Sjögren Syndrome Complicated by Mucosa-Associated Lymphoid Tissue Lymphoma and Lymphocytic Interstitial Pneumonia.

Sjögren syndrome (SS) is an autoimmune disease with exocrine glands dysfunction and multiorgan involvement. It is associated with increased risk of lymphoproliferative disorders, especially B-cell marginal zone lymphoma. While the role of F-18 Fluorodeoxyglucose position emission tomography/computed tomography (F-18 FDG PET/CT) for evaluation of lymphoma has been established, its use in patients with a chronic history of SS to evaluate for possible lymphoproliferative disorders or multiorgan involvement is limited. We present a case of chronic SS in which F-18 FDG PET/CT demonstrated FDG avid intraparotid and cervical lymph nodes pathologically proven to be mucosa-associated lymphoid tissue lymphoma. In addition, the patient had bibasilar cystic changes consistent with lymphocytic interstitial pneumonia

Depression and schizophrenia : cause, consequence or trans-diagnostic issue?

The presence of depression in schizophrenia has been a challenge to the Kraepelinian dichotomy, with various attempts to save the fundamental distinction including evoking and refining diagnoses such as schizoaffective disorder. But the tectonic plates are shifting. Here we put forward a summary of recent evidence regarding the prevalence, importance, possible aetiological pathways and treatment challenges that recognising depression in schizophrenia bring. Taken together we propose that depression is more than co-morbidity and that increased effective therapeutic attention to mood symptoms will be needed to improve outcomes and to support prevention

Affective instability and impulsivity predict nonsuicidal self-injury in the general population : a longitudinal analysis

Background Impulsivity and affective instability are related traits known to be associated with nonsuicidal self-injury, although few longitudinal studies have examined this relationship. The purpose of this study was to determine if impulsivity and affective instability predict future nonsuicidal self-injury in the general population while accounting for the overlap between these traits. Methods Logistic regression analyses were conducted on data from 2344 participants who completed an 18-month follow-up of the 2000 British National Psychiatric Morbidity Survey. Affective instability and impulsivity were assessed at baseline with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Nonsuicidal self-injury was assessed at baseline and follow-up during semi-structured interviews. Results Affective instability and impulsivity predicted the onset of nonsuicidal self-injury during the follow-up period. Affective instability, but not impulsivity, predicted the continuation of nonsuicidal self-injury during the follow-up period. Affective instability accounted for part of the relationship between impulsivity and nonsuicidal self-injury. Conclusions Affective instability and impulsivity are important predictors of nonsuicidal self-injury in the general population. It may be more useful to target affective instability over impulsivity for the treatment of nonsuicidal self-injury

Affective Instability, Childhood Trauma and Major Affective Disorders

BACKGROUND: Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. METHODS: AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. RESULTS: ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. LIMITATIONS: The ALS is a self-report scale and is subject to retrospective recall bias. CONCLUSIONS: AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder

Polymorphisms of MTHFR and MTR genes are not related to susceptibility to childhood ALL in north India

Background:Acute lymphoblastic leukemia (ALL) is the most worldwide common type of childhood cancer. Methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR) participate in folate pathways and are known as critical factors for DNA integrity as well as DNA hypomethylation. The aim of this work is to investigate frequency of MTHFR (677C→T and 1298A→C) and MTR (2756A→G) polymorphisms and their interaction with respect to possible effect on risk of childhood ALL among North Indian population. Procedure: A case control study from has been conducted on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls using PCR-RFLP method. Results: No statistically significant differences were observed for different genotypes between patients and controls (p>0.05). Significant difference for the risk of ALL in individuals having genotype of MTHFR 677TT (OR=0.61, 95% CI=0.21–1.77) and MTHFR 1298CC (OR=0.56, 95% CI=0.18–1.68) was not observed. The correlation of SNP of MTR gene and risk of ALL was not observed, too. Conclusions: The differences in distribution of possible combined genotypes of MTHFR (677C→T, 1298A→C) and MTR (2756A→G) between ALL patients and controls were statistically insignificant

Distal arthrogryposis syndrome

A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome

The prevalence of personality disorders in the community: a global systematic review and meta-analysis

Background Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders. Aims To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high and low and middle-income countries (LAMICs). Method We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094). Results Forty-six studies (from 21 different countries spanning six continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8 % (95% Confidence Intervals: 6.1-9.5). Rates were greater in high income (9.6%; 95% CI: 7.9-11.3%) compared with LAMI (4.3%; 95% CI =2.6-6.1%) countries. In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage versus one-stage assessment), county income (high versus LAMI) and interview administration (clinician versus trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of Cluster-A, B and C personality disorders were 3.8 % (3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%). Conclusions Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations