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Ghaziuddin M, Welch K. The michigan autism spectrum questionnaire: a rating scale for high-functioning autism spectrum disorders. Autism Res Treat 2013; 2013:708273. [PMID: 24381759 PMCID: PMC3870086 DOI: 10.1155/2013/708273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/02/2013] [Accepted: 10/21/2013] [Indexed: 11/20/2022]
Abstract
Although the DSM-5 has recently created a single category of autism spectrum disorder (ASD), delineation of its putative subtypes remains clinically useful. For this process, screening instruments should ideally be brief, simple, and easily available. The aim of this study is to describe the validity of one such instrument. We administered the Michigan Autism Spectrum Questionnaire (MASQ), a 10-item questionnaire, to 42 patients with ASD (age range 6-13 years, mean 9.7 years, SD 2.5, one female) and 18 patients with other psychiatric disorders (age range 6-17 years, mean 11.7 years, SD 3.8, 6 females). Responses to each item were scored from 0 to 4 yielding a total score of 30. Patients with intellectual disability were excluded. As a group, patients with ASD scored higher than those with other psychiatric disorders (Chi-square test with 1 df = 16.019, P < 0.0001). Within the ASD group, a linear discriminant analysis found that the best cut-off points were 22 or above for Asperger syndrome, 14 to 21 for autism/PDDNOS, and less than 14 for those with other psychiatric disorders. We propose that the MASQ can be used as a brief measure to screen high-functioning ASD from other psychiatric disorders and to identify its possible subtypes.
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Affiliation(s)
- M Ghaziuddin
- Department of Psychiatry, University of Michigan Medical Center, Plymouth Road, Ann Arbor, MI 48109-0277, USA
| | - K Welch
- Center for Statistical Consultation and Research (CSCAR), University of Michigan Medical Center, Plymouth Road, Ann Arbor, MI 48109-0277, USA
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Abstract
BACKGROUND Autism is a severe handicapping disorder of early childhood characterized by a distinct pattern of social and communication impairment with rigid ritualistic interests. In about 10-25% of cases, it is associated with known medical conditions. Population-based studies of autism have found that Klinefelter's syndrome (KS), a common chromosome abnormality, is sometimes associated with autism. However, few detailed case descriptions of patients with KS and autism have not been published. CASE REPORT In this paper, we describe the occurrence of autistic features in two cases of Klinefelter syndrome, one with the typical XXY karyotype and the other with the XXYY variant. CONCLUSION Autistic features may be more common in persons with Klinefelter syndrome than generally believed. We propose that all patients with KS should be screened for the presence of autism.
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Affiliation(s)
- P Jha
- Division of Child Psychiatry, University of Michigan Hospital, 200 East Hospital Drive, Ann Arbor, MI 48109-0277, USA
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Abstract
Catatonia is a life-threatening disorder characterized by motor abnormalities, mutism, and disturbances of behaviour, which is increasingly being diagnosed in persons with autism. In this report, we describe the presentation and course of catatonia in an adolescent with autism who responded to electroconvulsive therapy (ECT). The illness started with depressive symptoms, but the predominant feature was one of extreme obsessive slowing and immobility. We propose that catatonia should be ruled out as a cause of regression sometimes seen in adolescents with autism, and that catatonia of autism may index a distinct subtype with a particularly poor outcome.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan, Ann Arbor, MI 48109-0727, USA.
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Abstract
Autism is a childhood onset neurodevelopmental disorder characterized by reciprocal social deficits, communication impairment, and rigid ritualistic interests, with the onset almost always before three years of age. Although the etiology of the disorder is strongly influenced by genes, environmental factors are also important. In this context, several reports have described its association with known medical conditions, including infections affecting the central nervous system. In this report, we describe an 11-year-old Asian youngster who developed the symptoms of autism following an episode of herpes encephalitis. In contrast to previous similar reports, imaging studies suggested a predominant involvement of the frontal lobes. At follow-up after three years, he continued to show the core deficits of autism. This case further supports the role of environmental factors, such as infections, in the etiology of autism, and suggests that in a minority of cases, autistic symptoms can develop in later childhood.
