BACKGROUND & AIMS: :Activating KIR-HLA-C ligand complexes and HLA-G∗14bp insertion/deletion (+/-) polymorphism were associated to Autism Spectrum Disorders (ASD) and were suggested to correlate with inflammation during fetal development. We evaluated whether HLA-G∗14bp(+/-) and KIR-HLA-C complexes are associated with cognitive and behavioral scores and EEG profile in 119 ASD children (58 from Sardinia, 61 from Peninsular Italy). KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1 and HLA-G∗14bp(+/-) were molecularly genotyped by Single Specific Primer PCR and gel electrophoresis. Univariate linear model analysis adjusted for age, gender and provenience showed statistically higher scores of Childhood Autism Rating Scale (CARS) and Autistic Core Behavior in KIR2DS1-C2+/HLA-G∗14bp+ASD children (43.7±1.5, p=0.03; 3.3±0.1, p=0.03, respectively). These results suggested a synergistic polygenic association of KIR2DS1-HLAC2+/HLA-G∗14bp+ pattern with behavioral impairment in ASD children.

背景与目标： : 激活KIR-hla-c配体复合物和hla-g ∗ 14bp插入/缺失 (+/-) 多态性与自闭症谱系障碍 (ASD) 相关，并被认为与胎儿发育过程中的炎症相关。我们评估了119名ASD儿童 (58名来自撒丁岛，61名来自意大利半岛) 的hla-g * 14bp(+/-) 和KIR-hla-c复合物是否与认知和行为评分以及脑电图谱相关。KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1和hla-g * 14bp(+/-) 通过单特异性引物PCR和凝胶电泳进行分子分型。调整年龄，性别和出处的单变量线性模型分析显示，KIR2DS1-C2/hla-g * 14bp ASD儿童的儿童自闭症评分量表 (CARS) 和自闭症核心行为得分在统计学上更高 (43.7 ± 1.5，p = 0.03; 3.3 ± 0.1，p = 0.03)。这些结果表明，ASD儿童的KIR2DS1-HLAC2/hla-g ∗ 14bp模式与行为障碍具有协同的多基因关联。

BACKGROUND & AIMS: :Cognitive dysfunction syndrome is a major disease affecting old cats and is the consequence of severe and irreversible loss of brain cells and brain atrophy. The present study focused on the hypothesis that the optimal strategy for promoting successful brain ageing is to target risk factors associated with brain ageing and dementia. We used a nutritional strategy involving supplementation with a blend of nutrients (antioxidants, arginine, B vitamins and fish oil) to test this hypothesis. Middle-aged and old cats between 5·5 and 8·7 years of age were assigned to cognitively equivalent control or treatment groups based on prior cognitive experience and performance on baseline cognitive tests. The cats in the treatment group were maintained on a diet supplemented with the nutrient blend and the cats in the control group were maintained on the identical base diet without the additional supplementation. After an initial wash-in period, all cats were tested on a battery of cognitive test protocols. The cats fed the test diet showed significantly better performance on three of four test protocols: a protocol assessing egocentric learning, a protocol assessing discrimination and reversal learning and a protocol focused on acquisition of a spatial memory task. The results support the hypothesis that brain function of middle-aged and old cats can be improved by the nutrient blend that was selected to minimise or eliminate the risk factors associated with brain ageing and dementia.

背景与目标： : 认知功能障碍综合征是影响老猫的主要疾病，是严重且不可逆转的脑细胞丧失和脑萎缩的后果。本研究的重点是以下假设: 促进成功的大脑衰老的最佳策略是针对与大脑衰老和痴呆症相关的危险因素。我们使用了一种营养策略，包括补充营养素 (抗氧化剂，精氨酸，b族维生素和鱼油)，以检验这一假设。根据先前的认知经验和基线认知测试的表现，将5·5至8·7岁的中年和老年猫分配到认知上等效的对照组或治疗组。治疗组中的猫维持在补充营养混合物的饮食中，而对照组中的猫维持在相同的基础饮食中，而无需额外补充。在最初的冲洗期后，所有猫都接受了一系列认知测试协议的测试。喂养测试饮食的猫在四个测试协议中的三个协议中表现出明显更好的性能: 评估以自我为中心的学习的协议，评估歧视和逆转学习的协议以及专注于获取空间记忆任务的协议。结果支持以下假设: 可以通过选择营养混合物来改善中老年猫的脑功能，以最大程度地减少或消除与脑衰老和痴呆症相关的危险因素。

