Showing papers by "David Cohen published in 2015"

Modeling Linkage Disequilibrium Increases Accuracy of Polygenic Risk Scores

Abstract: Polygenic risk scores have shown great promise in predicting complex disease risk and will become more accurate as training sample sizes increase. The standard approach for calculating risk scores involves linkage disequilibrium (LD)-based marker pruning and applying a p value threshold to association statistics, but this discards information and can reduce predictive accuracy. We introduce LDpred, a method that infers the posterior mean effect size of each marker by using a prior on effect sizes and LD information from an external reference panel. Theory and simulations show that LDpred outperforms the approach of pruning followed by thresholding, particularly at large sample sizes. Accordingly, predicted R(2) increased from 20.1% to 25.3% in a large schizophrenia dataset and from 9.8% to 12.0% in a large multiple sclerosis dataset. A similar relative improvement in accuracy was observed for three additional large disease datasets and for non-European schizophrenia samples. The advantage of LDpred over existing methods will grow as sample sizes increase.

Relation of Frailty to Outcomes After Transcatheter Aortic Valve Replacement (from the PARTNER Trial)

Abstract: Transcatheter aortic valve replacement (TAVR) is an effective treatment for severe symptomatic aortic stenosis (AS) in patients who are inoperable or at high risk for surgery. However, the intermediate- to long-term mortality is high, emphasizing the importance of patient selection. We, therefore, sought to evaluate the prognostic value of frailty in older recipients of TAVR, hypothesizing that frail patients would experience a higher mortality rate and a higher likelihood of poor outcome 1 year after TAVR. This substudy of the Placement of Aortic Transcatheter Valves trial was conducted at 3 high-enrolling sites where frailty was assessed systematically before TAVR. In total, 244 patients received TAVR at the participating sites. Frailty was assessed using a composite of 4 markers (serum albumin, dominant handgrip strength, gait speed, and Katz activity of daily living survey), which were combined into a frailty score. The cohort was dichotomized at median frailty score. Outcomes measures were the time to death from any cause for >1 year of follow-up and poor outcome at 1 year. Poor outcome was defined as (1) death, (2) Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score

Autism as a Disorder of Biological and Behavioral Rhythms: Toward New Therapeutic Perspectives

Abstract: There is a growing interest in the role of biological and behavioral rhythms in typical and atypical development. Recent studies in cognitive and developmental psychology have highlighted the importance of rhythmicity and synchrony of motor, emotional, and interpersonal rhythms in early development of social communication. The synchronization of rhythms allows tuning and adaptation to the external environment. The role of melatonin in the ontogenetic establishment of circadian rhythms and the synchronization of the circadian clocks network suggests that this hormone might be also involved in the synchrony of motor, emotional, and interpersonal rhythms. Autism provides a challenging model of physiological and behavioral rhythm disturbances and their possible effects on the development of social communication impairments and repetitive behaviors and interests. This article situates autism as a disorder of biological and behavioral rhythms and reviews the recent literature on the role of rhythmicity and synchrony of rhythms in child development. Finally, the hypothesis is developed that an integrated approach focusing on biological, motor, emotional, and interpersonal rhythms may open interesting therapeutic perspectives for children with autism. More specifically, promising avenues are discussed for potential therapeutic benefits in autism spectrum disorder of melatonin combined with developmental behavioral interventions that emphasize synchrony, such as the Early Start Denver Model.

In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: Insights into contemporary practice from the TRANSLATE-ACS study:

Abstract: Aims:While randomized clinical trials have compared clopidogrel with higher potency adenosine diphosphate (ADP) receptor inhibitors among patients with acute myocardial infarction, little is known about the frequency, effectiveness and safety of switching between ADP receptor inhibitors in routine clinical practice.Methods and results:We studied 11,999 myocardial infarction patients treated with percutaneous coronary intervention at 230 hospitals from April 2010 to October 2012 in the TRANSLATE-ACS study. Multivariable Cox regression was used to compare six-month post-discharge risks of major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, or unplanned revascularization) and Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-defined bleeding between in-hospital ADP receptor inhibitor switching versus continuation of the initially selected therapy. Among 8715 patients treated initially with clopidogrel, 994 (11.4%) were switched to prasugrel or ti...

Protective factors against depression and suicidal behaviour in adolescence.

