Annerine Roos

Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women.

It has been suggested that women experience depression most commonly in the childbearing years and that reproductive events such as pregnancy and child birth may coincide with the onset of mood and anxiety disorders in women. Therefore, a brief screening tool, with good sensitivity/specificity for psychiatric diagnoses that could be administered to pregnant women would be a valuable and useful proxy measure. We assessed the validity of the K-10, using the SCID as the gold standard, in a sample of 129 healthy pregnant women who presented for care at midwife obstetric units in Cape Town, South Africa. A receiver-operating characteristic curve (ROC) analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the receiver-operating characteristic curve, 0.66), posttraumatic stress disorder (0.69), panic disorder (0.71), and social phobia (0.76). The K-10 may be a useful screening measure for mood and anxiety disorders in pregnant women.

Altered prefrontal cortical function during processing of fear-relevant stimuli in pregnancy

In non-pregnant individuals, the prefrontal cortex (PFC) is involved in the regulation of emotion, and appears to play a role in anxiety. Near-infrared spectroscopy (NIRS) detects cortical neural activation without harmful radiation making it safe for use in pregnancy. The aims of this study were to assess neural circuitry involved in processing fear-relevant stimuli during pregnancy using NIRS, and to determine associations between activation of this circuitry, distress and anxiety symptoms, attention to threat, cortisol, estrogen, progesterone and testosterone levels. There was significant activation of the PFC in response to fearful faces compared to rest in both pregnant and control groups. Within pregnancy, the activation was most pronounced at trimester 2, compared to the other trimesters. In pregnant women only (all trimesters), PFC activation was significantly associated with increased distress and anxiety, but with decreased selective attention to masked fear. PFC activation was also significantly associated with increased levels of cortisol and testosterone in pregnancy. PFC function appears to be altered during processing of fear-relevant stimuli in pregnancy. Changes in hormone levels may lead to changes in PFC function, and in turn to changes in cognitive-affective processing and anxiety. Further work is needed, however, to explore precisely how PFC function is altered in pregnancy; it is possible that certain changes reflect altered processing of threat stimuli, while others reflect attempts to compensate for distressing and anxious symptoms that emerge during pregnancy.

Predictors of distress and anxiety during pregnancy

OBJECTIVE There is a high incidence of distressing psychological symptoms including anxiety in pregnancy. Nevertheless, predictors of distress and anxiety during pregnancy have not been well characterized. We determined whether temperament and character, trait anxiety, resilience, and social support predicted distress and anxiety symptoms in pregnancy. METHOD Pregnant women (n=105) with low risk singleton pregnancies were recruited from Midwife Obstetric Units. Assessments of distress (using the K-10) and anxiety (using the Spielberger State Inventory) were undertaken in trimester 2 and 3. Measures of temperament and character, trait anxiety, resilience and social support were undertaken at the same time points. Regression analyses were used to determine predictors of distress and anxiety at each trimester. RESULTS Predictors of distress and anxiety were lower selfdirectedness, higher harm avoidance, higher trait anxiety, lower resilience, and lower social support, at each time point. CONCLUSION Understanding predictors of distress and anxiety in pregnancy may be useful in developing interventions for addressing such symptoms, as well as perhaps in preventing potential sequelae such as anxiety and mood disorders.

A comparison of brain volume and cortical thickness in excoriation (skin picking) disorder and trichotillomania (hair pulling disorder) in women

Skin picking disorder (SPD) and trichotillomania (hair pulling disorder, or HPD) significantly overlap in terms of clinical features. However, few studies have directly compared structural brain data in these disorders. The aim of this study was to compare volumes of brain structures and cortical thickness in patients with SPD and HPD, and determine involvement of fronto-striatal pathways. Seventeen female SPD, 17 HPD and 15 healthy age-matched controls underwent clinical assessment and structural MRI imaging. Group differences were determined in brain volume and cortical thickness, controlling for illness severity. Participants with SPD had greater volume of the ventral striatum bilaterally; and reduced cortical thickness in right hemisphere frontal areas, and greater thickness of the cuneus bilaterally compared to HPD and control participants. HPD participants demonstrated reduced thickness of the right parahippocampal gyrus compared to SPD and control participants. The findings here are partially consistent with previous structural work in SPD, and suggest some differences in the neurobiology of SPD and HPD. The more extensive involvement of the ventral striatum in SPD may suggest greater involvement of the reward system, while the more extensive involvement of the parahippocampal gyrus in HPD may be consistent with the dissociative symptoms often seen in these patients.

