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Jackson, MS, United States

Research suggests a higher prevalence of coexisting behavioural disorders, particularly Attention-Deficit Hyperactivity Disorder (ADHD), among children with enuresis in comparison to the general population. Studies generally have consisted of participants attending general paediatric medical clinics as opposed to facilities specialising in the treatment of psychiatric disorders. This descriptive investigation examined the frequency of enuresis and its psychiatric comorbidities among 363 children and adolescents referred for outpatient clinical psychological evaluation during a 12-month period. Results revealed that 16% of participants met diagnostic criteria for enuresis and that of these 98% had at least one comorbid psychiatric disorder. Mood disorders were the most common coexisting diagnoses, followed by ADHD and Oppositional Defiant Disorder. No association was found between a diagnosis of enuresis and participant intelligence. Implications for mental health providers are discussed. Copyright © NISC Pty Ltd.

Ryan J.J.,University of Central Missouri | Gontkovsky S.T.,Methodist Rehabilitation Center | Kreiner D.S.,University of Central Missouri | Tree H.A.,TBI Unit
Journal of Clinical and Experimental Neuropsychology | Year: 2012

Forty patients with relapsing-remitting multiple sclerosis (MS) completed the 10 core Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests. Means for age and education were 42.05 years (SD = 9.94) and 14.33 years (SD = 2.40). For all participants, the native language was English. The mean duration ofMS diagnosis was 8.17 years (SD = 7.75), and the mean Expanded Disability Status Scale (EDSS; Kurtzke, 1983) score was 3.73 (SD = 1.41) with a range from 2.0 to 6.5. A control group of healthy individuals with similar demographic characteristics also completed the WAIS-IV and were provided by the test publisher. Compared to controls, patients with MS earned significantly lower subtest and composite scores. The patients' mean scores were consistently in the low-average to average range, and the patterns of performance across groups did not differ significantly, although there was a trend towards higher scores on the Verbal Comprehension Index (VCI) and lower scores on the Processing Speed Index (PSI). Approximately 78% of patients had actual Full Scale IQs that were significantly lower than preillness, demographically based IQ estimates. © 2012 Psychology Press.

Clark J.H.,Methodist Rehabilitation Center | Hobson V.L.,Texas Tech University | O'Bryant S.E.,Texas Tech University Health Sciences Center
Archives of Clinical Neuropsychology | Year: 2010

Previous research has supported the use of percent retention scores in the neuropsychological assessment of memory, and many widely used memory measures provide for the calculation and normative comparison of these scores. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), an increasingly utilized assessment tool for cognitive impairment, provides normative data on delayed memory total raw scores only. The current study was aimed at determining the diagnostic accuracy of a novel percent retention score calculated from RBANS verbal memory subtests (delayed recall minus last learning trial) when distinguishing between normal controls, individuals diagnosed with Mild Cognitive Impairment, and individuals diagnosed with Alzheimer's disease. Results revealed excellent diagnostic accuracy of the RBANS percent retention scores when discriminating between the three groups. Findings suggest that RBANS percent retention scores provide excellent diagnostic accuracy offering supplementary information to clinicians and researchers alike. © 2010 The Author Published by Oxford University Press. All rights reserved.

Clark J.H.,Methodist Rehabilitation Center | O'Bryant S.E.,Texas Tech University Health Sciences Center | Smith G.E.,Mayo Medical School | Ivnik R.J.,Mayo Medical School | Petersen R.C.,Mayo Medical School
Journal of the American Geriatrics Society | Year: 2012

Objectives To investigate whether demographic (age and education) adjustments for the Mini-Mental State Examination (MMSE) attenuate mean score discrepancies between African-American and Caucasian adults and whether demographically adjusted MMSE scores improve the diagnostic classification accuracy of dementia in African-American adults over unadjusted MMSE scores. Design Cross-sectional study. Setting Community-dwelling adults participating in the Mayo Clinic Alzheimer's Disease Patient Registry and Alzheimer's Disease Research Center. Participants Three thousand two hundred fifty-four adults (2,819 Caucasian, 435 African American) aged 60 and older. Measurements MMSE score at study entry. Results African-American adults had significantly lower unadjusted MMSE scores (23.0 ± 7.4) than Caucasian adults (25.3 ± 5.4). This discrepancy persisted despite adjustment of MMSE scores for age and years of education using established regression weights or newly derived weights. Controlling for dementia severity at baseline and adjusting MMSE scores for age and quality of education attenuated this discrepancy. In African-American adults, an age- and education-adjusted MMSE cut score of 23/24 provided optimal dementia classification accuracy, but this represented only a modest improvement over an unadjusted MMSE cut score of 22/23. The posterior probability of dementia in African-American adults is presented for various unadjusted MMSE cut scores and prevalence rates of dementia. Conclusion Age, dementia severity at study entry, and quality of educational experience are important explanatory factors in understanding the existing discrepancies in MMSE performance between Caucasian and African-American adults. These findings support the use of unadjusted MMSE scores when screening older African Americans for dementia, with an unadjusted MMSE cut score of 22/23 yielding optimal classification accuracy. © 2011, The American Geriatrics Society.

Giacino J.T.,JFK Johnson Rehabilitation Institute | Whyte J.,Moss Rehabilitation Research Institute | Bagiella E.,Columbia University | Kalmar K.,JFK Johnson Rehabilitation Institute | And 17 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery. METHODS: We enrolled 184 patients who were in a vegetative or minimally conscious state 4 to 16 weeks after traumatic brain injury and who were receiving inpatient rehabilitation. Patients were randomly assigned to receive amantadine or placebo for 4 weeks and were followed for 2 weeks after the treatment was discontinued. The rate of functional recovery on the Disability Rating Scale (DRS; range, 0 to 29, with higher scores indicating greater disability) was compared over the 4 weeks of treatment (primary outcome) and during the 2-week washout period with the use of mixed-effects regression models. RESULTS: During the 4-week treatment period, recovery was significantly faster in the amantadine group than in the placebo group, as measured by the DRS score (difference in slope, 0.24 points per week; P = 0.007), indicating a benefit with respect to the primary outcome measure. In a prespecified subgroup analysis, the treatment effect was similar for patients in a vegetative state and those in a minimally conscious state. The rate of improvement in the amantadine group slowed during the 2 weeks after treatment (weeks 5 and 6) and was significantly slower than the rate in the placebo group (difference in slope, 0.30 points per week; P = 0.02). The overall improvement in DRS scores between baseline and week 6 (2 weeks after treatment was discontinued) was similar in the two groups. There were no significant differences in the incidence of serious adverse events. CONCLUSIONS: Amantadine accelerated the pace of functional recovery during active treatment in patients with post-traumatic disorders of consciousness. (Funded by the National Institute on Disability and Rehabilitation Research; ClinicalTrials.gov number, NCT00970944.) Copyright © 2012 Massachusetts Medical Society.

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