Katherine Callaghan is a fourth year medical student at Stony Brook University School of Medicine. Katherine obtained a B.S. from Cornell University and is currently persuing a career in Developmental and Behavioral Pediatrics. Michael Nevid is a fourth year medical student at Stony Brook University School of Medicine. Michael obtained a B.S. from Rochester University and is currently persuing a career in Pediatrics.
Case Presentation: Here we present 5 cases of pediatric and adolescent patients with PWS who exhibited episodic manic or hypomanic symptoms indicative of bipolarity. We subsequently discuss the individual treatment regimens of each patient. \r\n\r\nLiterature Review: Prader-Willi Syndrome (PWS) is a genetic disorder caused by loss of function on chromosome 15 (q11-q13). Baseline behavioral probles such as preoccupation with food or skin picking can make psychiatric diagnoses difficult to recognize in this population,6,8. Obsessive-compulsive tendencies and aggression are well known psychiatric illnesses seen in younger PWS populations4-5,8. Autism spectrum diagnoses have been noted as well9. However, little has been reported on the pediatric and adolescent population regarding bipolarity. In regards to treatment of psychiatric comorbidity, SSRIs have had efficacy in limiting obsessive compulsive and aggressive symptoms in some patients4. For psychotic episodes, atypical antipsychotics have had some success, as well as lithium for cycloid psychosis in adults2. Regardless of diagnosis, psychiatric comorbidity is an atypical feature of PWS10. When it does occur, individualized treatment should be explored to address these issues for optimization of patient health.\r\n\r\nClinical Significance: We have shown that bipolarity can be seen in pediatric and adolescent patients with PWS. The use of the antipsychotic Ziprasidone in these patients has helped to prevent further manic episodes. Ziprasidone, a weight neutral atypical, may be a better option than other atypicals when considering hyperphagia in PWS patients.\r\n\r\n
Mrs. Gaukhar Datkhabayeva is a PhD in human physiology. Her PhD thesis was devoted to EEG-investigation of functional brain state self-regulation. Mrs. Datkhabayeva has worked at the Kazakh Academy of Nutrition as a senior researcher for a number of years, and has carried out investigations of food and behavioral factors contributing to childhood obesity, as well as the influence of obesity on children’s cognitive functions, as part of a program of prevention of pediatric obesity in school-age children in Kazakhstan. Mrs. Datkhabayeva’s interests cover popularization of healthy nutrition and elaboration of effective strategies for the promotion of healthy nutrition choices.
Obese children have reduced indices of certain cognitive functions from the executive domain (EF). R. Machinskaya assumed that the difficulties with attention in children with ADHD originate from immaturity or non-optimal functional state of the frontal-thalamic system (FTS), which manifests itself as bilaterally-synchronous groups of theta waves in the frontal and/or central leads (FCTW) in the rest-state EEG. MRT studies have detected structural deviations as well as delayed development, primarily in the frontal lobes of the brain of obese adolescents. We have analyzed the frequency of FCTW occurrences in the EEG of 52 children with obesity and 46 matching children with normal weight (NW) and evaluated attention, mental flexibility (MF) and response inhibition in FCTW- and Non-FCTW children with obesity and NW. Among children with obesity, FCTW-children were more common than among their lean counterparts (60% and 30%, respectively). Toward the end of the Letter Cancellation Test (LCT), the obese children exhausted their attention. No observable differences were found in the cognitive outcomes between the Non-FCTW children with obesity and NW, while the FCTW-children with obesity demonstrated poorer performance in MF and number of viewed letters in the LCT vis-à-vis their lean counterparts. FCTW presence in the EEG of children with obesity positively correlates with the reaction time in a response inhibition test. In the FCTW-children, BMI and MF correlate reversely. Thus, children with obesity have an increased probability of a delayed functional development of FTS. It seems that children with a delayed development (or non-optimal state) of FTS combined with obesity have lower cognitive outcomes due to the fact that obesity exacerbates delays in the development or non-optimal state of FTS.rn rn