Selective attention to fearful faces during pregnancy

BACKGROUND There is some evidence that pregnancy may be associated with cognitive affective changes, including increased ability to encode emotional faces signaling threat and increased anxiety. Nevertheless, findings to date are inconsistent, and there are few data on correlations with endocrine and hormonal measures. The aim of this study was to investigate danger sensitivity, as measured by selective attention to fearful and angry faces during pregnancy, and to correlate findings with distress and anxiety levels, glucocorticoid (cortisol) and gonadal hormones (estrogen, progesterone and testosterone). METHODS Selective attention to fearful, angry and happy faces was assessed in pregnant women (n=44) and non-pregnant controls (n=25) using a modified version of an emotional Stroop task. General distress was assessed using the K-10, and state and trait anxiety using the Spielberger State-Trait Inventory. Levels of cortisol, estrogen, progesterone and testosterone were determined at trimester 2 and 3. Analyses of variance, regression and correlational analyses were used to investigate associations between variables. RESULTS Pregnant women showed altered attentional responses to fearful faces, in comparison to controls. When analyzed according to different levels of distress (K-10>20 or K-10≤20), distressed pregnant women had significantly increased selective attention to fearful faces compared to distressed non-pregnant controls. Attention to fear was significantly associated with increased levels of estrogen and progesterone at trimester 2, and decreased levels of cortisol at trimester 3 of pregnancy. CONCLUSION Heightened sensitivity to danger cues during pregnancy is consistent with a perspective that emphasizes the importance of parental precaution and the adaptive significance of responding to potentially hazardous stimuli during this period. Such changes may be particularly apparent in distressed women, and may be mediated by changes in glucocorticoid and gonadal hormone systems during pregnancy.

White matter integrity and cognitive performance in children with prenatal methamphetamine exposure

There is emerging evidence on the harmful effects of prenatal methamphetamine (MA) exposure on the structure and function of the developing brain. However, few studies have assessed white matter structural integrity in the presence of prenatal MA exposure, and results are inconsistent. This investigation thus used diffusion tensor imaging (DTI) to investigate white matter microstructure and cognitive performance in a group of prenatal MA exposed (or MA) children and controls of similar age. Seventeen MA children and 15 healthy controls (aged 6-7 years) underwent DTI and assessment of motor function and general cognitive ability. Whole brain analyses of white matter structure were performed using FSLs tract-based spatial statistics comparing fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). Mean diffusion values were extracted from white matter regions shown to differ across groups to determine whether variations in FA predicted cognitive performance. Analyses were controlled for maternal nicotine use. MA children showed significantly lower FA as well as higher MD, RD and AD in tracts that traverse striatal, limbic and frontal regions. Abnormal FA levels in MA children were significantly associated with poorer motor coordination and general cognitive ability sub-items that relate to aspects of executive function. Our findings suggest that, consistent with previous studies in older children, there are disruptions of white matter microstructural integrity in striatal, limbic and frontal regions of young MA exposed children, with prominent cognitive implications. Future longitudinal studies may clarify how prenatal MA exposure affects white matter structural connectivity at different stages of brain maturation.

Structural brain changes in prenatal methamphetamine-exposed children.

The global use of methamphetamine (MA) has increased substantially in recent years, but the effect of MA on brain structure in prenatally exposed children is understudied. Here we aimed to investigate potential changes in brain volumes and cortical thickness of children with prenatal MA-exposure compared to unexposed controls. Eighteen 6-year old children with MA-exposure during pregnancy and 18 healthy controls matched for age, gender and socio-economic background underwent structural imaging. Brain volumes and cortical thickness were assessed using Freesurfer and compared using ANOVA. Left putamen volume was significantly increased, and reduced cortical thickness was observed in the left hemisphere of the inferior parietal, parsopercularis and precuneus areas of MA-exposed children compared to controls. Compared to control males, prenatal MA-exposed males had greater volumes in striatal and associated areas, whereas MA-exposed females predominantly had greater cortical thickness compared to control females. In utero exposure to MA results in changes in the striatum of the developing child. In addition, changes within the striatal, frontal, and parietal areas are in part gender dependent.

Cortical thickness in obsessive-compulsive disorder: multisite mega-analysis of 780 brain scans from six centres.

