bluuebunny/crossref_metadata_2025 huggingface dataset:
Theory of Wrinkling in Sandwich
Construction
Authors: Yusuff Syed
Published: August 2016

In this paper a theory of wrinkling in Sandwich Construction is presented in two parts. In the first part, the thickness of the core is regarded as finite. The wrinkling stress is given by a simple square root formula consisting of the Young's moduli of the materials and the ratio of the thickness of the face and core. In the second part of the theory the same procedure is followed, with the main difference that shearing stresses in the core are also considered, and the analysis is extended to the case where the face is supported by a sufficiently thick or a semi-infinite medium. The result for the wrinkling stress is a cubic root formula which consists of the moduli of the materials but indirectly depends upon the geometry of the structure; this formula is valid only if the ratio of the thickness of the core and the face is greater than or at least equal to the ratio of the width of the marginal zone of distortions in the core, and the thickness of the face. The width of the zone is also useful as the criterion which discriminates between the two cases of buckling as envisaged in this paper. The theory is compared with the previous works, and also with the test results already available. The selection of the experimental data comprises steel, aluminium alloy and Papreg (laminated paper plastic) as the face; and onazote, cellular cellulose acetate, granulated cork, sponge rubber and expanded formvar as the core materials over a wide range of core-face thickness ratio. The agreement between the theory and the tests is satisfactory.
Flutter of Wings with Localised Masses
Authors: Molyneux W. G.
Published: August 2016

From a general consideration of the available data on the flutter of wings with localised masses certain deductions are made as to the possible types of flutter that can occur. On the basis of these deductions it is shown that there is an optimum choice of modes for use in flutter calculations for wings with localised masses. These modes are obtained with artificial constraints imposed on the wing at the localised mass section fixing the wing at this section in translation and/or pitch. It is deduced that for certain mass locations types of flutter are obtained that are insensitive to increase of localised mass, beyond a certain value, with flutter speeds considerably greater than that of the fixed root bare wing. It is also deduced that for the majority of aircraft configurations the maximum flutter speeds for these types of flutter will be realised when the localised mass is in the region of two-thirds semi-span from the root. A limited theoretical investigation is made for a rectangular unswept uniform wing with symmetric and antisymmetric body freedoms, to illustrate and confirm the conclusions derived from general considerations. At the same time the investigation shows that an ill placed localised mass can reduce the wing flutter speed to a very low value.
Response of Missile Erector Towers to Sudden Stops or Impact Loads
Authors: Cox Hugh L.
Published: August 2016

The Cantilever-Type mechanism often used in large missile erectors is subjected to heavy stresses when raising a missile from the horizontal to the vertical position for launching. In the event it becomes necessary to return the missile to the horizontal position, severe stresses in the erector, and possibly the missile itself may be developed if the lowering mechanism causes the erector to stop suddenly just before it reaches the horizontal position. This note presents a simple matric formulation of the problem which enables one who has access to an electronic digital computer to compute maximum deflections and load factors that occur as a result of a sudden stop.
Shear Moduli for Flat Panels and the Effect of Flange Flexibility
Authors: Simmons J. C.
Published: August 2016

This note describes an investigation into the secant and tangent moduli for flat panels in shear. Consideration is given to a comparatively recent analysis giving the secant modulus and comparison is made with he Society's Data Sheets.
Note on the Numerical Evaluation of the Wave Drag of Smooth Slender Bodies Using Optimum Area Distributions for Minimum Wave Drag
Authors: Eminton E. , Lord W. T.
Published: August 2016

The linearised theory value of the wave drag D at zero lift of a smooth slender body of arbitrary cross-sectional shape was shown by Ward to be given by

where S (x), 0 ⩽ x ⩽ 1, is the cross-sectional area distribution of the body and q is the kinetic pressure. The development of this result has aroused interest in two problems: the derivation of the optimum area distribution for minimum wave drag under certain specified conditions and the numerical evaluation of the wave drag of a specified area distribution. These apparently distinct problems have hitherto been treated separately, but it is shown here how an attempt to solve the first problem has led to a practical method of solving the second.
The Co-ordination of Aeronautical Research in The British Commonwealth
Authors: Coombes L. P.
Published: August 2016

I have chosen for my address the subject of Co-ordination of Aeronautical Research in the British Commonwealth, not only because this is a very important and vital matter, but because at this time there are being held in Melbourne meetings between aeronautical research workers from Australia, New Zealand, South Africa and the United Kingdom in certain fields of research. Simultaneously, in Canada similar meetings are being held between aeronautical research workers from Canada, United Kingdom and Australia.