Abstract: Objectives: To examine whether protective factors in the Protection for Adolescent Depression Study (PADS) moderate the impact of stressful events on depression and suicidal behaviour in the community and a clinical setting; and to study the influence of sex.

Outcomes of Inoperable Symptomatic Aortic Stenosis Patients Not Undergoing Aortic Valve Replacement: Insight Into the Impact of Balloon Aortic Valvuloplasty From the PARTNER Trial (Placement of AoRtic TraNscathetER Valve Trial)

Abstract: Objectives The aim of this report is to characterize the impact of balloon aortic valvuloplasty (BAV) in patients not undergoing aortic valve replacement in the PARTNER (Placement of AoRtic TraNscathetER Valves) trial. Background The PARTNER trial is the only randomized trial with independently adjudicated data of inoperable severe symptomatic aortic stenosis patients, allowing outcome analysis of unoperated-on patients. Methods The design and initial results of the PARTNER trial (Cohort B) were reported previously. After excluding patients with pre-randomization BAV, we compared patients undergoing BAV within 30 days of randomization (BAV group) with those not having BAV within 30 days of randomization (no BAV group) to characterize the use and impact of BAV. Results In the PARTNER Cohort B study, 179 inoperable patients were randomized to standard treatment including 39 patients (21.8%) who had undergone a BAV before randomization (previous BAV group). Of the 140 patients who did not have BAV before enrollment in the study, 102 patients (73%) had BAV within 30 days of study randomization (BAV group). Survival at 3 months was greater in the BAV group compared with the no BAV group (88.2%; 95% confidence interval [CI]: 82.0% to 94.5% vs. 73.0%; 95% CI: 58.8% to 87.4%). However, survival was similar at 6-month follow-up (74.5%; 95% CI: 66.1% to 83.0% vs. 73.1%; 58.8% to 87.4%). There was improvement in quality of life parameters when paired comparisons were made between baseline and 30 days and 6 months between the BAV and no BAV groups, but this effect was lost at 12-month follow-up. Conclusions BAV improves functional status and survival in the short term, but these benefits are not sustained. BAV for aortic stenosis patients who cannot undergo aortic valve replacement is a useful palliative therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894 )

Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia.

Abstract: We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) deter- mine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecu- tively hospitalized for a catatonic syndrome. We prospec- tively collected sociodemographic, clinical and treatment data. In total, 51 (77 %) patients underwent a BZD trial. BZDs were effective in 33 (65 %) patients, who were asso- ciated with significantly fewer severe adverse events (p = 0.013) and resulted in fewer referrals for electrocon- vulsive therapy (ECT) (p = 0.037). Other treatments included ECT (N = 12, 18 %); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia (p = 0.032). In contrast, the response was lower in boys (p = 0.044) and when posturing (p = 0.04) and mannerisms (p = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.

Risk and protective factors for suicidality at 6-month follow-up in adolescent inpatients who attempted suicide: an exploratory model

Abstract: OBJECTIVE: To assess risk and protective factors for suicidality at 6-month follow-up in adolescent inpatients after a suicide attempt. METHODS: One hundred seven adolescents from 5 inpatient units who had a suicide attempt were seen at 6-month follow-up. Baseline measures included sociodemographics, mood and suicidality, dependence, borderline symptomatology, temperament and character inventory (TCI), reasons for living, spirituality, and coping scores. RESULTS: At 6-month follow-up, 41 (38%) subjects relapsed from suicidal behaviours. Among them, 15 (14%) had repeated a suicide attempt. Higher depression and hopelessness scores, the occurrence of a new suicide attempt, or a new hospitalization belonged to the same factorial dimension (suicidality). Derived from the best-fit structural equation modelling for suicidality as an outcome measure at 6-month follow-up, risk factors among the baseline variables included: major depressive disorder, high depression scores, and high scores for TCI self-transcendence. Only one protective factor emerged: coping-hard work and achievement. CONCLUSION: In this very high-risk population, some established risk factors (for example, a history of suicide attempts) may not predict suicidality. Our results suggest that adolescents who retain high scores for depression or hopelessness, who remain depressed, or who express a low value for life or an abnormally high connection with the universe are at higher risk for suicidality and should be targeted for more intense intervention. Improving adolescent motivation in school and in work may be protective. Given the sample size, the model should be regarded as exploratory. Language: en

Association of Patient-Reported Health Status With Long-Term Mortality After Transcatheter Aortic Valve Replacement Report From the STS/ACC TVT Registry