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Affiliation(s)
- M Ghaziuddin
- Division of Child and Adolescent Psychiatry, University of Michigan Medical Center, Ann Arbor 48109-0390, USA.
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Abstract
Several studies have suggested a positive association between anxiety symptoms and suicidality in adults. However, relatively little is known about this topic in adolescents. To investigate this issue, we examined a group of adolescents admitted to our psychiatric inpatient unit. Fifty-six adolescents (mean age = 14.8 +/- 1.4; females = 34, males = 22; race = 95% Caucasians) participated in the study. Diagnoses were made using the DSM-III-R criteria and a diagnostic interview. Anxiety was found to significantly correlate with depression (r = .60; P = < .05) and suicidality (r = .72; P < .05). A multiple regression analysis revealed that anxiety and depression together accounted for more than half (55%) of the variance in suicidal ideation [F(2,46) = 28.4; P < .0001]. In addition, anxiety had an independent ability to predict suicidality (t = 5.01; P < .0001). Self-rated but not clinician-rated suicidality was positively correlated with both anxiety and depression. Clinical and research implications of these findings are discussed.
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Affiliation(s)
- N Ghaziuddin
- Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, USA.
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Abstract
Several recent reports have described the occurrence of autism in subjects with Down's syndrome (DS). However, relatively little is known about the family history of these subjects, especially with reference to autism. In order to address this issue, the present author examined 11 subjects with DS and autism (DSM-III-R; nine males), and compared them with seven controls with DS but without autism (DSM-III-R; three males). Details about family psychiatric history were obtained from both groups with an emphasis on autism and related disorders. Subjects with both DS and autism had an excess of first-degree relatives who met the description of the broader phenotype of autism. Seven (64%) of the subjects with autism had an affected parent as against one (14%) of the control group. Similarly, four out of 11 siblings (36%) in the DS with autism group showed features suggestive of the broader autistic phenotype compared to none in the control group. These findings suggest that, at least in some cases, autism-specific genetic factors may be important even when autism occurs in the presence of known medical conditions. Further studies of the mechanism of comorbidity of autism with medical conditions may help clarify the aetiology of the disorder.
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Ghaziuddin N, King CA, Welch KB, Zaccagnini J, Weidmer-Mikhail E, Mellow AM, Ghaziuddin M, Greden JF. Serotonin dysregulation in adolescents with major depression: hormone response to meta-chlorophenylpiperazine (mCPP) infusion. Psychiatry Res 2000; 95:183-94. [PMID: 10974357 DOI: 10.1016/s0165-1781(00)00163-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined central serotonin disturbance, as reflected by neuroendocrine hormones, among adolescents with major depression. Prolactin, cortisol, and growth hormone were measured following the infusion of a serotonin agonist, meta-chlorophenylpiperazine (mCPP). Twelve (M=6, F=6) medication-free adolescents with major depression (MDD) were compared with 12 (M=6, F=6) matched normal control subjects, ranging in age from 13 to 17 years. Baseline evaluations and a battery of laboratory tests were completed. mCPP, 0.1 mg/kg i. v., was administered in a placebo-controlled design. Analyses of the neuroendocrine hormones revealed that the depressed group had a higher baseline prolactin level and an augmented prolactin response to mCPP challenge than did the control group. The depressed group experienced a sharper baseline-cortisol decline between 08.00 and 11.00 h, and compared to control subjects they displayed an augmented response to the challenge. The depressed group reported more side effects than the control group during saline infusion, but not during mCPP infusion. Findings suggest that depressed adolescents have an elevated baseline prolactin level, and also experience enhanced prolactin and cortisol responses to the serotonergic challenge. These preliminary findings will be confirmed during our ongoing study.
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Affiliation(s)
- N Ghaziuddin
- Department of Psychiatry, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0390, USA.
