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Hill R, Phipps J, Greenwood R, Skuse D, Zhang ZJ. The effect of pre-treatment and process conditions on the gas barrier properties of fibrillated cellulose films and coatings: A review. Carbohydr Polym 2024; 337:122085. [PMID: 38710579 DOI: 10.1016/j.carbpol.2024.122085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
Microfibrillated cellulose (MFC) is a bio-material produced by disintegrating cellulose fibres into fibrillar components. MFC could offer a sustainable solution to packaging needs since it can form an excellent barrier to oxygen. However, a comprehensive understanding of how MFC characteristics impact barrier properties of MFC films or coatings is required. This article critically reviews how the extent of separation of fibres into fibrils-and any resulting changes to the crystallinity and degree of polymerisation of cellulose-influences gas barrier properties of MFC films or coatings. Findings from publications investigating the barrier performance of MFC prepared through different processes intending to increase the effectiveness of fibrillation are evaluated and compared. The effects of processing conditions or chemical pre-treatments on barrier properties of MFC films or coatings are then discussed. A comparison of reported results showed that morphology and size polydispersity of the cellulose strongly influence the barrier properties of MFC. However, changing the MFC production process to decrease fibril diameter and polydispersity can result in changes to cellulose crystallinity; reduction in fibril length; introduction of bulky functional groups; or increased fibril surface charge: all of which could have a negative impact on the barrier properties of the final films or coatings.
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Affiliation(s)
- Robyn Hill
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK; FiberLean Technologies, Par Moor Road, Par PL24 2SQ, UK.
| | - Jon Phipps
- FiberLean Technologies, Par Moor Road, Par PL24 2SQ, UK.
| | - Richard Greenwood
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - David Skuse
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK; FiberLean Technologies, Par Moor Road, Par PL24 2SQ, UK.
| | - Zhenyu Jason Zhang
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK.
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Kipkemoi P, Kariuki SM, Gona J, Mwangi FW, Kombe M, Kipkoech C, Murimi P, Mandy W, Warrington R, Skuse D, Newton CR, Abubakar A. Utility of the 3Di short version in the identification and diagnosis of autism in children at the Kenyan coast. Front Psychiatry 2024; 15:1234929. [PMID: 38487576 PMCID: PMC10937349 DOI: 10.3389/fpsyt.2024.1234929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction The precise epidemiological burden of autism is unknown because of the limited capacity to identify and diagnose the disorder in resource-constrained settings, related in part to a lack of appropriate standardised assessment tools and health care experts. We assessed the reliability, validity, and diagnostic accuracy of the Developmental Diagnostic Dimensional Interview (3Di) in a rural setting on the Kenyan coast. Methods Using a large community survey of neurodevelopmental disorders (NDDs), we administered the 3Di to 2,110 children aged between 6 years and 9 years who screened positive or negative for any NDD and selected 242 who had specific symptoms suggestive of autism based on parental report and the screening tools for review by a child and adolescent psychiatrist. On the basis of recorded video, a multi-disciplinary team applied the Autism Diagnostic Observation Schedule to establish an autism diagnosis. Internal consistency was used to examine the reliability of the Swahili version of the 3Di, tetrachoric correlations to determine criterion validity, structural equation modelling to evaluate factorial structure and receiver operating characteristic analysis to calculate diagnostic accuracy against Diagnostic Statistical Manual of Mental Disorders (DSM) diagnosis. Results The reliability coefficients for 3Di were excellent for the entire scale {McDonald's omega (ω) = 0.83 [95% confidence interval (CI) 0.79-0.91]}. A higher-order three-factor DSM-IV-TR model showed an adequate fit with the model, improving greatly after retaining high-loading items and correlated items. A higher-order two-factor DSM-5 model also showed an adequate fit. There were weak to satisfactory criterion validity scores [tetrachoric rho = 0.38 (p = 0.049) and 0.59 (p = 0.014)] and good diagnostic accuracy metrics [area under the curve = 0.75 (95% CI: 0.54-0.96) and 0.61 (95% CI: 0.49-0.73] for 3Di against the DSM criteria. The 3Di had a moderate sensitivity [66.7% (95% CI: 0.22-0.96)] and a good specificity [82.5% (95% CI: 0.74-0.89)], when compared with the DSM-5. However, we observed poor sensitivity [38.9% (95% CI: 0.17-0.64)] and good specificity [83.5% (95% CI: 0.74-0.91)] against DSM-IV-TR. Conclusion The Swahili version of the 3Di provides information on autism traits, which may be helpful for descriptive research of endophenotypes, for instance. However, for accuracy in newly diagnosed autism, it should be complemented by other tools, e.g., observational clinical judgment using the DSM criteria or assessments such as the Autism Diagnostic Observation Schedule. The construct validity of the Swahili 3Di for some domains, e.g., communication, should be explored in future studies.
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Affiliation(s)
- Patricia Kipkemoi
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Symon M. Kariuki
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Joseph Gona
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Martha Kombe
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Collins Kipkoech
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Paul Murimi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - William Mandy
- Division of Psychology and Language Sciences, University College London (UCL) Research Department of Clinical, Educational and Health Psychology, London, United Kingdom
| | - Richard Warrington
- Institute of Child Health, University College London (UCL), London, United Kingdom
| | - David Skuse
- Institute of Child Health, University College London (UCL), London, United Kingdom
| | - Charles R.J.C. Newton
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Amina Abubakar
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Chi Z, Devine RT, Wolstencroft J, Skuse D, Hughes C, Baker K. Rare neurodevelopmental conditions and parents' mental health - how and when does genetic diagnosis matter? Orphanet J Rare Dis 2024; 19:70. [PMID: 38360654 PMCID: PMC10870533 DOI: 10.1186/s13023-024-03076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Parents of individuals with rare neurodevelopmental conditions and intellectual disabilities (ID) are vulnerable to mental health difficulties, which vary between parents and within parents over time. The underlying cause of a child's condition can influence parents' mental health, via uncertain pathways and within unknown time-windows. RESULTS We analysed baseline data from the IMAGINE-ID cohort, comprising 2655 parents of children and young people with ID of known genetic origin. First, we conducted a factor analysis of the SDQ Impact scale to isolate specific pathways from genetic aetiology to parents' mental health. This suggested a two-factor structure for the SDQ Impact scale, with a "home & distress" dimension and a "participation" dimension. Second, we tested via structural equation modelling (SEM) whether genetic diagnosis affects Impact and mental health directly, or indirectly via children's characteristics. This analysis identified an indirect pathway linking genetic aetiology to parents' mental health, serially through child characteristics (physical disabilities, emotional and behavioural difficulties) and Impact: home & distress. Third, we conducted moderation analysis to explore the influence of time elapsed since genetic diagnosis. This showed that the serial mediation model was moderated by time since diagnosis, with strongest mediating effects among recently diagnosed cases. CONCLUSIONS There are multiple steps on the pathway from ID-associated genetic diagnoses to parents' mental health. Pathway links are strongest within 5 years of receiving a genetic diagnosis, highlighting opportunities for better post-diagnostic support. Recognition and enhanced support for children's physical and behavioural needs might reduce impact on family life, ameliorating parents' vulnerabilities to mental health difficulties.
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Affiliation(s)
- Zhaotian Chi
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK
| | - Rory T Devine
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - David Skuse
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Claire Hughes
- Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK.
- Department of Medical Genetics, University of Cambridge, Cambridge, UK.
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Hall JH, Chawner SJRA, Wolstencroft J, Skuse D, Holmans P, Owen MJ, van den Bree MBM. Irritability in young people with copy number variants associated with neurodevelopmental disorders (ND-CNVs). medRxiv 2023:2023.12.05.23299440. [PMID: 38106165 PMCID: PMC10723492 DOI: 10.1101/2023.12.05.23299440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background A range of rare mutations involving micro-deletion or -duplication of genetic material (copy number variants (CNVs)) have been associated with high neurodevelopmental and psychiatric risk (ND-CNVs). Irritability is frequently observed in childhood neurodevelopmental conditions, yet its aetiology is largely unknown. Genetic variation may play a role, but there is a sparsity of studies investigating presentation of irritability in young people with ND-CNVs. Aims This study aimed to investigate whether there is a difference in irritability in young people with rare ND-CNVs compared to those without ND-CNVs, and to what extent irritability is associated with psychiatric diagnoses and cognitive ability (IQ). Methods Irritability and broader psychopathology was assessed in 485 young people with ND-CNVs and 164 sibling controls, using the child and adolescent psychiatric assessment (CAPA). Autism was assessed using the Social Communication Questionnaire (SCQ), and Intelligence Quotient (IQ) by the Wechsler Abbreviated Scale of Intelligence (WASI). Results 54% of young people with ND-CNVs met the threshold for irritability; significantly more than controls (OR = 3.77, CI = 3.07-7.90, p= 5.31 × 10-11). When controlling for the presence of other psychiatric comorbidities, ND-CNV status was still associated with irritability. There was no evidence for a relationship between irritability and IQ. Conclusions Irritability is an important aspect of the clinical picture in young people with ND-CNVs. This work shows that genetic variation is associated with irritability in young people with ND-CNVs, independent of psychiatric comorbidities or IQ impairment. Clinicians should be aware of this increased risk to inform management and interventions.
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Affiliation(s)
- Jessica H Hall
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Samuel J R A Chawner
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London
| | - Peter Holmans
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Michael J Owen
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Marianne B M van den Bree
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, United Kingdom
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5
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Eaton J, Baingana F, Abdulaziz M, Obindo T, Skuse D, Jenkins R. The negative impact of global health worker migration, and how it can be addressed. Public Health 2023; 225:254-257. [PMID: 37949017 DOI: 10.1016/j.puhe.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Abstract
International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.
