bluuebunny/crossref_metadata_2025 huggingface dataset:
Design analysis of phosphor-free monolithic white light-emitting-diodes with InGaN/ InGaN multiple quantum wells on ternary InGaN substrates
Authors: Ooi Yu Kee , Zhang Jing
Published: May 2015

Phosphor-free monolithic white light emitting diodes (LEDs) based on InGaN/ InGaN multiple quantum wells (MQWs) on ternary InGaN substrates are proposed and analyzed in this study. Simulation studies show that LED devices composed of multi-color-emitting InGaN/ InGaN quantum wells (QWs) employing ternary InGaN substrate with engineered active region exhibit stable white color illumination with large output power (∼ 170 mW) and high external quantum efficiency (EQE) (∼ 50%). The chromaticity coordinate for the investigated monolithic white LED devices are located at (0.30, 0.28) with correlated color temperature (CCT) of ∼ 8200 K at J = 50 A/cm2. A reference LED device without any nanostructure engineering exhibits green color emission shows that proper engineered structure is essential to achieve white color illumination. This proof-of-concept study demonstrates that high-efficiency and cost-effective phosphor-free monolithic white LED is feasible by the use of InGaN/ InGaN MQWs on ternary InGaN substrate combined with nanostructure engineering, which would be of great impact for solid state lighting.
A recent survey of naturally occurring organohalogen compounds
Authors: Gribble Gordon W.
Published: May 2015

Environmental context
The general perception that nature does not produce compounds containing halogens – chlorine, bromine, iodine and fluorine – is now known to be erroneous. Modern isolation and identification techniques have led to the discovery of more than 5000 halogen-containing compounds from myriad marine and terrestrial plant and animal sources. Many of these compounds possess extraordinary biological activity, including anticancer, antiviral and antibacterial activity of potential human benefit.

Abstract
This short review presents the naturally occurring organohalogen compounds discovered and characterised in 2014. They include compounds from both marine and terrestrial organisms, such as algae, sponges, corals, tunicates, bryozoans, fungi, bacteria, cyanobacteria and plants. Several novel structural types have been characterised. From only ~24 in 1968, naturally occurring organohalogens currently number more than 5000, and they continue to be discovered in all regions of the world. This review presents the 114 discovered organohalogens from natural sources in the year 2014.
Substrate type affects the abundance and size of a coral-reef sponge between depths
Authors: Duckworth Alan R.
Published: May 2015

Substrate stability could influence abundance and size patterns of benthic organisms and thus affect community structure. Sponges on coral reefs are often found growing on calcareous rock and rubble that vary in stability, with loose rubble more easily moved by water flow, which is typically strongest in shallower water. Using the common Indo-Pacific sponge, Coscinoderma matthewsi (Lendenfeld, 1886), the present study examines the interaction of substrate type and depth (6 and 12m) on sponge abundance, size, morphology and skeletal properties (i.e. spongin fibres). Coscinoderma matthewsi was three times less common at 6m, with most sponges at this depth attached to rock, even though rubble had higher percentage cover. Mean sponge length, width and height were all greatest at 12m, with sponges growing largest on rock, probably because it is a more stable substrate for survival and growth. Morphology varied between depths, with most C. matthewsi individuals at 6m having a massive shape, whereas many sponges at 12m grew large lobes; this increases their surface area and possibly promotes filtration. Spongin density, length and width varied greatly among individuals; however, there was no consistent pattern across depth.
Mycalolide B dissociates dynactin and abolishes retrograde axonal transport of dense-core vesicles
Authors: Cavolo Samantha L. , Zhou Chaoming , Ketcham Stephanie A. , Suzuki Matthew M. , Ukalovic Kresimir , Silverman Michael A. , Schroer Trina A. , Levitan Edwin S.
Published: May 2015

