Chapter 16. Psychopathology: Biological Basis of Behavior Disorders
Follow us on Facebook and Twitter, or subscribe to our mailing list, to receive news updates. Learn more.
by Nora Schultz A unique population in northern Finland has helped reveal that schizophrenia, some autism spectrum disorders and other forms of cognitive impairment may all share a common genetic pathway. In Finland, there exist several small communities that used to live for years in isolation. Amongst the descendants of these groups, otherwise rare genes occur more regularly than elsewhere in the country because a level of inbreeding was almost inevitable. Nelson Freimer at the University of California, Los Angeles, and colleagues studied one of these communities, where schizophrenia and other neurological disorders are unusually common. His team first searched for any genetic deletions – chunks of DNA that are missing from a chromosome – that were more common in this group than in the general population. They found a promising candidate on chromosome 22. A deletion on this chromosome was present in 18 of 173 people from this isolated group, but in just one of the 1586 samples taken from people spread throughout the rest of Finland. Tests confirmed that people with schizophrenia or cognitive impairments were more likely to be missing this chunk of DNA. Identifying this deletion as a risk factor for schizophrenia and cognitive impairment puts us one step closer to understanding the biological processes at the root of such complex syndromes, says Freimer. © Copyright Reed Business Information Ltd.
Women living in urban centres in Canada with more than 500,000 inhabitants are at higher risk of postpartum depression than women in other areas, suggests a new study in the Canadian Medical Association Journal. Looking at the experiences of over 6,000 women who lived in rural, semi-rural, semi-urban or urban areas from the 2006 Canadian Maternity Experiences Survey, the study suggests that women in urban areas were at higher risk, with almost 10 per cent reporting postpartum depression compared with six per cent of women in rural areas, almost seven per cent of women in semirural areas and about five per cent in semiurban areas. Urban areas were found to have higher numbers of immigrant populations, and more women in these areas reported lower levels of social support during and after pregnancy. "We found that Canadian women who lived in large urban areas … were at higher risk of postpartum depression than women living in other areas," said Dr. Simone Vigod, psychiatrist at Women's College Hospital and scientist at Women's College Research Institute in Toronto. "The risk factors for postpartum depression [including history of depression, social support and immigration status] that were unequally distributed across geographic regions accounted for most of the variance in the rates of postpartum depression." The reason why immigrant woman appear to be at higher risk is not really known, she said. "Some theories are that it's related to social support or being away from their family." They could also have cultural barriers or needs that are not being met, she added. © CBC 2013
By Scicurious Most current treatments for depression target the serotonin system, a chemical messenger that plays a role in mood (though it also plays a role in many, many other things). Most of the antidepressant drugs on the market (such as Prozac, Celexa, and Zoloft) that target serotonin do it by blocking the recycling of serotonin, keeping it in the spaces between neurons and allowing it to be active for far longer than it might otherwise. The problem is, these drugs take a long time to work. Often many weeks. In that time, patients may grow frustrated as side effects happen and the needed effects don’t. Patients may be in very desperate straights when they first go on medication, and any extra time before the drugs work becomes that much more dangerous. The drugs may not work at all, causing doctors and patients to have to go through the entire, weeks long process over and over again. Scientists are looking for new antidepressant mechanisms, and trying to create more effective drugs. But there are various ways to go about it. You can go looking for an entirely new way of working, but you can also look at ways to make the current drugs work faster. One target that might help antidepressant drugs work faster is one of the many receptors for serotonin, the 5-HT1A receptor. Receptors are proteins that sit on cell surfaces, and bind chemicals. When they bind a chemical, they cause change, maybe by opening a channel, or starting a signal to make a neuron fire more, or less. What a receptor does depends on its type, but also where in the brain it is located and on what type of cell. © 2013 Scientific American