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Affiliation(s)
- J Eaton
- London School of Hygiene and Tropical Medicine, UK.
| | - F Baingana
- World Health Organization, African Regional Office, People's Republic of Congo
| | - M Abdulaziz
- Africa Centres for Disease Control and Prevention, Ethiopia
| | - T Obindo
- Association of Psychiatrists in Nigeria and University of Jos, Nigeria
| | - D Skuse
- University College London, UK
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Skuse D. A world of traditional healing in the Global South. BJPsych Int 2023; 20:77-78. [PMID: 38029433 PMCID: PMC10659831 DOI: 10.1192/bji.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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7
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Zarakoviti E, Shafran R, Skuse D, McTague A, Batura N, Palmer T, Dalrymple E, Bennett SD, Reilly C. Factor associated with the occurrence of epilepsy in autism: a systematic review. J Autism Dev Disord 2023; 53:3873-3890. [PMID: 35904650 PMCID: PMC10499929 DOI: 10.1007/s10803-022-05672-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 12/16/2022]
Abstract
This systematic review aimed to identify factors significantly associated with the occurrence of epilepsy in autistic individuals and to consider the impact of study quality on findings. Electronic databases were systematically searched on October 2nd, 2020 and records retrieved were limited to those published from 2000 onwards. Study quality was categorised as 'good', 'moderate' or 'weak'. Fifty-three studies were included and in studies where the prevalence of epilepsy was reported (n = 257,892), 18,254 (7%) had co-occurring epilepsy. Intellectual disability/cognitive impairment was the most commonly reported risk factor associated with occurrence of epilepsy in autistic individuals. The evidence supporting other, potentially relevant factors was weak and inconsistent and requires further evaluation. Only 9/53 studies were considered 'good' quality.
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Affiliation(s)
- Eleni Zarakoviti
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - David Skuse
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
| | - Amy McTague
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Neha Batura
- UCL Institute for Global Health (IGH), 30 Guilford Street, WC1N 1EH, London, UK
| | - Tom Palmer
- UCL Institute for Global Health (IGH), 30 Guilford Street, WC1N 1EH, London, UK
| | - Emma Dalrymple
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
| | - Colin Reilly
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH, London, UK.
- Research Department, Young Epilepsy, RH7 6PW, Lingfield, Surrey, UK.
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Skuse D. The benefits of digitisation of psychiatric care facilities. BJPsych Int 2023; 20:53. [PMID: 37531243 PMCID: PMC10387418 DOI: 10.1192/bji.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023] Open
Abstract
The potential benefits of providing digital mental healthcare to isolated rural populations are emphasised in two articles from Pakistan. Novel programmes of support have been instituted by both private and publicly funded services.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK. Email
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9
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Wolstencroft J, Mandy W, Brown-Wright L, Murin M, Skuse D, DeJong M. Can we distinguish the consequences of early maltreatment on child behaviour from idiopathic autism? Arch Dis Child 2023; 108:392-397. [PMID: 36609536 DOI: 10.1136/archdischild-2022-324156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify clinical features that could distinguish children presenting with autistic-like features and a history of severe early maltreatment from children with idiopathic autism spectrum disorders (ASDs). DESIGN Matched-comparison study. SETTING Great Ormond Street Hospital, UK. PARTICIPANTS 46 children with a history of early maltreatment, mean (SD) age 10.6 (3.3) years and 47 children with an ASD, mean (SD) age 10.4 (2.9) years. MAIN OUTCOME MEASURES A range of standardised interview and observational measures that are designed to quantify autistic traits. Caregiver and teacher reports were obtained on broader aspects of behavioural and emotional adjustment. RESULTS Both groups had normal range IQ and were predominantly male. On the basis of autistic traits alone, caregiver interview and structured observation concurred that over 60% of the formerly maltreated children met criteria for an ASD. Autistic symptom profiles were very similar in both groups, although children with idiopathic ASD had significantly more marked repetitive and stereotyped behaviours. Teacher and caregiver reports indicated that children from both groups had an increased and broadly similar prevalence of emotional and behavioural disorders. CONCLUSION Children presenting with a history of early maltreatment, who show autistic traits of behaviour, have a high risk of meeting diagnostic criteria for ASD. Their symptom profiles are virtually indistinguishable from children with idiopathic autism.
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Affiliation(s)
- Jeanne Wolstencroft
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - William Mandy
- Psychology and Language Sciences, University College London, London, UK
| | - Lucy Brown-Wright
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marianna Murin
- Anna Freud Centre, University College London, London, UK
| | - David Skuse
- BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Margaret DeJong
- Psychological and Mental Health Services, Queen Anne Street Clinic, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Wolstencroft J, Srinivasan R, Hall J, van den Bree MBM, Owen MJ, Raymond FL, Skuse D. Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin. JCPP Adv 2023; 3:e12128. [PMID: 37431317 PMCID: PMC10241472 DOI: 10.1002/jcv2.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/10/2022] [Indexed: 01/15/2023] Open
Abstract
Background Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD + IDD, in terms of both children's mental health and parental psychological distress. Methods Participants with a copy number variant or single nucleotide variant (5-19 years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co-occurring ASD, and co-occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio-economic deprivation. Results Of the 1904 participants with IDD, 701 (36.8%) had co-occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR = 1.84, 95% confidence interval [CI] 1.46-2.32, p < 0.0001; emotional disorders: OR = 1.85, 95%CI 1.36-2.5, p < 0.0001; disruptive behaviour disorders: OR = 1.79, 95%CI 1.36-2.37, p < 0.0001). The severity of associated symptoms was also greater in those with ASD (hyperactivity: B = 0.25, 95%CI 0.07-0.34, p = 0.006; emotional difficulties: B = 0.91, 95%CI 0.67 to 1.14, p < 0.0001; conduct problems: B = 0.25, 95%CI 0.05 to 0.46, p = 0.013). Parents of children with IDD and ASD also reported greater psychological distress than those with IDD alone (β = 0.1, 95% CI 0.85 to 2.21, p < 0.0001). Specifically, in those with ASD, symptoms of hyperactivity (β = 0.13, 95% CI 0.29-0.63, p < 0.0001), emotional difficulties (β = 0.15, 95% CI 0.26-0.51, p < 0.0001) and conduct difficulties (β = 0.07, 95% CI 0.07-0.37, p < 0.004) all significantly contributed to parental psychological distress. Conclusions Among children with IDD of genetic aetiology, one third have co-occurring ASD. Not only do those with co-occurring ASD present with a wider range of associated mental health disorders and more severe mental health difficulties than those with IDD alone, but their parents also experience more psychological distress. Our findings suggest that the additional mental health and behavioural symptoms in those with ASD contributed to the degree of parental psychological distress.
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Affiliation(s)
- Jeanne Wolstencroft
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ramya Srinivasan
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- UCL Division of PsychiatryUniversity College LondonLondonUK
| | - Jeremy Hall
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | - Marianne B. M. van den Bree
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | - Michael J. Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | | | - F. Lucy Raymond
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals NHS Foundation TrustCambridge Biomedical CampusCambridgeUK
- NIHR BioresourceCambridge Biomedical CampusCambridgeUK
| | - David Skuse
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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Skuse D. Practising psychiatry in Sri Lanka: challenges and opportunities. BJPsych Int 2023; 20:1. [PMID: 36812010 PMCID: PMC9909413 DOI: 10.1192/bji.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 02/10/2023] Open
Abstract
This month's issue of BJPsych International focuses on psychiatry in Sri Lanka, with articles on suggested improvements in education and training, the country's outdated legislation regarding involuntary psychiatric treatment, and the misuse of prescription medications.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK. Email
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12
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Maresh K, Papageorgiou A, Ridout D, Harrison NA, Mandy W, Skuse D, Muntoni F. Startle responses in Duchenne muscular dystrophy: a novel biomarker of brain dystrophin deficiency. Brain 2023; 146:252-265. [PMID: 35136951 PMCID: PMC9825594 DOI: 10.1093/brain/awac048] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 01/12/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is characterized by loss of dystrophin in muscle, however patients also have variable degree of intellectual disability and neurobehavioural co-morbidities. In contrast to muscle, in which a single full-length dystrophin isoform (Dp427) is produced, multiple isoforms are produced in the brain, and their deficiency accounts for the variability of CNS manifestations, with increased risk of comorbidities in patients carrying mutations affecting the 3' end of the gene, which disrupt expression of shorter Dp140 and Dp71 isoforms. A mouse model (mdx mouse) lacks Dp427 in muscle and CNS and exhibits exaggerated startle responses to threat, linked to the deficiency of dystrophin in limbic structures such as the amygdala, which normalize with postnatal brain dystrophin-restoration therapies. A pathological startle response is not a recognized feature of DMD, and its characterization has implications for improved clinical management and translational research. To investigate startle responses in DMD, we used a novel fear-conditioning task in an observational study of 56 males aged 7-12 years (31 affected boys, mean age 9.7 ± 1.8 years; 25 controls, mean age 9.6 ± 1.4 years). Trials of two neutral visual stimuli were presented to participants: one 'safe' cue presented alone; one 'threat' cue paired with an aversive noise to enable conditioning of physiological startle responses (skin conductance response and heart rate). Retention of conditioned physiological responses was subsequently tested by presenting both cues without the aversive noise in an 'Extinction' phase. Primary outcomes were the initial unconditioned skin conductance and change in heart rate responses to the aversive 'threat' and acquisition and retention of conditioned responses after conditioning. Secondary and exploratory outcomes were neuropsychological measures and genotype associations. The mean unconditioned skin conductance response was greater in the DMD group than controls [mean difference 3.0 µS (1.0, 5.1); P = 0.004], associated with a significant threat-induced bradycardia only in the patient group [mean difference -8.7 bpm (-16.9, -0.51); P = 0.04]. Participants with DMD found the task more aversive than controls, with increased early termination rates during the Extinction phase (26% of DMD group versus 0% of controls; P = 0.007). This study provides the first evidence that boys with DMD show similar increased unconditioned startle responses to threat to the mdx mouse, which in the mouse respond to brain dystrophin restoration. Our study provides new insights into the neurobiology underlying the complex neuropsychiatric co-morbidities in DMD and defines an objective measure of this CNS phenotype, which will be valuable for future CNS-targeted dystrophin-restoration studies.
