deletion sub-type group to show more efficient performance on a visuospatial planning task, the Tower of London (TOL), but this trend did not reach significance. CONCLUSIONS The lack of relative deficits in EF task performance does not support the hypothesis that EF differences could account for the high levels of behaviour problems found in PWS. Applying the Baddeley and Hitch model of working memory it is suggested that the PWS group have a relatively intact central executive and visuospatial sketchpad but a relative impairment in the phonological loop, perhaps relating to the capacity of the phonological store. This latter finding seems to be particularly salient for those with a deletion. As differences in EF ability were not found, it is suggested that a region of the brain involved in the modulation of emotion but not particularly with EF, the orbitofrontal cortex (OFC), may be implicated in the behaviour problems reported in PWS.
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Affiliation(s)
- R M Walley
- Department of Psychology, Edenhall Hospital, Musselburgh, East Lothian, UK.
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Wigren M, Hansen S. Rituals and compulsivity in Prader-Willi syndrome: profile and stability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:428-438. [PMID: 12919193 DOI: 10.1046/j.1365-2788.2003.00515.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is characterized by an increased risk for obsessive-compulsive disorder. This study investigated the nature of compulsive-like behaviours in the PWS. METHOD Parents of 50 individuals with PWS (aged 5-18 years) and 50 typically developing 4-year-old children completed the Childhood Routines Inventory. This instrument measures compulsive-like behaviours in normative childhood. RESULTS Many childhood compulsive behaviours are prevalent among older children and adolescents with PWS. Group differences were observed in that the PWS group, independent of age, gender and cognitive dysfunctions, exhibited more intense compulsive behaviours related to insistence on sameness in many daily activities and social contexts. Findings also revealed an age-independent low-prevalent pattern of PWS compulsivity, probably related to other features in the PWS symptomatology. CONCLUSIONS Compulsions of childhood do not subside with age in adolescents with PWS. The findings indicate that the differentiation between delayed childhood rituals and pathological manifestations of compulsive features is complex in PWS populations.
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Affiliation(s)
- M Wigren
- Department of Psychology, Göteborg University, Göteborg, Sweden.
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Abstract
Although people with intellectual disabilities are at increased risk for psychiatric disorders, the type and rate of these problems differ between those with different causes for their retardation. In this paper, we review behavioural and psychiatric problems in persons with Prader-Willi syndrome, a disorder caused by a paternally derived deletion at chromosome 15(q11-q13) in about 70% of affected patients, and by maternal uniparental disomy in the majority of the remaining patients. In addition to the syndrome's characteristic hyperphagia and food seeking, individuals with Prader-Willi syndrome also have increased risks of nonfood, compulsive behaviours. These include skin picking, which is highly prevalent, as well as more variable rates of hoarding, redoing and concerns with symmetry, exactness, cleanliness, ordering and arranging. Relative to others with mental retardation, persons with Prader-Willi syndrome are at a marked increased risk for developing full-blown, obsessive-compulsive disorder. In addition, many people with Prader-Willi syndrome show increased rates of tantrums, oppositionality and aggression. Recent findings suggest that they also have an increased risk of psychotic disorder or affective illness with a psychotic component, especially young adult patients and those with the maternal uniparental disomy as opposed to paternal deletion. Dietary approaches include a reduced-calorie diet and increased physical activity, as well as close supervision around food and keeping food locked away. To date, neither CNS stimulants nor anorectic agents have been effective in treating hyperphagia, in part because hyperphagia in Prader-Willi syndrome is attributed to decreased satiation as opposed to increased hunger. Treatment for compulsivity and maladaptive behaviours include: behavioural programming; a structured, predictable routine; extra help with transitions; family support; and pharmacotherapy. Although formal drug studies have yet to be conducted, SSRIs have been effective in reducing skin picking, compulsivity and aggressive episodes in some individuals with Prader-Willi syndrome. Atypical antipsychotics have also proven helpful in persons with psychotic features or extreme aggression and impulsivity. Largely on the basis of case studies, the risks and benefits of these and other drugs in Prader-Willi syndrome are reviewed. Drug trials that move beyond case studies and that assess the relative efficacy of behavioural treatments alone or in combination with pharmacotherapy are sorely needed.
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Affiliation(s)
- Elisabeth Dykens
- University of California Los Angeles, Los Angeles, California 90024, USA
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Descheemaeker MJ, Vogels A, Govers V, Borghgraef M, Willekens D, Swillen A, Verhoeven W, Fryns JP. Prader-Willi syndrome: new insights in the behavioural and psychiatric spectrum. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2002; 46:41-50. [PMID: 11851855 DOI: 10.1046/j.1365-2788.2002.00354.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder caused by the loss of the paternal contribution of the proximal part (15q11-q13) of the long arm of chromosome 15 (i.e. deletion, disomy and imprinting mutation). The syndrome is associated with distinct physical dysmorphism, as well as with specific behavioural and psychopathological characteristics. Psychiatric symptoms in adolescence and adulthood have been described, including acute cycloid psychosis, and obsessive compulsive, bipolar and pervasive developmental disorders. At the Centre for Human Genetics in Leuven, Belgium, 53 individuals (31 children and adolescents, and 22 adults) have been followed up for 15 years by a special multidisciplinary team. Attention was given to their medical, cognitive, behavioural and emotional development, and the evolution of psychiatric disorders in adolescence and adulthood. This study describes the psychiatric problems in four patients diagnosed with acute cycloid psychosis and traces their development from infancy to adolescence. Four other individuals needed psychiatric evaluation and treatment, and could be diagnosed as having unspecified bipolar disorder, also termed unstable mood disorder. Both groups were compared, and significant differences in early development and later evolution into adulthood were noted. The individuals with PWS who later developed psychotic episodes were described as active and extrovert toddlers, and showed autistic behaviour during their primary school education. Their intellectual functioning was in the moderate to severely retarded range. The individuals with PWS who later developed an unstable mood disorder were described as rather passive and introvert toddlers, and they presented less disturbed behaviour during their primary school education. The intellectual functioning of these subjects was in the normal to borderline range.