Link ID: 18463 - Posted: 08.06.2013
By CHRISTINE MONTROSS PROVIDENCE, R.I. — M is a 33-year old woman who swallowed silverware. She wasn’t psychotic, or out of touch with reality. She knew it was not a good idea to swallow forks and knives and she wasn’t trying to kill herself. In fact, each time she ingested utensils, she went to the emergency room so that doctors could remove them from her esophagus and stomach. Then the hospital transferred M to the psychiatric unit, where she was assigned to my care. Enlarge This Image Robert Frank Hunter When I met M she had already been hospitalized 72 times. She’d swallowed silverware — and batteries — before. Sometimes she inserted sharp objects or large doses of medication into her vagina. There are psychiatric patients who cut or burn themselves in an attempt to relieve mental anguish; M did both of these things, too, periodically, but she had primarily developed a maladaptive habit of ingesting or inserting dangerous objects into her body as a means of coping with stress. Each time, she said, she felt better afterward. Then she brought herself to the emergency room for treatment. M’s case is dramatic. But she is one of countless psychiatric patients who have nowhere to turn for care, other than the E.R. It is well known that millions of uninsured Americans, who can’t afford regular medical care, use the country’s emergency rooms for primary health care. The costs — to patients’ health, to their wallets, and to the health care system — are well documented. Less visible is the grievous effect this shift is having on psychiatric care and on the mentally ill. © 2013 The New York Times Company
Link ID: 18457 - Posted: 08.05.2013
Steve Connor A gene thought to be involved in nerve development can double the risk of schizophrenia when it is damaged, according to a pioneering study into one of most costly mental illnesses. The findings are further evidence of a genetic basis for schizophrenia – which affects about one in every 100 people at some time of their lives – and could lead to a greater understanding of the physical faults that might lead to the psychiatric disorder in some susceptible people. The chronic, long-term illness, which results in persistent delusions and hallucinations, is estimated to cost the NHS about £2bn a year in care and treatment alone. But the extra burden on patients, their families and the criminal justice system is thought to be at least twice as high. Scientists said the genetic fault they have discovered is also associated with a separate inherited disorder that results in learning difficulties and autism. This link, they said, is probably the result of them sharing a common biological pathway at the genetic level. The gene linked to schizophrenia, called TOP3B, is normally involved in unwinding the DNA double helix to allow other genes to function, especially when the nerve cells of the brain are developing, both in the womb and during the crucial first years of life. © independent.co.uk
Researchers have reverse-engineered the outlines of a disrupted prenatal gene network in schizophrenia, by tracing spontaneous mutations to where and when they likely cause damage in the brain. Some people with the brain disorder may suffer from impaired birth of new neurons, or neurogenesis, in the front of their brain during prenatal development, suggests the study, which was funded by the National Institutes of Health. “Processes critical for the brain’s development can be revealed by the mutations that disrupt them,” explained Mary-Claire King, Ph.D. External Web Site Policy, University of Washington (UW), Seattle, a grantee of NIH’s National Institute of Mental Health (NIMH). “Mutations can lead to loss of integrity of a whole pathway, not just of a single gene. Our results implicate networked genes underlying a pathway responsible for orchestrating neurogenesis in the prefrontal cortex in schizophrenia.” King, and collaborators at UW and seven other research centers participating in the NIMH genetics repository, report on their discovery Aug. 1, 2013 in the journal Cell. “By linking genomic findings to functional measures, this approach gives us additional insight into how early development differs in the brain of someone who will eventually manifest the symptoms of psychosis,” said NIMH Director Thomas R. Insel, M.D. Earlier studies had linked spontaneous mutations to non-familial schizophrenia and traced them broadly to genes involved in brain development, but little was known about convergent effects on pathways.
