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Females with high-functioning ASD are known to camouflage their autistic symptoms better than their male counterparts, making them prone to being under-ascertained and delayed in diagnostic assessment. Thus far the underlying cognitive processes that enable such successful socio-communicative adaptation are not well understood. The current results show sex-related differences in the cognitive profile of ASD individuals, which were diagnosed late in life exclusively. Higher verbal abilities were found in males (n = 69) as opposed to higher processing speed and better executive functions in females with ASD (n = 38). Since both sexes remained unidentified during childhood and adolescence, these results are suggestive for sex-distinctive cognitive strategies as an alternative to typically-developed reciprocal social behavior and social mimicry in high functioning ASD.

Clinical intuition and resent research (Senju et al., 2009) suggests that adults with high-functioning autism (HFA) are able to use explicit verbal information but fail to react upon subtle nonverbal cues in order to understand others and navigate social encounters. In order to investigate the relative influence of different domains of socially relevant information in HFA as compared to matched controls, we used verbal and nonverbal stimuli as a basis for an interpersonal impression formation task. Results demonstrated a reduced sensitivity to nonverbal cues in individuals with HFA when consideration of conflicting information from the different domains was required, although HFA participants could well evaluate nonverbal stimuli in isolation. Thus, in a more complex experimental setting nonverbal information had a comparably weak impact on the impression formation confirming that social processing is preferentially based on verbal information in HFA. (Contains 2 figures and 2 tables.)

Objective Early identification of patients at risk of space-occupying 'malignant' middle cerebral artery (MCA) infarction (MMI) is needed to enable timely decision for potentially life-saving treatment such as decompressive hemicraniectomy. We tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset. Methods In a prospective, multicenter, observational cohort study patients with acute ischemic stroke and MCA main stem occlusion were studied by MRI including diffusion-weighted imaging (DWI), perfusion imaging (PI), and MR-angiography within 6 hours of symptom onset. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI. Results Of 140 patients included, 27 (19.3%) developed MMI. The following parameters were identified as independent predictors of MMI: larger acute DWI lesion volume (per 1 ml odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06; p < 0.001), combined MCA + internal carotid artery occlusion (5.38, 1.55-18.68; p = 0.008), and severity of neurological deficit on admission assessed by the National Institutes of Health Stroke Scale score (per 1 point 1.16, 1.00-1.35; p = 0.053). The prespecified threshold of a DWI lesion volume >82 ml predicted MMI with high specificity (0.98, 95% CI 0.94-1.00), negative predictive value (0.90, 0.83-0.94), and positive predictive value (0.88, 0.62-0.98), but sensitivity was low (0.52, 0.32-0.71). Interpretation Stroke MRI on admission predicts malignant course in severe MCA stroke with high positive and negative predictive value and may help in guiding treatment decisions, such as decompressive surgery. In a subset of patients with small initial DWI lesion volumes, repeated diagnostic tests are required. ANN NEUROL 2010 [ABSTRACT FROM AUTHOR]

High-resolution proton magnetic resonance spectroscopy was performed on tissue specimens from 33 patients with astrocytic tumors (22 astrocytomas, 11 glioblastomas) and 13 patients with meningiomas. For all patients, samples of primary tumors and their first recurrences were examined. Increased anaplasia, with respect to malignant transformation, resulting in a higher malignancy grade, was present in 11 recurrences of 22 astrocytoma patients. Spectroscopic features of tumor types, as determined on samples of the primary occurrences, were in good agreement with previous studies. Compared with the respective primary astrocytomas, characteristic features of glioblastomas were significantly increased concentrations of alanine (Ala) ( p = 0.005), increased metabolite ratios of glycine (Gly)/total creatine (tCr) ( p = 0.0001) and glutamate (Glu)/glutamine (Gln) ( p = 0.004). Meningiomas showed increased Ala ( p = 0.02) and metabolite ratios [Gly, total choline (tCho), Ala] over tCr ( p = 0.001) relative to astrocytomas, and N-acetylaspartate and myo-inositol were absent. Metabolic changes of an evolving tumor were observed in recurrent astrocytomas: owing to their consecutive assessments, more indicators of malignant degeneration were detected in astrocytoma recurrences (e.g. Gly, p = 0.029; tCho, p = 0.034; Glu, p = 0.015; tCho/tCr, p = 0.001) in contrast to the comparison of primary astrocytomas with primary glioblastomas. The present investigation demonstrated a correlation of the tCho-signal with tumor progression. Significantly elevated concentrations of Ala ( p = 0.037) and Glu ( p = 0.003) and metabolite ratio tCho/tCr ( p = 0.005) were even found in recurrent low-grade astrocytomas with unchanged histopathological grading ( n = 11). This may be related to an early stage of malignant transformation, not yet detectable morphologically, and emphasizes the high sensitivity of 1H NMR spectroscopy in elucidating characteristics of brain tumor metabolism. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The investigation and differential diagnosis of Asperger syndrome in adults" by Fritz-Georg Lehnhardt, Astrid Gawronski, Hanna Kockler and colleagues in a 2013 issue along with a reply by the authors.