BACKGROUND & AIMS: :Cognitive decline is a feared aspect of growing old. It is a major contributor to lower quality of life and loss of independence in old age. We investigated the genetic contribution to individual differences in nonpathological cognitive ageing in five cohorts of older adults. We undertook a genome-wide association analysis using 549 692 single-nucleotide polymorphisms (SNPs) in 3511 unrelated adults in the Cognitive Ageing Genetics in England and Scotland (CAGES) project. These individuals have detailed longitudinal cognitive data from which phenotypes measuring each individual's cognitive changes were constructed. One SNP--rs2075650, located in TOMM40 (translocase of the outer mitochondrial membrane 40 homolog)--had a genome-wide significant association with cognitive ageing (P=2.5 × 10(-8)). This result was replicated in a meta-analysis of three independent Swedish cohorts (P=2.41 × 10(-6)). An Apolipoprotein E (APOE) haplotype (adjacent to TOMM40), previously associated with cognitive ageing, had a significant effect on cognitive ageing in the CAGES sample (P=2.18 × 10(-8); females, P=1.66 × 10(-11); males, P=0.01). Fine SNP mapping of the TOMM40/APOE region identified both APOE (rs429358; P=3.66 × 10(-11)) and TOMM40 (rs11556505; P=2.45 × 10(-8)) as loci that were associated with cognitive ageing. Imputation and conditional analyses in the discovery and replication cohorts strongly suggest that this effect is due to APOE (rs429358). Functional genomic analysis indicated that SNPs in the TOMM40/APOE region have a functional, regulatory non-protein-coding effect. The APOE region is significantly associated with nonpathological cognitive ageing. The identity and mechanism of one or multiple causal variants remain unclear.

背景与目标： : 认知能力下降是变老的一个令人恐惧的方面。这是导致老年生活质量下降和失去独立性的主要原因。我们调查了五个老年人群对非病理性认知衰老个体差异的遗传贡献。在英格兰和苏格兰的认知老化遗传学 (CAGES) 项目中，我们使用549   692单核苷酸多态性 (snp) 对3511无关的成年人进行了全基因组关联分析。这些个体具有详细的纵向认知数据，从中构建了用于测量每个人的认知变化的表型。位于tom40 (线粒体外膜40同源物的转位酶) 中的一个SNP-rs2075650与认知老化具有全基因组显着关联 (P = 2.5 × 10(-8))。该结果在三个独立的瑞典队列的荟萃分析中被复制 (P = 2.41 × 10(-6))。先前与认知衰老相关的载脂蛋白E (APOE) 单倍型 (与tom40相邻) 对笼子样本中的认知衰老具有显着影响 (P = 2.18 × 10(-8); 女性，P = 1.66 × 10(-11); 男性，P = 0.01)。Tom40/APOE区域的精细SNP图谱将APOE (rs429358; P = 3.66 × 10(-11)) 和tom40 (rs11556505; P = 2.45 × 10(-8)) 识别为与认知衰老相关的基因座。发现和复制队列中的插补和条件分析强烈表明，这种效应是由于APOE引起的 (rs429358)。功能基因组分析表明，tom40/APOE区域的snp具有功能性，调节的非蛋白质编码作用。APOE区域与非病理性认知老化显着相关。一种或多种因果变异的身份和机制仍不清楚。

BACKGROUND & AIMS: :A specific form of family therapy (family-based treatment) is the leading treatment for adolescents with anorexia nervosa. As this treatment has certain limitations, alternative approaches are needed. "Enhanced" cognitive behaviour therapy (CBT-E) is a potential candidate given its utility as a treatment for adults with eating disorder psychopathology. The aim of the present study was to establish, in a representative cohort of patients with marked anorexia nervosa, the immediate and longer term outcome following CBT-E. Forty-nine adolescent patients were recruited from consecutive referrals to a community-based eating disorder clinic. Each was offered 40 sessions of CBT-E over 40 weeks from a single therapist. Two-thirds completed the full treatment with no additional input. In these patients there was a substantial increase in weight together with a marked decrease in eating disorder psychopathology. Over the 60-week post-treatment follow-up period there was little change despite minimal subsequent treatment. These findings suggest that CBT-E may prove to be a cost-effective alternative to family-based treatment.