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Affiliation(s)
- Kate Maresh
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Queen Square Centre for Neuromuscular Diseases, University College London, London WC1N 3BG, UK
| | - Andriani Papageorgiou
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Deborah Ridout
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Neil A Harrison
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - William Mandy
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - David Skuse
- Department of Behavioural and Brain Sciences, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Queen Square Centre for Neuromuscular Diseases, University College London, London WC1N 3BG, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
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Abstract
OBJECTIVES Turner syndrome (TS) is a rare sex chromosome aneuploidy, with an incidence of four in 10,000 new-born girls. TS is often associated with impaired social communication skills, but the extent to which these are attributable to Autism Spectrum Disorders (ASD) is uncertain. We made standardized assessments of the mental health and associated neurodevelopmental disorders in children and adolescents with TS and report on the prevalence of concurrent conditions. METHODS Our sample comprised 127 girls with TS, 5-19 years of age. We obtained reports of their mental health from a combination of diagnostic interview (the Development and Wellbeing Assessment (DAWBA)), from the Strengths and Difficulties Questionnaire (SDQ) and from the Social Responsiveness Scale (SRS-2). Sources of information included parents, teachers and self-reports. The prevalence of mental health disorders in this sample was compared with age/sex matched national English data from typical controls. RESULTS Most individuals with TS (83%) had experienced significant social communication difficulties and nearly one in four (23%) met diagnostic criteria for ASD on the DAWBA. One-third (34%) had at least one mental health or neurodevelopmental condition, and those girls with an ASD were at a greater risk of a co-occurring emotional disorder and/or attention deficit hyperactivity disorder (ADHD). CONCLUSION Children and adolescents with TS are substantially more likely to meet criteria for ASD than their typically developing peers. Our finding has clinical implications for appropriate behavioural management from preschool through to adolescence.
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Affiliation(s)
- Jeanne Wolstencroft
- The Great Ormond Street Institute of Child Health, University College London, London, UK,Jeanne Wolstencroft, The Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
| | - William Mandy
- Division of Psychology and Language Sciences, University College London, London, UK
| | - David Skuse
- The Great Ormond Street Institute of Child Health, University College London, London, UK
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14
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Wolstencroft J, Wicks F, Srinivasan R, Wynn S, Ford T, Baker K, Chawner SJRA, Hall J, van den Bree MBM, Owen MJ, Skuse D, Raymond FL. Neuropsychiatric risk in children with intellectual disability of genetic origin: IMAGINE, a UK national cohort study. Lancet Psychiatry 2022; 9:715-724. [PMID: 35932790 PMCID: PMC9636306 DOI: 10.1016/s2215-0366(22)00207-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with intellectual disability frequently have multiple co-morbid neuropsychiatric conditions and poor physical health. Genomic testing is increasingly recommended as a first-line investigation for these children. We aim to determine the effect of genomics, inheritance, and socioeconomic deprivation on neuropsychiatric risk in children with intellectual disability of genetic origin as compared with the general population. METHODS IMAGINE is a prospective cohort study using online mental health and medical assessments in a cohort of 3407 UK participants with intellectual disability and pathogenic genomic variants as identified by the UK's National Health Service (NHS). Our study is on a subset of these participants, including all children aged 4-19 years. We collected diagnostic genomic reports from NHS records and asked primary caregivers to provide an assessment of their child using the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), the Adaptive Behaviour Assessment System 3 (ABAS-3), and a medical history questionnaire. Each child was assigned a rank based on their postcode using the index of multiple deprivation (IMD). We compared the IMAGINE cohort with the 2017 National Survey of Children's Mental Health in England. The main outcomes of interest were mental health and neurodevelopment according to the DAWBA and SDQ. FINDINGS We recruited 2770 children from the IMAGINE study between Oct 1, 2014 and June 30, 2019, of whom 2397 (86·5%) had a basic assessment of their mental health completed by their families and 1277 (46·1%) completed a medical history questionnaire. The mean age of participants was 9·2 years (SD 3·9); 1339 (55·9%) were boys and 1058 (44·1%) were girls. 355 (27·8%) of 1277 reported a seizure disorder and 814 (63·7%) reported movement or co-ordination problems. 1771 (73·9%) of 2397 participants had a pathogenic copy number variant (CNV) and 626 (26·1%) had a pathogenic single nucleotide variant (SNV). Participants were representative of the socioeconomic spectrum of the UK general population. The relative risk (RR) of co-occurring neuropsychiatric diagnoses, compared with the English national population, was high: autism spectrum disorder RR 29·2 (95% CI 23·9-36·5), ADHD RR 13·5 (95% CI 11·1-16·3). In children with a CNV, those with a familial variant tended to live in more socioeconomically deprived areas than those with a de novo variant. Both inheritance and socioeconomic deprivation contributed to neuropsychiatric risk in those with a CNV. INTERPRETATION Children with genomic variants and intellectual disability are at an increased risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk. Early genomic investigations of children with intellectual disability could facilitate the identification of the most vulnerable children. Additionally, harnessing parental expertise using online DAWBA assessments could rapidly identify children with exceptional needs to child mental health services. FUNDING UK Medical Research Council and Medical Research Foundation.
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Affiliation(s)
- Jeanne Wolstencroft
- NIHR BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Francesca Wicks
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ramya Srinivasan
- NIHR BRC Great Ormond Street Institute of Child Health, University College London, London, UK; UCL Division of Psychiatry, University College London, London, UK
| | | | - Tamsin Ford
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Kate Baker
- School of Clinical Medicine, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Samuel J R A Chawner
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK; Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - David Skuse
- NIHR BRC Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F Lucy Raymond
- School of Clinical Medicine, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK; NIHR Bioresource, Cambridge Biomedical Campus, Cambridge, UK.
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15
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Brogan P, Naden R, Ardoin SP, Cooper JC, De Benedetti F, Dicaire JF, Eleftheriou D, Feldman B, Goldin J, Karol SE, Price-Kuehne F, Skuse D, Stratakis CA, Webb N, Stone JH. The pediatric glucocorticoid toxicity index. Semin Arthritis Rheum 2022; 56:152068. [PMID: 35917759 DOI: 10.1016/j.semarthrit.2022.152068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To develop a Pediatric glucocorticoid toxicity index (pGTI), a standardized, weighted clinical outcome assessment that measures change in glucocorticoid (GC) toxicity over time. METHODS Fourteen physician experts from 7 subspecialties participated. The physician experts represented multiple subspecialties in which GCs play a major role in the treatment of inflammatory disease: nephrology, rheumatology, oncology, endocrinology, genetics, psychiatry, and maternal-fetal medicine. Nine investigators were from Canada, Europe, or New Zealand, and 5 were from the United States. Group consensus methods and multi-criteria decision analysis were used. The pGTI is an aggregate assessment of GC toxicities that are common, important, and dynamic. These toxicities are organized into health domains graded as minor, moderate, or major and are weighted according to severity. The relative weights were derived by group consensus and multi-criteria decision analysis using the 1000MindsTM software platform. Two quantitative scores comprise the overall toxicity profile derived from pGTI data: (1) the Cumulative Worsening Score; and (2) the Aggregate Improvement Score. The pGTI also includes a qualitative, unweighted record of GC side-effects known as the Damage Checklist, which documents less common toxicities that, although potentially severe, are unlikely to change with varying GC dosing. RESULTS One hundred and seven (107) toxicity items were included in the pGTI and thirty-two (32) in the Damage Checklist. To assess the degree to which the pGTI corresponds to expert clinical judgement, the investigators ranked 15 cases by clinical judgement from highest to lowest GC toxicity. Expert rankings were then compared to case ranking by the pGTI, yielding excellent agreement (weighted kappa 0.86). The pGTI was migrated to a digital environment following its development and initial validation. The digital platform is designed to ensure ease-of-use in the clinic, rigor in application, and accuracy of scoring. Clinic staff enter vital signs, laboratory results, and medication changes relevant to pGTI scoring. Clinicians record findings for GC myopathy, skin toxicity, mood dysfunction, and infection. The pGTI algorithms then apply the weights to these raw data and calculate scores. Embedded logic accounts for the impact of age- and sex-related reference ranges on several health domains: blood pressure, lipid metabolism, and bone mineral density. Other algorithms account for anticipated changes in the height Z-scores used in the growth domain, thereby addressing a concern unique to GC toxicity in children. The Damage Checklist ensures comprehensive measurement of GC toxicity but does not contribute to pGTI scoring, because the scored domains emphasize manifestations of GC toxicity that are likely to change over the course of a trial. CONCLUSIONS We describe the development and initial evaluation of a weighted, composite toxicity index for the assessment of morbidity related to GC use in children and adolescents. Developing the pGTI digital platform was essential for performing the nuanced calculations necessary to ensure rigor, accuracy, and ease-of-use in both clinic and research settings.
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Affiliation(s)
- Paul Brogan
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Ray Naden
- McMasterUniversity, Hamilton, Ontario, Canada
| | | | - Jennifer C Cooper
- University of Colorado Anschutz Medical Alifornia, San Francisco, CA, USA
| | | | | | - Despina Eleftheriou
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Brian Feldman
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jon Goldin
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Seth E Karol
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - David Skuse
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Nicholas Webb
- Royal Manchester Children's Hospital, Manchester, UK; Rheumatology Clinic, Bulfinch 165, Massachusetts General Hospital, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John H Stone
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK.