Objective: Valid knowledge about risk stratification is essential for the development of preventive approaches to reduce restraints., Methods:   This retrospective, monocentric study examined all 248 restraining measures used on 79 patients of a university psychiatric department in 2015. Eight institutional and seven patient-related factors were statistically calculated using logistic regression analysis and matched pairs., Results: A statistically significant increased probability of fixation was found in connection with a lower number of nurses per patient, a higher number of patients admitted by law, lower professional experience of nurses and in the nursing late shift as well as when admission occurred via emergency medical service., Conclusion: Based on the results, possible preventive organizational measures are elaborated and preconditions for a prospective evaluation of the complex factors influencing coercive measures are discussed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Status epilepticus (SE) is a severe neurological condition in which epileptic activity is prolonged or recurring, and the likelihood of spontaneous seizure cessation decreases over time. Evidence on the appropriate treatment regimen in therapy-refractory cases is still sparse. Electroconvulsive therapy (ECT) is known as a last resort treatment for SE due its anticonvulsant properties mediated by an increase in seizure threshold during the course of a treatment series. We examined the effects of ECT in a 61-year-old male patient with new-onset super-refractory SE (SRSE), for whom previous extensive efforts to achieve seizure control had failed. To achieve reliable seizure inductions in ECT concomitantly with an extended anticonvulsant treatment, we established a high-intensity ECT protocol: bitemporal ECT was conducted at a double-dosage setting (200% stimulation energy; equivalent to a mean charge of 1,031 mC) including three seizure stimulations during each treatment session on consecutive days until SRSE termination. After the first course of ECT, temporary seizure cessation was reached but lasted for only several days. A second course of ECT was then initiated, using the identical regimen but followed by tapering sessions every other day. Again, the SRSE terminated and after regaining consciousness the patient could be transferred to an acute rehabilitation facility. SRSE cessation can successfully be achieved by means of high-intensity ECT even after six weeks of prolonged SE and exhausted anticonvulsant pharmacotherapeutic strategies. As controlled clinical trials in the area of SRSE are still lacking, the relative significance of a high-intensity ECT protocol in this clinical setting has yet to be determined., Competing Interests: Conflicts of Interest The authors declare that they have no conflicts of interest.

Objective: New medical guideline recommendations for the treatment of major depressive disorders and regulative changes in the payment system of the German mental health care system warrant a revision of the framework in which electroconvulsive therapies (ECT) are offered., Methods: A cost structure analysis of the clinical resources essential for the ECT procedure was conducted and economically validated, exemplified at a German inpatient ECT treatment center., Results: The identification of directly attributable costs to the ECT intervention presupposes an accurate assessment of personnel engagement time and material consumption as well as an inclusion of overhead costs for the operational readiness of the hospital., Conclusion: The increasing importance of ECT in the clinical portfolio of therapy options demands an adequate refunding to support the expansion of this highly effective treatment. For the calculation of an appropriate reimbursement for ECT and ascertaining an acceptable contribution, a detailed knowledge of personnel costs and infrastructure settings of the respective hospitals is required., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)