Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders

PURPOSE

Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs).

METHODS

One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles.

RESULTS

A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η² = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η² = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η² = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2).

CONCLUSIONS

Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Epidemiology of violence against children in migration: A systematic literature review

BACKGROUND

Children in migration experience various forms of violence before, on, and after their migration journey. Epidemiological research on the prevalence of violence in this highly vulnerable group is lacking, however.

METHOD

A PRISMA-guided systematic literature review with a three-tiered search strategy was conducted by searching academic literature databases and gray literature on websites of international organizations and by contacting experts. All empirical studies published within the last 15 years were eligible. Predefined search terms related to violence, children, epidemiology, and migration were used.

FINDINGS

Of 1014 records, 17 studies met the inclusion criteria. Sample sizes ranged from 100 to 8,047, with a total of 16,915 children (Mdn = 311). Lifetime prevalence of violence varied considerably: Child physical maltreatment ranged from 9 %-65 % and child sexual abuse from 5 %-20 %. For internally displaced children, violence often occurred at the hands of those who were responsible for their care. Unfortunately, data on the context and country in which the violence occurred-in the country of origin, on route, or in the country of arrival-were lacking.

CONCLUSION

The discrepancy between the importance of the topic and the dearth of data is striking. Filling the gaps requires not only more rigorous methodology but also more research in general on the epidemiology of violence against children in migration. We outline methodological challenges and draft an agenda for improved data on the topic. There is an urgent need for evidence that supports the development and adaptation of effective, tailored, and child-sensitive prevention and intervention programs for children in migration.

Alternaria toxins of the alternariol type are not metabolised by human faecal microbiota

The metabolism of the Alternaria toxins alternariol (AOH), alternariol-9-O-methyl ether (AME) and altenuene (ALT) by the microbiota present in faeces from three human volunteers was studied. Faecal cultures were prepared as a 5% faeces suspension in brain-heart infusion broth and incubated with 50 μM of the toxins under anaerobic conditions for 72 h at 37 °C. The metabolism of AOH was also studied in pure bacterial cultures with either Escherichia coli DH5α or Lactobacillus plantarum BFE 5092 for 72 h at 37 °C. The three parent toxins were stable in uninoculated, heat-treated medium over a 72 h incubation period with a recovery of more than 90%. As a control for the activity of the faecal microbiota, the isoflavone daidzein was incubated with the faecal cultures and was transformed to its expected metabolites. In contrast, no metabolites of AOH, AME and ALT could be detected in the faecal cultures from the same volunteers, indicating that the gut microbiota was not capable of metabolising these substances. The Alternaria toxins could be shown to be at least partially bound to bacterial cells in a non-covalent manner, which may serve as a mechanism for their removal from the gut.

Kognitive Flexibilität bei jugendlichen Patienten mit unipolaren Affektiven Störungen unter Berücksichtigung geschlechtsbezogener Unterschiede

Fragestellung: Verschiedene Studien verweisen auf Einschränkungen in der kognitiven Flexibilität bei Patienten mit Affektiven Störungen (AS). Derzeit herrscht jedoch ein Forschungsmangel hinsichtlich neuropsychologischer Untersuchungen bei jugendlichen Patienten mit AS sowie der Erforschung geschlechtsbezogener Unterschiede. Ziel der vorliegenden Studie ist daher die Erfassung kognitiver Funktionen, insbesondere kognitiver Flexibilität, bei jugendlichen Patienten mit unipolaren Affektiven Störungen (UAS) im Vergleich zu einer gesunden Kontrollgruppe (KG). Methodik: In die Stichprobe wurden 17 männliche (MAlter = 15.4 ± 1.3) und 22 weibliche (MAlter = 15.6 ± 1.4) Patienten mit UAS sowie 20 männliche (MAlter = 16.0 ± 1.0) und 30 weibliche (MAlter = 15.7 ± 0.9) gesunde Kontrollprobanden einbezogen. Neben dem Einsatz einer neuropsychologische Testbatterie erfolgte die Erfassung depressiver Symptome, psychischer Belastung sowie Intelligenz. Ergebnisse: Die Ergebnisse zeigen keine signifikanten Gruppenunterschiede bezüglich kognitiver Flexibilität oder visueller Verarbeitungsgeschwindigkeit und lediglich tendenzielle Unterschiede hinsichtlich der motorischen Verarbeitungsgeschwindigkeit mit einer besseren Leistung bei der KG. Zudem ergeben sich keine geschlechtsbezogenen Unterschiede in der kognitiven Flexibilität, jedoch bessere Leistungen in der Verarbeitungsgeschwindigkeit bei weiblichen Probanden. Schlussfolgerung: Insgesamt betrachtet offenbaren sich keine Hinweise für gravierende Einschränkungen in der kognitiven Flexibilität und Verarbeitungsgeschwindigkeit oder diesbezügliche spezifische geschlechtsbezogene Unterschiede bei jugendlichen Patienten mit UAS. Mädchen scheinen, unabhängig von einer psychischen Beeinträchtigung, Vorteile in Bezug auf die Verarbeitungsgeschwindigkeit aufzuweisen.

