[A neonate with a mass on the upper back].

Immediately after birth, a skin-covered mass with weak consistency was noted on the back of a full-term newborn boy. Ultrasound and MRI (performed to exclude spina bifida occulta) showed a multicystic venolymphatic malformation. Sclerotherapy or surgical excision are possible treatments.

Treatment of nail psoriasis with efalizumab: a preliminary study.

Nail involvement is common in psoriasis, affecting 50% to 80% of all patients with the disorder. Pain may accompany nail involvement, restricting daily living activities, and therapy is limited by issues of efficacy and safety. The cases of 4 participants who had been enrolled in a 3-year study of efalizumab for the treatment of chronic moderate to severe plaque psoriasis are presented in this preliminary study.

Changes in neuronal activation with increasing attention demand in healthy volunteers: an fMRI study.

Several lines of evidence suggest that structures involved in mediating attention differentially respond to increasing processing demand. Investigation of differences in neuronal activation, however, has been complicated by methodological inconsistencies and concomitant discrepancies in degree of difficulty and subject effort between disparate tasks. In this study, we utilized fMRI to compare neural activation patterns associated with two related attention tasks associated with different degrees of processing load while controlling for degree of performance difficulty.

Reaction time measures of sustained attention differentiate bipolar disorder from schizophrenia.

Although continuous performance tasks (CPTs) are becoming more common in psychiatric research, it remains unclear which performance measures best differentiate psychiatric patient groups and along which psychological dimensions. To address this the authors examined sustained attention decrements in patients with bipolar disorder and schizophrenia using CPT measures of perceptual sensitivity, response bias, and psychomotor processing speed. Patients with bipolar disorder with psychotic features (N=20), schizophrenia (N=20), and healthy controls (N=20) were evaluated using structured clinical interviews.

Behavioral sensitization in humans.

Behavioral sensitization is the process whereby repeated, intermittent stimulant administration produces a progressively greater and enduring behavioral response. For over two decades, behavioral sensitization has been reliably demonstrated in a number of different animal species and has been proposed as a model for the development of stimulant dependence. However, the application of this model to humans is limited since there have been relatively few studies of sensitization in human subjects.

Human response to repeated low-dose d-amphetamine: evidence for behavioral enhancement and tolerance.

Previously, we reported progressively greater behavioral responses to repeated d-amphetamine in human subjects that represented a potential model of behavioral sensitization. To extend this work, 59 healthy volunteers were randomly assigned to one of three protocols: (1) placebo administered on days 1, 3, and 5 (PPP); (2) placebo administered on days 1 and 3, and d-amphetamine (0.25 mg/kg) on day 5 (PPA); and (3) d-amphetamine administered on days 1, 3, and 5 (AAA).

Persistent attentional dysfunction in remitted bipolar disorder.

Objectives: Although previous research has shown that attentional dysfunction is common during acute mood episodes in individuals with bipolar disorder (BPD), few studies have examined whether attentional deficits are evident during periods of symptom stability. The goal of this study was to determine whether clinically stable individuals with BPD would have attentional disturbances relative to healthy subjects.

Methods: Fourteen patients with BPD and 12 healthy comparison subjects participated in the study, and were administered the Degraded Stimulus Continuous Performance Test (DSCPT), Digit Span Distractibility Test (DSDT) and Grooved Pegboard Test (GPT).

Neuroimaging in bipolar disorder.

Objective: The authors reviewed neuroimaging studies of bipolar disorder in order to evaluate how this literature contributes to the current understanding of the neurophysiology of the illness.

Method: Papers were reviewed as identified, using the NIMH PubMed literature search systems that reported results of neuroimaging studies involving a minimum of five bipolar disorder patients compared with healthy comparison subjects.

Results: Structural neuroimaging studies report mixed results for lateral and third ventriculomegaly.

fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder.

Background: Previous studies suggest that a neural circuit involving over-activation of cortical, paralimbic, limbic, and striatal structures may underlie OCD symptomatology, but results may have been limited by medication use in those studies. To address this, we examined the effects of symptom induction on fMRI neural activation in medication-free patients with OCD.

Methods: Seven outpatients with OCD were exposed to individually tailored provocative and innocuous stimuli during fMRI scans.

Is impaired outcome following a first manic episode due to mood-incongruent psychosis?

Background: Mood-incongruent psychosis during the course of bipolar disorder has been associated with poor outcome. However, it remains unknown whether this is secondary to persistent affective or psychotic symptoms or both.

Method: Fifty patients with bipolar disorder between the ages of 16 and 45 years were recruited during their first psychiatric hospitalization for mania.

Twelve-month outcome in bipolar patients with and without personality disorders.

Background: We studied the 12-month course of illness after hospitalization for patients with a DSM-III-R diagnosis of bipolar disorder, manic or mixed episode, to identify the impact of a co-occurring personality disorder on measures of outcome.

Method: Fifty-nine patients with bipolar disorder hospitalized for the treatment of a manic or mixed episode were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization.

Traumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorder.

The authors examined the occurrence of traumatic brain injury (TBI) in individuals convicted of sexual offenses with and without bipolar disorder and a comparison group of patients with bipolar disorder without a history of sexual offending behaviors. Individuals convicted of sexual offenses and diagnosed with bipolar disorder had greater rates of brain injury resulting from head trauma than individuals convicted of sexual offenses without bipolar disorder and comparison patients with bipolar disorder. TBI predated the first sexual offense and/or the onset of bipolar disorder in most subjects.