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16
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Maresh KE, Papageorgiou A, Ridout D, Harrison NA, Mandy W, Skuse D, Muntoni F. 076 Increased physiological responses to threat in Duchenne muscular dystrophy: a potential CNS outcome measure. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Dystrophin is expressed in brain as well as muscle, and its loss in Duchenne muscular dystrophy (DMD) causes CNS disturbance in addition to muscle pathology. A DMD mouse model (mdx) exhibits exagger- ated fear responses to threat, which normalise with postnatal dystrophin-restoration therapies.To investigate whether fear responses are abnormal in DMD patients, we tested 31 DMD and 25 male control participants aged 7–12 years using a fear conditioning task. Participants viewed trials of two neutral visual stimuli: one ‘safe’ stimulus and one paired with a ‘threat’ (aversive noise) to enable fear condi- tioning. Both stimuli were subsequently presented without the noise to assess extinction of conditioned autonomic fear responses (skin conductance).The initial (unconditioned) response to threat was significantly greater in DMD than controls (p=0.016). Both groups similarly acquired conditioned fear responses (p=0.55). These were retained in controls during early extinction, and later extinguished, however DMD participants showed no significant discrimination between threat/safe stimuli in extinction.This study is the first to investigate fear responses in DMD boys, showing exaggerated unconditioned responses to threat, similar to mdx mice, and abnormalities of fear extinction. Establishing this objective measure of a potentially reversible CNS phenotype will benefit clinical trials of CNS-targeted dystrophin- restoration therapies.drkatemaresh@gmail.com
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17
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Lai AG, Chang WH, Skuse D. Autism and mental illness in children and young people require standardised approaches for assessment and treatment. Lancet Reg Health Eur 2022; 16:100360. [PMID: 35368370 PMCID: PMC8968054 DOI: 10.1016/j.lanepe.2022.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Alvina G. Lai
- Institute of Health Informatics, University College London, London, UK
| | - Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK
| | - David Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
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18
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Maresh K, Papageorgiou A, Ridout D, Harrison N, Mandy W, Skuse D, Muntoni F. Development of a novel startle response task in Duchenne muscular dystrophy. PLoS One 2022; 17:e0264091. [PMID: 35439255 PMCID: PMC9017900 DOI: 10.1371/journal.pone.0264091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Duchenne muscular dystrophy (DMD), an X-linked childhood-onset muscular dystrophy caused by loss of the protein dystrophin, can be associated with neurodevelopmental, emotional and behavioural problems. A DMD mouse model also displays a neuropsychiatric phenotype, including increased startle responses to threat which normalise when dystrophin is restored in the brain. We hypothesised that startle responses may also be increased in humans with DMD, which would have potential translational therapeutic implications. To investigate this, we first designed a novel discrimination fear-conditioning task and tested it in six healthy volunteers, followed by male DMD (n = 11) and Control (n = 9) participants aged 7–12 years. The aims of this methodological task development study were to: i) confirm the task efficacy; ii) optimise data processing procedures; iii) determine the most appropriate outcome measures. In the task, two neutral visual stimuli were presented: one ‘safe’ cue presented alone; one ‘threat’ cue paired with a threat stimulus (aversive noise) to enable conditioning of physiological startle responses (skin conductance response, SCR, and heart rate). Outcomes were the unconditioned physiological startle responses to the initial threat, and retention of conditioned responses in the absence of the threat stimulus. We present the protocol development and optimisation of data processing methods based on empirical data. We found that the task was effective in producing significantly higher physiological startle SCR in reinforced ‘threat’ trials compared to ‘safe’ trials (P < .001). Different data extraction methods were compared and optimised, and the optimal sampling window was derived empirically. SCR amplitude was the most effective physiological outcome measure when compared to SCR area and change in heart rate, with the best profile on data processing, the least variance, successful conditioned response retention (P = .01) and reliability assessment in test-retest analysis (rho = .86). The definition of this novel outcome will allow us to study this response in a DMD population.
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Affiliation(s)
- Kate Maresh
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- MRC Centre for Neuromuscular Diseases, UCL, London, United Kingdom
| | - Andriani Papageorgiou
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Deborah Ridout
- Department of Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, United Kingdom
| | - Neil Harrison
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - William Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - David Skuse
- Department of Behavioural and Brain Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- MRC Centre for Neuromuscular Diseases, UCL, London, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, United Kingdom
- * E-mail:
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19
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Skuse D. Providing mental health services in poverty. BJPsych Int 2022. [DOI: 10.1192/bji.2021.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Skuse D. BJPsych International: its aims and its future. BJPsych Int 2021. [DOI: 10.1192/bji.2021.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Our mission on BJPsych International is simple. First, to promote best practice in the care and treatment of people with mental health problems worldwide. Second, to educate psychiatrists and other mental health professionals about international developments in policy and the delivery of mental health services. We aim to provide a publication platform for authors globally, with a focus on those from low- and middle-income countries who have a message to send about innovations in their country's mental health services that would be of interest to our readership. Our recent success in obtaining a listing on PubMed makes all our articles accessible to a much wider audience and will enhance interest in the journal's unique content. Importantly, the journal, which has a distribution of over 20 000 copies, is entirely open access.
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21
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Skuse D. Current concerns about mental health in Bangladesh. BJPsych Int 2021; 18:77-78. [PMID: 34747946 PMCID: PMC8554942 DOI: 10.1192/bji.2021.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
This month's issue of BJPsych International focuses on Bangladesh, one of the most densely populated countries in the world and geographically vulnerable to a wide range of natural disasters. Mental health has been deteriorating since the COVID-19 crisis, but few psychiatrists and clinical psychologists are available to manage the consequences.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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22
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Wolstencroft J, Hull L, Warner L, Akhtar TN, Mandy W, Skuse D. 'We have been in lockdown since he was born': a mixed methods exploration of the experiences of families caring for children with intellectual disability during the COVID-19 pandemic in the UK. BMJ Open 2021; 11:e049386. [PMID: 34593495 PMCID: PMC8487017 DOI: 10.1136/bmjopen-2021-049386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to explore the experiences of parents caring for children with intellectual and developmental disabilities (IDD) during the UK national lockdown in spring 2020, resulting from the COVID-19 pandemic. DESIGN Participants were identified using opportunity sampling from the IMAGINE-ID national (UK) cohort and completed an online survey followed by a semistructured interview. Interviews were analysed using thematic analysis. SETTING Interviews were conducted over the telephone in July 2020 as the first UK lockdown was ending. PARTICIPANTS 23 mothers of children with intellectual and developmental disabilities aged 5-15 years were recruited. RESULTS Themes reported by parents included: managing pre-existing challenges during a time of extreme change, having mixed emotions about the benefits and difficulties that arose during the lockdown and the need for appropriate, individualised support. CONCLUSIONS Our findings confirm observations previously found in UK parents of children with IDD and provide new insights on the use of technology during the pandemic for schooling and healthcare, as well as the need for regular check-ins.
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Affiliation(s)
- Jeanne Wolstencroft
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - Laura Hull
- Division of Psychology and Language Sciences, University College London, London, England
| | - Lauren Warner
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - Tooba Nadeem Akhtar
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - William Mandy
- Division of Psychology and Language Sciences, University College London, London, England
| | - David Skuse
- The Great Ormond Street Institute of Child Health, University College London, London, England
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23
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Skuse D. Minority status, stigma, prejudice and bullying: growing up in jeopardy. BJPsych Int 2021; 18:53. [PMID: 34382958 PMCID: PMC8314990 DOI: 10.1192/bji.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
Stigma and alienation are suffered by many individuals with mental health disorders, in societies around the world. Rejection is all the more common among those who have intellectual disabilities or who are from ethnic minorities. In this issue, three papers consider the suffering experienced by patients with vulnerabilities that militate against their being in receipt of the psychiatric care they assuredly deserve.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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24
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Linden SC, Watson CJ, Smith J, Chawner SJRA, Lancaster TM, Evans F, Williams N, Skuse D, Raymond FL, Hall J, Owen MJ, Linden DEJ, Green-Snyder L, Chung WK, Maillard AM, Jacquemont S, van den Bree MBM. Correction: The psychiatric phenotypes of 1q21 distal deletion and duplication. Transl Psychiatry 2021; 11:372. [PMID: 34226486 PMCID: PMC8257584 DOI: 10.1038/s41398-021-01296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Stefanie C. Linden
- grid.5012.60000 0001 0481 6099Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands ,grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Cameron J. Watson
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK ,grid.4868.20000 0001 2171 1133Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jacqueline Smith
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Samuel J. R. A. Chawner
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Thomas M. Lancaster
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK ,grid.7340.00000 0001 2162 1699School of Psychology, University of Bath, Bath, UK
| | - Ffion Evans
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nigel Williams
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - David Skuse
- grid.83440.3b0000000121901201Behavioural and Brain Sciences Unit Institute of Child Health, University College London, London, UK
| | - F. Lucy Raymond
- grid.5335.00000000121885934Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Jeremy Hall
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Michael J. Owen
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - David E. J. Linden
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK ,grid.5012.60000 0001 0481 6099Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Live Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Wendy K. Chung
- grid.21729.3f0000000419368729Departments of Pediatrics and Medicine, Columbia University, New York, NY USA
| | - Anne M. Maillard
- grid.9851.50000 0001 2165 4204Service des Troubles du Spectre de l’Autisme et apparentés, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Jacquemont
- grid.8515.90000 0001 0423 4662Service de Génétique Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marianne B. M. van den Bree
- grid.5600.30000 0001 0807 5670Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Skuse D. Gambling and governmental responsibilities. BJPsych Int 2021; 18:29. [PMID: 34287400 PMCID: PMC8274408 DOI: 10.1192/bji.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Human beings seem to be genetically predisposed to take risks in the hope of reward, but in gambling the risks often significantly outweigh the rewards. Should societies and governments attempt to regulate gambling, and how? Two papers in this month's issue of BJPsych International discuss problem gambling in Nigeria and in Malaysia, and how government and society address it.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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Wolstencroft J, Kerry E, Denyer H, Watkins A, Mandy W, Skuse D. New approaches to social skills training: Blended group interventions for girls with social communication difficulties. Autism Res 2021; 14:1061-1072. [PMID: 33694323 DOI: 10.1002/aur.2495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
Social skills group interventions are increasing popular for children with social communication disorders but there is little evidence of their acceptability or effectiveness when delivered online. We report a feasibility study that adapted the Program for Education and Enrichment of Relational Skills (PEERS) to provide an intensive 8 week online delivery to female adolescents, blended with some face-to-face group meetings. A systematic multiple-case series design with case tracking was developed, comprising a 3-month baseline, a 2-month intervention and a 3-month follow-up period. Seven adolescents with Turner Syndrome and social communication difficulties (17-20 years) took part, together with their parents. Acceptability and feasibility were assessed by means of qualitative feedback and attendance rates. Changes in social adaptation were tracked using measures of social knowledge, social behaviour and autistic symptoms, plus anxiety and self-esteem. Attendance rates were consistently high and there were no dropouts. Qualitative feedback indicated the online format was acceptable to both the participants and their families. Objective outcome measures showed significant gains in social knowledge and improved social initiations from measures made during the pre-intervention baseline. This proof-of-principle pilot study demonstrated blended social skills interventions are both feasible and acceptable to adolescent females with social communication difficulties. LAY SUMMARY: Social skills groups are increasingly popular for children with social communication disorders, but there is little evidence for their use online. Psychological treatments that require weekly face-to-face sessions for both children and their parents are associated with practical difficulties, disrupting family life and school commitments. Our study, is the first to use a blended online and face-to-face social skills training program for adolescent girls with social communication difficulties. We showed that this new approach to treatment was acceptable to families and has a positive and significant impact on participant's social performance and social knowledge. This new treatment approach may increase the accessibility of treatment for adolescents and young adults, especially those with social communication difficulties. Autism Res 2021, 14: 1061-1072. © 2021 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.