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Abstract
The purpose of the study was to estimate prevalence of medication noncompliance among adolescents, following discharge from hospital. A second purpose was to identify predictors of such noncompliance. Seventy-one adolescents, who had been prescribed a medication during psychiatric hospitalization, were interviewed by telephone, 6-8 months post-hospitalization. Medication noncompliance was defined as discontinuing medication without the recommendation of the treating physician. Twenty-four subjects (33.8%) were noncompliant with medication. Age, race, gender, SES, diagnosis, type and number of medications, severity of depression, and family living arrangement did not predict noncompliance. We concluded that noncompliance with psychotropic medications was relatively common and difficult to predict in adolescents who had been hospitalized to a psychiatric inpatient unit; the majority of them suffered from depression. Clinicians should be aware that medication noncompliance may be common and a relatively unpredictable phenomenon.
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Ghaziuddin M, Thomas P, Napier E, Kearney G, Tsai L, Welch K, Fraser W. Brief report: Brief syntactic analysis in Asperger syndrome: a preliminary study. J Autism Dev Disord 2000; 30:67-70. [PMID: 10819122 DOI: 10.1023/a:1005416212615] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Several recent reports have described the presence of increased head circumference (megalencephaly) in patients with autism. Although some studies have described reports of megalencephaly in other disorders such as schizophrenia in adults, few such studies have been performed in children and adolescents. In the present study, the authors compared 20 subjects with autism/ pervasive developmental disorder (DSM-IV; all males; mean age = 10.9 years) with 20 controls with attention deficit hyperactivity disorder (DSM-IV; all males; mean age = 11.1 years). Four subjects and five controls had evidence of megalencephaly. In addition to their core symptoms, the autistic subjects with megalencephaly were hyperactive and impulsive. These findings suggest that megalencephaly may not be specific to autism, and when present, it may index the presence of additional symptoms such as hyperactivity and impulsivity.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan, Ann Arbor 48109-0390, USA.
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Abstract
This is the first reported use of electroconvulsive treatment (ECT) in an adolescent with bipolar mania who had been treated with craniectomy for an intracranial neoplasm. The reported case is of a 16-year-old girl with a history of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal ideation, depressed mood, irritability, olfactory hallucinations, early insomnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunction with a neuroleptic. The decision to use ECT was based on suicidal ideation, extreme disinhibition, and danger to self and others. Significant improvement in mood and remission in psychosis were noted after the eighth treatment. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing revealed no change in IQ. This report highlights rapid response and the ability to tolerate ECT in an adolescent diagnosed with bipolar disorder, who had also been treated with radiation and craniotomy.
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Affiliation(s)
- N Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor 48109, USA
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Abstract
Several reports have described the occurrence of chromosome abnormalities in autism, a neuro-developmental disorder characterized by social deficits, communication impairment, and a restricted range of interests. These include the fragile X abnormality and 15q duplications. In this report, we describe two cases of chromosome 2q37 and review the literature on this topic. We propose that deletion of the distal portion of the long arm of chromosome 2 (2q37) may be associated with some cases of autism and with a distinct phenotype. Increased awareness of the dysmorphic features associated with 2q37 deletions may aid in the molecular genetic analysis of this chromosome anomaly and clarify its relationship with autism.
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Affiliation(s)
- M Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA.
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Abstract
Asperger syndrome (AS) is a pervasive developmental disorder characterized by autistic social dysfunction and idiosyncratic interests in the presence of normal intelligence. There is no history of language delay. Although people with AS are known to suffer from comorbid psychiatric conditions, few studies have systematically addressed this topic. This preliminary report describes the occurrence of psychiatric disorders in a series of patients with AS diagnosed according to the ICD-10/DSM-IV criteria. Out of 35 patients (29 males and six females; mean age 15.1 years; mean verbal IQ 105.9; mean performance IQ 97.5; mean full-scale IQ 102.7), 23 patients (65%) presented with symptoms of an additional psychiatric disorder at the time of evaluation or during the 2-year follow-up. Children were most likely to suffer from attention deficit hyperactivity disorder, while depression was the most common diagnosis in adolescents and adults. The implications of these findings are discussed.