背景与目标： : 一种特殊形式的家庭治疗 (基于家庭的治疗) 是青少年神经性厌食症的主要治疗方法。由于这种治疗有一定的局限性，因此需要其他方法。“增强” 认知行为疗法 (cbt-e) 是一种潜在的候选药物，因为它可用于饮食失调精神病理学的成年人。本研究的目的是在具有明显神经性厌食症的代表性队列中，建立cbt-e后的近期和长期结果。从连续转诊到社区饮食失调诊所招募了49名青少年患者。每位治疗师在40周内接受了40次cbt-e治疗。三分之二的人完成了完整的治疗，没有额外的投入。在这些患者中，体重显着增加，进食障碍心理病理学显着减少。在治疗后60周的随访期内，尽管后续治疗很少，但变化不大。这些发现表明，cbt-e可能被证明是基于家庭的治疗的一种经济有效的替代方法。

BACKGROUND & AIMS: :The objective of the study was to determine how performance on cognitive assessments administered in the subacute phase of mild stroke change or remain stable over time. A prospective longitudinal cohort pilot study was used to assess the cognitive status of participants with mild stroke (n = 20) at two time points: (1) within 3 weeks post-discharge from the acute care setting following mild stroke, and (2) approximately 6 months post-mild stroke. Participants were given a battery of cognitive assessments at both time points that included the following measures: (1) Short Blessed Test, (2) California Verbal Learning Test (CVLT), (3) Connor's Continuous Performance Task (CPT), and (4) The Delis-Kaplan Executive Function System (DKEFS) Trail Making subtest. The only significant differences between the test administrations was on the CVLT Short Delay Free Recall (p = .027) and Long Delay Free Recall (p = .002) which was likely due to practice effects associated with this measure. The results of the study show that performance on standardised cognitive testing in the early phases of mild stroke remained stable over a 6 month period. These results help justify the necessity and ability to assess cognition immediately post-mild stroke in order to make accurate and appropriate rehabilitation recommendations.

背景与目标： : 该研究的目的是确定在轻度中风的亚急性阶段进行的认知评估的表现如何随时间变化或保持稳定。前瞻性纵向队列试验用于评估轻度卒中参与者 (n = 20) 在两个时间点的认知状况 :( 1) 轻度卒中后出院后3周内，以及 (2) 轻度卒中后约6个月。参与者在两个时间点都接受了一系列认知评估，包括以下措施 :( 1) 简短的祝福测试，(2) 加州语言学习测试 (CVLT)，(3) 康纳的持续表现任务 (CPT)，(4) Delis-Kaplan执行功能系统 (DKEFS) 跟踪子测试。测试管理之间的唯一显着差异是CVLT短延迟免费召回 (p =  .027) 和长延迟免费召回 (p =  .002)，这可能是由于与该措施相关的实践效果。研究结果表明，在轻度中风的早期阶段，标准化认知测试的表现在6个月内保持稳定。这些结果有助于证明轻度卒中后立即评估认知的必要性和能力，以便提出准确和适当的康复建议。

BACKGROUND & AIMS: :This study examined postconcussion symptom reporting within the first 5 years after mild traumatic brain injury (mTBI). Participants were 167 U.S. military service members (mean age, 27.6 years; 74.3% blast; 96.4% male) who were evaluated subsequent to injuries sustained in theater during Operations Iraqi and Enduring Freedom (92.8%) or from other combat-related operations. Participants completed the Neurobehavioral Symptom Inventory and Post-Traumatic Stress Disorder Checklist within 3 months of injury and at least one follow-up telephone interview at 6 (n = 46), 12 (n = 89), 24 (n = 54), 36 (n = 42), 48 (n = 30), and/or 60 months (n = 25) postinjury. Approximately half of the sample (49.7%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptom criteria for postconcussion disorder (PCD) at baseline. At all six follow-ups, 46.1-72.0% met DSM-IV criteria for PCD. However, only 20.4-48.0% reported persistent PCD from baseline to follow-up. A substantial minority had also improved (4.0-24.1%) or "developed" new symptoms (16.9-27.8%). Using regression analyses, baseline symptoms were somewhat predictive of PCD symptom reporting at follow-up, though this was not always reliable. Follow-up for all service members who sustain a combat-related mTBI in the context of polytrauma, regardless of the presence or absence of symptom reporting in the acute recovery stage, should be considered the rule, not the exception.