Familial rates of affective and substance use disorders in patients with first-episode mania.

Background: One explanation for the high co-occurrence between bipolar and substance use disorders is that substance abuse may precipitate affective symptoms in patients who otherwise may have not had the genetic risk for developing an affective illness. Previous studies comparing familial rates of affective illness between bipolar patients with and without alcohol use have provided conflicting results. We hypothesized that patients with bipolar disorder and antecedent alcohol abuse would have lower familial rates of affective illness than bipolar patients without antecedent alcohol abuse.

MRI analysis of the cerebellum in bipolar disorder: a pilot study.

Since qualitative CT studies have suggested decreased cerebellar size in patients with bipolar disorder, we performed a quantitative analysis of the cerebellum in patients with bipolar disorder to determine whether high-resolution, thin slice magnetic resonance imaging (MRI) morphometry would reveal similar results. Bipolar patients hospitalized for a first manic episode (n = 16), bipolar patients with prior manic episodes hospitalized for a manic episode (n = 14), and normal volunteers (n = 15) matched for age, sex, race, and education were recruited and anatomic brain scans were acquired using a Picker 1.5 Tesla MRI scanner.

Brain magnetic resonance imaging of structural abnormalities in bipolar disorder.

Background: The neuropathogenesis of bipolar disorder remains poorly described. Previous work suggests that patients with bipolar disorder may have abnormalities in neural pathways that are hypothesized to modulate human mood states. We examined differences in brain structural volumes associated with these pathways between patients with bipolar disorder hospitalized with mania and healthy community volunteers.

Twelve-month outcome of patients with DSM-III-R schizoaffective disorder: comparisons to matched patients with bipolar disorder.

Schizoaffective disorder is a relatively common illness with an uncertain relationship with bipolar disorder. The publication of DSM-III-R in 1987 operationalized the diagnosis of schizoaffective disorder, separating it from psychotic bipolar disorder by the presence of persistent psychosis in the absence of affective symptoms. Since that time, there have been few prospective outcome studies comparing schizoaffective and bipolar disorders.

Frontosubcortical neuroanatomy and the continuous performance test in mania.

Objective: The authors examined whether Continuous Performance Test scores correlate with frontosubcortical volumes in bipolar disorder.

Method: The subjects were 17 patients hospitalized for an acute manic episode and 12 group-matched comparison subjects. They underwent magnetic resonance imaging and completed the Continuous Performance Test.

Enhanced behavioral response to repeated d-amphetamine and personality traits in humans.

Background: This study examined whether the magnitude of the behavioral response to repeated d-amphetamine administration previously demonstrated in a double-blind study in humans was associated with certain personality characteristics.

Methods: Eleven normal volunteers completed the Tridimensional Personality Questionnaire (TPQ) prior to being administered three doses of d-amphetamine (0.25 mg/kg) alternating with three doses of placebo over 6 consecutive days.

Progressive behavioral response to repeated d-amphetamine challenge: further evidence for sensitization in humans.

Background: Behavioral sensitization is the process whereby intermittent stimulant exposure produces a time-dependent, enduring, and progressive behavioral response. Although animal models of sensitization are well established, the phenomenon has been relatively little studied in humans. In a previous study, we reported enhanced responses following a second as compared to a first amphetamine dose in eye-blink rate and ratings of increased motor activity/energy, increased speech, and elevated mood in normal human volunteers.

Symptom correlates of attentional improvement following hospitalization for a first episode of affective psychosis.

Background: This study examined patients with a first-episode of affective psychosis during acute and compensated states in order to determine whether changes in attentional functioning over time were accompanied by changes in the severity of psychotic or affective symptoms.

Methods: Attentional performance was measured in patients (n = 27) using the degraded-stimulus continuous Performance Test (CPT) and symptoms were assessed at the time of index hospitalization, and 2 months after discharge. A comparison group of normal volunteers (n = 31) also performed the CPT two months apart.

Attentional improvement following quetiapine fumarate treatment in schizophrenia.

This study examined changes in attentional performance in patients with schizophrenia during the 2 months after initiating treatment with quetiapine fumarate. Prior to treatment, attentional performance in patients with schizophrenia (n = 10) was significantly (p < 0.01) worse than in matched controls (n = 12).

Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization.

Background: Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization.

Method: Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis.

12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.

Objective: The authors studied the 12-month course of illness following hospitalization for a manic or mixed episode of bipolar disorder to identify potential outcome predictors.

Method: They recruited 134 patients with DSM-III-R bipolar disorder who were consecutively admitted for the treatment of a manic or mixed episode. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization.

Twelve-month outcome after a first hospitalization for affective psychosis.

Background: We studied the 12-month course of illness after a first hospitalization for affective psychosis to identify potential outcome predictors in this rarely studied patient population.

Methods: For this study, 109 patients consecutively admitted for their first psychiatric hospitalization for treatment of affective psychosis were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization and at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome predictors.

Attentional performance in patients with psychotic and nonpsychotic major depression and schizophrenia.

Objective: The authors examined Continuous Performance Test scores of patients with major depression with or without psychosis and schizophrenia.

Method: Patients with major depression with psychosis (N = 13), major depression without psychosis (N = 14), and schizophrenia (N = 15) and normal volunteers (N = 14) completed the degraded-stimulus version of the Continuous Performance Test. Patients were rated with the Hamilton Depression Rating Scale and measures of positive formal thought disorder.