Aeronautical research, like human flight, is of comparatively recent origin as far as serious work is concerned. In Australia we can be proud to have had one of the pioneers—Lawrence Hargreaves—while the Wright Brothers based the design of their aircraft on experiments with aerofoils carried out in a wind tunnel of their own design.
Note on the Bending of a Finite Parallelogrammic Plate Under Continuous Non-Loading
Authors: McKenzie K. I. , Rothman M.
Published: August 2016

In a previous note the authors gave a method of solution for the problem of a finite rectangular plate under constant skew and inclined loadings, two of the edges being rigidly held and the other two simply-supported. In this note the same problem is considered for a plate in the shape of a parallelogram.
A New Method for the Numerical Evaluation of Determinants
Authors: Macmillan R. H.
Published: August 2016

In the November 1955 issue of the Journal there is a Note, “ A New Method for the Numerical Evaluation of Determinants.” I would point out that this method is not new, but is given in “ The Theory of Determinants, Matrices and Invariants” by Turnbull (published by Blackie) at page 340, paragraph 7, under the heading “ Dodgson's Method of evaluating a determinant by condensation.”
The Plastic Bending of Heavily Curved Beams
Authors: Johnson W. , Senior B. W.
Published: August 2016

It is shown that when heavily curved circular beams of constant cross section are subjected to a compressive load along the “open” diameter, the load for the start of significant deformation as indicated by the reduction in diameter along the line of action of the load, may be estimated by the use of rectangular plastic stress blocks based on the yield stress of the material. Comparison of the experimental values obtained on specimens of duralumin and mild steel with those predicted theoretically are, on the whole, only slightly underestimated.
Air Traffic in Germany
Authors: Wronsky Martin
Published: August 2016

In addressing you, I wish to express, first of all, my sincerest thanks for the honour you have bestowed upon me to speak before the Royal Aeronautical Society of London about the “ Development of the Commercial Air Traffic in Germany.” It is with great pleasure I take the opportunity of giving you information about our ideas and intentions, and I hope that my explanations will assist in improving the understanding of our mutual needs in the service of the world's commercial air traffic. The Chairman of the Royal Aeronautical Society sent me a number of particular questions, and my speech, for this reason, goes in some instances very much into details which otherwise I would not have mentioned.

If I now ask you for your attention to tell you something about the air traffic in Germany, I may mention that I have been with the management of German air traffic companies since 1919.
Airscrews
Authors: Park W. E.
Published: August 2016

It is proposed to confine this paper entirely to the point of view of the propeller constructor.

More than 90 per cent, of the propellers now in use are constructed by shaping from a block formed by the glueing together of hardwood laminations. This type is cheap to produce either individually or in quantity, and has been proved by experience to be satisfactory for all types of aircraft, for tip speeds up to 1,000 feet per second, diameters up to 19 feet and for engines developing over 1,000 b.h.p., without showing any signs of having reached a structural limit.

This construction was standardised for production purposes by the Air Ministry during the War, and the official Handbook of Instructions is a most complete guide to the method of manufacture.

Other forms of construction are, to a certain extent, still in the experimental stage and will be considered chiefly by comparison with the standard type.
Unsteady Isentropic Flow with Variable Specific Heats
Authors: Benson R. S.
Published: August 2016

It is usual when plotting characteristic diagrams for unsteady flow fields to assume a constant ratio of specific heats. In the general theory of characteristics developed by Guderley the variable specific heats are introduced into the calculation of the characteristic constants. In the following method the variation in the ratio of the specific heats is included directly into the slope of the state characteristics. The position diagram may then be plotted directly by the usual techniques.
Note on the Effect of Rotation on the Frequencies of Lateral Vibrations of a Rod
Authors: Morris J.
Published: August 2016