背景与目标： : 这项研究检查了轻度创伤性脑损伤 (mTBI) 后头5年内的脑震荡后症状报告。参与者是167名美国军人 (平均年龄，27.6岁; 74.3% 爆炸; 96.4% 男性)，他们在伊拉克和持久自由行动 (92.8%) 或其他与战斗有关的行动中在战区受伤后接受了评估。参与者在受伤后3个月内完成了神经行为症状清单和创伤后应激障碍清单，并在6 (n = 46)，12 (n = 89)，24 (n = 54)，36 (n = 42)，受伤后48 (n = 30) 和/或60个月 (n = 25)。大约一半的样本 (49.7%) 在基线时符合精神疾病诊断和统计手册第四版 (dsm-iv) 脑震荡后障碍 (PCD) 的症状标准。在所有六次随访中，46.1-72.0% 符合dsm-iv PCD标准。然而，从基线到随访，只有20.4-48.0% 报告了持续的PCD。相当一部分也改善了 (4.0-24.1%) 或 “发展” 新症状 (16.9-27.8%)。使用回归分析，基线症状在一定程度上可以预测随访时的PCD症状报告，尽管这并不总是可靠的。对于在多发伤情况下维持与战斗相关的mTBI的所有服务人员，无论在急性恢复阶段是否存在症状报告，都应视为规则，而不是例外。

BACKGROUND & AIMS: :Cognitive insight refers to awareness of one's own thinking. Research has found deficits in cognitive insight in schizophrenia but studies of its links with positive symptoms and delusions have been equivocal. One possibility is that the association of cognitive insight with positive symptoms and delusions is moderated by other factors. To explore this issue this study examined whether level of socially naive self-appraisal moderated the relationship of two forms of cognitive insight, self-reflectivity and self-certainty with delusions and positive symptoms. Participants were 92 adults, with diagnoses of schizophrenia or schizoaffective disorder, who were administered the Positive and Negative Syndrome Scale, self-deceptive subscale from the Marlowe-Crowne Social Desirability Scale and the Beck Cognitive Insight Scale. Stepwise multiple regressions with the interaction term of the predictive and moderator variables suggested that social naiveté moderates the relationship between self-reflectivity and self-certainty with positive symptoms in general. Moreover, association between self-certainty and delusions was also moderated by social naiveté self-appraisal. All models were significant after controlling for willful impression management as well as a measure of executive function. Results suggest that higher levels of self-certainty are a risk factor for having greater positive symptoms including more severe levels of delusions, when one has a view of oneself that is not tempered by the perceptions of others. Concerning lower levels of self-reflectivity it may be that this combined with a socially naïve view of oneself leaves persons less inhibited when they are tempted to accept unusual thoughts and perceptions as accurate. Implications for treatment are discussed.

背景与目标： : 认知洞察力是指对自己思维的认识。研究发现精神分裂症的认知能力不足，但对其与阳性症状和妄想的联系的研究却模棱两可。一种可能性是，认知洞察力与积极症状和妄想的关联受到其他因素的调节。为了探讨这个问题，本研究检查了社交天真的自我评估水平是否调节了两种认知洞察力，自我反射和自我确定性与妄想和积极症状之间的关系。参与者为92名诊断为精神分裂症或分裂情感障碍的成年人，他们接受了阳性和阴性综合征量表，Marlowe-Crowne社会期望量表和Beck认知洞察力量表的自我欺骗性量表。具有预测变量和调节变量相互作用项的逐步多元回归表明，社会天真通常会缓和自我反射性和自我确定性与积极症状之间的关系。此外，社会天真的自我评估也减轻了自我确定性和妄想之间的联系。在控制了故意的印象管理以及执行功能的度量之后，所有模型都很重要。结果表明，当一个人对自己的看法不受他人的看法影响时，较高的自我确定性水平是出现更大积极症状 (包括更严重的妄想) 的危险因素。关于较低的自我反射率，这可能与对自己的社会天真的看法相结合，使人们在试图接受不寻常的想法和看法准确时受到的抑制较小。讨论了对治疗的影响。

BACKGROUND & AIMS: OBJECTIVE:To assess visual perception in 40 patients suffering from migraine with aura (MA), 40 patients suffering from migraine without aura (MO), and 40 controls. BACKGROUND:Visual perception abnormalities are a common feature in both MA and MO. METHODS:We performed luminance and color central perimetry. Black and white pattern reversal visual-evoked potentials were also assessed. RESULTS:Luminance perimetry was similar in patients and controls. Color perimetry instead revealed an impairment in the perception of red ("quantitative perception index") in migraine patients; this impairment was more pronounced in patients with MA (P < .001) than in those with MO (P < .05) and was related to the degree of photophobia recorded before testing. A subgroup of MO patients who had a migraine attack shortly after being tested also displayed a marked impairment in the perception of blue. This subgroup of patients had a statistically significant (P < .001) lower perception of blue than the rest of the MO patients, who had a migraine attack later; they also had a high degree of unpleasant perceptions after testing. Black and white visual evoked potentials were similar in patients and controls. CONCLUSION:The impairment in visual perception of red, which was more marked in MA than in MO patients, may be related to the degree of photophobia recorded before testing. The reduced perception of blue, which only occurred in a subgroup of MO patients in the premonitory phase of the migraine attack, probably occurs through mechanisms that involve dopaminergic function. We cannot exclude the possibility that the visual stimulations induced the migraine attack in this subgroup of MO patients shortly after they were tested.