By PAM BELLUCK For some people with severe mental illness, life is a cycle of hospitalization, skipped medication, decline and then rehospitalization. They may deny they have psychiatric disorders, refuse treatment and cascade into out-of-control behavior that can be threatening to themselves or others. Now, a study has found that a controversial program that orders these patients to receive treatment when they are not hospitalized has had positive results. Patients were much less likely to end up back in psychiatric hospitals and were arrested less often. Use of outpatient treatment significantly increased, as did refills of medication. Costs to the mental health system and Medicaid of caring for these patients dropped by half or more. The study evaluated the program run by New York State, known as Kendra’s Law because it was enacted after Kendra Webdale was pushed to her death on the New York City subway tracks by a man with untreated schizophrenia in 1999. Forty-four other states have some form of Kendra’s Law, but New York’s is by far the most developed because the state has invested significant resources into paying for it, experts say. From the start, Kendra’s Law has had staunch defenders and detractors. But the new analysis, led by researchers at Duke University and published in The American Journal of Psychiatry, joins a series of studies that suggest the program can be helpful for patients who, while they constitute only a small number of the people with mental illness, are some of the most difficult and expensive to care for. © 2013 The New York Times Company
By Simon Makin One common complaint about psychiatry is its subjective nature: it lacks definitive tests for many diseases. So the idea of diagnosing disorders using only brain scans holds great appeal. A paper published recently in PLOS ONE describes such a system, although it was presented only as an initial proof of concept. News reports, however, trumpeted the advent of “objective” psychiatric diagnoses. The paper used data from several earlier studies, in which researchers outlined key brain regions in MRI scans of people with bipolar disorder, ADHD, schizophrenia or Tourette's syndrome; people with low or high risk of developing major depressive disorder; and a healthy group. The scans were also labeled with the disorder or depression risk level of the original study participant. In the new study, scientists divided the scans randomly into two sets, one to build the diagnostic system and the other to test it. Their software then grouped the scans in the first set by the shape of various regions. Each group was labeled with the most common diagnosis found within it. During testing, the system analyzed the shapes of brain regions in each test scan and assigned it to the group it most resembled. The scientists checked its work by comparing the new labels on the test scans with the original clinical diagnoses. They repeated the procedure several times with different randomly generated sets. When the system chose between two disorders or one ailment and a clean bill of health, its accuracy was nearly perfect. When deciding among three alternatives, it did much worse. © 2013 Scientific American
Jaak Panksepp, the inventor of the term "affective neuroscience", is regarded as a radical in his field, with ground-breaking insights into emotional issues ranging from depression to playfulness. What makes him radical? First, his study of animal emotions, and his data-supported assertion that animals experience feelings as humans do. Using electrical stimulation of the brain, Panksepp has shown that all mammals have the same basic emotional system: i.e. underlying neural networks that are linked to feelings of raw emotion, and respond positively or negatively when aroused. For example, Panksepp has tickled rats to hear them 'laugh' ; in other species, he has conducted extensive experiments on what he calls "separation distress." Today's neuroscientists generally do not bother to consider the emotional life of animals, or put it on par with that of humans. But as Panksepp eloquently argues: "Animals do have emotional systems that generate feelings, even though hardly a neuroscientist yet acknowledges this fact." Second: Panksepp looks at what causes our feelings: the primary, instinctual networks in the brain that make them happen. Most neuroscientists, he confided in our phone conversation between Paris (where I teach) and Washington (where he teaches), look only at symptoms. "They are behaviorists. They follow the tradition of early psychologist William James, who looked at emotion as a mental after-effect, a cognitive read-out of autonomic bodily arousals, rather than as the brain system which drives us." He has been at odds with these behaviorists for most of his career, this despite the fact that Panksepp's major contributions to the field of emotion are now widely accepted, especially by psychotherapists treating patients for emotional concerns such as depression. © 2013 TheHuffingtonPost.com, Inc.
By Rachael Rettner, People with post-traumatic stress disorder (PTSD) often show differences in certain brain areas compared with healthy people, but it has been difficult to determine whether these differences are a cause or a consequence of the condition. Now, a number of new studies may help disentangle the condition’s causes from its effects and, in doing so, bring a better understanding of how the disorder might be prevented or treated. In a review article, researchers draw upon these studies to piece together a new model for how the condition arises. The model suggests that three factors are necessary for PTSD to develop: A person needs to have certain risk factors for the condition; he or she must be exposed to a traumatic event; and, after that event, further changes to the brain need to occur. With this view of the condition, researchers may ultimately be able to predict who is at risk for PTSD before experiencing a traumatic event and to treat people at the right time after trauma to prevent subsequent brain changes from occurring, thus keeping the disorder from progressing to its final form. “If the disease causes specific changes [in the brain], then treatment can cause the same change in the other direction,” said Roee Admon, a researcher at Harvard Medical School. He, along with colleagues, proposed the new PTSD model in the July issue of the journal Trends in Cognitive Sciences. According to the model, changes in two brain areas — the amygdala and the dorsal anterior cingulate cortex (dACC) — may predispose people to PTSD. © 1996-2013 The Washington Post
Link ID: 18389 - Posted: 07.18.2013
Trevor Stokes Reuters Talk therapy may be a helpful supplemental treatment for people with depression who have not responded to medication, a new study from the United Kingdom suggests. Researchers found that people with depression who had not improved despite taking antidepressants were three times more likely to experience a reduction in their depression symptoms if talk therapy was added to their treatment regimen compared with those who continued to take only antidepressants. The study is one of the first large trials to test the effectiveness of talk therapy given in tandem with antidepressants, the researchers said. Up to two-thirds of people with depression don’t respond fully to antidepressant treatment, and the findings suggest a way to help this group, the researchers said. “Until now, there was little evidence to help clinicians choose the best next step treatment for those patients whose symptoms do not respond to standard drug treatments," study researcher Nicola Wiles of the University of Bristol's Centre for Mental Health, Addiction and Suicide Research said in a statement. The study followed patients for one year. Future studies should examine the effectiveness of this treatment combination over the long term, as patients with depression can relapse after treatment, the researchers said.