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Affiliation(s)
- M Ghaziuddin
- Division of Child Psychiatry, University of Michigan Medical Center, Ann Arbor 48109-0390, USA
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Abstract
Limited information is available about the occurrence of depression in children with autism and other pervasive developmental disorders (PDD). Although depression has been described in autistic children, questions about its validity have often been raised. One approach to address this issue is to investigate family histories of those autistic children diagnosed with clinical depression. Based on data available in nonautistic children, autistic children with depression would be expected to show an increased family history of depression. Since studies of this nature have not been attempted in autistic children, we compared the family history of 13 autistic/PDD children with depression (11 male; 2 female; M full-scale IQ 86.2, SD 24.2; M age 10.4 years, SD 2.2) with 10 autistic/PDD children without a history of current or previous depression (9 male; 1 female; M full-scale IQ 67, SD 12.9; M age 10.5 years, SD 1.6). Diagnosis of depression was based on the DSM-III-R criteria and confirmed independently by two psychiatrists. Ten (77%) of the depressed children had a positive family history of depression compared to 3 (30%) of the nondepressed group, t(21)=-2.4; p=.02. These findings lend support to the validity of depression as a distinct condition in some children with autism/PDD and suggest that, as in the normal population, autistic children who suffer from depression are more likely to have a family history of depression.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan, Ann Arbor 48109-0390, USA
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Weidmer-Mikhail E, Sheldon S, Ghaziuddin M. Chromosomes in autism and related pervasive developmental disorders: a cytogenetic study. J Intellect Disabil Res 1998; 42 ( Pt 1):8-12. [PMID: 9534109 DOI: 10.1046/j.1365-2788.1998.00091.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Few studies have examined the occurrence of chromosome abnormalities in a large sample of patients with autism and related pervasive developmental disorders (PDDs). In the present report, the authors examined a consecutive series of 92 children with PDDs (DSM-III-R; 75 males and 17 females). A cytogenetic examination, including growth in folate deficient medium, was performed in all cases. Three patients (3.2%) (two females and one male) showed chromosome abnormalities: deletion of the long arm of chromosome 8; tetrasomy of chromosome 15; and XYY syndrome. Only the subject who had tetrasomy 15 met the criteria for autistic disorder, while the other were diagnosed as suffering from a PDD not otherwise specified (PDDNOS). Another patient showed an abnormal fragile site at Xq27 in three out of 100 cells. However, subsequent molecular studies did not confirm the presence of fragile-X syndrome. These results suggest that chromosome abnormalities are uncommon in traditional autism and may be relatively more common in people with PDDNOS.
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Abstract
Clumsiness has been proposed as a diagnostic feature of Asperger syndrome (AS), a type of pervasive developmental disorder recently introduced in the ICD-10 and DSM-IV. However, the extent to which this symptom is specific to AS is not clear. To investigate this issue, we compared a sample of AS children with age- and sex-matched groups of children with autistic disorder and pervasive developmental disorder not otherwise specified (PDDNOS). Twelve subjects with AS (ICD-10/DSM-IV; 11 males; average age 11.4 years; mean full-scale IQ 104.9) were compared with 12 subjects with autistic disorder (DSM-III-R; II males; average age 10.3 years; mean full-scale IQ 78.4) and 12 subjects with PDDNOS (DSM-III-R; 10 males; average age 10.1 years; mean full-scale IQ 78.2). The BruininksOseretsky test, a standardized test of motor coordination, was administered blind by the same investigator to all the three groups. While coordination deficits were found in all three groups, children with AS were found to be less impaired than those with autistic disorder and PDDNOS. However, no significant relationship was found between coordination scores and diagnosis after adjusting for the level of intelligence. These findings suggest that some patients with AS may be less clumsy than those with autistic disorder and that this difference may be the result of their higher level of intelligence. Studies based on larger samples using multiple measures of coordination are needed to further clarify the role of clumsiness in the classification of pervasive developmental disorders.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan Medical Center, Ann Arbor 48109-0390, USA
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Abstract
Autoimmunity may be a pathogenic factor in autism, a behavioral disorder of early childhood onset. Circulating autoantibodies are produced in organ-specific autoimmunity; therefore, we investigated them in the plasma of autistic subjects, mentally retarded (MR) subjects, and healthy controls. Autoantibodies (IgG isotype) to neuron-axon filament protein (anti-NAFP) and glial fibrillary acidic protein (anti-GFAP) were analyzed by the Western immunoblotting technique. We found a significant increase in incidence of anti-NAFP (P = .004) and anti-GFAP (P = .002) in autistic subjects, but not in MR subjects. Clinically, these autoantibodies may be related to autoimmune pathology in autism.