BACKGROUND There is accumulating evidence for the role of fronto-striatal and associated circuits in obsessive-compulsive disorder (OCD) but limited and conflicting data on alterations in cortical thickness. AIMS To investigate alterations in cortical thickness and subcortical volume in OCD. METHOD In total, 412 patients with OCD and 368 healthy adults underwent magnetic resonance imaging scans. Between-group analysis of covariance of cortical thickness and subcortical volumes was performed and regression analyses undertaken. RESULTS Significantly decreased cortical thickness was found in the OCD group compared with controls in the superior and inferior frontal, precentral, posterior cingulate, middle temporal, inferior parietal and precuneus gyri. There was also a group × age interaction in the parietal cortex, with increased thinning with age in the OCD group relative to controls. CONCLUSIONS Our findings are partially consistent with earlier work, suggesting that group differences in grey matter volume and cortical thickness could relate to the same underlying pathology of OCD. They partially support a frontostriatal model of OCD, but also suggest that limbic, temporal and parietal regions play a role in the pathophysiology of the disorder. The group × age interaction effects may be the result of altered neuroplasticity.

Normative data for the Tygerberg Cognitive Battery and Mini-Mental Status Examination in a South African population.

BACKGROUND Normative data for the Tygerberg Cognitive Battery (TCB) and Mini-Mental Status Examination (MMSE) (in South Africa) have not been formally examined before. The TCB was developed for the bedside pen-and-paper screening of cognitive impairment in each of the 6 main cognitive domains, including attention and concentration, speech, memory, praxis, gnosis, and executive functioning. The test is also used to diagnose different neuropsychiatric conditions. The MMSE is an established screen of cognitive status, which is often used as a comparative standard for novel screening tests such as the TCB. The TCB was initially developed in English and Afrikaans, and a Xhosa version was also initiated with this study so that the 3 most common languages of the region could be accommodated. AIMS The first aim of the study was to estimate normative test performance on the TCB and MMSE among controls, and the second aim was to develop a Xhosa version of the TCB. METHODS Assessments of the TCB and MMSE were carried out in a population of healthy individuals (n = 157). In addition, healthy Xhosa-speaking participants (n = 14) were screened using a Xhosa version of the TCB. RESULTS Reliability scores for all forms of the TCB were satisfactory. Age and education correlated significantly with TCB scores (r = -0.26, P < .01; r = 0.64, P < .01, respectively), whereas only education significantly correlated with MMSE scores (r = 0.32, P < .05). Normative values were calculated accordingly, that is, controlled for the effects of age and education. The TCB scores also correlated significantly with MMSE scores (r = 0.49, P < .05), demonstrating the potential of the TCB to serve as an alternate cognitive assessment tool, along with the MMSE, to focus neuropsychiatric investigations. Scores on the Xhosa version differed significantly on speech, praxis, and gnosis between the Afrikaans and English participant scores. CONCLUSION These normative data can be used to increase precision and to provide an impartial evaluation when applying TCB to evaluate the cognitive ability of neuropsychiatrically impaired adult patients. However, age and education effects should be considered when computing the results of cognitive assessment.

A study of the effects of prenatal alcohol exposure on white matter microstructural integrity at birth.

Background Neuroimaging studies have indicated that prenatal alcohol exposure is associated with alterations in the structure of specific brain regions in children. However, the temporal and regional specificity of such changes and their behavioural consequences are less known. Here we explore the integrity of regional white matter microstructure in infants with in utero exposure to alcohol, shortly after birth. Methods Twenty-eight alcohol-exposed and 28 healthy unexposed infants were imaged using diffusion tensor imaging sequences to evaluate white matter integrity using validated tract-based spatial statistics analysis methods. Second, diffusion values were extracted for group comparisons by regions of interest. Differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity were compared between groups and associations with measures from the Dubowitz neonatal neurobehavioural assessment were examined. Results Lower AD values (p<0.05) were observed in alcohol-exposed infants in the right superior longitudinal fasciculus compared with non-exposed infants. Altered FA and MD values in alcohol-exposed neonates in the right inferior cerebellar were associated with abnormal neonatal neurobehaviour. Conclusion These exploratory data suggest that prenatal alcohol exposure is associated with reduced white matter microstructural integrity even early in the neonatal period. The association with clinical measures reinforces the likely clinical significance of this finding. The location of the findings is remarkably consistent with previously reported studies of white matter structural deficits in older children with a diagnosis of foetal alcohol spectrum disorders.