Axonal transport is critical for maintaining synaptic transmission. Of interest, anterograde and retrograde axonal transport appear to be interdependent, as perturbing one directional motor often impairs movement in the opposite direction. Here live imaging of Drosophila and hippocampal neuron dense-core vesicles (DCVs) containing a neuropeptide or brain-derived neurotrophic factor shows that the F-actin depolymerizing macrolide toxin mycalolide B (MB) rapidly and selectively abolishes retrograde, but not anterograde, transport in the axon and the nerve terminal. Latrunculin A does not mimic MB, demonstrating that F-actin depolymerization is not responsible for unidirectional transport inhibition. Given that dynactin initiates retrograde transport and that amino acid sequences implicated in macrolide toxin binding are found in the dynactin component actin-related protein 1, we examined dynactin integrity. Remarkably, cell extract and purified protein experiments show that MB induces disassembly of the dynactin complex. Thus imaging selective retrograde transport inhibition led to the discovery of a small-molecule dynactin disruptor. The rapid unidirectional inhibition by MB suggests that dynactin is absolutely required for retrograde DCV transport but does not directly facilitate ongoing anterograde DCV transport in the axon or nerve terminal. More generally, MB's effects bolster the conclusion that anterograde and retrograde axonal transport are not necessarily interdependent.
Indigenes’ Responses to Immigrants’ Consumer Acculturation: A Relational Configuration Analysis
Authors: Luedicke Marius K.
Published: May 2015

Consumer research commonly conceptualizes consumer acculturation as a project that immigrants pursue when adjusting their consumer identities and practices to unfamiliar sociocultural environments. This article broadens this prevailing view by conceptualizing consumer acculturation as a relational, interactive adaptation process that involves not only immigrant consumption practices but also indigenes who interpret and adjust to these practices, thereby shaping the paths of possibility for mutual adaptation. Based on a Fiskenian relational configuration analysis, the study shows how indigenes in a rural European town interpret certain immigrant consumption practices as manifestations of a gradual sell-out of the indigenous community, a crumbling of their authority, a violation of equality rules, and of indigenes being torn between contradictory micro- and macro-social morals. The article contributes a broader conceptualization of consumer acculturation, highlights four sources of ethnic group conflict in a consumer acculturation context, and demonstrates the epistemic value of Fiskenian relational configuration analysis for consumer culture theory.
Turning to Space: Social Density, Social Class, and the Value of Things in Stores
Authors: O’Guinn Thomas Clayton , Tanner Robin J. , Maeng Ahreum
Published: May 2015

This article is about social space and material objects for sale within that space. We draw primarily on Goffman’s (1971) concepts of use space and possession territories to predict that as the social density of a given space increases, inferences of the subjective social class and income of people in that space fall. Eight studies confirm that this is indeed the case, with the result holding even for stick figures, thus controlling for typical visual indicators of social class such as clothing or jewelry. Furthermore, these social class inferences mediate a relationship between social density and product valuation, with individuals assessing both higher prices and a greater willingness to pay for products presented in less crowded contexts. This effect of inferred class on product valuation is explained by status-motivated individuals’ desire to associate with higher-status people. To the best of our knowledge, this research is the first to reveal the link between social density, status inferences, and object valuations. As such, it makes a novel contribution to what has come to be known in sociology as the topological turn: a renewed focus on social space.
Heart valve prostheses
Authors: Badano Luigi P. , Muraru Denisa
Published: May 2015

Echocardiography is the single most-useful imaging modality to assess heart valve prosteses function. In the majority of patients, transthoracic echocardiography (TTE) is sufficient to assess baseline prostehsis hemodynamics and routine follow-up studies. However, in patients with suspected dysfunction, particularly for prostheses in mitral position, the addition of transoesophageal echocardiography is usually necessary. Stress echocardiography may also be necessary in patients with exertional symptoms unexplained by the resting TTE. To increase accuracy in detecting prosthesis malfunction and to address patient management, a baseline echocardiographic study obtained between 3 and 6 months after valve replacement, should be used to compare follow-up study data.

The aim of this chapter is to summarize the normal appearance of heart valve prostheses by position and also to describe the echocardiographic findings of malfunctioning valves.
Endocarditis
Authors: Habib Gilbert , Thuny Franck
Published: May 2015

Imaging plays a key role in the assessment of infective endocarditis. Echocardiography, particularly transoesophageal echocardiography, gives useful information concerning the diagnosis of infective endocarditis, the assessment of the severity of the disease, the prediction of short-term and long-term prognosis, and the follow-up of patients under specific antibiotic therapy. Other imaging techniques, including magnetic resonance imaging, Computed tomography (CT) scan, and invasive angiography, are of limited value for the diagnosis of infective endocarditis, but are useful for the diagnosis and management of its complications. FDG PET/CT imaging seems the most promising new imaging technique, particularly for the diagnosis of prosthetic valve endocarditis
Echocardiography and detection of coronary artery disease
Authors: Sicari Rosa
Published: May 2015