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Affiliation(s)
- V K Singh
- Department of Psychiatry, University of Michigan, Ann Arbor 48109-1065, USA
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Elkins TE, Kope S, Ghaziuddin M, Sorg C, Quint E. Integration of a sexuality counseling service into a reproductive health program for persons with mental retardation. J Pediatr Adolesc Gynecol 1997; 10:24-7. [PMID: 9061631 DOI: 10.1016/s1083-3188(97)70040-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A socialization and sexuality counseling program was instituted as an integral part of a gynecologic service begun at the University of Michigan for persons with mental retardation. One hundred three patients were seen between 1986 and 1989 for counseling. Patients were referred for a variety of reasons, the most common being sexual behavior deemed inappropriate by the referring agent (i.e., direct care givers, parents, teachers, workshop supervisors, and other community professionals). Other concerns included sexual abuse, sterilization requests, sexuality and socialization education, marital questions, pregnancy assistance, abortion counseling, and family stress. Treatment techniques included gynecologic examination and follow-up, psychosexual education, psychiatric evaluation and follow-up, and group and individual psychosexual counseling. A majority of the patients improved during treatment. It is proposed that such a counseling program can play a useful role in the preparation of people with mental retardation to live in their communities as they deal with day-to-day decision making and should be an integral part of reproductive health care for this population.
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Affiliation(s)
- T E Elkins
- University of Michigan Medical Center, Department of Obstetrics, Ann Arbor, USA
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Abstract
Although the association of autism with Down's syndrome is said to be uncommon, several reports have described the co-occurrence of the two disorders. This report describes three additional cases of Down's syndrome with autism. In all the patients, a history suggestive of the broader phenotype of autism was obtained in parents. This suggests that familial factors specific to autism may play an important role even when autism complicates a known medical condition such as Down's syndrome.
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Affiliation(s)
- M Ghaziuddin
- Taubman Centre, University of Michigan Medical Centre, Ann Arbor 48109-0390, USA
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Abstract
Asperger syndrome (AS) is a pervasive developmental disorder recently introduced as a new diagnostic category in the ICD-10 and the DSM-IV. Along with motor clumsiness, pedantic speech has been proposed as a clinical feature of AS. However, few attempts have been made to define and measure this symptom. We studied 17 patients with AS (ICD-10; 14 male, 3 female; mean age 16.4 years, mean full-scale IQ 97) and compared them with a control group of 13 patients with normal-intelligence autism or high-functioning autism (HFA) (ICD-10/DSM-III-R; 12 male, 1 female; mean age 15.5 years, mean full-scale IQ 81.2). An operational definition of pedantic speech was formulated and a rating scale devised. 13 (76%) of the AS patients were rated as pedantic compared to 4 (31%) of the HFA group (chi 2 = 6.3; p = .01). Results suggest that pedantic speech is common in AS and may help differentiate AS from high-functioning autism.
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Flejter WL, Bennett-Baker PE, Ghaziuddin M, McDonald M, Sheldon S, Gorski JL. Cytogenetic and molecular analysis of inv dup(15) chromosomes observed in two patients with autistic disorder and mental retardation. Am J Med Genet 1996; 61:182-7. [PMID: 8669450 DOI: 10.1002/(sici)1096-8628(19960111)61:2<182::aid-ajmg17>3.0.co;2-q] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A variety of distinct phenotypes has been associated with supernumerary inv dup(15) chromosomes. Although different cytogenetic rearrangements have been associated with distinguishable clinical syndromes, precise genotype-phenotype correlations have not been determined. However, the availability of chromosome 15 DNA markers provides a means to characterize inv dup(15) chromosomes in detail to facilitate the determination of specific genotype-phenotype associations. We describe 2 patients with an autistic disorder, mental retardation, developmental delay, seizures, and supernumerary inv dup(15) chromosomes. Conventional and molecular cytogenetic studies confirmed the chromosomal origin of the supernumerary chromosomes and showed that the duplicated region extended to at least band 15q13. An analysis of chromosome 15 microsatellite CA polymorphisms suggested a maternal origin of the inv dup(15) chromosomes and biparental inheritance of the two intact chromosome 15 homologs. The results of this study add to the existing literature which suggests that the clinical phenotype of patients with a supernumerary inv dup(15) chromosome is determined not only by the extent of the duplicated region, but by the dosage of genes located within band 15q13 and the origin of the normal chromosomes 15.
