Pharmacologic Treatment of Cognitive Deficits and Hypersexuality Due to “Shaken-Baby Syndrome”

Developmental Outcomes Following Abusive Head Trauma in Infancy: A Systematic Review

OBJECTIVE

A systematic review of the literature was conducted to identify measures used to evaluate developmental outcomes after abusive head trauma (AHT), as well as describe outcomes among those with AHT, and explore factors and interventions influencing such outcomes.

DESIGN

This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The protocol is in PROSPERO, registration number CRD42020179592. On April 17, 2020, OVID Medline, Embase, OVID PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were searched (since inception). Inclusion criteria included original, peer-reviewed study data; AHT exposure; infants younger than 24 months at time of AHT; and evaluation of developmental outcomes. Reviewers independently evaluated studies for inclusion and assessed risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies. A descriptive synthesis approach was utilized as variability of study designs, follow-up periods, and outcome assessment tools precluded a meta-analytic approach.

RESULTS

Fifty-nine studies were included; 115 assessment tools were used to evaluate developmental outcomes; and 42 studies examined factors influencing outcomes. Two studies evaluated interventions. Five percent of studies ( n = 3) were rated low risk of bias.

CONCLUSIONS

Notable variation was observed in terms of case ascertainment criteria. Developmental outcomes after AHT have been assessed in a manner that limits understanding of how AHT impacts development, as well as the efficacy of interventions intended to improve outcomes. Researchers and clinicians are encouraged to adopt consistent diagnostic and assessment approaches.

Cognitive-Enhancing, Ex Vivo Antilipid Peroxidation and Qualitative Phytochemical Evaluation of the Aqueous and Methanolic Stem Bark Extracts of Lonchocarpus eriocalyx (Harms.)

Over 50 million persons are living with cognitive deficits worldwide, with over 80% of these individuals living in the developing world. The number of affected persons is projected to go over 152 million by the year 2050. Current drugs used for cognitive impairment are debatably ineffective, costly, inaccessible, and associated with undesirable events that call for the search for alternative and complementary approaches. Plants are arguably affordable, accessible, and efficacious. However, despite the reported healing claims, scientific data validating these claims are lacking. L. eriocalyx is traditionally used for the management of various conditions, including cognitive impairment but has not been scientifically explored. In this study, the Morris Water Maze (MWM) method was used to evaluate in vivo cognitive-enhancing effects of studied extracts of L. eriocalyx. Furthermore, following MWM experiments, brains were dissected and processed, and malondialdehyde profiles were determined. Qualitative phytochemical profiles of the studied plant extracts were also determined. The results showed that mice that were treated with the studied plant extracts took significantly shorter transfer latencies, navigation distances, and significantly longer latencies in the target quadrant (NW) (p < 0.05) compared with the negative control mice, indicating cognitive-enhancing activities. Furthermore, cognitively impaired mice that received the studied plant extracts had significantly lower MDA profiles compared with the MDA profile of the negative control group mice (p < 0.05). The cognitive-enhancing and MDA profile lowering effects were attributed to the presence of antioxidant phytoconstituents that ought to have modulated the redox state, thereby attenuating brain damage. These extracts can be, therefore, used for the management of cognitive deficits. Further studies leading to isolation and characterization of active molecules for cognitive impairment are recommended. Furthermore, the precise mechanism(s) through which these extracts exert their pharmacologic activity should be established.

Use of Propranolol for Hypersexual Behavior in an Adolescent With Autism

Objective: To report a case of an adolescent with autism with clinically significant hypersexual behaviors in whom a trial of low-dose propranolol led to major clinical improvement. Case Summary: This case report describes a 13-year-old boy with a history of autism who presented to the outpatient psychiatric clinic for hypersexual behaviors that started at the onset of puberty. The behaviors affected his functioning both at school and home. A trial of low-dose propranolol, 0.3 mg/kg/d (10 mg twice a day), targeting hypersexual behavior led to remarkable clinical improvement. The behaviors remained stable on this dose of propranolol for 1 year. Discussion: Hypersexual behavior exhibited by adolescent patients with autism can be a big challenge to manage. The literature on pharmacological options to manage these behaviors in children and adolescents with autism is limited. Clinical data of propranolol use are novel. Conclusion: To our knowledge, this is the first case report of low-dose propranolol leading to clinically significant improvement in hypersexual behaviors in an adolescent with autism. Propranolol use may expand the choice of treatment option in this patient population.