Coronary artery disease provokes an imbalance between myocardial oxygen supply and demand inducing myocardial ischaemia and infarction. Myocardial ischaemia causes left ventricular regional dyssynergy (an early, sensitive, and specific marker of ischaemia) and global dysfunction (a late and non-sensitive sign). To date, echocardiography has been the technique of choice for the assessment of regional ventricular function, both in resting conditions and even more so during stress, in spite of the dependence of echocardiographic imaging on the patient’s acoustic window and on the experience of the cardiologist interpreting the study. The advantages of feasibility, safety, reliability, and unsurpassed temporal resolution allow the documentation under optimal conditions of a regional dysfunction, which can be extremely localized in space and transient in time. Stress echocardiography is the combination of 2D-echocardiography with a physical, pharmacological, or electrical stress. The diagnostic end-point for the detection of myocardial ischaemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in post-ischaemic dilated cardiomyopathy. In spite of its dependence upon operator’s training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging.
Nuclear cardiology and detection of coronary artery disease
Authors: Stirrup James , Richard Underwood S.
Published: May 2015

Experience with radionuclide assessments of myocardial perfusion can be measured over decades. Single-photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) has been validated for the diagnosis and prognosis of cardiac disease and the technique is embedded in national and international guidelines. Positron emission tomography (PET) has been used to assess myocardial viability but it is now used increasingly to detect flow- limiting coronary artery disease (CAD). With alternative cardiac imaging techniques now available it is more important than ever to understand the principles, indications, and pitfalls of the options. No single technique provides a complete assessment of the heart; many provide complementary rather than equivalent information. In this chapter, the value of cardiac radionuclide imaging in stable CAD and acute coronary syndromes (ACS) is discussed, with a particular emphasis on the role of MPS, the most commonly used technique in nuclear cardiology.
Imaging the vulnerable atherosclerotic plaque
Authors: Vancraeynest David , Vanoverschelde Jean-Louis J.
Published: May 2015

Although mortality rates from ischaemic heart disease have decreased in the past decades, diseases of the heart and circulatory system remain the main cause of death in Europe, accounting for over 4 million fatalities each year (nearly half of all deaths). Arterial thrombosis superimposed on the atherosclerotic plaque precipitates an acute vascular event, which is what underlies the high mortality rate. The plaque morphologies responsible for thrombosis are either plaque rupture or plaque erosion. Plaque rupture is the most common cause of acute vascular events, and the rupture-prone plaques are called ‘vulnerable plaques’. Because the detection of such plaques represents the ‘Holy Grail’ for every clinician, much effort has been invested in accurately detecting the presence of vulnerable plaques using different imaging techniques. This chapter provides an overview of the currently available non-invasive imaging modalities aimed at detecting vulnerable plaques and discusses their place in clinical practice.
Evaluation of right ventricular function
Authors: Pierard Luc A. , Dulgheru Raluca E.
Published: May 2015

A correct and attentive evaluation of right ventricular (RV) morphology and function is mandatory in each patient. RV is considered rather difficult to assess by imaging techniques. However, with the use of echocardiography and CMR, a complete assessment of RV geometry and function is usually achievable. Because of its non-invasive nature, wide availability, and repeatability, echocardiography remains the first-line imaging technique to be used for assessing RV morphology and function in patients with suspected right-side heart disease. CMR is, undoubtedly, the ‘gold-standard’ in assessing RV volumes, ejection fraction, and tissue characterization. 3D-echocardiography, deformation imaging, and cardiac CT add valuable information, depending on the clinical question to be answered. A multi-modality approach for RV function assessment is recommended when echocardiography is not able to provide complete diagnostic information.
Cardiac resynchronization therapy: optimization and follow-up
Authors: Sitges Marta , Derumeaux Genevieve
Published: May 2015

Cardiac imaging techniques have an important role in the follow-up of patients undergoing cardiac resynchronization therapy (CRT) as they provide objective evidence of changes in cardiac dimensions and function. The role of echocardiography is well established in the assessment of left ventricular reverse remodelling and the evaluation of secondary (functional) mitral regurgitation. Additionally, echocardiography might be used for optimizing the programming of atrio-ventricular (AV) and inter-ventricular (VV) delays of current CRT devices. Acute benefits from this optimization have been demonstrated, but longer follow-up studies have failed to show a clear benefit of optimized CRT on top of simultaneous biventricular pacing on the outcome of patients with CRT. This chapter reviews the role of imaging in assessing follow-up and outcome of patients undergoing CRT, as well as the rationale, the methods used, and the clinical impact of optimization of the programming of CRT devices.
Pericardial effusion and cardiac tamponade
Authors: Leeson Paul , Becher Harald
Published: May 2015