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Dimitropoulos A, Feurer ID, Butler MG, Thompson T. Emergence of compulsive behavior and tantrums in children with Prader-Willi syndrome. AMERICAN JOURNAL OF MENTAL RETARDATION : AJMR 2001; 106:39-51. [PMID: 11246711 PMCID: PMC6744612 DOI: 10.1352/0895-8017(2001)106<0039:eocbat>2.0.co;2] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many adults with Prader-Willi syndrome are affected by behaviors such as tantrums, skin-picking, and compulsions. The nature and extent of these problems suggest more attention be directed to their emergence in childhood. Our purpose was to investigate behavior problems in children with this syndrome and identify the age at which these behaviors emerge. Parents of children with Prader-Willi syndrome, Down syndrome, and those developing typically completed questionnaires. Children with Prader-Willi syndrome exhibited more compulsions, skin-picking, and tantrums than did the other groups. A discriminant analysis of behavior variables derived two statistically significant functions that were interpreted as developmental milestones and problematic behavior. These functions correctly predicted membership for 79% of grouped cases.
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Affiliation(s)
- A Dimitropoulos
- John F. Kennedy Center, Vanderbilt University, Nashville, TN 37203, USA
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Clarke D. Prader-Willi syndrome and psychotic symptoms: 2. A preliminary study of prevalence using the Psychopathology Assessment Schedule for Adults with Developmental Disability checklist. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1998; 42 ( Pt 6):451-454. [PMID: 10030440 DOI: 10.1046/j.1365-2788.1998.4260451.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Psychopathology Assessment Schedule for Adults with Developmental Disability (PAS-ADD) checklist was used to screen for psychotic symptoms among people with Prader-Willi syndrome (PWS) aged 16 years and over. The scoring instructions for the PAS-ADD checklist were modified to take account of knowledge about the behavioural phenotype of PWS. Using modified scoring, 6.3% of the 95 people for whom checklists were completed had a possible psychotic disorder in the month before the assessment was made. The results should be treated as a crude estimate of the prevalence of psychotic symptoms associated with PWS in adult life in view of potential biases in the sample reported. These findings lend some support to the hypothesis that PWS has a non-chance association with psychotic symptoms and that the association is not entirely accounted for by the increased prevalence of psychosis associated with intellectual disability.
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Affiliation(s)
- D Clarke
- Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, UK
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Beardsmore A, Dorman T, Cooper SA, Webb T. Affective psychosis and Prader-Willi syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1998; 42 ( Pt 6):463-471. [PMID: 10030442 DOI: 10.1046/j.1365-2788.1998.4260463.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Previous studies have demonstrated that maladaptive behaviours are common amongst adults with Prader-Willi syndrome (PWS). Case reports have also previously demonstrated that psychosis can occur amongst adults with PWS. The present study was undertaken in order to gain a better understanding of the psychopathology of the psychosis of PWS. Twenty-three out of 25 adults identified with PWS living in Northamptonshire, UK, agreed to participate. Comprehensive psychiatric assessments (using the PPS-LD), and measures of adaptive and maladaptive behaviours (using the AAMR-ABS) were completed. Comparisons were made for the prevalence of psychiatric disorders against those from a previous epidemiological study of adults with intellectual disability of other aetiologies from a neighbouring county. The PWS group was found to have higher rates of affective disorders (a point prevalence of 17.4%), in which psychotic symptoms were common, but similar rates of schizophrenia/delusional disorders (4.3%) compared with the comparison group. Behaviour disorders were also common. Surprisingly, none of the PWS group was found to have generalized anxiety or phobic disorders. The diagnostic criteria for the episodes including psychotic symptoms are explored. The high rates of affective disorders is of clinical (i.e. treatment) importance as well as being of academic interest with regard to the genetics of psychiatric disorders.
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Affiliation(s)
- A Beardsmore
- Leicestershire Higher Training Scheme, Leicester General Hospital, UK
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Clarke D, Boer H, Webb T, Scott P, Frazer S, Vogels A, Borghgraef M, Curfs LM. Prader-Willi syndrome and psychotic symptoms: 1. Case descriptions and genetic studies. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1998; 42 ( Pt 6):440-450. [PMID: 10030439 DOI: 10.1046/j.1365-2788.1998.4260440.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Six people with Prader-Willi syndrome (PWS) who developed psychoses are described. Along with other literature reviewed in the present paper, the results imply an association between PWS and psychotic symptoms. Genetic studies were possible in five cases and SNRPN expression was examined in three cases. Maternal uniparental disomy and 15q11q13 deletions were found, demonstrating that psychotic symptoms are not associated with a single type of genetic abnormality.
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Affiliation(s)
- D Clarke
- Department of Psychiatry, University of Birmingham, UK
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