Link ID: 18375 - Posted: 07.15.2013
By JAN HOFFMAN From the shock of the cancer diagnosis onward, depression can take its well-documented toll on patients. Even patients who appear to pack away their fears during the grinding treatment journey to becoming cancer-free concede that when the regimen ends, they unspool emotionally. There has been less attention paid to the disease’s emotional impact on spouses. They, too, can become depressed. But with the roles of caregiver and cheerleader thrust upon them, they may feel constrained about expressing their darker feelings. Now a new analysis finds that within two years of a cancer diagnosis, the pervasiveness of depression in patients and their spouses tends to drop back to roughly the same levels as in the general population, only to be replaced by another mind-demon: anxiety, which can even intensify as time passes. 48 Were you a caretaker for someone with cancer? How did you take care of yourself while your partner was going through treatment? Join in the discussion below. The analysis, which looked at 43 studies involving 51,381 patients with a range of cancers, found that over all, nearly 18 percent of patients experienced serious anxiety two to 10 years after their diagnosis, compared with about 14 percent of the general population. But in a cluster of studies that looked at couples, anxiety levels in that time frame grew to as high as 28 percent in patients and 40 percent in their spouses. Copyright 2013 The New York Times Company
Link ID: 18372 - Posted: 07.13.2013
By NICHOLAS BAKALAR Using functional magnetic resonance imaging, researchers have found brain changes in preschool-age children with depression that are not apparent in their nondepressed peers. The study, in the July issue of The Journal of the American Academy of Child & Adolescent Psychiatry, examined 23 children 4 to 6 years old who had been diagnosed with depression and 31 of their healthy peers. Researchers used well-validated tests to diagnose depression, and eliminated from the study children with neurological disorders, autism or developmental disorders, or who had been born prematurely. None of the subjects was taking antidepressants. The children underwent M.R.I. brain scans while viewing pictures of happy, sad, fearful or neutral faces. The researchers found that right amygdala and right thalamus activity was significantly greater in the depressed children than in the others, a finding that has also been observed in depressed adolescents and adults. “We found something in the brain that is aligned with the idea of neurobiological models of depression — which parts of the brain are involved and how they interact,” said the lead author, Michael S. Gaffrey, an assistant professor in the department of psychiatry at Washington University in St. Louis. “We can begin to use this information in conjunction with other information — symptoms, other biological markers — to identify and eventually prevent and treat this disorder.” Copyright 2013 The New York Times Company
By Bruce Bower A surprisingly simple decision-making tool shows promise as a way for physicians to identify people with depression. An answer to the first of four questions was all that researchers usually needed to identify women who weren’t depressed, say psychologist Mirjam Jenny of the Max Planck Institute for Human Development in Berlin and her colleagues. Using all four questions, this tool spotted depressed women about as well as two more-complex methods, Jenny’s team reports June 24 in the Journal of Applied Research in Memory and Cognition. If the findings hold up in other studies, physicians and other professionals with no mental-health training could use this brief technique to tag individuals who need thorough depression evaluations. “This decision tree can be used to screen for depression, but not to reach a final diagnosis,” Jenny says. Her team drew on data from 1,382 German women who completed a 21-item screening questionnaire for depression on two occasions, separated by 18 months. Based on this measure, depression initially affected 3.6 percent of the sample, or 50 individuals, and later appeared in 1.9 percent of the sample, or 26 individuals. Women’s initial responses to a handful of items that best predicted whether they would rank as depressed 18 months later were used to create a four-question decision tree. The first question in the tree — “Have you cried more than usual in the last week?” — led the pack in identifying cases of depression. A “no” response to this or any of the other three questions — which inquired about feelings in the last week of disappointment or self-hate, discouragement about the future and personal failure — exempted women from being categorized as depressed. Those who responded “yes” to all four questions were classified as depressed. © Society for Science & the Public 2000 - 2013
Link ID: 18370 - Posted: 07.13.2013
