Psychiatry

OBJECTIVE: Compulsive hoarding is a debilitating problem that is often associated with obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder. However, the precise nosology of compulsive hoarding has yet to be determined. METHOD: Participants were 25 patients with severe compulsive hoarding with OCD and 27 patients with severe compulsive hoarding without OCD. Both groups were carefully characterized and compared on the following sociodemographic and clinical variables: precise phenomenology of hoarding behavior, severity of other OCD symptoms, axis I and axis II psychopathology, and adaptive functioning. For comparison purposes, the following individuals were also recruited: 71 patients with OCD without hoarding, 19 patients with anxiety disorder, and 21 community participants. RESULTS: Overall, the phenomenology of hoarding behavior was similar in the two hoarding groups. The majority of participants in both groups reported hoarding common items as a result of their emotional and/or intrinsic value. However, approximately one-fourth of participants in the compulsive hoarding with OCD group showed a different psychopathological profile, which was characterized by the hoarding of bizarre items and the presence of other obsessions and compulsions related to their hoarding, such as fear of catastrophic consequences, the need to perform checking rituals, and the need to perform mental compulsions before discarding any item. These patients had a more severe and disabling form of the disorder. The strong relationship between compulsive hoarding and obsessive-compulsive personality disorder was explained entirely by the overlapping item content. CONCLUSIONS: In most individuals, compulsive hoarding appears to be a syndrome separate from OCD, which is associated with substantial levels of disability and social isolation. However, in other individuals, compulsive hoarding may be considered a symptom of OCD and has unique clinical features. These findings have implications for the classification of OCD and compulsive hoarding in the next edition of DSM.

BACKGROUND AND PURPOSE: Neuroinflammatory molecules, including tumor necrosis factor-␣, inter-leukin1-␤, lymphocyte function associated molecule-1, and intercellular cell adhesion molecule-1 contribute to the development of brain abscess. We hypothesized that the high fractional anisotropy (FA) in the brain abscess cavity reflects the upregulation of these neuroinflammatory molecules. MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was performed in 24 patients with brain abscess and Staphylococcus aureus-treated as well as nontreated Jurket cell lines (at 4 time points: 1, 24, 48, and 72 hours). Neuroinflammatory molecules were quantified from the brain abscess cavity aspirate of the patients as well as from the heat-killed S aureus-treated and nontreated cell lines and correlated with DTI measures. RESULTS: The DTI-derived FA strongly correlated with the presence of neuroinflammatory molecules in the pus as well as in S aureus-treated cell lines; no such correlation was observed in nontreated cell lines. CONCLUSIONS: These data indicate that neuroinflammatory molecules confer high diffusion anisotropy inside the brain abscess cavity. We propose that increased FA reflects upregulated inflammatory response in brain abscess.

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

Clonidine, an alpha2-agonist, has been used in a large number of children and adolescents in combination with methylphenidate (MPH) to provide better control of Attention Deficit/Hyperactivity Disorder (ADHD) symptoms especially hyperactivity and impulsivity, aggression and oppositionality, tics and treatment emergent side effects of MPH such as insomnia. Clonidine has been found safe and effective in mentally retarded (MR) children with ADHD. Our report describes a MR child in which ADHD and Oppositional Defiant Disorder (ODD) symptoms worsened after addition of clonidine to MPH.

We report two cases diagnosed with Tuberous Sclerosis Complex (TSC) that showed relatively late onset developmental regression with loss of skills following onset of epileptic spasms at around two years of age. Both the cases were reported to be developing normally before the regression. The regression in both children was characterised by a sudden and dramatic loss of intellectual abilities, social, communication and play skills and the emergence of autistic symptoms. The loss of skills in one case temporarily improved following initial treatment with steroids, but recurred after seizures (including periods of status epilepticus) began again. In both cases, the loss of skills persisted after seizures were eventually controlled. At follow-up after 5 + years of age, one child had developed all the features of autism, whereas the child who had shown transient developmental improvement following treatment with steroids had developed a number of symptoms of autism, but not the full syndrome.