背景与目标：

BACKGROUND & AIMS: :The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.

背景与目标： : 认知行为治疗 (CBT) 对成年人焦虑的功效已得到多项荟萃分析的支持。然而，大多数只关注1个诊断，因此不允许进行诊断比较。这项研究检查了CBT在焦虑症中的功效。针对焦虑症的CBT试验达到了研究标准。单独使用认知疗法和暴露疗法，或与放松训练相结合，在焦虑症中是有效的，对于任何特定诊断的任何治疗成分都没有不同的功效。然而，当比较各种诊断时，广泛焦虑症和创伤后应激障碍的结果优于社交焦虑症，但没有其他差异。CBT效果优于无治疗和预期对照治疗，尽管初步证据表明CBT与仅松弛治疗相比具有相同的效果。

BACKGROUND & AIMS: :Z. V. Segal et al. (2006) demonstrated that depressed patients treated to remission through either antidepressant medication (ADM) or cognitive-behavioral therapy (CBT), but who evidenced mood-linked increases in dysfunctional thinking, showed elevated rates of relapse over 18 months. The current study sought to evaluate whether treatment response was associated with gains in decentering-the ability to observe one's thoughts and feelings as temporary, objective events in the mind-and whether these gains moderated the relationship between mood-linked cognitive reactivity and relapse of major depression. Findings revealed that CBT responders exhibited significantly greater gains in decentering compared with ADM responders. In addition, high post acute treatment levels of decentering and low cognitive reactivity were associated with the lowest rates of relapse in the 18-month follow-up period.

背景与目标： : Z。五.Segal等人 (2006) 证明，抑郁症患者通过抗抑郁药物 (ADM) 或认知行为疗法 (CBT) 治疗缓解，但证明了功能障碍思维的情绪相关增加，显示出超过18个月的复发率升高。当前的研究试图评估治疗反应是否与偏心的增加有关-观察一个人的思想和感觉作为暂时的，客观的心理事件的能力-以及这些增加是否缓解了与情绪相关的认知反应与重抑郁症复发之间的关系。调查结果显示，与ADM响应者相比，CBT响应者在偏心方面表现出更大的收益。此外，在18个月的随访期内，急性治疗后高水平的偏心和低认知反应性与最低的复发率相关。

BACKGROUND & AIMS: :Individuals with schizophrenia experience problems in the perception of emotion throughout the course of the disorder. Few studies have addressed the progression of the deficit over time. The present investigation explores face emotion recognition (FER) performance throughout the course of schizophrenia. The aim of the study was to test the hypotheses that: 1) FER impairment was present in ultra high-risk (putatively prodromal) individuals, and that 2) impairment was stable across the course of the illness. Forty-three individuals with a putative prodromal syndrome, 50 patients with first episode of schizophrenia, 44 patients with multi-episode schizophrenia and 86 unaffected healthy control subjects were assessed to examine emotion recognition ability. ANCOVA analysis adjusted for possible confounder factors and subsequent planned contrasts with healthy controls was undertaken. The results revealed deficits in recognition of sadness and disgust in prodromal individuals, and of all negative emotions in both first-episode and multi-episode patients. Furthermore, there were no significant differences between clinical groups. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of emotional recognition impairment before the onset of full-blown psychosis. Moreover, the deficit remains stable over the course of illness, fitting the pattern of a vulnerability indicator in contrast to an indicator of chronicity or severity.