[Cognitive flexibility in adolescent patients with unipolar affective disorders-gender differences]

OBJECTIVE

Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG).

METHOD

The study population consists of 17 male patients (M<inf>age</inf> = 15.4 ± 1.3) and 22 female patients with UAD (M<inf>age</inf> = 15.6 ± 1.4) as well as 20 male (M<inf>age</inf> = 16.0 ± 1.0) and 30 female (M<inf>age</inf> = 15.7 ± 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed.

RESULTS

The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed.

CONCLUSIONS

Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.

[Treatment of bulimia nervosa]

Many young women and also men are constantly dissatisfied with their body. In some cases the discontent with one's own body and the resulting restrictive eating behaviour can predetermine the path to bulimia nervosa. This article summarizes the treatment options and their respective evidence for bulimia nervosa. Apart from the choice of treatment setting, psychotherapeutic treatment measures and the role of psychopharmacologic drugs for the treatment of bulimia nervosa are discussed.

Zearalenone and its metabolites as endocrine disrupting chemicals

Zearalenone (ZEA) is a macrocyclic β-resorcylic acid lactone produced by numerous species of Fusarium. It frequently contaminates corn and cereal products in many regions of the world. The biological activity of ZEA is dominated by its pronounced oestrogenicity, which is even enhanced in certain reductive metabolites. This review updates the metabolism in fungi, plants and mammalian systems, as well as the pharmacokinetics of ZEA. The present evidence for the hormonal effects of the parent mycoestrogen and some of its metabolites in vitro and in farm and experimental animals in vivo is reviewed, together with its association with endocrine-disruptive effects in humans. Possible mechanisms of the oestrogenic and carcinogenic activity of ZEA are discussed and future areas of research proposed.

Psychopathology in underweight and weight-recovered females with anorexia nervosa

OBJECTIVE

To compare general and eating disorder-specific psychopathology in patients with acute anorexia nervosa (acAN), weight-recovered patients (recAN) and healthy control women (HCW).

METHODS

One hundred anorexia nervosa patients (66 acAN and 34 recAN) and 88 HCW were included in our study. Psychopathology was assessed by self-report questionnaires [Symptom Check List 90 Revised (SCL-90-R), Eating Disorder Inventory-2 (EDI- 2)] as well as by interview [Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX)] and compared using multivariate analysis of variance. Plasma leptin levels were determined using enzyme linked immunosorbent assay.

RESULTS

Mean comparisons indicated highly significant differences between acAN and recAN subjects on all psychopatholgy variables, except for perfectionism. RecAN subjects did not differ from HCW. Partial weight recovery was associated with decreasing levels of psychopathology. Correlational analyses suggested strong negative associations between leptin levels and psychopathology.

CONCLUSION

Prolonged malnutrition, as indicated by suppressed plasma leptin levels, is strongly related to eating disorder-specific as well as general psychopathological symptoms. Weight recovery is associated with the absence of psychopathology. These data emphasize the interaction between somatic and psychological variables.

The assessment of body image distortion in female adolescents with anorexia nervosa: the development of a Test for Body Image Distortion in Children and Adolescents (BID-CA)

The purpose of this study was to develop an instrument (Test for Body Image Distortion in Children and Adolescents, BID-CA) suitable for adolescents to detect and quantify body image distortion. Participants were patients with anorexia nervosa (AN; N=75), healthy age-matched control participants (N=268) and age-matched thin female athletes (N=50) with a mean age of 15.2 (standard deviation =2.0) years. We assessed body image distortion (arm, waist, and thigh) using the BID-CA and two scales of the Eating Disorder Inventory-2 (EDI-2; Drive for Thinness, Body Dissatisfaction). Diagnostic validity of the BIDCA was analyzed with receiver operating characteristic (ROC) curves. Additional regression analyses revealed the variables BID-CA thigh and EDI-2 Drive for Thinness to be the best at predicting body image distortion among AN patients. In conclusion, the BID-CA showed good diagnostic validity. It is efficient, language independent, time-saving and seems appropriate for children and adolescents.