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Affiliation(s)
- Jeanne Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eleanor Kerry
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hayley Denyer
- King's College London, Social Genetic and Developmental Psychiatry Centre, London, London, UK
| | | | - William Mandy
- Faculty of Brain Sciences, Division of Psychology and Language Sciences, University College London, London, UK
| | - David Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Adhya D, Swarup V, Nagy R, Dutan L, Shum C, Valencia-Alarcón EP, Jozwik KM, Mendez MA, Horder J, Loth E, Nowosiad P, Lee I, Skuse D, Flinter FA, Murphy D, McAlonan G, Geschwind DH, Price J, Carroll J, Srivastava DP, Baron-Cohen S. Atypical Neurogenesis in Induced Pluripotent Stem Cells From Autistic Individuals. Biol Psychiatry 2021; 89:486-496. [PMID: 32826066 PMCID: PMC7843956 DOI: 10.1016/j.biopsych.2020.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/12/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autism is a heterogeneous collection of disorders with a complex molecular underpinning. Evidence from postmortem brain studies have indicated that early prenatal development may be altered in autism. Induced pluripotent stem cells (iPSCs) generated from individuals with autism with macrocephaly also indicate prenatal development as a critical period for this condition. But little is known about early altered cellular events during prenatal stages in autism. METHODS iPSCs were generated from 9 unrelated individuals with autism without macrocephaly and with heterogeneous genetic backgrounds, and 6 typically developing control individuals. iPSCs were differentiated toward either cortical or midbrain fates. Gene expression and high throughput cellular phenotyping was used to characterize iPSCs at different stages of differentiation. RESULTS A subset of autism-iPSC cortical neurons were RNA-sequenced to reveal autism-specific signatures similar to postmortem brain studies, indicating a potential common biological mechanism. Autism-iPSCs differentiated toward a cortical fate displayed impairments in the ability to self-form into neural rosettes. In addition, autism-iPSCs demonstrated significant differences in rate of cell type assignment of cortical precursors and dorsal and ventral forebrain precursors. These cellular phenotypes occurred in the absence of alterations in cell proliferation during cortical differentiation, differing from previous studies. Acquisition of cell fate during midbrain differentiation was not different between control- and autism-iPSCs. CONCLUSIONS Taken together, our data indicate that autism-iPSCs diverge from control-iPSCs at a cellular level during early stage of neurodevelopment. This suggests that unique developmental differences associated with autism may be established at early prenatal stages.
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Affiliation(s)
- Dwaipayan Adhya
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Vivek Swarup
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Roland Nagy
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lucia Dutan
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Carole Shum
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eva P Valencia-Alarcón
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Maria Andreina Mendez
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jamie Horder
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paulina Nowosiad
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Irene Lee
- Behavioural and Brain Sciences Unit, Population Policy Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - David Skuse
- Behavioural and Brain Sciences Unit, Population Policy Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Frances A Flinter
- Department of Clinical Genetics, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel H Geschwind
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Human Genetics, University of California, Los Angeles, Los Angeles, California
| | - Jack Price
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Jason Carroll
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Deepak P Srivastava
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom.
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Linden SC, Watson CJ, Smith J, Chawner SJRA, Lancaster TM, Evans F, Williams N, Skuse D, Raymond FL, Hall J, Owen MJ, Linden DEJ, Green-Snyder L, Chung WK, Maillard AM, Jacquemont S, van den Bree MBM. The psychiatric phenotypes of 1q21 distal deletion and duplication. Transl Psychiatry 2021; 11:105. [PMID: 33542195 PMCID: PMC7862693 DOI: 10.1038/s41398-021-01226-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 01/06/2023] Open
Abstract
Copy number variants are amongst the most highly penetrant risk factors for psychopathology and neurodevelopmental deficits, but little information about the detailed clinical phenotype associated with particular variants is available. We present the largest study of the microdeletion and -duplication at the distal 1q21 locus, which has been associated with schizophrenia and intellectual disability, in order to investigate the range of psychiatric phenotypes. Clinical and cognitive data from 68 deletion and 55 duplication carriers were analysed with logistic regression analysis to compare frequencies of mental disorders between carrier groups and controls, and linear mixed models to compare quantitative phenotypes. Both children and adults with copy number variants at 1q21 had high frequencies of psychopathology. In the children, neurodevelopmental disorders were most prominent (56% for deletion, 68% for duplication carriers). Adults had increased prevalence of mood (35% for deletion [OR = 6.6 (95% CI: 1.4-40.1)], 55% for duplication carriers [8.3 (1.4-55.5)]) and anxiety disorders (24% [1.8 (0.4-8.4)] and 55% [10.0 (1.9-71.2)]). The adult group, which included mainly genetically affected parents of probands, had an IQ in the normal range. These results confirm high prevalence of neurodevelopmental disorders associated with CNVs at 1q21 but also reveal high prevalence of mood and anxiety disorders in a high-functioning adult group with these CNVs. Because carriers of neurodevelopmental CNVs who show relevant psychopathology but no major cognitive impairment are not currently routinely receiving clinical genetic services widening of genetic testing in psychiatry may be considered.
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Affiliation(s)
- Stefanie C Linden
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Cameron J Watson
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jacqueline Smith
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Samuel J R A Chawner
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Thomas M Lancaster
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- School of Psychology, University of Bath, Bath, UK
| | - Ffion Evans
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nigel Williams
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - David Skuse
- Behavioural and Brain Sciences Unit Institute of Child Health, University College London, London, UK
| | - F Lucy Raymond
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Live Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Anne M Maillard
- Service des Troubles du Spectre de l'Autisme et apparentés, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Jacquemont
- Service de Génétique Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marianne B M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
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Skuse D. Conflict and community: mental health in the Arab world. BJPsych Int 2021; 18:1. [PMID: 34287393 PMCID: PMC8274415 DOI: 10.1192/bji.2020.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
This month's issue of BJPsych International focuses on the Middle East, with papers on psychiatric care in conflict zones, the persistence of institutionalisation in Arab countries, service delivery in Iraq, improved media attitudes towards mental illness in Qatar and integration of mental health services into primary care in that country.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
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30
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First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, Poznyak VB, Gureje O, Lewis-Fernández R, Maercker A, Brewin CR, Cloitre M, Claudino A, Pike KM, Baird G, Skuse D, Krueger RB, Briken P, Burke JD, Lochman JE, Evans SC, Woods DW, Reed GM. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 2021; 20:34-51. [PMID: 33432742 PMCID: PMC7801846 DOI: 10.1002/wps.20825] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Vladimir B Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Angelica Claudino
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - David Skuse
- Brain and Behaviour Science Unit, Institute of Child Health, University College London, London, UK
| | - Richard B Krueger
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - John E Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Douglas W Woods
- Offiice of the Provost and Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Solmi F, Bentivegna F, Bould H, Mandy W, Kothari R, Rai D, Skuse D, Lewis G. Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study. J Child Psychol Psychiatry 2021; 62:75-85. [PMID: 32361997 PMCID: PMC8425328 DOI: 10.1111/jcpp.13255] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Some people with eating disorders have difficulties with social communication. However, no longitudinal evidence regarding the direction of this association exists. We investigated trajectories of autistic social traits across childhood and adolescence in adolescents with and without disordered eating behaviours in early adolescence. METHODS We used data from the Avon Longitudinal Study of Parents and Children. Our disordered eating measure indicated presence of any, monthly and weekly disordered eating (fasting, purging, dieting, binge eating) at age 14 years. Autistic social traits were reported by mothers using the Social and Communication Disorders Checklist (SCDC) at age seven, 11, 14 and 16 years. We modelled SCDC score trajectories using multilevel negative binomial models adjusting for a number of child- and maternal-level confounders. RESULTS Of the 5,381 adolescents included in our sample, 421 (7.8%) experienced one or more disordered eating behaviours, and 148 (2.8%) weekly episodes. Adolescents with disordered eating had a 20% increase in SCDC scores (relative risk (RR) 1.23, 95% confidence interval (CI):1.14, 1.32) compared to those without disordered eating. This association was particularly apparent for those reporting weekly (RR 1.43, 95%CI: 1.27, 1.61) as opposed to monthly disordered eating (RR 1.12, 95%CI: 1.01, 1.22). CONCLUSIONS Greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence. Although mechanisms of this association need to be elucidated, clinicians should be aware that autistic social traits could have predated the eating disorder when managing people with these conditions.