背景与目标： : 精神分裂症患者在整个疾病过程中都会遇到情绪感知问题。很少有研究解决赤字随时间推移的进展。本研究探讨了精神分裂症整个过程中的面部情感识别 (FER) 表现。该研究的目的是检验以下假设: 1) 在超高危 (假定为前驱) 个体中存在FER损伤，并且2) 损伤在整个病程中是稳定的。评估了43例假定的前驱综合征患者，50例首发精神分裂症患者，44例多发作精神分裂症患者和86例未受影响的健康对照受试者，以检查情绪识别能力。进行了ANCOVA分析，以调整可能的混杂因素，并随后与健康对照进行了计划对比。结果显示，前驱个体对悲伤和厌恶的认识不足，以及首发和多发作患者对所有负面情绪的认识不足。此外，临床组之间没有显着差异。在精神分裂症的神经发育模型的框架内，我们的结果表明在全面精神病发作之前存在情绪识别障碍。此外，赤字在疾病过程中保持稳定，符合脆弱性指标的模式，而不是慢性或严重程度的指标。

BACKGROUND & AIMS: INTRODUCTION:Even though cognitive impairment is manifested in almost all patients with schizophrenia, the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) study showed no significant difference between first- and second-generation psychotropic drugs in improving cognitive abilities. Discovering new drugs that can improve impaired cognition, thus, is an attractive treatment target for patients with schizophrenia. AREAS COVERED:This article briefly reviews about donepezil, a highly selective (IC(50) = 6.7 nM) centrally acting reversible acetylcholinesterase inhibitor that has been approved by FDA for treating cognitive deficit states such as in Alzheimer's disease and its uses in clinical trials for the treatment of schizophrenia. The literature search included PubMed and Cochrane library with the following words: donepezil, schizophrenia and cognitive impairments. EXPERT OPINION:The results of several clinical trials utilizing donepezil as an adjunct to second-generation antipsychotic drugs targeting cognitive deficits in schizophrenia subjects have been disappointing and would not lead clinicians to consider this as a potential treatment option. While longer randomized controlled trials, increase dosage and selected groups of patients at different stage of cognitive impairment may provide a better understanding of the potential for this drug in addressing cognitive deficits, results to date have not been encouraging.

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BACKGROUND & AIMS: OBJECTIVE:To examine the neuropsychologic profile of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes) and relate it to neuropathologic findings. BACKGROUND:MELAS is one of over 40 mitochondrial disorders. Symptoms include seizures, strokelike episodes, headaches, memory impairment, hemianopsia, hearing loss, short stature, diffuse limb weakness, exercise intolerance, nausea, and vomiting. Age of onset ranges from 2 to 40 years. A hallmark of MELAS is normal development until the first symptoms appear. METHOD:Because information regarding the neuropsychologic functioning of these individuals is sparse, we report findings from detailed neuropsychologic evaluations for a 13-year-old white male and a 33-year-old African-American male with MELAS. RESULTS:Results revealed global patterns of deterioration in executive function, attention, language, memory, visuospatial, and motor functioning. In both patients, brain scans revealed posterior pathology in the absence of frontal pathology. CONCLUSIONS:We compared our findings with other documented cases and concluded that MELAS is characterized by a pattern of global deterioration. This pattern differs from that observed in other mitochondrial disorders. The absence of identifiable frontal lobe pathology despite the presence of deficits in executive functioning may be related to the distribution patterns of deficient mitochondria and neuronal projection patterns.

背景与目标：

BACKGROUND & AIMS: BACKGROUND AND AIMS:Several studies have shown that cognitive therapy is an effective treatment for social anxiety disorder (SAD). However, it remains unclear which of the complex interventions are associated with an anxiety reduction during the course of treatment. The aim of this study was to examine the impact of the intervention referred to as the "self-focused attention and safety behaviours experiment" on treatment outcome. METHOD:This study was part of a randomized controlled trial including 16 sessions of either individual cognitive therapy (CT) or interpersonal therapy (IPT) for SAD. Of particular importance, a concomitant time-series analysis was used to investigate the impact of the self-focused attention and safety behaviours experiment on subsequent social anxiety (1, 2, 3, and 4 weeks after the intervention) in 32 patients with SAD, who are receiving cognitive treatment. RESULTS:The results revealed a significant reduction of social anxiety after the self-focused attention and safety behaviours experiment during the subsequent month of treatment. CONCLUSION:The findings of the current study confirm current cognitive theories of SAD and demonstrate the importance of interventions that target self-focused attention and safety behaviour in cognitive therapy for SAD.

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BACKGROUND & AIMS: OBJECTIVES:To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement. SETTING:One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS:Patients were included consecutively from date of admission to the unit. INCLUSION CRITERIA:age 18-65 years, International Classification of Diseases 10 diagnoses F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. EXCLUSION CRITERIA:acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years. OUTCOME MEASURES:Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data. RESULTS:Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning. CONCLUSIONS:Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.

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