Diagnostik von Persönlichkeitsstörungen im Jugendalter nach SKID-II

Zusammenfassung: Fragestellung: Ziel der vorliegenden Untersuchung war eine Überprüfung der Anwendbarkeit des Strukturierten Klinischen Interviews für DSM-IV, Achse II: Persönlichkeitsstörungen (SKID-II) im Jugendalter sowie eine Untersuchung zur Übereinstimmung zwischen SKID-II Diagnosen und klinischem Urteil. Zusätzlich wurde der Frage nachgegangen, welche Faktoren bei Patientinnen einer jugendpsychiatrischen Inanspruchnahmepopulation Persönlichkeitsstörungen (PS) prognostizieren. Methodik: Insgesamt wurden 110 stationär behandelte, jugendpsychiatrische Patienten im Alter von 14-18 Jahren mit dem SKID-II und dem Persönlichkeitsstil- und Störungsinventar (PSSI) untersucht. Ergebnisse: 32.7% der untersuchten Patienten zeigten nach SKID-II die Diagnose einer PS. Die Übereinstimmung zwischen kategorialem Urteil (PS liegt vor versus PS liegt nicht vor) des SKID-II und der klinischen Diagnose erwies sich insgesamt als niedrig. Lediglich für die histrionische PS und für die Borderline-PS ergaben sich annehmbare bis sehr gute Übereinstimmungen. Logistische Regressionsanalysen identifizierten «Anorexia nervosa (bulimisch)», «einfache Aktivitäts- und Aufmerksamkeitsstörung/Störung des Sozialverhaltens (ADHD/SSV)» und «Schicht» als relevante prognostische Faktoren für PS. Schlussfolgerungen: Das SKID-II, das primär für Erwachsene entwickelt wurde, ist für den Gebrauch bei Jugendlichen gut einsetzbar. Im jugendpsychiatrischen Bereich sind die Diagnosen Anorexia nervosa (bulimisch) und ADHD/SSV eng mit der Entwicklung einer PS assoziiert.

Idebenone treatment fails to slow cognitive decline in Alzheimer's disease

OBJECTIVE

To determine the effect of idebenone on the rate of decline in Alzheimer's disease (AD).

METHODS

A 1-year, multicenter, double-blind, placebo-controlled, randomized trial was conducted. Subjects were over age 50 with a diagnosis of probable AD and had Mini-Mental State Examination (MMSE) scores between 12 and 25. Subjects were treated with idebenone 120, 240, or 360 mg tid, each of which was compared with placebo. Primary outcome measures were the Alzheimer's Disease Assessment Scale-Cognitive Subcomponent (ADAS-Cog) and a Clinical Global Impression of Change (CGIC). Secondary outcome measures included measurements of activities of daily living, the Behavioral Pathology in Alzheimer's Disease Rating Scale, and the MMSE.

RESULTS

Five hundred thirty-six subjects were enrolled and randomized to the four groups. Except for a slight difference in age, there were no differences in patient characteristics at baseline. For the primary outcome measures, there were no significant overall differences between the treatment groups in the prespecified four-group design. In an exploratory two-group analysis comparing all three treated groups combined with placebo, drug-treated patients performed better on the ADAS-Cog in both the intent-to-treat (ITT) and completers analyses. There were no differences in the CGIC scores for the ITT or completers analyses in either the four-group or the two-group analyses. There were no overall differences on any of the secondary outcome measures in any of the analyses.

CONCLUSION

Idebenone failed to slow cognitive decline in AD that was of sufficient magnitude to be clinically significant.

Pericardial effusions in anorexia nervosa

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

Genotoxic potential of xenobiotic growth promoters and their metabolites

This paper reviews data reported in the literature as well as recent and unpublished studies from our laboratory on the metabolism and genotoxicity of the xenobiotic growth promoters 17beta-trenbolone, melengestrol acetate and zeranol. In our metabolic study, the oxidative in vitro metabolites generated by hepatic microsomes from rats, bovine and humans were analyzed by HPLC and GC/MS. 17beta-Trenbolone gave rise to at least 13 monohydroxylated products, whereas 12 mono- and dihydroxylated metabolites were obtained with melengestrol acetate and at least 5 with zeranol. The genotoxic potential of the parent compounds was studied using the following endpoints: induction of HPRT mutations in cultured V79 cells and of lacI mutations in E. coli; induction of micronuclei in V79 cells; and formation of DNA adducts in cultured primary rat hepatocytes. Negative results were obtained in most of these assay systems. Only the micronucleus induction was marginally positive with 17beta-trenbolone and zeranol at near-cytotoxic concentrations. Commercial melengestrol acetate was found to contain an impurity causing apoptosis in V79 cells. The genotoxic potential of the numerous oxidative metabolites of the xenobiotic growth promoters remains to be studied.

Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease: a randomized controlled trial. Alzheimer's Disease Cooperative Study

CONTEXT

Several reports from small clinical trials have suggested that estrogen replacement therapy may be useful for the treatment of Alzheimer disease (AD) in women.

OBJECTIVE

To determine whether estrogen replacement therapy affects global, cognitive, or functional decline in women with mild to moderate AD.

DESIGN

The Alzheimer's Disease Cooperative Study, a randomized, double-blind, placebo-controlled clinical trial conducted between October 1995 and January 1999.

SETTING

Thirty-two study sites in the United States.

PARTICIPANTS

A total of 120 women with mild to moderate AD and a Mini-Mental State Examination score between 12 and 28 who had had a hysterectomy.

INTERVENTIONS

Participants were randomized to estrogen, 0.625 mg/d (n = 42), or 1.25 mg/d (n = 39), or to identically appearing placebo (n = 39). One subject withdrew after randomization but before receiving medication; 97 subjects completed the trial.