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Affiliation(s)
- W L Flejter
- Department of Pediatrics, University of Utah, Salt Lake City 84132, USA
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Ghaziuddin N, King CA, Naylor MW, Ghaziuddin M, Chaudhary N, Giordani B, Dequardo JR, Tandon R, Greden J. Electroconvulsive treatment in adolescents with pharmacotherapy-refractory depression. J Child Adolesc Psychopharmacol 1996; 6:259-71. [PMID: 9231319 DOI: 10.1089/cap.1996.6.259] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effectiveness and safety of ECT in pharmacotherapy-refractory depression was examined in 11 hospitalized adolescents (ages 16.3 +/- 1.7 years, 10 females) with a primary DSM-III-R diagnosis of mood disorder, which had failed to respond to three or more adequate trials of antidepressant pharmacotherapy. After a thorough diagnostic evaluation, patients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) administrations. ECT was commenced with bilateral treatment in 2 adolescents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 patients improved to a clinically significant degree. Significant improvements were noted in scores on the Children Depression Rating Scale-Revised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) (p < 0.05). Euthymia, defined as CDRS-R score < or = 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examination showed no significant decline in cognitive functioning. Neuropsychological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attention, concentration, and long-term memory search. Minor side effects, experienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complication of tardive seizure (after full recovery of consciousness) occurred in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending further research on ECT in youth, it is recommended that ECT should only be administered to youth in hospital settings, that all regularly administered psychotropic medications (including antidepressants) be discontinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficient, but that 15 treatments may occasionally be necessary for treating depressed adolescents. With the understanding that scientific evaluation of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have failed to respond to antidepressant pharmacotherapy.
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Affiliation(s)
- N Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Abstract
Asperger syndrome (AS) is a pervasive developmental disorder widely regarded as a mild variant of autism. To investigate if AS is associated with a history of fewer obstetric insults compared to autism, we examined the developmental history and obstetric records of 10 males with AS (mean full scale IQ 95.3), and compared them with 10 autistic males with a full scale IQ of 70 or above (so-called high-functioning autism; mean full scale IQ 82.6). Males with AS showed a trend toward lower Apgar scores at one minute (chi-square = 4; df = 1; P = 0.04) and were more likely to have been born to mothers outside the optimal age group of 20-30 years (chi-square = 5; df = 1; P = 0.02). They were also less likely to have been irritable and floppy as infants (chi-square = 3.8; df = 1; P = 0.05). However, the total optimality scores did not differ significantly between the two groups.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan, Ann Arbor 48109-0390, USA
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Abstract
To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; M age: 11.0 years; M full-scale IQ: 75.3) with PDD and depression, with an age- and sex-matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; M age: 9.8 years; M full-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental stressors in the onset of depression in this population.
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Affiliation(s)
- M Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Abstract
Asperger syndrome (AS) is a pervasive developmental disorder generally regarded as a variant of autism. While it has been included in the ICD-10 and DSM-IV as a distinct diagnostic entity, it is still unclear to what extent it differs from high-functioning autism (HFA). Persons with HFA have been reported to show a variety of deficits of thought processes. Abnormalities such as poor reality testing, perceptual distortions, and areas of cognitive slippage have been described using the Rorschach inkblot test (Dykens, Volkmar, & Glick, 1991). Since AS has been conceptualized as a mild variant of autism, we hypothesized that persons with AS will have fewer abnormalities on the Rorschach test compared to persons with HFA. To test this hypothesis, we compared 12 subjects with AS (ICD-10, 10 male, mean age = 12.2 +/- 3.3 years, mean full-scale IQ = 99.6) with 8 subjects with HFA (ICD-10/DSM-III-R, 7 male, mean age = 12.2 +/- 3.8 years, mean full-scale IQ = 83.4) on the Rorschach test. AS subjects demonstrated a trend towards greater levels of disorganized thinking than the HFA group. They were also more likely to be classified as "Introversive" suggesting that AS subjects may have more complex inner lives involving elaborate fantasies, Also, AS subjects tended to be more focused on their internal experiences. However, overall, the Rorschach test was not found to differentiate the two diagnostic groups on the majority of structural variables. Implications of these findings are discussed with regard to the diagnostic validity of Asperger syndrome.