A pericardial effusion is an accumulation of fluid within the pericardial space and can occur in response to a range of conditions including inflammatory, iatrogenic, metabolic, and neoplastic problems. Cardiac tamponade describes the clinical situation in which the collection of fluid has become severe enough to cause haemodynamic compromise and is characterized by hypotension and tachycardia, with an exaggerated respiratory motion of the jugular venous pulse. Tamponade is an acute problem that usually requires immediate intervention with drainage of the effusion by pericardiocentesis. Echocardiography is the modality of choice for initial diagnosis, investigation, and monitoring of pericardial effusions. Echocardiography also identifies changes in cardiac function suggestive of cardiac tamponade, such as collapse of the right atrium and ventricle, as well as exaggerated variation in transvalvular Doppler flow with respiration. Echocardiography can also be used to plan the removal of fluid by pericardiocentesis and be of value during the procedure to confirm location of the pericardiocentesis needle. As an adjunct to echocardiography, cardiac computed tomography and magnetic resonance provide further detailed information on fluid characteristics and localization of effusions, although are usually impractical for acute management of effusions and, in particular, tamponade. However, these additional modalities are particularly suited to investigation of related pathology and can inform on the appearance and thickness of the pericardium, as well as identify pathology within the heart or wider thoracic field of view that may underlie the effusion.
Myocarditis
Authors: Mahrholdt Heiko , Yilmaz Ali , Sechtem Udo
Published: May 2015

The symptoms and signs of myocarditis are non-specific. Thus, myocarditis is a differential diagnosis in many patients with heart complaints. As clinical tools, such as history taking, physical examination, blood tests, the ECG, and the chest X-ray are not sufficient to ascertain the diagnosis of myocarditis, additional information from cardiac imaging techniques, or endomyocardial biopsy are necessary to confirm or exclude the disease. Echocardiography still represents the first-choice imaging modality in patients with a clinical suspicion of myocarditis, since it offers the acquisition of comprehensive anatomic and functional data very quickly at the bedside of the patient. Due to its non-invasiveness, the lack of radiation exposure, its image quality, which helps assessing and quantifying cardiac function, and its high tissue contrast, which can be modified using various pulse sequences, CMR has become an important technique for evaluating patients with suspected myocarditis. Emerging hybrid PET/CT and PET/MRI techniques may have considerable potential for future cardiovascular inflammation imaging because they combine PET, a highly sensitive and quantitative modality to detect even low-grade inflammation, with CT or MRI that enable non-invasive assessment of cardiovascular anatomy with excellent spatial resolution. However, when managing patients with inflammatory heart disease today, it should be kept in mind that endomyocardial biopsy remains the only technique that can directly assess the presence and intensity of myocardial inflammation in vivo. Therefore, it is the technique of choice if clinically indicated to differentiate between active and healed myocarditis.
How Major Is Major Depression?
Authors: Paris Joel
Published: May 2015

Major depression, as defined in DSM-5, is not necessarily “major.” Its history can be traced back to a unitary theory of dépression in which all symptoms are seen as falling on a continuum. The danger is that sadness, if it lasts for any length of time, will be diagnosed as depression. This approach has supported treatment practices that are not evidence-based. Not all patients meeting diagnostic criteria can be successfully treated with antidepressant medication. Psychiatry cannot become a clinical science unless it can separate what is pathological from what is normal.
Post-traumatic Stress Disorder
Authors: Paris Joel
Published: May 2015

Post-traumatic stress disorder (PTSD) is a diagnostic epidemic affecting contemporary mental health practice. Overdiagnosis can lead to inappropriate treatment It does not lead to pharmacological treatment, but can be associated with misdirected psychotherapy. It is not widely understood that most psychological traumas, even severe ones, do not produce lasting symptoms. Patients who develop PTSD have previous vulnerability to mental disorder, and should not be seen as reacting simply to external évents.
Attention Deficit Hyperactivity Disorder
Authors: Paris Joel
Published: May 2015

Attention deficit hyperactivity disorder (ADHD) has become another diagnostic epidemic, associated with the medicalization of all problems in attention, whatever their real cause. This trend has led to the over-prescription of stimulants, which are now much more commonly provided to both children and adults. This practice is of particular concern when adults who have never had childhood ADHD are given this diagnosis on the basis of attention problems alone. The DSM-5 criteria for adult ADHD have become broader, in spite of notable comorbidity. This is another example of the tendency to make diagnoses of mental disorders that are believed to benefit from a specific psychopharmacological treatment.
Other Disorders in Which Overdiagnosis Is a Risk
Authors: Paris Joel
Published: May 2015