MAIN OUTCOME MEASURES

The primary outcome measure was change on the Clinical Global Impression of Change (CGIC) 7-point scale, analyzed by intent to treat; secondary outcome measures included other global measures as well as measures of mood, specific cognitive domains (memory, attention, and language), motor function, and activities of daily living; compared by the combined estrogen groups vs the placebo group at 2, 6, 12, and 15 months of follow-up.

RESULTS

The CGIC score for estrogen vs placebo was 5.1 vs 5.0 (P = .43); 80% of participants taking estrogen vs 74% of participants taking placebo worsened (P = .48). Secondary outcome measures also showed no significant differences, with the exception of the Clinical Dementia Rating Scale, which suggested worsening among patients taking estrogen (mean posttreatment change in score for estrogen, 0.5 vs 0.2 for placebo; P = .01).

CONCLUSIONS

Estrogen replacement therapy for 1 year did not slow disease progression nor did it improve global, cognitive, or functional outcomes in women with mild to moderate AD. The study does not support the role of estrogen for the treatment of this disease. The potential role of estrogen in the prevention of AD, however, requires further research.

Clomipramine-induced urinary retention in a cat

A 10-year-old, female, spayed shorthair with presumed psychogenic alopecia was treated with clomipramine (1 mg/kg body weight/day). The cat developed urinary retention within 2 days. Clomipramine was discontinued. Clinical signs resolved over the next 7 days. The urinary retention was attributed to the anticholinergic effects of clomipramine.

Treatment of ataxia in isolated vitamin E deficiency caused by alpha-tocopherol transfer protein deficiency

Dysfunction of the alpha-tocopherol transfer protein causes ataxia with isolated vitamin E deficiency. A 14-year-old male patient presented with ataxia and mental symptoms caused by a homozygous (552G-->A) alpha-tocopherol transfer protein mutation. After initiation of high-dosage alpha-tocopherol therapy, the organic mental syndrome disappeared and cognitive function improved rapidly. Neurologic recovery, however, was slow and incomplete.

Studies on the genotoxicity of the mammalian lignans enterolactone and enterodiol and their metabolic precursors at various endpoints in vitro

The mammalian lignans enterolactone (ENL) and enterodiol (END) are formed by intestinal bacteria from the plant lignans matairesinol (MAT) and secoisolariciersinol (SEC), respectively, which are ingested with different types of food. ENL and END are weak estrogens. According to epidemiological and biochemical studies, lignans may act as anticarcinogens, but little is known about their genotoxic potential. We have therefore investigated the effects of ENL, END, MAT and SEC on cell-free microtubule assembly and at the following genetic endpoints in cultured male Chinese hamster V79 cells: disruption of the cytoplasmic microtubule complex, induction of mitotic arrest, induction of micronuclei and their characterization by CREST staining, and mutagenicity at the HPRT gene locus. The lignans were tested at concentrations of 200 microM in the cell-free system and 100 microM in cultured cells, which represents the limit of solubility in each assay. The established aneuploidogen diethylstilbestrol and the clastogen 4-nitroquinoline-N-oxide were used as positive reference compounds. As none of the four lignans had any activity at the endpoints studied, we conclude that ENL, END, MAT and SEC are devoid of aneuploidogenic and clastogenic potential under the experimental conditions used in this study.

Aneuploidogenic and clastogenic potential of the mycotoxins citrinin and patulin

The aneuploidogenic and clastogenic potentials of the mycotoxins citrinin (CIT) and patulin (PAT) were studied by determining inhibition of microtubule assembly under cell-free conditions and by measuring induction of mitotic arrest and micronuclei in cultured Chinese hamster V79 cells. Both CIT and PAT inhibited cell-free microtubule polymerization in a concentration-dependent manner. PAT, but not CIT, bound covalently to reactive thiol groups of microtubule proteins. At concentrations without gross cytotoxicity, mitotic arrest and CREST-positive micronuclei, i.e. micronuclei containing whole chromosomes/chromatids, were induced by CIT and PAT in V79 cells. The time course of micronucleus induction and positive CREST staining indicate the aneuploidogenic potential of CIT and PAT. CREST-negative micronuclei, i.e. micronuclei containing acentric chromosomal fragments, were induced by PAT but not by CIT, implying a clastogenic potential of PAT. The aneuploidogenic and clastogenic potential of PAT and the aneuploidogenic potential of CIT may well contribute to the putative carcinogenicity of these mycotoxins in long-term animal studies.

