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Biomedical subjects

M J Kruesi

Publications and source records attributed to M J Kruesi.

At least 37 records · Page 2Linked to original sources
PubMed1991

Determinants of expressed emotion in families of disturbed and normal children.

Both high expressed emotion (EE) and psychiatric disorders were frequent in the parents of children and adolescents with disruptive behavior disorder (DBD, N = 34) and obsessive compulsive disorder (OCD, N = 49) compared to normal controls (NC, N = 41). Parental psychiatric diagnosis was significantly related to high-EE in fathers (p = .0002) and mothers (p = .0001) of all groups combined, and in parents of the ill groups (p = .03). Absence of diagnosis was associated with low-EE in fathers (p = .0006) and mothers (p = .04) of the controls. Psychiatric diagnosis was the only significant predictor for high-EE in fathers, while for mothers child's diagnosis was a stronger predictor.

Adolescent↗
PubMed1991

Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome.

Chronic fatigue syndrome is characterized by persistent or relapsing debilitating fatigue for at least 6 months in the absence of a medical diagnosis that would explain the clinical presentation. Because primary glucocorticoid deficiency states and affective disorders putatively associated with a deficiency of the arousal-producing neuropeptide CRH can be associated with similar symptoms, we report here a study of the functional integrity of the various components of the hypothalamic-pituitary-adrenal axis in patients meeting research case criteria for chronic fatigue syndrome. Thirty patients and 72 normal volunteers were studied. Basal activity of the hypothalamic-pituitary-adrenal axis was estimated by determinations of 24-h urinary free cortisol-excretion, evening basal plasma total and free cortisol concentrations, and the cortisol binding globulin-binding capacity. The adrenal cortex was evaluated indirectly by cortisol responses during ovine CRH (oCRH) stimulation testing and directly by cortisol responses to graded submaximal doses of ACTH. Plasma ACTH and cortisol responses to oCRH were employed as a direct measure of the functional integrity of the pituitary corticotroph cell. Central CRH secretion was assessed by measuring its level in cerebrospinal fluid. Compared to normal subjects, patients demonstrated significantly reduced basal evening glucocorticoid levels (89.0 +/- 8.7 vs. 148.4 +/- 20.3 nmol/L; P less than 0.01) and low 24-h urinary free cortisol excretion (122.7 +/- 8.9 vs. 203.1 +/- 10.7 nmol/24 h; P less than 0.0002), but elevated basal evening ACTH concentrations. There was increased adrenocortical sensitivity to ACTH, but a reduced maximal response [F(3.26, 65.16) = 5.50; P = 0.0015). Patients showed attenuated net integrated ACTH responses to oCRH (128.0 +/- 26.4 vs. 225.4 +/- 34.5 pmol/L.min, P less than 0.04). Cerebrospinal fluid CRH levels in patients were no different from control values (8.4 +/- 0.6 vs. 7.7 +/- 0.5 pmol/L; P = NS). Although we cannot definitively account for the etiology of the mild glucocorticoid deficiency seen in chronic fatigue syndrome patients, the enhanced adrenocortical sensitivity to exogenous ACTH and blunted ACTH responses to oCRH are incompatible with a primary adrenal insufficiency. A pituitary source is also unlikely, since basal evening plasma ACTH concentrations were elevated. Hence, the data are most compatible with a mild central adrenal insufficiency secondary to either a deficiency of CRH or some other central stimulus to the pituitary-adrenal axis. Whether a mild glucocorticoid deficiency or a putative deficiency of an arousal-producing neuropeptide such as CRH is related to the clinical symptomatology of the chronic fatigue syndrome remains to be determined.

Adrenal Cortex↗
PubMed1991

A preliminary assessment of behavioral problems in children with mastocytosis.

OBJECTIVE: The objectives of this study were to 1) review mastocytosis in terms of the behavioral pathology in adults, and 2) to assess a group of pediatric patients with mastocytosis to determine if similar behavioral pathology is evident. METHOD: Twelve children ages two to eleven referred to the NIH, a tertiary referral center for mastocytosis, were studied. Questionnaires were mailed for assessment of the child's behavior: parents completed the Childhood Behavior Checklist (CBCL) and children four years of age or more were evaluated by their teachers via the Child Behavior Checklist-Teacher Report form. Scores were compared to published normative data and to published data from other medically ill pediatric groups. Pathology was defined as present if the child scored greater than two standard deviations above published age and sex-matched norms. RESULTS: Mean factor scores on the CBCL for children with mastocytosis did not differ significantly from published norms, but individual ratings by parents were significantly elevated in four of ten subjects. Moreover, CBCL ratings by parents were similar to those seen in other medically ill pediatric groups. None of the teacher ratings were in the pathological range. CONCLUSIONS: The results of this study indicate that no clear excess of pathology exists in children with mastocytosis. Individual children treated with antihistamines for mastocytosis seem to have a nonspecific increase in behavioral difficulties at rates similar to other medically ill groups. No unique behavioral pattern implicating histamine overproduction was identified.