by Kelly Servick It almost seems like a mystical correlation. Babies conceived at certain times of the year appear healthier than those conceived during other times. Now, scientists have shown that the bizarre phenomenon is actually true—and they think they may know why it happens. The work is "a really long-overdue analysis," says economist Douglas Almond of Columbia University, who was not involved in the study. "This is maybe not quite a smoking gun," he says, "but it's much stronger than the previous evidence." As early as the 1930s, researchers noticed that children born in winter were more prone to health problems later in life: slower growth, mental illness, and even early death. Among the proposed explanations were diseases, harsh temperatures, and higher pollution levels associated with winter, when those expectant mothers and near-term fetuses might be most vulnerable. But recently, as economists looked at demographics, the picture got more complicated. Mothers who are nonwhite, unmarried, or lack a college education are more likely to have children with health and developmental problems. They are also more likely to conceive in the first half of the year. That made it hard to tease out the socioeconomic effects from the seasonal ones. Economists Janet Currie and Hannes Schwandt of Princeton University took a new approach to resolving this long-standing question, using data from the vital statistics offices in New Jersey, New York, and Pennsylvania about births between 1994 and 2006. To control for socioeconomic status, their study looked only at siblings born to the same mother. And lo and behold, seasonal patterns persist, they report online today in the Proceedings of the National Academy of Sciences. © 2010 American Association for the Advancement of Science
By GRETCHEN REYNOLDS In an eye-opening demonstration of nature’s ingenuity, researchers at Princeton University recently discovered that exercise creates vibrant new brain cells — and then shuts them down when they shouldn’t be in action. For some time, scientists studying exercise have been puzzled by physical activity’s two seemingly incompatible effects on the brain. On the one hand, exercise is known to prompt the creation of new and very excitable brain cells. At the same time, exercise can induce an overall pattern of calm in certain parts of the brain. Most of us probably don’t realize that neurons are born with certain predispositions. Some, often the younger ones, are by nature easily excited. They fire with almost any provocation, which is laudable if you wish to speed thinking and memory formation. But that feature is less desirable during times of everyday stress. If a stressor does not involve a life-or-death decision and require immediate physical action, then having lots of excitable neurons firing all at once can be counterproductive, inducing anxiety. Studies in animals have shown that physical exercise creates excitable neurons in abundance, especially in the hippocampus, a portion of the brain known to be involved in thinking and emotional responses. But exercise also has been found to reduce anxiety in both people and animals. How can an activity simultaneously create ideal neurological conditions for anxiety and leave practitioners with a deep-rooted calm, the Princeton researchers wondered? So they gathered adult mice, injected them with a substance that marks newborn cells in the brain, and for six weeks, allowed half of them to run at will on little wheels, while the others sat quietly in their cages. Copyright 2013 The New York Times Company
By RONI CARYN RABIN Martha Rhodes experienced her first bout of depression at 13. By her late 50s, she had taken just about every antidepressant there is, including Zoloft, Lexapro and Paxil — which did the trick for many years, but had side effects — then Effexor, Lamictal, Seroquel and Abilify. After a suicide attempt in 2009, she tried something radically different: transcranial magnetic stimulation, or TMS, a treatment in which magnetic pulses are used to stimulate parts of the brain believed to be involved in mood regulation. Unlike electroconvulsive or shock therapy, which is also used to treat stubborn depression, TMS does not generally produce seizures. Every day, she spent just over half an hour in a chair with a powerful magnet affixed to the front left side of her head. After four weeks, “I woke up and something was different,” said Mrs. Rhodes, who wrote a book, “3,000 Pulses Later” describing the treatment. “I felt lighter. I didn’t wake up in the morning and wish I were dead.” For Mrs. Rhodes, 63, a former advertising executive in Danbury, Conn., TMS treatment was transformative, and she no longer needs antidepressants. But there are still many questions about just how many severely depressed patients respond to TMS, which requires daily office visits for several weeks, costs thousands of dollars and is often not covered by insurance. For the therapy, patients sit in a doctor’s office with a large magnet pressed to the left side of their heads. The idea is that a pulsed magnetic field, similar to that used in M.R.I.’s, creates an electrical current in the surface of the brain that “resets” the patient’s mood regulatory system. Copyright 2013 The New York Times Company
Link ID: 18337 - Posted: 07.02.2013