In certain problems such as the vibration of airscrews or gyroplane rotor blades, account must be taken of the effect of the imposed rotation on the frequencies of vibration. A direct solution of the appropriate equation of motion is usually impracticable and in consequence recourse is had to the application of Rayleigh's Principle. But even this powerful device may involve increasing labour as ascending overtones are considered. In this note an empirical rule is indicated whereby the effect of rotation may be assessed. For a uniform rod the empirical rule is shown to be a very close approximation, particularly with ascending overtones. In other cases such as a tapered rod the rule is shown to apply, but the approximation is not so close.
The Flapping Flight of Birds. II
Authors: Walker Gilbert T.
Published: August 2016

In a paper in the number of this journal for November, 1925, it was shown that if a flying machine were fitted with wings of standard section and these were flapped in a rhythmical manner, the machine would be supported and propelled, its weight, dimensions and velocity being those of a typical bird; the degree of accuracy attempted in the analysis did not exceed five per cent.

A subsequent examination of the power involved established a high efficiency; but this was due to a large amount of negative work during up–beats; and although such conditions might be maintained in a mechanical model they were unlikely in a bird, which has a large muscle, the pectoralis minor, for lifting its wings. In a bird efficiency seemed to require that the angle of incidence of the outer portion during an up–beat should be negative (see §7, p. 593, of the previous paper); the angle was however made zero (see §9) in order to secure adequate lift, and it is this feature which gives rise to the negative work.
The Cruise of the Royal Air Force Far East Flight
Authors: Cave–Browne–Cave H. M.
Published: August 2016

The Royal Air Force Far East Flight formed at Felixstowe in May, 1927, to carry out long cruises in the East with four flying boats of the Southampton type. Some of the principal objects of the cruises were:—

(a)

To give Service personnel experience in carrying out long cruises with a Flight operating independently of surface vessels and shore bases, and to exercise their initiative and resource under widely varying conditions.

(b)

To gain technical and operational experience for the development of flying boats.

(c)

To collect information on seaplane bases, harbours and local conditions affecting aircraft throughout the routes flown; and

(d)

To show the flag and foster the spirit of mutual co–operation between the Mother Country and the parts of the British Empire visited.

The personnel of the Flight consisted of a Flying Party of four boats’ crews of two officers and two airmen each, and a Base Party of three officers and 23 airmen.
The Training of Aircraft Apprentices
Authors: Breese C. D.
Published: August 2016

It is with considerable diffidence that I find myself about to address you to-night upon the subject of the Paper, which is “The Training of Aircraft Apprentices.” I say with considerable diffidence, firstly; because I realise how very important to the future of aeronautical practice is this question of the preliminary training of mechanics, and secondly, because my own practical experience of this subject is limited to a few years.

I hope that some of those who will take part in the discussion, after the reading of the Paper, will correct any mis-statements I may make in connection with civilian apprentices and will be able to put before you such problems as, are peculiar to that side.
The Articulated Connecting Rod—An Alternative Method for Finding Accelerations
Authors: Farren W. S.
Published: August 2016

In Mr. Fearn's article on this subject in the February number of the Journal, in which a solution is given in the form of a Fourier series, a reference is made to the unsatisfactory results of an attempt to use double differentiation of the displacement curve. It is generally recognised that such a process is fundamentally inaccurate, and analytical methods, either exact or approximate, are usually given in books dealing with mechanisms. For mechanisms of the piston-connecting rod type, in which the higher harmonics of the motion of the driven member diminish very rapidly, two harmonics in all generally give all the necessary accuracy, both for displacement and acceleration. Mr. Fearn's solution is of this type, though he includes a fourth harmonic (see e.g., the expression for ρ at the top of page 138).
Did exposure to a severe outbreak of pandemic influenza in 1918 impact on long-term survival?
Authors: WILSON N. , BOYD M. , NISA S. , CLEMENT C. , BAKER M. G.
Published: August 2016