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Affiliation(s)
- M Ghaziuddin
- Division of Child and Adolescent Psychiatry, University of Michigan Hospitals, Ann Arbor 48109-3290, USA
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Ghaziuddin M, Tsai L. PDD changes in DSM-IV. J Am Acad Child Adolesc Psychiatry 1995; 34:264-5. [PMID: 7896664 DOI: 10.1097/00004583-199503000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Although Asperger syndrome (AS) has been included in the ICD-10 as a distinct category within the pervasive developmental disorders, it is still unclear to what extent it differs from normal-intelligence autism (high-functioning autism; HFA). Persons with AS are said to be particularly clumsy. To test the hypothesis that clumsiness can reliably distinguish AS from autism, the present authors compared 11 patients with AS (ICD-10; 10 males; mean age, 13.6 years; mean IQ, 98) with nine patients with HFA (ICD-10/DSM-III-R; eight males; mean age, 12.9 years; mean IQ, 84). Clumsiness was assessed by the Bruininks-Oseretsky test. Both groups showed problems with coordination and the distribution of standard scores was virtually identical. This suggests that motor clumsiness, as measured by tests of coordination, may not reliably distinguish AS from HFA. However, qualitative differences may occur between the two groups in the manner in which movements are performed. Further research with larger samples may elicit differences into the pattern of motor deficits that occur in autism and AS.
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Abstract
The use of lithium to treat child and adolescent psychiatric disorders is becoming more common. Since the publication of the report of The Committee on Biological Aspects of Child Psychiatry of the American Academy of Child Psychiatry in 1978, a considerable body of literature has accumulated on the efficacy of lithium in treating adolescent bipolar disorders, childhood aggression, and behavioral disorders associated with mental retardation and developmental disorders. Efforts to understand lithium's mechanism(s) and refinements in psychiatric diagnosis have contributed to its growing use.
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Affiliation(s)
- N Alessi
- University of Michigan Medical Center, Department of Psychiatry, Ann Arbor 48109-0290
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31
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Abstract
Few reports have described the psychiatric co-morbidity of Noonan syndrome. While mental retardation is a common feature of Noonan syndrome, the diagnosis of autism using operational criteria has not been reported. In this paper, the authors describe the association of Noonan syndrome with autism. They propose that the co-morbid diagnosis of autism should be considered during the clinical assessment of persons with Noonan syndrome.
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Affiliation(s)
- M Ghaziuddin
- Department of Child Psychiatry, University of Michigan, Ann Arbor
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Ghaziuddin M, Sheldon S, Tsai LY, Alessi N. Abnormalities of chromosome 18 in a girl with mental retardation and autistic disorder. J Intellect Disabil Res 1993; 37 ( Pt 3):313-317. [PMID: 8334323 DOI: 10.1111/j.1365-2788.1993.tb01288.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Structural autosome defects have rarely been described in autism. In this report, the authors describe the association of autism and mental retardation in a girl with mosaicism for a duplication of the long arm of chromosome 18 and a deletion of the short arm of chromosome 18.