Other disorders that can suffer from overdiagnosis include autistic spectrum disorders, anxiety disorders, and mild neurocognitive disorders. Autism in particular threatens to become a diagnostic epidemic as patients with a wide range of symptoms are seen as falling in the spectrum. While there is no pharmacological treatment for this condition, disability payments can be an issue. Generalized anxiety disorder and mild neurocgnitive disorder are also quite broadly defined in DSM-5.In each case, it can be difficult to distinguish these conditions from other mental disorders or from normality.
Mental illness management in corrections
Authors: Scott Charles L. , Falls Brian
Published: May 2015

An increasing number of individuals with mental illness are now treated in correctional environments instead of community settings. In the incarcerated population, prevalence estimates of serious mental illness (SMI) range from 9 to 20% compared to 6% in the community. More astonishingly, over three times more persons with serious mental illness in the United States are located in jails and prisons than in hospitals. It was not always like this. How did U.S. correctional systems become de facto mental health institutions for so many? Scholars point to a number of reasons for the increasing prevalence of mental illness among incarcerated individuals, including deinstitutionalization and limited community resources, prominent court decisions and legislative rulings, and the ‘revolving door’ phenomenon. There are many similarities between correctional and community mental health care services. Both systems typically provide appropriate medications, emergency care, hospitalization, medication management, and follow-up care. However, key differences often exist in correctional systems, including restricted formularies due to concerns of medication abuse or cost, alternative involuntary medication procedures, restricted access by visitors, and the inability of mental health providers to control the treatment environment. This chapter summarizes the historical context of correctional versus community mental health; factors resulting in the increasing management of people with mental illness in correctional settings; and similarities and differences between the provision of mental health care in correctional versus community settings.
Formative case law and litigation
Authors: Jones Mohamedu F.
Published: May 2015

The presence of comprehensive correctional mental health treatment programs and services in any given jail or prison is often due to successful class action litigation. This chapter reviews the legal and constitutional background for correctional mental health care in the United States and addresses many of the critical ways these courts impact policy and care delivery on a daily basis. Several court decisions have shaped modern correctional mental health care delivery. Officials are obligated under the Eighth Amendment to provide convicted prisoners with adequate medical care, which extends to mental health treatment. Pre-trial detainees also have a right to adequate physical and mental health care under the Due Process Clause of the Fourteenth Amendment of the Constitution). Since the Supreme Court proclaimed that inmates have a constitutional right to adequate health care, much has been written about the controlling decisions, their implications and applications by courts, and their implementation in correctional systems. There are, however, discrete issues related to mental health care in corrections that patients and providers in prisons and jails contend with daily that may not yet be resolved as matters of constitutional law. Case law and litigation are driving innovation in standards of care and enhancing the quality of correctional mental health. These reforms are gaining acceptance as preferred and expected standards of correctional mental health care in jails and prisons, and may reflect the present day ‘evolving standard of decency,’ becoming touchstones of constitutionally adequate care across systems.
Communication in correctional psychiatry
Authors: Aufderheide Dean
Published: May 2015

When the competing cultures and communication styles of correctional and health care professionals clash, communication is compromised and the potential for problems and unwanted outcomes is compounded. Notwithstanding the inherent cultural differences among interdisciplinary staff, effective communication in a correctional setting is especially challenging for psychiatrists. Whether transitioning from the protective structure of a residency, or moving from a private practice or other mental health setting, psychiatrists working in a jail or prison will likely experience their new environment as replete with competing interests and priorities. Also, unlike in a health care setting, where physicians are at the top of the hierarchy, psychiatrists working in a jail or prison are further down the organizational hierarchy. It is in such an environment that it becomes critically important for psychiatrists to develop communication strategies that are successful in creating effective and sustainable working relationships not only with patients, but also with the facility’s leadership, security staff, treatment team members, and other interdisciplinary staff. This chapter will discuss ways in which psychiatrists play a critical role in mission requirements that necessitate effective communication skills with interdisciplinary staff in jails and prisons. From identifying the variables in the correctional culture that shape communication to improving interdisciplinary collaboration, this chapter will explore the ways in which correctional psychiatrists can model effective communication styles and strategies that enhance professional credibility and improve treatment outcomes.
Interviewing in correctional settings
Authors: Lee Li-Wen
Published: May 2015