There is some suggestion that infection with pandemic influenza may increase long-term mortality risks. Therefore we aimed to determine if exposure to a severe outbreak of pandemic influenza on a troopship in 1918 impacted on lifespan in the survivors. The troopship with the outbreak cohort had 1107 personnel and the comparison cohort was from two contemporaneous troopships (1108 randomly selected personnel). Data were collected from online individual military files. The main finding was that there was no statistically significant difference in the lifespan of the outbreak cohort and the comparison cohort (means of 71·5 and 71·0 years, respectively). Indeed, the outbreak cohort was actually more likely to survive into the period from 1950 onwards (P = 0·036) and to participate in the Second World War (P = 0·043). There were no significant differences between the cohorts in terms of occupational class, but the comparison cohort had a higher proportion of rural occupations (33·3% vs. 27·0%, P < 0·001) and was very slightly older in mid-1918 (27·8 vs. 27·2 years, P = 0·028). In conclusion, this study found no support for the hypothesis that exposure to the 1918 influenza pandemic adversely impacted on the lifespan in the survivors, at least in this male and military-age population.
Epidemiological impact of a syphilis vaccine: a simulation study
Authors: CHAMPREDON D. , CAMERON C. E. , SMIEJA M. , DUSHOFF J.
Published: August 2016

Despite the availability of inexpensive antimicrobial treatment, syphilis remains prevalent worldwide, affecting millions of individuals. Furthermore, syphilis infection is suspected of increasing both susceptibility to, and tendency to transmit, HIV. Development of a syphilis vaccine would be a potentially promising step towards control, but the value of dedicating resources to vaccine development should be evaluated in the context of the anticipated benefits. Here, we use a detailed mathematical model to explore the potential impact of rolling out a hypothetical syphilis vaccine on morbidity from both syphilis and HIV and compare it to the impact of expanded ‘screen and treat’ programmes using existing treatments. Our results suggest that an efficacious vaccine has the potential to sharply reduce syphilis prevalence under a wide range of scenarios, while expanded treatment interventions are likely to be substantially less effective. Our modelled interventions in our simulated study populations are expected to have little effect on HIV, and in some scenarios lead to small increases in HIV incidence, suggesting that interventions against syphilis should be accompanied with interventions against other sexually transmitted infections to prevent the possibility that lower morbidity or lower perceived risk from syphilis could lead to increases in other sexually transmitted diseases.
The Last Laugh
Authors: Trimble Michael
Published: August 2016

Freud writes in his startlingly innovative book, Wit and Its Relation to the Unconscious, that “…our philosophical inquiries have not awarded to wit the important role that it plays in our mental life.” He pointed out the difficulties of studying the phenomenon scientifically, and went on to analyze the meanings of jokes and why we laugh. He emphasized the “pleasure in economy” that the central nervous system derives from the pithy nature of the witty synthesis. Since then, several authors have brought forward their own theories, Arthur Koestler among them. However, neuroscientists have shown little interest in the subject.

This needs urgent attention. It is therefore welcome that at least one group of scientists is taking jokes seriously. They set up a “Laugh Lab” Web site to investigate humor, and respondents from all over the world were asked to vote for the “best” of several jokes displayed on the site. Their responses will be analyzed and hypotheses tested.
Consensus Statement: The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression
Authors: Hirschfeld Robert M. A. , Keller Martin B. , Panico Susan , Arons Bernard S. , Barlow David , Davidoff Frank , Endicott Jean , Froom Jack , Goldstein Michael , Gorman Jack M. , Guthrie Don , Marek Richard G. , Maurer Theodore A. , Meyer Roger , Phillips Katharine , Ross Jerilyn , Schwenk Thomas L. , Sharfstein Steven S. , Thase Michael E. , Wyatt Richard J.
Published: August 2016

A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17–18,1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap?
Electroencephalography in Catatonic Disorders Due to General Medical Conditions and Psychiatric Disorders
Authors: Carroll Brendan T. , Goforth Harold W. , Boutros Nashaat N. , Anfinson Theodore J. , Werner Lisa
Published: August 2016

In an effort to aid the clinician in the differential diagnosis of catatonic states, we assessed the nature of electroencephalography (EEG) findings in both medical and psychiatric forms of catatonia. An exhaustive review of the literature on catatonia due to a general medical condition (CDGMC) was performed in addition to a prospective review of catatonic patients at The Ohio State University Neuwpsychiatric Facility.