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Affiliation(s)
| | | | - Helen Bould
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
| | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Radha Kothari
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Dheeraj Rai
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,NIHR Biomedical Research CentreUniversity of BristolBristolUK,Avon and Wiltshire PartnershipNHS Mental Health TrustBristolUK
| | - David Skuse
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Glyn Lewis
- Division of PsychiatryUniversity College LondonLondonUK
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Maresh K, Papageorgiou A, Ridout D, Harrison N, Mandy W, Skuse D, Muntoni F. DMD – BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Skuse D. Reflections on community mental healthcare around the world. BJPsych Int 2020; 17:25. [PMID: 32558817 PMCID: PMC7283116 DOI: 10.1192/bji.2020.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
This editorial introduces three papers in BJPsych International on community mental healthcare in the diverse cultures of Greece, Cambodia and Malawi.
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Affiliation(s)
- David Skuse
- Professor of Behavioural and Brain Sciences, Division of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, UK.
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Taylor L, Skuse D, Blackburn S, Greenwood R. Stirred media mills in the mining industry: Material grindability, energy-size relationships, and operating conditions. POWDER TECHNOL 2020. [DOI: 10.1016/j.powtec.2020.04.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kennedy J, Hembry P, Green D, Skuse D, Lewis S. Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: A decade of experience. Clin Child Psychol Psychiatry 2020; 25:471-482. [PMID: 31957478 DOI: 10.1177/1359104519898215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychiatric inpatient treatment for children is sometimes beneficial, but predictors of who benefits, and in what circumstances, are largely unknown. This study aimed to identify personal and environmental factors that influence outcome in an adolescent unit that accepts both emergency and planned admissions. METHODS Routine standardised intake and outcome measures were analysed for the period 2009-2018. Potential predictors assessed included the Children's Global Assessment Scale (CGAS), engagement with treatment, behavioural attitudes and peer relationships on the unit. FINDINGS One hundred and twelve admissions were tracked. Mean age of admission was 16 years, and 71% were female. A total of 61% had higher (better) CGAS scores on discharge than on admission; 34% of inpatients fully engaged with their treatment. Median admission duration was 118 days for males and 196 days for females. Admission lengths were much shorter for ethnic minority patients, but group sizes were small. Longer admissions led to greater improvement. Poor outcomes were associated with failure to engage with treatment and a deterioration in peer relationships. INTERPRETATION Compliance with treatment and female gender were both significant predictors of positive change during admission. The establishment of good and supportive peer relationships during the admission was also a potent indicator of benefit.
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Affiliation(s)
- Jane Kennedy
- Great Ormond Street Institute of Child Health, University College London, UK
| | - Philippa Hembry
- Simmons House Adolescent Unit, Whittington Health NHS Trust, UK
| | - Dan Green
- Great Ormond Street Institute of Child Health, University College London, UK
| | - David Skuse
- Great Ormond Street Institute of Child Health, University College London, UK.,Great Ormond Street Hospital for Children, UK
| | - Simon Lewis
- Simmons House Adolescent Unit, Whittington Health NHS Trust, UK.,University College London Hospitals NHS Foundation Trust, UK
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Wolstencroft J, Mandy W, Skuse D. Experiences of social interaction in young women with Turner syndrome: A qualitative study. Child Care Health Dev 2020; 46:46-55. [PMID: 31322282 DOI: 10.1111/cch.12710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Turner Syndrome (TS; 45,X) is a sex chromosome aneuploidy associated with deficits in social interaction, for which clinical care guidelines have recently recommended trialling a social skills training intervention. The present study aimed to gather preliminary evidence to support a training programme for young women. METHODS Semi-structured interviews and psychometric questionnaires about social ability were administered to young women with TS aged 16 to 25 years old (n=17) and their parents (n=20). Interview transcripts were analysed using thematic analysis. RESULTS Although young women with TS experienced a "wide range of social competencies," they attributed social challenges to "personal and contextual factors." The magnitude of these challenges to social integration intensified during adolescence. They felt increasingly "out of sync" with their peers. They also considered their social abilities to be better than their parents did; on a scale of autistic traits (rated by parents), half had mild to severe autistic traits. Most expressed interest in taking part in a social skills programme. CONCLUSION Young women with TS are aware they experience difficulties in social communication, and they express interest in improving their social skills. Accordingly, social skills training during adolescence would be welcomed by them and their families. Any intervention should take account of their feelings of social dislocation arising from hearing difficulties together with limited recognition, and slow processing, of social cues.
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Affiliation(s)
- Jeanne Wolstencroft
- The Great Ormond Street Institute of Child Health, University College London, London, UK
| | - William Mandy
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - David Skuse
- The Great Ormond Street Institute of Child Health, University College London, London, UK
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Wolstencroft J, Robinson L, Srinivasan R, Kerry E, Mandy W, Skuse D. A Systematic Review of Group Social Skills Interventions, and Meta-analysis of Outcomes, for Children with High Functioning ASD. J Autism Dev Disord 2019; 48:2293-2307. [PMID: 29423608 PMCID: PMC5996019 DOI: 10.1007/s10803-018-3485-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Group social skills interventions (GSSIs) are a commonly offered treatment for children with high functioning ASD. We critically evaluated GSSI randomised controlled trials for those aged 6–25 years. Our meta-analysis of outcomes emphasised internal validity, thus was restricted to trials that used the parent-report social responsiveness scale (SRS) or the social skills rating system (SSRS). Large positive effect sizes were found for the SRS total score, plus the social communication and restricted interests and repetitive behaviours subscales. The SSRS social skills subscale improved with moderate effect size. Moderator analysis of the SRS showed that GSSIs that include parent-groups, and are of greater duration or intensity, obtained larger effect sizes. We recommend future trials distinguish gains in children’s social knowledge from social performance.
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Affiliation(s)
- J. Wolstencroft
- The Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - L. Robinson
- Institute of Psychiatry, King’s College London, 103 Denmark Hill, London, SE5 8AF UK
| | - R. Srinivasan
- The Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - E. Kerry
- The Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - W. Mandy
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - D. Skuse
- The Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
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Chawner SJRA, Owen MJ, Holmans P, Raymond FL, Skuse D, Hall J, van den Bree MBM. Genotype-phenotype associations in children with copy number variants associated with high neuropsychiatric risk in the UK (IMAGINE-ID): a case-control cohort study. Lancet Psychiatry 2019; 6:493-505. [PMID: 31056457 DOI: 10.1016/s2215-0366(19)30123-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several copy number variants (CNVs) are associated with a high risk of neurodevelopmental and psychiatric disorders (referred to as ND-CNVs). We aimed to characterise the effect of ND-CNVs on childhood development and investigate whether different ND-CNVs lead to distinct and specific patterns of cognitive and behavioural outcomes. METHODS In this case-control study, we used data from the Intellectual Disability and Mental Health: Assessing the Genomic Impact on Neurodevelopment (IMAGINE-ID) study. Children aged 4 years and older with pathogenic CNV or single nucleotide variants were recruited via the UK National Health Service (NHS) medical genetic clinic network and via patient support groups to complete broad online phenotyping, from whom children aged 6-19 years with at least one of a specific group of ND-CNVs (1q21.1 [proximal duplication, and distal deletion and duplication], 2p16.3 deletion, 9q34.3 deletion, 15q11.2 deletion, 15q13.3 deletion and duplication, 16p11.2 [proximal deletion and duplication, and distal deletion], and 22q11.2 deletion and duplication) and their families were approached for a deep phenotyping, home-based assessment, and we report on this sample here. We invited siblings of index children to participate as controls, for whom the presence of ND-CNVs was excluded by use of microarray results and also medical records where possible. We systematically assessed the children for psychiatric disorders and broader traits of neurodevelopmental, cognitive, and psychopathological origin and compared results of ND-CNV carriers with control siblings to test the hypothesis that phenotypes would differ by genotype, both quantitatively in terms of severity and qualitatively in the pattern of associated impairments. FINDINGS Between Oct 1, 2014, and Dec 31, 2018, of 2819 children recruited, 258 (9%) had one ND-CNV of interest, with 13 CNVs across nine loci, and underwent a home-based assessment. 106 control siblings were enrolled. 186 (80%) of ND-CNV carriers met criteria for one or more psychiatric disorder (odds ratio [OR] 13·8, 95% CI 7·2-26·3, compared with controls). The risk of attention-deficit hyperactivity disorder (OR 6·9, 3·2-15·1), oppositional defiant disorder (OR 3·6, 1·4-9·4), any anxiety disorder (OR 2·9, 1·2-6·7), and autism spectrum disorder traits (OR 44·1, 15·3-127·5) was particularly high compared with controls. ND-CNV carriers were impaired across all neurodevelopmental, cognitive, and psychopathological traits compared with controls. Only moderate quantitative and qualitative differences in phenotypic profile were found between genotypes. Overall, the range of phenotypes was broadly similar for all ND-CNV genotypes. Traits did show some evidence of genotypic specificity, with rank-based analyses showing moderate qualitative and quantitative profile differences between ND-CNVs; however, the specific genotype accounted for a low proportion of variance in cognitive and behavioural outcomes (approximately 5-20% depending on the trait). INTERPRETATION The 13 ND-CNVs studied have a similar range of adverse effects on childhood neurodevelopment, despite subtle quantitative and qualitative differences. Genomic risk for neuropsychiatric disorder has pleiotropic effects on multiple processes and neural circuits and indicates that future research should avoid being narrowly focused on single phenotypes. FUNDING UK Medical Research Council and Medical Research Foundation.
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Affiliation(s)
- Samuel J R A Chawner
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Peter Holmans
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - F Lucy Raymond
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - David Skuse
- Great Ormond Street Hospital, Institute of Child Health, University College London, London, UK
| | - Jeremy Hall
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.