Microbial utilization of the neurotoxin domoic acid: blue mussels (Mytilus edulis) and soft shell clams (Mya arenaria) as sources of the microorganisms

The neurotoxin domoic acid is produced in quantity by the diatom Pseudo-nitzschia multiseries and is released to the environment directly and indirectly via food chains. Presumably there is a mechanism for the biodegradation and disposal of domoic acid and as bacteria are logical candidates for such an activity, a search for bacteria competent to carry out biodegradation of domoic acid was initiated. Extensive trials with a wide variety of bacteria isolated mainly from muds and waters taken from the marine environment showed that the ability to grow on or degrade domoic acid was rare; in fact, domoic acid was inhibitory to resting cells or growing cultures of most of these bacteria. In contrast, using enrichment techniques, it was possible to isolate from molluscan species that eliminate domoic acid readily, i.e., blue mussels (Mytilus edulis) and soft-shell clams (Mya arenaria), bacteria that exhibited growth with and biodegradation of domoic acid when supplemented with low concentrations of growth factors. The species that retain domoic acid for lengthy periods, such as sea scallops (Placopecten magellanicus) and red mussels (Modiolus modiolus), only occasionally yielded bacteria with this capability. The differences may be a result of the mechanisms used by the different shellfish in dealing with domoic acid, i.e., freely available in the blue mussels and soft-shell clams but likely sequestered in the digestive glands of sea scallops and red mussels and thus, largely unavailable for bacterial utilization. The results show that Mytilus edulis and Mya arenaria, almost uniquely, are prime and reliable sources of domoic acid utilizing bacteria. These findings suggest a strong possibility that autochthonous bacteria may be significant factors in the elimination of the neurotoxin in these two species of shellfish.

Microbial utilization of the neurotoxin domoic acid: blue mussels (Mytilus edulis) and soft shell clams (Mya arenaria) as sources of the microorganisms

The neurotoxin domoic acid is produced in quantity by the diatom Pseudo-nitzschia multiseries and is released to the environment directly and indirectly via food chains. Presumably there is a mechanism for the biodegradation and disposal of domoic acid and as bacteria are logical candidates for such an activity, a search for bacteria competent to carry out biodegradation of domoic acid was initiated. Extensive trials with a wide variety of bacteria isolated mainly from muds and waters taken from the marine environment showed that the ability to grow on or degrade domoic acid was rare; in fact, domoic acid was inhibitory to resting cells or growing cultures of most of these bacteria. In contrast, using enrichment techniques, it was possible to isolate from molluscan species that eliminate domoic acid readily, i.e., blue mussels (Mytilus edulis) and soft-shell clams (Mya arenaria), bacteria that exhibited growth with and biodegradation of domoic acid when supplemented with low concentrations of growth factors. The species that retain domoic acid for lengthy periods, such as sea scallops (Placopecten magellanicus) and red mussels(Modiolus modiolus), only occasionally yielded bacteria with this capability. The differences may be a result of the mechanisms used by the different shellfish in dealing with domoic acid, i.e., freely available in the blue mussels and soft shell clams but likely sequestered in the digestive glands of sea scallops and red mussels and thus, largely unavailable for bacterial utilization. The results show that Mytilus edulis and Mya arenaria, almost uniquely, are prime and reliable sources of domoic acid utilizing bacteria. These findings suggest a strong possibility that autochthonous bacteria may be significant factors in the elimination of the neurotoxin in these two species of shellfish.Key words: bacteria, neurotoxin, domoic acid, elimination, bivalve molluscs.

Finding and treating depression in Alzheimer's patients: a study of the effects on patients and caregivers

Unrecognized and untreated depression occurs frequently in Alzheimer's disease (AD) patients, adding to the agony already experienced by patient and caregiver. The authors screened AD patients living with a family caregiver for depression. Twelve patients with confirmed depression were treated in an open-label study with antidepressant medication, with dosage adjustment by a psychiatrist at Weeks 2, 4, 8, and 16. Data collection occurred at baseline, Week 4, and Week 16. Depression decreased significantly (p < .01). Contrary to expectations, patient functional capacity declined (p = .045). Cognition remained unchanged (p > .05). Caregiver burden, caregiver depressive symptomatology, and quality of life of patient and caregiver remained unchanged (p > .05). The authors conclude that depression in AD can be detected if a collateral source, such as the caregiver, is available. The depression can and should be treated. More research is needed to determine the impact on patient functioning, caregiver burden, caregiver depressive symptomatology, and quality of life of patient and caregiver.

Results of the screening program for congenital hypothyroidism in Berlin (1978-1995)