The association between pharmacologic drug intoxication and forensic-specific intent

Two criminal cases are presented in which the counsel for the defendants requested an expert witness to opine whether their drug-intoxicated clients were capable of forming the specific intent necessary to commit the felonies for which they were charged. Intent from a legal standpoint is often times a poorly understood concept among expert witnesses. The application of a criminal defense of intoxication depends upon the nature of the crime the defendant is accused. The intoxication defense cannot be applied to general intent crimes. In cases where specific intent crimes are charged against the defendant, voluntary intoxication may be used to prove that the defendant could not possess the capacity to formulate the intent as a necessary element of the crime. Voluntary intoxication may be used as a defense in specific intent crimes to negate the critical element of intent required for the prosecution to prove in criminal cases. Without being able to prove intent, the prosecution has not met their burden of proving that every element of the crime has been met, thus resulting in an acquittal.

Practitioner review: beyond shaken baby syndrome: what influences the outcomes for infants following traumatic brain injury?

BACKGROUND

Traumatic brain injury (TBI) in infancy is relatively common, and is likely to lead to poorer outcomes than injuries sustained later in childhood. While the headlines have been grabbed by infant TBI caused by abuse, often known as shaken baby syndrome, the evidence base for how to support children following TBI in infancy is thin. These children are likely to benefit from ongoing assessment and intervention, because brain injuries sustained in the first year of life can influence development in different ways over many years.

METHODS

A literature search was conducted and drawn together into a review aimed at informing practitioners working with children who had a brain injury in infancy. As there are so few evidence-based studies specifically looking at children who have sustained a TBI in infancy, ideas are drawn from a range of studies, including different age ranges and difficulties other than traumatic brain injury.

RESULTS

This paper outlines the issues around measuring outcomes for children following TBI in the first year of life. An explanation of outcomes which are more likely for children following TBI in infancy is provided, in the areas of mortality; convulsions; endocrine problems; sensory and motor skills; cognitive processing; language; academic attainments; executive functions; and psychosocial difficulties. The key factors influencing these outcomes are then set out, including severity of injury; pre-morbid situation; genetics; family factors and interventions.

CONCLUSIONS

Practitioners need to take a long-term, developmental view when assessing, understanding and supporting children who have sustained a TBI in their first year of life. The literature suggests some interventions which may be useful in prevention, acute care and longer-term rehabilitation, and further research is needed to assess their effectiveness.

Hypersexuality in inpatient children and adolescents: recognition, differential diagnosis, and evaluation

We describe a 17-year-old girl with hypersexuality resulting from virilization, the latter a consequence of polycystic ovary syndrome, and we review the literature pertinent to hypersexuality in children and adults. Inappropriate sexual behavior (a common cause of disruption among children who are hospitalized for psychiatric disorders) may be caused either by hypersexuality or by simply ill-regulated behavior: a definition of hypersexuality is proposed that can be applied at the bedside (namely, sexual behaviors or fantasies that have abruptly increased in frequency by comparison with a previous baseline, are of sufficient excessiveness to disrupt expected or usual social, academic, or occupational functioning, or constitute a source of distress), so that this distinction can be made promptly, and we present a differential diagnosis for hypersexuality to direct its evaluation. Virilization does not seem to be a common cause of hypersexuality in children and adolescents, but it should not be overlooked when it does exist. The differential diagnosis of hypersexuality in adults, which we present for comparison, is much larger than it is in children.