A total of 105 patients had documented, specific clinical and EEG information, with neurologic conditions accounting for 82.8% of case reports. Results from the case series of 31 episodes of catatonia indicate that there is an increased likelihood of diffuse slowing in patients with CDGMC versus psychiatric catatonia. Given the observed rate of abnormalities, EEG is an important but underutilized tool in the differential diagnosis of catatonic disorders.
Neuroimaging in OCD: Clinical Implications
Authors: Rauch Scott L.
Published: August 2016

An overview is provided regarding neuroimaging in obsessive-compulsive disorder (OCD). The author emphasizes convergent research results across various experimental paradigms and their implications for neurobiological models of OCD. The article concludes with an outline of future considerations that highlights emerging concepts and techniques. This work was intended to serve as a concise summary of the field, and thus to provide a springboard for discussion about this topic at the upcoming International Obsessive Compulsive Disorder Conference.
The Role of Serotonin in Posttraumatic Stress Disorder: Neurobiology and Pharmacotherapy
Authors: Connor Kathryn M. , Davidson Jonathan R.T.
Published: August 2016

Much attention has been given to the role of catecholamine dysfunction in posttraumatic stress disorder (PTSD), and only recently have researchers begun to focus on serotonin (5-HT) in PTSD. Serotonin appears to be a factor in responses followin extreme stress, such as those that precede PTSD. In this review, the authors provide a brief overview of the concept of PTSD and specific issues of clinical concern. The role 5-HT in the neurobiology of PTSD is explored in a review of animal model studies and of clinical investigations of paroxetine binding, pharmacologic challenges, and neuroimaging. Data on the use of 5-HT in PTSD treatment are provided in a review of both open-label and controlled studies of serotonergically active drugs.
Neuroscientific Approach to Emotions and Feelings: The Last Frontier of the New Millennium
Authors: Marazziti Donatella
Published: August 2016

For centuries, emotions and feelings have been considered a domain of poets, writers, novelists, or psychologists who have tried to explore their secretive natures. They have been debating the crucial question of what they are, without providing any exhaustive answer except magnificent descriptions of them or sophisticated psychodynamic interpretations.
Treatment Considerations for Depression in the Elderly
Authors: Dunner David L.
Published: August 2016

While an episode of depression can first present in late life, it is more likely to be a recurrence of a disorder that began earlier in life or a continuation of a chronic form of depression. Depression in the elderly often occurs in the context of ongoing medical conditions. The treatment for these medical conditions may pose problems in treatment of depression due to increased likelihood of drug interactions. This article discusses pharmacotherapeutic and psychotherapeutic approaches to the treatment of depression in the elderly population.
Adherence to Treatment for Geriatric Depression and Anxiety
Authors: Wetherell Julie Loebach , Unützer Jürgen
Published: August 2016

Patient nonadherence to pharmacologic and psychosocial treatments for geriatric depression and anxiety poses a serious barrier to effective clinical care. Rates of nonadherence may be as high as 60% in older adults. Factors associated with nonadherence include lack of information and misperceptions about mental illness and its treatment, stigma, lack of family support, cognitive impairment, adverse events, side effects, cost of treatments, poor physician-patient communication or relationship, and other barriers, such as lack of transportation. Effective interventions to improve adherence are personalized and include both behavioral and educational components. Several current projects that combine pharmacotherapy and psychotherapy for geriatric depression in an integrated care model show promise as interventions to improve rates of treatment and adherence.
Psychosocial Function and Economic Costs of Obsessive-Compulsive Disorder
Authors: Hollander Eric , Stein Dan J. , Kwon Jee H. , Rowland Clayton , Wong Cheryl M. , Broatch James , Himelein Carol
Published: August 2016

The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.

Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.

Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD, and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
Depressed Subjects Have Decreased rCBF Activation During Facial Emotion Recognition
Authors: George Mark S. , Ketter Terence A. , Parekh Priti I. , Gill Debra S. , Marangell Lauren , Pazzaglia Peggy J. , Herscovitch Peter , Post Robert M.
Published: August 2016

Depressed subjects have deficits in facialemotion recognition that resemble the deficits found in persons with focal right hemisphere brain damage. To locate the brain regions responsible for this problem, the authors imaged regional cerebral blood flow (rCBF) with H2O15 positron emission tomography in 10 mood-disordered patients, as well as in 10 age- and sex-matched healthy comparison subjects, while the subjects matched photographs for facial emotion or, as a control, facial identity. While matching faces for emotion, mood-disordered subjects had decreased rCBF activation bilaterally in their temporal lobes, as well as in the right insula, compared with healthy comparison subjects. Abnormal function of limbic and paraiimbic regions may partially explain the facial emotion-recognition deficits previously noted in depressed subjects.
Psychopharmacology of Depression in the Next Millennium
Authors: Goodnick Paul J.
Published: August 2016

