Review: Psychiatric Disturbances in CADASIL

The featured article is ‘Psychiatric Disturbances in CADASIL’ by Valenti and colleagues. This is a brief article in which the authors present two cases of CADASIL with psychiatric disturbance and then review the literature. CADASIL stands for Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencepalopathy and is an example of a vascular condition predisposing to subcortical vascular dementia and having an identified genetic aetiology. The disease results from a mutation on the Chromosome 19 Notch3 gene.

Firstly the authors present two of their own cases – one being associated with post-partum psychosis in a 30-year old with an established mutation in the Notch3 gene and the other being a 72 year old lady with a prior history of depression. The only difficulty here is establishing causality in these cases as depression is common in the general population and the case of post-partum psychosis occurred at an early age and again causality is not demonstrated.

Next the authors go on to review the literature in the field and they clearly identify both the utilised search terms and search years in addition to stipulating other supplementary techniques they adopted for the identification of relevant papers. However it is not clear why the search years were limited to 1993-2007. The authors have assembled the results of these various papers into two tables with frequency of diagnostic categories identifiable at a glance. The authors show that depression is particularly common and that of other psychiatric diagnoses much less common. As they point out though, a number of investigators have not used stringent criteria for establishing psychiatric diagnoses. This in itself is problematic and we cannot ascertain the proportion with formal diagnoses from the table. Even more problematic is the lack of case-controls. We don’t have an age or gender breakdown for the different samples and it is not clear what comorbidity there was. A case-control study would provide evidence for a higher than expected rate of depression in this population. The authors conclude that future studies in this area should address methodological shortcomings in previous studies and establish temporal sequences from longitudinal data. Given the obvious difficulties in working with studies which have a different focus, the authors have done well to extract useful data for informing future research in this area.

Steps to Treatment 5 (complete longitudinal study, establish temporal data set for psychiatric illness in this population, utilise data to form population screening guidelines, incorporate into policy, prevention after screening)

References

Valenti R, Poggesi A, Pescini F, Inzitari D, Pantoni L. Psychiatric disturbances in CADASIL: A brief review. Acta Neurol Scand. 2008. 118. 291-295.

Steps To Treatment (STT)

STT = Steps To Treatment. An estimate of the number of steps between the results and translation into practice i.e. treatment. This is an opinion.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

10 comments

  1. I do not generally comment on web sites but I needed to drop in and say thanks for making this, I absolutely agree with the fact and with a little luck people today can understand this argument.

    Like

  2. Took me time to read all the comments, but I really enjoyed the article. It proved to be Very helpful to me and I am sure to all the commenters here! It’s always nice when you can not only be informed, but also entertained! I’m sure you had fun writing this article.

    Like

  3. What i do not realize is actually how you’re not really much more well-liked than you may be now. You’re very intelligent. You realize thus significantly relating to this subject, produced me personally consider it from so many varied angles. Its like women and men aren’t fascinated unless it is one thing to accomplish with Lady gaga! Your own stuffs outstanding. Always maintain it up!

    Like

  4. Hi there We’re so happy We found the site, I truly found u by error, whilst We was browsing within Aol regarding something different, Nonetheless I’m here and We would certainly like to state cheers for the fantastic posting plus a over-all entertaining blog

    Like

  5. I make my living writing, but I am not nearly as good as you. I’m not sure I would have the focus to do all the homework you’ve done on this topic. This is great.

    Like

  6. Keep up the fantastic work, I read few articles on this website and I conceive that your web blog is really interesting and contains bands of fantastic info.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s