Conducting psychiatric interviews is oftentimes a unique challenge in jails and prisons. Interviews are conducted in a wide array of conditions and settings, acute or chronic, privacy and safety issues, contentious or collaborative. According to the Bureau of Justice Statistics in 2005, more than half of all jail and prison inmates had a recent history of symptoms of a mental health problem. This high rate of mental illness is both an opportunity for, and a challenge to, providing much needed treatment. Without adequate assessment and treatment, inmates with mental illness may harm themselves, other inmates, correctional staff, become victimized, or disrupt facility operations. An essential component in assessment and appropriate management is the psychiatric interview. While there are helpful standards and guidelines regarding mental health services in correctional settings, relatively little has been written about the specific impact of the correctional setting on conducting mental health interviews, or on the specific features of the correctional population that should be understood when conducting the mental health interview. Given the importance of the interview in providing mental health treatment, the essential elements and complexities involved in conducting an effective interview in the correctional setting will be presented in the following chapter. Various aspects of the psychiatric interview will be reviewed with particular attention given to how the correctional population and setting can impact the interview process. Issues of countertransference are also present and are discussed. This chapter discusses both the contexts as well as the practices that are appropriately adapted to correctional settings.
Detoxification or supervised withdrawal
Authors: Lubelczyk Rebecca
Published: May 2015

Drugs or alcohol are used at the time of the offense by over half of all detainees, necessitating screening for both intoxication and risk of withdrawal from substances at intake. Intoxication and withdrawal can mimic signs and symptoms of an acute mental disorder or exacerbate an underlying chronic disease. One of the most difficult challenges a clinician may face is differentiating whether the presentation is due to a combination of intoxication/withdrawal and mental illness versus mental illness alone. Using substances while on psychiatric medications can alter the pharmacology, change the effectiveness, and exacerbate the side effects of medications, potentially causing lack of response, nonadherence, or dangerous physical effects. Substance use also puts the patient at risk for trauma and exposure to infections from risky behaviors while intoxicated. The clinician faces an imposing challenge in any attempt to accurately assess underlying psychopathology in the midst of acute detoxification. It is a generally accepted practice to reassess the patient’s psychotropic treatment needs once their detoxification is complete, but individual cases may require acute intervention based on the severity of the patient’s mental illness. This chapter attempts to educate the correctional clinician on the common presentations of intoxication and withdrawal syndromes of various substances. The similarities and distinctions of such syndromes with mental illnesses are discussed. Standardized medical management approaches to safeguard patient safety during supervised withdrawal are also presented. Following such a process allows the clinician to subsequently assess the patient’s true mental health and substance abuse treatment needs.
Medication administration and management
Authors: Knox Catherine M.
Published: May 2015

The courts and professional organizations recognize access to clinically appropriate and timely treatment with psychotropic medication as an essential element of an adequate correctional mental health system. While receiving treatment, incarcerated patients must be monitored and supervised clinically so that optimal patient outcomes are achieved. For many mentally ill inmates incarceration is an opportunity to receive treatment that was not accessible in the community; in one study only one third of those diagnosed with schizophrenia or bipolar disorder were receiving medication at the time of arrest compared to two thirds during incarceration. There are many steps, people, and processes involved in getting medication to the patient within a correctional facility. The major components of pharmacy services are prescribing, dispensing, distribution and continuity. The structural aspects of medication administration can also be altered to improve adherence. These include simplifying the medication regime by reducing the number of doses each day, changing to a long acting preparation, and administering medication at times and in ways that are safer and more convenient for the patient and yet clinically acceptable. Reducing reasons for medication discontinuity due to transfers and schedule conflicts also reduces the incidence of adverse events and optimizes treatment efficacy. Almost universally, all medication administration to psychiatric patients in jails and prisons is through directly observed therapy. This allows for opportunities and challenges for correctional patient care in medication lines and on cell blocks or dormitories. This chapter reviews the structural, procedural, and clinical concerns of medication administration and management in jails and prisons.
Diagnostic prevalence and comorbidity
Authors: Thomas Stuart D. M.
Published: May 2015