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Affiliation(s)
- M Ghaziuddin
- Department of Child Psychiatry, University of Michigan, Ann Arbor 48109-0390
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33
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Ghaziuddin M, Tsai LY, Ghaziuddin N, Eilers L, Naylor M, Alessi N, Hill EM. Utility of the head computerized tomography scan in child and adolescent psychiatry. J Am Acad Child Adolesc Psychiatry 1993; 32:123-6. [PMID: 8428864 DOI: 10.1097/00004583-199301000-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Despite the widespread use of computerized tomography (CT) in child and adolescent psychiatry, studies have not looked at its overall usefulness in a clinical setting. In this report, the authors examined 122 inpatients who had CT scans of the head. Only 27 patients had an abnormal CT scan. None of the patients had a change made in the diagnosis or treatment as a result of the scan findings. The authors suggest that routine CT scans of the head in child and adolescent inpatients is of limited value. In view of the rising costs of medical investigations, and the risk of irradiation to the developing brain, they suggest the need for clear indications for this procedure in clinical child and adolescent psychiatry.
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Affiliation(s)
- M Ghaziuddin
- Division of Child and Adolescent Psychiatry, University of Michigan Hospital, Ann Arbor 48109-0390
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Affiliation(s)
- M Ghaziuddin
- Department of Child Psychiatry, University of Michigan Hospital, Ann Arbor 48109
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Affiliation(s)
- M Ghaziuddin
- Department of Child and Adolescent Psychiatry, University of Michigan Hospital, Ann Arbor 48109-0390
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Abstract
Depressive illness in a patient with Down's syndrome and autism responded to fluoxetine. The importance of diagnosing superimposed depression in people with developmental disorders is emphasised.
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Affiliation(s)
- M Ghaziuddin
- Taubman Center, University of Michigan Medical Center, Ann Arbor 48109-0390
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Affiliation(s)
- M Ghaziuddin
- University of Michigan Medical Center, Ann Arbor
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Ghaziuddin M, Tsai LY, Ghaziuddin N. Brief report: haloperidol treatment of trichotillomania in a boy with autism and mental retardation. J Autism Dev Disord 1991; 21:365-71. [PMID: 1938782 DOI: 10.1007/bf02207333] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Despite the known association of folie à deux with low intelligence, very few reports of its occurrence in people with documented mental retardation have been published. A case of folie à deux in a 32 year old man with moderate mental retardation is described and the clinical implications discussed. The need for an increased awareness of the existence of mental illness in the mentally handicapped is also emphasized.
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Affiliation(s)
- M Ghaziuddin
- Department of Child Psychiatry, University of Michigan Hospitals, Ann Arbor 41809-0390
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Abstract
Erotomanic delusions occurred in a depressed mentally handicapped woman. Although erotomania is generally classified with paranoid disorders, in people with mental handicap, depression may be the more commonly associated illness.
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Affiliation(s)
- M Ghaziuddin
- Division of Child and Adolescent Psychiatry, CAPH
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Abstract
Symptoms resembling mania following withdrawal of diazepam in a mentally handicapped woman are described. The importance of considering benzodiazepine withdrawal in the assessment of acute behavioural disorders of the mentally handicapped is emphasized. Attention is also drawn to the paucity of research regarding the use of antianxiety drugs in the mentally handicapped.
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Abstract
In a study of the prevalence of life events in recurrent depression, 40 patients with recurrent episodes were compared to 33 who were experiencing their first depressive illness. Thirty out of 33 (90.9%) first episode cases experienced life events prior to the onset of illness whereas only 20 out of 40 (50%) of the recurrent group gave such as history. Patients with a first episode had an average of 2.2 life events in the six months prior to onset, whereas recurrent patients experienced average of only 0.8 life events (p less than 0.05). Negative as well as exit events were also significantly more frequent among the first episode group. Although life events, age and sex all contributed to the recurrence of depression, most of the variance was not accounted for by any of these factors.
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Affiliation(s)
- M Ghaziuddin
- University of Michigan Hospitals, Ann Arbor 48109-0706
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Abstract
A retrospective study of 65 consecutive referrals for behavioural disorder of mentally handicapped patients living in the community revealed that 31 of these were associated with life events sustained in the 12 months prior to the referral. These patients were usually mildly handicapped, while those who presented with behaviour disorder without a history of recent life events were usually more severely retarded. The differences between the two groups are discussed and the need for further research emphasised.
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Affiliation(s)
- M Ghaziuddin
- Department of Mental Handicap, University Hospital, Nottingham
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