Screening for congenital hypothyroidism for all newborns of the former western parts of the city of Berlin was instituted in 1978 by determination of the TSH levels in dried filter paper blood spots of the 3rd to 5th day of life. Since 1991 the newborns of the former eastern parts have been also included in the same screening program. From 1978 to 1995 a total number of 104 newborns with permanent congenital hypothyroidism have been detected resulting in a prevalence of congenital hypothyroidism of 1:3800. The etiological diagnosis of hypothyroidism was made by imaging studies (ultrasonography or 99mTc scintigraphy) and assessment of serum thyroglobulin and thyroid hormone levels. Using this approach in 37 children (30 female, 7 male) the diagnosis of athyrosis, in 20 children (15 female, 5 male) the diagnosis of ectopy and in 21 children (18 female, 3 male) the diagnosis of thyroid hypoplasia was made, 16 children (8 female, 8 male) had a normally sized gland and 4 (1 female, 3 male) had congenital goiter. In 86% of all patients the age at onset of thyroxine (L-T4) replacement therapy was 8 or 9 days of life (3-42 days) and the median initial L-T4 dose was 14 micrograms/kg/day (10-16 micrograms/kg/day). The intellectual outcome of 77 children (2-16 years) was studied and normal scores for the intelligence (IQ) and developmental (DQ) quotients were found in 71 (92%). Outcome was not correlated to the age at onset of treatment, the initial dose and the severity of hypothyroidism, but there was a positive correlation of the socioeconomic status of the family and the IQ of the patients. The results of the screening program in Berlin document that an early and efficient thyroxine replacement can normalize the intellectual outcome of patients with congenital hypothyroidism independent of the severity of the disease as assessed by the residual thyroid function detectable at diagnosis.

A new pathogenic mutation in the APP gene (I716V) increases the relative proportion of A beta 42(43)

We report a novel mutation in the amyloid precursor protein gene (APP I716V) which probably leads to familial early onset Alzheimer's disease with an onset age in the mid 50s. Cells transfected with cDNAs bearing this mutation produce more A beta 1-42(43) than those transfected with wild-type APP and this effect is additive with that of the previously reported APP V717I mutation thus providing a novel approach for further increasing A beta 1-42(43) in model systems.

[Kleine-Levin syndrome--diagnostic and therapeutic problems]

An overview of the literature is given and an attempt is made to describe the diagnostic problems associated with this etiologically unclear disorder. The only successful therapy to date is treatment with lithium. A case study is presented of a 14-year-old boy with typical symptoms. Within a period of 12 months the boy had 6 episodes characterized by hypersomnia and hyperphagia, each lasting between 8 and 14 days. The symptom-free intervals lasted from 10 days to 8 months. Extensive medical and neurological evaluation including single-photon emission-computed tomography (SPECT) showed no abnormalities, and no criteria for another psychiatric disorder were met. After the sixth episode we considered treating the patient with lithium, but this option was rejected by his family. The patient has remained asymptomatic (36-month follow-up). A possible relationship to endogenous psychotic disorders and the role of neurotransmitter metabolism are discussed. Computer-assisted analysis of electroencephalographic activity revealed high signal complexity, which we believe suggests a primary cortical regulatory defect.

A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study

BACKGROUND

There is evidence that medications or vitamins that increase the levels of brain catecholamines and protect against oxidative damage may reduce the neuronal damage and slow the progression of Alzheimer's disease.

METHODS

We conducted a double-blind, placebo-controlled, randomized, multicenter trial in patients with Alzheimer's disease of moderate severity. A total of 341 patients received the selective monoamine oxidase inhibitor selegiline (10 mg a day), alpha-tocopherol (vitamin E, 2000 IU a day), both selegiline and alpha-tocopherol, or placebo for two years. The primary outcome was the time to the occurrence of any of the following: death, institutionalization, loss of the ability to perform basic activities of daily living, or severe dementia (defined as a Clinical Dementia Rating of 3).

RESULTS

Despite random assignment, the baseline score on the Mini-Mental State Examination was higher in the placebo group than in the other three groups, and this variable was highly predictive of the primary outcome (P<0.001). In the unadjusted analyses, there was no statistically significant difference in the outcomes among the four groups. In analyses that included the base-line score on the Mini-Mental State Examination as a covariate, there were significant delays in the time to the primary outcome for the patients treated with selegiline (median time, 655 days; P=0.012), alpha-tocopherol (670 days, P=0.001) or combination therapy (585 days, P=0.049), as compared with the placebo group (440 days).

CONCLUSIONS

In patients with moderately severe impairment from Alzheimer's disease, treatment with selegiline or alpha-tocopherol slows the progression of disease.

Interference with microtubules and induction of micronuclei in vitro by various bisphenols

Bisphenols, in particular bisphenol-A (BP-A), are monomers of various plastics including polycarbonates and epoxy resins which are used in numerous consumer products. The release of BP-A from some of these materials has recently been reported. BP-A is a weak estrogen and structurally related to the aneuploidogenic stilbene estrogen diethylstilbestrol (DES). We have therefore studied BP-A and four other bisphenols for their aneuploidogenic potential by assaying their (i) interference with the cell-free assembly of microtubules (MT); (ii) disruption of the cytoplasmic MT complex in cultured Chinese hamster V79 cells; (iii) disruption of the mitotic spindle and induction of metaphase arrest in V79 cells; and (iv) induction of micronuclei (MN) in V79 cells. At concentrations without gross cytotoxicity, BP-A as well as its alkyl-fluorinated and ring-methylated analog were active at all endpoints tested, whereas the bisphenol without alkyl groups was completely inactive. 4,4'-Dihydroxybenzophenone was inactive against cell-free and cytoplasmic MT but disrupted the mitotic spindle and induced metaphase arrest and MN. The MN caused by the various bisphenols were analyzed for the presence of kinetochores by staining with CREST antibodies. All induced MN were CREST-positive, implying that they contain whole chromosomes/chromatids. The effects on MT and the induction of metaphase arrest and of CREST-positive MN suggest that the environmental estrogen BP-A and some of its analogs are potential aneuploidogens.