Child↗
PubMed1990

Cerebrospinal fluid monoamine metabolites, aggression, and impulsivity in disruptive behavior disorders of children and adolescents.

Cerebrospinal fluid levels of 5-hydroxyindoleacetic acid, a metabolite of serotonin, were measured in relation to aggression, impulsivity, and social functioning in 29 children and adolescents with disruptive behavior disorders. The cerebrospinal fluid 5-hydroxyindoleacetic acid level was low compared with that of age-, sex-, and race-matched patients with obsessive-compulsive disorder. Within the disruptive group, significant negative correlations with age-corrected 5-hydroxyindoleacetic acid level were seen for the child's report of aggression toward people and the expressed emotionality of the child toward his or her mother; other correlations of age-corrected 5-hydroxyindoleacetic acid level with measures of aggression were in the expected negative direction but did not reach statistical significance. Impulsivity per se and socioenvironmental factors were not significantly related to cerebrospinal fluid 5-hydroxyindoleacetic acid concentration.

Adolescent↗
PubMed1990

CSF somatostatin in childhood psychiatric disorders: a preliminary investigation.

Disruptive behavior disorders and obsessive-compulsive disorder have been associated with serotonergic dysfunction as well as particular body habitus findings in pediatric patients. Somatostatin, a peptide which stimulates serotonin release and inhibits growth hormone release, was measured in the cerebrospinal fluid (CSF) of 10 children with disruptive behavior disorders and in 10 age-, sex-, and race-matched pairs of obsessive-compulsive disorder patients. Decreased concentrations of somatostatin were found in disruptive behavior disorder patients relative to obsessive-compulsive children, even after controlling for differences in Tanner stage. In contrast to studies in adults, those patients in a depressed state did not have lower CSF somatostatin concentration.

Adolescent↗
PubMed1990

Normal controls and biological reference values in child psychiatry: defining normal.

About half of adults volunteering as normal control research subjects may be rejected because of significant psychopathology, but no parallel study has been done to date for pediatric subjects. Of 152 applicants (ages 6 to 18) for participation as paid normal controls, 44% were found ineligible and at least 31.8% of the child volunteers had probable or certain psychiatric disorders. Successive screenings, including rating scales and structured interviews, were necessary to obtain controls meeting a defined standard of psychiatric health. Careful scrutiny of child volunteers in biological psychiatric research is needed to assure meaningful comparisons.

Adolescent↗
PubMed1989

EEG spectra in severely dyslexic men: rest and word and design recognition.

To identify and localize differences in brain functioning, electrical activity was recorded with a full complement of scalp electrodes in 14 healthy, severely dyslexic men (mean age = 22 years, S.D. = 3) and 15 matched controls during rest and during word and design recognition. The electroencephalograms were spectrum analyzed, and the mean amplitude in each of 5 bands--delta, theta, alpha, slow beta and fast beta--compared topographically between conditions and groups. The two tasks did not elicit differentially lateralized patterns of electrical activity, but produced anteroposterior differences in alpha and theta. The Designs task, more difficult for both groups, was associated with less posterior alpha than was the Words task. The strongest group difference was likewise seen along an anteroposterior axis on the Designs task. With performance equal to that of controls, the dyslexics showed relatively greater fronto-central theta and less posterior theta (a more activated state), suggesting that dyslexics were compensating for less efficient information processing. There were no group differences in overall amplitude in any band for any condition. The differences in the topographic distribution of theta may reflect subtle differences in brain organization or compensatory recruitment of widely distributed neuronal networks.

Adult↗
PubMed1989

Urinary free cortisol output and disruptive behavior in children.

Hostile, impulsive, and aggressive behaviors have been associated with decreased urinary free cortisol (UFC) output. This is the first study to assess 24-hour UFC output in disruptive behavior disorders. The UFC of 19 boys with attention deficit and/or conduct disorder was compared with that of 19 age, race, and IQ matched normal controls studied as inpatients. Continuous Performance Test scores showed greater impulsivity in the disruptive group. UFC output did not differ between groups. However, UFC and difficulty were positively correlated on the continuous performance test in the form of longer interstimulus intervals and longer reaction times.

Adolescent↗
PubMed1989

Lack of seasonal variation in pediatric lumbar cerebrospinal fluid neurotransmitter metabolite concentrations.

Seasonal variation of cerebrospinal fluid (CSF) monoamines, particularly 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) has been reported for psychiatrically ill and normal adults. Circannual variability was examined for a group of 72 children (mean age = 159.4 +/- 40.3 (SD), range 77-238 months), with a primary diagnosis of obsessive-compulsive disorder (OCD) or disruptive behavior disorder (DBD) (attention deficit disorder, oppositional disorder and/or conduct disorder), from whom CSF had been obtained systematically. There were no seasonal differences in mean concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), HVA, or 5-HIAA, either for the group as a whole, for the separate diagnostic (OCD vs DBD) categories or for the pre-pubertal subgroup. Log-corrected HVA concentrations for the Tanner IV and V subgroup differed by season with summer concentrations less than those of fall (P = 0.06) and winter (P = 0.005). The results suggest that pubertal changes may play a role in any expression of circannual variability.