Over the last half of the 20th century, there have been a series of psychopharmacologic strategies for treatment of depression. As we approach the next century, new therapies in varying stages of American release are being developed. This review will focus on information available for the following proposed antidepressants: 1) reboxetine, a norepinephrine selective reuptake inhibitor; 2) milnacipran, a combined serotonin/norepinephrine reuptake inhibitor; 3) a new enantiomer of fluoxetine, a selective serotonin reuptake inhibitor; 4) duloxetine, another combined serotonin/norepinephrine reuptake inhibitor; 5) sunepitron, a combined 5-HT1A agonist and α2 antagonist; and, 6) MK-869, a substance P inhibitor. Finally, other possible developing directions will be reviewed, including corticotropin-releasing factor.
Diagnosis and Clinical Management of Headaches
Authors: Greenfield Daniel P. , Hariharan Subramanian
Published: August 2016

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.
Gender Differences in Major Depressive Disorder and Bipolar Disorder
Authors: Leibenluft Ellen
Published: August 2016

This paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not been found. In BPD, women are more likely than men to develop a rapid-cycling course. Gender differences in treatment response, particularly in regard to mood stabilizing medications, warrant further study.
Acamprosate for the Treatment of Alcohol Dependence: A Review of Double-Blind, Placebo-Controlled Trials
Authors: Mason Barbara J. , Ownby Raymond L.
Published: August 2016

Acamprosate (calcium acetyl-homotaurine) is a synthetic compound that crosses the blood-brain barrier and has a chemical structure similar to that of the naturally occurring amino acid neuromediators, homotaurine and γ-aminobu-tyric acid (GABA). Acamprosate appears to act primarily by restoring normal N-methyl-D-aspartate (NMDA) receptor tone in the glutamate system, and has been shown to have a specific dose-dependent effect on decreasing voluntary alcohol intake in animals with no effects on food and water consumption. The safety and efficacy of acamprosate in alcohol-dependent outpatients is currently under evaluation in the United States. Acamprosate has been available by prescription since 1989 in France and more recently in most European and Latin American coutries as well as Australia, South Africa, and Hong Kong. More than 4 million people have been treated with acamprosate since it became commercially available.

The purpose of this article is to review all available double-blind, placebo-controlled clinical trials evaluating the safety and efficacy of acamprosate treatment of alcohol dependence. This work encompasses 16 controlled clinical trials conducted across 11 European countries and involves more than 4,500 outpatients with alcohol dependence. Fourteen of 16 studies found alcohol-dependent patients treated with acamprosate had a significantly greater rate of treatment completion, time to first drink, abstinence rate, and/or cumulative abstinence duration than patients treated with placebo. Additionally, a multinational open-label study of acamprosate in 1,281 patients with alcohol dependence found acamprosate to be equally effective across four major psychosocial concomitant treatment programs in maintaining abstinence and reducing consumption during any periods of relapse. An absence of known strong predictors of response to acamprosate, in conjunction with a modest but consistent effect on prolonging abstinence, and an excellent safety profile, lend support to the use of acamprosate across a broad range of patients with alcohol dependence.
An Analysis of 17 Catatonic Patients Diagnosed With Neuroleptic Malignant Syndrome
Authors: White Denise A. C. , Robins Ashley H.
Published: August 2016

