Antidepressant medications may be poorly tolerated in youth with a familial risk for developing mania. Controlled studies further assessing treatments for depression and anxiety in HR youth are urgently needed.
Objective
Although previous neuroimaging studies suggest that adolescents with bipolar disorder exhibit smaller amygdala volumes compared with healthy adolescents, whether these abnormalities are present at illness onset or instead develop over time remains unclear. The aim of this study was to conduct a prospective longitudinal investigation comparing amygdala neurodevelopment among adolescents following their first manic episode, adolescents with attention deficit hyperactivity disorder (ADHD), and healthy adolescents.
Method
Thirty adolescents hospitalized for their first manic/mixed episode associated with bipolar disorder, twenty-nine adolescents with ADHD, and twenty-four demographically matched healthy teens underwent magnetic resonance imaging scans at index assessment and approximately 12 months later. Adolescents with bipolar disorder were prospectively evaluated using diagnostic interviews and symptom rating scales.
Results
Mixed models examining group-by-time effects for both left (p=0.005) and right (p=0.002) amygdala volumes were statistically significant. Change in left (p=0.01) and right (p=0.0008) amygdala volumes from baseline to 12 months were significantly different among groups. Specifically, left amygdala volumes increased over time in healthy adolescents (p=0.008) and adolescents with ADHD (p=0.0009), but not in adolescents with bipolar disorder (p=0.3). Right amygdala volume increased over time in adolescents with ADHD (p<0.001), but not in healthy adolescents nor in adolescents with bipolar disorder (p=0.1 and p=0.3, respectively). In adolescents with bipolar disorder, baseline total amygdala volume was significantly greater in those who subsequently achieved symptomatic recovery as compared to those who did not achieve recovery (p=0.02).
Conclusions
Adolescents with mania fail to exhibit normal increases in amygdala volume that occur during healthy adolescent neurodevelopment.
This preliminary study investigated the neurofunctional effects of carbamazepine-extended release (XR) treatment in 11 manic youth with bipolar disorder during performance of a sustained attention task, the Continuous Performance Task – Identical Pairs version, during functional magnetic resonance imaging (fMRI). All patients underwent baseline fMRI, and 10 patients were scanned again at endpoint. Nine demographically matched normal youth, who were scanned once, served as controls. Carbamazepine-XR treatment was associated with normalization of activation in right Brodmann Area 10. These results suggest that carbamazepine-XR treatment may correct prefrontal dysfunction in adolescent mania.
PurposeTo determine differences in patient's reported quality of life and self-reported breast cosmesis between whole breast radiation therapy (WBRT) and accelerated partial breast irradiation (APBI) via single and multi-lumen high-dose-rate (HDR) brachytherapy for women with early stage breast cancer.Material and methodsPatient information was retrospectively reviewed and survey data were prospectively collected for women treated between 2004 to 2014 (APBI) and 2012 to 2014 (WBRT). Criteria for APBI treatments were ER+ (after 2010), N0 (after 2010), T < 3 cm, and post-menopausal. All patients were given a survey with modified FACIT (Functional Assessment of Chronic Illness Therapy) breast quality of life questions to rate their amount of pain, self-consciousness, low energy, presence of lymphedema, and breast cosmesis.Results242 APBI patients and 59 WBRT patients were identified. In the WBRT cohort, 34 women met departmental criteria for APBI treatment (WBRT who were APBI eligible). The FACIT survey was completed by 80 women treated with APBI (33%; mean follow-up time of 14 months), and 26 women treated with WBRT who were APBI eligible (76%; mean follow-up time of 26 months). During the first year post-treatment, low energy (p = 0.009), self-consciousness (p = 0.0004), and lymphedema (p = 0.0002) scores were significantly lower in the APBI cohort when compared to women treated with WBRT who were APBI eligible. During the second year post-treatment, women treated with APBI reported significantly better breast cosmesis (p = 0.04). The single-lumen balloon (score = 6.3/10) was found to be associated with worse cosmesis compared to the multi-lumen balloons (Mammosite ML and Contura; score = 8.2/10; p = 0.002). There were no significant differences in rates of recurrence between balloons or treatments (p > 0.05).ConclusionsAPBI treated patients reported higher cosmetic satisfaction than patients in the matched WBRT cohort. Quality of life scores tended to improve over time. Multi-lumen catheters provided superior cosmetic results compared to single-lumen catheters.
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