Abstract: Background— Although transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status measure, assessed directly from patients, that integrates 2 clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes. Methods and Results— Among 7769 patients from 286 sites in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. The KCCQ Overall Summary Score was categorized as very poor: <25, poor: 25 to 49, fair: 50 to 74, or good: ≥75. Before TAVR, health status was rated as very poor in 28%, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a broad range of baseline covariates, patients with very poor health status had a 2-fold increased hazard of death over the first year after TAVR (adjusted hazard ratio, 2.00; 95% confidence interval, 1.58–2.54), whereas those with poor and fair health status had intermediate outcomes (adjusted hazard ratio, 1.54; 95% confidence interval, 1.22–1.95 and adjusted hazard ratio, 1.20; 95% confidence interval, 0.94–1.55, respectively). Conclusions— In a national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR.

A Multidimensional Approach to the Study of Emotion Recognition in Autism Spectrum Disorders.

Abstract: Although deficits in emotion recognition have been widely reported in Autism Spectrum Disorder (ASD), experiments have been restricted to either facial or vocal expressions. Here, we explored multimodal emotion processing in children with ASD (N=19) and with typical development (TD, N=19), considering uni (faces and voices) and multimodal (faces/voices simultaneously) stimuli and developmental comorbidities (neuro-visual, language and motor impairments). Compared to TD controls, children with ASD had rather high and heterogeneous emotion recognition scores but showed also several significant differences: lower emotion recognition scores for visual stimuli, for neutral emotion, and a greater number of saccades during visual task. Multivariate analyses showed that: (1) the difficulties they experienced with visual stimuli were partially alleviated multimodal stimuli. (2) Developmental age was significantly associated with emotion recognition in TD children, whereas it was the case only for the multimodal task in children with ASD. (3) Language impairments tended to be associated with emotion recognition scores of ASD children in the auditory modality. Conversely, in the visual or bimodal (visuo-auditory) tasks, the impact of developmental coordination disorder or neuro-visual impairments was not found. We conclude that impaired emotion processing constitutes a dimension to explore in the field of ASD, as research has the potential to define more homogeneous subgroups and tailored interventions. However, it is clear that developmental age, the nature of the stimuli, and other developmental comorbidities must also be taken into account when studying this dimension.

Coping skills among adolescent suicide attempters: results of a multisite study.

Abstract: OBJECTIVES: A multisite study was undertaken to advance our understanding of how coping skills, depression, and suicidal ideation are related among adolescents who attempt suicide Two hypotheses were postulated: productive coping and nonproductive coping would be associated, respectively, with lower and higher depression scores when age, sex, and stressful life events (SLEs) were controlled; and productive coping and nonproductive coping would be associated, respectively, with the presence and absence of suicidal ideation when age, sex, and SLEs were controlled METHODS: Participants were 167 adolescents (13 to 17 years of age) hospitalized for attempting suicide in 5 pediatric departments across France Four instruments were administered: the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, the Adolescent Coping Scale, the Life Events Questionnaire, and the Columbia-Suicide Severity Rating Scale Descriptive analyses and univariate and multiple regression models were completed RESULTS: Both hypotheses were confirmed Focus on the positive emerged as a significant variable in both models; depression emerged as a significant variable in the suicidal ideation model The only sex difference observed was that girls made greater use of wishful thinking and seek social support CONCLUSIONS: These findings suggest that coping skills are important mechanisms through which depression and suicidal ideation are maintained after attempting suicide In intervening with adolescents who have attempted suicide, it may be useful to emphasize cognitive work geared to looking on the bright side, positive thinking, and fighting depression Language: en

Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder

Abstract: OBJECTIVE: DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD. METHODS: Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: "adolescents," "children," "paediatric," "youth," "irritability," "temper outbursts," "aggression," "rage," "disruptive behaviour," "treatment," "dysphoria," "autism," "mental retardation/intellectual disability," "impulsivity," "ADHD," "oppositional defiant disorder," and "conduct disorder." A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained. RESULTS: Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. CONCLUSION: Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities. KEYWORDS: aggression; bipolar disorder; depression; disruptive mood dysregulation; irritability; mood stabilizers Language: en

A Systematic Review of the Evidence for Impaired Cognitive Theory of Mind in Maltreated Children

Abstract: Compared to the large number of studies exploring difficulties in emotion recognition in maltreated children, few (N=12) have explored the cognitive aspect of theory of mind, i.e., the ability to understand others’ thoughts and intentions. A systematic review of these studies shows inconsistent results regarding cognitive theory of mind tasks. Youths with a history of maltreatment are more likely to fail at false belief tasks (N=2). However, results are less conclusive regarding other tasks (perspective-taking tasks, N=4; and hostile attribution tasks, N=7). Additionally, only one study controlled for potential psychopathology. Measures of psychopathology and other cognitive abilities, in addition to theory of mind, are required to establish a specific association between maltreatment and the cognitive dimension of theory of mind.

