Anxiety Disorders: Cavanna AE

Robertson MM, Cavanna AE. · Department of Mental Health Sciences, Royal Free and University College Medical School, University College London, London, UK. · Neurocase. · Pubmed #18781427 No free full text.

Abstract: We report the case of a child affected by Gilles de la Tourette syndrome and comorbid obsessive-compulsive disorder who claimed to have caused the September 11, 2001 terrorist attacks in the United States by failing to accomplish a stereotyped compulsive ritual. Special attention is paid to the relationship between the patient's neuropsychiatric symptoms and the belief that he personally had influenced the outcome of an internationally notorious disaster. Prognostic and treatment implications are also presented, along with a review of the literature on the clinical and psychosocial impact of terrorist attacks and natural disasters on children suffering from neuropsychiatric disorders.

Cavanna AE, Mula M, Strigaro G, Servo S, Tota G, Barbagli D, Collimedaglia L, Viana M, Cantello R, Monaco F. · Department of Neurology, Amedeo Avogadro University, Novara, Italy. · Epilepsia. · Pubmed #18479402 No free full text.

Abstract: Pathological gambling symptoms (PGS), that is, the subjective urge to gamble and the actual gambling behaviors, are currently acknowledged as relatively common symptoms among Western countries, with an estimated point prevalence of 0.6-1.1% in the general population. Converging evidence suggests that PGS are overrepresented in patients with neurological conditions affecting dopaminergic reward pathways, and can be expressed in both impulse control disorders and obsessive-compulsive spectrum disorders. This study explored the clinical correlates of PGS in patients with epilepsy. Eighty-eight consecutive adult outpatients recruited at three epilepsy clinics in northern Italy were assessed using the Gambling-Symptom Assessment Scale (G-SAS), along with a battery of psychometric instruments to index depression (Beck Depression Inventory [BDI]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI]), and obsessionality (Yale-Brown Obsessive Compulsive Scale [YBOCS]) symptoms. On the G-SAS, patients with a diagnosis of temporal lobe epilepsy (TLE) reported a mean [sd] G-SAS score of 2.0 [5.7], significantly higher than patients with frontal lobe epilepsy (FLE) (0.6 [1.7]) and idiopathic generalized epilepsy (IGE) (0.4 [1.4]). Moreover, multiple regression analysis showed that G-SAS scores were selectively predicted by YBOCS scores, thus suggesting an association between the expression of obsessional spectrum symptoms and PGS in patients with TLE. Alterations in the mesolimbic reward system could represent the putative neuropathological substrate for this multifaceted clinical picture.

Mula M, Cavanna AE, Critchley H, Robertson MM, Monaco F. · The Neuropsychiatry Research Group, Department of Clinical & Experimental Medicine, Section of Neurology, Amedeo Avogadro University, C.so Mazzini, 18, Novara 28100, Italy. · J Neuropsychiatry Clin Neurosci. · Pubmed #18451194 links to  free full text

Abstract: Phenomenology of comorbid obsessive-compulsive disorder was compared in nine patients with temporal lobe epilepsy and 15 with Tourette syndrome. Content of obsessive-compulsive themes focuses on sexuality and impulsiveness in Tourette syndrome and existential thoughts in temporal lobe epilepsy.

Cavanna AE, Robertson MM, Critchley HD. · Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK. · Acta Neurol Scand. · Pubmed #17986097 links to  free full text

Abstract: OBJECTIVES: Gilles de la Tourette syndrome (GTS) is a chronic tic disorder associated with comorbid psychopathology, including obsessionality, affective instability and attention-deficit hyperactivity disorder. Evidence linking GTS with schizophrenia-like symptoms is limited and equivocal, despite a common putative substrate involving dopaminergic dysfunction within frontostriatal circuits. The aim of this study was to quantify the prevalence of schizotypal traits in GTS and to detail the relationship between schizotypy and comorbid psychopathology. MATERIALS AND METHODS: A total of 102 subjects with GTS were evaluated using the Schizotypal Personality Questionnaire and standardized neurological and psychiatric rating scales. The predictive interrelation between schizotypy, tic-related symptoms and psychiatric comorbidities was investigated using correlation and multiple regression analyses. RESULTS: In our clinical population, 15% of the subjects were diagnosed with the schizotypal personality disorder according to the DSM-IV criteria. The strongest predictors of schizotypy were obsessionality and anxiety ratings. The presence of multiple psychiatric comorbidities correlated positively with schizotypy scores. CONCLUSIONS: Schizotypal traits are relatively common in patients with GTS, and reflect the presence of comorbid psychopathology, related to the anxiety spectrum. In particular, our preliminary results are consistent with a shared neurochemical substrate for the mechanisms underpinning tic expression, obsessionality and specific schizotypal traits.

Robertson MM, Cavanna AE. · Department of Mental Health Sciences, University College London, UK. · Psychiatr Genet. · Pubmed #17417057 No free full text.

Abstract: BACKGROUND: The genetics and phenotypes of Gilles de la Tourette syndrome are complicated. Once indicated to be inherited as a single major autosomal dominant condition, several areas of interest on many chromosomes and one gene have been identified for Gilles de la Tourette syndrome, but no results have been replicated. Factor analytic studies suggest that there are more than one Gilles de la Tourette syndrome phenotype and it is not a unitary condition. OBJECTIVE: To characterize Gilles de la Tourette syndrome phenotypes in a group of individuals who underwent a complete genome scan. METHODS: We studied 85 members of a multiply affected multigenerational kindred, of whom 69 displayed Gilles de la Tourette syndrome-related symptoms (tics, obsessive-compulsive behaviours, obsessive-compulsive symptoms, attention deficit hyperactivity symptoms), using first a hierarchical cluster analysis followed by a principal component factor analysis. RESULTS: Three significant factors resulted from our analysis, accounting for approximately 42% of the symptomatic variance: Factor 1 (predominantly 'pure tics'), Factor 2 (predominantly 'attention deficit hyperactivity disorder and aggressive behaviours') and Factor 3 (predominantly 'depression-anxiety-obsessional symptoms and self-injurious behaviours'). Different kinds of tics occurred in all three factors. Only frowning/raising eyebrows and sniffing/smelling loaded significantly on both Factors 1 and 3. CONCLUSION: Our results give further evidence that the genetics of Gilles de la Tourette syndrome is complex and suggest that Gilles de la Tourette syndrome is not a unitary condition, thus confirming the results of earlier studies which have described several Gilles de la Tourette syndrome phenotypes. Although a genome scan on the pedigree reported three areas of interest and the present study found three factors, further studies would have to be undertaken to elucidate whether the three factors 'mapped' with the genetic data. Possible reasons for our findings and suggestions for future research are discussed.