Prisons and jails remain a growth industry, with many countries increasing correctional services to cope with the ever-burgeoning inmate population. One longstanding issue is the perceived increase in prevalence of mental disorders that are found in correctional settings compared to the community. Definitions of mental illness and methods of assessment vary substantially. That said, emerging data reflect some consistency in the range of estimated prevalence. Personality disorder (predominantly antisocial personality disorder) is the most common mental disorder among prisoners, accounting for 65% of male and 42% of female prisoners. Estimated rates of psychosis in some settings are as high as 3.7% for males and 4.0% for females, while major depressive disorders are found in up to 10% of male and 12% of female prisoners. Estimated point prevalence rates for alcohol abuse and dependence varied between 18 and 30% for male prisoners and between 10 and 24% for female prisoners; these estimates were between 10 and 48% for males and 30 to 60% for female prisoners with respect to drug dependence and abuse. The rates of almost all disorders are several times higher than those found in the general community, and the rates of comorbidity are exceptionally high. This chapter outlines the best available correctional prevalence of common mental disorders and considers the key assumptions and methodological challenges around ascertaining rates of these different diagnoses.
Psychotic disorders
Authors: Brink Johann , Tomita Todd
Published: May 2015

The presentation of psychotic disorders in jails and prisons can be quite complex and diverse. In addition to the schizophrenia spectrum disorders, there are the many disorders of unclear etiology or secondary to the neurotoxic effects of substance abuse. In parallel, the provision of empirically informed care for incarcerated offenders with psychotic disorders presents significant clinical, security, and administrative challenges. However, strong scientific evidence exists that a configuration of interventions offers substantial benefit in the treatment of incarcerated individuals with psychotic disorders. Such a configuration incorporates both psychotherapy and psychopharmacology. Specifically, cognitive behavioral therapy, designed and presented within a risk-needs-recovery (R-N-R) framework, when combined with appropriate pharmacological interventions, has strong empirical support as best practice in the treatment of severe mental illness in the correctional population. Further, specific issues related to care coordination, treatment engagement and adherence, implementation of best practice, and treatment fidelity each contribute to resulting symptom reduction and functional improvement. Careful attention to reducing the risks of inappropriate polypharmacy through clinician feedback and practice monitoring is another critical element. This chapter discusses the evidence basis for appropriate treatment of the psychotic disorders and the range of opportunities for both psychotherapy and psychopharmacology in correctional settings.
Mood disorders
Authors: Kamath Jayesh , Shah Ajay
Published: May 2015

Depression and Bipolar Disorder comprise a substantial percentage of all psychiatric care in the community. This is also the case in correctional settings. Diagnosis and treatment may vary in multiple ways, given the context and characteristics of jails and prisons. Reassessment of symptomatology at every visit, especially in the first few months of incarceration, enhances accurate diagnosis. The clinical presentation of many individuals at the time of incarceration is frequently confounded by substance withdrawal, adjustment issues, and other comorbidities. The clinical picture frequently evolves and allows improved accuracy over weeks to months. Decades of research conducted in the community and correctional settings have shown a close but controversial relationship between mood disorders, aggression, and criminality. This may be reflected in a substantially increased risk of multiple incarcerations as with the observation that inmates with bipolar disorders are 3.3 times more likely to have had four or more previous incarcerations compared with inmates who had no major psychiatric disorders. In terms of management risks, studies conducted with both genders in the correctional setting have shown a strong association between depression and near-lethal suicide attempts. Data reflect the importance of both psychotherapy and targeted, thoughtful medication management in the effective treatment of mood disorders. This chapter discusses the data and those characteristics, as well as core management, best-practice, and evidence based therapeutic approaches to the treatment of major depressive disorders and bipolar disorders in jails and prisons.
Attention deficit disorders
Authors: Appelbaum Kenneth L. , Murphy Kevin R.
Published: May 2015

The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in correctional settings is in itself problematic and quite contentious; treating the disorder more so. Community prevalence studies estimate that 2.5% to 4% of adults in the United States and worldwide meet diagnostic criteria for ADHD. Some research findings suggest that ADHD occurs at far greater prevalence rates among criminal justice populations than in the population at large. The nature of the condition, its assessment, and its management combine to create a perfect storm of potentially vexing challenges for the prison psychiatrist. This chapter reviews those diagnostic and treatment challenges, including the risk of diversion and misuse of controlled substances among inmates. An assessment and treatment model is presented that takes into account and minimizes risk while helping ensure access to care in appropriately selected cases. Some inmates have a compelling need for treatment, potentially including stimulant medications. Neither unbridled use nor complete elimination of stimulants makes good clinical or administrative sense for correctional systems. An approach that relies on current impairment in significant functional areas, meaningful involvement in treatment, and absence of active misuse of substances will allow access to medication for those with verifiable need while lessening the risks associated with prescription of controlled substances in jails and prisons. The issues of differential diagnosis in a population with epidemic substance abuse, the challenges of appropriate management, and an evidence-based treatment model are discussed in this chapter.
General medical disorders with psychiatric implications
Authors: Garcia Erik J. , Ferguson Warren J.
Published: May 2015