Coping strategies associated with suicidal behaviour in adolescent inpatients with borderline personality disorder.

Abstract: OBJECTIVES: To compare the coping strategies of adolescents with borderline personality disorder (BPD) to the coping strategies of adolescents without BPD, and to explore the association of coping with suicidal ideation and attempts among adolescents with BPD. METHOD: Adolescent inpatients (n = 167) aged 13 to 17 years were admitted after suicide attempts and evaluated within 10 days, using the abbreviated version of the Diagnostic Interview for Borderlines-Revised, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version supported by a team consensus best estimate method for the primary diagnosis, the Adolescent Coping Scale, and the Columbia-Suicide Severity Rating Scale. RESULTS: Firstly, compared with adolescents without BPD, adolescents with BPD relied more on nonproductive coping strategies, mostly avoidant strategies, and less on productive coping strategies. Secondly, coping appeared as a factor associated with suicidal ideation in adolescents with BPD. While while controlling for age, sex, and depression, multivariate analyses showed a significant positive association between the coping strategy to focusing on solving the problem and suicidal ideation. CONCLUSION: The use of avoidant strategies by adolescents with BPD could be viewed as attempts to increase emotional regulation. Problem-solving strategies in the immediate aftermath of a suicide attempt may prevent adolescents with BPD from overcoming a crisis and may increase suicidal ideation. Language: en

Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement A Placement of AoRTic TraNscathetER Valve (PARTNER) Trial Substudy

Abstract: Background—In the Placement of AoRTic TraNscathetER Valve (PARTNER) randomized controlled trial (RCT), which represented the first exposure to transapical transcatheter aortic valve replacement (TA-TAVR) for many clinical sites, high-risk patients undergoing TA-TAVR derived similar health-related quality of life (HRQoL) outcomes when compared with surgical aortic valve replacement (SAVR). With increasing experience, it is possible that HRQoL outcomes of TA-TAVR may have improved. Methods and Results—We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-ups among 875 patients undergoing TA-TAVR in the PARTNER nonrandomized continued access (NRCA) registry and compared these outcomes with those of the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes Study Short-Form 12, and the EuroQoL-5D, with the KCCQ overall summary score serving as the primary end point. The NRCA TA-TAVR and RCT TA-TAVR and SAVR groups we...

Psychotherapy for depression in children and adolescents: study protocol for a systematic review and network meta-analysis

Abstract: Introduction Depression is common among children and adolescents and is associated with significantly negative effects. A number of structured psychosocial treatments are administered for depression in children and adolescents; however, evidence of their effectiveness is not clear. We describe the protocol of a systematic review and network meta-analysis to evaluate the efficacy, quality of life, tolerability and acceptability of the use of psychological intervention for this young population. Methods and analysis We will search PubMed, EMBASE, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS, Dissertation Abstracts, European Association for Grey Literature Exploitation (EAGLE) and the National Technical Information Service (NTIS) from inception to July 2014. There will be no restrictions on language, publication year or publication type. Only randomised clinical trials (RCTs) with psychosocial treatments for depression in children and adolescents will be considered. The primary outcome of efficacy will be the mean overall change of the total score in continuous depression severity scales from baseline to end point. Data will be independently extracted by two reviewers. Traditional pairwise meta–analyses will be performed for studies that directly compared different treatment arms. Then we will perform a Bayesian network meta–analyses to compare the relative efficacy, quality of life, tolerability and acceptability of different psychological intervention. Subgroup analyses will be performed by the age of participants and the duration of psychotherapy, and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. The results will be published in a peer–reviewed journal and disseminated electronically and in print. The meta–analysis may be updated to inform and guide management of depression in children and adolescents. Trials registration number PROSPERO CRD42014010014.