This study was conducted to show that catatonia is a predisposing factor for neuroleptic malignant syndrome (NMS) and to review the nosological relationship between catatonia and NMS. Seventeen consecutive cases of NMS were analyzed prospectively with reference to clinical and investigative findings before and after exposure to a neuroleptic. The series comprised eight males and nine females, ranging in age from 18 years to 65 years. Prior to neuroleptic exposure, all patients exhibited features compatible with criteria for catatonia (mutism/excitement) according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R). Following neuroleptic administration (single dose in nine cases), patients deteriorated into a febrile, rigid, and obtunded state accompanied by autonomic dysfunction and raised creatine phosphokinase levels. These features were consistent with a diagnosis of NMS. Neuroleptics were discontinued and supportive medical treatment instituted. Benzodiazepines were beneficial in eight cases in relieving stupor, but bromocriptine and dantrolene were generally ineffective. In all patients diagnosed with NMS in the authors' series, catatonia was an invariable prodromal state. It appears that the administration of a neuroleptic intensified the preexisting catatonic state and precipitated a malignant variant of the disorder, which is currently recognized as NMS. The authors, therefore, challenge the separate nosological status of NMS and catatonia and suggest that these syndromes are part of a unitary pathophysiological disorder.
A European Perspective on Depression in the Community: The DEPRES Study
Authors: Arbabzadeh-Bouchez Saena , Tylee Andre , Lépine Jean-Pierre
Published: August 2016

Depression is one of the most prevalent disorders in the general population, causing personal and social disability and impairment. Major studies assessing the diagnosis and management of depression have shown that it is often underdiagnosed and undertreated. A pan-European study aimed at assessing the extent and consequences of depression in six different countries is reported in this article. Different types of depressive profiles are analyzed and their respective management has been compared. The importance of improving diagnosis and treatment of depression is underlined. Appropriate management of depression depends on the recognition of depressive symptoms by patients, their possibility of seeking care, and the ability of the primary care physician to recognize the disorder and prescribe the appropriate medicines. Improvement in all of these fields is necessary.
Structural Alterations in Depression: Cellular Mechanisms Underlying Pathology and Treatment of Mood Disorders
Authors: Duman Ronald S.
Published: August 2016

Basic and clinical studies over the past 10 years have lead to a fundamental shift in our understanding of mood disorders. These studies demonstrate that mood disorders and stress are accompanied by structural alterations in the brain; moreover, these structural alterations are reversible with antidepressant treatment. These alterations include changes in the length and number of neuronal processes, the number of neurons and glia, and even the rate of neurogenesis in the adult brain. Work is also being conducted to identify the molecular mechanisms underlying these changes and the adaptations that are critical to the therapeutic actions of antidepressant treatment. Some of the intracellular targets include second messengers, gene transcription factors, and neurotrophic factors that could oppose the actions of stress and depression. Taken together, this exciting new work describes and details structural alterations of limbic brain regions that are extremely dynamic and adaptive. Further understanding of the abnormalities in these systems that lead to mood disorders will provide more efficacious and possibly faster-acting therapeutic interventions.
Computerized Perceptual Analysis of Patients with Body Dysmorphic Disorder: A Pilot Study
Authors: Yaryura-Tobias José A. , Neziroglu Fugen , Chang Robert , Lee Sean , Pinto Anthony , Donohue Laura
Published: August 2016

Many factors influence the development of body image, one of which is the perception we have of our body. Perception can refer to actual visual input or the interpretation of vision; in other words, cognitive appraisal. The goal of this preliminary study is to determine if three groups (body dysmorphic disorder, obsessive-compulsive disorder, and a non-psychiatric control group) differed in the perception of their faces. Thirty individuals, 10 in each group, were asked to make changes to a computerized image of their face. In addition, affective and perceptual tests were administered. The groups did not differ on affective and perceptual organizational measures, although the obsessive-compulsive disorder group reported a higher level of anxiety than the body dysmorphic disorder group. Imaging software showed that facial features were modified by patients with body dysmorphic disorder and obsessive-compulsive disorder in about 50% of cases. No modifications were made in the control group. Future studies need to investigate the possible causes of these differences.
Ethical and Methodological Issues in Academic Mental Health Research in Populations Affected by Disasters: The Oklahoma City Experience Relevant to September 11, 2001
Authors: North Carol S. , Pfefferbaum Betty , Tucker Phebe
Published: August 2016

Empirical data from research studies are vital to guiding mental health interventions following disasters. However, few data are available for this purpose. Important advances in policy and procedures for the conduct of organized research emerged from the Oklahoma City bombing, yielding cooperative working relationships among researchers and culminating in the ethical attainment of informative research data. However, the academic community was again caught off guard after the September 11, 2001, terrorist attacks.