The Spanish Instrument Protocol: design and implementation of a study to evaluate treatment efficacy Instruments for Spanish-speaking patients with Alzheimer's disease. The Alzheimer's Disease Cooperative Study

Development of improved outcome measures for Alzheimer's disease (AD) clinical trials is a major objective of the Alzheimer's Disease Cooperative Study (ADCS), an NIA-sponsored, multisite clinical trials consortium. The ADCS is committed to recruiting and following minority patients in clinical trials. At present, a serious impediment to recruiting non-English-speaking minorities is the lack of instruments with adequate translation. Because Spanish is the second most commonly spoken language in the United States and because persons of Hispanic origin represent approximately 10% of the population, we conducted an instrument development protocol for Spanish-speaking patients. Evaluating treatment efficacy in Spanish-speaking AD patients requires the development of assessments that are comparable to those used for English-speaking participants in clinical trials. The ADCS Instrument Development Project evaluated the sensitivity, reliability, and validity of new or improved measures in each of five assessment domains: (a) cognition (immediate and delayed memory, praxis, attention, and executive function); (b) clinical global change; (c) activities of daily living; (d) behavioral symptoms (agitation and other noncognitive symptoms); and (e) cognition in severely impaired patients. These new treatment efficacy instruments were translated for Spanish speakers and a Spanish Instrument Study was conducted in parallel with the English version of the study. This report describes instrument translation, entry criteria, and recruitment procedures. In addition, the demographic and clinical characteristics of the cohort at baseline are presented and compared to the English-speaking cohort. Implications for the development of comparably sensitive Spanish language instruments are discussed.

Interaction of p-benzoquinone and p-biphenoquinone with microtubule proteins in vitro

p-benzoquinone (BQ) and p-biphenoquinone (BPQ) are metabolites of the human myelotoxin and leukemogen benzene, which has been reported to induce aneuploidy in mammalian cells. Because a possible mechanism for the aneuploidogenic effect of benzene may be the disruption of the mitotic spindle by covalent binding of BQ and BPQ to microtubule proteins (MTP), we have studied the reaction of these quinones with MTP and its consequences for microtubule (MT) formation under cell-free conditions. Both BQ and BPQ inhibit the assembly of MTP to MT in a concentration-dependent manner. This interaction is accompanied by a spectral change of the quinones and loss of free sulfhydryl groups of MTP. With 40 microM BQ or BPQ, 50% inhibition of MT assembly was observed and associated with the loss of 1.3 thiol groups per tubulin dimer. Further analysis showed that native MTP form monoadducts, but no diadducts nor disulfide bonds with both BQ and BPQ. The formation of covalent quinone/MTP monoadducts was unequivocally demonstrated by GC/MS analysis of the respective thioanisols liberated by alkaline permethylation. Denatured MTP or glutathione or 2-mercaptoethanol gave rise to the virtually exclusive formation of monoadducts with BQ but led to a high proportion of disulfide bonds with BPQ. Therefore, BQ and BPQ react differently with thiol compounds capable of disulfide bond formation. The fact that both quinones form only monoadducts with native MTP can be explained by the assumption that the thiol groups of native tubulin are not prone to oxidative disulfide bond formation. This proposition was supported by the lack of native MTP to form disulfide bridges upon treatment with hydrogen peroxide/horseradish peroxidase under conditions leading to a complete oxidation of glutathione. The covalent binding of the benzene metabolites BQ and BPQ to critical thiol groups of tubulin inhibits MT formation under cell-free conditions and may also interfere with the formation of a functional spindle apparatus in the mitotic cell, thus leading to the abnormal chromosome segregation and aneuploidy induction reported for benzene.

A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's disease

A 1-year, double-blind, placebo-controlled, randomized, parallel-group study compared the efficacy and safety of acetyl-L-carnitine hydrochloride (ALCAR) with placebo in patients with probable Alzheimer's disease (AD). Subjects with mild to moderate probable AD, aged 50 or older, were treated with 3 g/day of ALCAR or placebo (1 g tid) for 12 months. Four hundred thirty-one patients entered the study, and 83% completed 1 year of treatment. The Alzheimer's Disease Assessment Scale cognitive component and the Clinical Dementia Rating Scale were the primary outcome measures. Overall, both ALCAR- and placebo-treated patients declined at the same rate on all primary and most secondary measures during the trial. In a subanalysis by age that compared early-onset patients (aged 65 years or younger at study entry) with late-onset patients (older than 66 at study entry), we found a trend for early-onset patients on ALCAR to decline more slowly than early-onset AD patients on placebo on both primary endpoints. In addition, early-onset patients tended to decline more rapidly than older patients in the placebo groups. Conversely, late-onset AD patients on ALCAR tended to progress more rapidly than similarly treated early-onset patients. The drug was very well tolerated during the trial. The study suggests that a subgroup of AD patients aged 65 or younger may benefit from treatment with ALCAR whereas older individuals might do more poorly. However, these preliminary findings are based on past hoc analyses. A prospective trial of ALCAR in younger patients is underway to test the hypothesis that young, rapidly progressing subjects will benefit from ALCAR treatment.