Adolescent↗
PubMed1989

Psychiatric diagnoses in patients who have chronic fatigue syndrome.

Patients with persistent fatigue are often suspected of having psychiatric illnesses, particularly depression. The authors used the Diagnostic Interview Schedule to assess the lifetime prevalence of psychiatric disorders in 28 patients who met Centers for Disease Control case definition criteria for chronic fatigue syndrome. Compared with studies of the general population and studies of chronically medically ill patients who received the same structured interview, the rates of psychiatric illness in patients with the chronic fatigue syndrome appeared high. An examination of the medical histories of the 28 patients indicated that psychiatric disorders more often preceded the chronic fatigue than followed it.

Adult↗
PubMed1988

Concentration gradient of CSF monoamine metabolites in children and adolescents.

Whether the lumbar cerebrospinal fluid (CSF) concentration gradient of monoamine metabolites found in adults is influenced by age or pubertal status was studied in 26 children ranging from 6.5 to 17.3 years of age. Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) were assayed by high-power liquid chromatography (HPLC) with electrochemical detection. Eight patients were prepubertal (Tanner stage I). The slopes in units of picomoles/milliliter/milliliter for regression lines for CSF monoamine metabolite concentrations versus milliliter of CSF collected were 5.07 +/- 0.65, 10.13 +/- 2.0, and 0.67 +/- 0.22 for 5-HIAA, HVA, and MHPG, respectively, for the group as a whole. Significant correlations with age, height, weight, or Tanner stage were not found for the HVA or MHPG concentration gradients. Tanner stage and 5-HIAA slope were significantly correlated. Three of eight prepubertal patients had nonsignificant 5-HIAA gradients. CSF studies in pediatric populations must control for aliquot collected, as the size of the gradient could produce differences sufficient to mimic a "positive" clinical study if the aliquots collected are not the same.

Adolescent↗
PubMed1988

Objective and subjective side effects of research lumbar punctures in children and adolescents.

Lumbar punctures are a common clinical procedure in pediatric populations, yet little systematic information about side effects or the child's perspective of the procedure is available. In a subset (n = 20) of a sample of children and adolescents with disruptive behavior disorders, we recorded children's ratings of research lumbar puncture in comparison to other hospital experiences of blood sampling, electroencephalography, and going to school. Lumbar puncture did not differ from the other procedures in terms of preference. (School attendance was the last choice of 50% of our patients.) Postlumbar puncture headache occurred in 13 of 60 (22%) patients (age 6.5-19.8 years). Adults may overestimate the relative noxiousness of lumbar punctures in children.

Adolescent↗
PubMed1987

Regional cerebral blood flow in severe developmental dyslexia.

Regional cerebral blood flow was measured under three task conditions in 14 men with severe developmental dyslexia and their control subjects using a xenon 133 inhalation technique. No group differences in overall level or in pattern of gray matter flow were seen under relatively undemanding cognitive conditions. Despite minimal group differences in performance, the dyslexic group showed an increased hemispheric asymmetry (left greater than right) on a semantic classification task and a reduced anteroposterior difference on a line orientation task relative to controls. The exaggerated asymmetry suggests the possibility of less efficient information processing or inadequate bihemispheric integration. The reduced anteroposterior gradient may reflect a deficit in the ability of frontal systems to respond adequately to cognitive demands.

Adult↗
PubMed1987

Effects of sugar and aspartame on aggression and activity in children.

Habitual sugar consumption and behavior following challenge by sugar and aspartame were studied in 30 preschool boys. The 18 subjects whose parents considered them sugar reactive had more disruptive behavior problems at baseline than the other 12 subjects. Habitual sugar consumption correlated only with duration of aggression against property in alleged responders. Double-blind crossover challenges with aspartame, saccharin, sucrose, and glucose produced no significant effect on aggression or observers' ratings of behavior. Lower actometer counts followed the trials of aspartame, but the difference was not apparent to observers. It is unlikely that sugar and aspartame are clinically significant causes of disruptive behavior.

Aggression↗
PubMed1986

Magnetic resonance imaging of brain anatomy in severe developmental dyslexia.

The brain anatomy of ten men (aged 18 to 28 years) with persistent, severe developmental dyslexia was examined with magnetic resonance imaging to explore the possibility of visualizing pathology not seen in previous computed tomographic scan studies. Nine of the ten examinations were clinically normal. One showed a focal finding thought to be incidental to dyslexia. The volume of the temporal lobes was judged to be symmetrical in nine of ten examinations, a finding supportive of previous computed tomographic scan and neuropathologic reports of unusual symmetries of posterior brain regions. Thus, despite its sensitivity, magnetic resonance imaging failed to identify a common focal pathology. The choice of imaging planes (particularly coronal) and lack of bone artifact may, however, prove useful for studying macroscopic asymmetries in dyslexia.

Adolescent↗