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Gorman KM, Meyer E, Grozeva D, Spinelli E, McTague A, Sanchis-Juan A, Carss KJ, Bryant E, Reich A, Schneider AL, Pressler RM, Simpson MA, Debelle GD, Wassmer E, Morton J, Sieciechowicz D, Jan-Kamsteeg E, Paciorkowski AR, King MD, Cross JH, Poduri A, Mefford HC, Scheffer IE, Haack TB, McCullagh G, Millichap JJ, Carvill GL, Clayton-Smith J, Maher ER, Raymond FL, Kurian MA, McRae JF, Clayton S, Fitzgerald TW, Kaplanis J, Prigmore E, Rajan D, Sifrim A, Aitken S, Akawi N, Alvi M, Ambridge K, Barrett DM, Bayzetinova T, Jones P, Jones WD, King D, Krishnappa N, Mason LE, Singh T, Tivey AR, Ahmed M, Anjum U, Archer H, Armstrong R, Awada J, Balasubramanian M, Banka S, Baralle D, Barnicoat A, Batstone P, Baty D, Bennett C, Berg J, Bernhard B, Bevan AP, Bitner-Glindzicz M, Blair E, Blyth M, Bohanna D, Bourdon L, Bourn D, Bradley L, Brady A, Brent S, Brewer C, Brunstrom K, Bunyan DJ, Burn J, Canham N, Castle B, Chandler K, Chatzimichali E, Cilliers D, Clarke A, Clasper S, Clayton-Smith J, Clowes V, Coates A, Cole T, Colgiu I, Collins A, Collinson MN, Connell F, Cooper N, Cox H, Cresswell L, Cross G, Crow Y, D’Alessandro M, Dabir T, Davidson R, Davies S, de Vries D, Dean J, Deshpande C, Devlin G, Dixit A, Dobbie A, Donaldson A, Donnai D, Donnelly D, Donnelly C, Douglas A, Douzgou S, Duncan A, Eason J, Ellard S, Ellis I, Elmslie F, Evans K, Everest S, Fendick T, Fisher R, Flinter F, Foulds N, Fry A, Fryer A, Gardiner C, Gaunt L, Ghali N, Gibbons R, Gill H, Goodship J, Goudie D, Gray E, Green A, Greene P, Greenhalgh L, Gribble S, Harrison R, Harrison L, Harrison V, Hawkins R, He L, Hellens S, Henderson A, Hewitt S, Hildyard L, Hobson E, Holden S, Holder M, Holder S, Hollingsworth G, Homfray T, Humphreys M, Hurst J, Hutton B, Ingram S, Irving M, Islam L, Jackson A, Jarvis J, Jenkins L, Johnson D, Jones E, Josifova D, Joss S, Kaemba B, Kazembe S, Kelsell R, Kerr B, Kingston H, Kini U, Kinning E, Kirby G, Kirk C, Kivuva E, Kraus A, Kumar D, Kumar VKA, Lachlan K, Lam W, Lampe A, Langman C, Lees M, Lim D, Longman C, Lowther G, Lynch SA, Magee A, Maher E, Male A, Mansour S, Marks K, Martin K, Maye U, McCann E, McConnell V, McEntagart M, McGowan R, McKay K, McKee S, McMullan DJ, McNerlan S, McWilliam C, Mehta S, Metcalfe K, Middleton A, Miedzybrodzka Z, Miles E, Mohammed S, Montgomery T, Moore D, Morgan S, Morton J, Mugalaasi H, Murday V, Murphy H, Naik S, Nemeth A, Nevitt L, Newbury-Ecob R, Norman A, O’Shea R, Ogilvie C, Ong KR, Park SM, Parker MJ, Patel C, Paterson J, Payne S, Perrett D, Phipps J, Pilz DT, Pollard M, Pottinger C, Poulton J, Pratt N, Prescott K, Price S, Pridham A, Procter A, Purnell H, Quarrell O, Ragge N, Rahbari R, Randall J, Rankin J, Raymond L, Rice D, Robert L, Roberts E, Roberts J, Roberts P, Roberts G, Ross A, Rosser E, Saggar A, Samant S, Sampson J, Sandford R, Sarkar A, Schweiger S, Scott R, Scurr I, Selby A, Seller A, Sequeira C, Shannon N, Sharif S, Shaw-Smith C, Shearing E, Shears D, Sheridan E, Simonic I, Singzon R, Skitt Z, Smith A, Smith K, Smithson S, Sneddon L, Splitt M, Squires M, Stewart F, Stewart H, Straub V, Suri M, Sutton V, Swaminathan GJ, Sweeney E, Tatton-Brown K, Taylor C, Taylor R, Tein M, Temple IK, Thomson J, Tischkowitz M, Tomkins S, Torokwa A, Treacy B, Turner C, Turnpenny P, Tysoe C, Vandersteen A, Varghese V, Vasudevan P, Vijayarangakannan P, Vogt J, Wakeling E, Wallwark S, Waters J, Weber A, Wellesley D, Whiteford M, Widaa S, Wilcox S, Wilkinson E, Williams D, Williams N, Wilson L, Woods G, Wragg C, Wright M, Yates L, Yau M, Nellåker C, Parker M, Firth HV, Wright CF, FitzPatrick DR, Barrett JC, Hurles ME, Al Turki S, Anderson C, Anney R, Antony D, Artigas MS, Ayub M, Balasubramaniam S, Barrett JC, Barroso I, Beales P, Bentham J, Bhattacharya S, Birney E, Blackwood D, Bobrow M, Bochukova E, Bolton P, Bounds R, Boustred C, Breen G, Calissano M, Carss K, Chatterjee K, Chen L, Ciampi A, Cirak S, Clapham P, Clement G, Coates G, Collier D, Cosgrove C, Cox T, Craddock N, Crooks L, Curran S, Curtis D, Daly A, Day-Williams A, Day IN, Down T, Du Y, Dunham I, Edkins S, Ellis P, Evans D, Faroogi S, Fatemifar G, Fitzpatrick DR, Flicek P, Flyod J, Foley AR, Franklin CS, Futema M, Gallagher L, Geihs M, Geschwind D, Griffin H, Grozeva D, Guo X, Guo X, Gurling H, Hart D, Hendricks A, Holmans P, Howie B, Huang L, Hubbard T, Humphries SE, Hurles ME, Hysi P, Jackson DK, Jamshidi Y, Jing T, Joyce C, Kaye J, Keane T, Keogh J, Kemp J, Kennedy K, Kolb-Kokocinski A, Lachance G, Langford C, Lawson D, Lee I, Lek M, Liang J, Lin H, Li R, Li Y, Liu R, Lönnqvist J, Lopes M, Iotchkova V, MacArthur D, Marchini J, Maslen J, Massimo M, Mathieson I, Marenne G, McGuffin P, McIntosh A, McKechanie AG, McQuillin A, Metrustry S, Mitchison H, Moayyeri A, Morris J, Muntoni F, Northstone K, O'Donnovan M, Onoufriadis A, O'Rahilly S, Oualkacha K, Owen MJ, Palotie A, Panoutsopoulou K, Parker V, Parr JR, Paternoster L, Paunio T, Payne F, Pietilainen O, Plagnol V, Quaye L, Quail MA, Raymond L, Rehnström K, Ring S, Ritchie GR, Roberts N, Savage DB, Scambler P, Schiffels S, Schmidts M, Schoenmakers N, Semple RK, Serra E, Sharp SI, Shin SY, Skuse D, Small K, Southam L, Spasic-Boskovic O, St Clair D, Stalker J, Stevens E, St Pourcian B, Sun J, Suvisaari J, Tachmazidou I, Tobin MD, Valdes A, Van Kogelenberg M, Vijayarangakannan P, Visscher PM, Wain LV, Walters JT, Wang G, Wang J, Wang Y, Ward K, Wheeler E, Whyte T, Williams H, Williamson KA, Wilson C, Wong K, Xu C, Yang J, Zhang F, Zhang P, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cooper N, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Fox JC, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Machado R, Mackenzie R, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith K, Sohal A, Southgate L, Staines S, Staples E, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Tait RC, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Webster A, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia. Am J Hum Genet 2019; 104:948-956. [PMID: 30982612 DOI: 10.1016/j.ajhg.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.
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Skuse D. Training innovations in low- and middle-income countries. BJPsych Int 2019; 16:27. [PMID: 31144680 PMCID: PMC6520539 DOI: 10.1192/bji.2019.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Srinivasan R, Wolstencroft J, Erwood M, Raymond FL, van den Bree M, Hall J, Skuse D. Mental health and behavioural problems in children with XXYY: a comparison with intellectual disabilities. J Intellect Disabil Res 2019; 63:477-488. [PMID: 30993819 DOI: 10.1111/jir.12607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The phenotype of children with XXYY has predominantly been defined by comparison to other sex chromosome aneuploidies trisomies affecting male children; however, the intellectual ability of children with XXYY is lower than children with other sex chromosome aneuploidies trisomies. It is not known to what extent the phenotype identified to date is specific to XXYY, rather than a reflection of lower IQ. This study evaluates the mental health and behaviour of children with XXYY, in comparison to children with intellectual disabilities of heterogeneous genetic origin. METHODS Fifteen children with XXYY and 30 controls matched for age (4-14 years), sex and intellectual ability were ascertained from the IMAGINE ID study. IMAGINE ID participants have intellectual disabilities due to genetic anomalies confirmed by National Health Service Regional Genetic Centre laboratories. The mental health and behaviour of participants was examined with the Development and Well-being Assessment and the Strengths and Difficulties Questionnaire. RESULTS Children with XXYY experienced significantly more frequent and intense temper outbursts than the control group. CONCLUSION Our results suggest that temper outbursts may be specifically associated with the XXYY phenotype. These problems have a significant impact on the daily lives of boys with XXYY and their families. It is crucial to ensure that families are well supported to manage these difficulties.
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Affiliation(s)
- R Srinivasan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - M Erwood
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - F L Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Biomedical Campus, Cambridge, UK
| | - M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - J Hall
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - D Skuse
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Niarchou M, Chawner SJRA, Doherty JL, Maillard AM, Jacquemont S, Chung WK, Green-Snyder L, Bernier RA, Goin-Kochel RP, Hanson E, Linden DEJ, Linden SC, Raymond FL, Skuse D, Hall J, Owen MJ, van den Bree MBM. Correction: Psychiatric disorders in children with 16p11.2 deletion and duplication. Transl Psychiatry 2019; 9:107. [PMID: 30837452 PMCID: PMC6400999 DOI: 10.1038/s41398-019-0441-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the co-authors, Marianne B.M. van den Bree has had her name incorrectly abbreviated by citation manager. It was stated as "Bree MBMVD14", but has been updated to "van den Bree, M.B.M." in the HTML, PDF, and XML versions of this article.