Effects of novel 3,4-bisphenylhex(3)enes on cell proliferation in malignant and normal cells

The growth-inhibitory effect of several newly synthesized alkyl derivatives of 3,4-bisphenylhex(3)ene was studied in four tumor cell lines and three healthy primary cell systems. A marked inhibition of cell proliferation was noted in the neoplastic cells but not in the primary systems. No effect on the cytoplasmic or mitotic microtubule system but an increase in the gross level of 5-methylcytosine in nuclear DNA was observed. It is speculated that the selective growth inhibition of tumor cells is due to DNA-hypermethylation.

Effects of estrogens on microtubule polymerization in vitro: correlation with estrogenicity

Several estrogens of diverse classes, namely stilbene estrogens, steroidal estrogens, phytoestrogens, mycoestrogens, lignans, and bisphenol A, were studied for their ability to interfere with the assembly of microtubules under cell-free conditions. Inhibition of microtubules in intact cells may lead to the induction of micronuclei and aneuploidy and thereby contribute to estrogen-mediated carcinogenesis. Diethylstilbestrol and various other stilbene estrogens, as well as bisphenol A, were good inhibitors of microtubule polymerization whereas the other tested compounds were devoid of this activity. Therefore, the ability of estrogenic substances to interact with microtubules does not correlate with the hormonal activity.

Institutional placement for patients with Alzheimer's disease. How to help families with a difficult decision

Family members confronting the difficult decision of whether to place a patient with Alzheimer's disease in an institution find it helpful to have explicit criteria on which to base their decision. Regular incontinence of bladder and bowel, inability of the patient to cooperate in his or her care, inability of the patient to realize that he or she is at home with familiar caregivers, the withdrawal of a paid caregiver, risk to the health of the primary caregiver, and primary caregiver burnout are all grounds for considering institutional placement. Options include assisted living facilities, dementia-specific assisted living facilities, general nursing homes, and nursing homes with dementia-specific care units. Institution-like care can be provided at home, but this is expensive and may be inconvenient and stressful for family members. Hospice care is appropriate at the end of the patients's life.

Comparative tumorigenicity of picene and dibenz[a,h]anthracene in the mouse

The carcinogenic activity of the two polycyclic aromatic hydrocarbons (PAHs), picene (benzo[a]chrysene) and dibenz[a,h]anthracene (DBA), was determined in NMRI mice by five different experimental protocols in order to find out if picene is a carcinogen as predicted by recent quantum mechanical calculations in contrast to earlier observations which could not confirm any carcinogenic activity of picene. Single s.c. treatment of adult mice with picene or DBA (308 nmol/animal, each) led to the formation of fibrosarcomas in 63.3% of treated animals regardless of the PAH used. Chronic epicutaneous application of both PAHs (total dose 1.36 mumol) to the back of mice resulted in the development of papillomas with a tumor rate of 22% in the case of picene and of 32% in the case of DBA. When newborn mice were s.c. treated once on day 2 of their life with each of the two PAHs (400 nmol/animal), 27.8% of treated animals developed lung adenomas after 40 weeks in the case of picene compared to 92.1% in the case of DBA. Histopathological examination of the tumors in the three experimental models revealed no difference in the type of tumor between picene and DBA. Epicutaneous application of both PAHs (600 nmol/animal) followed by chronic treatment with 12-O-tetradecanoyl-phorbol-13-acetate for 24 weeks led to the formation of papillomas in 93% of animals treated with DBA while picene showed no tumorigenic activity at all. Initiation of tumorigenesis in the two-stage tumor model with 7,12-dimethylbenz[a]anthracene (1 mumol/animal) and chronic treatment with picene (total dose 4.8 mumol) for 24 weeks was equally ineffective in producing tumors in NMRI mice. This rare biological property of picene, which is a complete carcinogen, yet at most a very weak tumor initiator, is explained in terms of its inefficient biotransformation to mutagenic and carcinogenic metabolites as compared to the strong tumor initiator DBA.

Comparative studies of conversion disorders in childhood and adolescence

In a syndrome validation study, four groups of patients suffering from conversion disorders, anxiety states, obsessive-compulsive disorder and emotional disorders, as well as a healthy control group, were compared. The following findings emerged: besides female preponderance and greater age, a higher rate of low SES subjects and social migration patients suffering from conversion disorders displayed a greater proportion of psychiatric and medical diseases in their parental heritage.