Hypomorphic variants of cationic amino acid transporter 3 in males with autism spectrum disorders

Abstract: Cationic amino acid transporters (CATs) mediate the entry of L-type cationic amino acids (arginine, ornithine and lysine) into the cells including neurons. CAT-3, encoded by the SLC7A3 gene on chromosome X, is one of the three CATs present in the human genome, with selective expression in brain. SLC7A3 is highly intolerant to variation in humans, as attested by the low frequency of deleterious variants in available databases, but the impact on variants in this gene in humans remains undefined. In this study, we identified a missense variant in SLC7A3, encoding the CAT-3 cationic amino acid transporter, on chromosome X by exome sequencing in two brothers with autism spectrum disorder (ASD). We then sequenced the SLC7A3 coding sequence in 148 male patients with ASD and identified three additional rare missense variants in unrelated patients. Functional analyses of the mutant transporters showed that two of the four identified variants cause severe or moderate loss of CAT-3 function due to altered protein stability or abnormal trafficking to the plasma membrane. The patient with the most deleterious SLC7A3 variant had high-functioning autism and epilepsy, and also carries a de novo 16p11.2 duplication possibly contributing to his phenotype. This study shows that rare hypomorphic variants of SLC7A3 exist in male individuals and suggest that SLC7A3 variants possibly contribute to the etiology of ASD in male subjects in association with other genetic factors.

Cluster-Randomized Clinical Trial Examining the Impact of Platelet Function Testing on Practice The Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome Prospective Open Label Antiplatelet Therapy Study

Abstract: Background— Little is known about how clinicians use platelet function testing to guide choice and dosing of adenosine diphosphate receptor inhibitor (ADPri) therapy in routine community practice. Methods and Results— The Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (ACS)—Prospective, Open Label, Antiplatelet Therapy Study (TRANSLATE-POPS) was a cluster-randomized trial in which 100 hospitals were assigned access to no-cost platelet function testing versus usual care for acute myocardial infarction patients treated with percutaneous coronary intervention. In both arms, ADPri treatment decisions were left up to the care team. The primary end point was the frequency of ADPri therapy adjustment before discharge. Secondary end points included 30-day rates of major adverse cardiovascular events and Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries–defined bleeding events. Platelet function testing was performed in 66.9% of patients treated in intervention sites versus 1.4% of patients in usual care sites. Intervention arm patients were more likely to have ADPri therapy adjustment than usual care patients (14.8% versus 10.5%, P =0.004; odds ratio 1.68, 95% confidence interval 1.18–2.40); however, there were no significant differences in 30-day major adverse cardiovascular events (4.8% versus 5.4%, P =0.73; odds ratio 0.94, 95% confidence interval 0.66–1.34) or bleeding (4.3% versus 4.2%, P =0.33; odds ratio 0.86, 95% confidence interval 0.55–1.34). One-year outcomes were also not significantly different between groups. An as-treated analysis showed higher incidence of ADPri therapy adjustment among intervention arm patients who received platelet function testing than untested usual care arm (16.4% versus 10.2%, P <0.0001), but no significant differences in major adverse cardiovascular events or bleeding. Conclusions— TRANSLATE-POPS found that when clinicians routinely used platelet function testing, they were more likely to adjust their choice or dosing of ADPri therapy; yet with few changes in therapy overall, significant differences in clinical outcomes were not seen. Clinical Trial Registration— URL: . Unique identifier: [NCT01088503][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01088503&atom=%2Fcirccvint%2F8%2F6%2Fe001712.atom

On the existence of synchrostates in multichannel EEG signals during face-perception tasks

Abstract: Phase synchronisation in multichannel electroencephalography (EEG) is known as the manifestation of functional brain connectivity. Traditional phase synchronisation studies are mostly based on time average synchrony measures, and hence do not preserve the temporal evolution of the phase difference. Here we propose a new method to show the existence of a small set of unique phase synchronised patterns or 'states' in multi-channel EEG recordings, each 'state' being stable of the order of ms, from typical and pathological subjects during face perception tasks. The proposed methodology bridges the concepts of EEG microstates and phase synchronisation in the time and frequency domain, respectively. The analysis is reported for four groups of children including typical, autism spectrum disorder, low and high anxiety subjects—a total of 44. In all cases, we observe consistent existence of these states—termed as synchrostates—within specific cognition-related frequency bands (beta and gamma bands), though the topographies of these synchrostates differ for different subject groups with different pathological conditions. The inter-synchrostate switching follows a well-defined sequence capturing the underlying inter-electrode phase relation dynamics in a stimulus- and person-centric manner. Our study is motivated by the well-known EEG microstate exhibiting stable potential maps over the scalp. However, here we report a similar observation of quasi-stable phase synchronised states in multichannel EEG. The existence of the synchrostates coupled with their unique switching sequence characteristics could be considered as a potentially new field over contemporary EEG phase synchronisation studies.