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.
Psychiatric aspects of pain management
Authors: Trestman Robert L.
Published: May 2015

Chronic pain differs from acute pain in many ways. First, by definition, it has become enduring and goes beyond the expected period of healing, whether post-trauma, post-surgery, or as part of a degenerative or progressive disease. The typical time frame used for defining chronic pain is defined as pain that persists beyond a six month window. Another characteristic that distinguishes chronic from acute pain is the emotional element of perceived suffering. This component of chronic pain becomes important in the assessment and subsequent treatment of chronic pain. Chronic pain management in a correctional setting is very challenging due to a host of factors. First, the majority of people being treated have a history of substance abuse disorders. Further, as a whole, the population of incarcerated adults has a disproportionate prevalence of significant chronic medical and psychiatric conditions. Finally, access to illicit drugs is limited, if not completely eliminated in correctional settings, shifting the environmental demand characteristics to prescription medication misuse. This chapter addresses issues of the psychiatric assessment and management of chronic pain in correctional settings. Information is provided regarding the factors to be elicited in a chronic pain interview, the methods used to assess chronic pain, and the assessment factors appropriate to integrate into a management plan. The methods used to manage chronic pain, including close coordination with a treatment team, cognitive behavioral interventions, and pharmacological management are presented. Tracking treatment outcomes from a psychiatric perspective in the correctional setting are then discussed.
Aggression
Authors: Trestman Robert L.
Published: May 2015

Managing aggression is a challenge for psychiatry in all settings. Recognizing opportunities for appropriate assessment and intervention in correctional settings is an important component of correctional psychiatry. Studies reflect significant risks of violence for both correctional officers and inmates. Although prison homicides occur at rates below estimated community homicide rates, the rate of non-lethal violence is substantial. The data for assault are less clear, as definitions of what constitutes assault vary. Inmate-on-inmate assault has been estimated to range from 2 per 1000 inmates to as high as 200 per 1000 inmates. However assault is defined, correctional officers who have been the target of offender violence have elevated risk of emotional exhaustion and burnout. Effectively addressing aggression requires a thoughtful and comprehensive approach that may incorporate elements of environmental management, evaluation of potential motivating factors, differential diagnosis, and a coordinated intervention. This always involves includes effective communication among stakeholders including the patient. Recommended milieu changes and psychotherapeutic and / or pharmacologic interventions need to be explicitly defined; available data are described in this chapter. Consistent oversight and follow up to measure the effects of each component of the intervention(s) is critical, as aggressive behavior may be both habitual and episodic. This chapter reviews the factors that contribute to the broad range of assaultive behavior observed in correctional settings, and some of the pragmatic issues and opportunities for assessment, diagnosis, and treatment of aggressive behaviors, both impulsive and predatory.
Self-injurious behaviors
Authors: Appelbaum Kenneth L.
Published: May 2015

One of the most challenging management challenges in correctional settings is self-injurious behavior (SIB). Often, the motivations, demographics, and characteristics are distinct from SIB found in the community. In community samples, about 4% of adults report a history of SIB with no significant gender differences in rate. Despite its serious consequences in jails and prisons, reliable data on self-injury in those settings remains sparse. A survey of the 51 state and federal directors of correctional mental health services in the United States found that less than 2% of inmates per year self-injure. Although relatively few inmates engage in this behavior, they do so often enough that almost all systems that responded to the survey reported at least weekly incidents and over 70% of systems had episodes occurring several times per week to more than once per day. The most common psychiatric conditions associated with SIB include psychotic, personality, cognitive, and mood disorders. Environmental factors, which include behavioral triggers and responses, often play a key role in SIB, especially in jails and prisons. Self-injury can return a degree of control and autonomy to inmates who otherwise have limited means to affect their environment, cope with stress, or get what they want. Effective management of self-injurious behaviors in correctional settings almost always requires partnership and cooperation between health care and custody staff. This chapter reviews context and nosology, epidemiology and best practices for assessment, diagnosis, and intervention in jail and prison settings.