Suggestions to surmount these obstacles include incorporating research infrastructures into disaster preparedness plans in advance; organizing the community of researchers; and working closely with major funding organizations. Methodological issues pertaining to measurement of psychopathology include the importance of obtaining diagnostic data; interpreting the meaning of symptoms in the absence of a psychiatric disorder; differentiating preexisting symptoms from those that emerged after the disaster, and optimal timing of postdisaster assessment.
How to Launch a National Internet-Based Panel Study Quickly: Lessons From Studying how Americans are Coping With the Tragedy of September 11, 2001
Authors: Butler Lisa D. , Seagraves David A. , Desjardins Juliette C. , Azarow Jay , Hastings T. Andrew , Garlan Robert W. , DiMiceli Sue , Winzelberg Andrew , Spiegel David
Published: August 2016

This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001. The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally. In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks. This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment. We also discuss issues that we did not anticipate, including the survey intervention. We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures.
New Findings, New Thinking, and New Expectations in Alzheimer's Disease
Authors: Grossman Hillel , Marin Deborah
Published: August 2016

Almost 100 years ago, Alois Alzheimer described the case of Auguste D., a woman who developed delusions and memory impairment at 56 years of age. Alzheimer went on to detail the symptoms and neuropathology of the disease that came to carry his name. For most of the subsequent century, however, little more was learned: Alzheimer's disease remained an entity with a well-described syndromal presentation, clinical course, and a distinct neuropathology but little else appreciated. Only in the past 20 years have findings regarding the pathogenesis of AD and potential treatments emerged. The emergence of standardized criteria for both the clinical diagnosis of AD and its pathological definition; the mainstreaming of a pathogenetic theory; the development of animal models; the identification of specific gene risk factors; and the first round of approved treatments have recently come to light.

This wealth of discovery has been fueled by the development of new techniques and technologies. Equally important has been the shift in attitude regarding cognition in the elderly. The notion of “senility” has been largely supplanted by a growing appreciation that cognitive decline is not the rule and is indicative of a distinct disease process. This realization spurs the research to determine who declines, who does not, and the risks factors for decline. This paradigm shift has allowed a renewed focus on disease processes related to memory decline in aging, and particularly AD. This issue of CNS Spectrums focuses on the shift in thinking about AD. We are on the cusp of a dramatic change in our understanding of the risks for AD, the mechanisms for its genesis, and how it might be prevented and treated.

Hillel Grossman, MD, expands the paradigm shift by focusing on diabetes mellitus and its relationship to AD. Early epidemiologic studies saw a seeming protective effect from AD among patients with diabetes mellitus. More recent prospective studies note that diabetes mellitus and insulin resistance seem to heighten the risk for AD. This finding has moved to the laboratory, where observations related to insulin-degrading enzyme and its role in amyloid metabolism suggest a potential mechanism for this heightened risk.
Social Anxiety and Premorbid Personality Disorders in Paranoid Schizophrenic Patients Treated With Clozapine
Authors: Pallanti Stefano , Quercioli Leonardo , Pazzagli Adolfo
Published: August 2016

The concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R—Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (≥35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.
Vagus Nerve Stimulation: A New Form of Therapeutic Brain Stimulation
Authors: George Mark S. , Nahas Ziad , Bohning Daryl E. , Lomarev Mikhael , Denslow Stuart , Osenbach Richard , Ballenger James C.
Published: August 2016

Although the vagus nerve has traditionally been considered to perform efferent functions, in reality it performs significant afferent functions as well, carrying information from the body, head, and neck to the brain. Preliminary studies examining this afferent activity led to the theory that vagus nerve stimulation (VNS) could successfully control seizure activity in persons who are refractory to antiepileptic medications. Unlike other forms of brain stimulation, VNS is unable to directly stimulate multiple discrete areas of the brain; however, through several pathways, it is able to relay sensory information to higher brain regions. An implantable VNS device known as the VNS™ NeuroCybernetic Prosthesis (NCP) System has been used in approximately 9,000 epilepsy patients in Europe and the United States since 1994. The implant has reduced seizure frequency by an average of 25% to 30%, with minimal side effects. Studies underway are also showing some degree of success in the management of treatment-refractory depression. The future efficacy of the implantable system in other disorders may depend on whether the implant can be more precisely focused to affect different brain regions. Research in this area is underway.