Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied conservative diagnostic criteria for TTM (ages 10–17, n = 133). Analyses reveal trends toward higher levels of dysfunction in families of TTM youth relative to normative samples, although no differences achieved statistical significance. However, scores on the Family Assessment Measure and the Attitudes Toward My Child scales were similar to those in clinical samples of youth with cystic fibrosis, an eating disorder, or an anxiety disorder. While these results indicate that family functioning and parental attitudes in TTM were not generally or extremely problematic, family issues may nevertheless warrant particular clinical evaluation and attention in more severe TTM cases.

Purpose: Computerized Tomography Enterography (CTE) has emerged as an imaging procedure for assessment of CD activity and anatomy. Comparison of CTE with small bowel follow through (SBFT) for detection of strictures using surgical findings as the gold standard in CD has not been performed. We sought to determine the accuracy of preoperative SBFT and CTE studies and its correlation with the intra-operative strictures or fistulas in CD pts undergoing SB surgery. Methods: This was a retrospective cohort study at a tertiary referral center. CD pts who had undergone SB surgeries between 1/2006 and 9/2008 and had a preoperative SBFT and/or CTE within 4 months prior were included. This interval was based on our protocol that optimizes medical therapy over 8-12 weeks preceding surgery. We reviewed the radiology reports and documented the number of strictures and/or fistulas seen by either modality. All surgeries were performed by a single CD surgeon. The number of intra-operative strictures was determined by the insertion of a Foley catheter to 200 cm from the resected segment followed by 2cm balloon inflation with pull through. Chi-square tests were used to compare detection rates between the different techniques. Results: Sixty-one CD pts who underwent SB surgery and had at least one preoperative imaging study within 4 months prior. Of those, 53 pts had SBFT, 19 pts had CTE and 12 pts had both. On a per patient analysis, SBFT correctly identified 48/51 (94.1%) pts who were found to have any stricture which was higher than the detection rate for CTE (12/15 pts, 80%, p=0.09). Using the most conservative estimate for test performance, SBFT correctly identified all strictures in 73.2% of pts, a rate similar to CTE (57.1%, p=0.3). On a per stricture analysis, SBFT identified 62/88 (70.5%) strictures found during surgery compared to 11/21 for CTE (52.4%, p=0.09). With pts with at least 2 strictures the sensitivity was 52.6% for SBFT and 16.7% for CTE (p=.11), however on a per stricture analysis SBFT had a significantly higher detection rate compared to CTE, 62.1 vs. 30.8 (p=0.03). In the subgroup of pts who had had both examination within 4 months prior to surgery, SBFT identified 8/11 strictures (72.8%) compared to 5/11 for CTE (45.5%, p=0.18). With regards to detection of fistulas, both CTE (4/6, 67%) and SBFT (7/12, 58.3%) performed comparably (p=0.7). Conclusion: In our CD cohort, SBFT showed a trend towards more accurate detection of strictures compared to CTE with equivalent performance for fistulas detection. In patients with multiple strictures SBFT had significantly better detection rate than CTE on a per stricture basis. Larger, head-to-head studies may be required to determine the optimal pre-operative SB imaging modality.

'Psychotic' and 'non-psychotic' subtypes of bipolar disorder may lie on a nosological continuum that is most clearly defined by verbal memory impairment.

Fibromyalgia syndrome (FM) is a common clinical disorder characterized by severe widespread soft-tissue pain, chronicity, and allodynia. Diagnosed by chronic widespread body pain and unusual tenderness in response to digital pressure at anatomically identified soft tissue sites, FM is increasingly being recognized as a central nervous system disorder. FM patients commonly suffer from insomnia and depression, as well as other comorbidities that complicate the diagnosis, such as anxiety, fatigue, headaches, cognitive impairment, and stress intolerance. Important differential diagnoses include the various rheumatological disorders as well as sleep disorders. Because the presentation of FM is heterogeneous, the goal of treatment is an individualized approach that considers the severity of the patient's pain, the presence of other symptoms and comorbidities or stressors, and the degree of functional impairment. New pharmacologic treatments approved by the Food and Drug Administration offer important options to FM patients, and are expected to improve both diagnosis and treatment of FM. In most cases, the management of patients with FM involves both pharmacologic and nonpharmacologic treatments.

Anorexia nervosa (AN) patients may present with cardiac autonomic system dysfunction. Power spectral analysis of heart rate variability (HRV) is a reliable noninvasive examination for the quantitative assessment of the central sympathovagal interaction that modulates cardiovascular autonomic function. In the present study, HRV parameters were assessed in female adolescent AN inpatients in the malnourished phase at admission, at discharge when achieving weight restoration, and 24-36 months after discharge, when considered remitted. Nineteen normal-weight female controls were similarly assessed. Spectral analysis of HRV was done with the fast Fourier transform algorithm. At admission and discharge, patients underwent routine laboratory examinations and responded to questionnaires assessing eating-related preoccupations, behaviors, and personality attributes, depression and anxiety. Compared with the controls, AN patients had significantly lower heart-rate and HRV, lower total power and low frequency components, elevated high frequency components, and decreased low to high frequency power ratio as assessed with the power spectral analysis at all three evaluation points. These disturbances were not correlated with the baseline laboratory and psychometric measures. Our preliminary findings suggest that female adolescent AN inpatients may have a cardiovascular autonomic dysfunction in the form of vagal abnormality present not only in malnourished patients, but also persisting following short-term and long-term weight restoration.