By Carrie Arnold We all experience the occasional life-changing event—a new baby, a cross-country move, a serious injury. In rare cases, such events can precipitate a mental disorder. The problem is compounded because people often assume their suffering is par for the course after such upheaval. In reality, relief is probably a short treatment away, via therapy or medication. For a new mother, dealing with a newborn is fraught with anxieties. Did I fasten the car seat properly? Is the baby still breathing? In more than one in 10 new mothers, these normal worries can escalate into more serious obsessions that can interfere with her ability to care for herself and her baby. Most of the research on postpartum psychiatric problems has focused on depression and psychosis. Obstetricians such as Emily Miller of Northwestern University, however, were also noticing a range of anxiety-related disorders, including intrusive thoughts and repetitive behaviors. “It's good to check that your baby is strapped into the car seat,” Miller notes. “But these women aren't just doing it once. They're doing it over and over, and it's interfering with their lives.” With her colleagues, Miller followed 461 women after they gave birth. Eleven percent said they had obsessions and compulsions two weeks after delivery that the researchers found to be the equivalent of mild to moderate obsessive-compulsive disorder (OCD)—a sharp increase over the 2 to 3 percent rate of OCD in the general population. Half of these women's symptoms continued six months' postpartum, and an additional 5.4 percent developed new OCD symptoms in that time. The afflicted women indicated that their symptoms were distressing, taking up a significant amount of time and otherwise interfering with their daily life. © 2013 Scientific American
Male twin Vietnam veterans with post-traumatic stress disorder (PTSD) were more than twice as likely as those without PTSD to develop heart disease during a 13-year period, according to a study supported by the National Institutes of Health. This is the first long-term study to measure the association between PTSD and heart disease using objective clinical diagnoses combined with cardiac imaging techniques. “This study provides further evidence that PTSD may affect physical health,” said Gary H. Gibbons, M.D., director of the NIH's National Heart, Lung, and Blood Institute (NHLBI), which partially funded the study. “Future research to clarify the mechanisms underlying the link between PTSD and heart disease in Vietnam veterans and other groups will help to guide the development of effective prevention and treatment strategies for people with these serious conditions.” The findings appear online today in the Journal of the American College of Cardiology and in the September 10 print issue. Researchers from the Emory University Rollins School of Public Health in Atlanta, along with colleagues from other institutions, assessed the presence of heart disease in 562 middle-aged twins (340 identical and 222 fraternal) from the Vietnam Era Twin Registry. The incidence of heart disease was 22.6 percent in twins with PTSD (177 individuals) and 8.9 percent in those without PTSD (425 individuals). Heart disease was defined as having a heart attack, having an overnight hospitalization for heart-related symptoms, or having undergone a heart procedure. Nuclear scans, used to photograph blood flow to the heart, showed that individuals with PTSD had almost twice as many areas of reduced blood flow to the heart as individuals without PTSD.
The risk posed by some popular antidepressants in early pregnancy is not worth taking for women with mild to moderate depression, an expert has warned. Professor Stephen Pilling says evidence suggests SSRIs can double the risk of a child being born with a heart defect. The drugs have been used by up to one in six women of child-bearing age. A manufacturer contacted by the BBC denies any link to major foetal malformations. Panorama has spoken to eight mothers who had babies born with serious heart defects after taking a commonly used SSRI (selective serotonin reuptake inhibitors) antidepressant while pregnant. Currently, prescription guidelines for doctors only warn specifically against taking the SSRI, paroxetine, in early pregnancy. But Prof Pilling, expert adviser to the National Institute for Health and Care Excellence (NICE), says that advice is about to be updated. "The available evidence suggests that there is a risk associated with the SSRIs. We make a quite a lot of effort really to discourage women from smoking or drinking even small amounts of alcohol in pregnancy, and yet we're perhaps not yet saying the same about antidepressant medication, which is going to be carrying similar - if not greater - risks," he said. When Anna Wilson, from Ayrshire, had her 20-week scan, doctors realised her son had a serious heart problem and would need immediate heart surgery when he was born. David Wilson David will need further surgery before he starts school Now eight months old, David was hooked up to machines for the first five weeks of his life. He will need more open-heart surgery before he starts school and doctors say he may not live beyond 40. BBC © 2013