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Affiliation(s)
- Maria Niarchou
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia.
| | - Samuel J R A Chawner
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Joanne L Doherty
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Anne M Maillard
- Centre Cantonal Autisme, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Jacquemont
- Service de Génétique Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | | | - Raphael A Bernier
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | | | - Ellen Hanson
- Neurodevelopmental Disorders Phenotyping Program, Divisions of Developmental Medicine and Genetics, Program in Genomics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
- Division of Psychiatry, Children's Hospital Boston, Boston, MA, USA
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Stefanie C Linden
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - F Lucy Raymond
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - David Skuse
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Michael J Owen
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Marianne B M van den Bree
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
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Niarchou M, Chawner SJRA, Doherty JL, Maillard AM, Jacquemont S, Chung WK, Green-Snyder L, Bernier RA, Goin-Kochel RP, Hanson E, Linden DEJ, Linden SC, Raymond FL, Skuse D, Hall J, Owen MJ, Bree MBMVD. Psychiatric disorders in children with 16p11.2 deletion and duplication. Transl Psychiatry 2019; 9:8. [PMID: 30664628 PMCID: PMC6341088 DOI: 10.1038/s41398-018-0339-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/09/2022] Open
Abstract
Deletion and duplication of 16p11.2 (BP4-BP5) have been associated with an increased risk of intellectual disability and psychiatric disorder. This is the first study to compare the frequency of a broad spectrum of psychiatric disorders in children with 16p11.2 deletion and duplication. We aimed to evaluate (1) the nature and prevalence of psychopathology associated with copy number variation (CNV) in children with 16p11.2 by comparing deletion and duplication carriers with family controls; (2) whether deletion and duplication carriers differ in frequency of psychopathology. 217 deletion carriers, 77 deletion family controls, 114 duplication carriers, and 32 duplication family controls participated in the study. Measures included standardized research diagnostic instruments. Deletion carriers had a higher frequency of any psychiatric disorder (OR = 8.9, p < 0.001), attention deficit hyperactivity disorder (ADHD) (OR = 4.0, p = 0.01), and autism spectrum disorder (ASD) (OR = 39.9, p = 0.01) than controls. Duplication carriers had a higher frequency of any psychiatric diagnosis (OR = 5.3, p = 0.01) and ADHD (OR = 7.0, p = 0.02) than controls. The prevalence of ASD in child carriers of deletions and duplications was similar (22% versus 26%). Comparison of the two CNV groups indicated a higher frequency of ADHD in children with the duplication than deletion (OR = 2.7, p = 0.04) as well as a higher frequency of overall psychiatric disorders (OR = 2.8, p = 0.02) and psychotic symptoms (OR = 4.7, p = 0.02). However, no differences between deletion and duplications carriers in the prevalence of ASD were found. Both deletion and duplication are associated with an increased risk of psychiatric disorder, supporting the importance of early recognition, diagnosis, and intervention in these groups.
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Affiliation(s)
- Maria Niarchou
- Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK. .,Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia.
| | - Samuel J. R. A. Chawner
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Joanne L. Doherty
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Anne M. Maillard
- 0000 0001 2165 4204grid.9851.5Centre Cantonal Autisme, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Jacquemont
- 0000 0001 0423 4662grid.8515.9Service de Génétique Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Wendy K. Chung
- 0000000419368729grid.21729.3fDepartments of Pediatrics and Medicine, Columbia University, New York, NY USA
| | | | - Raphael A. Bernier
- 0000000122986657grid.34477.33Department of Psychiatry, University of Washington, Seattle, WA USA
| | - Robin P. Goin-Kochel
- 0000 0001 2160 926Xgrid.39382.33Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Ellen Hanson
- 000000041936754Xgrid.38142.3cNeurodevelopmental Disorders Phenotyping Program, Divisions of Developmental Medicine and Genetics, Program in Genomics, Children’s Hospital Boston, Harvard Medical School, Boston, MA USA ,0000 0004 0378 8438grid.2515.3Division of Psychiatry, Children’s Hospital Boston, Boston, MA USA
| | - David E. J. Linden
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Stefanie C. Linden
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - F. Lucy Raymond
- 0000000121885934grid.5335.0Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - David Skuse
- 0000000121901201grid.83440.3bBehavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
| | - Jeremy Hall
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK ,0000000121885934grid.5335.0Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Michael J. Owen
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Marianne B. M. van den Bree
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Wolstencroft J, Mandy W, Skuse D. Protocol: New approaches to managing the social deficits of Turner Syndrome using the PEERS program. F1000Res 2018; 7:1864. [PMID: 31016010 PMCID: PMC6456833 DOI: 10.12688/f1000research.15489.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 10/07/2023] Open
Abstract
Turner Syndrome (TS) is a sex chromosome aneuploidy (45,X) associated with social skill difficulties. Recent clinical care guidelines recommend that the Program for the Education and Enrichment of Relational Skills (PEERS) social skills intervention programme be trialled in this population. PEERS has been successfully used in adolescents with autism spectrum conditions without intellectual disabilities. The PEERS program will be piloted with adolescents and young women with TS aged 16-20 using an uncontrolled study trial with a multiple-case series design. The program will be delivered face to face and online. The assessment battery is designed to measure social skills comprehensively from diverse informants (parent, teacher young person). It includes measures of social performance, social knowledge and social cognition. Parents and young people taking part in the intervention will also feedback on the acceptability and feasibility of the pilot. The outcomes of this small scale pilot (n=6-10) will be used to adapt the programme based on feedback and estimate the sample for a future randomised controlled trial.
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Affiliation(s)
- Jeanne Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - William Mandy
- Clinical, Education and Health Psychology, University College London, London, WC1E 6BT, UK
| | - David Skuse
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Abstract
Turner Syndrome (TS) is a sex chromosome aneuploidy (45,X) associated with social skill difficulties. Recent clinical care guidelines recommend that the Program for the Education and Enrichment of Relational Skills (PEERS) social skills intervention programme be trialled in this population. PEERS has been successfully used in adolescents with autism spectrum conditions without intellectual disabilities. The PEERS program will be piloted with adolescents and young women with TS aged 16-20 using an uncontrolled study trial with a multiple-case series design. The program will be delivered face to face and online. The assessment battery is designed to measure social skills comprehensively from diverse informants (parent, teacher young person). It includes measures of social performance, social knowledge and social cognition. Parents and young people taking part in the intervention will also feedback on the acceptability and feasibility of the pilot. The outcomes of this small scale pilot (n=6-10) will be used to adapt the programme based on feedback and estimate the sample for a future randomised controlled trial.
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Affiliation(s)
- Jeanne Wolstencroft
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - William Mandy
- Clinical, Education and Health Psychology, University College London, London, WC1E 6BT, UK
| | - David Skuse
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Srinivasan R, McWilliams A, Skuse D. The clinical assessment of low mood. Br J Hosp Med (Lond) 2018; 79:C167-C172. [PMID: 30418835 DOI: 10.12968/hmed.2018.79.11.c167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ramya Srinivasan
- Wellcome Trust Clinical Training Fellow/ST6 in Child and Adolescent Psychiatry, UCL Division of Psychiatry, London W1T 7NF
| | - Andrew McWilliams
- NIHR Academic Clinical Fellow and CT3 in Psychiatry, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London
| | - David Skuse
- Professor of Behavioural and Brain Sciences and Honorary Consultant in Developmental Neuropsychiatry, University College London Institute of Child Health, London
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Mandy W, Pellicano L, St Pourcain B, Skuse D, Heron J. The development of autistic social traits across childhood and adolescence in males and females. J Child Psychol Psychiatry 2018; 59:1143-1151. [PMID: 29672866 DOI: 10.1111/jcpp.12913] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Autism is a dimensional condition, representing the extreme end of a continuum of social competence that extends throughout the general population. Currently, little is known about how autistic social traits (ASTs), measured across the full spectrum of severity, develop during childhood and adolescence, including whether there are developmental differences between boys and girls. Therefore, we sought to chart the trajectories of ASTs in the general population across childhood and adolescence, with a focus on gender differences. METHODS Participants were 9,744 males (n = 4,784) and females (n = 4,960) from ALSPAC, a UK birth cohort study. ASTs were assessed when participants were aged 7, 10, 13 and 16 years, using the parent-report Social Communication Disorders Checklist. Data were modelled using latent growth curve analysis. RESULTS Developmental trajectories of males and females were nonlinear, showing a decline from 7 to 10 years, followed by an increase between 10 and 16 years. At 7 years, males had higher levels of ASTs than females (mean raw score difference = 0.88, 95% CI [.72, 1.04]), and were more likely (odds ratio [OR] = 1.99; 95% CI, 1.82, 2.16) to score in the clinical range on the SCDC. By 16 years this gender difference had disappeared: males and females had, on average, similar levels of ASTs (mean difference = 0.00, 95% CI [-0.19, 0.19]) and were equally likely to score in the SCDC's clinical range (OR = 0.91, 95% CI, 0.73, 1.10). This was the result of an increase in females' ASTs between 10 and 16 years. CONCLUSIONS There are gender-specific trajectories of autistic social impairment, with females more likely than males to experience an escalation of ASTs during early- and midadolescence. It remains to be discovered whether the observed female adolescent increase in ASTs represents the genuine late onset of social difficulties or earlier, subtle, pre-existing difficulties becoming more obvious.
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Affiliation(s)
- William Mandy
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Liz Pellicano
- Department of Educational Studies, Macquarie University, Sydney, NSW, Australia
| | - Beate St Pourcain
- Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | | | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Skuse D. Mental health in the context of economic development. BJPsych Int 2018; 15:71. [PMID: 30524127 PMCID: PMC6277946 DOI: 10.1192/bji.2018.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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