Intérêt des unités neurocomportementales multidisciplinaires dans la prise en charge des décompensations aiguës des patients présentant un trouble du spectre autistique

Abstract: Resume Objectifs A l’adolescence, certains sujets souffrant de troubles du spectre autistique (TSA) presentent des troubles du comportement severes Cet article resume les deux premieres annees d’activite d’une unite nouvelle dediee a ces situations complexes Methodes Apres deux etudes colligeant les facteurs de risque de decompensation aigue parmi les adolescents et jeunes adultes atteints de TSA admis en unite neurocomportementale pluridisciplinaire specialisee (Perisse et al, 2010 ; Guinchat et al, 2015), nous proposons de resumer les principaux enseignements cliniques que nous avons acquis et d’illustrer, au travers de trois situations cliniques paradigmatiques, la pertinence de notre approche pluridisciplinaire Resultats Les etiologies les plus frequentes de decompensation aigue parmi les patients atteints de TSA sont les causes organiques (epilepsie, pathologies douloureuses), environnementales (absence de soins, trouble de l’adaptation) et psychiatriques (catatonie, episode depressif majeur, trouble bipolaire, schizophrenie) Apres la demarche diagnostique, traiter l’epilepsie, les pathologies douloureuses, les comorbidites psychiatriques et les causes environnementales a ete particulierement utile En outre, une plus longue duree d’hospitalisation etait correlee a un score plus eleve a l’echelle de fonctionnement global a la sortie, et ce meme apres ajustement des facteurs confondants Les observations cliniques rapportent la demarche diagnostique et la conduite du traitement d’une cause organique intriquee a des desordres lies a une iatrogenie medicamenteuse (cas 1), d’une comorbidite psychiatrique non autistique (cas 2), et d’une communication environnementale deviante avec consequences developpementales (cas 3) Conclusion Les troubles severes du comportement des adolescents autistes peuvent etre dus a des facteurs de risque environnementaux, psychiatriques ou somatiques (epilepsie, pathologies algiques) La pertinence de la prise en charge de ces troubles du comportement en unites neurocomportementales specialisees est soutenue par les resultats recueillis apres deux ans d’activite

Critical aortic stenosis and acute ascending aortic penetrating ulcer managed utilizing transapical TAVR and TEVAR.

Abstract: Thoracic endovascular aortic repair (TEVAR) of acute ascending aortic pathology is feasible; however, the unique features of this aortic segment in addition to access challenges restricts its use to a select, high-risk subset of patients. With the advent of TAVR, large device delivery using transapical access has become a well-defined technique. We report a patient with critical aortic stenosis and an acute ascending aortic penetrating ulcer with tamponade managed successfully utilizing transapical TAVR and TEVAR. To our knowledge, this is the first reported case of a hybrid single-stage TAVR and ascending aortic TEVAR using transapical access. © 2015 Wiley Periodicals, Inc.

There Is No Cure for Existence: On the Medicalization of Psychological Distress

Abstract: The current model of biological psychiatry assumes that mental suffering results from cerebral/neuronal disturbances yet to be identified. Under this model, the lowering of diagnostic thresholds or the invention of new disorders are surprising given that there have been no major etiological findings for decades. No clinical or epidemiological research demonstrates biological causes for problems defined as mental disorders, no more than research validates the numerous categories that supposedly describe them. The diagnostic spiral leads to the increasing prescription of drugs, sometimes for life, even if they have not been shown to have any substantial positive effect on any measure of “morbidity” for mental disorders. Today, the lives of children and adults are punctuated by the consumption of psychotropic drugs prescribed by physicians who are pushed to diagnose, treat, and control their symptoms. We aimed at showing that, despite these inarguable failures, the scientific and media discourse gives the public a warped view of reality where progress in biological psychiatric research is unceasing. Therefore we call for a paradigm shift in mental health: critical thinking, openness of mind, and analysis of the scientific and institutional discourse must be encouraged among all practitioners because their ethical commitment to their patients demands it.