The Clinical Characteristics of ADHD and Obsessive-Compulsive Disorder Comorbidity

Objective: To investigate the clinical implications of obsessive-compulsive disorder (OCD) and ADHD comorbidity in adults. Method: The OCD patients who had and had no diagnosis of adulthood ADHD were compared in terms of several demographic and clinical variables. Results: The mean number of obsessions and compulsions; hoarding, symmetry, and miscellaneous obsessions; ordering/arranging and hoarding compulsions; total, attentional, and motor subscale scores of Barratt Impulsivity Scale (BIS)-11 were more frequent among the patients with OCD-ADHD. The mean age of onset was more likely to be earlier in ADHD-OCD group than in OCD group. Impulsivity, symmetry obsessions, and hoarding compulsions strongly predicted the coexistence between ADHD and OCD. Conclusion: OCD-ADHD comorbidity in adults seemed to be associated with an earlier onset of OCD, with the predominance of impulsivity, and with a different obsessive-compulsive symptom (OC) profile from OCD patients without a diagnosis of ADHD.

A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale–Revised in patients with minimally conscious state

Objective: To investigate which conscious behaviour is most frequently detected using the Coma Recovery Scale-Revised in patients with minimally conscious state. Design: Multicentre, cross-sectional study. Setting: One intensive care unit, 8 post-acute rehabilitation centres and 2 long-term facilities. Subjects: Fifty-two patients with established diagnosis of minimally conscious state of different aetiology. Main measures: All patients were assessed by the Coma Recovery Scale-Revised. Results: In most patients (34/52) non-reflexive responses were identified by two or more subscales of the Coma Recovery Scale-Revised, whereas in 14 patients only the visual subscale could identify cortically-mediated behaviours, and in the remaining 4 patients only the motor subscale did so. The clinical signs of intentional behaviour were most often detected by the visual subscale (43/52 patients) and by the motor subscale (31/52), and least frequently by the oromotor/verbal subscale (3/52) of the Coma Recovery Scale-Revised. This clinical pattern was observed independently from time post-onset and aetiology. Conclusions: Non-reflexive visual behaviour, identified by the visual subscale of Coma Recovery Scale-Revised, is the most frequently detected intentional sign consistent with the diagnosis of minimally conscious state, independently from aetiology and time post-onset.

Impulsivity in adolescent bipolar disorder

Objective: Increased impulsivity has been shown to be a trait feature of adults with bipolar disorder (BD), yet impulsivity has received little study in adolescents with BD. Thus, it is unknown whether it is a trait feature that is present early in the course of the disorder. We tested the hypotheses that self-reported impulsiveness is increased in adolescents with BD, and that it is present during euthymia, supporting impulsiveness as an early trait feature of the disorder.Methods: Impulsiveness was assessed in 23 adolescents with BD and 23 healthy comparison (HC) adolescents using the self-report measure of impulsivity, the Barratt Impulsiveness Scale (BIS), comprised by attentional, motor and non-planning subscale scores. Effects of subscale scores and associations of scores with mood state and course features were explored.Results: Total and subscale BIS scores were significantly higher in adolescents with BD than HC adolescents. Total, attentional and motor subscale BIS scores were also significantly higher in the subset of adolescents with BD who were euthymic, compared to HC adolescents. Adolescents with BD with rapid-cycling and chronic mood symptoms had significantly higher total and motor subscale BIS scores than adolescents with BD without these course features.Conclusion: These results suggest increased self-reported impulsiveness is a trait feature of adolescents with BD. Elevated impulsivity may be especially prominent in adolescents with rapid-cycling and chronic symptoms.

Using Cluster Analysis to Interpret the Variability of Gross Motor Scores of Children With Typical Development

Background Longitudinal research on gross motor percentile rank scores of children with typical development has documented intra-individual variability of scoring patterns. Clinically, interpreting these fluctuations presents a challenge for therapists. Objective The aim of this study was to determine the utility of cluster analysis as a technique to organize the gross motor scoring patterns of children with typical development into clinically relevant groups. Design This was a descriptive, exploratory study using data from 2 longitudinal studies. Participants Sixty-six children with typical development participated in the study. Methods The children were assessed on the gross motor subscale of the Peabody Developmental Motor Scales at 9, 11, 13, 16, and 21 months of age and on the gross motor subscale of the Peabody Developmental Motor Scales, 2nd edition, at 4, 4.5, 5, and 5.5 years of age. Demographic and health data were collected. Parents were interviewed when the children were 8 years of age. Cluster analysis was conducted. Demographic and health data were compared across clusters. Results Four distinct and clinically relevant clusters were identified. A significant difference was found among the clusters for total number of illnesses. Limitations The children in these analyses were at low risk for gross motor problems. Further research with a more high-risk sample is needed to validate the clinical utility of the identified clusters. Conclusions Cluster analysis techniques may offer a mechanism to explore longitudinal data in physical therapy research. The techniques provided a mechanism to group data without losing the richness of information provided by the intra-individual variability of scoring patterns. Clinically, examination of distinct scoring patterns may lead to improved accuracy in screening for gross motor concerns compared with the traditional use of single-assessment cutoff points.

A randomized controlled trial evaluating a topical treatment for chemotherapy-induced neuropathy: NCCTG trial N06CA

9531 Background: Chemotherapy induced peripheral neuropathy (CIPN) is a prevalent dose limiting toxicity for several important cancer treatment agents. CIPN can impair function and cause distress. There are no proven pharmacologic treatments for established CIPN currently. This double blind randomized placebo controlled trial evaluated a compounded topical gel for this problem. The novelty of this treatment is that it might incorporate several agents with different mechanisms of action to provide relief locally without negative systemic effects. Methods: Patients with CIPN (rated ≥4 out of 10) for at least one month, related to previous and/or concurrent exposure to neurotoxic agents, were randomized to baclofen 10 mg, amitriptyline HCL 40 mg and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) vs placebo (PLO) to determine its effect on numbness, tingling, pain, and motor function. Exclusion criteria included other causes and/or current treatment for peripheral neuropathy. The primary endpoint was the baseline adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks. Results: Between February and May 2008, 208 patients were enrolled onto this trial. Four week data are shown in the table below, higher numbers being better. The percentage of patients that had improvements of at least 10, on a 100 point scale, in the motor subscale was statistically significantly higher in the BAK-PLO arm, p=.04. There were no unwanted toxicities associated with the BAK-PLO that were significantly different from placebo and no evidence of CNS or systemic toxicity. Conclusions: Topical treatment with BAK-PLO appears to moderately improve symptoms of CIPN. This topical gel was well tolerated without systemic side effects. [Table: see text] No significant financial relationships to disclose.